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Home My WebLink About07-4782ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 Attorneys for Plaintiff: E-mail: dchristonherna,aneino-rovner.com Estate of Maureen Asper JOHN AAPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants NO. 6 ~ ~-- ~l ~ ~~ C avr ( ~er,~, JURY TRIAL DEMANDED NOTICE TO DEFEND 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 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 fail to do so the case may proceed without you and 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 AVISO LISTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se persentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veinte (20) dias despues de la notificacion de esta Demand y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a , las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier soma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Used puede perder dinero o propiedad u otros derechos importantes pars used. LISTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 357036 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Han•isburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 Attorneys for Plaintiff: E-mail: dchristonhernu,an¢ino-rovner com Estate of Maureen Asper JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants NO. a ~ - y ~ ~~ CLu-~-2 ~.c~...-, JURY TRIAL DEMANDED COMPLAINT Plaintiff John Asper Jr. is an adult individual and a citizen of the Commonwealth of Pennsylvania, who resides at 7405 Wentzville Road, Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff John Asper Jr. is the Administrator of the Estate of Maureen Asper, by Letters of Administration duly issued by the Register of Wills of Cumberland County under File Number 2005-00873. A short certificate is attached as Exhibit A. 3. Maureen Asper died on September 20, 2005. 4. Defendant James Hardesty, M.D., is a physician specializing in general surgery and is licensed to practice medicine in Pennsylvania with offices located in Cumberland County, Pennsylvania. Plaintiff is asserting a professional liability claim against Dr. Hardesty. A Certificate of Merit is filed herewith. 5. Defendant Belvedere Medical Corporation is a professional corporation created under the laws of the Commonwealth of Pennsylvania which at all relevant times employed Defendant James Hardesty, M.D., who was acting within the course and scope of his employment for the Defendant Corporation. Plaintiff is asserting a professional liability claim against Belvedere Medical Corporation. A Certificate of Merit is filed herewith. 6. Defendant Joseph Acri, M.D. is a physician specializing in internal medicine and is licensed to practice medicine in Pennsylvania. Dr. Acri regularly practices medicine in Cumberland County, Pennsylvania. Plaintiff is asserting a professional liability claim against Dr. Acri. A Certificate of Merit is filed herewith. 7. Defendant Acri Internal Medicine Services, LLC is a professional corporation created under the laws of the Commonwealth of Pennsylvania which at all relevant times employed Defendant Joseph Acri, M.D., who was acting within the course and scope of his employment for the Defendant Limited Liability Company. Plaintiff is asserting a professional liability claim against Acri Internal Medicine Services, LLC. A Certificate of Merit is filed herewith. 357036 2 8. At all relevant times, Dr. Acri was the agent and/or the ostensible agent of Defendant Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center. 9. Defendant Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center is a for profit corporation under the laws of the Commonwealth of Pennsylvania, which at all relevant times was the principal of Dr. Acri and employed hospital nursing staff who were acting within the course and scope of their employment for the Defendant Hospital. Plaintiffs are asserting a professional liability claim against Carlisle HMA, Inc., d/b/a Carlisle Regional Medical Center. A Certificate of Merit is filed herewith. 10. On or around August 18, 2005, Dr. Hardesty performed a laparoscopic cholecystectomy on Maureen Asper. The surgery was an outpatient procedure performed at Carlisle Regional Medical Center. 11. On August 20, 2005, Maureen Asper was seen at Belvedere Medical Corporation by Dr. Shaun Bryant where she was found to have a significant bile leak from her upper mid-line incision with bile staining of her clothing. 12. Maureen Asper was admitted directly to Carlisle Regional Medical Center, and on August 20, 2005, she underwent an ERCP with stenting performed by Dr. Robert Levy to correct her bile leak. 13. Following the stenting procedure, Maureen Asper was admitted to the Intensive Care Unit of the Defendant Hospital due to impending sepsis and respiratory distress. 14. While in the ICU, Maureen Asper was cared for by Dr. Joseph Acri, who the Plaintiff believed was an employee of the Defendant Hospital. 357036 3 15. Plaintiff John Asper Jr. was never provided any information that caused, or should have caused, him or his family to question the employer-employee relationship between Dr. Acri and the Defendant Hospital. 16. While in the ICU, Mrs. Asper was also cared for by the nurses and/or other hospital agents whose signatures appear on the ICU charts and notes. 17. Plaintiff John Asper Jr. was never provided any information that caused, or should have caused, him or his family to question the employer-employee relationship between the individuals working in the Defendant Hospital and the Defendant Hospital. 18. Plaintiff John Asper Jr. and his family relied upon the reputation of the Defendant Hospital when they made the decision to place their trust and Mrs. Asper's life, in the hands of Dr. Acri and the other individuals working in the Defendant Hospital. 19. Maureen Asper remained orally intubated in the intensive care unit for 19 days. 20. On September 8, 2005, at 7:05 a.m., Mrs. Asper's arterial blood gases showed that she had a PCO2 of 45.2 mmHg, and a PO2 of 195.0 mmHg. At the time, oxygen saturation was 98.1 %, and her hemoglobin was very low at 6.7 g/dL. 21. On September 8, 2005, at 4:20 p.m., Maureen Asper was taken to the operating room. At that time, Defendant James Hardesty, M.D., performed a tracheotomy on Mrs. Asper and inserted a 9 Portex tracheotomy tube at the level of her fourth tracheal ring. 22. At 5:47 p.m., arterial blood gasses showed that Mrs. Asper's blood had a pH of 7.225, a PCO2 of 59.4 mmHg, and a PO2 of 65.0 mmHg. Mrs. Asper's oxygen saturation had fallen to 87.4%, and her hemoglobin was still low at 10.9 g/dL. 357036 4 23. At 6:00 p.m., an air leak was noted in the ICU. Mrs. Asper's oxygen saturation was noted to be 92-95%. 24. At 7:30 p.m., Dr. Hazdesty was in to see Mrs. Asper. An air leak was again noted in the ICU records. 25. At 8:00 p.m., Mrs. Asper's ventilator was changed. According to ICU records, her condition remained unchanged. 26. At 9:13 p.m., arterial blood gases revealed that Mrs. Asper's blood had a pH of 7.299, a PCO2 of 50.0 mmHg, and a PO2 of 80mmHg. Mrs. Asper's oxygen saturation was 93.6%, and her hemoglobin was only 9.1 g/dL. 27. According to ICU records, Dr. Hazdesty was notified of Mrs. Asper's arterial blood gas results at 9:15 p.m. 28. At 10:00 p.m., Mrs. Asper was turned. The air leak from azound the tracheotomy tube remained. According to ICU records, Dr. Hazdesty was at Mrs. Asper's bedside. 29. At 10:34 p.m., arterial blood gasses revealed that Mrs. Asper had a blood pH of 7.320, a PCO2 of 46.4 mmHg, and a PO2 of 107 mmHg. Mrs. Asper's oxygen saturation was 95.8%, and her hemoglobin level was 8.7 g/dL. 30. At 11:45 p.m., Mrs. Asper had much generalized edema. Mrs. Asper also had swelling on the right side of her neck lateral to her tracheotomy tube with no ecchymosis. 31. At that time, the treating nurses did not call for a physician or respiratory therapist. 357036 5 32. At 1:45 a.m., on September 10, 2005, Mrs. Asper was having increased swelling into the left side of her face and into her neck. She still had no ecchymosis. 33. At that time, the treating nurses did not call for a physician or respiratory therapist. 34. At 2:30 a.m., Mrs. Asper had very low posterior breath sounds. She was turned by two nurses while a third nurse attempted to keep the tracheotomy tube stable. During the turn, Ms. Asper's blood pressure increased to 208 over 108. 35. At 2:35 a.m., Mrs. Asper was returned to her back, but her blood pressure remained elevated and her respiratory rate increased with increased effort. 36. Nurses attempted to suction Mrs. Asper's tracheotomy tube; however, they were unable to pass the suction catheter more than four inches into it. 37. By 2:40 a.m., Mrs. Asper's oxygen saturation had fallen into the 80~' percentile. 38. Nurses began bagging Mrs. Asper via her tracheotomy tube. 39. A code 99 was called to which the respiratory therapist, nurse anesthetist, and Dr. Acri responded by 2:45 a.m. 40. At this time, Mrs. Asper was experiencing rapidly increasing subcutaneous emphysema that was now in all of her face and chest and was moving into her abdomen. 41. Mrs. Asper's oxygen saturation fell to 33%. Nurses continued bagging via the tracheotomy tube. 42. At 2:58 a.m., Dr. Acri successfully intubated Mrs. Asper via oral intubation. 357036 6 43. Dr. Acri ordered and reviewed an x-ray. The x-ray showed that the oral trachea tube was in the proper position. The x-ray also showed a right pneumothorax. 44. Nothing was done about the pneumothorax at that time. 45. At 3:05 a.m., Mrs. Asper's oxygen saturation reached 80%. Her face remained cyanotic (bluish), and her eyelids remained swollen. 46. After oral intubation, Mrs. Asper's oxygen saturation climbed very slowly. 47. At 3:25 a.m., Maureen Asper's pulse ox showed that her oxygen saturation reached 87% for the first time since she has been orally intubated. 48. By 3:30 a.m., Dr. Hardesty was notified of the morning's events. 49. Dr. Hardesty returned to the ICU at 4:00 a.m. At that time, Mrs. Asper continued to experience increasing subcutaneous emphysema. 50. Dr. Hardesty reviewed the chest x-ray taken earlier that morning. 51. Nothing was done about the pneumothorax at that time. 52. By that time, the subcutaneous emphysema had spread to Mrs. Asper's pubic area, and her abdomen had become extremely large and rigid. 53. At 4:03 a.m., arterial blood gas tests showed that Mrs. Asper had a PO2 of 51 mm Hg and oxygen saturation of 78.4%. 54. At 4:46 a.m., arterial blood gas tests showed that Mrs. Aser had a PO2 of 52 mm Hg and oxygen saturation of 82.6%. 55. By 5:00 a.m., Plaintiff John Asper Jr. had begun to sit outside the door to his wife's room. 357036 7 56. At 6:00 a.m., Mrs. Asper's pulse ox showed oxygen saturation of 87%; however, her pulse was 100-110 and her upper face remained cyanotic (bluish) and her nail beds had become dusky. 57. At 6:35 a.m., the nurse's note revealed that Mrs. Asper's pulse ox had been steadily falling since 6:00 a.m. and that it was now at 80%. 58. At that time, Dr. Hardesty attempted extra breaths beyond the set rate of 30 breaths per minute. 59. A consult from pulmonary medicine diagnosed Mrs. Asper with a hypoventilation from barotrauma / pneumothorax and hypoxemia. The doctor recommended placement of a right chest tube. 60. At 9:00 a.m., Mrs. Asper's blood pressure fell as low as 70 over 38. 61. Dr. Hardesty placed a chest tube into Mrs. Asper's right axilla (arm pit) at some point between 9:00 a.m. and 10:30 a.m. 62. By 10:35 a.m., Mrs. Asper's PO2, oxygen saturation, blood pressure, and pulse were within or were close to normal ranges. 63. It is believed and therefore averred that Mrs. Asper suffered an anoxic brain injury on September 8 and 9, 2005. 64. A bronchoscopy performed on September 12, 2005, showed that at that time, the tracheotomy tube placed by Dr. Hardesty on September 8, 2005, was not in Mrs. Asper's trachea and instead ended in a blind pouch. 65. On September 20, 2005, Mrs. Asper died after life support was discontinued. 357036 8 COUNTI JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED V. JAMES HARDESTY M.D. 66. Paragraphs 1 through 65 are incorporated herein by reference. 67. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant James Hardesty, M.D., which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) he decided to perform and did perform a tracheotomy on Mrs. Asper while she was suffering from ARDS; (b) he failed to ensure that the tracheotomy tube was secure before leaving the hospital on September 8, 2005; (c) he failed to properly correct the air leak from the tracheotomy before leaving the hospital on September 8, 2005; (d) he failed to ensure that the tracheotomy tube was properly placed before he left the hospital on September 8, 2005; (e) he failed to timely diagnose or treat Mrs. Asper's subcutaneous emphysema; and (f) he failed to timely diagnose or treat Mrs. Asper's right pneumothorax. COUNT II JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED V. BELVEDERE MEDICAL CORPORATION 68. Paragraphs 1 through 67 are incorporated herein by reference. 69. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Belvedere Medical Corporation through 357036 9 their agent Dr. James Hardesty which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 70. At all relevant times, Dr. James Hazdesty was an employee, apparent or ostensible employee, agent, apparent or ostensible agent, and servant of the Defendant Belvedere Medical Corporation. Defendant Belvedere Medical Corporation is responsible for his negligence under the doctrine of respondeat superior and appazent agency. COUNT III JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED V. JOSEPH ACRI M.D. 71. Paragraphs 1 through 70 are incorporated herein by reference. 72. All of Plaintiffs' damages aze the direct and proximate result of the negligent, cazeless, and substandard Gaze provided by Defendant Joseph Acri, M.D. which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) he failed to timely diagnose or treat Mrs. Asper's subcutaneous emphysema; (b) he failed to timely diagnose or treat Mrs. Asper's right pneumothorax; and (c) he failed to properly supervise the staff in the ICU and allowed them to continue bagging Mrs. Asper via her tracheotomy after the tube had become dislodged, thereby increasing her subcutaneous emphysema and pneumothorax. COUNT IV JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER. DECEASED V. ACRI INTERNAL MEDICINE SERVICES LLC 73. Paragraphs 1 through 72 are incorporated herein by reference. 357036 1 0 74. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Acri Internal Medicine Services, LLC, through its agent Defendant Dr. Joseph Acri which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 75. At all relevant times, Dr. Joseph Acri was an employee, apparent or ostensible employee, agent, apparent or ostensible agent, and servant of the Defendant Belvedere Medical Corporation. Defendant Acri Internal Medicine Services, LLC, is responsible for his negligence under the doctrine of respondeat superior and appazent agency. COUNT V JOHN ASPER JR., INDIVIDUALLY, AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER 76. Pazagraphs 1 through 75 aze incorporated herein by reference. 77. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center, through its agent Defendant Dr. Joseph Acri which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 78. At all relevant times, Dr. Joseph Acri was an employee, apparent or ostensible employee, agent, apparent or ostensible agent, and servant of Defendant Cazlisle HMA Inc. d/b/a Carlisle Regional Medical Center. Defendant Cazlisle HMA Inc. d/b/a Carlisle Regional Medical Center is responsible for his negligence under the doctrine of respondeat superior and apparent agency. 357036 1 1 79. All of Plaintiffs' damages were the direct and proximate result of the negligent, cazeless, and substandard care provided to Mrs. Asper by nurses and other individuals whose signatures or initials appeaz on the ICU notes attached as Exhibit B which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) they failed to timely notify an attending physician of Mrs. Asper's subcutaneous emphysema, symptoms of which appeaz in the records as eazly as 11:45 p.m.; (b) they failed to seek assistance from a physician before attempting to turn a patient with an unstable and leaking tracheotomy tube; (c) they attempted to turn a patient with an unstable and leaking tracheotomy tube; (d) they caused or allowed Mrs. Asper's tracheotomy tube to become dislodged; (e) they attempted to bag Mrs. Asper via her tracheotomy tube despite the fact that it was apparent that the tube had become displaced, thereby increasing her subcutaneous emphysema; and (fj they failed to timely call a Code 99 after attempting to turn Mrs. Asper and dislodging her tracheotomy tube. 80. All of the Plaintiffs' damages were the result of the negligent, cazeless, and substandazd care provided to Mrs. Asper by Defendant Carlisle HMA Inc. d/b/a Cazlisle Regional Medical Center, through its agents, the nurses and other individuals whose signatures or initials appeaz on Exhibit B which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 81. At all relevant times, the nurses and other individuals whose .names or initials appeaz on Exhibit B were employees, apparent or ostensible employees, agents, apparent or 357036 1 2 ostensible agents, and servants of Defendant Carlisle HMA Inc. d/b/a Cazlisle Regional Medical Center. Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center is responsible for their negligence under the doctrine of respondeat superior and apparent agency. CLAIM I-SURVIVAL ACTION JOHN ASPER JR., ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER 82. Pazagraphs 1 through 81 are incorporated herein by reference. 83. Plaintiff John Asper Jr. brings this action on behalf of the Estate of Maureen Asper, deceased, under and pursuant to 42 Pa. C.S.A. § 8302. 84. Defendants' negligence, as alleged herein, was the legal cause of Mrs. Asper's death. 85. Defendants' negligence, as alleged herein, increased the risk that Mrs. Asper would suffer from and die from an anoxic brain injury. 86. Defendants' negligence, as alleged herein, significantly decreased Mrs. Asper's period of survival. 87. Defendants aze liable to the Estate of Maureen Asper for damages set forth herein. 88. Plaintiff John Asper Jr., Administrator of the Estate of Maureen Asper, deceased, hereby files claims on behalf of the Estate for damages suffered by the Estate including medical expenses, pain and suffering Mrs. Asper experienced prior to her death, Mrs. Asper's loss of 357036 13 earnings and future earning capacity, and all other damages properly recoverable under 42 Pa. C.S.A. § 8302. WHEREFORE, Plaintiff John Asper Jr. as Administrator of the Estate of Maureen Asper, deceased, and Individually and in his own right, demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. CLAIM II-WRONGFUL DEATH JOHN ASPER JR., ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d!b/a CARLISLE REGIONAL MEDICAL CENTER 89. Paragraphs 1 through 88 are incorporated herein by reference. 90. Plaintiff John Asper Jr. brings this action pursuant to the Wrongful Death Act, 42 Pa. C.S.A. § 8301, on behalf of the wrongful death beneficiaries enumerated below. 91. Defendants' negligence, as alleged herein, was the legal cause of Mrs. Asper's death. 92. Defendants' negligence, as alleged herein, increased the risk that Mrs. Asper would suffer from and die from an anoxic brain injury. 93. Defendants' negligence, as alleged herein, significantly decreased Mrs. Asper's period of survival. 357036 14 94. The following aze the names of all individuals entitled by law to recover damages for the wrongful death of Maureen Asper: Name Relationshi to Mrs. As er Address John As er Jr. Husband Carlisle, PA Melissa Kenned Dau hter Shermans Dale, PA Jennifer Wilson Daughter York Haven, PA 95. As a direct result of the Defendants' negligence, which caused Maureen Asper's death, the wrongful death beneficiaries have incurred funeral expenses, and claims are made therefor. 96. As a direct result of the Defendants' negligence, which caused Maureen Asper's death, the wrongful death beneficiaries have been, and will in the future be, deprived of Maureen Asper's services, contribution, and support, and all other classes of damages allowed by 42 Pa. C.S.A. § 8301, and claims are made therefor. WHEREFORE, Plaintiff John Asper Jr. as Administrator of the Estate of Maureen Asper, deceased, and Individually and in his own right, demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. CLAIM III-NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS JOHN ASPER JR. v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER. 97. Paragraphs 1 through 96 are incorporated herein by reference. 35'7036 15 98. Beginning around 5:00 a.m. on September, 9, 2005, Plaintiff John Asper Jr. was sitting outside the door to his wife's hospital room and was able to see and hear what was going on inside the ICU. 99. During the time that Mr. Asper was outside the room, the door to Mrs. Asper's room was wide open. 100. As a direct result of the Defendants' negligence which caused and/or contributed to the death of his wife, Maureen Asper, Mr. Asper suffered severe emotional distress, and a claim is made therefor. WHEREFORE, Plaintiff John Asper Jr. demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00),exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. Respectfully submitted, ANGINO & ROVNER, P.C. ,---- Daryl E. hristopher, Esquire I.D. No. 91895 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Attorney for Plaintiffs Date: August 9, 2007 357036 1 6 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH _ Register for the Probate of Wills and Granting _ Letters of Administration in and for _ CUMBERLAND County, do hereby certify that on • the 30th day of September, Two Thousand and Five, Letters of ADMINISTRATION in common form were granted by the Register of said County, on the estate of MAUREENEASPER late of MIDDLESEX T©WNSH/P (F/rst MlddJe, Lesry in said county, deceased, to JOHN WASPER JR (first, MiddFe, Last! and that Barrie has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 30th day of September Two Thousand and Five. File No. 2005-00873 PA Fi 1 e No . 21- 05- 0873 Date of Death 9/20/2005 S . S . # 161-34-0904 eputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED S ~I ~, i , ASPER, MAUREEN E Acci//5008063 MR//0001044167 08120!2005 Nr1RDESTY, DAME D06:0713111942 063 F CARLISLE REGIONAL MEDICAL CTR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0012-A 11 DATE: pp ~ ~,~.~ •~~ ~ r ~~. i y' g 4~s3'SJi Addressograph TIME ApDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN ~ G~3~ ~i -~~ ~~ Awake alert oriented to TPP; , , c9 ~ Speech lucid, cooperative, calm; i ll i i ll ll BEST VERBAL MOTOR ~ ~~ ~~~ZX~-~ C~'~~ ~ mov ng a extrem t es equa y we . Responds to verbal stimuli. EXT. MOVEMENT-ARM R j L ( (~`is'{, r _ Vii, / C UC;.7rc ~' ' ~ [ ~ ^/ . Z Behaviors: ^ Restless ^ Confused ^ C i i ^ ^ EXT. MOVEMENT-LEG R 1 L, G ~ ~~, ~ . ~~ ombative Anx ous Un~cooperat ve ^ Depressed ^ Withdrawn ^~Other~~~ PIL mm /reaction '~ ~{ •2 - i~~~ "1°i~c't~'l; c Yyspneic at Rest ^ Within Normal Limits: Resp : ^ D J ~'~~~ ~~~ ~Z- . ~~ ' byspneic on Exertion Respirations unlabored; C9 .