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Home My WebLink About01-0238 .. . April 29, 2002 IJi~ olln-7 r" .~) -_, Cumberland County Court House Recorder of Wills 3 South Hanover Street Carlisle, P A 17013 , . . " In Re: Helen A Richwine, Docket #21-01-238, Civil Orphans Court I am writing to report that Helen Richwine died December 30, 2001, Previous to her death, Helen lived at 320 North 21 st Street, Camp Hill, P A 17011, a CP ARC Residential Group Home. Helen's medical diagnoses include dementia, cancer of uterine lining (resolved with surgery), diabetes, irritable bowel syndrome, bilateral moderate hearing loss, gallstones, hypertension, Alzheimer's disease, hydrocephalus and moderate mental retardation. Her mental health diagnoses include bipolar disorder, anxiety and depression. Helen saw her family physician approximately every 3 months. She had annual dental exams, audiology evaluations, and eye exams. Helen had psychiatric medication reviews every 2 to 3 months, gynecologic exams every 6 months, and saw her neurologist as needed. Staff provided 24-hour supervision, and support with all areas of Helen's daily living (meals, medications, laundry, self-care, transportation, community involvement, etc.) Helen attended an elderly day program three days a week as well. Helen's cause of death as noted on her certificate of death is: cardiopulmonary arrest, myocardial infarction and coronary artery disease. Sincerely, ~(k\ j) SLC4( l\tdith Scholl Plenary Guardian of Helen Richwine I~>I c A, -:hi~ 1S to certify that the information here given is correctly copied from an original certificate of death duly fIled with me as Loca! Registrar. The original certifIcate will be forwarded to the State Vital Records Office for permanen~ filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ""11(11111"'h'"",-",, 'IIII~~\.\" OF PE,i"-" ~ll~/~~t!'J~ ~\ ~I _ Iib.~'''' \~":. ~~( "'~' '?~ ~~/ .c~,_ - \~~ ,.,il ~. !~~ \ ~~~.~:;~ '. !.':/ - ~- / ~ ,-~ ~rA /~I\ -:. :.t~ -------<~r II ----:.,;T1MEN1-\\"= ~ ItI"l '''''''''''''''/1#11111111 I" If W'JL f? ' tL Fee for this certificate. $2.00 Local Registrar P 8010219 ~Lt.1i Ju. ~L ~ 2()o~ 1110; i4J H.w 2181 COMMONWEALTH Of PENNSYlVANIA e OEPARTMENT Of HEALTH e VITAL RECOROS CERTIFICATE OF DEATH , PI:.JPRINT N....uE Of DECEDENT If .rSf_ M.doIe, Loi.sa>> SEX Female STATE FilE NUWSER SOCI"L SECuRITY NUMBER 192 _ 52_ ,( PI"......EN r Bl..CK INK 2. "GE Il.51 B"""'.y) UNDER 1 YEAR MonIho Daye -- BIRI HPlACE iCo'; "r.d 31a1801 fCleqoCououyJ PLACE CW DEATH ICtoeck ONy (Jfle - - .;.ee ,,1SlfUcl.c:)flS on Oftlel ~) HOSPITAl. Inp..._ ~ ERlOuIpaI"'" 0 72 y,. 5 COUNTY OF OERH Cumberland East Pennsboro White .... ... DECEDENT'SUSU"L OCCUPMION (~i':)(~.~'::u'::~:) Laborer KINO OF 8USINESS/INDUSIRY MARIT..l STMUS . .._.... Newer....,..... w_, ~eve'l'M~ried SURVIVING SPOUSE (It de, ~ve ffidlOetl Nmel I.. fATHER'S NAME IF.St .."""", La"l 320 North 21 st Street Camp Hill, Pennsylvania 17011 DECEDENT'S "CTUAI. RE SlDENCE ISee IOSlrUCl.ona on otIle' s.de) 12. 13. n.. Slale Pennsylvania Did ------- Ween. Cumberland _, 17..0 _.__lNe<bn - 17tt.Cou 17d_[j~:C=':::of Camp Hill e..,_ I.. INFQRWANT'S NAME (T ypetPrI"'l William D. Kling Carol Ferenz MOIHl::R.SN..ME,F......"".......,.,.,Sufnam.) Verna Agnes Rowe 10. INFOR.....NT'S117N~~~n'6t"e7St~e1.,C~\isle, Pa. 17013 2010. PlACE OF DISPOSITION. Heme 01 C._.r;, C'lII1lalOfy LOCATION. CilylTown. 51.... r., Code or 0U\8r PlM:. o u o o ! Mt Victory Cemetery Gardners, PA 17065 21c. lICENSE NU"BER FD-012662-L NA"E AND ADDRESS OF FAClury Uc. Myers Funeral Home, Inc 37 East Main Street Mechanicsburg, Pa 17055 lICENSE NUMBER DATE SIGNED (Month. Day. _, 23b. 2)c. DATE PRONOuNCED DEAD l"o"lh. D.v, Yearl Wl.S CASE REFERRED JO ..EOCAl. EXA..INERlCORONER1 24. /1. .3-() M 25. Q..L~ ~, .:J-b 0 I 28. - 0 21. PART I: Ent.' t~ dIMU.S. Intunes Of oompM:allOOlo whKh c.1used lhe dealh 00 nolanla, (he mode 01 dying, sucfl as cardiac 01 resplf3lo a(l8~. shod!; 01 heart fallur. I Approxlmata PART H: Other Stglur~ condnM:M\S concrlbuhng 10 deillh, bUt llsa only one CilUM on each tine t: =-..:=~ not re&ulNlg lr'lh ~ cauM gwen III PART I ~DlAlfCAUSf.{fll\dl (~ / ( /).... . =,,:,=~ · .14~.~iM:sfi-~~Z--JE~~~ .~~i- f-;;l-t~.~/,-.-t 1 A - l /";L ~ -.,... I I b ~~~;s~i-d.S[tU~E Of~L..L. ~L _~::s.: -------------:-- c \.. .(r....~' -~ \,,.--~.... "t/,.....,!.e. ^.,j" ( ~ ("~ : -1tiE~I~AsA6j'fQUENCEOf) -- -7 L! - - __L.~ - L ------r u ---- d _ _ _ _ . WERE "UTOPSY FINDINGS WANNER OF Ot:"TH D..TE OF INJURY TIME OF INJURY """IlABlE PRIOR 10 (Moortl. Dav. Veat) COMPLETION Of CAUSE Of' DEATH' NoD INJURY AI WOfIK1 IlESCRIB~ HOw INJURY OCCURRED Suoc... [)( [] n P.ndtng Inveshg.;lIton fJ [] [] ;~CE OF INJURY' Alllom4. I.rm~;"', 1ac1ar;, olfic. bu-';'. ..e ISpec,wl 30e. Yoo [] No fJ Y.. 0 No Ox ..- _. ~ LOC"TlON(SU_ ColyllOwn Sial., COUld no<< be delermlneo 301. . SIGNATURE AND TITlE OF CERTIFIER n3a . LICE. NSE NU"BER ,< .-. ~. :3. C ~"TE SlGNEZt;' "'~Da . '".". []31.M1>-(.'. 1/ I. (;~ 3~_.L __~_ ~-____ N....E AND "DDRESS Of "WON 'fIHO COM-.!')oHED yolWSE 'Jf)!Af [] (lIem17l1Ypeor;~) ~((~4.73-r::..V/y-?' hi I) 32. ,Jj..,.........(~>L )" ki.' ,,":: /), //"(1 :L~~ DATE FILED 1"'''''1h Dav Vel" ~ qJ.lJ IT rc.y 2 / 2 ()o 2. 34 2... 2.... UATIFIEA ICt'eck 001" onel .CERTIFYING PHYSICIAN l,Phy"SlC:klO CetbtyltlQ cause 01 tkalh .....hen .mo.lhe' l)h....s.c,ao hdS plOflOUOCed dedlh dnucun~eled Item 23) To Ihe beat 01 my knowa.dge. de.th OCCUlTed due ao .... cauw(s) and manner .. s.ated 29. 'PAONOU..CING AND CERTIFV.NO PHYSK:IAH tPhvs.cldn h(Jlt~ ;..l1~llOUllClng lJedltl dlld l:ellIIYI()Q lo..:ause 01 aedtf\l To th. baal 01 my kl'lOwladga, death occurred ~t the u.n., dat., and place, and due 101M cause(a) and manne' U s'aled.. 'MEDICAl EXA..INERICORONER On the b..i. of ..aminaUon andlor 'n"eshg.atlon. in my opinion, death occurred ilt Ihe lime, dille, and place, and due to the cause(a) and ". :::~~ii:"K~t!