HomeMy WebLinkAbout04-0221IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER: 21-04-221
: EMERGENCY GUARDIANSHIP
PRELIMINARY DECREE
And ~fi~ow this ~.~th day of March, 2004, it is hereby ORDERED and DECREED that
the ;p~elimi/i~ry Decr~'e entered in the above-captioned matter on March 4, 2004, is hereby
VACATED.' ~ '~
It is furthe~[~tDERED and DECREED that this 5th day of March, 2004, Harold
S. Irwin, III, Esquire, is appointed to represent the alleged incapacitated person, Shirley
Drane.
It is further preliminarily ORDERED and DECREED that The Area Agency on
Aging, in and for Cumberland County, Pennsylvania is appointed as emergency plenary
guardian of the person and estate of Shirley Drane for the purpose of providing medical
decision-making authority.
The Court shall holding a hearing on March 9, 2004 at 11:00 a.m. in Courtroom
No. 2, Cumberland County Courthouse, pursuant to 20 Pa.C.S.A. Section 5513.
BY T~T:
Je
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER:
: EMERGENCY GUARDIANSHIP
PRELIMINARYDECREE
And now this day of
DECREED that ~ ~ ~/ ~.
alleged incapacitated person, Shirley Drane.
~C:~_~-~., 2004, it is hereby ORDERED and
~is appointed to represent the
It is further preliminarily ORDERED and DECREED that The Area Agency on
Aging, in and for Cumberland County, Pennsylvania is appointed as emergency plenary
guardian of the person and estate of Shirley Drane for the purpose of providing medical
decision-making authority.
The Court shall holding a hearing on ~ ~ ,2004 at
pursuant to 20 Pa.C.S.A. Section 5513.
dj.: ~d 17- ~]VW PO. J.
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER:
: EMERGENCY GUARDIANSHIP
AND NOW comes, Carlisle Regional Medical Center, by and t~ough it~couns~l,:
Farrell & Ricci, P.C., by Marc T. Levin, Esquire, and requests that th~Honora-~le co~rt~
enter an Order granting an emergency plenary guardianship of the person and estate of
Ms. Shirley Drane for the following reasons:
1. The alleged incapacitated person is Ms. Shirley Drane, an adult female aged
61.
2. Ms. Drane is currently a patient at the Carlisle Regional Medical Center.
3. Prior to her hospitalization, Ms. Drane resided at the Cumberland County
Nursing Home, Clairmont Road, Carlisle, Cumberland County, Pennsylvania.
4. Ms. Drane has no known relatives.
5. Currently Ms. Drane is receiving medical services at the Carlisle Regional
Medical Center, 246 Parker Street, P.O. Box 4100, Carlisle, PA 17013.
6. Prior to her admission to the hospital, Ms. Drane was receiving medical care
at the Cumberland County Nursing Home and was receiving assistance from the
Cumberland County MH/MR office.
7. The Petitioner requests that this Honorable Court appoint a representative of
the Area Agency on Aging in and for Cumberland County, Pennsylvania as temporary
guardian of the person and estate of Ms. Drane.
8. The Area Agency on Aging in and for Cumberland County, Pennsylvania is a
public service agency responsible for the care and supervision of older adults unable to care
for themselves and by and through its solicitor, Anthony DeLuca, Esquire, has agreed to act
as guardian of the person and estate of Ms. Drane.
9. The Area Agency on Aging in and for Cumberland County, Pennsylvania does
not have any interest that is adverse to the interests of Ms. Drane, the alleged
incapacitated person.
10. The emergency plenary guardianship of the person and estate of Ms. Shirley
Drane is necessary for the following reasons:
a) Ms. Drane is an elderly woman who lives as a resident at the Cumberland
County Nursing Home.
b) Because of her limited financial means, Ms. Drane lacks the ability to seek
private placement for her medical needs.
c) Ms. Drane has no known family members; accordingly, there are no family
members or friends who can provide for surrogate decision-making on Ms.
Drane's behalf.
d) The Cumberland County Nursing Home has relinquished responsibility
for the care of Ms. Drane upon her admission to the Carlisle Regional Medical
Center.
e) At this time, there is no other reasonable alternative to effect the proper
care of Ms. Drane besides the appointment of a plenary guardian of the
person and estate.
f) Ms. Drane suffers from recurrent respiratory collapse. As a result of her
respiratory condition, Ms. Drane will potentially suffer from numerous
medical complications, which will require an ability to understand the nature
of the complications and how they will be treated. The treatments necessary
will include the need to provide informed consent to permit the medical
treatments.
g) Ms. Drane is both severely mentally retarded with psychotic behavior and
is unable to speak; therefore, she is unable to participate in medical decision
making on her own behalf. See Affidavit of Dr. William Tarng (Ms. Drane's
attending physician) attached hereto as Exhibit "A."