~- 5-uG~ GiL/i~~~•~ Bilateral chest excursion; ^ Retractions ^ Other ~~ ~ ~~ Absence of cou hand secretions; g Cough: ^ Productive ^ Nonproductive ~ /~ Bilateral reath sounds clear. ^ Other 1 G~~ 1~2 ~~ ~~ ~ Ches ymmetric Asymmetrical putum: ^ White ^ Y Ilow Breath Sound ^ L se enacious ~~ GU' / ~ LC~Oi /U 1 -clear ther ` Z.G~~ a w `I 2 -diminished CT: Location 7 3Lr ~ ' I ~ ~G~~ [~~~ "~.~ 3 -rates ^ Suction cm - 7 U ~ ~ 4 - rhonchi ^ Gravity drainage ,A ~ ~, ~ ~'~~f(J~ ~' 5 -wheezes Drainage characteristics Z 6 - bronchial 'S i~ 17 ~ .~ ~J)7 7 -absent R L Air leak ^ Yes ^ No ~ /Q m , ~ ~ ~ S~~.U-~ G~~~ Crepitus ^ Yes ^ No ~ _ ~ ^ Within Normal Limits: ~/~_~ A ^ Irregular istant ~.~ ~~~T/ L/v/ l Apical rate regular; ^ Murmur ^ Other ~ ~ tZ' ~ / ~'~~ ~/ ~/ z Peripheral pulses 2+/3; Cap fJ - 7 v Normal capillary fill; Refill: ^ Brisk ^ Delayed ~ ~-,~~, ~~L ~ `~. a Absence of peripheral edema; Heart Rhythm: SR ~ `' ~d ~ 0 if applicable, IV's and central Heart Sounds: S4 1 S Cir I ~ /~~ / ~~.9 ~ /~ ~ [ Edema: Location: ~ lines patent and infusing well • , a with absence of infiltrates/ Degree ^ 1+ + ^ 3+ ^Non- ittin k~ ~i~&ynf Cl-Y~ttin ' ~~ `S ~ ~ g p g , ( x~. ~s~. . LG/.F (.(J~ 1+= 1/4 i 2+= 1/2 i 3+= 1 i ) . n. S~ ~~rL ( n.; n.; ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm Abdomen soft, non-distended; ^ Tender ^ Other Bowel sounds present in all quads; Bowel ^ Hypoactive ~ nd/~~ Sounds: ^ Hyper ctive^ Absent Absence of N/V a ~ c9 ` ~ incontinence Tubes^ NGT GT /Q~ ~ S~Z' ^ Gtube ^ Jtube ^ Colostomy ^ Other Type: Patent C~'es ^ No ~^ </yG~ ~ ^ Ileostomy SuctierrType J ~!/~ Foley Pate t s ^ No ~iOf;~~"~ C a r~~p ~Q c c. Drainage Drainage ^ Within Normal Limits: Skin: ~ ale ^ Dry ^ Flushed ^ Cool F- Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash Z normal skin turgor; Absence of ^ Ecchymotic ^ Jaundiced ^ Other w skin integrity alterations Location # O C7 Wound 2 Incision ther Wound #~ n Is opp ~' ^ Other ~'~%Z~ ti C L ~ w oca on ~` L~ Z}Zet~ t/~' ~Ie~ Location " z Dressing ^ Dry ~,I~nt~a~ct~ ^ Other Dressing ^ Dry ntact ^ Other ~~ i~ 1 Drainage chara. S ~GLd dfjZ~ ~ ~~ ~ ~~ `` Drainage chara. ~x~T1v" re+~~%}/2~1i1/,~ Braden Scale Score r Provisions for Safe Environment: Restraints in use. ^ Y*see restraint flow sheet plief~ properly ^ Y Call bell and phone within reach; Restraints ap ~ ~, ID band on. Fall Risk: Ly'N ^ Y INITI LS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE INITIALS : _, . ~~c~YYL~'I`'`Q~t' ~J .. ddressoc,~rapn . ~ ~, ASr'CR, ~r1P.URr~fJ C Rcct~50CBOS~ h~R,','000~ODOB 07131189401 ~ 0 F !ARCESTY, J„~ 1E CgR~I~LE F"i: "~ :L AIEDICdL CTR Pi' «Ir~=~gimel. I~"~il'PIIIII!'1il ootz.a It D E N rem 2 DIET: % TAKEN B-L-D n I 2 AM/PM CARE ' v ~ 2 2 ORAL CARE f ~~ - 21 FOLEY CATHETER CARE ' 2 SKIN CARE ~ ~~ 1 1 BITE BLOCK CHANGE 1 TRACH CARE 1 INNER CANNULA CHANGE / - 1 w 1 TURN ~ ~ 1 SPORT BED ROTATION / 1 ROM ^ ' 1 ,. - 1 UP # JI,tJ J - rnG.~.~vi.~ - //i I.C.U. Fiow Sheet CaIU1sIF y BP x REGIONAL ~`-` '~ MEDICAL C E N T~~-E'F~ PULSE • DATE: i IC 0610 (06!04) I 0700 0800 0900 1000 1100 1200! 1300 P. 50 40 30 20 0 00 90 80 70 60 50 / 40 30 20 10 00 ! ~ 30 ~ s6 70 30 50 ~ 40 30 20 10 SP ~/ ~j n~nn ORCI(~ ~0~0 00~ 11 0 01200 ~ ~00 ~ 400 MEAN ARTERIAL PRESSURE CENTRAL VENOUS PRESSURE J 1 / t"I PAP (SYS/DIAS) PCWP CARDIAC OUTPUT/CARDIAC INDEX SYSTEMIC VASCULAR RESISTANCE ARE WAVE TEST HEMODYNAMIC WAVEFORM WNL I SQU TER LENGTH SWAN GANZ PLACEMENT-EXTERNAL CATHE Setting A8G Setting N Actual Tidal Volume ~'~ 5 Zj" Time H ' a Set Rate (SIMV, AC) ~ /j P FIOz ~C; pCOz ~ ~~~ 2 PEEP l~ pOz ~~ t- Ozsat ,; Z CPAP ~ PS HCOs .~. X ETT Size Position BE ~ L ~ LACT ~E f f ~ ~ ~1 /~ ~ ~ z . ~~ Tube feed ~ , i : '1 /`~~ Oral tal T i l H o ve at Urine /!f_~%: Cumu n ~~ Setting 7 ~- iS" !5 - iG 'Gl ..~ ~G/v' C / /Sd ~5~ i 5 ~ /~ ASP~R, P~,^,i,~~rEi~ Acctli5G08GS3 ~.9~.~2001044167 0812012005 f;AROESTY, JAll1E DOB:0713111942 063 F ISLE fiEG10.':.1L t.IE:,I~AI CTR ;i;~IIIIIIIIIIIIIIII'.!illllllliillll!Ilill 0012•A 11 _ y. DATE: non ~~nn ~~nn ~~nn ~~a 0 0100 JUV iouv ---- I I~ i ~ li ~t .,~~ aA~~ N0 "I bVU it w io vv I~; - -- --- - •~• ie ~3 i~~ I ~. b Settin A6G 5ettm Acv semn H6U Demo ~+ ~: '~ • -- yi3 -- - 2-•~ - - o I C2' . ~c?. C~ ~lt~.~l !be id ~.~ iU ~ ~`.~ n~r. ~, ~.j.V ~~~ J --1. ~. n~ S Ly' , G "~ C~' ~~ ~ 5 L+ 10 ~f~ ;'~ ~ ~ ~~ ,- 4, ~ ~ Z ~~. ~ 1a-~ ~ ASPER, MAUREEN E Acct~5008063 MR/t0001044167 0812012005 HARDESTY, JAME D06:0713111942 063 F .ISLE REGIONAL MEDICAL CTR lu~~tlllllllllillillllllllllllilllllllllilll oo1z~A 11 .,~..~~y .,...~ .,o..~~~a .~o~ .~c~uiiy _ u oeuniy no~i aeuui~ r~o~i zso 240 230 220 z1o zoo 1so 180 170 160 150 140 130 120 110 100 90 80 70 so 50 40 30 20 10 !~:~ .s DATE: TIME ~ ~ L Bun L~~ Na ~ L~ K L~ CI ~~ C02 , 1~. j Glu ~l> Cr ~ C"/ WBC '~", 1 Hgb ~~.' Hct ~ ~i~ . `" Plt f ~7 ;' PUINR Ptt CPK CK-MB/MB% Troponin I Mag ~. FS BS 1500 2300 0700 TOTAL Oral p IV Sol.nf 6/d2~ 2 w rn / i /~~ I `~'~ Q / / ..~67 I tl<<i z ~-3~v / ~i~.~-'/ ~ 3 / TOTAL /r 7S H'1 ~ Urine ''.~" i ICS NG Stool o~ ~"G a f- 0 TOTAL j . "~ S" 1 7 Cumulative TOTAL: I o~ Adm. Wt. Yest. t. Today's Wt. )200 0300 0400) "' ~ ~ 0500 0600 n~~i can~yiaNn - ^ Restraints andlor Seclusion P / R ^ Redirection/Diversion/Other measures attempted ^ Remains free of injury ASPER, MAUREEN E ^ Patient/family verbalizes understanding A t#5008063 MR#0001044167 0812012005 ^ Other cc HARDESTY JAME DOB:07f31j1942 063 F ^ Alteration in Comfort: Pain , ^ Defines pain on age-appropriate sgale CARLISLE REGIONAL MEDICAL CTR ^ Verbalizes/ indicates behaviorally relief of pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~) 0012-A 11 S~~ ~ _, ^ Other/Age Specific ~ ^ At Risk for Falls/Iniurv ^ Remains free from injury ^ Factors of risk are eliminated Select the appropriate problem(s) and expected outcomes: P / R ^ Other/Age Specific ^ Nutritional Status (Nutritional Manual) ^Imoaired ~vsical mobility: weakness/paralysis/self-care deficit ^ ^ Maintains full joint ROM and strength ^ ^ Able to perform ADL's ^ ^ No evidence of complications, such as contracture or ^ Other skin breakdown ~ ^ Age Specific ^ Other/Age Specific ~mpaired Gas Exchange/Ineffective Airw$y Clearance ^ Imoaired skin and/or tissue integrity (potential for) oten ial for ~'~/ ^ Absence of reddened areas ~ ^ Skin remains intact Maintains patent airway en saturation >90%" Maintains ox ~~" ~ ^ Other/Age Specific yg ^ Expresses feeling of comfort in maihtaining air exchange Infection: Invasive lines catheter pneumonia trauma. surgical ~'~ ' ^ Clear bilateral breath sounds ~ ounds (potential for) ^ Other/Age Specific d Patient is free from infection ~ f ~ ^ Fluid Volume -Alteration in ^ Clear, odorless respiratory secretions ^ For Deficit ^ Invasive line(s) insertion site(s) show no signs of inflammation -Vital signs stable (return to baseline) ~ ^ Other/Age Specific -Adequate fluid intake ^ Knowledge Deficit ^ For Excess ^ Verbalizes understanding of disease process, treatment -Lung sounds clear (return to baseline) i regimen and/or medications -Absence of Edema (return to baseline) ^ Verbalizes understanding of surgery -Weight loss (return to base line ~ ^ Other/Age Specific -Balanced I/O _ ^ PsvcholoQcal or Spiritual Distress Anxiety/Denial/Fear/ ^ Alteration in Metabolic Status R/T: Diabetes/Renal Failure/ Loneliness/Powerlessness/Sensory Deprivation (includes Surgical Other Fear ^ Patient is free of injury i ,] Appears less anxious and is less dependent ^ Patient weight stabilized to baseline ^ Asks reality-oriented questions ^ Electrolytes in normal range for patient ~ ^ Uses effective coping mechanisms or verbalizes need for ^ Heart/breath sounds wnl for patient additional help ^ Other ~ ^ Identifies area of conflict/ambivalence in faith due to ^ situation ^ ^ Alteration in CV Function RlT: ^ .( C.O./Hypertension/Cardiac Dysrhythmia/ ^ Age Specific Fluid volume overload _ deficit/ ~ Interventions Myocardial Ischemia ^ Hemodynamic stability ^ C.O. stable or improved P =Priority R =Reviewed by D/C =Discontinued Res =Resolved ^ Vital Signs and U.O. stable ^ Able to perform ADLs Reference: Mosb~Patient Care Star)dards Manual Plan of Care Discussed with Patient/S.O. I. Educational Needs Init Sin re 1.Orientation to Room/Hospital 4. IV Therapy ^NA 7. Medications ~ ~ . 2. Plan of Care 5. Discharge Planning 8. ~ 3. Pain 6. Diagnosis 9. II. Initial and On oin Barriers to Learnin III. Initial and On oin Instruction Barrier? Method of Person ' Eval Date Y N Comments To is # Instruction T u ht Comments ~ ~d g~ InHi s ~~(~ ~ ' .~. ~ ;~ ~ ~ 1 23. 4 DISC %''~; Refer to "Patient Teaching upon dmission" Sheet G~ Barriers to Learning: Barriers include any condition that decreases the patient's and/or family's receptiveness to teaming (blindness, deafiess, cogn tive tleticit, contusion, tlecreasetl i_uu, anxiety, pain, desire to learn, age, cultural or language barriers, biopsychosocial limitations, etc.) Method of Instruction Codes: V = Video; B =Book(let); TS =Teaching Sheet; D =Demo; Disc =Discussion Examples: V = "Giving Insulin Injection" or B = "Carbohydrate Counting" or TS = "Crutchwalking" or D = "Insulin Injection" Evaluation Codes: P = Proficientlno further instruction needed; R = ReinforcemenVReview Needed; 0 =Needs Outpatient F/U ASPER, MAUREEN E Acctl~5008063 MRy0001044167 0812012005 HARDESTY, JAME DOB:0713111942 063 F CARLISLE REGIONAL MEDICAL CTR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I~~~~~~~~~~~ 0012•A I1 I neTG• Addressograph TIME A[bDITIONAL ASSESSMENT DATA ^ Within Normal Limits: - EYES OPEN Awake, alert, oriented to TPP; 11 ~ Speech lucid, cooperative, calm; BEST VERBAL MOTd 1 movin all extremities a uall well. y R L ' Responds to verbal stimuli. EXT. MOVEMENT-ARM 1 ~ W Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R L~ ~ `/~ Z ^ Combative ^ Anxious ^ Uncooperative i R L X , f ~ ^ Depressed ^ Withdrawn ^ Other on PUPIL mm I react k G/ t R es ^ Wi N 'ts: Rasp.: ^Dyspneic at __ aspirations unlabor ^Dyspneic on Exertion Bilateral chest excursion; ^ Retractions ^ Other etians tive d ^ N ~~~~ onpro uc sence o coug cr ; Cough: ^ Productive Bilateral breath sounds clear. ^ Other mmetrical symmetrical Sputum: ^ White ^ Yellow Chest S y s i T ~ a ou enac Breath Sounds: ^ Loose _ ~ 1 -clear p'6her G~ ` n, ~ ~ 2 -diminished CT: Location y t 3 -ra es ^ Suction cm ~ 4 - rhonchi ^ Gravity drainage 5 -wheezes Drainage characteristics 6 - bronchial 7 -absent Air leak ^ Yes ^ No L ~Q Crepitus ^ Yes ^ No ^ Limits: AP: ^ Irregular ^ Distant Apical rate regular; ^ Murmur ^ Other Cap 2+/3 h l ~ - ; es era Perip ormal capillary fill; Refill: ^ Brisker Delayed th : /" rt Rh H m y ea Absence of r dema; . if i bl ,IV's and centra Heart Sounds: S4 S3 ~rcle) Ines pate and infusing well, Edema: Location: + ^ 2+ ^ 3+ ~ - ~ with absence of infiltrates/ ~ Degree v ^ Pitting ^Non-pitting S&S infection. ~ ~j ."~-~'JfL~~"~% ~1+=1/4in.;2+=1/2in.;3+=1in.) it l Li d ^ Fi ' ~.._ m rm ana ^ W s: ~ Abdomen: ^ Distende Abdom n ~ ,non-distended; ^ Tender ^ Other owe soun s pre ads; Bowel ^ Hypoactive l andlor bladder Sounds: ^ Hyperactive Absent b f NN +.~ ~ C7 owe , Absence o incontinence Tubes^ NGT ^ OGT Jt b e u ^ Gtube ^ ~ ^ Colostomy ^ Other Type: Patent ^ Yes ^ No ^ Ileostomy ~/ Suction Type j ^ No L7 Y / ' P t t ~ ~ „ , e~ . en ~ a ~,J Foley a 11r ' ~ /,fi n'~ e a ' ~ . r l li.~, g / Drainage ~ ,, ^ Flushed ^ Cool ^ D ^ W~ Ski l ^ P ry a e n: in warm and dry; color norma ; ^ Diaphoretic ^ Cyanotic ^ Rash ^ Oth ~ z er normal s an urgor, ^ Ecchymotic ^ Jaundiced W ~ skin integrity alterations Location ~ Wound #2 Incision ^ Other I ~ / ~ Wound # 1 I cision ^ h ~ ~~~' Location ~ z ~ ^ Oth r Location Dressing ^ Dry Inta t _ Dressing ry ntact ^ Other Drainage chara. Drainage chara. Braden Scale Score } restraint flow sheet Y* N ~ ' see ^ Provisions for Safe Environment: Restraints in use ~ ~ f~~ Restraints ap~li~Properly ^Y }~ 1 4F d - . ~ , ~w 2n $ La - ' barid on. Fall Risk: LfN ^ Y % ui INITIALS GNATURE/TITLE INITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE ~SPER, MAUREEN E Acct~5008063 MR~00010D0B 07j3 0894~~ 069 F `ARDESTY, JAME Illllllllllllillllllllllllllllllillllllllllll~ cTR oolz-A 11 DATE: ~i t ~_ ~ D8 i Addressograph I TIME ADDITIONAL ASSESSMENT DA ^ Within Normal Limits: EYES OPEN ~ '/ ,~. /' r /~i%/ c9 Awake, alert, oriented to TPP; Speech lucid, cooperative, calm; BEST VERBAL MOTOR cif ~ ~~~ ~- f ~~ ~ moving all extremities equally well. R , L I EC ~ / / ' i !' '~~ f~~' "~ O Responds to verbal stimuli. EXT. MOVEMENT-ARM G ~ C/ i GGl l ~`L ~ W Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R /` L/ `~` ;, ~ "~ , ' ~ ' -~! '; '~ ~ J Z ^ Combative ^ Anxious ^ Uncooperative ^ Depressed ^ Withdrawn ^ Other PUPIL mm /reaction ~- L .. j//'' , G " ' ;-" t R t i ~~ ~~ ' ff L~ ~ t't~~L ~~ .~F ~~1~(F ~T~F~ ~~ ~~`~ ~ es c a ^ Within Normal Limits: Resp.: ^ Dyspne Respirations unlabored; ^Dyspneic on Exertion L' ~~~•~((~ t.'~Z(~,1, ~: ti'I'U.CC Bilateral chest excursion; ^ Retractions ^ Other ,~ ~ Pk ~~Q9 ~ <(~ ~ h and secretions; roductive f ^ N Ab d i 1 . coug onp sence o ve uct Cough: ^ Pro . Bilateral breath sounds clear. ^ Other (~j Q6ri -~ Q& ~ ~Y'tC'G"~ ~~'mQ VUII`~1`~ ~ Chest Symmetrical !Asymmetrical Sputum: ^ White ^ Yellow ious ^ T } I^ l~lL4'l" G ~4 l;/1n •~'U '~~Q J 0 ~• enac Breath Sounds: ^ Loose 1 -clear ^ Other ~ ~^_ _ RR y1 {{ ,/~GG •'r1G~'lB' ~C ' ' l~tvU ~'IC~U' ~ a ) ; ` 2 -diminished CT: Location 9 ~ " (•~"~'U (;~ N; (~1C~ ~ ~ tL J~t~ ti w / ~ cm 3 -roles ^ S ti , ~ . ~ ~ , on uc ' 4 - rhonchi ^ Gravity drainage ~,r~~1c ~ ir~,rv,~v, u .i ~ 5 -wheezes Drainage characteristics 6 - bronchial ii ``,^, rr ~ ~~ ZQ lA (~ ~~~~~ • Uv~ 7 -absent Air leak ^ Yes ^ No R L S` , L ~ l'. J" ~ M' ~~~1 r t' L ~. Crepitus ^ Yes ^ No ,~CfU~,I l ~~ `~ ~ ~ ~ t ~ ^ Within Normal Limits: AP: ^ Irregular ^ Distant I ~~ r,~'(~rC. ~.r1} ,~ ~;~iL~YI ~ ~ `~ Apical rate regular; ^ Murmur ^ Other ~,nr,. ~ ~~ t ~ ~~ V/~~~ ~ Q v ~y~ -~ CaP ulses 2+/3 l i h P ""~ ` ' ; era p er p Normal capillary fill; Refill: ^ Brisk ^ Delayed thm: art Rh H C~t~ UL a ~ ~,, "/YIC~"F tV`/1 U Y'l~r'•~/` ~' y e Absence of peripheral edema; if applicable, IV's and central Heart Sounds: S4 1 S3 (Circle) ti L r1f dt I [~ r ~ F!~ ' .~GJ,`•.ll ~" "~ ~ ~ ' ~ on: oca lines patent and infusing well, Edema: with absence of infiltrates! Degree ^ 1+ :-0'2+ ^ 3+ ~ ~,..~ ~ ' ~,,~'~ v S&S infection. ^ Pitting ^Non-pitting (1+ = 1/4 in.; 2+ = 1/2 in.; 3+ = 1 in.) ,~",'~ (~~ '1 ' 1 . U r 4ti~~ (/~ I/ o~ l Limits: ^ Withi N d ^ Fi ~ ~ \ ( ~ . (~ l ~ "' ~~ " ` ~~ ~ orma n rm Abdomen: ^ Distende Abdomen soft, non-distended; ^ Tender ^ Other (' ,~" ~ ~ ,'~/~, V Y`~-fYl~~i Bowel sounds present in all quads; Bowel ^ Hypoactive 1f ~ ~ ;, F I~~ ~ ~ ' ~ ~' `~ bowel and/or bladder Sounds: ^ Hyperactive^ Absent e of NN Ab ./t ~ ~ V f , I t ~ , senc C7 incontinence Tubes^ NGT ^ OGT ^ Jt b b u e e ^ Gtu ~ ^ Colostomy ^ OtherType: Patent^ Yes ^ No ^ Ileostomy ~.{ Suction Type I Yes Q N t t l P F en ~ ey a o ~ Drainage Drainage //,(~^ ~'///G1~~ ^ Within Normal Limits: Ski ^ Flushed ^ Cool ^ D l ^ P ry e a n: Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash f Ab d ^ Oth z er sence o normal skin turgor; ^ Ecchymotic ^ Jaundice W skin integrity alterations Location ~ C7 Wound #2 ^ Incision ^ Other Wound # 1 ^ Iqqc' ion ^ Other Location ~ z Location r''G ( [/~Gf'L1Ld' ~ Dressing ^ Dry ^ Intact ^ Other i _ Dressing ~ry ~ Intact ^ Other Drainage chara. Drainage chara. Braden Scale Score r ^ N ^ Y*see restraint flow sheet i i t n use n s Provisions for Safe Environment: Restra hone within reach; Restraints applied properly ^Y nd il b ll C ~ p o e a ID band on. Fall Risk: ^ N ^ Y INIT S FSIGNATU ITLE INITIALS ITITLE E IGNATUR S INITIALS SIGNATURE/TITLE ~~ ( ~ iiA• ASPER, MAUREEN E Acct#5008063 MR#00010DOB 0713101g94PI 0603 F NARDES7Y, JAME CARLISLE REGIONAL MEDICAL CTR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0012•A 11 DATE: : iR r icos~o los/oa Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN ~ ~~ ~ ~~' • ~ ~ ~^ ~ Awake, alert, oriented to TPP; t% , 9 ~ ., _~; ~ ! ~ Speech lucid, cooperative, calm; BEST VERBAL MOTOR i / : /~ ~ moving all extremities equally well. MOVEMENT-ARM T R , L / ~ ~ ~ ~ ~ ~ .z ~"' '~' - ''''~ ' O Responds to verbal stimuli. . EX i , ~ w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R 7 L ~ / -" ~ ~ ~ ~ , -,,. Z ^ Combative ^ Anxious ^ Uncooperative ti / ~ LL // `l! ~ ~' ~ ~ ^ Depressed ^ Withdrawn ^ Other on reac PUPIL mm / L / ~ ^ Within Normal Limits: Resp.: ^Dyspneic at Rest ~ ,~~ ,, ~ ~j~~~~ ~ ' ~ Respirations unlabored; ^Dyspneic on Exertion ~.~ y ~ ~ ~ GG G Bilateral chest excursion; ^ Retractions ^ Other _ / , , . ~ ~ /, J , retions tive d d h f ^ N '~ ~l ~~ ' ~ sec uc an onpro coug Absence o ; Cough: ^ Productive ~" '` `' ~ Bilateral breath sounds clear. ^ Other ~ ~`d1 ~: ~ ~ 7 i G~ ~ ~ } ~ Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow ious ^ T / ~ ; , - ,~ ~-.: ' ~ ~ ~?~- mil t 7 ~ enac Breath Sounds: ^ Loose ~ 1 -clear ^ Other / ~ ". , ,, ,ry-, '' y 2 -diminished CT: Location ` ~~ ~ ~~ `~ ~~ ~ ~ cm 3 -rates i ` ` ~ ' on ^ Suct ~ ~ ~ 4 - rhonchi ^ Gravity drainage ' !„~j (,~ T : ~ ~ ~ ~!~/% ~ ~/ j ' 5 -wheezes Drainage characteristics ~„ ~„ ai ~ r 6 - bronchial ~ ~ ~' ' 7 -absent Air leak ^ Yes ^ No .a ,,,, Crepitus ^ Yes ^ No Within Normal Limits: AP: ^ Irregular ^ Distant Apical rate regular; ^ Murmur ^ Other -~ Cap 2+/3 l i h l P ; ses pu er p era N Normal capillary fill; Refill: ^ Brisk ^ Delayed thm: art Rh H y e Absence of peripheral edema; o if applicable, IV's and central Heart Sounds: S4 S3 (Circle) i on: lines patent and infusing well, Edema: Locat ~ with absence of infiltrates/ Degree ^ 1+ 2+ ^ 3+ v S&S infection. ^ Pitting ^Non-pitting (1+ = 1/4 in.; 2+ = 1/2 in.; 3+ = 1 in.) l Limits: ^ Withi N d ^ Fi d orma rm n e Abdomen: ^ Disten Abdomen soft, non-distended; ^ Tender ^ Other Bowel sounds present in all quads; Bowel J~Hypoactive bowel and/or bladder Sounds: ^ Hyperactive^ Absent f NN Ab ~ c7 , sence o incontinence Tubes^ NGT ~OGT be ^ Jt u ^ Gtube O ^ Colostomy ^ OtherType: Patent^ Yes ^ No ~~~./ Suction Type C2,1~[:~/Y/!/~ti ^ Ileostomy Patent Yes No l F ey o Drainage ~: ~ ~ Drainage ^ Flushed ^ Cool ^ Within Normal Limits: Ski ^ Pale ^ D ry n: Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash z ence of r Ab d ^ Oth ki t di l J e urgor, s n ce norma s aun ^ Ecchymotic ^ W skin integrity alterations Location ~ Wound #2 ^ Incision ^ Other c7 Wound # 1 Q Incision ^ Other Location z Location dbi~t-~J?~>? Dressing ^ Dry ^ Intact ^ Other Dressing ~ Dry ^'fntact ^ Other Drainage chara. Drainage chara. C~i'~ Eil'•~D'~1 Braden Scale Score ~ ^ N ^ Y*see restraint flow sheet i i t R t n use n s es ra C~Provisions for Safe Environment: .~ hone within reach; Restraints applied properly ^ Y ll bell and J C N p a ID band on. Fall Risk: ^ N ^ Y INI S NATURElT E INITIALS SIGNATURElTITLE INITIALS SIGNATURE/TITLE r ASPER, MAUREEN E • ~ ?+: PUPIL REACTION EXTREMITY MOVEMENT ± SLUGGISH +1 +2 +3 +4 + REACTIVE PUPILS (mm)3 • • 4 - NON-REACTIVE 9. ~ • 7• 8• COMA SCALE CODE RESPONSE ~ 2 3 Q 5 6 EYES NEVER TO TO SPONTA- OPEN PAIN SOUND NEOUS INAPPRO- CON- INCOMP FUSED ORI- VERBAL NONE SOUNDS PRIATE CONVER- ENTED WORDS SATION FLEXION FLEX. LOCAL- OBEYS EXTEN- MOTOR NONE SIGN ABNOR. MATH- IZES COM- DRAW PAIN MANDS BODY SECRETION CODES COLOR:G-GREEN,Y-YELLOW,T-TAN,BL-BLACK, WH-WHITE, MA-MAROON,R-RED, CG-COFFEE GROUND, ST-STRAW, LY-LIGHT YELLOW, DY-DARK YELLOW, LA-LIGHT AMBER, DA-DARK AMBER, TE-TEA, CR-CRANBERRY, P-PINK, BO-BLOODY, DR-DARK RED, RU-RUBA, SE-SEROSA APPEARANCE:TH-THICK, FR-FROTHY,C-CLEAR, M-MUCOSY,CL-CLOUDY, CT-C TS, S-SEDIMENT, SD-SEEDY, FL-FLECKS,T-TARRY SC-SCANT, S-SMALL, M-MO R~(ATE'L'-LA/R'GE Acct~5008063 MR~0001044167 0812012005 HARDESTY, JAME DOB:0713111942 063 F CARLISLE REGIONAL MEDICAL CTR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~I~~~~~~~~~~~~~~~~ 0012•A I1 SEDATION: 0 =NONE (A 2=MODERATE (Often Drowsy, Easy To Arouse) 3=SEVERE 1 = Inll_u (uccasronauyuruwsy, cnay iun~uuac~ lent: Difficult To Arouse) 4=SLEEP (Normal SIeE PAIN MANAGEMENT Intervention: Pt states Pain controlled: (time/level) Epidural pain/sedation Epidural Site / I Initials: Pt states Pain controlled: (timellevel) Epidural pain/sedation Epidural Site / Initials: (R)elaxation TIME DATE ADDITIONAL NURSES nu I is - - ~ d~ ~ - - /r ) s' - v ~ ~ n r i r c ,, ~~ + % ~i~Jai~-/ ~ ` n ~ ( 4~ V w.J 7 - 9 ~ sp ' , ~ .cam r ~ ~~ ~ / ~ - ~ , s ~ //,, ~/ idressog~aph i SPER, Il1~UREEN E Acct~5008063 M({~OCOlODOB 0713 089401 Oho F IIARDESTY, JAMS IIIIIIIIIIIIIIIIIIIIIIIIIIIlIIIIIIIIIIIIIIIII cTR oo'2•A" 0700 D E N DIET: % TAKEN B-L-D ~ ~r 4M / PM CARE ~ (, DRAL CARE ~" FOLEY CATHETER CARE '1 SKIN CARE v~ BITE BLOCK CHANGE ~ TRACH CARE INNER CANNULA CHANGE 1 TURN c, ?7i -/Y~ ~ SPORT BED ROTATION ROM ( 008 CHAIR / BSC AMBULATE SIDE RAILS UP # ~ BED POSITION LOW ~ ~'` CALL BELL IN REACH SCD'S -PRESSURE ~ - TEMP 240 230 210 - 200 190 170 160 - 150 140 130 120 110 90 80 70 60 40 30 10 - 250 220 180 - 100 - 50 20 RESP. 07 00 , • I.C.U. Flow Sheet 'CARIISIE ' BP x REGIONAL 'PULSE • htEDICA{r C-ENTER .._ ,~~ ' ', DATE: IC 0610 (06104) /~ ~ 1300 1400 0800 0900 1000 !?~00 r~ 0 MEAN ARTERIAL PRESSURE +~ OUS PRESSURE CENTRAL VEN PCWP IAS ) PAP (SYSID CARDIAC OUTPUT/CARDIAC INDEX C VASCULAR RESISTANCE SYSTEMI HEMODYNAMIC WAVEFORM WNLISOUARE WAVE TEST SWAN GANZ PLACEMENT -EXTERNAL CATHETER LENGTH Setting AB( Actual Tidal Volume Time a Set Rate (SIMV, AC) PH n ~ 7 ' FI02 pCOz ~ -; r, = PEEP POz 7 ~' Z CPAP Ozsat ' Z ~ pg HC03 <<' ETT Size Position BE ''~ LACT Iv ~VS'S < 1 i''~° 5 C c t~/a' ~ ,~,_~• ~l ~ ~' Y t/5: ~~h , c a i~ S ~.:~ -~, z Tube feed ~,• ~• ,: % ~ 3~~, S l O ra Urin /iU°c.; Cumulative Total ~ ~ ~'. Setting ic/ C; l~• 3, ~. , •. ICS' ~~~~ i c ~ . Zj i /S srs ' C 2c~~ S ~) ;' • ~ ,~~ .'C i0~' rc ~' i :,~ i~r ;'~I %~' Ic Q t ~ ~, i LiD ASPER, PJIAUREEN E Acct#5008063 MR~0001044167 08f201Z005 HARDESTY, JAME DOB:07~3111942 063 f ISLE REGIONAL h1EDICAL CTR li~~idl~~~~~~~~~~~~~~~~~~~~,~~~~~~~~~~~~~~~~ 0012•A I1 1600 1700 1800 1900 DATE: 2000 2100 2200 2300 2400 0100 n1~ '00 18 00 19 00 ZU UU ~i uu « w - - - ' T ~ Z "T nor_ cew~.... oar. carrion ABG Setting ABG Setting ABG Seltin ABG Settin ABG Settin AB a in ' ~' o~.~~~~ ,,..,, ,...,.... ..-- - - ~ y 0 ~ ; n a ~, ~. ~ .~ ~ , . ~ 2 ~ ~- ` ~ r ~' ` ~ ' / v .- ~. %,. c r c ~ ~l ~ < 1 Cj (~ / I%< ./~ ~b r ~ ~ ~ ,~) f , ~ ' ~'' "~ / r : , i G ~~ ~> n -,~ ~- - ~ -~ ~~ ASPER, MAUgEEN E Acct~{50CBOe3 MR~0001044? F7 0812012005 Ht QTY, JAME DOD:0713i11942 063 F CA,...,LE RCGIONAL MEDICAL CTR ~i~~~~li~i~~~~~~~~~~~~~~~~~~~~~~~'~~~~~~~~~~~ 0012~A I1 ~0 0300 0400 0500 0600 C 1 i ~ 0 030~b J 0 00~ 0500 0600 r ~ Settin ABG Settin ABG Settin Attu ~eain r~oa i -{" G U .- ~' 1.j ~ ~~ , c - _ ;~ ~; ti DATE: 50 40 30 20 10 00 90 80 70 60 50 40 30 20 110 100 90 80 70 60 50 40 30 20 10 Urine rj~' ~ C' NG Stool .,~~. 