=__n_- - L21112~E I . .; IN THE COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT 2001 PETITION OF CATHERINE CORNMAN TO CONSIDER HELEN A. RICHWINE'S PRIOR FUNERAL ARRANGEMENTS, TO PREVENT CIRCUMVENTION OF PRIOR FUNERAL ARRANGEMENTS AND PROVIDE FOR IMPLEMENTATION OF PRIOR FUNERAL ARRANGE- MENTS THROUGH HOLLINGER FUNERAL HOME AS PREVIOUSLY CONTRACTED. TO THE HONORABLE JUDGES OF SAID COURT: I have received notification of a Court Proceeding to be held in Court Room 3, Cumberland County Courthouse, Carlisle, PA on April 9, 2001 at 10:30 AM. I am expressing a desire that the court consider my concern in this proceeding. My concern is not about who is appointed Guardian of Helen A. Richwine. I am concerned that whomever is appointed as Guardian adhere to Helen A. Richwine's prior arrange- ments for burial should she become deceased. Helen A. Richwine made funeral arrangements with Hollinger Funeral Home, Mt. Holly Springs, PA and deposited money into a Burial Reserve Account with CCNB, N. A., P. O. Box 8, Mt. Holly Springs, PA. 17065 on November 4, 1981. This money has accumulated interest and is set aside for Helen A. Richwine's burial and in the manner arranged with the funeral home. Helen A. Richwine's funeral arrangements include being buried beside her adoptive parents Catherine and Charles Richwine at a specified burial site. Helen A. Richwine made no arrangements to be cremated and cremation should not be an alternate consideration. ,. IN RE: HELEN A. RICHWINE Page 2 There is sufficient money available in Helen A. Richwine's Burial Reserve Account for her burial in the manner Ghosen by her and previously arranged through Hollinger Funeral Home. I am asking the Court to address this concern because it is in the best interest of Helen A. Richwine. Copies to: Clerk of the Court In The Court of Common Pleas of Cumberland County, PA Orphans' Court Division ,Hon. Judge George E. Hoffer The Dale F. Shughart Community Law Center (Attorney for Petitioner Ms. Judith Scholl) Disability Law Clinic 45 North Pitt Street Carlisle, PA 17013 (717) 243-3696 Date: April 3, 2001 V~4/:?~~/ fit/! Douglas Richwine Power-of-Attorney for Catherine Cornman 5920 W. Wolf St. Phoenix, Az. 85033 IN THE COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT or A GUARDIAN NO. 238 ORPHANS' COURT 2001 PETITION OF CATHERINE CORNMAN TO CONSIDER HELEN A. RICHWINE'S PRIOR FUNERAL ARRANGEMENTS, TO PREVENT CIRCUMVENTION OF PRIOR FUNERAL ARRANGEMENTS AND PROVIDE FOR IMPLEMENTATION OF PRIOR FUNERAL ARRANGE- MENTS THROUGH HOLLINGER FUNERAL HOME AS PREVIOUSLY CONTRACTED. TO THE HONORABLE JUDGES OF SAID COURT: I have received notification of a Court Proceeding to be held in Court Room 3, Cumberland County Courthouse, Carlisle, PA on April 9, 2001 at 10:30 AM. I am expressing a desire that the court consider my concern 1n this proceeding. My concern is not about who is appointed Guardian of Helen A. Richwine. I am concerned that whomever is appointed as Guardian adhere to Helen A. Richwine's prior arrange- ments for burial should she become deceased. Helen A. Richwine made funeral arrangements with Hollinger Funeral Home, Mt. Holly Springs, PA and deposited money into a Burial Reserve Account with CCNB, N. A., P. O. Box 8, Mt. Holly Springs, PA. 17065 on November 4, 1981. This money has accumulated interest and 1S set aside for Helen A. Richwine's burial and in the manner arranged with the funeral home. Helen A. Richwine's funeral arrangements include being buried beside her adoptive parents Catherine and Charles Richwine at a specified burial site. Helen A. Richwine made no arrangements to be cremated and cremation should not be an alternate consideration. I ,. IN RE: HELEN A. RICHWINE Page 2 There is sufficient money available in Helen A. Richwine's Burial Reserve Account for her burial in the manner chosen by her and previously arranged through Hollinger Funeral Home. I am asking the Court to address this concern because it is In the best interest of Helen A. Richwine. Copies to: Clerk of the Court In The Court of Common Pleas of Cumberland County, PA Orphans' Court Division Hon. Judge George E. Hoffer The Dale F. Shughart Community Law Center (Attorney for Petitioner Ms. Judith Scholl) Disability Law Clinic 45 North Pitt Street Carlisle, PA 17013 (717) 243-3696 Date: April 3, 2001 c;()~~~k~ /11/l Douglas Richwine Power-of-Attorney for Catherine Cornman 5920 W. Wolf St. Phoenix, Az. 85033 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION IN RE: HELEN A RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT 2001 ORDER OF COURT AND NOW, this _ day of , 2001, after hearing, it is determined that Helen Arlene Richwine is incapacitated to make or communicate responsible decisions regarding her care, and accordingly, Judy Irene Scholl is appointed the plenary guardian of her person. By the Court, Hon. George E. Hoffer IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT 2001 ORDER OF COURT AND NOW, this _ day of , 2001, after hearing, it is determined that Helen Arlene Richwine is incapacitated to make or communicate responsible decisions regarding her care, and accordingly, Judy Irene Scholl is appointed the plenary guardian of her person. By the Court, Hon. George E. Hoffer IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT 2001 ORDER OF COURT AND NOW, this _ day of , 2001, after hearing, it is determined that Helen Arlene Richwine is incapacitated to make or communicate responsible decisions regarding her care, and accordingly, Judy Irene Scholl is appointed the plenary guardian of her person. By the Court, Hon. George E. Hoffer IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT 2001 ORDER OF COURT AND NOW, this _ day of , 2001, after hearing, it is determined that Helen Arlene Richwine is incapacitated to make or communicate responsible decisions regarding her care, and accordingly, Judy Irene Scholl is appointed the plenary guardian of her person. By the Court, Hon. George E. Hoffer IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN : NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I, hereby certify that I served a true and correct copy of the Citation and Petition of Guardianship, on the following: Catherine Cornman RD4 Skyview Drive Hershey, P A 17033 by U.S. mail, certified, return receipt requested and postage paid, on March 14, 2001. Dated: April 5, 2001 ~~ Jonathan Fish Certified