h) Ms. Drane is currently suffering from severe end stage Chronic
Obstructive Pulmonary Disease, a condition which renders her oxygen
dependent. Ms. Drane's carbon dioxide levels are chronically at dangerous
levels of two times normal. She is currently intubated and ventilator
dependant. In the event she cannot be weaned from the ventilator within a
week to ten days, Ms. Drane will be required to undergo a tracheostomy for
long-term ventilator therapy.
i) A tracheostomy is a medical procedure which requires the surgical opening
of the trachea for insertion of a breathing tube.
j) A tracheostomy is a necessary surgical procedure for long term ventilator
support since an endotracheal tube, if left in place, will cause the formation of
painful pressure ulcers of the throat and lips.
k) A tracheostomy is a surgical procedure, which requires a patient's
informed consent.
l) Ms. Drane is incapable of providing her informed consent to undergo the
suggested tracheostomy.
m) Failure to undergo the tracheostomy could result in the unnecessary and
prolonged suffering of the patient as a result of the development of severe,
painful pressure ulcers.
n) Without the appointment of a guardian, the medical staff of the Carlisle
Regional Medical Center is unable to provide the reasonable and necessary
medical treatments to properly care for Ms. Drane, since the patient is
unable to provide the necessary consents for her continued care.
11. A plenary guardianship will permit the appropriate decision-making to take
place in the short term and potentially avoid the premature and unnecessary death of Ms.
Drane.
12. It is hoped that once Ms. Drane undergoes the proposed tracheostomy, she
will experience an improvement in her breathing, which may permit her return to the
Cumberland County Nursing Home.
13. If Ms. Drane's medical condition improves, the need for a plenary guardian
may cease to exist.
WHEREFORE it is respectfully requested that this Honorable Court issue an Order
appointing a representative of the Area Agency on Aging in and for Cumberland County,
Pennsylvania as guardian of the person and estate of Shirley Drane for the purpose of
providing medical decision-making authority.
Date:
FARRELL & RICCI, P.C.
Marc T. Levir~,/~squire
Attorney I.D. No. 70294
Joseph A. Ricci, Esquire
Attorney I.D. No. 49803
4423 North Front Street
Harrisburg, PA 17110
(717) 230-9201
Counsel for Carlisle Regional Medical Center
EXHIBIT A
AFFIDAVIT OF WILLIAM TARNG, M.D,
AND NOW this ff.~-~h day of March, 2004, I, William Tarng, M.D., do hereby
swear and affirm:
1. I am a physician licensed to practice medicine in the Commonwealth of
Pennsylvania.
2. My medical practice is limited to the specialty of internal medicine.
3. I am the attending physician for Carlisle Regional Medical Center patient
Shirley Drane.
4. Ms. Drane became a patient of the Carlisle Regional Medical Center on
February 29, 2004.
5. Ms. Drane is a patient suffering from severe end-stage Chronic Obstructive
Pulmonary Disease. She is severely mentally disabled, displays psychotic behaviors and is
non-communicative.
6. Ms. Drane currently requires breathing support with a ventilator;
accordingly, she is currently in need of the use of an endotracheal tube.
7. The long-term use of an endotracheal tube will cause the patient to suffer
painful pressure ulcerations of the throat and lips.
8. Painful pressure ulcers caused by an endotracheal tube can be avoided if the
patient undergoes a surgical procedure known as a tracheostomy.
9. A tracheostomy involves the surgical entry into the trachea to allow the
placement of a breathing tube.
10. A tracheostomy is a surgical procedure which requires a patient's informed
consent.
11. Ms. Drane's mental impairment, coupled with her lack of ability to
communicate, prevents her from being able to provide her informed consent to any medical
care which she may require.
12. Failure to obtain the necessary consents for surgical intervention will subject
Ms. Drane to painful and unnecessary pressure ulcers of the throat and lips.
Respectfully submitted,
Date:
William Tarn~,~/M.D.
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
: DOCKET NUMBER: 21-04-221
;
: EMERGENCY GUARDIANSHIP
PRELIMINARY DECREE
It is hereby ORDERED and DECREED that this 8th day of March, 2004, the
Court's Preliminary Decree entered March 5, 2004, is EXTENDED pursuant to 20
Pa.C.S.A. Section 5513 for up to twenty (20) days or until such time as the full
guardianship proceeding is held pursuant to 20 Pa.C.S.A. Section 5511 and a resulting
permanent Decree is entered, whichever occurs first.
The Court has scheduled and shall holding a full guardianship hearing on March 9,
2004 at 11:00 a.m. in Courtroom No. 2, Cumberland County Courthouse, pursuant to 20
Pa.C.S.A. Section 5513.