3 ~ w ~ ,-~ i a O TOTAL ,~n ~' s b U Cumulative TOTAL: Adm. Wt. Yest. t. Today's Wt. ~F. ' ~ l O P / R u IS n ^ Restraints and/or Sec ^ Redirection/Diversion/Other measures attempted ' ^ Remains free of injury ^ Patient/family verbalizes understanding MAUREEN E PER ^ other , AS t~5008063 Mf?n0001044167 0812012005 ^ Alteration in Comfort: Pain ..,,riDESTY, JA6iE D06:0713111942 063 F ^ Defines pain on age-appropriate scale ^ Verbalizes/ indicates behaviorally relief of pain CARLISLE REGIONAL MEDICAL CTR ^ Other/Age Specific II~II'111111'1111111,II~III~,II~~I~~~~II~~'~~ 0012-A I1 ^ At Risk for Falls/Iniurv ^ Remains free from injury ^ Factors of risk are eliminated es: t d ^ Other/Age Specific com ou Select the appropriate problem(s) and expecte P / R l Status (Nutritional Manuall n iti ^ N t Impaired physical mobility weakness/paralysis/self-care deficit CI I r o a u ^ [p Maintains full joint ROM and strength ' Lj ^ 'D Able to perform ADL's N ^ ^ No evidence of complications, such as contracture or ^ Other skin breakdown ^ Age Specific ^ Other/Age Specific Impaired Gas Exchange/Ineffective Airway Clearance ^ Impaired skin and/or tissue integrity (potential forl (potential forl ~~ ^ Absence of reddened areas j~ Maintains patent airway ~ 3 ^ Skin remains intact ^ Other/Age Specific / Maintains oxygen saturation >90% Expresses feeling of comfort in maintaining air exchange Infection' Invasive lines catheter pneumonia trauma, surgical ~S , ^ Clear bilateral breath sounds wound otentiai for ~,/ ~' ^ Other/Age Specific Patient is free from infection rf ^ Fluid Volume -Alteration in c ^ Clear, odorless respiratory secretions ^ For Deficit ` ^ Invasive line(s) insertion site(s) show no signs ofinflammation -Vital signs stable (return to baseline) ^ OtherlAge Specific -Adequate fluid intake ~ ^ Knowledge Deficit ^ Verbalizes understanding of disease process, treatment ^ For Excess -Lung sounds clear (return to baseline) ` ~ regimen and/or medications -Absence of Edema (return to baseline) ~ ^ Verbalizes understanding of surgery -Weight loss (return to base line) ^ Other/Age Specific -Balanced I/O L /DeniallFear/ ' Anxiet l Di t i i Alteration in Metabolic Status R/T• Diabetes/Renal Failure/ Z y ress s r tua ^ Psychological or Sp r2 = Loneliness/Powerlessness/Sensory Deprivation (includes Surgical Other : ~ Patient is free of injury z ~ ~t Fear ]Appears less anxious and is less dependent - Patient weight stabilized to baseline i ^ Asks reality-oriented questions ^ Electrolytes in normal range for patient ^ Uses effective coping mechanisms or verbalizes need for ^ Heart/breath sounds wnl for patient additional help ^ Other ^ Identifies area of conflict/ambivalence in faith due to ^ y situation ^ z ^ ^ Alteration in CV Function R/T: .L C.O./Hypertension/Cardiac Dysrhythmia/ ^ Age Specific Fluid volume overload _ deficft_/ D Interventions Myocardial Ischemia ^ Hemodynamic stability stable or improved ^ C O P =Priority R =Reviewed by D/C = Disconiinued Res =Resolved . . ^ Vital Signs and U.O. stable ^ Able to perform ADLs Reference: Moses Patient Care Standards Manual Plan of Care Discussed with PatienUS.O. ~ Ini Sig n re ~ ~' Educational Needs I ~ ~ _ . '' 1.Orientation to Room/Hospital 4. IV Therapy ^NA 7. Medications 0 2. Plan of Care 5. Discharge Planning 8. Z 3. Pain - 6. Diagnosis 9. 0 i= Initial and On pin Barriers to Learnin II III. Initial and On pin Instruction z ~ . Barrier? Method of Person Eval ~9Be ~ Date Y N Comments Initi To is # Instruction Tau ht Comments p ~t,C,, L' ~ ~,/, = 1, 2, 3, 4 DISC ~' ~ ' ~~ i Refer to "Patient Teaching upon Admission" Sheet ~ rr a z J a _ ~? ..___ ___ . _ , ____:__. o ....:..... .....:..a...,..,,,.,,.,,~a;.,., ir,a+ricr.aacPC tha patient's and/orfami lv's receptiveness to learning (blindness, deafiess, cognitive deficit, confusion, decreased LOC, c anxiety, pain, desire to learn,Vage, cultural or language barriers, biopsychosocial limitations, etc.) J Method of Instruction Codes: V = Video; B =Book(let); TS =Teaching Sheet; D =Demo; Disc =Discussion Examples: V = "Giving Insulin Injections" or B = "Carbohydrate Counting" or ~ TS = "Crutchwalking" or D = "Insulin Injection" ~ Evaluation Codes: P = ProficienUno further instruction needed; R = ReinforcemenUReview Needed; 0 =Needs Outpatient FIU ASPER, ~{AUREEII E Acct~5GG806311~'.Rir0001044167 O81?012005 HAROESTY, JAME D06:0713111942 063 F CARLISLE REGIONAL MECICAL CTR Illilllllllllilllllllllllllllllllllllllllllll oot2-A I1 DATE: ~~ ~ ~ ., .- .j ~~~ Addressograph TIME DIT AD TONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN } I ~~/v / ~ / ~Z ~.w /^-! : ~C" v( ;t ( Awake alert oriented to TPP; , ( w i ir • ( , , / O Speech lucid, cooperative, calm; i ll t iti ll ll BEST VERBAL MOTOR ~ r / ''JJ ,~ vy~ ~f ;^ ~ !/~/.~!'b ct `- i li ~ mov ng a ex rem es equa y we . R L / C ~ Responds to verbal stimuli. EXT. MOVEMENT-ARM ~ , JJ~-~ ~ l~ C c'~ ~~ c = ~ v z Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R L S ~ / , _ ~' ~, ~ ' ti ^ C b ^ A i ^ U ti ~` ` l ~' u `'~ om ve a nx ous ncoopera ve ^ Depressed ^ Withdrawn ^ Other PUPIL mm /reaction ~ ~ ~ L ~ C ,2 ^~, ~J - S ~ i „r ~~:~ ~ ^ Within Normal Limits: Resp.: ^Dyspneic at Rest ~ / -~ ~ ~ ~! '~ ~ `~ l'?'~ `! Respirations unlabored; ^ Dyspneic on Exertion Bil l h ^ R i ^ ! ~ ~ , ~~ ~ sic t ~ ~,~ S atera c est excursion; etract ons Other ,~I ~ ~ ~/~ ~ ~ Absence of cough and secretions; Cough: ^ Productive ^ Nonproductive ~I" "fir ~ ~ /'~~ Bilateral breath sounds clear. ^ Other ~~J~„~ /.!' L 5 ~ ! r . ! ~ Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow ~ ~- ~ ~ ~" ~ -` ~ f- Breath Sounds: ^ Loose ^ Tenacious ~ ' ~ ~ ~ L:r 1 -clear ^ Other ~ y , ~~ ~~ ' ~., 2 di i i h d ' ~ ~ \ , ~ ~ a rn P l - m n s e y CT: Location -% ~' ' / ~ ~ w t 3 -rates f$Suction U cm `~ J ~ '"~ - °~``~' ~ 4 - rhonchi ^ Gravity drainage ~ , L S C t ~ 5 -wheezes D i t i ti h ~ ~2 ' ra nage c arac er s cs 6 - bronchial ~~ ~ ~~ 7 b t , ~ G'~ y ` - a sen L Air leak 1Z( Yes ^ No I / it Y ^ N ~ C ~ ~ ' ~ L ,,~~ ~ ~ lz ~ Gt [ rep us ~- es o ~' ~/l l ~'f ,~ r ii '7 Wit m Normal Limits: AP: ~ Irregular ^ Distant ~ ~ .,. ~ k n ~, G ~~ - o ,~ r a Apical rate regular; ^ Murmur ^ Other ~ Peripheral pulses 2+/3; Cap ~ ,Sc! ~ ~, lx. , ~ ~ ~ v Normal capillary fill; Refill: ^ Brisk_ ^ Delayed ' ~ , , ' ~ ~ ~ Q ~-~ <~ Absence of peripheral edema; Heart Rhythm: ' ~ J ~`!, ~.yi-- ii /- G~~" -G G .c, '~ L ~ if applicable, IV's and central Heart Sounds: S4 S3 (CiYcle) ` k r ~ f ~,~ ~ _ ~~ J J ~ 2 lines patent and infusing well, Edema: Location: ~~ c ~ ~ 1 .. ~ with absence of infiltrates/ Degree ^ 1+ [~+ ^ 3+ - / ~ ~ ,, ` ~' ~ ~/~~ 1 ~ v S&S infection C~Pitting ^Non-pitting ~ ~ / t . (1+ = 1/4 in.; 2+ = 1/2 in.; 3+ = 1 in.) .~ .~ /7ik ~-- ~y~//,~ ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm ~ ~Z'' ~~ •v ! r u ~"' r ~ 1~.~ - ~ ~ 'S Abdomen soft, non-distended; ^ Tender ^ Other Bowel sounds present in all quads; B l ~ H i ~t"^'+?'"/ ~ .i'2 `; `2/f ~ owe ypoact ve Absence of NN, bowel andlor bladder Sounds: ^ Hyperactive^ Absent n /~~~ ~`~ ?. ~ /,+ ~n c9 incontinence Tubes^ NGT ^ OGT i. fat / ^ Gtube ^ Jtube - ~ m ~ ,~ Si t~~' / j ^ Colostomy ^ Other Type: Patent ^ Yes ^ No ^ Il o t ti S T e s omy uc on ype Foley Patent ®Yes ^ No 1 ~ ~ ~' ~ Drainage ,- Drainage /~~ ~- / ° ' ~J ~'`~/ t N ^ Within Normal Limits: Skin: ~ Pale ^ Dry C~Flushed ^ Cool ~ Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash Z normal skin turgor; Absence of -};~Ecchymotic ^ Jaundiced ^ Other w skin integrity alterations ~y.•-4~• Location ~ W d #2 i i ^ Oth ^ I C7 w oun _ nc s on Wound # 1 ^ Ir~ci~ior~ ^ Other ~i Location •2-'tr. r= - u ' ," ,J~ ~J Location z Dressing ~ Dry ntact Other Dressing L~Dry. ®,)ntac~t; ^Other Drainagechara. S ' 'f Drainage c ar /i~'~( (/-/~v . Braden Scale Score S ®Provisions for Safe Environment: Restraints in use ~N ^ Y'see restraint flow sheet ~ Call bell and phone within reach; Restraints applied properly ^Y ID band on. Fall Risk: ~ N ^ Y rn INITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE INITIALS SIGNATURElTITLE ASPER, I~~AUREEN E Acct~5008063 MR//0001044167 08f2012005 HARDESTY, JAME D03:G7~31I1942 063 F CARLISLE REGIONAL MEDICAL CTR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0012•A I1 DATE: ~ ~ -` ~ '"', Naaressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: A k l rt i EYES OPEN ~~C„ / ~ !L C ( ~ s ~ . y, wa e, a e , or ented to TPP; t t7 Speech lucid, cooperative, calm; BEST VERBAL MOTOR '7( / 7 ; ~ : ~ ~y - ~ ~ ~ ' ~ moving all extremities equally well , ;~ ~ C ~ . Responds to verbal stimuli. EXT. MOVEMENT-ARM R ~ LI ~. /~ . ~~, ~~/i~'/~~ " z Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R f L! / ~ ~' ~ ' ~ ~ ~~ ^ Combative ^ Anxious ^ Uncooperative ~~' " ~ ^ Depressed ^ Withdrawn ^ Other PUPIL mm /reaction R- ~ ~~~I ~ ~~ ° ~+ ~~~" ~ ~' ,~ ^ Within Normal Limits: Resp.: ^Dyspneic at Rest ' ~' ~ ~ i~ % ' C ~ - ~~ ~, Respirations unlabored; ^Dyspneic on Exertion Bilateral chest excursion; ^ Retractions Q( Other - ~ LAS ~„,, ~ ~'-,2z ' '~~~ ~ -~- Absence of cough and secretions; Cough: ^ Productive ^ Nonproductive / ~ ~~ . `v l~= - ~ , `~ = ` !~ ~ y~.~, Bilateral breath sounds clear. ^ Other , ~, ~~ ~ ~ ~., ~+ ~ Ch t S t i l ` ~ ~ I ~ ~' es ymme r ca /Asymmetrical Sputum: ^ White ^ Yellow ~ ,i - ~ C ` ` Breath Sounds: ^ Loose ^ TenaciQUS r.! . c ~ C,: 4-~ ~ l ~ ~ ~!. a { 1 -clear .e( Other ck'i7' ~4 JC1 2 -diminished '~t- ~l t.~~ G ~/~- ~~,~~. _. (/ ~ ' 3 -rates ] ? ~ fY2 ~`=~ = L' ~ i - , Suction G cm ~ y - c f t _ t ~ ~ ,~ 4 - rhonchi ^ Gravity drainage 5 -wheezes , r / f v ~ - ~~ ~ ~ Drainage characteristics y. - ~ ` '3 6 - bronchial _ ~ ~ ~ ~ J ~ ~ -absent { ~ / ~ R L Air leak ,., ~I Yes ~ No ~ ~ - Sf~ -- Crepitus Yes ^ No Gyr , >rt~ei t +.rliCg / -- / - ~ =~ ~t' ~ ^ Within Normal Limits: AP: ^ Irregular ^ Distant ~„~r, ~~~~~- Apical rate regular; ^ M ^ O h ~ urmur t er Peripheral pulses 2+/3; Cap /~ ~( ~ ~ v No l ill ll f , ~,,~ ~ , ~ ~ ~~: Q > rma cap ary i ; Refilf: ^ Brisk ~ ^ Delayed Absence of peripheral edema; Heart Rhythm: ;~ T-,~'• (, . ;; { /~GILi~ ' Sw..~J /~~ ~ ~~ C ~ if applicable, IV s and central Heart Sounds: S4 S3 (Circle) // ~~ ~ lines atent and infusin well, Edema: Location: ~- G a with absence of infiltrates/ Degree ^ 1+ ~.2+ ^ 3+ ~ •- ~ `" t i S&S infection. ^ Pitting ^Non-pitting ~~ ~ c / 1 ~~ ~ c ~- (1+= 1/4 in.; 2+= 1/2 in.; 3+= 1 in.) ~„ .~yw _ / ,_,__- v ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm Abdomen s ft di t d d o , non- s en e ; ^ Tender ^ Other Bowel sounds present in all quads; Bowel ^ Hypoactive ~ Absence of NN, bowel and/or bladder Sounds: ^ Hyperactive^ Absent c7 incontinence T ubes^ NGT ^ OGT ^ Gtube ^ Jtube ^ Colostomy ^ Other Type: Patent ^ Yes ^ No ~ l ^ Ileostomy Suction Type r'~G v Foley Patent Yes ^ No Draina e ( 9 ~ %~ D • ' g , rainage (,c% ,;~;dz ~~c"s ^ Within Normal Limits: Skin: ^ Pale ^ Dry Flushed ^ Cool Skin warm and dry; color normal F w ; ^ Diaphoretic ^ Cyanotic ^ Rash normal skin turgor; Absence of ~`Ecchymotic ^ Jaundiced ^i Other ski i t it l ~ n n egr y a terations Location Wound #2 ^ Incision ^ Other w Wound # 1 ^ Incision ^ Other t- Location Location CJ'~i67dlJ:r~~ Dressi ^ D ^ I ? ng ry ntact ^ Other Dressing C~'Dry ~ ^ Other Drainage chara. Draina e chara g . Braden Scale Score 'Provisions for Safe Environment: Restraints in use ^ N ^ Y*see restraint flow sheet r Call bell and phone within reach; Restraints applied properly ^ Y ID band on F ll Ri k ^ ^ . a s : N Y a INI S SIryNATUR I LE IN ITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE // ,ASPER, ~,gAUREEN E AcctN5C08063 h1~iMGCC1CDC[i 0713101894Y~069 F HARDESTY, JAME CARLISLE REGIONAL MEDICAL CTR i~~~~~,~~~~~~~~~1~~~~~~~~~~~i~~~~~~~I~~~I~~~ 0012•A I1 DATE: ~ ~ ~•~ ty~ J ~ ~ ~ } Icasio ios~a Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN I ~~J )( ~ ~~ ~/f' ~,.~' '' "7 ~?r~ } Awake, alert, oriented to TPP; ~ Gy. _ ,- ,~, ' - ` c7 Speech lucid, cooperative, calm; BEST VERBAL MOTOR 1 / i ,!l~ ~ / ~ ~ ~ ~ moving all extremities equally well. Responds to verbal stimuli. EXT. MOVEMENT-ARM R 1 L . 1 " - ~. ~ ~~~5 ~ ~ = ~ ~k .~' w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R ~ L1 .~ -~` G~~ti~ ~r, ~~ ~ '~; ~ o ~~ -' Z ^ Combative ^ Anxious ^ Uncooperative ^ Depressed ^ Withdrawn ^ Other PUPIL mm I reaction ~- L~' ,,y? ~~ C11~ c` Jt' ^'~ i j/Lf t Rest i ^D • ,- , , ~' '~~ ~ ~~ ' ~ /' yspne c a ^ Within Normal Limits: Resp.: ' Respirations unlabored; ^Dyspneic on Exertion j~'~ ~ c~~lC •- i ,~~ ~e7 Bilateral chest excursion; ^ Retractions ^ Other Absence of cough and secretions; C roductive oductive ^ Non h ^ P ~ ,/' ~ 7` l~rGf '~ ~~L, ~ '' ~~~ p r : oug Bilateral breath sounds clear. ^ Other ~ W GS ~ ~ , /'./~~L~- ~'~ ~ Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow ose ^ Tenacious ^ L ~` (' l ~`^ ~ ~' /~/' ' ~~ ~ o Breath Sounds: 1 -clear ^ Other ~" ~ ~ _ / ~ 1 i ~ L `'I " i % , ` . a 2 -diminished CT: Location~~X('i/~f[% ~ , t~ , , - • l , w 3 -tales ~ S tio vlG' ' cm ~~ ~~ / ` , ~ ~ . ' uc n Y~'~111 4 - rhonchi ^ Gravity drainage b • ~• ~~ : - °' /'' ' ~~> ~ ` ! 5 -wheezes Drainage characteristics hi l b 6 . ~ , ~, y % `~ '~ ~~ ~ ~~ a ronc - ~ / ~ 7 -absent R L Air leak ~ Yes ^ No - -~. ~ . f _, ~/' ~ •,~ ~~'lz . Crepitus ~ Yes ^ No • L`~ ?~• ~ •-~ ,? ^ Within Normal Limits: AP: ^ Irregular ^ Distant ~,~ '.~ • ~~ ~ " -`+-" ~~ ` ' • Apical rate regular; ^ Murmur ^ Other ~ _ ~' ''J ' ~ Peripheral pulses 2+/3; Cap ( " v Normal capillary fill; Refill: ^ Brisk ~,.~ Delayed j ~~%~ / r ~ , •~ ~ l ~ ~ ~ Q heral edema; Heart Rhythm: •/ ~ l•: eri nce of Abs E l ' " ~ ~ ''` p p e Circle) S4 ~ S3 d ' ~ - > ( s: s and central Heart Soun if a licable, IV ~., . y , a ~ , Location: Ed ll ema: , lines patent and infusing we with absence of infiltrates! Degree ^ 1+ ^ 2+ ^ 3+ /.~Lr• ~j j• . ~ ~ ' Q itti N , ~ , v ng on-p S&S infection. ^ Pitting ^ (1+ = 1/4 in.; 2+ = 1!2 in.; 3+ = 1 in.) ~ ,~ _ y ~~ ~'~",/ 7 ~ i !' ^ Within Normal Limits: : ^ Distended ^ Firm Abd y ~ / ~ •I t ~ ~ ~~`~•%f~~ 4 " omen Abdomen soft, non-distended; ^ Tender ^ Other l'C/ ~': , • ~~ ' "-~ c ~: ; G ~ ' ll d i / 5 1 ~ ~ ~ ~ / ' " ^ ' qua n a Bowel sounds present s; Bowel ^ Hypoactive . • • ~ ~ ~ ' - ~ / j bowel and/or bladder Sounds: ^ Hyper~~ctive^ Absent Absence of NN ' % ~y / ~ ;` ~ c=7 , incontinence Tubes^ NGT []'OGT ~ ^ Gtube ^ Jtube _ ~ ^ Colostomy ^ Other Type: Patent ^ Yes ^ No _ ' ~ ' ~^ ~ ~ G r ^ I leostomy Suction Type ~~.~ ~L~ ,C7~Y~s ^ No Foley Patent ~ , lllzc) Drainag ~/iG~ Drainage~'i!i% ~ , ^ Within Normal Limits: Skin: ^ Pale Dry ^ Flushed ^ Cool Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash normal skin turgor; Absence of diced ^ Other ti ^ J E h w aun ~ cc ymo c ~ skin integrity alterations ocation c7 Wound #2 ^ Incision ^ Other Wound # 1 Incision ^ Other Location z Location /r,''' (r%i1~- Dressing ^ Dry ^ Intact ^ Other Dressing Dry ,C7lntact ^ Other Drainage chara. Drainage chara. Braden Scale Score Restraints in use ^ N ^ Y"see restraint flow sheef t f E i S " nv ronmen : a e Provisions for i Call bell and phone within reach; Restraints applied properly ^ Y N ID band on. Fall Risk: ^ N ^ Y INIT S SI(uNATURE/Tl INITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE • G, A~~ ~~ NT/FAMILY D ~aRGE PLANWIN~ • DI HAR E IN TR ~ 1~1~ ~ Physician's instructions reviewed with Patient/Signficant Other, signed, copy given. ~ f' ~xiptions gnren. ~ Patients own medications returned. ~ 1 nt/Significant Other accurately restates all instructions. Ooes not request ary further Health Ed. ~ Insiruded to call Physician/Hospihal if any problemsJquestions develop. DISCHARGED: Date 1 Time: To: ~ Home ~ Other. 'Ambulatory ~ WC ~ Ambulance ~ : ~ Family ~ Other. .~- Signature: , - `~ /~' y~ ME NOTES ~~ 7J~ J 7 ~~.J ~! ))DATE/ll ~,~ lJ~~ t?:GJ ,~I.e~ n ~.fl./~~,(A ~ldlr''/.c~'I/ ~' .!~ rri, .~ r _ /~l~ru1 Gam'. o _ r! ~- ~ G .- ~ n . ~lU Z 4~ < ,; ' y .~' ~ J e s r - ~K-- ~~-~ -/ z`°i ~. !~ ASPER, MAUREEN E Acct~15008063 MRp0001044167 0812012005 HARDESTY, JAME DOB:0713111942 063 F CARLISLE REGIONAL MEDICAL CTR IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII oo12-A 11 gCARLIS7~ REGIONAL MEDICAL CENTER NURSING DOCUMENTATION FORM ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO JAMES HARDESTY, M.D. I, Daryl E. Christopher, certify that: (~ an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR () the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. r ~_ Date: August 9, 2007 Daryl E. Christopher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717)238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO BELVEDERE MEDICAL CORPORATION I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR (~ the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: August 9, 2007 Daryl hristopher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO JOSEPH ACRI. M.D. I, Daryl E. Christopher, certify that: (~ an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standazds and that such conduct was a cause in bringing about the harm; AND/OR () the claim that this defendant deviated from an acceptable professional standazd is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the caze, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. ~ Date: August 9, 2007 Daryl E. hris opher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 Attorneys for Plaintiff: JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO ACRI INTERNAL MEDICINE SERVICES LLC I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the Gaze, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standazds and that such conduct was a cause in bringing about the harm; AND/OR (~ the claim that this defendant deviated from an acce table rof ' p p esslonal standard Is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standazd and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standazds and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: August 9, 2007 Daryl E. Christopher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717)238-6791 Fax: (717)238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO CARLISLE HMCA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR (~ the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: August 9, 2007 Daryl E. hristopher, Esquire Counsel for Plaintiffs 362282 VERIFICATION I, ,John Asper, Jr., Individually and as Administrator of the Estate of Maureen Asper, deceased, Plaintiff, have read the foregoing PLAINTIFF'S COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. Witnes hn sper, Jr. Dated: 7~3~p 7 361453 J ~M~S )~J~Kd~str , m.n. ~_~.~. ~5v w~~ 1Nut 1~~7~fonn ~f. C~~ I~'s(c. ~~' . ° 13e~ ~ e ~ urn. 1"Vl r-d.~ u41 ~. S'U ~l1 ~ ~ n~ uJ~ ~ J~fS'T~c~ m ! lG-v-~ Ca~I,'sr~, , ~~ J~ S ~~ ~c R ~ , m . ~. -~~, ~-e rNA! f Y~ ~ ~ ~' N ~e~e~ K-~e wN ~° o-~ 4 ~ ~ ~dr 1 (~ / 7335 1. Ale I ~~S ~e,_.._ l~ 1'1'1 C.. .1- N ~• ~~Jq. y~ S R,'~ QR~`~~ p ~ ~0~3 G~~-tis~~,~' ~ ~ `~ V v/~ `~ ' '1 C r> ^~ ~ J ,~ ~ ~ " ~~T . .., 3 --r~ ~ i . _...~ -~, -~ i.~ ~-'~ ~ ' - _ _ ; S <`.R7 -1 ~~ c.:) 1~ "J.J ~ 4r~ "!~ V ~ ~ MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centenriew Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE l ~ PLEASE ENTER our appearance on behalf of Defendant, James Hardesty, M.D., in the above-captioned matter. McQUAIDE BLASKO Dated: August 24, 2007 By: Grant H. Fleming, Esquir I.D. #16212 Maureen A. Gallagher, Esquire I.D. #53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 ~ ~ ~ ~, ,_, -r~ {- a ~~ ~+ ~ i.1 f/~ ,,,, ~ ~ ~ ~' ~y _ S ~ f 1 " ~ ~•:_: ~..., «y.~ wi ~ ~ r.S ~f~ ~,y ~~ E~ ` i y~r w W -'iy ~ +i J r.a MCQUAIDE, BLASKO, PEENING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attomey I.D. No. 16212 Maureen A. Gallagher, Esq. Attomey I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and. JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M. D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and -= says that service of a true and correct copy of Defendants' Praecipe to Enter Appearance was provided by First Class mail, postage prepaid on this 24~' day of August, 2007, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 1 71 1 0-1 708 McQUAIDE, BLASKO, FLEMING & FAULKNER, INC. Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire Sworn to and subscribed before me this 24"' day of August. 2007. ~otary Public ., ,, ~,~.-~ ,. KRA~IlFJ UI~~Oq jl0lory h#1NC C~~lR1! 1WR ~A1R!!i COtM1Y M~- ComrnMMc~:~~pw~ Oct Z4, ~ ~ a ~ d !'; rr< 3~. =~ . _ r-'' ~ G'7 . R7 i ., L~ ~ +``~ ~ ~~~ "~11~f '~ j~3ft~ ~~~~ RUQS .A~ s~ 8a9tit~lt~"14tt'~~"Y?NTtt1 MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b1a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL : PROFESSIONAL LIABILITY ACTION : NO. 2007-4782 JURY TRIAL DEMANDED DEFENDANT JAMES HARDESTY M.D'S PRELIMINARY OBJECTIONS TO PLAINTIFF'S COMPLAINT AND NOW, comes the Defendant, James Hardesty, M.D., by and through his attorneys, McQuaide Blasko Law Offices, and files the within Preliminary Objections to Plaintiff's Complaint and in support thereof avers as follows: 1. This medical malpractice action was instituted. by Complaint filed August 13, 2007. in addition to Objecting Defendant James Hardesty, M.D. ("Dr. Hardesty"), Plaintiff has named the following Defendants: Belvedere Medical Corporation, Joseph Acri, M.D., Acri Internal Medicine Services, LLC and Carlisle Regional Medical Center. 2. Plaintiff filed Certificates of Merit as to all Defendants, concurrent with the filing of his Complaint. 3. Plaintiffs Complaint asserts negligence in the care and treatment provided to Plaintiffs decedent Maureen Asper, who died on September 20, 2005 following admission to Carlisle Regional Medical Center on August 20, 2005. Plaintiff has asserted claims for wrongful death, survival, and negligent infliction of emotional distress purportedly arising from the care provided by the Defendants at Carlisle Regional Medical Center. 4. Plaintiffs specific claims of negligence against Dr. Hardesty are set forth at Count I, Paragraphs 67(a)-(f). In summary, Plaintiff asserts Dr. Hardesty was negligent in performing a tracheotomy on Mrs. Asper, and in improperly placing and securing the tracheotomy tube. Plaintiff also alleges that Dr. Hardesty failed to ensure the correction of an air leak associated with the tracheotomy, and further failed to diagnose or treat subcutaneous emphysema and right pneumothorax. According to the Complaint, these acts of negligence occurred in the afternoon and evening of September 8, 2005, and upon Dr. Hardesty's return to the hospital in the early morning 2 r hours of September 9, 2005. Complaint, Paragraphs 21, 23-25, 27-28, 48-49 and 67(a)-(f). 5. In addition to the above-referenced allegations, Plaintiff asserts a claim for negligent infliction of emotional distress against Dr. Hardesty, and all of the other Defendants, at Claim III of the Complaint. 6. Plaintiffs claim for negligent infliction of emotional distress is set forth in its entirety as follows: "98. Beginning around 5:00 a.m. on September 9, 2005, Plaintiff John Asper, Jr. was sitting outside the door to his wife's hospital room and was able to see and hear what was going on inside the ICU. 99. During the time that Mr. Asper was outside the room, the door to Mrs. Asper's room was wide open. 100. As a direct result of the Defendants' negligence which caused and/or contributed to the death of his wife, Maureen Asper, Mr. Asper suffered severe emotional distress, and a claim is made therefor." Complaint, Paragraphs 98-100. 