Legal Intern DISABILITY LA W CLINIC 45 N. Pitt St. Carlisle, P A 17013 717 -243-3696 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE : ADJUDICATION : OF INCAPACITY AND : APPOINTMENT OF A GUARDIAN : NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the Citation and Petition for Guardianship on the following: Mark Evans CumberlandlPerry- MH/MR 16 West High Street Carlisle, P A 17013 by U. S. Mail, first class. Service was completed on March 15th, 2001 at approximately 4:00 p.m. Dated: March 29,2001 5k Jonathan Fisher Certified Legal Intern DISABILITY LA W CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 HELEN A. RICHWINE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NC(" '~ - 238 ORPHANS' COURT 2001 IN RE: IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with this Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by DISABILITY LAW CLINIC is attached. You are hereby ordered to appear at a hearing to be held in Court Room No. 3 , Cumberland County Courthouse, Carlisle, Pennsylvania, on APRIL 9 ,2001_, at 10: 30 A .M. to tell the Court why it should not find you to be an Incapacitated Person and appoint a Guardian to act on your behalf. To be an Incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation be conducted as to your alleged incapacity. If the Court decides that you are an Incapacitated Person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to ~}~- , ...:..~.: ~-':..:-::" ;".. +. . - -. .'-'" .~t-"'-..... _. ...--...----- ~ , . make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited or full powers to act for you. " If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or gift of your money or other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the hearing in your absence and may appoint the Guardian requested. By: ('\ , .~. / \ - , . ; () I /)/(ta C, ~1 -<- ' Clerk, rphans ( Court DIVISIon Cumberland County, Carlisle, PA My Commission Expires 1 st Monday, January, 200~__ DATED: MARCH 13,2001 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADJUDICA TION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the Citation and Petition for Guardianship on the following: Esther M. McNaughton 17 Maurice Drive Mt. Holly Springs, P A 17065 by U. S. Mail, first class. Service was completed on March 15th, 2001 at approximately 4:00 p.m. Dated: March 29,2001 .-s.f:: Jonathan Fisher Certified Legal tern DISABILITY LA W CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE : ADmDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I hereby certify that I served a true and correct copy of the Citation and Petition for Guardianship on the following: Pam Shenk Cumberland/Perry Association of Retarded Citizens 117 N. Hanover Street Carlisle, P A 17013 by U. S. Mail, first class. Service was completed on March 15th, 2001 at approximately 4:00 p.m. Dated: March 29, 2001 5k- Jonathan Fishe Certified Legal Intern DISABILITY LA W CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADmDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN : NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I, hereby certify that I served a true and correct copy of the Citation and Petition of Guardianship, on the following: Catherine Cornman RD4 Skyview Drive Hershey, PA 17033 by U.S. mail, certified, return receipt requested and postage paid. Dated: March 14 , 2001 ~~ Jonathan Fish r Certified Legal Intern DISABILITY LAW CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 ,;),-C" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT AFFIDAVIT OF SERVICE I, Pam Shenk, hereby certify that I am a competent adult who is not a party to these proceedings and that I served a true and correct copy of the Citation and Petition for Guardianship on the alleged incapacitated person, Helen A. Richwine, by hand delivering a copy of the same to Helen A. Richwine at 117 N. Hanover Street, Carlisle, Cumberland County, Pennsylvania, at 3: 15 pm on March 15,2001. I verify that the statements made in this Affidavit of Service are true and correct to the best of my personal knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. S 4904, relating to unsworn falsification to authorities. Date: March 29,2001 ~~~ Pam Shenk " .. MAR 2 320D1tP C~ IN THE COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADmDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS COURT 2001 ~ ORDEROFCOURT AND NOW, thiS~ day o~ 2001, upon review ofthe attached petition, it is hereby ordered that Eugene H. Stecher, M.A., may testify by telephone at the hearing regarding the adjudication of incapacity and appointment of a guardian of the person of Helen Arlene Richwine. By the Court, . : IN THE COURT OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION In re: Helen A. Richwine : ADJUDICATION OF : INCOMPETENCY AND APPOINTMENT : OF A GUARDIAN OF THE PERSON : No. 238 ORPHANS COURT 2001 PETITION TO ALLOW EUGENE H. STECHER. M.A.. TO TESTIFY BY TELEPHONE IN THE HEARING REGARDING ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON OF HELEN ARLEN RICHWINE Petitioner, Judith Irene Scholl, hereby petitions this Court to allow Eugene H. Stecher, M.A., to testify by telephone in the hearing regarding the adjudication of incapacity and appointment of guardian of the person of Helen A. Richwine. In support of her petition, Judith I. Scholl avers as follows: 1. A hearing has been scheduled in this matter regarding the incapacity and guardianship of Helen A. Richwine. The hearing is scheduled for April 9, 2001, at 10:30 a.m., The Honorable George E. Hoffer presiding. 2. At the hearing, the petitioner plans to call Eugene H. Stecher, M.A., as an expert witness. Mr. Stecher will offer testimony pertaining to the psychological evaluation which he performed on the alleged incompetent, Helen A. Richwine. A copy of the psychological evaluation is attached as Exhibit A. 3. On April 9, 2001, Mr. Stecher will only be available via telephone from 10:30 a.m. to 11:30 a.m. 4. Mr. Stecher has been allowed to testify via telephone in past guardianship proceedings. 5. Mr. Stecher's testimony is important to a valid determination of Ms. Richwine's capacity. 