TH :
ge
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CU!VIBER~ COUNTY PENNSYLV.~X~IA
: DOCKET NUMBER: 21-04-221
:
: EM]it{G.~JN(JY GOAI-tDIANSI-IIP
O~DER
And now t~J.s 9~ day of March, 2004, it is hereby ORDERED and DECREED
the ~ea Agen~ on ~g m and for C~berland Count, Pennsylva~a is hereby
appo~d as plen~ ~ar~an of the person and esta~ of S~ley Dr~e p~su~t ~ 20
Pa.C.S.A. 5513.
~~ ~ , 2004 a~_/l:~.m.
de~erm~a~io~ of per~anen~ ~ar~anS~p.
IN RE: SHIRLEY DRANE
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
21-04-221 ORPHANS' COURT
ORDER OF COURT
AND NOW, this 23rd day of March, 2004, the hearing currently scheduled for April
6, 2004, is cancelled and rescheduled to Tuesday, April 20, 2004, at 11:00 a.m., in
Courtroom Number 2, Cumberland County Courthouse, Carlisle, Pennsylvania.
Edgar B. Bayley, J.
Joseph A. Ricci, Esquire
For Carlisle Regional Medical Center
Harold S;3iwin, ti,I;: Esquire
For Shid~ Drane
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~IE, SHIRLEY A
-- TRANSFERRED:
~ISFERRED TO:
L DIAGNOSES:
MS3 O322 D
12/O7/2OO3
Claremont Nursing and Rehabilitation Center
; respiratory failure wit~ hypercarbia secondary to chronic obstructive pulmonary disease.
~ic hypercapnia with hypoventilation.
~1 retardation, i
'oesophageal reflux disease.
DITION AT DISCHARbE: Improved.
,~ULTATIONS: None
12/O7/2003
1022672
~EDURES: None.
HARGE PLANS:
Transfer to Clarem0nt Nursing and Rehabilitation Center.
Oxygen at 3 liters per minute.
BiPAP at h.s. i
Discharge medications: Levaquin 500 mg per PEG tube q.d.; metoclopramide 5 mg per PEG tube
q. 8 hours; Depakebe 500 mg per PEG tube q. 12 hours; Jevity per PEG tube at 60 cc per hour;
DuoNebs q. 4 hour~ p.r.n, bronchospasm.
CRY OF PRESENT IJLNESS: Shirley is a 60-year-old mentally retarded female resident of the
mont Nursing and Rel~abilitation Center who has a history of chronic obstructive pulmonary disease
'.hronic CO2 retention ~Vith chronic hypercapnia. She had been noted to have a decreased leve of
;iousness and had beSn turning cyanotic after taking off her BiPAP, which she wears chronically at
He. During the day, slle is supplemented with nasal cannula oxygen. She was noted to have
;n desaturations severhl times a day prior to discharge. Shirley has been admitted to this facility on a
,er of occasions for sirdilar episodes of acute respiratory failure.
;ICAL EXAMINATION: General - The patient was lying on a stretcher in the emergency department
acute distress. Vital s gns - Temperature was 96.5° F, heart rate 91 and regular respiratory rate 24,
Iood pressure 188/15,". 02 ,saturation on presentation was 83%. HEENT exam - Normocephalic
traumatic. Oral cavity was c~ear. Neck - Supple without adenopathy or thyromegaly. Chest exam -
sional basilar rhonchi. No obvious wheezing was noted. Heart exam - Regular rate and rhythm
at murmurs, heaves, o thrills. Abdomen - PEG tube in place. Bowel sounds were present. The
hen was otherwise sol and nontender. Musculoskeletal exam - Trace edema.
SSlON LABORATORY DATA AND X-RAYS: White count was 7.0, hemoglobin 12.6, and platelet
287,000. BUN was 1 ~1, creatinine 0.4, electrolytes within normal limits, and glucose 90. Liver
~n studies were withinlr~ormal limits. Arterial blood gas on admission revealed a pH of 7.28, a pCO2
_~, and a pO2 of 99 on 6 liters of oxygen by nasal cannula. Electrocardiogram revealed a normal
rhythm and no acute ST/T-wave changes. Her admission chest x-ray revealed a poor inspiratory
slight cardiomegaly, ~Jnd parenchymal scars at both bases.