7. Defendant Dr. Hardesty objects to Plaintiffs claim for negligent infliction of emotional distress against him, upon the basis that. Plaintiff has failed to state a claim upon which relief may be granted under this theory of recovery. 1. Demurrer to Plaintiff's Claim for Nestlinent Infliction of Emotional Distress Anainst Dr. Hardesty 8. Paragraphs 1 through 7 are incorporated herein by reference as though set forth at length. 9. Plaintiff has failed to plead or allege facts which would support his claim for negligent infliction of emotional distress, because he has failed to plead both: 1) J contemporaneous observation of a discrete traumatic event, and 2) resulting physical injuries of an unremitting or continuing nature. 10. Pursuant to the appellate case law of this Commonwealth, a bystander seeking to assert a claim for negligent infliction of emotional distress must be able to plead and prove: 1) that plaintiff was located near the scene of the accident, as contrasted with being a distance away from it; 2) that his shock resulted from a "direct emotional impact upon the plaintiff from the sensory and contemporaneous observance of the accident, as contrasted with learning of the accident from others after its occurrence;" and 3) that the plaintiff and the injured person were closely related. Sinn v. Burd, 404 A.2d 685 (Pa. 1979). 11. The basis for recovery under a claim of negligent infliction of emotional distress is the traumatic impact of viewing the negligent injury of a close relative. 12. Under Pennsylvania law, plaintiff must witness the negligent act itself and not just the resulting traumatic injury to the loved one. Love v. Cramer, 606 A.2d 1175 (Pa. Super. 1992). 13. In this case, Plaintiff did not plead and cannot prove that he suffered shock from a direct emotional impact, caused by the sensory and contemporaneous observance of the allegedly negligent act. 14. The physical injury at issue in this case is an anoxic brain injury to Mrs. Asper, which Plaintiff contends occurred as the result of Dr. Hardesty's improper performance, and follow up care, of a tracheotomy. 15. As noted supra, Plaintiff's entire claim for negligent infliction of emotional distress is based upon the allegation that he began sitting outside the door of his wife's 4 hospital room "around 5:00 a.m. on September 9, 2005," was able to see and hear what was going on inside the ICU, and the door to his wife's room was "wide open." Complaint, Paragraphs 98-99. 16. Although Plaintiff asserts that he suffered severe emotional distress "as a d/rect result of the Defendants' negligence which caused and/or contributed to the death of his wife," nowhere in the Complaint does the Plaintiff assert that he witnessed one of the discrete and identifiable acts of negligence alleged in the Complaint. See Complaint, Paragraph 100 (emphasis and italics supplied). 17. Although Plaintiff has asserted this claim for negligent infliction of emotional distress in a conclusory manner against all of the Defendants collectively, he must properly establish the elements of the claim as to each Defendant individually. 18. With respect to Dr. Hardesty, however, Plaintiff has not asserted that he witnessed Dr. Hardesty's allegedly negligent performance of a tracheotomy on Plaintiffs wife, nor has Plaintiff alleged that he witnessed any of the allegedly negligent acts which occurred on September 8, 2005. 19. To the contrary, Plaintiff asserts he did not begin sitting outside his wife's hospital room until September 9, 2005, the day after Dr. Hardesty's allegedly negligent performance of a tracheotomy, placement of the tracheotomy tube, securing of the tracheotomy tube, and improper correction of the air leak. Compare, Paragraphs 67(a)- (d) and Paragraph 98. 20. If Plaintiff did not contemporaneously observe these acts of alleged negligence, then it is impossible for him to have sustained a "direct emotional impact" from them, sufficient to warrant a claim for negligent infliction of emotional distress. 5 21. Similarly, the Complaint contains no allegation that Mr. Asper observed Dr. Hardesty's allegedly negligent misdiagnosis or improper treatment of his wife's subcutaneous emphysema and right pneumothorax, at the time of the claimed malfeasance. Compare, Paragraphs 67(e)-(f) and Paragraph 98. 22. Therefore, the specific allegations of negligence directed to Dr. Hardesty cannot serve as the basis for a claim of negligent infliction of emotional distress against him. 23. Further, in order to state a prima facie case of negligent infliction of emotional distress, the plaintiff must allege resulting physical injuries which are unremitting or of a continuing nature. See, Love v. Kramer, supra. 24. Within his Complaint, Plaintiff has failed to allege any physical injury as required under Pennsylvania law. See, Complaint, Paragraphs 98-100. 25. Therefore, Plaintiff has failed to state a claim upon which relief may be granted for negligent infliction of emotional distress. WHEREFORE, Defendant James Hardesty, M.D. respectfully requests this Honorable Court sustain his Preliminary Objection in the nature of a demurrer to Plaintiff s claim of negligent infliction of emotional distress, and dismiss Claim III, Paragraphs 97-100 of the Complaint against him, with prejudice. Respectfully submitted, McQUAIDE BLASKO Dated: ~ ~ lp'7 By: ""~Q;e~cl~,. 1 Maureen A. Gallagher, E uire Erin Dragann, Esquire Attorneys for Defendant James Hardesty, M.D. 6 8 ~~ v- ~~ a r a~ i_ ~~..,, ~..~ ..~ e ~` g~ BY: ANDREW H. BRIGGS E-MAIL: abriggs@postschell.com I.D. # 53072 BY: KAREN E. MINEHAN E-MAIL: mminehan@postschell.com I.D. # 78050 POST & SCHELL, P.C. 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 PHONE: 717-391-4454 JOHN ASPER, JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER, JR., individually and in his own right Plaintiff vs. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA, INC., d/b/a CARLISLE REGIONAL MEDICAL CENTER Defendants ATTORNEYS FOR DEFENDANT CARLISLE HMA, INC., DB/A CARLISLE REGIONAL MEDICAL CENTER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-4782 CIVIL ACTION -- MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED ENTRY QF APPEA-RA-NCE/JURY TRIAL DEMAND TO THE PROTHONOTARY: Kindly enter our appeazance on behalf of Defendant, Cazlisle HMA, Inc., d/b/a Cazlisle Regional Medical Center in the above-captioned matter. Also, please enter at this time our demand for a trial by twelve jurors. POST & SCHELL, P.C. By: Dated: September 13, 2007 .~idrew H. Briggs, Esquire - Kazen E. Minehan, Esquire Attorneys For Defendant Cazlisle HMA, Inc., d/b/a Cazlisle Regional Medical Center -2- CERTIFICATE OF SERVICE I, ANDREW H. BRIGGS, ESQUIRE, attorney for Defendant, CARLISLE HMA, INC., DB/A CARLISLE REGIONAL MEDICAL CENTER hereby state that a true and correct copy ~ of the foregoing document(s), sent by first-class mail, postage prepaid on the date set forth ~ below, was served upon the following individual(s): Grant Fleming, Esquire McQuaide, Blasko 600 Centerview Drive Suite 5103 Hershey, PA 17033-2903 Daryl E. Christopher, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Dated: ~ ~ L Y V U.~~~ POST & SCHELL, P.C. By: ew H. Briggs, E wire Karen E. Minehan, Esquire Attorneys For Defendant Carlisle HMA, Inc., d/b/a Carlisle Regional Medical Center 4 ~ .1~ ~~ r, Z~ ~.. ~T ~.. ~ ..~~ ~^. .~ ~- MCQUAIDE, BLASKO, FLEMlA1G & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney l.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 171333 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) .~ Maureen A. Gallagher, Esquire, attorney for Defendant, James Hardesty, M.D. in the above-captioned matter, after having been duly sworn according to law, deposes and says that a true and correct copy of De#endant's Request for Production of Documents directed to Co-Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center was made by re lar mail at the post office Hershey, Pennsylvania, postage prepaid, this ay f , 2007 to the attorney of record: Karen E. Minehan, Esquire POST & SCHELL 237 N. Prince Street Lancaster, PA 17603 Joseph Acri, M.D. Acri Internal Medicine Assoc., LLC 689 Yorktown Road Lewisberry, PA 17339 Acri Internal Medicine Assoc., LLC 689 Yorktown Road Lewisberry, PA 17339 Carlisle HMC Inc. d/b/a Carlisle Regional Medical Center 45 Sprint Drive Carlisle, PA 17013 Belvedere Medical Corporation 850 Walnut Bottom Road Carlisle, PA 17013 Sworn to and Subs ribed before me this ~ d y of Se6tember 2007. ~j~U1R1A1 SEAL SETH J V+/I150N y Pubnc ~ {MI COt}NTV My C pct 24, 2009 McQUAIDE, BLASKO, SCHWARTZ, FLEMING & FAULKNER INC. B '~ e~G... ~jV Y~ Maureen A. Gallagher, E ire '~ ~ ~ ~ _ ~'" " -, ~~' v ~ ~ ~ ` A //.~~~r yy .. ~ !~~ ~~~aslAti yNlf YSMA3L1 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717)238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED PRAECIPE TO REINSTATE TO THE PROTHONOTARY: Please reinstate the attached Complaint for service on Defendants Joseph Acri, D.O. and Acri Internal Medicine Services, LLC at 243 North 24th Street, Camp Hill, Cumberland County, Pennsylvania 17011. Date: September 19, 2007 Respectfully submitted, ANGINO & OVNER, P.C. Daryl .Christopher, Esquire I.D. No. 91895 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiffs a CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of PRAECIPE TO REINSTATE COMPLAINT on the following via postage prepaid, first class United States mail, addressed as follows: Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 Counsel for James Hardesty, M. D. Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 Counsel for Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center Belvedere Medical Center 850 Walnut Bottom Road Carlisle, PA 17013 ~~ Marcy L. B sser Date: September 19, 2007 357036 w 0 0 G n .~ .s r~ t ~ .G ,~~ --,~,-, C..~ G ra t/~ 3 C7~ ~ys.. ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 Attorneys for Plaintiff: E-mail: dchristopher u,an~ino-rovner.com Estate of Maureen Asper JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants NO. 07-4782 CIVIL TERM JURY TRIAL DEMANDED NOTICE TO DEFEND 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 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 fail to do so the case may proceed without you and 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se persentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veinte (20) Bias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a , las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion Como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Used puede perder dinero o propiedad u otros derechos importantes para used. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717} 249-3166 37036 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# :91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717)238-6791 Fax: (717} 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 CIVIL TERM JURY TRIAL DEMANDED AMENDED COMPLAINT 1. Plaintiff John Asper Jr. is an adult individual and a citizen of the Commonwealth of Pennsylvania, who resides at 7405 Wertzville Road, Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff John Asper Jr. is the Administrator of the Estate of Maureen Aspex, by Letters of Administration duly issued by the Register of Wills of Cumberland County under File Number 2005-00873. A short certificate is attached as Exhibit A. 3. Maureen Asper died on September 20, 2005. 4. Defendant James Hardesty, M.D., is a physician specializing in general surgery and is licensed to practice medicine in Pennsylvania with offices located in Cumberland County, Pennsylvania. Plaintiff is asserting a professional liability claim against Dr. Hardesty. A Certificate of Merit is filed herewith. 5. Defendant Belvedere Medical Corporation is a professional corporation created under the laws of the Commonwealth of Pennsylvania which at all relevant times employed Defendant James Hardesty, M.D., who was acting within the course and scope of his employment for the Defendant Corporation. Plaintiff is asserting a professional liability claim against Belvedere Medical Corporation. A Certificate of Merit is filed herewith. 6. Defendant Joseph Acri, D.O. is a physician specializing in internal medicine and is licensed to practice medicine in Pennsylvania. Dr. Acri regularly practices medicine in Cumberland County, Pennsylvania. Plaintiff is asserting a professional liability claim against Dr. Acri. A Certificate of Merit is filed herewith. 7. Defendant Acri Internal Medicine Services, LLC is a professional corporation created under the laws of the Commonwealth of Pennsylvania which at all relevant times employed Defendant Joseph Acri, D.O., who was acting within the course and scope of his employment for the Defendant Limited Liability Company. Plaintiff is asserting a professional liability claim against Acri Internal Medicine Services, LLC. A Certificate of Merit is filed herewith. 8. At all relevant times, Dr. Acri was the agent and/or the ostensible agent of Defendant Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center. 357036 2 9. Defendant Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center is a for profit corporation under the laws of the Commonwealth of Pennsylvania, which at all relevant times was the principal of Dr. Acri and employed hospital nursing staff who were acting within the course and scope of their employment for the Defendant Hospital. Plaintiffs are asserting a professional liability claim against Carlisle HMA, Inc., d/b/a Carlisle Regional Medical Center. A Certificate of Merit is filed herewith. 10. On or around August 18, 2005, Dr. Hardesty performed a laparoscopic cholecystectomy on Maureen Asper. The surgery was an outpatient procedure performed at Carlisle Regional Medical Center. 11. On August 20, 2005, Maureen Asper was seen at Belvedere Medical Corporation by Dr. Shaun Bryant where she was found to have a significant bile leak from her upper mid-line incision with bile staining of her clothing. 12. Maureen Asper was admitted directly to Carlisle Regional Medical Center, and on August 20, 2005, she underwent an ERCP with stenting performed by Dr. Robert Levy to correct her bile leak. 13. Following the stenting procedure, Maureen Asper was admitted to the Intensive Care Unit of the Defendant Hospital due to impending sepsis and respiratory distress. 14. While in the ICU, Maureen Asper was cared for by Dr. Joseph Acri, who the Plaintiff believed was an employee of the Defendant Hospital. 317036 3 g i 15. Plaintiff John Asper Jr. was never provided any information that caused, or should have caused, him or his family to question the employer-employee relationship between Dr. Acri and the Defendant Hospital. 16. While in the ICU, Mrs. Asper was also cared for by the nurses and/or other hospital agents whose signatures appear on the ICU charts and notes. 17. Plaintiff John Asper Jr. was never provided any information that caused, or should have caused, him or his family to question the employer-employee relationship between the individuals working in the Defendant Hospital and the Defendant Hospital. 18. Plaintiff John Asper Jr. and his family relied upon the reputation of the Defendant Hospital when they made the decision to place their trust and Mrs. Asper's life, in the hands of Dr. Acri and the other individuals working in the Defendant Hospital. 19. Maureen Asper remained orally intubated in the intensive care unit for 19 days. 20. On September 8, 2005, at 7:05 a.m., Mrs. Asper's arterial blood gases showed that she had a PCO2 of 45.2 mmHg, and a PO2 of 195.0 mmHg. At the time, oxygen saturation was 98.1 %, and her hemoglobin was very low at 6.7 g/dL. 21. On September $, 2005, at 4:20 p.m., Maureen Asper was taken to the operating room. At that time, Defendant James Hardesty, M.D., performed a tracheotomy on Mrs. Asper and inserted a 9 Portex tracheotomy tube at the level of her fourth tracheal ring. 22. At 5:47 p.m., arterial blood gasses showed that Mrs. Asper's blood had a pH of 7.225, a PCO2 of 59.4 mmHg, and a PO2 of 65.0 mmHg. Mrs. Asper's oxygen saturation had fallen to 87.4%, and her hemoglobin was still low at 10.9 g/dL. 37036 4 23. At 6:00 p.m., an air leak was noted in the ICU. Mrs. Asper's oxygen saturation was noted to be 92-95%. 24. At 7:30 p.m., Dr. Hardesty was in to see Mrs. Asper. An air leak was again noted in the ICU records. 25. At 8:00 p.m., Mrs. Asper's ventilator was changed. According to ICU records, her condition remained unchanged. 26. At 9:13 p.m., arterial blood gases revealed that Mrs. Asper's blood had a pH of 7.299, a PCO2 of 50.0 mmHg, and a PO2 of 80mmHg. Mrs. Asper's oxygen saturation was 93.6%, and her hemoglobin was only 9.1 g/dL. 27. According to ICU records, Dr. Hardesty was notified of Mrs. Asper's arterial blood gas results at 9:15 p.m. 28. At 10:00 p.m., Mrs. Asper was turned. The air leak from around the tracheotomy tube remained. According to ICU records, Dr. Hardesty was at Mrs. Asper's bedside. 29. At 10:34 p.m., arterial blood gasses revealed that Mrs. Asper had a blood pH of 7.320, a PCO2 of 46.4 mmHg, and a PO2 of 107 mmHg. Mrs. Asper's oxygen saturation was 95.8%, and her hemoglobin level was 8.7 g/dL. 30. At 11:45 p.m., Mrs. Asper had much generalized edema. Mrs. Asper also had swelling on the right side of her neck lateral to her tracheotomy tube with no ecchymosis. 31. At that time, the treating nurses did not call for a physician or respiratory therapist. 317036 5 32. At 1:45 a.m., on September 10, 2005, Mrs. Asper was having increased swelling into the left side of her face and into her neck. She still had no ecchymosis. 33. At that time, the treating nurses did not call for a physician or respiratory therapist. 34. At 2:30 a.m., Mrs. Asper had very low posterior breath sounds. She was turned by two nurses while a third nurse attempted to keep the tracheotomy tube stable. During the turn, Ms. Asper's blood pressure increased to 208 over 108. 35. At 2:35 a.m., Mrs. Asper was returned to her back, but her blood pressure remained elevated and her respiratory rate increased with increased effort. 36. Nurses attempted to suction Mrs. Asper's tracheotomy tube; however, they were unable to pass the suction catheter more than four inches into it. 37. By 2:40 a.m., Mrs. Asper's oxygen saturation had fallen into the 80`" percentile. 38. Nurses began bagging Mrs. Asper via her tracheotomy tube. 39. A code 99 was called to which the respiratory therapist, nurse anesthetist, and Dr. Acri responded by 2:45 a.m. 40. At this time, Mrs. Asper was experiencing rapidly increasing subcutaneous emphysema that was now in all of her face and chest and was moving into her abdomen. 41. Mrs. Asper's oxygen saturation fell to 33%. Nurses continued bagging via the tracheotomy tube. 42. At 2:58 a.m., Dr. Acri successfully intubated Mrs. Asper via oral intubation. 37036 43. Dr. Acri ordered and reviewed an x-ray. The x-ray showed that the oral trachea tube was in the proper position. The x-ray also showed a right pneumothorax. 44. Nothing was done about the pneumothorax at that time. 45. At 3:05 a.m., Mrs. Asper's oxygen saturation reached 80%. Her face remained cyanotic (bluish), and her eyelids remained swollen. 46. After oral intubation, Mrs. Asper's oxygen saturation climbed very slowly. 47. At 3:25 a.m., Maureen Asper's pulse ox showed that her oxygen saturation reached 87% for the first time since she has been orally intubated. 48. By 3:30 a.m., Dr. Hardesty was notified of the morning's events. 49. Dr. Hardesty returned to the ICU at 4:00 a.m. At that time, Mrs. Asper continued to experience increasing subcutaneous emphysema. 50. Dr. Hardesty reviewed the chest x-ray taken earlier that morning. 51. Nothing was done about the pneumothorax at that time. 52. By that time, the subcutaneous emphysema had spread to Mrs. Asper's pubic area, and her abdomen had become extremely large and rigid. 53. At 4:03 a.m., arterial blood gas tests showed that Mrs. Asper had a PO2 of 51 mm Hg and oxygen saturation of 78.4%. 54. At 4:46 a.m., arterial blood gas tests showed that Mrs. Aser had a PO2 of 52 mm Hg and oxygen saturation of 82.6%. 55. By 5:00 a.m., Plaintiff John Asper Jr. had begun to sit outside the door to his wife's room. 357036 7 56. At 6:00 a.m., Mrs. Asper's pulse ox showed oxygen saturation of 87%; however, her pulse was 100-110 and her upper face remained cyanotic (bluish) and her nail beds had become dusky. 57. At 6:35 a.m., the nurse's note revealed that Mrs. Asper's pulse ox had been steadily falling since 6:00 a.m. and that it was now at 80%. 58. At that time, Dr. Hardesty attempted extra breaths beyond the set rate of 30 breaths per minute. 59. A consult from pulmonary medicine diagnosed Mrs. Asper with a hypoventilation from barotrauma / pneumothorax and hypoxemia. The doctor recommended placement of a right chest tube. 60. At 9:00 a.m., Mrs. Asper's blood pressure fell as low as 70 over 38. 61. Dr. Hardesty placed a chest tube into Mrs. Asper's right axilla (arm pit) at some point between 9:00 a.m. and 10:30 a.m. 62. By 10:35 a.m., Mrs. Asper's PO2, oxygen saturation, blood pressure, and pulse were within or were close to normal ranges. 63. It is believed and therefore averred that Mrs. Asper suffered an anoxic brain injury on September 8 and 9, 2005. 64. A bronchoscopy performed on September 12, 2005, showed that at that time, the tracheotomy tube placed by Dr. Hardesty on September 8, 2005, was not in Mrs. Asper's trachea and instead ended in a blind pouch. 65. On September 20, 2005, Mrs. Asper died after life support was discontinued. 357036 8 COUNTI JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED v. JAMES HARDESTY, M.D. 66. Paragraphs I through 65 are incorporated herein by reference. 67. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant James Hardesty, M.D., which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) he decided to perform and did perform a tracheotomy on Mrs. Asper while she was suffering from ARDS; (b) he failed to ensure that the tracheotomy tube was secure before leaving the hospital on September 8, 2005; (c) he failed to properly correct the air leak from the tracheotomy before leaving the hospital on September 8, 2005; (d) he failed to ensure that the tracheotomy tube was properly placed before he left the hospital on September 8, 2005; (e) he failed to timely diagnose or treat Mrs. Asper's subcutaneous emphysema; and (f) he failed to timely diagnose or treat Mrs. Asper's right pneumothorax. COUNT II JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED v. BELVEDERE MEDICAL CORPORATION 68. Paragraphs I through 67 are incorporated herein by reference. 69. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Belvedere Medical Corporation through 357036 9 their agent Dr. James Hardesty which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 70. At all relevant times, Dr. James Hardesty was an employee, apparent or ostensible employee, agent. apparent or ostensible agent, and servant of the Defendant Belvedere Medical Corporation. Defendant Belvedere Medical Corporation is responsible for his negligence under the doctrine of respondeat superior and apparent agency. COUNT III JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED v. JOSEPH ACRI, D.O. 71. Paragraphs 1 through 70 are incorporated herein by reference. 