6. Telephone testimony will help to reduce the costs of this proceeding. This will benefit C-PARC, which is financing this action for the benefit of Ms. Richwine. WHEREFORE, counsel for petitioner respectfully requests that this Court allow the telephone testimony of Eugene Stecher, M.A., at the hearing regarding the incapacity and guardianship on Helen A. Richwine. f:- .--s ~'J J onathan Fi~' r Certified Legal Intern Date: 3/2.3/0 I ~' ~ 'J { . L 1\/ R RT E. RAINS Supervising Attorney TER! HENNING Staff Attorney DISABILITY LAW CLINIC 45 North Pitt Street Carlisle, P A 17013 (717) 243-3696 ~ , r f)(hib/~ A MAIN OffiCE 412 Erford Road Camp Hill, PA 17011 Stanley E. Schneider, Ed.D. Director (iGUIDANCE ASSOCIA rES OF ,." PENNSYLVANIA ...... ~ Camp Hill: (717) 732.2917 Hershey: (717) 533-4312 Carlisle: (71 n 245-2289 Chambersburg: (717) 263.9392 fAX: (717) 732.5375 PSYCHOLOGICAL EVALUATION Client: BID: Age: Refemng Agency: Case Manager: Evaluation Date: Helen Richwine 8/24/29 70 Cumberland Peny MHJMR Susan Carbaugh 3/17/00 Referral Information. Helen has been referred for a psychological evaluation to help determine levels of intellectual functioning and daily adaptation toward qualification for the services of Medical Guardianship. . Assessment Tools. Observation and Interview, Wechsler Adult Intelligence Sca1e-llI, Bender Motor Gestalt Test, Human Figure Drawing. Obsen'ation. Helen was accompanied by Karen Connolly who is a Family Living Program Supervisor with C-P ARK. She presented as a smiling excitable woman of short stature, casually attired, who was quite talkative and expressed fears that she would be taken from her current living quarters. Speech was clear for the most part, but there were severe deficits in comprehension and information processing that required many repetitions of even simple questions. Helen also quite easily and frequently forgot the task at hand and verbally pursued her own agenda. Additionally, we were only briefly into the testing when she began making .. statements such as, "fm getting tired now." However, she was able to make an attempt with all items presented. Inten'iew. Helen resides with David and Nancy Rose who are Family Living Providers with C- PARK. From 1973 until 1998 Helen's had resided in a Group Home. Helen has been diagnosed with the onset of Alzheimer's disease, and recently an operation was performed which placed a shunt to relieve pressure on the brain. Helen is able to help out at home with simple tasks such as setting the table. However, she needs assistance with all personal care tasks, and she is not trusted to take independent walks. Helen is quite sociable, and on a normal week day schedule she attends the Messiah Elderly Day Activities Center three times per week. She also goes many places with the Rose family. Another enjoyable activity for her is coloring. TV is not a primary activity. There is very occasional contact from a family member. Standardized Assessment. Results of the WAIS-ID follow: Verbal IQ - 55 Performance IQ - 47 Full Scale IQ - 46 ~Comprehensive Psychological Services . Drug and Alcohol Treatment.::::fJ r . , V erhal Tests Vocabulary Similarities Arithmetic Digit Span Infonnation Comprehension Scaled Scores 3 2 2 2 2 2 Performance Tests Picture Completion Digit Symbol-Coding Block Design Matrix Reasoning Picture Arrangement Scaled Scores 1 1 I- I I By these measures of cognitive skills Helen is functioning in the moderate range of mental retardation. Although the lowest possible scaled scores are recorded for the performance subtests, the scores are still deceiving because Helen only responded to one item correctly among all of the tests. Therefore, we might reasonably conclude that a neurological factor may be interfering with information processing in the visual/perceptual channel. The nine Render figures were presented to Helen to copy in order to obtain information about intellectual level and to screen for possible neurological complications. Helen could reproduce a circle, simple angles, and a wave, but she could not combine them to maintain the gestalt of any figure. When asked to copy a series of dots she wrote down a series of numbers. In the context of her WAIS-ill scores, the Bender performance suggests moderate mental retardation with neurological complications. For her Human Figure Drawing Helen first drew an animal figure which she said was a duck, and then she drew a female figure with the appearance of a very young child, no more than a few years old. The developmental quality is consistent with the above observations about level of intellectual functioning. Diagnostic and Oinical Impressions. The data consistently suggests a diagnosis of Moderate mental retardation (318.0) with neurological complications (294.9). The previous diagnosis of '. Alzheimer's disease suggests a continuing deterioration of self-management competence over time. Helen is certainly very deserving of all services offered through the county :MR office. And, of course, a Medical Guardian could look after Helen's best interests by assisting her to express various awarenesses, experiences, and needs. .- ~~ ?/ AL" Eug e H. Stecher, M.A Psychologist GAP/MHMREva1/HelenRichwine 3/17/00 2 VERIFICA TION I verify that the statements made in the foregoing PETITION TO ALLOW EUGENE H. STECHER, M.A., TO TESTIFY BY TELEPHONE IN THE HEARING REGARDING ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON OF HELEN ARLEN RICHWINE are true and correct, to the best of my knowledge, information and belief. I understand making any false statement would subject me to the penalties of 18 Pa.C.S. ~4904, relating to unsworn falsification to authorities. ."5. . i ~ Jonathan Fis;L - Certified Legal Intern '--r " -/- L ^ // ~ ~RTE. RAINS- Supervising Attorney TERI HENNING Staff Attorney Date: 3iz3/01 . IN THE COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE ADmDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS COURT 2001 CERTIFICATE OF SERVICE I, hereby certify that I served a true and correct copy of the Petition To Allow Eugene H. Stecher, M.A., To Testify By Telephone In The Hearing Regarding Adjudication Of Incapacity And