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HomeMy WebLinkAbout09-05-01 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: : No. ~,~! - C)~-q. ~-' APPOINTMENT OF A GUARDIAN : OF THE PERSON OF MILDRED J. GERBER, : an alleged incapacitated person : PETITION FOR APPOINTMENT OF A GUARDIAN OF THE PERSON IN ACCORDANCE WITH 20 PA C.S.A. § 5511 TO THE HONORABLE, THE JUDGES OF SAID COURT: 1. The Petitioner is Frederick E. Gerber, II, the son of Mildred J. Gerber, the alleged incapacitated person. The Petitioner resides at 4287 Kearney Lane, Fairfax, VA 22033. 2. The Petitioner was appointed Emergency Guardian of the Estate of Mildred J. Gerber by Order of this Honorable Court on January 25, 2001. 3. PNC BANK was appointed the plenary Guardian of the Estate of Mildred J. Gerber by Order of this Honorable Court on March 22, 2001. A copy of said Order is marked Exhibit 'A', attached hereto, and incorporated herein by reference. 4. The alleged incapacitated person, Mildred J. Gerber, is 86 years of age, a widow, and resides at 623 Hilltop Drive, New Cumberland (Cumberland County), Pennsylvania 17070. The alleged incapacitated person's date of birth is November 9, 1914 and her Social Security No. is 176-32-5872. 5. The following persons are the alleged incapacitated person's only living next-of-kin: a. Frederick E. Gerber, II, an adult individual, her son, 4287 Kearney Lane, Fairfax, VA 22033 b. Jane N. Heflin, an adult individual, her daughter, 270 N. Garfield, Lombard, IL 60148 c. Marilyn J. Gerber, an adult individual, her daughter, who has a Pennsylvania residence of 42 Drexel Place, New Cumberland, PA 17070 and a California residence of 1830 Gough St., Apt. 2, San Francisco, CA 94109. 6. The assets of the alleged incapacitated person are valued at approximately $462,000 comprised of the following: a. Residence at 623 Hilltop Drive, New Cumberland, Pennsylvania 1 7070 $145,000 b. Furniture and furnishings, equipment, etc. $7,000 c. Jewelry and personal possessions $10,000 d. Living Trust of Mildred J. Gerber (Frederick E. Gerber, II, Trustee) $300,000 7. The alleged incapacitated person's monthly income is approximately $4,228 which includes: a. Social Security benefits $653.00 .... ~b~,~Deceased-husband~s~civil servicepension P . ~-05.~)0 c. Deceased husband's military pension $2,122.00 d. Fred E. Gerber (deceased husband of Mildred J. Gerber) Trust, discretionary payment representing rent from rental property in Baltimore, MD $400.00_~ 8. The alleged incapacitated person was not and is not a member of the armed services of the United States and is not receiving benefits from the United States Veterans Administration. 9. The alleged incapacitated person is suffering from infirmities of old age and lack of short-term memory, when pressured becomes easily confused, when pressured cannot make intelligent decisions and when pressured lacks ability to fully understand the consequences of her actions. 2 10. The proposed Guardian of the Person of the alleged incapacitated person is the Petitioner, Frederick E. Gerber, II. 11. Mildred J. Gerber, the alleged incapacitated person, in her Power of Attorney dated January 21,2001, Paragraph 20 states as follows: "For the purpose of recording my wishes in a convenient place, I record here that if it is necessary to appoint a Guardian of my person or a Guardian of my Estate, it is my desire that my Agent be appointed". Frederick E. Gerber, II, is appointed as Agent of the Power of Attorney. A copy of said Power of Attorney is marked Exhibit "B', attached hereto, and incorporated herein by reference. 12. The Petitioner is the Executor of his father's Estate, is the Trustee of a Trust established by his father, is the Trustee of the alleged incapacitated person's Living Trust, is the named Executor in the alleged incapacitated person's Will, is the Agent appointed in the alleged incapacitated person's Power-of-Attorney, is a Colonel in the United States Army stationed in Falls Church, Virginia, is the Director of Health Care Operations under the United States Army Surgeon General. He has participated in the presentation of testimony in excess of 12 times before Congressional Committees concerning the health care of military personnel. 13. The Petitioner has no personal adverse interests to the alleged incapacitated person. 14. The Petitioner has attempted to protect his mother, the alleged incapacitated person, in the following ways: ...... ......... 1 .~ Petitio~er~:has~attempted-to-find less restrictive alternatives for~the-~, care, needs and protection of his mother. 