~ITAL COURSE: The patient was admitted with acute respiratory failure and hypercapnia, reflecting
ute exacerbation of het' chronic underlying respiratory ailment. She was treated with DuoNeb
Page~ 1 of 2
THISIDOCUMENT
IS NOT A LEGAL COPY UNLESS SIGNED
CARLISLE REGIONAL,MEDICAL CENTER
TRANSFER SUMMARY
9268991
DRANE, SHIRLEY A
MS3 0322 D 1022672
12/03/2003 12/27/1942
TARNG, WILLIAM W
DR/~
neb~
She
day.
peri:,
was
prec
Ong
rega
haw
purs
adm
bac~
gum
DPA
D:
T:
C:
Pag~
J 12/07/2003
qE, SHIRLEY A
MS3 0322 D 1022672
lizer treatments, as weJll as empiric antibiotic therapy in the form of Claforan 1 gram IV q. 8 hours.
'eceived her BiPAP therapy at night and was supplemented with nasal cannula oxygen during the
With these measures,i her respiratory status improved. Serial arterial blood gas determinations were
,rmed which did show ~.teady improvement in her hypercarbia. On 12/04/2003, an arterial blood gas
~erformed which revealed a pH of 7.32, a pCO2 of 92, and a pO2 of 62 on 3 liters of oxygen. A
scharge arterial blood ias performed on 12/06/2003 is pending at this time.
/
}ing discussions were andertaken with the risk management department and hospital counsel
'ding guardianship for (his patient. It has become increasingly troublesome that the patient does not
a legal guardian to make surrogate decisions on her behalf. Discussions were undertaken regarding
Jing legal measures to lsecure guardianship for this patient. Hospital counsel will meet with the
nistrators and representatives of the Claremont Nursing and Rehabilitation Center following transfer
to this facility. It is hoCed that a reasonable solution can be obtained regarding Shiriey's
lianship.
Imw
12/06/2003 13:46:0~
12/07/2003 21:57:3~4
~his document was authenticated by David P. Albright, M.D. on 12/08/2003 17:19:23.
I David P. Albright, M.D.
David P. Albright, M.D.
Mr. Joseph Ricci,/~ttorney at Law, 4423 N Front St, Harrisburg, PA 17110
Claremont Nursingland Rehabilitation Center
2 of 2
DOCUMENT IS NOT
~ LEGAL COPY UNLESS SIGNED
CARLISLE 'REGIONAL MEDICAL'CENTER
TRANSFER SUMMARY
9268991
DRANE, SHIRLEY A
MS3 0322 D 1022672
12/03/2003 12/27/1942
TARNG, WILLIAM W
PATIENY
MED REC
PHYSICI
TRANSF~
DIAGNOS
1. Let
2. Inc
DIAGNOS
1. Dec
2. Men
3. Chr
chr
HISTORY
Claremo
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possibl
decreas
PHYSICA
about 1
breath
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of 728,
were
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excelle
CAF JLE REGIONAL MEDICAL CENTi
CARLISLE, PA 17013
DISCHARGE SUMMARY
DRANE, SHIRLEY A
001022672~
SAEIUD SAFAEE-SEMIROMI
ERNEST JO~EF,MD
DOB: 12/27/1942
PT ADMN: 9262706
ADMN DTE: 9/13/2003
DSCG DTE: 9/26/2003
LOCATION: 0204 W
60Y
RRED TO: Cla~emont Nursing and Rehabilitation Center
S ON ADMISSIOn:
.argy.
ceased shortne!ss of breath.
IS ON DISCHARGe:
leased level o!f consciousness.
zal retardation.
}nic obstructive pulmonary disease BiPAP dependent
}nic carbon .i . , ,
dlpxzde retention.
The patient is a 60-year-old white female resident of
.t Nursing and Rehabilitation Center who was admitted te
}ital because Nf exacerbation of COPD. She has been
~ several times recently to the hospital. Each time she
e, she was tuned up a little bit and sent back home. The
has chronically elevated pC02 in the 70-80 range.
at times, it! gets worse and goes over 100 and then she
~rgic and is r~admitted to the hespital. This is what
en this admission, as well. There were reports of
aspiration, ~s well. The patient's exygenatien was
d.
unt was eleva'
pCO2 of 88.9,
atively norma
EXAMINATION: Sats were 94% on BiPAP. Heart rate was
!0. Blood pre~sure was 120/70 Lungs had decreased
~ounds on bothl sides. She was tachycardic. Otherwise,
~ical examination was pretty normal. Level of
~sness was decueased. She was not following any
zed at 16.2. Her ABGs originally showed pH
pO2 of 59, bicarb of 42. Otherwise, labs
ent was admitted and put on BiPAP and Levaquin. While
.ospital, her ~evel of consciousness never really was
~t but she has,mental retardation so it is really
CONTINUED ON PAGE 2
PATI :
MED RE(:
PHYSICi
CAE ~LE REGIONAL MEDICAL CENT'
i CARLISLE, PA 17013
DISCHARGE SUMMARY
DRANE, SHIRLEY A
001022672
SAEIUD SAPAEE-SEMIROMI
ERNEST JO~ EF,MD
DOB: 12/27/1942
PT ADMN: 9262706
ADMN DTE: 9/13/2003
DSCG DTE: 9/26/2003
LOCATION: 0204 W
diffi( to assess tlhat. She remained on tube feedings
were to get h~r . We
off the BiPAP but then she was going back
into retention aUd increased level of lethargy. Eventually,
BiPAP s changed to overnight and then off for the days. There
was ant attempt ~t getting the patient power of attorney
since think that t~e ultimate solution for this patient would
be trac
tomy and p~tting her on chronic ventilation.