Appointment Of A Guardian Of The Person Of Helen A. Richwine, on the following: Helen Richwine 17 Maurice Drive Mt. Holly Springs, P A 17065 Catherine Cornman RD4 Skyview Drive Hershey, PA 17033 Pam Shenk CumberlandlPerry Association of Retarded Citizens 117 N. Hanover Street Carlisle, P A 17013 Mark Evans CumberlandlPerry- MHlMR 16 West High Street Carlisle, P A 17013 Esther M. McNaughton 17 Maurice Drive Mt. Holly Springs, P A 17065 . Hilda Richwine 1255 Goodyear Rd. Gardners, PA 17324 Zula Richwine 1255 Goodyear Rd. Gardners, PA 17324 by U.S. mail, first class. Dated: March 23, 2001 Jonailian :2cr ~ Certified Legal Intern DISABILITY LAW CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 IN THE COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In re: Helen A. Richwine ADmDICATION OF INCOMPETENCY AND APPOINTMENT OF A GUARDIAN OF THE PERSON NO. 238 ORPHANS COURT 2001 CONSENT AND APPROVAL FOR APPEARANCE UNDER Pa.B.A.R. 322 I, Judith Irene Scholl, hereby consent to the appearance of Jonathan Fisher, a Certified Legal Intern under the supervision of an attorney, on my behalf in the above-entitled proceeding before the Honorable George E. Hoffer at 10:30 a.m. on Monday, April 9, 2001. Date O~ 109/0 J GUi% )~(( . JutJ Irene Scholl l As the supervising attorney for Jonathan Fisher, certified under Pa.B.A.R. 322, I approve of his appearance on behalf of the above-named client in the above-named proceeding. Date 0'1 / CPt 101 rp~z:~ ~RT E. RAINS Supervising Attorney TERI HENNING Staff Attorney DISABILITY Y LA W CLINIC 45 North Pitt Street Carlisle, P A 17013 717-243-2968 - iii 1 , Stanley E. Schneider, Ed.D. Director, Guidance Associates 412 Erford Road Camp Hill, P A 17011 (717) 732-2917 Guidance Associates of P A Branch Office 473 Lincoln Way East Chambersburg, P A 17201 RESUME 2001 Eugene H. Stecher, M.A. 473 Lincoln Way East Chambersburg, Pa. 17201 Work Phone: 717-263-9392 e-mail: stecher@pa.net Education 1965 - A.B., Albright College, Reading, Pa. 1968 - M.Div., lTnited Seminary, Dayton, Ohio. 1983 - M.A., Loyola College, Baltimore, Md. Work History 1968-1973 - Pastoral Ministry. 1973-1980 - Pa Dept. of State, various professional and administrative positions. 1975-1987 - Director, CONTACT-Chambersburg, 24-Hour Helpline. 1982-1983 - Wilson College, Coordinator of Counseling Services. 1983-1984 - Special Assistant, State Board of Psychology. 1983-1987 - Psychological Associate, Guidance Associates ofPa. 12/3/87 to present - Psychologist in private practice Experience and Contracts: Not Current Research and Statistics: State Board of Psychology. Evaluations: Scotland School for Veterans' Children. Therapist: Letterkenny Anny Depot Health Clinic. Group Education Programs: Franklin/Fulton D/A Council. Child Custody Mediation Officer: 39th Judicial District (1990-1995) Current Exoerience and Contracts: Evaluations. Therapy. Consultation Self, professional, and agency referrals: Families/CoupleslIndividuals EAP/Managed Care Contracts: Magellan, United Behavioral Health, and others Credentialed by state offices: Medical Assistance, BDD, OVR Guidance Associates of Pa, Camp Hill Eugene H. Stecher, M.A. Licensed Psychologist 473 Lincoln Way East Chambersburg, P A 17201 (717) 263-9392 Professional Credentials Pennsylvania Psychologist License (Ps-005074-L). Pennsylvania Psychological Association (Member). Registered Custody Evaluator, Professional Academy of Custody Evaluators (Diplomate). ;: PETITIONER'S · EXHIBIT i .s i y!tt!OIrlv( U E- C"'" C' i if r.: n ,'\, Y,'1 S ~ Jrp4 n. ,-, .J l.., 1...... I', ~ '<~ J . Counseling · Psychological Testing · Anger Management · Mediation/Custody · lItigation ,,- . . , MAIN OFFICE 412 Erford Road Camp Hill, PA 17011 Stanley E. Schneider, Ed.D. Director ~GUIDANCE ASSOCIA YES OF ,.' PENNSYL VANIA ~ ~ PSYCHOLOGICAL EV ALVA nON Camp Hill: (717) 732-2917 Hershey: (717) 533-4312 Carlisle: (717) 245-2289 Chambersburg: (717) 263-9392 FAX: (717) 732-5375 Client: BID: Age: Referring Agency: Case Manager: Evaluation Date: Helen Richwine 8/24/29 70 Cumberland Perry MH&1R Susan Carbaugh 3/17/00 Referral Information. Helen has been referred for a psychological evaluation to help determine levels of intellectual functioning and daily adaptation toward qualification for the services of Medical Guardianship. Assessment Tools. Observation and Interview, Wechsler Adult Intelligence Scale-ill, Bender Motor Gestalt Test, Human Figure Drawing. Observation. Helen was accompanied by Karen Connolly who is a Family Living Program Supervisor with C-P ARK. She presented as a smiling excitable woman of short stature, casually attired, who was quite talkative and expressed fears that she would be taken from her current living quarters. Speech was clear for the most part, but there were severe deficits in comprehension and information processing that required many repetitions of even simple questions. Helen also quite easily and frequently forgot the task at hand and verbally pursued her . ~ own agenda. Additionally, we were only briefly into the testing when she began making '. statements such as, "I'm getting tired now." However, she was able to make an attempt with all items presented. Interview. Helen resides with David and Nancy Rose who are Family Living Providers with C- PARK. From 1973 until 1998 Helen's had resided in a Group Home. Helen has been diagnosed with the onset of Alzheimer's disease, and recently an operation was performed which placed a shunt to relieve pressure on the brain. Helen is able to help out at home with simple tasks such as setting the table. However, she needs assistance with all personal care tasks, and she is not trusted to take independent walks. Helen is quite sociable, and on a normal week day schedule she attends the Messiah Elderly Day Activities Center three times per week. She also goes many places with the Rose family. Another enjoyable activity for her is coloring. TV is not a primary activity. There is very occasional contact from a family member. Standardized Assessment. Results of the WAIS-ill follow: Verbal IQ - 55 Performance IQ - 47 Full Scale IQ - 46 ~Comprehensive Psychological Services ; PETITIONER'S