2. Petitioner has obtained caretakers to stay with his mother during much of the day each day. 3. Petitioner further cares for his mother every weekend by traveling from Virginia where the Petitioner lives and works. 4. One of the mother's daughters, Jane Heflin, visits frequently to care for her mother, the alleged incapacitated person. 15. However, these alternatives, the Petitioner feels, have provided less than fully adequate measures for the care, needs and protection of his mother, the alleged incapacitated person. 3 16. These above referenced measures for the benefit, care and protection of the alleged incapacitated person have not been successful because of the following: a. The alleged incapacitated person because of her loss of short- term memory cannot always remember whether she took her pills or not and therefore either may not take her pills or may take too many pills. b. The alleged incapacitated person is not able to take care of her proper hygiene without the daily caretakers mentioned above. c. The alleged incapacitated person can no longer drive so that groceries, medicines and other items must be obtained for her. d. The alleged incapacitated person has suffered a mental deterioration according to both Dr. Sabo and Dr. Cadieux, who have examined her. e. The alleged incapacitated person has suffered an emotional decline according to both Dr. Sabo and Dr. Cadieux. f. The alleged incapacitated person has suffered a decline in her adaptive behavioral skills according to both Dr. Sabo and Dr. Cadieux. g. The alleged incapacitated person does not or cannot recognize her own needs. The unavailability of caretakers at certain times and the diverse number of caretakers ~s~-~ot-completely-satisfactory as a~solution for the needs, care and protection of the alleged incapacitated person. i. It is the opinion of Dr. Cadieux that in the near future the alleged~ incapacitated person may need institutional care for her needs, care and protection. j. One daughter, Marilyn J. Gerber, who the Petitioner believes took major advantage of the mother during the year 2000, has made further attempts to contact and gain control of the mother following the appointment of PNC Bank as plenary Guardian of the mother's Estate. 4 k. The Petitioner has observed that his mother's interaction with this daughter, Marilyn J. Gerber, is emotionally draining on his mother. I. Marilyn J. Gerber, the daughter, has attempted since the mother's husband's death to control the mother primarily for Marilyn's benefit and not for the mother's benefit. (1) In the year 2000, when Marilyn moved in to the mother's residence, she attempted to have her mother sign numerous documents. (2) Marilyn had her mother sign as a Plaintiff in a case for the removal of the Petitioner from his fiduciary positions as Executor of the late Fred Gerber, Sr.'s Estate and Trustee of the late Fred Gerber, Sr.'s Irrevocable Living Trust. (3) Marilyn caused Mildred to sign a Revocation of the Appointment of Fred E. Gerber, II, Power of Attorney for the mother and Trusteeships in both the late Fred Gerber's Irrevocable Living Trust and the mother's Living Trust. (4) Marilyn J. Gerber also wanted a new Will and Power of Attorney drafted for the mother which would cause the mother to change her extensive prior planning and change from her son, Fred E. Gerber, II, to Marilyn as both Executor and Power of Attorney. (5) Your Petitioner believes these were not drafted nor signed by the mother. Your Petitioner believes that the mother when in the presence of Marilyn or being ordered by Marilyn to do something, yields to Marilyn in order to obtain peace and harmony in the mother's life. m. Doctor Roger Cadieux in his psychological evaluation recommended that a Guardian be sought to take care of the mother's activities of daily living as well as a Guardian to manage her financial assets and affairs. A copy of said report is marked Exhibit "C", attached hereto, and incorporated herein by reference. n. The Petitioner believes that the daughter's, Marilyn Gerber's, demands on the mother emotionally drain the mother. 