Howew although we !tried, we were unable to get the process
thro~ She is going to go back to the nursing home and there
is to be some Legal attempt to resolve the issue At th
d
time, s oes not ha~e a power of attorney so if she does show
up back in the emergency room, she needs to be intubated and put
on ave ilator but w[e cannot do a tracheostomy. The patient is
far fro really beingi well. We have tried what we could for her
respira problems.i However, I think at this time we are at
the pomi where we ar~ exhausting our possibilities short of
ventil her.
If not, she is going
prognos~[s on this pat
improve~nent of her co
Other p s that w~ noticed in this patient were some CHF and
she was given some LaSlx and that improved. She has chronic
metabolic alkalosis a~ compensation for her CO2 retention. She
had increased blood s~gars while she was here so that needs to
be addr ssed when she~ goes. I asked for b.i.d. Accu-Cheks so
that ca be addressed and she can be put on medication while she
is in t e nursing hom~. Also, her potassium level for the last
few day~ has been high--the highest being 5.7. I am getting a
potassi'~m level on the 26th to check on that. If it is
elevate~ she is goin~ to be held here until that normalizes.
home on the 26th. The
Signe(
DD:
DT:
JN,/m'
THIS DOCUME IT IS NOT A L~
~o be discharged
lent is very poor for any meaningful
ndition.
JULIU~ ....
~AL COPY UNLESS SIGNED
CHART COPY
PAGE
60Y
2 OF
PATIEN[
MED RE(
PHYSIC]
DATE
DATE
CAR'
LE REGIONAL MEDICAL CENTF
CARLISLE, PA 17013
! DISCHARGE SUMMARY
: DRANE, SHIRLEY A
: 001022672 1
AN: DAVID P A~BRIGHT,MD
ERNEST JOSEF,MD
DISCHARGE DIAGNOSES:
1. Chronic obstruct~
2. Hi~tory of severe
3. Ga~troesophageal
perlcutaneous endc
4. His
5. His
6. His
MED I CAq
q.d.,
30 mg
times
1 gm q.
DOB: 12/27/1942
PT ADMN: 9256973
ADMN DTE: 7/05/2003
DSCG DTE:
LOCATION: 0012 A
HISTORY
of Clar
was brc
obtunda
present
She fai
not hav
State a
x-ray w
wheezes
20.
HOSPITA
hours·
her lun
that ut
given h
or comm
proced~
ADMISSION: 07/05/03.
DISCHARGE: 07/08/03.
ye pulmonary disease with CO2 retention.
mental retardation.
reflux disease with dysphagia, status post
scopic gastrostomy tube.
tory of myocardial infarction.
tory of heari] g loss.
tory of arthritis.
IONS: Albute~ol/Atrovent nebulizers q.i.d., Lasix 10 mg
epakene 250 mg b.i.d., Prilosec 20 mg q. day, Prednisone
· day times t~o, 20 mg q. day times two, 10 mg q. da
wo and then d~scontinue; Ativan 0.25 mg b.i.d.,-Cara~ate
a.c. at h.s.,i Reglan 5 mg t.i.d.
OF PRESENT I~LNESS: Patient is a 60-year-old resident
emont Nursing IHome with a history of CO2 retention, who
~ght to the e~ergency department with increasing
zion. She had been admitted last month with similar
Ation. Her C~2 on admission was 105 with a pO2 of 62.
[ed BiPAP tri~l and was eventually intubated. She does
e a power of
~ttorney and is apparently a ward of the
nd is a full qode, which is very unfortunate. Chest
~s unremarkablie on admission and lungs did not reveal any
CBC was normal BMP was normal. Depakote level was
i '
COURSE: Patient was admitted on ventilator for 48
She was easilly extubated and had no noticeable w
· ~ . heezes in
s. Because ~f her persmstent C02 retention, it was felt
imately she ~robably needs a tracheostomy, although
r baseline level of function, the lack of understanding
~nication, we felt that this would not be a legitimate
fe to pursue; , at the time of transfer back to
60Y
CONTINUED ON PAGE 2
PATIEN
MED RE
PHYSI
the nu
to a D]
this.