72. All of Plaintiffs' damages are the direct and proximate result of the negligent, careless, and substandard care provided by Defendant Joseph Acri, D.O. which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) he failed to timely diagnose or treat Mrs. Asper's subcutaneous emphysema; (b) he failed to timely diagnose or treat Mrs. Asper's right pneumothorax; and (c) he failed to properly supervise the staff in the ICU and allowed them to continue bagging Mrs. Asper via her tracheotomy after the tube had become dislodged, thereby increasing her subcutaneous emphysema and pneumothorax. COUNT IV JOHN ASPER JR., INDIVIDUALLY AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER DECEASED v. ACRI INTERNAL MEDICINE SERVICES, LLC. 73. Paragraphs 1 through 72 are incorporated herein by reference. 357036 1 Q 74. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Acri Internal Medicine Services, LLC, through its agent Defendant Dr. Joseph Acri which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 75. At all relevant times, Dr. Joseph Acri was an employee, apparent or ostensible employee, agent, apparent or ostensible agent, and servant of the Defendant Acri Internal Medicine Services, LLC. Defendant Acri Internal Medicine Services, LLC, is responsible for his negligence under the doctrine of respondent superior and apparent agency. COUNT V JOHN ASPER JR., INDIVIDUALLY, AND AS THE ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER 76. Paragraphs 1 through 75 are incorporated herein by reference. 77. All of the Plaintiffs' damages were the result of the negligent, careless„ and substandard care provided to Mrs. Asper by Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center, through its agent Defendant Dr. Joseph Acri which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 78. At all relevant times, Dr. Joseph Acri was an employee, apparent or ostensible employee, agent, apparent or ostensible agent, and servant of Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center. Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center is responsible for his negligence under the doctrine of respondent superior and apparent agency. 357036 1 1 79. All of Plaintiffs' damages were the direct and proximate result of the negligent, careless, and substandard care provided to Mrs. Asper by nurses and other individuals whose signatures or initials appear on the ICU notes attached as Exhibit B which increased the risk that Mrs. Asper would suffer an anoxic brain injury as follows: (a) they failed to timely notify an attending physician of Mrs. Asper's subcutaneous emphysema, symptoms of which appear in the records as early as 11:45 p.m.; (b) they failed to seek assistance from a physician before attempting to turn a patient with an unstable and leaking tracheotomy tube; (c) they attempted to turn a patient with an unstable and leaking tracheotomy tube; (d) they caused or allowed Mrs. Asper's tracheotomy tube to become dislodged; (e) they attempted to bag Mrs. Asper via her tracheotomy tube despite the fact that it was apparent that the tube had become displaced, thereby increasing her subcutaneous emphysema; and (f) they failed to timely call a Code 99 after attempting to turn Mrs. Asper and dislodging her tracheotomy tube. 80. All of the Plaintiffs' damages were the result of the negligent, careless, and substandard care provided to Mrs. Asper by Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center, through its agents, the nurses and other individuals whose signatures or initials appear on Exhibit B which increased the risk that Mrs. Asper would suffer an anoxic brain injury as set forth above. 81. At all relevant times, the nurses and other individuals whose names or initials appear on Exhibit B were employees, apparent or ostensible employees, agents, apparent or 357036 1 ostensible agents, and servants of Defendant Carlisle HMA Inc. d/b/a Carlisle Regional Medical Center. Defendant Carlisle HMA Inc, d/b/a Carlisle Regional Medical Center is responsible for their negligence under the doctrine of respondent superior and apparent agency. CLAIIVI I-SURVIVAL ACTION JOHN ASPER JR., ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, D.O., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER 82. Paragraphs 1 through 81 are incorporated herein by reference. 83. Plaintiff John Asper Jr. brings this action on behalf of the Estate of Maureen Asper, deceased, under and pursuant to 42 Pa. C.S.A. § 8302. 84. Defendants' negligence, as alleged herein, was the legal cause of Mrs. Asper's death. 85. Defendants' negligence, as alleged herein, increased the risk that Mrs. Asper would suffer from and die from an anoxic brain injury. 86. Defendants' negligence, as alleged herein, significantly decreased Mrs. Asper's period of survival. 87. Defendants are liable to the Estate of Maureen Asper for damages set forth herein. 88. Plaintiff John Asper Jr., Administrator of the Estate of Maureen Asper, deceased, hereby files claims on behalf of the Estate for damages suffered by the Estate including medical expenses, pain and suffering Mrs. Asper experienced prior to her death, Mrs. Asper's loss of 3 57036 13 earnings and future earning capacity, and all other damages properly recoverable under 42 Pa. C.S.A. § 8302. WHEREFORE, Plaintiff John Asper Jr. as Administrator of the Estate of Maureen Asper, deceased, and Individually and in his own right, demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. CLAIM II-WRONGFUL DEATH JOHN ASPER JR., ADMINISTRATOR OF THE ESTATE OF MAUREEN ASPER, DECEASED v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, D.O., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER 89. Paragraphs 1 through 88 are incorporated herein by reference. 90. Plaintiff John Asper Jr, brings this action pursuant to the Wrongful Death Act, 42 Pa. C.S.A. § 8301, on behalf of the wrongful death beneficiaries enumerated below. 91. Defendants' negligence, as alleged herein, was the legal cause of Mrs. Asper's death. 92. Defendants' negligence, as alleged herein, increased the risk that Mrs. Asper would suffer from and die from an anoxic brain injury. 93. Defendants' negligence, as alleged herein, significantly decreased Mrs. Asper's period of survival. 357036 14 94. The following are the names of all individuals entitled by law to recover damages for the wrongful death of Maureen Asper: Name Relationshi to Mrs. As er Address John Asper Jr. Husband Carlisle, PA Melissa Kennedy Daughter Shermans Dale, PA Jennifer Wilson Daughter York Haven, PA 95. As a direct result of the Defendants' negligence, which caused Maureen Asper's death, the wrongful death beneficiaries have incurred funeral expenses, and claims are made therefor. 96. As a direct result of the Defendants' negligence, which caused Maureen Asper's death, the wrongful death beneficiaries have been, and will in the future be, deprived of Maureen Asper's services, contribution, and support, and all other classes of damages allowed by 42 Pa. C.S.A. § 8301, and claims are made therefor. WHEREFORE, Plaintiff John Asper Jr. as Administrator of the Estate of Maureen Asper, deceased, and Individually and in his own right, demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. CLAIM III-NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS JOHN ASPER JR. v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, D.O., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER. 97. Paragraphs 1 through 96 are incorporated herein by reference. 357036 15 98. Beginning around 5:00 a.m. on September, 9, 2005, Plaintiff John Asper Jr. was sitting outside the door to his wife's hospital room and was able to see and hear what was going on inside the ICU. 99. During the time that Mr. Asper was outside the room, the door to Mrs. Asper's room was wide open. 100. On the morning of September 9, 2005, Mr. Asper observed Dr. Acri's and Dr. Hardesty's negligent failure to diagnose or treat Mrs. Asper's pneumothorax and subcutaneous emphysema which caused or increased the risk of her anoxic brain injury. 101. Over the next 11 days, Mr. Asper witnessed the effect that the anoxic brain injury had on his wife. 102. As a result of witnessing the negligence of Dr. Acri and Dr. Hardesty on the morning of September 9, 2005, Mr. Asper has suffered and may in the future suffer from stress and anxiety, and claims are made therefor. WHEREFORE, Plaintiff John Asper Jr. demands judgment against the Defendants in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any amount requiring compulsory arbitration. ANGINO & ROVNER, P.C. Daryl E. istop er, Esquire I.D. No. 91895 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Date: September 26, 2007 Attorney for Plaintiffs 37036 1 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE . I, GLENDA EARNER STRASBAUGH .~ Register for the Probate of Wi31s and Granting _ Letters of Administration in and for _ CUMBERLAND County, do hereby certzfy that on the 30th day of September, Two Thousand and Fi ve, Letters of ADM/N/STRAT/ON in common form were granted by the Register of ' said County, on the estate of MAUREENEASPER late of M/DDLESEX TOWNSHIP JFtrs~ MJdd/G. Lest) in said county, deceased, to JOHNWASPERJR /first, Middle, las8 and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the sea3 of said office a t CARLISLE, PENNSYLVANIA, this 3 0th day of September Two Thousand and Five. File No. PA Fi3e No. Date of Death S~. S. # 2005- 00873 21- 05- 0873 9/20/2005 161-34-0904 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEA PLAINTIFF'S EXHIBIT ASPER, MAUREEN E Acct1l5008063 MRf{0001044167 08(20(2005 hAROESTY, JAME D06:0713111942 063 F CARLISLE REGIONAL MEDICAL CTR Illlllllillllllllllllllllllllllliplllillllll oo12-A I1 DATE: ~` r„! •,~ Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN ~ „~;~ ~'~'~`SL~ ~-tG ~~% } c~ Awake, alert, oriented to TPP; Speech lucid, cooperative, calm; BEST VERBAL MOTOR ~ r L'ti~ /'~+.~~ ~'•L~ ~ O moving all extremities equally well. Responds to verbal stimuli. EXT. MOVEMENT-ARM R j L . ( ~ i / /~ ~, ' G U~ ~' @ [ ~i ~ / . ~ w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R ~ Lj G is ~~. .~~ ~/ ~ ~,~,~y >~~~" Z ^ Combative ^ Anxious ^ Un~cooperative ^ Depressed ^ Withdrawn Cg~>~ther~~~%~ PIL mm /reaction ~ '~ ~( ~ .Z ~{f"~~%!`(-~~ C: ~~`'~I; ~ ~ ~~~ ~~ neic at Rest ^ D ''s R ' - p esp.: ^ Within Normal Limits: ~~JJ Respirations unlabored; Cg'Dyspneic on Exertion ~ jZGG~l G/L~i/If~~ Bilateral chest excursion; ^ Retractions ^ Other ~ ~~~ ~ ~~~ Absence of cough and secretions; C roductive ^ Productive ^ Non h / / p : oug Bilateral breath sounds clear. ^ Other 1 ~~-~ /'~ ~(/l ~i' Ches ymmetric Asymmetrical ~putum: ^ White ^ Y low ^ L se enacious L:.'~ CC~-~Ci~~/1/: a Breath Sound r ` Ll'Z~''~~G th ~ e 1 -clear a ~ rL 2 -diminished CT: Location ~, ~ ~ ~ C ~ C' J ~ L ~~~~ ! ~ w 7 3 -rates ^ S ction cm ~ . ` ` ~`~ i ~i L l~t'7 ~ l. (, ~ u 4-rhonchi ^ Gravitydrainage ~ / ~~~ ,~'~J"7~/,~! 5 -wheezes Drainage characteristics ~ 6 - bronchial 'S ~ /~ ~ ~~~ %~ ~~ (i / / ~~/7 R L y -absent Air leak ^ Yes ^ No ~ ~L i ~~~ G ~<.~(. / Crepitus ^ Yes ^ No ~ ' '~' / / ^ Within Normal Limits: ~/~L AP: ^ Irregular istant G >~i!~ T [ Apical rate regular; ^ Murmur ^ Other Y ~ Y ~Z-t'~~`~ t.Z~~~ / /~ lJ / Peripheral pulses 2+/3; Cap v Q Normal capillary fill; Refill: ^ Bris S n ^ Delayed heral edema; Heart Rhythm: K eri Absence of ~, ~~ , /,J.LG~ L~C`"~L ~`" p p cl ntral Heart Sounds: S4 1 S d if li bl IV' / / / - ~ ~ ~ s an ce ca app e, Edema: Location: i ll i f . ~ !~' a ng we , lines patent and n us with absence of infiltrates/ Degree ^ 1+ + ^ 3+ ~~ ~' ~~ itti ^N ~ ' r, ng on-p tting p~. ~~~ ~ [t~ %~grynf S ~ C ~~,L (1+= 114 in.; 2+= 1/2 in.; 3+= 1 in.) ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm Abdomen soft, non-distended; ^ Tender ^ Other d t i ll l d qua n a Bowe soun s presen s; Bowel ^ Hypoactive Absence of NN, b wet and/ bladder Sounds: ^ Hyper ctive^ Absent c=7 ~LG6?~/~~~'(~ Tubes^ NGT ~GT i ti ncon nence Lrji~i~ ^ Gtube ^ Jtube QE'~/~ ~ ~ ~ ^ Colostomy ^ Other Type: Patent L~'S'es ^ No ~ ~~~~ ^ Ileostomy Susi+ef*'TYPe c c- Foley Pate t s ^ No ~j~~,~Q%j L ~ a ~CrD /D . Drainage Drainage ^ Within Normal Limits: Skin: ~ ale ^ Dry ^ Flushed ^ Cool Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash z normal skin turgor; Absence of ^ E undiced ^ Other h ti ^ J a ymo c cc w ~ skin integrity alterations Location C7 ~~ Wound #2 Incision Other LJlncis"o ^ Other ~-~~~(2-~ Wound # ti L ~' w ~ oca on ,~,~~_ ~~;~.~/,~ //~ ~ ? , Location Dressing ^ Dry Intact ^ Othe Dressing ^ Dry ntact ^ Other ~ Drainage chara S~~E•'l7ZLd' ~fJ~i . ~~--~~'' ~~ ~~~~ Drainage chara. ~1TlV~ ~~ i~r2~lii~ Braden Scale Score r Provisions for Safe Environment: Restraints in use. N ^ Y'see restraint flow sheet Call bell and phone within reach; Restraints applie properly ^ Y ID band on. Fall Risk: ^ Y PLAINTIFF'S INITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE INITIALS EXHIBIT ~.vn~v~'r-~2~ ~ v r 3ressograph RSt'ER, ~.1~'.Uf~r~fJ E ficet:~50CII0S0 h~R"00010441 G7 08I20f2005 'r!fiRCESTY, J;~~~1E DOB:O-!13111942 063 F CARLI:'LE Ft~^I: •;%L MEDICAL CTR I!;!4i;1+!~~!!U~tlf~l;`;:~-11,1!11111!;~fi oo~z•fin mnn IC D610 (06104) I.C.U. Flow Sheet 'CARI~SLE - _ w° B P x REGIONS ~ ~ ";, :~ MEDICAL CENT-E R' PULSE • DATE: nRnn Hann innn ~~nn ,onn ,~~~ D E N reMP - 250 - --- -- )LET: °k TAKEN B-L-D Q 24D M / PM CARE - V 230 , 1 )RAL CARE '~ ~,~ 220 210 ~OLEY CATHETER CARE ~ - 2D0 " 190 SKIN CARE ~} 3lTE BLOCK CHANGE 180 170 `` RACH CARE 160 NNER CANNULA CHANGE ~ - 150 ' ~ 140 ~ TURN n, ~ SPORT BED ROTATION / 130 120 t ROM '~ ~ 110 - 1 DO DOB CHAIR ! BSC ~ AMBULATE „ Y 90 o ~ SIDE RAILS UP # / /~ ? X3 70 +' 60 BED POSITION LOW ,: ~- ~, CALL BELL 1N REACH ~- ~ SCD'S -PRESSURE ~J 40 30 ~(• 20 _ i0 07 00 ~B Da ~~ 0 00 ~ 11. 0 ~ 112 n0 Gi!thn ~ ann MEAN ARTERIAL PRESSURE CENTRAL VENOUS PRESSURE J ~ ~I l ~' ~, I PAP (SYS/DIAS} PCWP CARDIAC OUTPUTJCARDIAC INDEX SYSTEMIC VASCULAR RESISTANCE IHEMODYNAMIC WAVEFORM WNL(SQUARE WAVE TEST SWAN GANZ PLACEMENT -EXTERNAL CATHETER LENGTH Actual Tidal Volume ,G'C ~ ~i'~ Time - - "y p- Set Rate (S1MV, AC) j~l~ pH n , FI02 ;yC p"COz ti~5' 7 ~ PEEP /~ pOz [:S- w X O ETT Size Position BE , LAC7 Tube feed ~ , ~ ; •~ „ Cry! Oral ~ Urine ///~; Cumulative Total ~ ~ n ~ ,,: ASPER, P.~,",~~~EiV Acctfl5C080S3 ~ ~~.~20010~;•416? 0812012005 I;ARDESTY, JAh1E 006:07(3111942 063 F ISLE fEG10.':.1L tlE;,1~AL CTR ~,;,~~~III!1111!lllllll'.;illllll;~iflll!illl; oo12-A 11 )0 1600 1700 1800 ~C DATE: 1900 2000 2100 2200 2300 ~24 0 0100 ~C' a~~ 600 17 00 18 00 11 't9 1• 00 ~cu vu ri vu - - 1~ ~3 i•~ I ~. cew;.... can c<n~~~ ARG Bettina ABG Setting ABG Settin ABG Settin ABG Setting ABG Settin ABG Seam Hn~ aemn r.ov ~-~-~ ~-•~••• -- ---- / U V J~~. l.~ ~~7.~ Ul.' id ~ `~~C ~~ ~ ~ J ~' ~ r ' ~ ; s l~' ' jLy' , i "' ~ c~' ~~{ ~ ~; ~ 1 ~ l- ~ nl .J1J ~ .~ V ! ~ '1~ v ~~ ~ ;~ /. y Lt~) q ~~'19 ~U . Lµ~« n' ~I ASPER, MAUREEN E Accttl5008063 MRI/0001044167 0812DI2005 HARDESTY, JAME D0B:0713111942 063 F ISLE REGIONAL MEDICAL CTR Illull~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0012-A 11 250 240 230 220 z1o 200 190 180 170 160 1sa 140 130 120 110 100 so so 70 so so 40 30 20 10 ~~ ~ _ DATE: TIME C~ ~ ~ Bun ~~~ Na ~ ~/ K ~~ CI /~ , C02 "l/• Glu ~lJ Cr C'.-j WBC ~~. ~ Hgb ~° . Hct ~~~,~ J Plt f p ; PUINR Ptt CPK CK-M B!M B Troponin I Mag I. FS BS 1500 2300 0700 TOTAL Oral 6 IV SOI.r+~ 6/~~~• 3 Z a ~ -;;1~j J UI~i ~~/ 3S ~ j ~~~`i ib1 -c~.y Y'~' S TOTAL f /7S ~I `~~~ Q ~ 7 Cumulative TOTAL: I o Adm. Wt. Yest. Wt. Today's Wt. Urine ^.~ i ICS 7 NG Stool 'g d~ % ;Ti a 0 TOTAL % •..S'~ I I ~ ?/ I 200 0300 0400/ "' • ~ 0500 0600 ^ Restraints and/or Seclusion P / R ^ Redirection/Diversion/Other measures attempted D Remains free of injury ASPER, MAUREEN E ^ Patient/family verbalizes understanding Acct#/5008063 MR#1000104z1167 0812012005 D Other NARDESTY, JAME DOB:O1j3111942 063 F ^ Alteration in Comtort: Pain CARLISLE RE610NAL MEDICAL CTR ^ Defines pain on age-appropriate scale s/ i ^ Verbaliz dicates behaviorally relief of pain 5.,. IIIIIIIIIIIillinlllllll(Illllillllllilllllli 0012•A 11 ~~ e ~ ~ ^ Other/A e S ecific ti D At Risk f F U ll i or a s n urv ^ Remains free from injury ^ Factors of risk are eliminated Select the appropriate problem(s) and expected outcomes: P / R D Other/Age Specific ^ Impaired physical mobil: weakness/paralysis/self-care deficit ^ Nutritional Status (Nutritional Manual) ^ M t i f i H ^ a a n ns u joint ROM and strength bl ' ~ D A e to pertorm ADL s ^ ^ No evidence of complications, such as contracture or ^ Other skin breakdown ^ Age Specific ^ Other/Age Specific ~mpaired Gas Exchanoe/Ineffective Airway Clearance ^ Im aired skin and/or tissue inte n p g_ty jootential fort i l f _ ^ Absence of reddened areas oten a or ^ Skin remains intact Maintains patent airway M ~~'~ ^ Other/A e S ecific aintains oxygen saturation >90% g p ^ Expresses feeling of comfort in maintainin air exchan e ~nfection: Invasive lines catheter pneumonia trauma surgical ,.r/ g g ^ Clear bilateral breath sounds /wounds (potential for L, / ^ Other/Age Specific ~f Patient is free from infection 5 ^ Fl id Vol Alt ti i ^ Clear, odorless respiratory secretions ' u ume - era n on ^ For Deficit ^ invasive line(s) insertion site(s) show no signs of inflammation -Vital signs stable (return to baseline) ~ ^ Other/Age Specific - Adequate fluid intake ^ Knowledge Deficft ^ For Excess D Verbalizes understanding of disease process, treatment -Lung sounds clear (return to baseline) + regimen and/or medications -Absence of Edema (return to baseline) ^ Verbalizes understanding of surgery -Weight loss (return to base line) i ^ Other/Age Specific -Balanced I/O D Psvchofogical or Spiritual Distress: Anxiety/Denial/Fear/ ^ Alteration in Metabolic Status R/T: Diabetes/Renal Failure! Loneliness/Powerlessness/Sensory Deprivation (includes Surgical Other /Fear ^ Patient is free of injury ]Appears Less anxious and is less dependent D Patient weight stabilized to baseline D Asks reality-oriented questions ^ Electrolytes in normal range for patient ~ ^ Uses effective coping mechanisms or verbalizes need for D Heart breath sounds wnl for patient i additional help ^ Other p D Identifies area of conflict/ambivalence in faith due to ^ situation ^ ^ Alteration in CV Function R/T: ^ 1 C.O./Hypertension/Cardiac Dysrhythmia/ ^ Age Specific Fluid volume overload _ deficit / ~ Interventions Myocardiallschemia D Hemodynamic stability ^ C.O. stable or improved. ^ Vital Signs and U stable O P =Priority R =Reviewed by D/C =Discontinued Res =Resolved . . ^ Able to perform ADLs Reference: Mosby Patient Care Standards Manual Plan of Care Discussed with Patient/S.O. 1. Educational Needs snit Sign ure ,~" 1.Orientation to Room/Hospital 4. IV Therapy ^NA 7. Medications =» i 2. Plan of Care 5. Discharge Planning 8. '' ~ 3. Pain 6. Diagnosis 9. II. Initial and On pin Barriers to Learnin 111. Initial and On pin Instruction Barrier? Method of Person Eval Date Y N Comments To is # Instruction Tau ht Comments ~ 5'' Initi s ~4'C ~ ' ? ' = ~/ , • 1 2~.. ' 4 DISC -~ ~% ~ ~ Refer to "Patient Teaching upon Admission" Sheet ; v Barriers to Learning: Barriers include any condition that decreases the patient's and/or family's rereotiveness to leamina fhlindness daafiesa tnnnitiva tiafirit mnfilcinn !t?C~P.ACPIt I nc anxiety, pain, desire to learn, age, cultural or language barriers, luopsychosocial limitations, etc.) Method of Instruction Codes: V = Video; B =Book(let); TS =Teaching Sheet; D =Demo; Disc =Discussion Examples: V = "Giving Insulin Injections" or B = "Carbohydrate Counting" or TS = "Crutchwalking" or D = "Insulin Injection" Evaluation Codes: P = Proficient/no further instruction needed; R = ReinforcementlReview Needed; 0 =Needs Outpatient F/U ASPER, MAUREEN E Acct#(5008063 MR~0001044167 0812012005 HARDESTY, JAME OOB:0713111942 063 F CARLISLE REGIDNAL MEDICAL CTR 11111Iil111111lllllllllllllllllllllllllllllll oo12-A 11 I DATE: _` iT3._ / / it i i.., .f i in., .~Li G7 ~ 7 -2 ,' i ,~- ~~~ Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: TPP EYES OPEN r 1 ~7~ ' } ; Awake, alert, oriented to c9 Speech lucid, cooperative, calm; BEST VERBAL MOTd ~ moving all extremities equally well. R - ' ~ Responds to verbal stimuli. EXT. MOVEMENT-ARM w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R L I ~ /~ z ^ Combative ^ Anxious ^ Uncooperative R ' - ' ^ Depressed ^ Withdrawn ^ Other PUPIL mm /reaction k ~ ~ ,e neic at Rest s Res : ^D ^ Wi N it y p p. s: espirations unlabor ^Dyspneic on Exertion Bilateral chest excursion; ^ Retractions ^ Other Bence of coup cretions; Cou h: ^ Productive ^ Nonproductive ~ g Bilateral breath sounds clear. ^ Other Chest Symmetrical symmetrical Sputum: ^ White ^ Yellow Q ath Sounds: ^ Loose Tenacious Br ~° tY e 1 -clear CtT6t-her , G~ ` J a "1 "I 2 -diminished CT: Location w 3 -rates ^ Suction cm ~ 4 - rhonchi ^ Gravity drainage wh ez s 5 - e e Drainage characteristics 6 - bronchial 7 -absent qir leak ^ Yes ^ No L -- ~fC Crepitus ^ Yes ^ No ^ Limits: AP: ^ Irregular ^ Distant , ~ Apical rate regular; ^ Murmur ^ Other ~ Peripheral es 2+/3; Cap N orma capillary fill; Refill: ^ Bris~ Delayed Absence of er edema; Heart Rhythm: > if li bl ,IV's and centra Heart Sounds: S4 S3 ircle) ~ Edema: Location: f well sin I e nd inf t , g n e a u s pa ~ with absence of infiltrates/ - Degree + ^ 2+ ^ 3+ _ Q itti ^N ^ Pitti - U on ng p ng S&S infection. .-~- ~ t ~L~~ (1+ = 114 in.; 2+ = 112 in.; 3+ = 1 in.) ^ W' rural Limits: ~ Abdomen: ^ Distended ^ Firm `- Abdom n o ,non-distended; ^ Tender ^ Other a uads owe soun s pre ; Bowel ^ Hypoactive Absence of NN, bowel andlor bladder Sounds: ^ Hyperactive Absent ,,. ~ incontinence Tubes^ NGT ^ OGT ^ Gtube ^ Jtube c7 ^ Colostomy ^ Other Type: Patent ^ Yes ^ No - ^ Ileostomy ~/ Suction Type Foley Patent L7 YeV ^ No ~~~f f=i-~I, ~r ~ ~ J y `I G' ra`~ns'g~e Draina e i`~p~~ . g , ^ W Skin: ^ Pale ^ Dry ^ Flushed ^ Cool ~ in warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash i F- normal s <In urgor; ^ E otic ^ Jaundiced ^ Other h w ym cc ~ skin integrity alterations Location - ~ Wound # 1 I cision ^ her Wound #2 Incision ^ Other ~ ~~' ~ ~- 1 ~ Location ~ ,~~ / z Location Dressing ^ Dry Inta t ^ Oth r Dressing ry ntact ^ Other Drainage chara. , Drainage chara. Braden Scale Score ~ Provisions for Safe Environment: Restraints in use N ^ Y'see restraint flow sheet ~ ~ ' ~ ;/r~ Restraints ap Ip ie~.{~roperly ^ Y - " ~ ~ ~'FJ band on. ~ Fal! Risk: ^ Y 1 - ~~~ INITIALS GNATUREITITLE INITIALS SIGNATURElTITLE INITIALS SIGNATURElrITLE / ~ ASPER, MAl1REEN E • AcctN5008063 MR~00010006 07j3 089401 X803 f ~'4ROESTY, JAME 1111111111{IIIIIIIIIIIIIIIIIIIfIInIIIIIIIIifL cTR oot2-A i~ DATE: ~_ ~ 0~ i Addressograph ' TIME ADDITIONAL ASSESSMENT DA ^ Within Normal Limits: TPP d t i EYES OPEN ~ '/` ~` ~ j~~;j/ .