5 o. Daughter, Marilyn Gerber, attempted to control and disrupt provision of father's health care in his last illness. The Petitioner believes Marilyn Gerber will attempt also to control and disrupt provision of health care to mother, alleged incapacitated person. p. The Petitioner believes that the daughter, Marilyn Gerber, has sought and will continue to seek to gain access to the mother in order to exert control over the mother including changing health care to the detriment of the mother. Mildred J. Gerberhas expressed to the Petitioner that she feels like a prisoner when the daughter has gained access to her and has lived with her. q. Attorney Jacqueline Verney, attorney for alleged incapacitated person wrote defiant trespass letters to Marilyn Gerber directing Marilyn Gerber to stay off Mildred Gerber's residential real property. Despite these warning letters, Marilyn Gerber has come onto the real property. The Petitioner has been informed by the caretakers hired for the mother that Marilyn J. Gerber has attempted to gain access to the mother following the Hearing in March, 2001, appointing PNC Bank as plenary Guardian of the Estate. r. The Petitioner believes that the daughter, Marilyn Gerber, will continue to seek to gain access to the mother in order to attempt to exercise or gain some control over the mother to the detriment of the mother. Attached hereto and incorporated herein by reference is a letter written by Marilyn Gerber to mother. 16. The alleged incapacitated person is represented by Jacqueline E. Verney, Esquire, Carlisle, Pennsylvania. 17. No other court has ever assumed jurisdiction in any proceeding to determine the capacity of the alleged incapacitated person, except as stated in Paragraph 3 above. 18. The Consent of Frederick E. Gerber, II, to act as Guardian of the Person~ is marked exhibit "D", attached hereto and incorporated herein. 19. The Petitioner requests that he be appointed Guardian of the Person of Mildred J. Gerber, the alleged incapacitated person. 20. Failure to appoint a Guardian of the Person of Mildred J. Gerber, the alleged incapacitated person, will result in irreparable harm to her person. 6 21. Your Petitioner seeks Guardian of the Person for his mother, the alleged incapacitated person, in order to be able to fully provide for her care, protection and needs without the possible influence or interference from person or persons who would not have the mother's best interests in mind more particularly, Marilyn J. Gerber. WHEREFORE, The Petitioner respectfully requests this Honorable Court award a citation directed to Mildred J. Gerber, the alleged incapacitated person, with notice thereof to be given to immediate next of him, her children who are not Petitioners: Marilyn J. Gerber and Jane N. Heflin, to show cause why she should not be judged an incapacitated person and Frederick E. Gerber, II, appointed Guardian of her person. Respectfully submitted, RUPP AND MEIKLE Richard C Rupp -'f Sup. Court I.D. No..' 34832 355 North 21st Street, Suite 205 Camp Hill, PA 1 7011 (717) 761-3459 Attorney for Petitioner IN RE: APPOINTMENT OF A IN THE COURT OF COMMON PLEAS OF GUARDIAN OF THE ESTATE OF CUMBERLAND COUNTY, PENNSYLVANIA MILDRED J. GERBER NO. 21-01-92 FINDINGS (1) Mildred J. Gerber, born November 9, 1914, suffers from dementia that impairs her capacity to make and communicate decisions. (2) Her ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that she is totally unable to manage her financial resources. (3) The estrangement between one of her daughters and her other daughter and son, and the substantial assets in her estate, requires the appointment of a corporate guardian. (4) A plenary guardian of the estate is necessary because her incapacity is permanent. (5) The guardianship must be for an unlimited period. ORDER OF COURT AND NOW, this 22nd day of March, 2001, PNC Bank is appointed plenary guardian of the estate of Mildred J. Gerber.By A T~.jE COPY FROM Exhi bi-l- "A" Richard C. Rupp, Esquire For Petitioner Jacqueline M. Verney, Esquire For Mildred J. Gerber Marilyn Gerber, Pro se 42 Drexel Place New Cumberland, PA 17070 :saa DURABLE POWER OF ATTORNEY NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD WHICH MAY INCLUDE POWERS TO SELL POWERS TO HANDLE YOUR PROPERTY. PERSONAL PROPERTY OR OTHERWISE DISPOSE OF ANY REAL O1~ YOU. WITHOUT ADVANCE NOTICE TQ YOU OR APPROVAL BY THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS,. BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAy EXERCISE THE POWERS O/YEN HERE THRouoHOUT' your An'ER YOU INCAPAcrr^TED, t c ss vo, EXPRESSLY LIMIT THE DURATION OF ~I-~SE POWERS POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S ~ x uo REVOKE THESE AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF 1T FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE' POWERS AND DUTIES OF ANY AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE HJLLY IN 20 Pa. C.S. Ch. $6. IF THERE IS ANYTHING ABOUT TI-IlS FORM THAT YOU DOD NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD F~PLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. I, MILDRED j. GERBER of 623 Hilltop Drive, New Cumberland, Cumberland County, Pennsylvania hereby appoint my son, Frederick E. Gerber, Il, (hereina[~ referred to .as "agent") my agent for me and in my name and place. I direct my agent to transat:t all my business and to manage all my property and affairs as completel as including but not limi,-,~ · ........ . .... Y I myself might do if ~ ,,-,, ~<r~smg me following powerS, personally present, omprormse, ertt0rce, or otherwise ?:t .with respect to any contract of any sort whatsoever E hibi+' "15" includi~.g but not..limited to, leases and mortgages: possession to any real or personal pro.l~..rty .that ma), ?. requ~.red to be prod or 'tramfen~ I~. contract or in the performance of any obhgatton entered into or'i~curr~d by me °r on my 2. INVESTMENTS, To invest in all forms of real and personal prop:ny w~thout any restriction whatsoever as to the kind of investments, including, but not limited to. United State~ Treasury Bonds which are redeemable at par in payment of federal estate taxes. 3. REGISTRATION OF PROPERTY. To hold property unregistered or in the name ora nominee. 4. .PERSONAL PROPERTY. To buy or sell at public or private sale for cash or credit or partly for each, exchange, pi. edge, lease, give or acquire options for sales or exchanges or leases, or by any other means whatsoever to acquire, dispose of, repair, alter or manage tangible or intangible personal property or any interest, therein; and, without limitation, with respect to any securities, to comply with any securities laws or regulations, to execute indemnity agreements, to purchase insurance and to pay commissions or discounts.required by any underwriting. 5. .REAL PROPERTY. To buy or sell at public or private sale for cash or credit or partly for each, exchange, mortgage, encumber, lease for any period of time, give or acquire options for sales, purchases, exchanges orleases, dedicate, or by any other means whatsoever; to acquire or dispose of real property or any interest therein; to partition and subdivide real property; to manage real property; to repair, alter, erect, or tear down any structure of part thereof; and to file such plans, applications, or other documents in connection therewith and do such other acts as may be requested by any government or other authority having or purporting to have jurisdiction. 6. SECURITIES. To vote in person or by proxy at any meeting, to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, to make payments in connection therewith, and in general to exercise ail fights of a security holder. 7. INSURANCE. To procure, alter, extend or cancel insurance against any and ail risks aff'ectingL:goperty and persons, and against liability,.damage or claim of any sort.~:-~-~- ' ---- 8. LOANS. To borrow money in such amounts for such periods and upon such -- -terms as my attorney shall deem proper and to secure any loan by the mortgage or pledge of any property, and I specifically authorize my attomey to borrow money and pledge property as collateral for the purpose of purchasing United States Treasury Bonds which are redeemable at par in payment of federal estate taxe~: · 9. BANK ACCOUNTS. To sign checks, drafts and other instruments or otherwise make withdrawals from any checking, savings, transaction or other deposit account in my name, and to endorse checks payable to me and receive the proceeds thereof in cash or otherwise; to open and close checking, savings, transaction or other deposit~ accounts in my name; to purchase and redeem savings certificates, certiticates of deposit or similar insmunents in my name; to execute and deliver receipts for any funds withdrawn or savings certificate, certificate of deposit or similar instrmnent which I now have or may hereafter acquire, the same as I could do if personally present. Any financial institution may continue to rely on this pOwer o£ attorney until it tvc~ notice from me that this power of attorney is revoked might incur by relying on this power after termination or revocation but before it receive~ such · -,~,..s o~ mirt~ panie~. ~'h~ch notice, or .at any t~ne because of wrongful acts, omissions or rePresentations of my attorney with respect to uansacuons, covered by this power of attorney. My agent shall be subject to w~tever bank roles and regulations I world be subject to. 10. INDIVIDUAL RETIREME. NT ACCOUNT. To request and receive distributions fi'om any of my Individual Retirement Accounts; to give the purchase instructions for and sale of securities in those accounts; to execute on my behalf any powers of attorney or other instruments needed for those porlxJses; and to endorse notes, checks, dmRs and bills of exchange, and to make contributions to those accounts. 