with 2
be bac]
just
avoid
fair c¢
Signe :
Dm: 7/08/2003
DT: F/08/2003
CC,/s~h 8416
THIS DOCUMEiT IS NOT A L~GAL
CAR' LE REGIONAL MEDICAL CENTE
CARLISLE, PA 17013
I DISCHARGE SUMMARY
: DRANE, SHIRLEY A DOB: 12/27/1942
: 001022672~ PT ADMN: 9256973
C iAN: DAVID p A~BRIGHT,MD ADMN DTE: 7/05/2003
ERNEST JOhEF,MD DSCG DTE:
i LOCATION: 0012 A
?sing home, I ~m not sure whether the State can change her
[R/DNI. I will talk to the social workers today about
She was felt ~table to be returned to the nursing home
liters nasal ~annula oxygen, but again I suspect she will
i in the hospil~al, at which point we ultimately should
'ach her if sh~ keeps re-presenting with CO2 retention, to
epeated hospitalizations. Patient was transferred in
ndition.
CHRISTINA C LLINS,MD
COPY UNLESS SIGNED
CHART COPY
PAGE
60Y
2 OF
CARl ~LE REGIONAL MEDICAL CENTE.,
CARLISLE, PA 17013
PATIENT: DRANE, SHIRLEY
MED REC: 001022672
PHYSICIAN: WILLIAM W TARNG,MD
ERNEST JOSEF,MD
DISCHARGE SUMMARY
DOB:
PT AD N:
ADMN ~TE:
DSCG DTE:
LOCATION:
12/27/194
9254791
6/09/200
6/12/200
DISCHARGE DIAGNOSIS:
1. Respiratory failure.
2 Respiratory acidosis.
3 Chronic obstructive pulmonary disease.
4 Mental retardation.
5 Carbon dioxide retention.
6 Severe mitral regurgitation.
7 Renal failure.
8 Gastroesophageal reflux disease.
9 Dysphagia.
10. Myocardial infarction.
11. Aphasia.
12. Arthritis.
13. Emphysema.
HOSPITAL COURSE: This 60-year-old female was admilted on
06/09/2003. Please see H&P for indications for admission. The
patient came in with decreased level of consciousn ss and
respiratory failure. This was felt to be secondar~
b~nzodz~zepine oversedation The ~a~ ....... t~
' · ~ u=~l~u waS a~mltt
gmven BiPAP which improved he ~-' ' . i ed a~d was
~ r v .... mlatzon. Dur~n~ her hospital
course, she was placed on BiPAP at night and that brought down
her high level of carbon dioxide to a normal levellwhich was
approximately 70.6. Although this is elevated, th~s pC02 is the
level that the patient normally retains, being a c~ronic COPD
patient. Her pH on discharge was 7.43, pC02 70.6,ipO2 75 on
10 L Oxymizer. The patient will be transferred ba~k to the
nursing home and benzodiazepines should be held. She also
should continue her Oxymizer or supplemental oxygen. At the
nursing home, she should continue all her medications except
benzodiazepines which should be withheld and oversedation should
also be held in this patient.
This patient did not have a power of attorney and it the time of
discharge, legal input was requested to
help with !uture medical
decision making on the patient's behalf and a powe~ of attorney
may be necessary to assign to a legal guardian.
Signed:
PRAGNESH M PATEL,MD
DD: 6/12/2003
DT: 6/14/2003
PP/mts 7762
THIS DOCUMENT IS NOT A LEGAL COPY UNLESS SIGNED PAGE
CHART COPY
60Y
1 OF 1
Carlisle Regional Medical Center
Laboratory, 246 P~rker St. Duckkyu Chang,
Carlisle, PA 17013~ Henry S. Crist M.D., Pathologist
, M.D., Pathologist
| i autoreporting lab
DRA~E, SHIRLEY A ]
MRN: 10001022672 Location:ICU-0011 A Admitted:02/29/04
DOB:Ii2/27/1942 Age 61 Sex:F
PhysJ.cian: HILDEN, MICHAEL
Dat~
BLO(
WB~
RB~
HG~
HC~
MC¥
MC~
MCH
RD~
PL!