- c9 ; o ente Awake, alert, or Speech lucid, cooperative, calm; BEST VERBAL MOTOR >'if ~ ,~2~ f ~~ -----~~-' ~ O~ moving all extremities equally well. Responds to verbal stimuli. EXT. MOVEMENT-ARM R . L ~ ~LG /; -' Cl ~:,~~- - (~ i %~ 1-~~-1 w Z Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R % L/ `~''~; , ~ . ~; ~ `.L. / .. ~-- ~ ~, ^ Combative ^ Anxious ^ Uncooperative ti U IL / ~ L , ~ / • ^ Depressed ^ Withdrawn ^ Other on reac mm P P - . j ~ G - - /,. `~ ~~ t~ t ` ~t 'F ~~(~ ~ Crtr L~ ) ~C~E~ 112 : ^Dyspneic at Rest ma! Limits: Res ^ Withi N ' i, . ` . y ~ • p. or n irations unlabored; ^Dyspneic on Exertion Res }~ ~~ ( ~jl ',~-(~j ~ -~(~ ; ~ p , _ , , . , Bilateral chest excursion; ^ Retractions ^ Other y~ ~) 1B2S ~ ~ ~~ ~k ~ Absence of cough and secretions; Cou h: ^ Productive ^ Nonproductive G 1 V~' ' g Bilateral breath sounds clear. ^ Other L>LP'n'k' p P6r1 ~ Q~C ~ t'Y'tC'G"~ ~~~ j } t o Chest S mmetrical / As mmetrical S utum: ^ White ^ Yellow v v p ll )i1~ l kU ~'U(~6U 'L' ~t F- Breath Sounds: ^ Loose ^ Tenacious . , I 4 ilYIC G ~ 1 -clear ^ Other y, { ~~ l'~Il'vl;~" ~'i ~~, (;~ • ;~ ~ ,~ ~~ a 2 -diminished CT: Location N 3 -rates ~ ^ Suction cm ~, •a y,,.~ . I 1 ~Nv ~~L Jfi -~ (•"I I U 1.4~ ~tC~ 4 - rhonchi ^ Gravity drainage 5-wheezes ~ ~i"'~- (~r(.~YI(, ~ ~~r"tNlq u I ~ Drainage characteristics 6 - bronchial / ~^ '' 'ul (~ 71~1k4~u . Uv 7 -absent R L Air leak ^ Yes ^ No },~ " ~~.~~ , ~, ~I/1,t, ~~~1-'Q Rr ~. ~ Crepitus ^ Yes ^ No ~ ~ ^ Within Normal Limits: AP: ^ Irregular ^ Distant (~1.7 1l~ }~r'~ ,~~~;~~c~ Z .fi t Apical rate regular; ^ Murmur ^ Other (~,,n~ , l ' ~ ' ~~ ~ ~~ kQ ~ `~ ~ - Peripheral pulses 2+/3; Cap '[ 4 . ~ r .(, i ~l~- ! V ~ ~J v Normal capillary fill; Refill: ^ Brisk ^ Delayed r,' U~ ~, r ^ Yl~~~~~' ~ ~ ~~ ~ ~ Q Absence of peripheral edema; Hean: Rhythm: - - ~ ~ ~ a ~( U - ~• > if a livable, IV's and central Heart Sounds: S4 1 S3 (Circle) p ff ~ ~~ ~ ~;.Q.E'~ ~ ~r ~~~\~ ~ ~ ~ Edema: Location: atent and infusing well lines l ' ` `" '`;~' L ~ v"' Q , p with absence of infiltrates/ Degree ^ 1+ ..0"2+ ^ 3+ ~. ~~ ~ `y~ ~ ~ ~~ ~~~fi ittin ^ Pitti ^Non- ' ""` v g p ng S&S infection. (1+ = 1/4 in.; 2+ = 112 in.; 3+ = 1 in.) ,~",' ~ ~~ }i`J . U r V/~,f~~ (r1 ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm ~ ~ti /~ ` ~ ~~~ ~ ` ~~' ~ Abdomen soft, non-distended; ^ Tender ^ Other ~ ,~u~ ,~, V ~ ~~,! uads; Bowel sounds resent in all q p Bowel ^ Hypoactive ~ ,~ E ff~ -r ~ ~ ` // ~ ~ Absence of NN, bowel and/or bladder Sounds: ^ Hyperactive^ Absent ', • t l~~f .~ ~~. l`/ [ ' . ~ incontinence Tubes^ NGT ^ OGT i ^ Gtube ^ Jtube ~ ^ Colostomy ^ Other7ype: Patent^ Yes ^ No ^ Ileostomy Suction Type Foley Patent .Yes Q Np Drainage C ` G'~~ Drainage ^ Within Normal Limits: Skin: ^ Pale ^ Dry ^ Flushed ^ Cool ~ Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash Z normal skin turgor; Absence of ^ Ecch motic ^ Jaundiced ^ Other w y skin integrity alterations Location ~ C7 Wound #2 ^ Incision ^ Other Wound # 1 ^ I c' ion ^ Other Location w ~,z~ ti ~- L //t ~ ~ z on oca ~/~ %,~ Dressing ^ Dry ^ Intact ^ Other ~! Intact ^ Other Dressing ^'bry .. Drainage chara. Drainage chara. Braden Scale Score C~Provisions for Safe Environment: Restraints in use ^ N ^Y'see restraint flow sheet Call bell and phone within reach; Restraints applied properly ^ Y ~ ID band on. Fall Risk; ^ N ^ Y INITd S rSIGNATUR' TITLE INITIALS GNATURE/TITLE I S INITIALS SIGNATUREFfITLE r• rG I ~~ ~~ (~il~Uli~1 ~~ ASPER, MAUREEN E ~ ~_~~. _ AcctN5008063 MRt{0001044167 0312012005 _ HARDESTY, JAME D06:07~3111942 063 F CARLISLE REGIIIIIONAL MEDICAIIL CTR (~~~~~~ ~~~~~ ~~+~~ ~~~~f i~l~~ ~~~~~ «l~~ ~~~~ ~~~1 00 i 2-A I1 DATE: Icos~o Addressogreph TIME ADDITIONAL ASSESSMENT DATA ^ Within Norma! Limits: EYES OPEN / ~~ ~ ~'~ ~ ` n 'A ' ~' = } Awake, alert, oriented to TPP; ~ / 0 Speech lucid, cooperative, calm; BEST VERBAL MOTOR r% j ! ' " /lG '~~ moving all extremities e uall well y j ~ j q y . Responds to verbal stimuli. EXT. MOVEMENT-ARM Rf L: / '~"<~% ' ;! ' ' - ~ ~ ~ ~ ~u Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R ~ Lt,~ ;' ~ , . / ~ ; ~ Z ^ Combative ^ Anxious ^ Uncoo erative p ^ Depressed ^ Withdrawn ^ Other PUPIL mm !reaction ~ LL ' G ~ .~ • ~, ~ ' ,~~/~~' ^ Within Normal Limits: Resp.: ^Dyspneic at Rest ~~3- ~L` .. Z` ~ ' ~ 1 Respirations unlabored; ^Dyspneic on Exertion ' ~ ~~ ~ 4 s "' ,.., r r ~ i ~ ~ ~~ - ~ Bilateral chest excursion; ^ R tr ti ^ Oth ~ ~ ` ~ ' L e ac ons er ' ~ ~ Absence of cough and secretions; Cough: ^ Productive ^ Nonproductive ~ r / r / /l ~ ' /~~ ~7 J ~ Bilateral breath sounds clear. ^ Other . s ,?~ , .r ~ ' ~ Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow ~ ~ ,.;- ~ ;~ ~ a Breath Sounds: ^ Loose ^ Tenacious • ~ ~ T E . -' ,JiI L' IY 1 -clear ^ Other j < <-! -, ~ ,• ,,,~ Z -diminished ~ ~ CT: Location 3 -rates ,/; ^ Suction cm : .-~ - %' "'' ~--~~~ ~ L.,/~~ ~ ~ `~~' ~ r' S -wheezes ^ Gravity drainage Draina e characteristics D, ~~'^G ' , .7 ~ ~ i,, , ;. ~~ ` ~~~, ' ~r ~ 1 g r 6 - bronchial ~, _ ,i' ~~ ~, 7 -absent / i ' R L Air leak ^ Yes ^ No Crepitus ^ Yes ^ No . ---- ' " ~? ~" ~.~;'- ~~~ `~~~~ J ~~ lv ~~-~ Within Normal Limits: AP: ^ Irregular ^ Distant A ical rate l ^ M ~ p regu ar; urmur ^ Other Peripheral pulses 2+/3; Cap ~ Normal capillary fill; Refill: ^ Brisk ^ Delayed y Absence of peripheral edema; Heart Rhythm: S ^ ~ I ~ if applicable, 1V's and central Heart Sounds: S4 53 (Circle) o lines patent and infusing well, Edema: Location: Q with absence of infiltrates/ Degree ^ 1+ 2+ ^ 3+ v S&S infection. ^ Pitting ^Non-pitting (1+ = 1/4 in.; 2+ = 1/2 in.; 3+ = 1 in.) ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm Abdomen soft, non:distended; ^ Tender ^ Other Bowel sounds present in all quads; gOWel 'H oactive ~ C9 yp Absence of NN, bowel and/or bladder Sounds: ^ Hyperactive^ Absent incontinence Tubes^ NGT ~OGT ^ Gtube ^ Jtube ^ Colostomy ^ Other Type: Patent ^ Yes ^ No ~~ ^ Ileostomy Suction Type C~,l~~/ ' t;~ t: i I j Foley Patent Jd'Yes No D i ~ ' / ra nage ~i ~~,ll( y~y,~ Drainage ^ Within Norma! Limits: Skin: ^ Pale ^ Dry ^ Flushed ^ Cool Skin warm nd d l l ~ a ry; co or norma ; ^ Diaphoretic ^ Cyanotic ^ Rash w normal skin turgor; Absence of ^ Ecchymotic ^ Jaundiced ^ Other ~ skin integrity alterations Location ~ ~ Wound #2 ^ lncision ^ Other w Wound # i Q Incision ^ Other t- Location Location~,6iY~ ~? D ? ressing ^ Dry ^ Intact ^ Other Dressing D~ntact ^ Other Drainage there. D ~ " E rainage chara.~ %~ • Braden Scale Score } ~ C~'Provisions for Safe Environment: Restraints in use ^ N ^ Y`see restraint flow sheet Call bell and phone within reach; Restraints applied properly ^ Y ~ ID b d an on. Fall Risk: ^ N ^ Y ~ INI S NATURE/T E 1NITIALS SIGNATURElTITLE INITIALS SIGNATURE/TITLE S b-, -1'•w Sr .. ~ .r PUPIL REACTION EXTREMITY MOVEMENT ± SLUGGISH +1 +2 +3 +4 + REACTIVE PUPILS (mm) 3 . 4 • - NON-REACTI VE 2 • • 5. • • 7 • B COMA SCALE CODE RESPONSE 1 Z 3 Q 5 6 EYES NEVER TO TO SPONTA- OPEN PAIN SOUND NEOUS INCOMP. INAPPRO- CON- FUSED ORI- VERBAL NONE SOUNDS PRIATE CONVER- ENTED WORDS SATION FLEXION FLEX. LOCAL- OBEYS MOTOR NONE EXTEN- SIGN ABNOR WTH^ IZES COM- DRAW PAIN MANDS ASPER, MAUREEN E Acct/15008063 MR~0001044167 08120J2005 HARDEST'f, JAME D0B:0713111942 063 F CARLISLE REGIOfJAL MEDICAL CTR IIIIIIIIIIIIIII((II(If IIIIIIIIINIIINIIIIIII oolz-A I1 SEDATION: 0 =NOME (Alert) 1 =MILD (Occasionally Drowsy; Easy IoArouse) 7-M~~ERATE fOffen Drowsv Easv7oArouse) 3=SEVERE (Somnolent: Difficult 7o Arouse) 4=SLEEP (Normal Sleep) PAIN MANAGEMENT Inte~ entionr (M)eT to (P}osition change (R)elaxation technique _ Pt states Pain controlled: (time/level) Epidural pain/sedation Epidural Site ,/ 1 Initials: BODY SECRETION CODES Location: Pain Level COLOR: G-GREEN, Y-YELLOW, T-TAN, BL-BLACK, WH-WHITE, MA-MAROON, R-RED, DY-DARK YELLOW LIGHTYELLOW T Y W Scale Used: , , • RA , L CG-COFFEE GROUND, ST•S lA-LIGHT AMBER, DA-DARK AMBER, TE-TEA, CR-CRANBERRY, P-PINK, Intervention: BO-BLOODY, DR-DARK RED,RU-RUBA,SE-SEROSA T OTS Pt states Pain controlled: (time level) -C , APPEARANCE: TH-THICH. FR-FROTHY, C-CLEAR, M-MUCOSY, CL-CLOUDY, C 5-SEDIMENT, SD-SEEDY, FL-FLECKS, T-TARRY Epidural pain/sedation Epidural Site / AR GE • SC-SCANT, S-SMALL, M-yMORATE, L-L ~ / / ~%~ j~C ~~~1 ` `'~~"'"l ~ Initials: TIME DATE ADDITIONAL NURSES NOTES 4 ) -~ - Jlf~' v _ r ,~ 9 \_ r - . ,.., ~ r ,. . , ~, l ~ -~ ,J' .G G ~~ ~ / ~//yJ/~ I ~~~~~ / '` a. ~ / I ~./_ L f / i ~ ~~ ~ ~ ~ ' ~ /~ ~ ~ L~' - ~ 7 - .i- ~• C 30 ,( C~ ~ ~ r ~ ~ / - r:1/' - ~ X J n' ., ~l~I.~/1,.,,.. ~ // .~ ~. .JaTL/~f~(ll,> _ , ~~: ~'V C~--~ /1 1 /i~i'~.'- ,ressograph SPER, h4AUREEN E Acct~6008063 MR~0001 ODDB 0713 oSg40106C3 F tIARDESTY, DAME Iliillltllllllllllll(Il1111liillilli111111111LC7R Do~z-A!~ D E N IET: °k TAKEN B-L-D ~';, ul / PM CARE ~ ~ RAL CARE DLEY CATHETER CARE "~ KIN CARE ~ ITE BLOCK CHANGE / RACH CARE JNER CANNULA CHANGE URN s>~7i -/~'~ ~, L" ;PORT BED ROTATION :OM )OB CHAIR / BSC ,MBULATE SIDE RAILS UP # ~ ~ ~ 3ED POSITION LOW :ALL BELL IN REACH iCD'S -PRESSURE `~ TEMP - 25( 24C 23C 22C 21C - 20C 19C 180 170 160 - 150 140 130 1zo 110 - 100 90 80 70 60 • 50 4D 30 20 10 RESP. Oi I.C.U. Flow Sheet CARIxSLE s p x REGIONAL M E D I C A k- C•~E N T E R ~ r ,- PULSE ~ DATE: ~ ~ ~ .. `' ~ . IC 0610 (06!04) ruu 0U 1200 1 nn Hann Hann ~nnn AxYln _! I I I ! ~~nn 1A/1h MEAN ARTERIAL PRESSURE G CENTRAL VENOUS PRESSURE { / ~! PAP (SYS/DIAS) PCWP CARDIAC OUTPUT/CARDIAC INDEX SYSTEMIC VASCULAR RESISTANCE HEMODYNAMIC WAVEFORM WNL l SQUARE WAVE TEST SWAN GANZ PLACEMENT-EXTERNAL CATHETER LENGTH Actual Tidal Volume Time (~ a Set Rate (SIMV, AC) pH j . ~i ' • ? L~ ~ FIO2 pcoz I :; ~ ~ , , 3 "G1~ ~ PEEP p02 j ~, ~ 7Lj/ ~L' n t 4~ . tZ CPAP 02sat ~,.` y,;~, } Ps Hco3 ~,~ 3, - , .J ~. ~ ETT Size Position 8E ~' ~ • r 'LACY _`' /1 N ~' G' 2c"' s ~~7 %• Y t~5' ` Cols i ~ i~< f~ /~° iG' ~1 f z i~S~ -v /a 'o ~~ .i j4 L ~' .~ Tube feed ~~•~.: j ~ 3~[, S /~ ' C` ~ G ~ ~ Oral F, Urin ~~, (-i ~.; Cumulative Total t" ~ ~ r.i. C+ ~;~. ASPER, PJIAUREEN E Acc1~5008063 MR~'0001044167 081202005 HARDESTY, DAME DDB;D7131 J]942 063 F ISLE RE610NAL MEDICAL CTR ~~~~i~~~I(lIIIII(IIII(IIIIIIIIIIIIIIIIIIIIIII oo]z~A 11 1600 1700 1800 1900 DATE: _ . . _ 2000 2100 2200 2300 2400 0100 Satten GRf: CcNin ARC CcH7.... eor_ ceK~.,,. _ ~ / / _ ~ fl~^ ~ ~ =~ ~~ v , . '~ .- 3 . /: c ~ ~ [ r t ~~~/ i=l~ ~G~ /~. ~ ~ "' ~ c ~ ,i ASPER, MAU,gEEN E Acci#l50CBOE3 MR#{0001044'67 08120(2005 tip QTY, JAME 000:07/3;(1942 063 F CA,...,~E RC&IONAL MEDICAL CTR 11'!(li~'11111111l1111119111111(111f 1(1111'1 oo12-A 11 0300 0400 OSOU 0600 AC(i 250 240 23D 220 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 60 5D 40 30 20 10 Urine aG~ ~~~ NG Stool k'' ;.~: 3e ~U f.. F- O 1 TOTAL ~ 3''C/ ~- 3 s (,, tl Cumulative TOTAL: Adm. Wt. Yest. Wt. Today's Wt. ~C . ~ ,~. ;t'# `' ti DATE: ASPER, MAUREEN E t115008063 MI?~0001044167 08f20(2005 ..,,riDESTY, JAI1iE DOB:07f31f 1942 063 F CARLISLE REGIONAL MEDICAL CTR Illllllllllllllllllllllllllllllllllllllllllll OD12•A I1 Select the appropriate problem(s) and expected outcomes: Impaired ohysical mobility: weakness/paralysis/self-care deficft ~ Maintains full joint ROM and strength 'L7 Able to perform ADL's ^ No evidence of complications, such as contracture or skin breakdown ^ Other/Age Specific ^ Impaired skin and/or tissue inte rite !potential for} ^ Absence of reddened areas ^ Skin remains intact ^ Other/Age Speck ~nfection: Invasive lines. catheter. pneumonia. trauma, surgical wound otential for Patient is free from infection ^ Clear, odorless respiratory secretions ^ Invasive line(s) insertion sites} show no signs of inflammation ^ Other/Age Specific ^ Knowledge Deficit ^ Verbalizes understanding of disease process, treatment regimen and/or medications ^ Verbalizes understanding of surgery ^ Other/Age Speck ^ Psychological or Spiritual Distress• Anxiety/Denial/Pearl Loneliness/Powerlessness/Sensory Deprivation includes Surgical ~ ~ Fear ~ Appears less anxious and is less dependent ^ Asks reality-oriented questions ^ Uses effective coping mechanisms or verbalizes need for additional help ^ Identifies area of conflict ambivalence in faith due to situation ^ Alteration in CV Function RR: .l C.O./Hypertension/Cardiac Dysrhythmia/ Fluid volume overload _ deficit / Myocardial fschemia ^ Hemodynamic stability ^ C.O. stable or improved ^ Vital Signs and U.O. stable ^ Able to perform ADLs Plan of Care Discussed with PatienUS.O. ~-Interventions D/C =Discontinued Res =Resolved Reference: MosbkPatient Care Standards Manual Educational Needs 1.Orientation to RoomlNospital 2. Plan of Care 3. Pain - II. Initial and Ongoing Barriers to Learnt Barrier? Date Y N I Comments 4. IV Therapy ^NA 7. Medications 5. Discharge Planning 8. 6. Diagnosis 9. ini Sigtt' re ~ III. Initial and Ongoing Instructior Method of Person Tonic # Instruction Taught Comments Eval ~~ _ ~,~'~:C~ ~ G; ~ ~,~; :/„~,:, ~ ~ 1, 2, 3, 4' DISC ~y~;/~,(> ~ Refer to "Patient Teaching upon Admission" Sheet) f ~~ Barriers to Learning: Barriers include any condition that decreases the patient's and/or family's receptiveness to teaming (blindness, deafness, cognitive deficit, confusion, decreased LOC, anxiety, pain, desire to learn, age, cultural or language barriers, biopsychosocial limitations, etc.) Method of Instruction Codes: V =Video; 8 =Book(let); TS =Teaching Sheet; D =Demo; Disc =Discussion Examples: V = "Giving Insulin Injections" or B = "Carbohydrate Counting" or TS = "Crutchwalking' or D = "Insulin Injection' Evaluation Codes: P = ProticienUno further instruction needed; R = ReinforcemenUReview Needed; 0 =Needs Outpatient FIU ^ Restraints and/or Seclu rs on ^ Redirection/Diversion/Other measures attempted ^ Remains free of injury ^ Patientlfamiiy verbalizes understanding ^ Other ^ Alteration in Comfort: Pain ^ Defines pain on age-appropriate scale ^ Verbalizes/ indicates behaviorally relief of pain ^ Other/Age Specific ^ At Risk for Falls/Iniurv ^ Remains free from injury ^ Factors of risk are eliminated ^ Other/Age Specific Patient is free of injury Patient weight stabilized to baseline ^ Electrolytes in normal range for patient ^ HearUbreath sounds wnl for patient ^ Nutritional Status (Nutritional ManuaC ^ _ ^ ^ Other Age Specific _ ja Impaired Gas Exchange/Ineffective Airway Clearance (potential fob Maintains patent airway Maintains oxygen saturation >9t)°~ Expresses feeling of comfort in maintaining air exchange ^ Clear bilateral breath sounds ^ Other/Age Specific ^ Fluid Volume -Alteration in ^ For Deficit - Vital signs stable (return to baseline) - Adequate fluid intake ^ For Excess -Lung sounds clear (return to baseline) -Absence of Edema (return to baseline) - Weight loss (return to base line} -Balanced I/O Alteration in Metabolic Status RlT: Diabetes/Renal Failures ^ Other ^ Age Specific- ASPER, UTAUREEN E Acct/15008063 haR~0001044167 0812012005 HARDESTY, JAME DOB:07f31l1942 063 F CARLISLE REGIONAL MECICAL CTR I(III(I(~fIIIIIIIIilllilllliilillilllllllill Dote-A 11 DATE: :~ ~- _ _~ ~ §~~ Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN ~ ~ ~lv / SL'' '~ ~~l ~ l2"^~ "'!• ~ Awake alert oriented to TPP; / +-~;• } ~ , , Speech lucid, cooperative, calm; movin all extremiti u ll ell s BEST VERBAL MOTOR ~ f _ ,~ ~ ~~ 2, f ;~ ~ Ut/-!? `+ t `- / ~/ ~ g y w . e eq a R d t b ti li l EXT MOVEMENT ARM R L j ~ ~ ' ~ it espon s o ver a . s mu . - ~ j j~-- j f /~ Li c ~ v c = ~ ~/ w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R L ~~ ~ //, ._ ~' / ~ ' ~ ( Z ^ Combative ^ Anxious ^ Uncoo rative ` ~ 7 c. Lt ~~ (. _ ! pe ^ Depressed ^ Withdrawn ^ Other PUPIL mm /reaction ~ ~ L ~ ~ ~ ?, fiat -- ~ _~ ~ ;;,~ ~ - ^ Within Normal Limits: Resp.: ^Dyspneic at Rest ~/ ~~ -~ -' Respirations unlabored; ^Dyspneic on Exertion Bilateral che t cu i ^ R t ti ^ Oth // ~ ~ f'' ~ yi ` ~'~~ ~i S s ex rs on; rac ons er e b f ,n ~ sence o A cough and secretions; Cough: ^ Productive ^ Nonproductive "v~'" "2c - / y. /~~ 't- ~ Bilateral breath sounds clear. ^ Other ~.! •-/~~~ S ~ ~ ! rC, . ~ F- Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow Breath Sounds: ^ Loose ^ Tenacious ~- /~ ~ ~~1 vt~~' - ~ G ~~I L~ ~ i 1 -clear ^ Other c 2 -diminish d ~~ ~ ~ y` . 1~'I~ I,, ~~,~ ~ ,~•,•,/ N t e j ' ~ CT: Location -%?~ / , ~ ' C~ Suction U cm ( `` '' S "v -"" ~ %'r~'' ~ j 4 - rhonchi ~ ^ Gravity drainage D i t ti h i ~ ,~ ~ S L , „ ~' ' ra nage c arac er s cs 6 - bhon h al ~~ / ~ - 7 -absent /Y~' f U'~ ' ` J I~ L / , Air leak C~ Yes ^ No . ~ it -Y ^ N ~ Cr ` ~ ,~ ~ Z ~~ ~/ ep us ~ es o h ~ ~.' / . K [[[ ~/ / r ~ ;~ , L ,~ '~ Wit in Normal Limits: AP: ,~ Irregular ^ Distant J G~ ~ .{- .,, / k /y~, l~ - ra i A l ^ c , r a p ca rate regular; ^ Murmur ^ Other i ( r ~ Per pheral pulses 2+/3; Cap x. , ~ ~ ~ / ct ~ ~ v Normal capillary fill; Refill: ^ Brisk ^ Delayed Absence of peripheral edema; Heart Rhythm: '' J ~-+~~~~s~ ~,y,- j ~ ~ . `~' L ~ci % G„ ~- ~-G ~ ~, O if applicable, IV's and central Heart Sounds: S4 (;~1- S3 ((;iFcle) ~ < ~ ` ~~ / ~ > ~ "' o 2 lines patent and infusing well, Edema: Location: ~~' c '1 _ `- t-f /(.f ~ ~ ~ x with absence of infiltrates/ Degree ^ 1+ ~+ ^ 3+ 5&S infection. L~Pitting ^Non-pitting ~, ~ ~' ~ ~ h v (1+ = 1/4 in.; 2+ = 1/2 in.; 3+ = 1 in.) ~' f n /yti ,iYYl~.f.11/ ^ Within Normat Limits: Abdomen: ^ Distended ^ Firm ~~ ~ -7- .1-_."/'• ! , v+ .~'~'l" c= l/,. G 4 ~ (--5 Abdomen soft, non-distended; ^ Tender ^ Other Bowel sounds present in all quads; Bowel ~ H a tiv `' ~ ~ r"' 7'"~ / '~~ ~c ~2/~ ypo c e ~ Absence of NN, bowel and/or bladder Sounds: ^ Hyperactive^ Absent /~ ~ ~ ~ ~`~- ~. ~ ~,~ '- ~'' c9 incontinence Tubes^ NGT ^ OGT fat ~ ^ Gtube ^ Jtube ~ ^ Colostomy ^ Other Type: Patent^ Yes ^ No / '~ 5 c ~1c~ ^ Ileostomy Suction T e yp Foley Patent ®Yes ^ No Ar / j /~/I ~ ,fir ~ / ` ~ ! ` Drainage ,- Draina e /~L / ,~ ~^'~/ g ' L' •!q I ^ Within Normal Limits: Skin: ~ Pale ^ Dry C±~Flushed ^ Cool Ski d n warm an dry; color normal; ^ Dia hor ti ^ C ti ^ R h ~ Z p c e yano c as normal skin turgor; Absence of qq --l~Ecch motic ^ Jaundiced ^ Other y ~ skin integrity alterations 7'y.~J• Location Wound #2 ^ clslon ^ Oth ~ w ~ _ Wound # 1 ^ I ci io ^ Other ~ ~.~ Location ~ •2'tc ~~ -/)~r~~i , Location c '~~ ? Dressin ~D Dressing (Dry, f~,kitact ^ Other g rY l~ Intact Other ' / Drainage chars. S ' G / ''~ •-f 7 • l r/ •.%;~-~ . Drainage c ara. Braden Scale Score ®Provisions for Safe Environment: Restraints in use l~N ^ Y'see restraint flow sheet ~ Call bell and phone within reach; Restraints applied properly OY ` i ID band on. Fall Risk: ~ N ^ Y v INITIALS SIGNATURElTITLE INITIALS SIGNATURE/TITLE INITIALS SIGNATURE/TITLE ASPER, h~AUREEN E Acct1l5008063 MRff00010441u7 0812012005 HARDESTY, JAME 0013:D713111942 063 F CARLISLE REGIONAL MEDICAL CTR 111111111111111111111111111111111111111111lI1 Do12-A 11 DATE: ~ ~ `~ ~: ', '~, Addressograph I TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: EYES OPEN /CG'' ;' v / <..~ << ~(~ IG' G ' o r Awake, alert, oriented to TPP; S eech lucid, coo erative, calm; P P BEST VERBAL MOTOR '7'f ~ ~ 7 % ` ~'; ° ~l I l~ ' ' .% ~~~ ~ O moving all extremities equally well. Responds to verbal stimuli. EXT. MOVEMENT-ARM R ~ L ' , ~.-, ~,~~ (~i^,/~~+ - ~ w Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R ~ y ~ ;,~~; ~~ : ,r. ~:' ~ ' ~.^,1~-' Z ^ Combative ^ Anxious ^ Uncooperative ^Depressed ^ Withdrawn ^ Other PUPIL mm 1 reaction R, L ,< JC`'I ./ '- /C/~ ` y~j - Li(~ / ' /~~~ '~5 neic at Rest s Res : ^D i l Li ~~' ~ ~ ~ ~ / ~ C ! ~/ ~• y p p. ^ Within Norma m ts: rti i E - ' ~ ~ ~ ~! on c on xe Respirations unlabored; ^Dyspne G ~ `'~~ ~~ '~s- (i~5 ~' Bilateral chest excursion; ^ Retractions ~ Other '_ " /G ~ ` ~ Absence of cough and secretions; Cou h: ^ Productive ^ Nonproductive ~ v l C - l ` - :: • ~ ~ g Bilateral breath sounds clear. ^ Other ~ ~`,~'.~~ 1~- ~ ~~~ >. ~ ~ Chest Symmetrical /Asymmetrical Sputum: ^ White ^ Yellow ^ Loose ^ Tenacious d B th S ' F- ~ oun s: rea 1 -clear ~ Other d~f1~ f ~T -JCS ' ' j f ~/ t Y,~... c~~'" ~!yZc' "- a ~ w ~ 2 -diminished CT: Locatio /~ ~! a-= 3 - ra les ~ ? I ~ Suction G cm ~ / ~ ~: ~ A.C'~ 5 ~(= c'% ~ :~ tit , c-- ~ '7 4 - rhonchi ^ Gravity drainage 5 h ~ ,~ ~. ~/J ~=~ ~~ o -w ~ eezes Drainage characteristics 6- bronchial :,~(-1 ~' /+~~ ~i!/.:f~c~ R L T -absent Air leak Yes ~ No ~, ~,>,,121 ~~.iy~~. l-; ~ Crepitus Yes ^ No ,~ ~ ,fib SC ~ ^ Within Normal Limits: AP: ^ Irregular ^ Distant 5.,~~ (r'~/A..~~ ~ y ~a Apical rate regular; ^ Murmur ^ Other ~ / / /p '~ ' ~`~ ~ ~ Peripheral pulses 2+/3; Cap ~-Y -c'~•+. ~ ~f C t ~ v Normal capillary fill; Refill: ^ Brisk ^ Delayed ~ Absence of peripheral edema; Heart Rhythm: J % "~" G. • ::{ ~L LiC S / ~~~ ~ y_ ~~ s !~'°Y if applicable, IV's and central Heart Sounds: S4 GS.1-, S3 (Circle) ~ ~'c /~ _ ~ ~ ~ O Edema: Location: ell f i t t d i li ~ S `' ~' " ~.r o , us ng w nes pa en an n r a with absence of infiltrates/ Degree ^ 1+ 2+ ^ 3+ itti ~ N ^ Pitti - '~" c (1 ~~ ~r ' t ~' U on-p ng ng S&S infection. (1+= 114 in.; 2+= 1!2 in.; 3+= 1 in.) ~ ~ ~~„„~ -~~` ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm Abdomen soft, non-distended; ^ Tender ^ Other uads t in ll B l d s presen a q owe soun ; Bowel ^ Hypoactive Absence of NN, bowel and/or bladder Sounds: ^ Hyperactive^ Absent ~ incontinence Tubes^ NGT ^ OGT ^ Gtube ^ Jtube ~ ^ Colostomy ^ Other Type: Patent ^ Yes ^ No // ' ~ GGfv ^ Ileostomy Suction Type ~t Foley Patent Yes ^ No Drainage C 4 ~J Drainage~,r/C',;i?Cl~:~(.~ ^ Within Normal Limits: Skin: ^ Pale ^ Dry Flushed ^ Cool Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash w normal skin turgor; Absence of ~,r Ecch motic ^ Jaundiced g Other y skin integrity alterations L cation c~ Wound #2 ^ Incision ^ Other Wound # 1 ^ Incision ^ Other Location F 7G '% " Location G :rI G Dressing ^ Dry ^ Intact ^ Other - ? Dressing yl~'Dry Intact ^ Other Drainage chara. Drainage chara. Braden Scale Score 'Provisions for Safe Environment: Restraints in use ^ N ^ Y*see restraint flow sheet LL Call bell and phone within reach; Restraints applied property ^ Y ~ ID band on. Fall Risk: ^ N ^ Y INI 5 SI~NATURE/~I LE INITIA LS SIGNATURE(TITL E INITIALS SIGNATURE/TITLE n / / ASPER, I~~AUREEN E Accti'1/50G8063 h1i1'GGC1CC4R10~l31oa94GlO6o F HARDESTY, JANiE ~ARLiSIE REGIONA! MEDICAL CTR .[lilllllllllllllllllllllllll;illlllllllilll oo12-All "" - fi r DATE: ;,~, ~ ~-= Fmk :-~ •f , i '~ IC0610 Addressograph TIME ADDITIONAL ASSESSMENT DATA ^ Within Normal Limits: l d t TPP k rt i t A EYES OPEN I ~ I~~J ~ ' ' . )~ 1Cjcif ~ ~ ,'j j !/ ' 7 ~ ~ rk1, y, en o ; wa e, a e , or e ~, GT_ C9 Speech lucid, cooperative, calm; BEST VERBAL MOTOR ~ f I ~ / ' 11C~ , ~~ ~/~ ~ moving all extremities equally well. R L! ' ~ Responds to verbal stimuli. EXT. MOVEMENT-ARM / j a ; ~'S ~' = / ,lX G" ° w Z Behaviors: ^ Restless ^ Confused EXT. MOVEMENT-LEG R ~ L/ ,~ - q ~ G`f~ ~~ ~!~~'~'~"~ .~ ~~ ^ Combative ^ Anxious ^ Uncooperative ti PUPI I ~ L~- ` • r'm : ^ Depressed ^ Withdrawn ^ Other reac on L mm - ~~ ~G i ~-, ,,~~,i~ ~~i~ ~~ : ^Dyspneic at Rest ^ Within Normal Limits: Resp ~ '~~~ vim''' ' f ~~~ ~ ~ ~/ . Respirations unlabored; ^Dyspneic on Exertion j/',~ ' • • ~ ~~C .. r , `~~7 ! Bilateral chest excursion; ^ Retractions ^ Other ~ ~f rig ~ ~- ~ L' ~ Absence of cough and secretions; Cough• ^ Productive ^ Nonproductive 7` ~/~ ~ /~~ ~ ~ ~" Bilateral breath sounds clear. ^ Other ~ V Z5 ~ ^ , Jr~ ~_ ~~'~ ~ /~/j~ / c, ~ Chest Symmetrical !Asymmetrical Sputum: ^ White ^ Yellow ~ .,/' ~ ~ Breath Sounds: ^ Loose ^ Tenacious _ ~ ~ ~' l ~~~ ~ '" ~~' ' ~% ~ 1 -clear ^ Other ~ y ,f n f' G t : -~ /• 1 ` ~ ; ~ , ` . - a a ,"' 2 -diminished CT: Locationr~lX('i/~i'r~% • ~ N w 3 -rates 7 r!7 Suction~•L~ cm ~~~ ~C` l ' %li% ' ~ ti V~' 4 - rhonchi 5 -wheezes ^ Gravity drainage . ; , _/ ~ ~ '~ , ° `L~ -f' ~~' Drainage characteristics 6 - bronchial •~~ l~s ~' ~ <+ ~', ~~J %GJ 7 -absent R L Air leak ~ Yes ^ No ., , ...: ,~ ~ ll,:s ~ ~ - ' :,r % / Crepitus ~ Yes ^ No ^ Within Normal Limits: AP: ^ Irregular ^ Distant i,o '.