11. SAFE DEPOSIT BOXI~S To have access to and control over the contents of any safe deposit box rented by me, to rent safe deposit boxes 'in my name, to close out and execute safe deposit boxes in my name, to close out and execute and deliver receipts for safe deposit boxes in my name, and to do all acts regarding any safe deposit boxes in my name, which I now have or may hereaRer acquire, the same as I could do if personally present; provided that my agent shall not deposit or keep in any such safe deposit box any property/n which my agent has a personal interest. Any financial in-~titution may continue to rely on this power of attorney until it receives written notice from me that this power of attorney is revoked or actual notice of my death and shall be indemnified and held harmless by me and my estate, personal representatives and heirs against any liability or loss, including lawyers' fees, costs of suit and claims or third parties, which it might incur by relying on this power aider termination or revocation but before it receives such notice, or at any time because of wrongxCul acts, omissions or representations of my agent with respect to transactio~ covered by this power of attorney. My agent shall be subject to whatever bank rules and regulations I would be subject. 12. RECEIFrS AND APPROVAL OF ACCOUNTS To receive a payment of any kind, including a bequ6st, devise, gitt or other tmmfer of real or personal property to me in my own right or as a fiduciary for another, and to give full receipt and ac4uittance therefor, or a refunding bond therefor, to approve aceoums of any business,, estate, trust, partnership or other transaction whatsoever in which I may have any interest of any nature whatsoev~, and to enter int°- any compromise and release in regard thereto. _ or arbitrate any el .y m any manner interested, and for that purpose to enter into agreements to compromise or arbitrate, and either through counsel or otherwise to carry on such compromises or arbiwation and perform or enforce anY award entered in arbitration. 14. .INSTITUTION AND DEFENSE OF CLAIMS, To institute, prosecute, defend, compromise, or otherwise dispose of, and to appear for me in, any proceedings at law or in equity or otherwise before any tribunal for the enforcement or for the defense of any claim, either alone or in conjunction with other persons, relating to me or to any property of mine Or any other person (including the authority to sue if this power of attorney is not honored), and to retain, discharge and substitute counsel and authonz~ in any such' action of proceedings. 15. TAXES. To prepare, execute and file in my name and on my behalf any return, report, protest, application for correction of assessed valuation of real or other property, appeal, brief, claim for refund, or petition, including petition to the United States Tax Court, in connection with any tax imposed or purported to be imposed by any government, authority or agency, or claimed, levied or assessed by any government, authority or agency and to pay any such tax and to obtain any extension of time for any of the foregoing; to execute waivers of restrictions on the assessment and collection of deficiency in any tax; to execute closing agreements and all other documents, instruments and papers relating to any tax liability of mine of any sort; to.institute and carry on either through counsel or otherwise any proceeding in connection with contesting any such tax or to recover any tax paid, or to resist any claim for additional tax or any proposed assessment or levy thereof, and to enter into any agreements of stipulations for compromise of other adjustment or disposition of any tax. 16. DISCLAIMER_ To execute, deliver and file or record disclaimers of any part or all of any property, power or interest passing to or for me under any will, deed of trust or otherwise. 17. E. MPLOYMENTOFOTI4E_.RS To employ accountants, attorneys-at-law, investment counsel, custodians, agents, servants, and others, and to delegate to them, to remove them, and to pay them such remuneration as my attorney shall deem proper. 