AUT¢
NeY
Ly~
Mot
Eos
Bas
Neu
Ly~
Mor~
Eos
Bas
Key
DRA
Printed:
Order#
~&Time Ordered
Requested by
39080046
03/07/04 07:29
TARNG, WILLIAM
FINAL
HEMATOLOGY
TEST-NAME RESULT AB REF-RANGE UNITS
COLLECTED 03/08,,/04 06:00 RECEIVED 03/08/04 06:34
D CELL COUNT
C
HATED DIFFEREITIAL
t%
ph%
o%
%
oh#
for Abnormal
~E, SHIRLEY A
03/08/2004 07:30
6.3
3.15
9.7
32.1
102.0
30.9
30.4
15.1
364
L
L
L
H
L
80.0
6.3
8.7
3.8
1.2
5.03
0.39
0.55
0.24
0.08
L
H
L
3.8-11.0
3.40-5.30
10 9-14 7
33 0-43 0
80 0-96 0
26 0-34 0
31 0-36 0
11 0-16 0
140-400
x10^3
x10^6
g/dl
%
fl
Pg
~/d~
%
x10^3
40.0-80.0
15.0-50.0
1 0-8.0
0 0-6.0
0 0-2.0
1 3O-8.80
1 00-4.20
0 00-0.60
0 00-0.40
0 00-0.20
%
%
%
%
%
x10^3
x10~3
x10^3
x10^3
x10^3
~olumn (L=Low H=High AB=Abnormal C=Critical T=Toxic)
ICU 0011 A
PAGE:
Carlisle Regional Medical Center
Laboratory, 246 Parker St. Duckkyu Chang, M.D., Pathologist
Carlisle, PA 17013, Henry S. Crist, M.D., Pathologist
! autoreporting lab
DRA/'E, SHIRLEY A ~
MRN: 0001022672 Location:ICU-0011 A Admitted:02/29/04
DOB:12/27/1942 Age 61 Sex:F
Physician: HILDEN, MICHAEL
Order# 39080046 FINAL
Date&Time Ordered 03/07/04 07:29
Requested by TARNG, WILLIAM
CHEMISTRY
TEST-NAME RESULT AB REF-RANGE UNITS
COLLECT~u 03/08~04 05:30 RECEIVED 03/08/04 06:34
ROUTINE CHEMISTRY
BU~ 15 7-18 mg/dl
Sodium 139 136-145 mmol/1
Potassium 4.9 3.5-5.1 mmol/L
ChlDride 100 98-107 mmol/1
Ca~Don Dioxide ~ 30.8 21.0-32.0 mmol/L
FB: Glucose 126 H 70-100 mg/dl
Fasting Interpretation:
Normal fas!ting glucose: 70-100
Impaired flasting glucose: 101-125
(Patientt may benefit from a 2hr Glucose Tolerance Test)
Diagnosticl for diabetes: >=126
Ca~ ~ium '
8.1 L 8.5-10.1 mg/dl
Cre~tinine 0.4 L 0.6-1.0 mg/dl
Key
DRA
Printed:
for Abnormal Iolumn (L=Low H=Hiqh AB=Abnormal C=Critical T=Toxic)
~"-', SHIRLEY A ICU 0011 A
)3/08/2004 07:36
PAGE
USE BALL PRESS
POINT PEN FIRMLY T 4 0 0 3 -I--
Authorization is hereby given to dispense the generic equivalent unless otherwis~ indicated by the physician.
P top po chang
Date ~ COrn lets rtion with each Level of care e!lndicate'
)rde~ With~ CheCk M~i
[] Outpatient Procedure: (procedure) f( r (medical reason).
[] Place in Outpatient Observation Services for (medical reason).
[] Admit as inpatient for (medical reason).
Physician Signature:
Date i m~me ii Additional Orders: (Dates/Times required)
Allergies SenSitivities ~N~
Weight Height Diagnosis C &~ t [ ~ ~ P ~ :
DO NOT WRITE
Physician's Orders CHART
T~ Rev4/~ (RC~I~I) ' RED~P~RS
Date
Physiciar
Date
Time
Signature:
Authorization is ~ereby given to dispense the genedc equivalent unless otherwise indicated by the physician...,i T 4 0 0 3
Complete t portion with each Level of Care change, Indicate order with a Check Mark.
[] Outpatierit Procedure:
[] Plac___~e i_n ~ Observation Services for
[] Admit as ~npatient for
Time Additional
(procedure) for
rs: (Da~sjTimes required)
· (medical reason).
(medical reason).
(medical reason).
Neight J F
Physician',,
T4003 Rev4/O0 (RC#
Sensitivities [] NKA
~=ight J Diagnosis
; Orders
)914041 )
CHART
DO NOT WRITE
ORDERS UNLESS
RED # APPEARS
4-
Date
Physician
Date
i USE BALL PRESS
POINT PEN FIRMLY T 4 0 0 3
Authorization is h~reby given to dispense the generic equivalent unless otherwise indicated by the physician.
Time Complete top,portion with each Level of Care change. Indicate order with a Check Mark.
[] Outpatient ~rocedure: (procedure) for
[] Place in O~tpatient[ Observation Services for
[] Admit as Itpatient for
~ignatu?: l,/~, %
'ime i Additional Ordl~ (Dates/Times recl~i~~
4-
(medical reason).
(medical reason).
(medical mason).