~ '", -~ ~~ - .' ' / J,,, -~ Apical rate regular; ^ Murmur ^ Other Peri herai ulses 2+/3; Ca P P P ________!•,= '' ''' ~% l ~• l /.! V Normal ca Illa fill; Refill: ^ Brisk Dela ed ,/ ~~ ~ ~~~ ! ~ ~ ~ Q Absence of peripheral edema; Heart Rhythm: •% ~ ~.. ' i!~ ,l % ' ~ r' 6 > if applicable, IV's and central Heart Sounds: S4 ~, 1 c S3 (Circle) ~., _ p ~ , / r 6~ ~ ~ , 'C Edema: Location: lines patent and infusing well ~ , r ~ with absence of infiltrates/ Degree ^ 1+ ^ Z+ ^ 3+ ~ ~.3C . ~ ~ ~ % ~~/ / • ittin ^ Pittin ^Non- f ti S&S i ~` v g p g n ec on. ~ (1+= 114 in.; 2+= 1/2 in.; 3+= 1 in.) ~) ~'~'~/~T ~ .~ F ~i • .~~ ~' ^ Within Normal Limits: Abdomen: ^ Distended ^ Firm ~ 2 I ~ ! ~ ` ~/'. ~'lIQ' • _ ~ ~ ~ Abdomen soft, non-distended; ^ Tender ^ Other l ~/5 v 4 >>l' ' ~~1,''~' ~ ~ ' . .• i?; L Bowel sounds present in all quads; ~ , ~ _ ~ , . ~ ,l " - Bowel ^ Hypoactive „ . - <~ ~ ~ ~ ' ' ' ~ Absence of N/V, bowel andlor bladder Sounds: ^ Hyper~~ctive^ Absent % .~~ /~~ , t7 incontinence Tubes^ NGT Q"OGT ^ Gtube ^ Jtube ~ ^ Colostomy ^ Other Type: Patent ^ Yes ^ No ~ Gy' ~~ ~ ~ ' ^ Ileostomy Suction Type ir ~/.~ ~~ Foley Patent, ,G~Y~s ^ No Drainages//l<i~i",~1G>y Drainag~~~~G9 _ ^ Within Normal Limits: Skin: ^ Pale Dry ^ Flushed ^ Cool ~ Skin warm and dry; color normal; ^ Diaphoretic ^ Cyanotic ^ Rash normal skin turgor; Absence of motic ^ Jaundiced ^ Other Ecch w ~ ~ y skin integrity alterations ocation ~ Wound # 1 Incision ^ Other Wound #2 ^ incision ^ Other Location W .•~` ,,, ~ ,, ti L ' ~ - I ? oca on ' - Dressing ^ Dry ^ Intact ^ Other Qintact ^ Other Dressin Dry , g Drainage chara. Drainage chara. Braden Scale Score H `Provisions for Safe Environment: Restraints in use ^ N ^ Y'see restraint flow sheet Q Call bell and phone within reach; Restraints applied properly ^ Y y ID band on. Fall Risk: ^ N ^ Y INIT S SI~NATUREITI INITIALS SIGNATURE/TITLE INITIALS SIGNATUREITITLE air' ~ ~` y.' NTIFAMILY D ~ARGE P(ANNtNe~ it HAR E iN TR . ,JN ~ Physician's instructions reviewed with Patient/Signficant Other, signed, copy given- ~ 1- ~iptions given. ~ Patient's own medications returned. - ~ i nt/Significant Other accurately restates all instructions- Does not request any further Health Ed. ~ lrtshvcted to call Physician/Hospilal if any problemslquestions deveiop- HSCHARGED: Date /Time: To: ~ Home ~ Other, j 'Ambulatory ~ WC ~ Ambulance ~ ~ Family ~ Other ,~- Sgr:ature: ~ 1i~~ ~(~ l.~ r ~~ '~ ~ ~~ DATEfRME NOTES a ~~ ~ ~1!) Z 4z ~' ~ L ' t A :/ ASPER, MAUREEN E Acct~/5008063 MRt/0001044167 08!2012005 NAROESTY, JAME DOB:D713111942 063 F CARLISLE REGIONAL MEDICAL CTR Iillllllllllllllllillllllllllllllllllllllllll Do12-A 11 ~~~I /CL~h; _. ~/// ~~CARLIS~~ REGIOI~IAL M E D I C A L C E N T E R NURSING DOCUMENTATION FORM h- ~. ~: ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street i Harrisburg, PA 17110-1708 Phone: 717 2 - ( ) 38 6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO JAMES HARDESTY, M.D. I, Daryl E. Christopher, certify that: (X) an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR () the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. . Date: September 26, 2007 Daryl E. hristopher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO BELVEDERE MEDICAL CORPORATION I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR (X) the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: September 26, 2007 Daryl E. hristopher, Esquire Counsel for Plaintiffs 362282 i ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717)238-6791 Fax: (717)238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys f'or Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO JOSEPH ACRI, D.O. I, Daryl E. Christopher, certify that: an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR O the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. L.,/ Date: September 26, 2007 Daryl E. istopher, Esquire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# :91895 4503 North Fron[ Street Harrisburg, PA 1 71 10-1 708 Phone: (717) 238-6791 Fax: (717)238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO ACRI INTERNAL MEDICINE SERVICES, LLC I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR (X) the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR O expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: September 26, 2007 Daryl E. C r> stop er, squire Counsel for Plaintiffs 362282 ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants Attorneys for Plaintiff: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF MERIT AS TO CARLISLE HMCA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER I, Daryl E. Christopher, certify that: () an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; AND/OR (X) the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR () expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. _. Date: September 26, 2007 Daryl E. Christ p er, Esquire Counsel for Plaintiffs 362282 i VERIFICATION I, John Asper Jr., Individually and as Administrator of the Estate of Maureen Asper, have read the foregoing PLAINTIFFS' COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. ~---_ Witness Asper Jr. Dated: 9~~(Qlp.7 364430 i; CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of AMENDED COMPLAINT on the following via certified mail, postage prepaid, first class United States mail, addressed as follows: Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 Counsel for James Hardesty, M. D. Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 Counsel. for Carlisle HMA, lnc. d/6/a Carlisle Regional Medical Center Belvedere Medical Center 850 Walnut Bottom Road Carlisle, PA 17013 Joseph Acri, D.O. and Acri Internal Medicine Services. LLC 243 North 24th Street Camp Hill, PA 17011 ~,.. Marcy L. Brymesse Date: September 26, 2007 357036 ~7 ~ (~) ~_a 7 ~, r ~-. ~;-, ~' j-- t f~'.~ ~-..7 _ .. -~" ~... .. l 1 -. ~_ .~ THOMAS, THOMAS & HAFER, LLP Evan Black, Esquire Attorney LD. 17884 Hugh P. O'Neill, III, Esquire Attorney I.D. 69986 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717)441-7051 Attorneys for Defendant Joseph Thomas Acri, D.O. JOHN ASPER, JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION NO. 07-4782 JURY TRIAL DEMANDED JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, D.O., ACRI INTERNAL MEDICINE SERVICES, LLC. and CARLISLE HMA, INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, . Defendants PRAECIPE FOR ENTRY OF APPEARANCE To the Prothonotary: Kindly enter the appearance of Evan Black, Esquire and Hugh P. O'Neill on behalf of the Defendant, Joseph T. Acri, D.O. only, relative to the above-captioned action. Respectfully submitted, Thomas, o as & Hafer, LLP Date: U ~ ~~ By: Evan Black, Esquire Thomas, Thomas and Hafer, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717)441-7051 Attorney for Defendant, Joseph T. Acri, D.O. CERTIFICATE OF SERVICE I, Joan L. Wolfe, an employee of the law firm of THOMAS, THOMAS, & HAFER, LLP do certify that I served the foregoing document on the following person(s), by depositing the same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania addressed as follows: Daryl E. Christopher, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Grant H. Fleming, Esquire McQuaide Blasko 600 Centerview Drive Suite 5103 Hershey, PA 17033 Andrew H. Briggs, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 THOMAS, THOMAS &HAFER, LLP -~~~ ~ ~~ Date: l - " Jo .Wolfe G ' ..~ ~ ~sl ~~~ ~•- --- ;~ ,i"~` ~- ~~ l~ Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22, Defendants certify that: MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant (1) a notice of intent to serve the subpoenas with a copy of the subpoenas attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoenas are sought to be served, ..~ (2) a copy of the notice of intent, including the proposed subpoenas, is attached to this certificate, (3) no objection to the subpoenas have been received, and counsel for Plaintiff has agreed to waive the 20 day notice (4) the subpoenas which will be served are identical to the subpoenas which are attached to the notice of intent to serve the subpoenas. Date: /G k G - ,G A orney for the Def ndant es ~ fw MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher., Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Defendant intends to serve subpoenas identical to the ones attached to this notice. You have twenty (20) days from the dated listed below in which to file of record and serve upon the undersigned an objection to the subpoenas. If no objection is made the subpoenas may be served. Date: ~D Z 0 G~GGtPe~~-L, ,~ Maureen A. Gallagher Attorney for Defendant H esty r JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and JOHN ASPER, JR., Individually and in his own right, Plaintiffs v. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION JAMES HARDESTY, M.D., NO. 2007-4782 BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant JURY TRIAL DEMANDED SUBPOENA TO PRODUCE DOCUMENTS OR THINGS TO: Milton S. Hershey Medica] Center Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: any and all records pertaining to Maureen Asper (DOB: 7/31 /42), including but not limited to patient information forms, progress notes, diagnostic studies, treatment records, correspondence, memos, notes, outside records, electronic/database records, billing records, etc. at MCQUAIDE BLASKO LAW OFFICES, 600 Centerview Drive, Hershey, PA 17033 You may deliver or mail legible copies of the documents or produce things by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena, within twenty (20) days after its service; the party serving this subpoena may seek a court ordering compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Maureen A. Gallagher, Esq. ADDRESS: 600 Centerview Drive, Hershey, PA 17033 TELEPHONE: 717-531-1199 SUPREME COURT ID# 53790 ATTORNEY FOR: Defendant Hardesty DATE: Seal of the Court By the Court Prothonotary JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED SUBPOENA TO PRODUCE DOCUMENTS OR THINGS TO: Penn State University Physicians Group -Silver Spring Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: any and all records pertaining to Maureen Asper (DOB: 7/31/42), including but not limited to patient information forms, progress notes, diagnostic studies, treatment records, correspondence, memos, notes, outside records, electronic/database records, billing records, etc. at MCQUAIDE BLASKO LAW OFFICES, 600 Centerview Drive, Hershey, PA 17033 You may deliver or mail legible copies of the documents or produce things by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena, within twenty (20) days after its service, the party serving this subpoena may seek a court ordering compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: Maureen A. Gallagher, Esq. ADDRESS: 600 Centerview Drive, Hershey, PA 17033 TELEPHONE: 717-531-1199 SUPREME COURT ID# 53790 ATTORNEY FOR: Defendant Hardesty DATE: Seal of the Court By the Court Prothonotary ~`~' C~ v G --' Ga '~ .7 s C`7 i i a ( r'~! "F'.~ Ey, .rr '`~1 ~ ~ r~~~~.~t ~~ ~ i + -Z'1 ~ ~ ~ ~ "~ ~ ~ ~ "1 SHERIFF'S RETURN - REGULAR CASE NO: 2007-04782 P ` COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL RONALD HOOVER Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon HARDESTY JAMES M D the DEFENDANT at 1546:00 HOURS, on the 20th day of August 2007 at BELVEDERE MEDICAL CENTER 850 WALNUT BOTTOM ROAn CARLISLE, PA 17013 by handing to SUSAN COSTA, RN, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 4.80 Affidavit .00 Surcharge 10.00 f ],-_ . 0 0 lbllglb~ %""' 32.80 Sworn and Subscibed to before me this day of , So Answers: ~'''.~~_ R. Thomas Kline 10/08/2007 ANGINO & ROVNER By ~~~ Deputy/' Sheri f f A.D. SHERIFF'S RETURN - REGULAR CASE N0: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL DAVID MCKINNEY Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon ACRI JOSEPH M D the DEFENDANT at 1507:00 HOURS, on the 24th day of September, 2007 at 243 N 24TH STREET CAMP HILL, PA 17011 by handing to NATALIE ACRI, WIFE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: So Answers: Docketing 6.00 Service 14 .4 0 - r%~~ ~r-~`~...~' Affidavit .00 Surcharge 10.00 R. Thomas Kline .00 j,~ljq/p~ ~ 30.40 10/08/2007 / ANGINO & ROVNER Sworn and Subscibed to By: -z-~ ~ before me this day Deputy heriff of _ A.D. SHERIFF'S RETURN - REGULAR CASE N0: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL DAVID MCKINNEY Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon ACRI INTERNAL MEDICINE SERVICES LLC the DEFENDANT at 1507:00 HOURS, on the 24th day of September, 2007 at 243 NORTH 24TH STREET CAMP HILL, PA 17011 by handing to NATALIE ACRI ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 6.00 Service .00 Affidavit .00 Surcharge 10.00 .00 /p`/9/D7 ~-~.. d 16.00 Sworn and Subscibed to before me this day of , So Answers: ~ ~ ~ ~' R. Thomas Kline 10/08/2007 ANGINO & ROVNER By ~ eputy S erif A.D. SHERIFF'S RETURN - REGULAR CASE N0: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL SHAWN HARRISON Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon BELVEDERE MEDICAL CORPORATION the DEFENDANT at 1251:00 HOURS, on the 20th day of August 2007 at 850 WALNUT BOTTOM ROAn CARLISLE, PA 17013 LAURIE HOLTRY, BOOKKEEPER by handing to ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 6.00 Service .00 Affidavit .00 Surcharge 10.00 io~rg~b 7 ~~,,,. . 0 0 16.00 Sworn and Subscibed to before me this day of So Answers: R. Thomas Kline 10/08/2007 ANGINO & ROVN,E,R ~~ BY • [`. ~ I 1 ` A.D. ,: " Deputy Sheri f f SHERIFF'S RETURN - REGULAR CASE N0: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL SHAWN HARRISON Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon CARLISLE HMA INC DBA CARLISLE REGIONAL MEDICAL CENTER the DEFENDANT at 1240:00 HOURS, on the 20th day of August 2007 at 45 SPRINT DRIVE CARLISLE, PA 17015 by handing to CHRISTY LAWER, SECRETARY, ADULT IN CHARGE a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: So Answers: Docketing S e rv i c e 6.00 4. 8 0 ~~~~ ~ ~ J-~`-~ Affidavit .00 ~ Surcharge 10.00 R. Thomas Kline .00 lo/i~~e?~'~.~ / 20.80 10/08/2007 ANGINO & ROVN Sworn and Subscibed to P By: before me this day Deputy Sheriff of A.D. SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: ' COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: T /YTIT T/1 ('t T"ITITT TR T but was unable to locate Him deputized the sheriff of YORK in his bailiwick. He therefore serve the within COMPLAINT & NOTICE County, Pennsylvania, to On October 8th 2007 this office was in receipt of the attached return from YORK Sheriff's Costs: So answers: _..---~' Docketing 6.00 = -' Out of County 9 . 00 `"'~ ~"'~ - ~~ -- Surcharge 10.00 Thomas Kli e Dep York County 52.20 Sheriff of Cumberland County Postage 2.96 8 0.16 / ,rv f / gld ~ ~, „ti 10/08/2007 ANGINO & ROVNER Sworn and subscribe to before me this day of A.D. SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2007-04782 P COMMONWEALTH OF PENNSYLVANIA: ' COUNTY OF CUMBERLAND ASPER JOHN JR ET AL VS HARDESTY JAMES MD ET AL R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: ACRI INTERNAL MEDICINE SERVICES LLC but was unable to locate Them in his bailiwick. He therefore deputized the sheriff of YORK County, Pennsylvania, to serve the within COMPLAINT & NOTICE On October 8th 2007 this office was in receipt of the attached return from YORK Sheriff ' s Costs : So answer ~...-- Docketing 6 . 00 ...--~-=~~ ' ...~',f- Out of County .00 ~~~ Surcharge 10.00 R: Thomas Kline .00 Sheriff of Cumberland County .00 16.00 ,/ ~r~,iy~o i 10/08/2007 ANGINO & ROVNER Sworn and subscribe to before me this day of , A.D. . 1 OF 2 COUNTY OF YORK OFFICE OF THE SHERIFF S~ R ;'; ; ~o 45 N. GEORGE ST.,YORK, PA 17401 SHERIFF SERVICE ~~~~~ PROCESS RECEIPT and AFFIDAVIT OF RETURN ~''"E'~'~ ~~ ~"~ ~"~ ~ D1 Nf?T ~"I'A~CN ANY C`~~P 1 PLAINTIFF/SI 2 COURT NUMBER John AspAr Jr st al -4782 Y~iX>3i34 4. TYPE OF WRIT OR COMPLAINT 3 DEFENDANT/SI J~nAs Hardesty NiD et al No~ QCeI and "Cciipraint SERVE 5 NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC TO SERVE OR DESCRIPTION OF PROPERTY 70 BE LEVIED, AT IAGntu, Vr'r surer Joseph Acri NID 6 ADDRESS (STREET OR RFO WITH BOX NUMBER, APT NO ,CITY, BORO, TWP ,STATE ANO ZIP CODE) AT 689 Yorktown Road Lpwistt~n, PA 17339 7 INDICATE SERVICE d PERSONAL l3 PERSON iN CHARGE EPUTIZE ", ~Rr~ aV 1ST CLASS MAIL U POSTED •-I OTHER NOW August 17 , 20 0? I, SHERIFF OF yt~ COUNTY, P ,doh y deputize t riff of York COUNTY to execute this ~ n K retu they ~rsg to law. This deputization being made at the request and risk of the plaintiff., SHERIFF OF C NTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SEf~~~ Q F C 0 U N T Y C~xftbt3rland P1easQ mail rt-atuxn of servicA to CtmlbArli~nd County Sheriff. Thank you. ADV FEE PAID BY CUMBERLAND CO SHERIFF NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN -Any deputy sheriff levying upon or attaching any property under within wnt may leave same without a watchman, in custody of whomever is found in possession, after notirying person of levy or attachment, without liability on the part of such deputy or the sheriB to any plaintiff heron for any loss, desWdion, or removal of any property before SheriKs sale thereof. 9. TYPE NAME and ADDRESS of ATTORNEY /ORIGINATOR and StGNATUR ~ ELEPHONE NUMBER t t DATE FILED 4503 NORTH FRONT STREET, HARRISBURG, PA 17110-1708 717-238-6791 8-13-2007 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW (Trns area must de comp~eteo rt nonce is to oe maaeol CUMBERLAND CO SHERIFF f4R 1~5E t3. t scknowledge receipt of the wrd t4. DATE RECEIVED t5. Expiration/Hearing Date complaint as irxligted above. M J M C G I L L Y C S O 8- 2 0- 2 0 0 7 9 -12 - 2-n 0 7 16. HOW SERVED: PERSONAL ( ) RESIDENCE ( ) POSTED ( ) POE ( ) SHERIFF'S OFFICE ( ) OTHER ( ) SEE REMARKS BELOW 17. I -rereby ceAiry and return a NOT FOUND because I am unable to locate the individual, company, etc. named above. (See remarks below.) 1 NAME ANO TITLE OF INDIVIDUAL SERVED !LIST ADDRESS HERE IF NOT SHOWN ABOVE (Relationship to Defendant) 19. Date of Service 20 Time of Service 2t. ATTEMPTS T Miles int. D to Time Mles tn1. Date Time Miles Int. Date Time Miles Int . Date Time Miles InL Date Time Miles Int. © S ~'~ 22. REMARKS: DR. ACRI I NFORMED THE DEPUTY ftY PHONE THAT HF N0~ ~IORKS AT CARLISLE REGIONAL HOSPITAL. 23. Advance Costs 24. Service Costs 25 N/F 26. Mileage 27. Postage 28. Sub Total 29. Pound 30 Notary 31 Surchg. 32. Td. Coats 33 Casts Due ar eland heck No $225.00 q,Q~ Q. b• d ~u'^ao ~©a a~ 1 ? l 34. ForNyn County Costs 35. Advance Costs 36. Service Gosts 37. Notary Cert. 38 Mileage/PoslagrlNot Found 39. Total Costs 40. Costs Due or Refund 41. AFFIRMED and subscribed to bef a me 42. day 4t ~~~~, v ~~ ~~_ Ll~:~, L ~' ,,! 1"~ Nv-P,RY PUBLIC a,1Y C:'`:° _..~ ~ =J:':j. 12, 2009 44. Signatwe of 45. DATE Dep. Slrerill _~ 46. Signature of York 47. DATE County Sheriff r, . 8/ 3 0/ 0 7 William M Hose, Sheriff 1% 48. Sign`aturc o/ Forego 49 DATE .. _:~ C F ?_ ~~ COUNTY'OF YORK OFFICE OF THE SHERIFF 45 N. GEORGE ST.,YORK, PA 17401 SERVICE CALL (717) 7'11-9601 SHERIFF SERVICE N~TR~"TK"~'~i PROCESS RECEIPT and AFFIDAVIT OF RETURN PL.EA,S'E TYPE !OI+~.Y Lp~' 1 ~ 13 QO- ITT DETAt~ A~iY C48 1 PLAINTIFFIS/ John AspAr Jr 3. DEFENDANTISf Jams Hardesty MD et al 2 COURT NUMB ~7-4782 ~~ 4 TYPE OF WRIT OR COMPLAINT rr rr NoticA and OI~~Ccfiplaint SERVE ~ IVAMt Ut INUIVIUUAL, GUMMANI, GUKYUKAI IUN, t I G 1 U StKVt UK UtSGK1Y I IUN Uh YKUYtK 1 C IU tSt LtVItU, Al IAI;HtU, VK JVLU Acri Internal MedicinA Servic4s LLC 6. ADDRESS (STREET OR RFO WITH BOX NUMBER, APT NO., CITY, BORO, TWP ,STATE ANO ZIP CODE) AT 689 Yorktown Road Lewisberry, PA 17339 7. INDICATE SERVICE: O PERSONAL O PERSON IN CHARGE DEPUTIZE ~~~,~ G 1ST CLASS MAIL U POSTED U OTHER NOW August 1 , 20 I, SHERIFF OF 11C COUNTY, PA, d reby deputi sheriff of Yark COUNTY to execute thi It ere rn ording to law. This deputization being made at the request and risk of the plaintiff., - SHERIFF OF COUNTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SE~$ Q F C 0 U N T Y Ct~nbQrland Please mail return of service to CtuttbArland County ShQriff. Thank you. ADV FEE PAID BY CUMBERLAND CO SHERIFF NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN -Any deputy sheriff levying upon or attaching any property under within writ may leave same wiUwut a watchman, in custody of whomever is found in possession, after notiying person of levy or attachment, without liability on the part of such deputy or the sheriff to any plaintiff herein for any Ions, desWdion, or removal of any property before sherifrs sale thereof. 9. TYPE NAME and ADDRESS of ATTORNEY /ORIGINATOR and SIGNATUBt~ R Y L E . CHRIST 0 P H E R , E ~ TELEPHONE NUMBER t 1 DATE FILED 4503 NORTH FRONT STREET, HARRISBURG, PA 17110-1708 717-238-5791 8-13-2007 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must be completed if notlce is to be mailed). CUMBERLAND CO SHERIFF SPACE ~i.OW FOR USE OF THE ~. - DO NOT WRITE BELOW THIS LSE 13. I scknowk'dge receipt of the writ 14. DATE RECEIVED 15. ExpirationlHearing Date o<complaintasineir~tedabove. MJ MCG I LL YCSO 8-20-2007 9-12-2007 16. HOW SERVED: PERSONAL ( ) RESIDENCE ( ) POSTED ( ) POE ( ) SHERIFF'S OFFICE ( ) OTHER ( ) SEE REMARKS BELOW 17. I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, etc. named above. (See remarks below.) 18. NAME AND TITLE OF INDIVIDUAL SERVED /LIST ADDRESS HERE IF NOT SHOWN ABOVE (Relationship to Defendant) 19. Date of Service 20 Time of Service 21. ATTEMPTS D k Tim MI Int. D to Time Miles Int. Dale Time Miles Int. Date Time Miles Int. Date Time Miles Int. Dale Time Miles Int. _ ~~ ~ S~2-~ 535 ~~ 22. REMARKS: C 1 " DID. ACRT NO't~ =~~ORKS AT CARLISLE REGIONAL HOSPIT"L 23. Advance Costs 24 Service Costs 25. N/F 26. Mileage 27. Postage 28. Sub Total 29. Pound 30 Notary 31. Surchg. 32. Tot. Costs 33 Costs Due or Refund Check No 34. Foniyrt County Costs 35. Advance Costs 36. Service Costs 37. Notary Cert. 38. Mileage/PoslageJNot Found 39. Total Costs 40. Costs Due or Refund FF SO ANSWERS 11. A IRµ~~rfQ..XUO,tp~f ,14~ 42 4a. Signature of Sheriff De 45. DATE . ' p. ~. _ Y,',:~ ILL S ,~,L~~CI'lLY~Q NOTA LISr L (' .t,^, `~iAPY PUBLIC c' ~ ~ ~~P>t 1eK000~TY Y 46. Signature of York County Sheriff William M ~~ Hose Sherif~i' ~ ~~ ~~'~.__ 47. DATE -- 8/30/07 -~_._~_~-_-~. ~____ _~~.. - - .__- 48. Signalwe of Foregn CountySheriR 49 DATE 50. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE 151. DATE RECEIVED OF AUTHORIZED ISSUING AUTHORITY AND TITLE 1. WHITE -Issuing AuMlority 2. PINK -Attorney 3. CANARY - SheriRs Office 1. BLUE - SherArs Office r <.a ,,.~,, su ? Wd a~ art ~~~~ M ~ Nt J 1 e {gYjy{M(i{ E ` -'.- ~+.~y .,.. V ~ J ~ 'v~ V a.~ (4 ~ ..2 ~! J ~.: E ..,.. MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased,and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and .