18. REVOCABLE TRUST TO BE CREATED. To execute any revocable deed of trust on my behalf'under the terms of which (i) my agent or any one or more other persons or corporations with fiduciary powers selected by my agent is named as the trustee or trustees, (ii) during my lifetime the entire net income and as much principal as I. my agent or my trustee thinks is desirable shall be paid to me or for my benefit (including those I am legally obligated to support), and (iii) upon my death the principal and any undistributed income shall be payable to the executor or administrator of my estate; and to transfer property to the trustee or trustees thereunder. 19. REVOCABLE TRUSTS PREVIOUSLY CREATED. To add any property to any revocable deed or trust executed by me for my benefit even through the trust may not be -- - payable upon my death to my estate and to revoke in whole or in part any such trust. 20. For the purpose of recording my wishes in convenient plai:e, I record here that if it is necessan, to appoint a guardian of my person or a guardian of my estate it is my desire that my agent be apl~ointed. 21. GIFTS. To make gilts which do not exceed my annual federal gilt tax exclusion or other tax exempt glib. 22. GENERAL. To do all things which my agent shall deem proper in order to carry out any of the foregoing enurnemted powers, which shall be construed in the broadest possible manner. In no event shall my agent take any action concerning a policy of' insurance on my agent's life. The descripl}ve headings of this general power attorney are inserted for convenience only and shall not be deemed to affect the meaning or construction of any of the provisions hereof or to limit in any way the construction thereof in the broadest possible manner. 23. SUBSTITUTION. My agent shall have the full power of substimti°n and revocation, and such substitution or revocation may relate to, or be limited to, any one or more or ali foregoing acts or pow.ers, or be limited as to time or in such other respect as my agent shall deem 24. RATIFICATION. I hereby ratify and confum ali that my agent or the substitute or substitutes therefor shall lawfully do or cause to be done by virtue h~reof. 25. RELIANCE BY OTI~.R.~. This power of attorney shall continue in force and may be accepted and relied upon by anyone to whom it is presented despite my purported revocation of this power, the age of this power, the issuance of a 'court decree declaring my incompetency or my death, until written notice of such event is received by such person. 26. EFFE~ OF MY DISABIL_ITY This power of attorney shall not be affected by my disability or incapacity and shall specifica/iy continue atter such disability and incapacity. 27. GOVERNING LAW. This power of attorney shall be governed by and interpreted in accordance with Pennsylvania law. __ _ COMMONWEAL~ OF PENNSYLVANIA · : SS. - COUNTY OF CUMBERLAND : officer, personally appeared Mildred ,/. g]erber, kno~n to me (or satisfactory proven) to be the petson'whose name is subscribed to the foregoing insuument, and acknowledged that she executed it for the purpose therein contained. Witness my hand and official sea] the day and year aforesaid. · " . 'N tary Public I, F~e~ck E. Gerber, H, ~ve r~ ~e a~ched ~ower of a~omey ~ ~ ~e Felon iden~ed ~ ~e ~ent for ~e p~cip~. I he, by ac~owledge ~t ~ ~e absence of a specific p~vision to ~e ~n~ ~ ~e ~wer ofa~omey or ~ 20 P~C.S when I act ~ agent: I ~l exe~ise ~e powe~ for ~e ~e~t of ~e p~cip~. I s~l k~p ~e ~se~ of~e p~cip~ sep~e ~om my ~ets. I s~l exe~ ~o~ble ~u~on ~d p~ence. I ~1 k~p a ~1 ~d ~e ~cord of ~l action, ~ceipts ~d disb~emen~ on be~if of~e p~cip~. COMMONWEALTH AFFII,IATES, P.C. A Psychiatric & Psychological Association Suite 38, Northwood Office Center 2215 Forest Hills Drive Harrisburg, PA 17112 Office: (717) 540-5353 Fax: (717) 540-5151 March 21, 2001 Kimberly Young, MD Dunham US Army Health Clinic 450 Bigner Road, Suite 1 Carlisle Barracks, PA 17013-5003 Re: Mrs. Mildred Gerber Dear Dr. Young: I recently had the opportunity, along with the rest of our geriatric assessment team, to evaluate your patient, Mrs. Mildred Gerber. The interpretive interview was held on this date with Mrs. Gerber, as well as her son, Frederick, in attendance. In reviewing the information from Colonel Gerber, as well as what was supplied to us by her clinical psychology evaluation in the past, we were able to consolidate our interview process as well as to compare neuropsychological results from one point in time to another. To summarize Mrs. Gerber's presentation, she has had somewhat of a precipitous cognitive decline, i.e., problems with perception, thought and memory over the last two years. In reviewing her neurologist's evaluation in 1999, at which time her Mini Mental