J qlBIT I ~ 11 If) I ~ Drug and Alcohol Treatment ~ . . . Verbal Tests Vocabulary Similarities Arithmetic Digit Span Information Comprehension Scaled Scores 3 2 2 2 2 2 Perfonnance Tests Picture Completion Digit Symbol-Coding Block Design Matrix Reasoning Picture Arrangement Scaled Scores 1 1 1 1 1 By these measures of cognitive skills Helen is functioning in the moderate range of mental retardation. Although the lowest possible scaled scores are recorded for the performance subtests, the scores are still deceiving because Helen only responded to one item correctly among all of the tests. Therefore, we might reasonably conclude that a neurological factor may be interfering with information processing in the visual/perceptual channel. The nine Bender figures were presented to Helen to copy in order to obtain information about intellectual level and to screen for possible neurological complications. Helen could reproduce a circle, simple angles, and a wave, but she could not combine them to maintain the gestalt of any figure. When asked to copy a series of dots she wrote down a series of numbers. In the context of her W AIS- ill scores, the Bender performance suggests moderate mental retardation with neurological complications. F or her Human Figure Drawing Helen first drew an animal figure which she said was a duck, and then she drew a female figure with the appearance of a very young child, no more than a few years old. The developmental quality is consistent with the above observations about level of intellectual functioning. Diagnostic and Clinical Impressions. The data consistently suggests a diagnosis of Moderate mental retardation (318.0) with neurological complications (294.9). The previous diagnosis of " Alzheimer's disease suggests a continuing deterioration of self-management competence over time. Helen is certainly very deserving of all services offered through the county 11R office. And, of course, a Medical Guardian could look after Helen's best interests by assisting her to express various awarenesses, experiences, and needs. ~. ?/ Ak;> Eug e H. Stecher, M.A. Psychologist GAPIMHMREvallHelenRichwine 3/17/00 2 Shelley A. Carrara. Esq. Deputy Prothonotary Patricia A. Henard Cmef Clerk Supreme Court of Pennsylvania Western District September 6, 2000 801 City-County Building Pittsbuflh. PA 15219 "12-565-2816 www.aopc.org Robert E. Rains, Esq. Disability Law Clinic 45 N. Pitt Street Carlisle, PA 17013 RE: Fisher, "Jonathan NO.SS9 INT 2000 Dear Attorney Rains: The above-named law student has been approved and certified under Pa. B.A. R. 321 and 322 by: Dickinson School of Law Fejdman, Harvey Associate Dean as 8 duly enrolled law student who has completed at least three (3) semesters of legal studies, or the equivalent thereof, as being of good character and competent legal ability, and as being adequately trained to perform as a legal intern as of September 5,2000. Pursuant to such certmcat;on and in accordance with and subject to the provisions of Pa. B.A.R. 321 and 322, the above-named student has been certified as a legal intern and you have been approved to perform the duties of supervising attorney. WITNESS my signature and the 8eal of this Court, September 6, 2000 lalf - PETITIONER'S 1 EXHIBIT i '-II t I MAR 05 200f{fJ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE eIVIL ACTION--ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. ~3t'. or.r1L ORPHANS COURT ~CO I AND NOW, this PRELIMINARY DECREE / yt.-. \"" r; (j day of 1Ft tLuV, ,~, I , upon consideration of the Petition for Adjudication of Incapacity And Appointment of a Plenary Guardian of The Person of Helen A. Richwine, it is hereby ORDERED and DECREED that: 1. A citation is awarded, directed to Helen A. Richwine, to show cause why she should not be adjudged an incapacitated person and why a plenary guardian of her person should not be appointed; the hearing thereon to be held in Court Room Cumberland County Courthouse, Carlisle, Pennsylvania, on4~c{ Cj ;Lth' I , at f t{;3 0 o'clock, -IfoMo 2. Petitioner shall cause to be served by personal service the Citation and 3 Petition, together with an attached Notice pursuant to the provision of 20 Pa.C.S.A. S 5511(a) upon Helen A. Richwine, the allegedly incapacitated person, at least twenty days prior to the Court hearing. The contents and terms of the Citation, Petition and Notice shall be explained to the maximum extent possible in language and terms the allegedly incapacitated person is most likely to understand in accordance with the provisions of 20 Pa.C.S.A 95511 (a). An affidavit of service containing specific averments as to the above requirements shall be presented at the beginning of the court hearing. 3. At least twenty days prior notice of the court hearing, together with a copy of the Petition, shall be given personally or by certified mail to all persons who are sui juris and who would be entitled to share in the estate of the alleged incapacitated person if she died intestate, in accordance with the provision of20 Pa.C.S.A. S 5511(a), and more particularly, to the following individuals: Catherine Cornman RD4 Skyyiew Drive Hershey, P A 17033 Hilda and Zula G. Richwine 1255 Goodyear Rd. Gardners, P A 17324 4. Petitioner and/or counsel for petitioner shall notify the court, in writing, at least seven days prior to the court hearing if counsel has not been retained by or on behalf of the allegedly incapacitated person in accordance with the provisions of 20 Pa.C.S.A.s5511(a). This notice shall also contain all pertinent information which would indicate to the Court whether or not counsel should be appointed to represent the interests of the allegedly incapacitated person. 