-~ says that service of a true and correct copy of Defendant's Response to Co- Defendant's Request for l~duction of ocuments was provided by First Class mail, postage prepaid on this day of d ~P, 2007, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Karen E. Minehan, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 Evan Black, Esquire THOMS, THOMAS & HAFER LLP 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 McQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: ('~. Maureen A. Gallagher, Es ui e Sworn to and subscribed bef__or~~ me this day ry Public ....r.. TM+ ~ vvr<soN NOtarY Public pF aRY lYVP, du1PNIN COUNlY My ~ ,mission Expires Oct 24.2009 f_"; ~" ~ -_ V ,,:; ~ r ~ z : r:.::. ~ ; ;~> r~ _, -~-~ ......... ,A ~y t _ (~ ~J ~/l ..ti ~~ ~-~ MrA~tt4M Nt~~- ;+~~.~ ris ~ATlJ~ r <raf~ .~- MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIAB/ILITY ACTION NO. 2007-4782 / JURY TRIAL DEMANDED JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased; JOHN ASPER, JR., Individually and in his own right; MELISSA KENNEDY AND MICHAEL KENNEDY, her husband; and JENNIFER WILSON AND RUSSEL WILSON, III, her husband Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4865 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above- captioned matter, after having been duly sworn according to law, deposes and says that service of a true and correct copy of Defendant Hardesty's Response to Defendant Carlisle Regional Medical Center's Request for Production of Documents was provided by First Class mail, postage prepaid on this l~h day of November, 2007, to the following: Daryl E. Christopher, Esquire ANGINO 8~ ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Andrew Briggs, Esquire Bradley Sprout, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 Evan Black, Esquire THOMS, THOMAS & HAFER LLP 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 Belvedere Medical Corporation 850 Walnut Bottom Road Carlisle, PA 17013 Acri Internal Medicine Assoc., LLC 689 Yorktown Road Lewisberry, PA 17339 Sworn to and subscribed before me this~~ay of No~cember, 007._ Public rawt~ sit tt• .- wK.soN t+btary Public r~RR1r rmn! oru~Ptta~i cotn~inr My ConxnMgpn Expkoa Oct 24, Y009 McQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By. ~"( LC/~ Maureen A. Gallagher, Esquire iF?;? :1:~iAt~"1i+f /tf,)'' iwY t WT38AwU3 :,'>tyc, b5 ' )CJ ~^,+a7~i ~tr~tz +>r,<<,..+ a t ,R ANGINO & ROVNER, P.C. Daryl E. Christopher, Esquire Attorney ID# : 91895 4503 North Front Street Harrisburg, PA 17110-1708 Phone: (717) 238-6791 Fax: (717) 238-5610 Attorneys for Plaintiff: E-mail• dchristo~her amino-rovner com Estate of Maureen Asaer JOHN ASPER 3R., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION v. NO. 07-4782 Civil Term JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED STIPULATION OF COUNSEL TO DISMISS AND NOW, come the parties individually or by and through their respective counsel and hereby stipulate to dismiss the above-captioned action with prejudice. The dismissal of this action shall have no effect, prejudicial or otherwise, on Cumberland County Docket No. 07-4865 Civil. This document may be executed in multiple counterparts, and copies of signatures shall be considered effective as originals. ,,, . ,. Daryl E. Christopher, Esquire I.D. No. 91895 Angino & Rovner, P.C. 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel,for Plaintiffs Date: ~ f ~`~~ ~(~e~:e~-Ge.. Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 Counsel for James Hardesty, M. D. Date: 1'$ I08 Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 (717) 291-4532 Counsel for Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center Date: Larry B. Selkowitz, Esquire Stevens & Lee, P.C. Harrisburg Market Square 17 North Second Street, 16th Floor Harrisburg, PA 17101 (717) 234-1090 Counsel for Belvedere Medical Center Date: Evan Black, Esquire Hugh P. O'Neill, Esquire Thomas, Thomas & Hafer, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717) 441-7051 Counsel for Joseph T. Acri, D.O. Date: Civil. This document may be executed in multiple counterparts, and copies of signatures shall be considered effective as originals. ~-.. ~.--- Daryl .Christopher, Esquire I.D. No. 91895 Angino & Rovner, P.C. 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel. for Plaintiffs Date: ~~ f~~ Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 (717)291-4532 Counsel for Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center Date: Stevens & Lee, P.C. L/ Harrisburg Market Square 17 North Second Street, 16`h Floor Harrisburg, PA 17101 (717) 234-1090 Counsel for Belvedere Medical Center Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 Counsel for James Hardesty, M. D. Date: Evan Black, Esquire Hugh P. O'Neill, Esquire Thomas, Thomas & Hafer, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717)441-7051 Counsel for Joseph T. Acri, D.O. Date: Date: Civil. This document may be executed in multiple counterparts, and copies of signatures shall be considered effective as originals. .---- Daryl E. hristopher, Esquire I.D. No. 91895 Angino & Rovner, P.C. 4503 N. Front Stree± Harrisburg, PA 17110 (717} 238-6791 Counsel for Plaintiffs Date: ~I~/~$ Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 (717)291-4532 Counsel for Carlisle HMA, Inc. d/bla Carlisle Regional Medical Center Date: Larry B. Selkowitz, Esquire Stevens & Lee, P.C. Harrisburg Market Square 17 North Second Street, 16`fi Floor Harrisburg, PA 17101 (717) 234-1090 Counsel for Belvedere Medical Center Date: Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centervie~v Drive, Suite 5 i 03 Hershey, PA 17033 (717) 531-1199 ('rnincol fnr.Inmoc Nnrdvch~ iL1 n Hugh P. O'Neill, Esquire Thomas, Thomas & Hafer, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717)441-7051 Counsel for Joseph T. Acri, D.O. Date: 1~3a/O .' Civil. This document may be executed in multiple counterparts, and copies of signatures shall be considered effective as originals. ~-- ___._ Daryl .Christopher, Esquire I.D. No. 91895 AnRino R~ Re :~neY P.C. 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiffs Date: ~ljjU`~ ~:'~ drew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 (717) 291-4532 Counsel for Carlisle HMA, lnc. d/b/a Carlisle Regional Medica! Center Date:'3) ~~~ Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 Counsel for James Hardesty, M D. Date: Evan Black, Esquire Hugh P. O'Neill, Esquire Thomas, Thomas & Hafer, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717) 441-7051 Counsel for Joseph T. Acri, D.O. Date: Larry B. Selkowitz, Esquire Stevens & Lee, P.C. Harrisburg Market Square 17 North Second Street, 16'h Floor Harrisburg, PA 17101 (717) 234-1090 Counsel for Belvedere Medical Center Date: CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of STIPULATION TO DISMISS on the following via postage prepaid, first class United States mail, addressed as follows: Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 Counsel for James Hardesty, M.D. Bradley N. Sprout, Esquire Post & Schell, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 Counsel for Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center Hugh P. O'Neill, Esquire Thomas, Thomas & Hafer 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 Counsel for Joseph T. Acri, D.O. Larry B. Selkowitz, Esquire Stevens & Lee 17 North Second Street, 16'" Floor Harrisburg, PA 17101 Counsel for Belvedere Medical Center arcy L. Brym ser Date: March 17, 2008 --~ r ~--a r:~ -r1 9 ~,Y.Y _.3 ~~ ~~ t~,~. :.? '"C7 ? 3 "...~ C~ " eNy ~~' ~ " L.~3 ""~ 5 MaR 1 ~ zoos JOHN ASPER JR., Administrator of the Estate of Maureen Asper, deceased, and JOHN ASPER JR., Individually and in his own right, Plaintiffs v. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D., ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION NO. 07-4782 Civil Term JURY TRIAL DEMANDED ORDER th AND NOW, this ~, ~ day of ~ pr c,~ , 2008, it is hereby Ordered and Decreed that based on the Stipulation of Counsel to Dismiss, the above-captioned action is DISMISSED WITH PREJUDICE. The dismissal of this action shall have no effect, prejudicial or otherwise, on the case captioned under Cumberland County Docket No. 07-4865 Civil. BY THE COURT: Distribution: See attached sheet J. ~h.o o~ ~i~iy~`.1.~~'~~.~i.'~;~~~~ ~l~1 ~Q ~r,~,^,,,~...~~ywa MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, NO. 2007-4782 Defendant JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22, Defendants certify that: (1) a notice of intent to serve the subpoenas with a copy of the subpoenas attached thereto was mailed or delivered to each party at least 20 days prior to the date on which the subpoenas are sought to be served, (2) a copy of the notice of intent, including the proposed subpoenas, is attached to this certificate, (3) no objection to the subpoenas have been received, and (4) the subpoenas which will be served are identical to the subpoenas which are attached to the notice of intent to serve the subpoenas. Date: ~` ai~ ~0 .l/~ Maureen A. Gallag r, Esq ' " Attorney for D endant MCQUAIDE, BLASKO, FLEMING & FAULKNER, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centenriew Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased and JOHN ASPER, JR., Individually and in his own right, Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA Plaintiffs v. CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/bia CARLISLE REGIONAL MEDICAL CENTER, Defendant NO. 2007-4782 JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENAS TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Defendant intends to serve subpoenas identical to the ones attached to this notice. You have twenty (20) days from the dated listed below in which to file of record and serve upon the undersigned an objection to the subpoenas. If no objection is made the subpoenas may be served. Date: 1- d ~~ j`/ Maureen A. Gallagh , Esquir Attorney for Defendant ~i~!'~ COMMONVdEALTH OF PE1~~NSYI:VANIA COUNTY OF CUMBERLAND JOHN ASPER JR., Administrator of the Estate of MAUREEI~T ASPER v. JAI~~S HARDESTY, M.D., et al. File No. 2007 456 Civil SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Erie Insurance (Name of Person or Entity) Within twenty (20} days after service of this subpoena. you are ordered by the court to produce the following documents or thins: :4ny and all employment records, employee information forms; correspondence, pa}roll; timesheets, pertaining To MAUREEN ASPER, DOB 7/31/42 At McQuaide Blakso Law Office. 600 Centerview Drive. Suite 5103. Hershev. P.A 17033 (Address) You may deliver or mail legible copies of the documents or produce things requested by this subpoena together with the certificate of compliance, to t1?e party malting this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or tlun~s required by this subpoena v~*ithin twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comp]y with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLORTING PERSON: NAME: Maureen A. Crallaaher. Esquire .ADDRESS: 600 Centerview Drive. Suite 510 Hershev. PA 17033 TELEPHONE : 717 - 5 31-1194 SU~'REME COL-RT ID ~ 53790 ATTOR1~rEYFOR: Defendant Hardesty Date: 3/as/ps .. See Court BY THE CCQURT: ro ono 1 rvision Deputy COMMON~~~EALTH OF PENNSYLVAl~'IA COUI~rI'Y OF CUMBERLAND JOHN ASPER, JR.; Administrator of the Estate of MAU-KEEN ASPER v. JAMES H.~RDESTY. M.D.. et al. File No. 2007 4865 Civil SUBPOENA TO PRODUCE DOCU~NTS OR T~tGS FOR DISCOV-ERY PURSUANT TO RULE 4009.22 TO: Health Assurance (Name of Parson or Entity) aTithin twenty (20} days after service of this subpoena; you are ordered by the court to produce the follo~a~ing documents or things: Any and all records, insurance forms, correspondence; explanation of benefits, pertaining to NL4UREEN ASPER, DOB 7/31/42 ,4t McQuaide Blakso Law Office. 600 Centerview Drive. Suite 5103. Hersbev. PA 17033 (Address) You may deliver or mail legible copies of the documents or produce things requested by this subpoena. together c~Rth the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service; the parry serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA VJAS ISSUED AT THE REQUEST OF THE FOLLORTING PERSON: NAME: Maureen A. Gallasher. Esquire ADDRESS: 600 Centerview Dm~e. Suite 5103 Hersbev. PA 17033 TELEPHO?vE: i17-531-1199 SUPREME COURT ID # 53790 ATTORI~TEY-FOR: Defendant Hardest~~ Date: .3~o25~D8 .. of the Court BY THE OURT: Prothono yr ivision Deputy t'~ +v r'-~ c.-a ,~.. t~ ~.r,~ <~: ,r; : y , ,, ~ _.. ~~ _ .~~" ~' ~~ ~~ 'sue` ~ -X7 ? i- rFE PROTHONOTAR 2011 JL 13 Ph 2` 48 CM PENN YLVANI?A TY McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, Esquire Attorney I.D. No. 53790 magallagher@mgblaw.com Carolyn E. Moser, Equire Attorney I.D. No. 94019 cemoser@mgblaw.com 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 (717) 531-1193 (fax) JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Plaintiffs V. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Carolyn E. Moser, attorney for Defendant, James Hardesty, M.D., in the above- captioned matter, after having been duly sworn according to law, deposes and says that service of a true and correct copy of Defendants' Joint Motion in Limine to Preclude the Report and/or Testimony of Plaintiffs' Expert, Sharon Fasnacht, or, in the alternative, Motion to Open Discovery and for Extension of Time to Conduct Discovery Regarding Ian Kennedy, was provided via First Class mail, postage prepaid, on this 10th day of June, 2011, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Evan Black, Esquire THOMS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 Sworn to and subsibed before me this /0"'c-- day o , 2011. Notary Public NOTARIAL SEAL DEANNA M HOEY Notary Pubk DERRY TOWNSHIP, DAUPHIN COUNTY My Commission Expires mar 5, 2013 Andrew Briggs, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 McQUAIDE BLASKO, INC. By: cww?, (F Carolyn . Moser, Esquire t 2011 AN 13 PM 12: "UMSERLA.hD ..Ofi?ejy MCQUAIDE BLASKO, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Plaintiffs V. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and says that service of a true and correct copy of Defendant James Hardesty, M.D.'s Supplemental Answers and Objections to Plaintiffs' Interrogatories, was provided via electronic mail, on this 9th day of June, 2011, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 dchristopher@angino-rovner.com Evan Black, Esquire THOMS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 eblack@tthlaw.com Sworn to and subs ribed be re me this day o , 2011. Notary I ublic NOTARIAL SEAL DEANNA MN W Nduy Pubk DERRY TOWNSHIP, OAWM CKWY MY C"Mms a Expi?M UN 5.2913 Andrew Briggs, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 abriggs@postschell.com McQUAIDE BLASKO, INC. By. ? ati?.tec_ ???? f ? Z Maureen A. Gallagher, uire F iL?'7_' I.?- 7 W t Idr PR ','a 2G I { JUN 15 A4410, 2_ I ?MMBERLAND ?LlJN ? PENNSYLVA11I1A° MCQUAIDE BLASKO, INC. By: Grant H. Fleming, Esq. Attorney I.D. No. 16212 Maureen A. Gallagher, Esq. Attorney I.D. No. 53790 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Plaintiffs V. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and says that service of a true and correct copy of Defendant James Hardesty, M.D.'s Supplemental Answers and Objections to Plaintiffs' Interrogatories, was provided via electronic mail, on this 14th day of June, 2011, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 dchristopher@angino-rovner.com Evan Black, Esquire THOMS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 eblack@tthlaw.com Sworn to and subsc ,gibed b Are me this _day of g , 2011. Notary Public NOTARIAL SEAL DEANNA M HOEY Notary Public DERRY TOWNSHIP, DAUPNNI COUNTY Nlp CM1101 IN ExpkM Nhr S. Ufa Andrew Briggs, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 abriggs@postschell.com McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, 9quire 41 '-'LEO-OFFiCE ICE PROTHONOTARY 2011 JUN 30 AM 10: 13 McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, Esquire Attorney I.D. No. 53790 magallagher@mqblaw.com Carolyn E. Moser, Equire Attorney I.D. No. 94019 cemoser@mgblaw.com 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 (717) 531-1193 (fax) JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, v. Plaintiffs JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant CUMBERLAND COUNTY PENNSYLVANIA Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and says that service of a true and correct copy of Defendant, James Hardesty, M.D.'s Motions for Summary Judgment, was sent by First Class mail, postage prepaid, on this 471 day of June 2011, to the following: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Andrew Briggs, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 Evan Black, Esquire THOMAS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 Sworn to and subs 'Elbed be a me this,2q day of ? .2011. " Notary Public v NoR?s? DEANNA M MY Notary PWO ?pDy? HI??aDAtlPNM? 5 ; IAy McQUAIDE BLASKO, INC. By: u? au.4? a ka'e? Maureen A. Gallagher, Esq ' e .i4 .. 2I I J[i 29 AM 10: 4- 9 CUMBERLAND COUNTY PENNSYLVANIA McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, Esquire Attorney I.D. No. 53790 magallagher@mqblaw.com Carolyn E. Moser, Equire Attorney I.D. No. 94019 cemoser@mgblaw.com 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 (717) 531-1193 (fax) JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA Plaintiffs V. CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Carolyn E. Moser, attorney for Defendant, James Hardesty, M.D., in the above- captioned matter, after having been duly sworn according to law, deposes and says that service of true and correct copies of Defendant, James Hardesty, M.D.'s Brief in Support of Motions for Summary Judgment, were sent by First Class mail, postage prepaid, on this 28th day of July, 2011, to the following: Daryl E. Christopher, Esquire Andrew Briggs, Esquire ANGINO & ROVNER, P.C. POST & SCHELL 4503 North Front Street 1857 William Penn Way Harrisburg, PA 17110-1708 P. O. Box 10248 Lancaster, PA 17605-0248 Evan Black, Esquire THOMAS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 McQUAIDE BLASKO, INC. By: 1 _( _ (I Carolyn Moser, Esquire Sworn to and subscribed before me this ;7, day of July, 2011. Notary Public NOTARIAL SEAL DEANNA M HOEY Notary Public DERRY TOWNSHIP, DAUPHIN COUNTY My Commission Expires Mar 5, 2013 ib i'HE fi0i RON0 TA F,1, 'i 20 11 AU1 - 2 AM 10: 56 CUMBERLAND COUNTY PENNSYLVANIA McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, Esquire Attorney I.D. No. 53790 magallagher@mgblaw.com Carolyn E. Moser, Equire Attorney I.D. No. 94019 cemoser@mgblaw.com 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 (717) 531-1193 (fax) JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Attorneys for Defendant James Hardesty, M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA Plaintiffs V. CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant NO. 2007-4782 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE I, Maureen A. Gallagher, attorney for Defendant, James Hardesty, M.D., in the above-captioned matter, after having been duly sworn according to law, deposes and says that service of true and correct copies of Defendant, James Hardesty, M.D.'s Notices of Deposition, were sent by facsimile and First Class mail, postage prepaid, on this 1 st day of August, 2011, to the following: Daryl E. Christopher, Esquire Andrew Briggs, Esquire ANGINO & ROVNER, P.C. POST & SCHELL 4503 North Front Street 1857 William Penn Way Harrisburg, PA 17110-1708 P. O. Box 10248 Lancaster, PA 17605-0248 Evan Black, Esquire THOMAS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 McQUAIDE BLASKO, INC. By: 4faze49AA- Maureen A. Gallagher, uire Sworn to and subscribed before me this / day of August, 2011. Notary 4?ublic NOTARIAL SEAL DEANNA M HOEY Notary PubliC DERRY TOWNSHIP, DAUPHIN COUNTY E Coen *810n ExPNM Mar S, 2013 .? 01 LLU-OFFICE ' ""' PROTHONOTARI' McQUAIDE BLASKO, INC. By: Maureen A. Gallagher, Esquire Attorney I.D. No. 53790 magallagher@mgblaw.com Carolyn E. Moser, Equire Attorney I.D. No. 94019 cemoser@mgblaw.com 600 Centerview Drive, Suite 5103 Hershey, PA 17033 (717) 531-1199 (717) 531-1193 (fax) JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, deceased, and JOHN ASPER, JR., Individually and in his own right, Plaintiffs V. JAMES HARDESTY, M.D., BELVEDERE MEDICAL CORPORATION, JOSEPH ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant '311 AUG -8 Aid 11= 13 Attorneys for Defer 'MERLAND COUNTY James Hardesty, M.D. NhISYLVAt?lA COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Julie Cassel, employee of McQuaide Blasko Law Office, certify that on this 5th day of August, 2011, served a true and correct copy of the Notice of Records Deposition directed to Kathleen Zimmerman, on all counsel of record or parties of interest via facsimile and by depositing a copy of the same in the US Mail, postage prepaid, at the Post Office, Hershey, PA and addressed as follows: Daryl E. Christopher, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Evan Black, Esquire THOMAS, THOMAS & HAFER 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 Andrew Briggs, Esquire POST & SCHELL 1857 William Penn Way P. O. Box 10248 Lancaster, PA 17605-0248 Julie Cassel .ED-OFFN:L THE PROTHONO CO I if SEP 12 PM 12: 0 5 . CUMBERLAND COUNTY PENNSYLVANIA SCHMIDT KRAMER Daryl E. Christopher, Esquire Attorney 1D# : 91895 209 State Street Harrisburg, PA 17101 P(717) 232-6300 F(717) 232-6467 dchristopher@schmidtkramer.com Attorneys for Plaintiffs JOHN ASPER, JR., Administrator of the Estate of MAUREEN ASPER, JR., Individually and in his own right, Plaintiffs V. JAMES HARDESTY, M.D. BELVEDERE MEDICAL CORPERATION, JOSEPH. ACRI, M.D. ACRI INTERNAL MEDICINE SERVICES, LLC, and CARLISLE HMA INC. d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION — MEDICAL PROFESSIONAL LIABILITY ACTION NO. 2007-4782 PRAECIPE TO DISCONTINUE To: David D. Buell, Prothonotary; Please discontinue the above referenced matter with PREJUDICE. Date: 0// Respectfully Submitted, SCHMIDT KRAMER Daryl E. Christopher, Esquire Attorney ID# : 91895 209 State Street Harrisburg, PA 17101 (717) 232-6300 FAX (717) 232-6467 Attorneys for Plaintiff dchristopher@schmidtkramer.com CERTIFICATE OF SERVICE I, Laura Trimble, an employee of the law firm of Schmidt Kramer, P.C., do hereby certify that I am this day serving a true and correct copy of Praecipe to Withdraw upon all counsel of record via postage prepaid first class United States mail addressed as follows: Grant H. Fleming, Esquire Maureen A. Gallagher, Esquire McQuaide Blasko 600 Centerview Drive, Suite 5103 Hershey, PA 17033 Attorney for Defendant James Hardesty, M.D. Andrew H. Briggs, Esquire Karen E. Minehan, Esquire Post & Schell, P.C. 1857 William Penn Way PO Box 10248 Lancaster, PA 17605 Attorney for Defendant Carlisle HMA, Inc. d/b/a Carlisle Regional Medical Center Evan Black, Esquire Hugh P. O'Neill, Esquire Thomas, Thomas, & Hafer, LLP 305 North Front Street PO Box 999 Harrisburg, PA 17108 Attorney for Defendant Joseph T. Acri, D.O. Larry B. Selkowitz, Esquire Stevens & Lee, P.C. Harrisburg Market Square 17 North Second Street, 16th Floor Harrisburg, PA 17101 Attorney for Defendant Belvedere Medical Center Date: 9H(- p