Status was 30 out of 30, as compared to what it is that wa see today, we see a 50% decline, at least on that test alone. For example, she lost 6 points alone in orientation and all 3 points in recall, indicative of a highly possible problem with cognitive abilities. In addition to that, her Clock Drawing Test was greatly impaired. Aside from being able to place the numbers on the face of the clock, when asked to place the hands of the clock at 2:45, she wrote a straight line to all of the numbers on the clock and then concretely placed the numbers 2:45 on the face of the clock. Mrs. Gerber's cognitive condition is somewhat complicated by the information provided by the family and documented by the court system, that there is a possible impropriety as it relates to her oldest daughter's interaCtion with her as it relates to financial affairs. In fact, there is an ongoing guardianship Exhi bi- "c_." Mrs. Mildred Gerber 2 March 21, 2001 process that is not only contentious but also emotionally draining to Mrs. Gerber at the present time. In reviewing our current evaluation, i.e., neuropsychological tests, Mrs. Gerber wes both pleasant and cooperative and attempted all the tasks presented. She presented as a clean, welt groomed and stylishly dressed woman who wes talkative and befuddled in her speech. She was struggling with the tangentiality as it related to her stream of thought· There wes evident anomia, i.e., word finding difficulties. In looking at the Wechsler Memory Scale Revised, her verbal memory wes 68, her visual memory score wes 73, leading to a General Memory Index of 65, all two to three standard deviations below the norm. Most significantly, her attention and concentration wes 62, two and a half standard deviations from the mean. Delayed recall wes 56, three standard deviations below the mean, all three indicating severe memory impairment. The inclusions of Michael S. Greevy, Ph.D., our clinical psychologist, wes that Mrs. Gerber "had severe impairment in attention and concentration, as well as delayed recalled being severely impaired." The results on a clinical basis would indicate that Mrs. Gerber would have significant difficult cadng for herself without 24-hour supervision. Based upon this evaluation, the diagnosis according to the DSM-IV would be as follows: Axis I: Senile Onset Dementia, probable mixture of vascular and Alzheimer's type. Based upon this evaluation and diagnosis, I would recommend the following: 1. It does appear that Mrs. Gerber could benefit from the institution of a cholinesterase inhibitor, i.e., Adcept at an initial dose of 5 mg. at h.s. If after 8 weeks this medication dose is tolerated, it can be increased to 10 mg. at h.s. 2. There does appear to be an element of depression and the ongoing difficulty with gdeving the loss of her husband. Having said that, then I would suggest that if she tolerates the Adcept well and the depression is _ still prominent, then she could be administered Celexa 10 mg. q.a.m, to be increased to 20 mgl as tolerated. 3. It would seem appropriate to pursue guardianship as Mrs. Gerber is not able to not only take care of her activities of daily living but to manage her financial assets as well. 4. I did recommend to Colonel Gerber that his mother could benefit from ongoing counseling as well as case management services. We will attempt to provide that as well. Mrs. Mildred Gerber 3 March 21, 2001 I'm hopeful that this information is helpful to your care of Mrs. Gerber. If I can be of further assistance to you, please do not hesitate to contact our office. Sincerely yours, Roger O. Cadieux, MD RJC/IId cc: Colonel Frederick E. Gerber 3313-1205 Windham Circle Alexandria, VA 22302 COMMONWEALTH AFFILIATES, P.C. A Psychiatric & Psychological Association Suile 38. Norlhwood Center Roger J. Cadieux, M.D. 2215 Forest Hills Drive MD 020877-E Harrisburg, Pa 17112 Office: (717) 540-5353 Name: Address: ~ Date: In order for a brand name producl lo be dispensed Ibc pre~ "Brand Necessary" or "Brand Medically Necessary" in the s~acc below. [ Suhslilulion Permissible Dr. Refill, limes. D.E.A. Reg. GUARDIAN'S CONSENT I, Frederick E. Gerber, II, consent to be the guardian of the person for Mildred E. Gerber, my mother, the alleged incapacitated person. Date: 8- I. 0 -o ~ ~11_~_ - F~erber, II VERIFICATION I, Frederick E. Gerber, II, verify that the facts set forth in the foregoing Petition are true and correct to the best of my knowledge, information and belief. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. Date: ~- 1.0- 0 \ F( ~ 1~- -- rber, II