5. The allegedly incapacitated person shall be present at the court hearing unless it is established by clear and convincing medical evidence that her physical or mental condition would be harmed by her presence in court in accordance with the provisions of20 Pa.C.S.A s5511(a). r. 1. : IN THE COURT OF : CUMBERLAND COUNTY , PENNSYLVANIA : ORPHAN'S COURT DIVISION In re: Helen A. Richwine : CIVIL ACTION-ADJUDICATION OF : INCOMPETENCY AND APPOINTMENT : OF A GUARDIAN OF THE PERSON : No. PETITION OF JUDITH IRENE SCHOLL SUPPORTING ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON OF HELEN ARLENE RICHWINE, AN INCAPACITATED INDIVIDUAL, PURSUANT TO 20 Pa.C.S. CH.55 TO THE HONORABLE JUDGES OF SAID COURT: The Petitioner, Judith Irene Scholl, residing at 130 East Locust Street, Mechanicsburg, Cumberland County, Pennsylvania, 17055, deposes and says: 1. Judith Irene Scholl is the named Petitioner in the above titled civil cause of action and Helen Arlene Richwine is the allegedly incapacitated person. 2. This petition is made to inform the Court as to the incapacity of Helen A. Richwine and appoint Judith A. Scholl as legal guardian of her person. 3. Helen A. Richwine is seventy-one (71) years old, has never been married and resides with Esther M. McNaughton, a private citizen, who resides at 17 Maurice Drive, Mt. Holly Springs, Cumberland County, Pennsylvania, 17065. Helen A. Richwine is not a patient of a mental hospital. 4. Name and address of person/institution providing residential services: Cumberland-Perry Association for Retarded Citizens ("C-PARC") 117 N. Hanover Street, PO Box 386 Carlisle, PA 17013 5. Names and addresses of other service providers: Cumberland/Perry - MH/MR (Case Management) 16 West High Street Carlisle, P A 17013 Case Manager: Susan Carbaugh Esther M. McNaughton 17 Maurice Drive Mt. Holly Springs, PA 17065 6. Helen A. Richwine's next of kin is her adoptive cousin (a member of Helen's adoptive family), Catherine Cornman, who resides in Hershey, Pennsylvania. She has asked that Helen refrain from contacting her by telephone. Another relative is Lucy Richwine, age eighty-eight (88), who resides in Mt. Holly, Pennsylvania. She is the widow of Helen's adoptive cousin, Ross Richwine. Lucy has given consent to Helen's medical procedures in the past. She is in agreement with this petition to determine Helen A. Richwine incapacitated and appoint Judith I. Scholl as her guardian of her person. 7. Guardianship of the person is being sought because Helen A. Richwine's mental retardation coupled with the onset of Alzheimer's disease impairs her capacity to make decisions. This petition is instituted to aid and benefit Helen A. Richwine. The nature of Petitioner's relationship with Helen is that of a close personal friend, as well as her long term acquaintance through C-PARC. 8. Petitioner is not seeking guardianship of the estate because C-PARC is better equipped to handle those matters than she. 9. Helen A. Richwine is incapacitated as defined in Chapter 55 of the Probate Estates and Fiduciaries Code. She is an adult whose ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that she is totally unable to meet essential requirements of her physical health and safety. 10. In a psychological evaluation (attached as Exhibit A) performed by Eugene H. Stecher, M.A., of Guidance Associates of Pennsylvania on March 17, 2000, Helen A. Richwine's range of functioning was determined to be "moderately mentally retarded." She is dependent upon others for self-management. She has limited independent personal care skills. The onset of Alzheimer's disease has compounded her pre-existing mental disability. 11. Helen A. Richwine also suffers from diabetes, irritable bowel syndrome, gallstones, hearing loss, and hypertension. 12. Efforts have been made to allow Helen to retain as much autonomy as possible. However, she continues to be dependent upon others to assist her in her personal care. This care is currently being provided by Esther McNaughton, with whom Helen resides. 13. Petitioner is qualified to be Helen A. Richwine's guardian because she is interested in her welfare and has no interest adverse to hers. In addition, Petitioner has ample experience caring for individuals with disabilities such as Helen A. Richwine's. Petitioner worked for approximately eight (8) years at "C-PARC," and managed the cases of twenty- seven (27) clients, including Helen A. Richwine's. Petitioner is currently pursuing a sociology degree at Wilson College. 14. Helen A. Richwine has no current guardian already appointed. 15. Petitioner hereby gives her written consent to become legal guardian of Helen A. Richwine for the duration of Petitioner's life or Helen A. Richwine's life, whichever shall end first. WHEREFORE, Petitioner respectfully requests that this court adjudicate Helen A. Richwine an incapacitated person and assign to Petitioner powers of guardianship of the person of Helen A. Richwine. or), / I] UJ, crt) J Date: ~ JI qj l,. c.,' \/' / ,1/ U'[1 ~/U I '5t-- Jonathan Fisher Certified Legal Intern ~/ L R . ~E. RAIN~ Supervising Attorney TERI HENNING Staff Attorney " J ~ / - DISABILITY LAW CLINIC 45 North Pitt Street Carlisle, P A 17013 (717) 243-3696 I verify that the statements made in the foregoing PETITION SUPPORTING ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON are true and correct, to the best of my knowledge, information and belief. I understand making any false statement would subject me to the penalties of 18 Pa.C.S. 94904, relating to unsworn falsification to authorities. ( Date:;;~ - AO. ),(;0 \ VERIFICA TION 7J{w/1 '-/ ,~ -,,-~ r f)(h i b, t A MAIN OFFICE 412 Erford Road Camp Hill, PA 17011 Stanley E. Schneider, Ed.D. Director c;GUIDANCE ASSOCIA YES OF .." PENNSYL VANIA """ r Camp Hill: (71 n 732-2917 Hershey: (71n 533-4312 Carlisle: (71 n 245-2289 Chambers burg: (71 n 263-9392 FAX: (71 n 732-5375 PSYCHOLOGICAL EVALUATION Client: BID: Age: Referring Agency: Case Manager: Evaluation Date: Helen Richwine 8/24/29 70 Cumberland Peny MH/MR Susan Carbaugh 3/17/00 Referrallnformation. Helen has been referred for a psychological evaluation to help determine levels of intellectual functioning and daily adaptation toward qualification for the services of Medical Guardianship. . Assessment Tools. Observation and Interview, Wechsler Adult Intelligence Sca1e-ITI, Bender Motor Gestalt Test, Human Figure Drawing. Observation. Helen was accompanied by Karen Connolly who is a Family Living Program Supervisor with C-P ARK. She presented as a smiling excitable woman of short stature, casually attired, who was quite talkative and expressed fears that she would be taken from her current living quarters. Speech was clear for the most part, but there were severe deficits in comprehension and information processing that required many repetitions of even simple questions. Helen also quite easily and frequently forgot the task at hand and verbally pursued her own agenda. Additionally, we were only briefly into the 'testing when she began making '0 statements such as, "I'm getting tired now." However, she was able to make an attempt with all items presented. Interview. Helen resides with David and Nancy Rose who are Family Living Providers with C- PARK. From 1973 until 1998 Helen's had resided in a Group Home. Helen has been diagnosed with the onset of Alzheimer's disease, and recently an operation was performed which placed a shunt to relieve pressure on the brain. Helen is able to help out at home with simple tasks such as setting the table. However, she needs assistance with all personal care tasks, and she is not trusted to take independent walks. Helen is quite sociable, and on a normal week day schedule she attends the Messiah Elderly Day Activities Center three times per week. She also goes many places with the Rose family. Another enjoyable activity for her is coloring. TV is not a primary activity. There is very occasional contact from a family member. Standardized Assessment. Results of the W AlS-ID follow: Verbal IQ - 55 Performance IQ - 47 Full Scale IQ - 46 ~Comprehensive Psychological Services . Drug and Alcohol Treatment ~ r~"'---" (' Verhal Tests Vocabulary Similarities Arithmetic Digit Span Infonnation Comprehension Scaled Scores 3 2 2 2 2 2 Performance Tests Picture Completion Digit Symbol-Coding Block Design Matrix Reasoning Picture Arrangement Scaled Scores 1 1 l' 1 1 By these measures of cognitive skills Helen is functioning in the moderate range of mental retardation. Although the lowest possible scaled scores are recorded for the perfonnance subtests, the scores are still deceiving because Helen only responded to one item correctly among all of the tests. Therefore, we might reasonably conclude that a neurological factor may be interfering with infonnation processing in the visual/perceptual channel. The nine Bender figures were presented to Helen to copy in order to obtain information about intellectual level and to screen for possible neurological complications. Helen could reproduce a circle, simple angles, and a wave, but she could not combine them to maintain the gestalt of any figure. When asked to copy a series of dots she wrote down a series of numbers. In the context of her W AIS- ill scores, the Bender perfonnance suggests moderate mental retardation with neurological complications. For her Human Figure Drawing Helen first drew an animal figure which she said was a duck, and then she drew a female figure with the appearance of a very young child, no more than a few years old. The developmental quality is consistent with the above observations about level of intellectual functioning. Diagnostic and Clinical Impressions. The data consistently suggests a diagnosis of Moderate mental retardation (318.0) with neurological complications (294.9). The previous diagnosis of '. Alzheimer's disease suggests a continuing deterioration of self-management competence over time. Helen is certainly very deserving of all services offered through the county MR office. And, of course, a Medical Guardian could look after Helen's best interests by assisting her to express various awarenesses, experiences, and needs. .- 6~~ ~ ~;> Eug e H. Stecher, M.A. Psychologist GAPlMHMREvallHelenRichwine 3/17/00 2 -. ... IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION IN RE: HELEN A RICHWINE CIVIL ACTION - ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. ~ CIVIL ORPHANS COURT ~ ORDE,R AND NOW, this i day of COURT , 2001, after hearing, it is determined that Helen Arlene Richwine is incapacitated make or communicate responsible decisions regarding her care, and accordingly, Judy Irene Scholl is appointed the plenary guardian of her person. By the Court, 1. SENDER: COMPLETE THIS SECTION . Complete Items 1,2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1 ~rtit ~d~ssed to I{ I . ~~ M~lU-A-1tL 1'J..56-~~~ ~) ~ 113~~. D. Is delivery address different from item 1? If YES, enter delivery address below: o Agent o AddresseeMON PLEAS DYes NTY PENNSYL VANIA o No , SION 3. Service Type ~ertified Mail o Registered o Insured Mail o Express Mail ~eturn Receipt for Merchandise o C.O.D. JARDIAN JRT 4. Restricted Delivery? (Extra Fee) ,&lYes 2. Article Number (Copy from service label) PS Form 3811 , July 1999 Domestic Return Receipt 102595-99-M-1789 I, hereby certify that I served a true and correct copy of the Citation and Petition of Guardianship, on the following: Hilda Richwine 1255 Goodyear Road Gardens, PA 17324 by U.S. mail, certified, return receipt requested and postage paid, as evidenced by her signature, dated 03/15/01, on the attached green card. Dated: April 5, 2001 -5 .-J-~ Jonathan Fisher Certified Legal Intern DISABILITY LA W CLINIC 45 N. Pitt St. Carlisle, P A 17013 717-243-3696 r - IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: HELEN A. RICHWINE ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN NO. 238 ORPHANS' COURT CERTIFICATE OF SERVICE I, hereby certify that I served a true and correct copy of the Citation and Petition of Guardianship, on the following: Zula G. Richwine 1255 Goodyear Road Gardens, PA 17324 by U.S. mail, certified, return receipt requested and postage paid, as evidenced by her signature, dated 03/15/01, on the attached green card. Dated: April 5, 2001 SENDER: COMPLETE THIS SECTION . delivery address different from item 1? If YES, enter delivery address below: I . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. ,. Art~~ Md_ j;. i2. dJw.. ' ~~~ .11Ml.~ fJA J 7 ff.;).i.f 3. Service Type 1!i Certified Mail 0 Express Mail o Registered Ji.,Return Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) "'Yes 2. cle Number (Copy from service label) a PS Form 3811 , July 1999 Domestic Return Receipt . .102595-99-M-1789