CAIlergies
Sensitivities
eight ir Height Diagnosis
Physician's Orders
T4003 Rev 4/00 (l~C# 0914041)
CHART
DO NOT WRITE
ORDERS UNLESS
RED # APPEARS
4-
I USE BALL PRESS
POINT PEN FIRMLY T 4 0 0 3
Authorization is h,;reby given to dispense the genedc equivalent unless otherwise indicated by the physician.
Date Time Complete top portion with each Level of Care change. Indicate order with a Check Mark.
[] Outpatient'Procedure: (procedure) for (medical reason).
[] Place in O~ Jtpatient Observation Services for (medical reason).
[] Admit as Ir~patient for
I (medical reason).
Physician Signature:
Date Time Additional Ord~,rs: (Dates/Times required)
Weight ' Height Diagnosis ~ F
Cn~LtSLE P~
DO NOT
T4003 Rev 4/00 (F ~¢ 0914041) RED ¢ APPEARS
USE BALL PRESS
POINT PEN FIRMLY
T4003
Authorization is h 9mby given to dispense the generic equivalent un/ess otherwise indicated by the physician.
Date I ~me C°mPlete t°["[][] PlaceOUtpatienlin OiJtpatientPr°cedure:P°rti°n Observation with eaCh LeVelservices°f caCefor Changei(pr°cedure) Indicate °rderfor with a CheCk MarkI (medical(medicalreas°n)'reason).
[] Admit as I~patient for (medical mason).
~Physician Signature:
·
Date Time iAdditional Ord,
;rs: (Dates/Times required)
1 /¢,.S
?Allergies
Weight
Physicia
T4003 Rev 4/00
Sensitivities
Height I Diagnosis
~'s Orders
-I NKA
CHART
DO NOT WRITE
ORDERS UNLESS
RED # APPEARS
¢~.C 000t0~¢72
C~L~$'LE PA
I USE BALL PRESS
~ POINT PEN FIRMLY
Authorization is h~reby| gNen to dispense the generic equivalent un/ess otherwise indicated by the physician.
~me ;; :c°mplete t°l~ P°rti°n With each Level °f Care change indicate °rder with a CheCk Ma
[] Outpatien~ Procedure: (procedure) for
(medica/ reason).
[] Place in 0 Jtpatient Observation Services for (medical reason).
[] Admit as Ir ~patient for (medical reason).
Physician Signature:
l ...... D~,te Time i Additional Ordr,rs: (Dates/Times required)
~~ SenSitivities 5~
Weight Height Diagnosis
C ~C OOOlO~'e~?2
Physicia~ t's Orders CHART DONOT~E
ORDERS UNLESS
T40~ Rev4/~ (I C~ ~14~1) RED ~P~RS
-F
Date
Time
Physician Signature:
Date ! Time
Authorization is ~
Complete to
[] Outpatien
[] Place in O
[] Admit as
Additional Ord
USE BALL PRESS
POINT PEN FIRMLY
ereby given to dispense the generic equivalent unless otherwise indicated by the physician.
T 4 0O3
~ortion with each Level of Care change. Indicate order with a Check Mark.
Procedure:
(procedure) for
Jtpatient Observation Services for
3atient for
,~rs: (Dates/Times required)
-F
(medical reason).
(medical reason).
(medical reason).
k~. eight / Height Diagnosis
~o~h3Y~} ,Co~a~ ~'~So, ~ ~ ¢ers
DO NOT WRITE
CHART O,DE.S UNLESS
RED ~ APPEARS
Sensitivities
)~3 ~ 2/'~/ I ~q ~ F /C M I 246 PARKER STREET, P.O. BOX4100
"C OOO [ O2 ~'~ ~ CARLISLE, PA 17013-0310
C~RLISL[ PA
PHYSlClAN"S ORDERS
PA"IENT IDENTIFICATION STANDING VENTILATOR CARE ORDERS
DATE NOTED
{DERED ORDERS BY
~ ~ ~ ~ ~ Sta~ding orde~ following endotracheal intubation or tracheostomy
, unless othe~ise modified by the a~ending physician.
~ ~ Ve~tilator se~ings ~r Respi~ato~ Cam Practitioner. RCP may make ventilator changes to co,ct
bio ~ gas abno~alities.
~ Po table chest x-ray STAT tt ~en Q am x 3 days. ~ ~
~ AB ~ 30 minutes following v(ntilator set-up, Q AM x 3 days, and when indicated during an acute crisis. ~_.
~ Titl ~te F102 by oximet~ to r ~aintain Sp02 > 92%.
-~ PI~;e Salem tube to Iow inte ~i~ent suction.
~ Tr~ :heal aspirate for gram s lain, cultu~, and sensitiv,~. ~
GE 3, Basic Met, liver unless pmviousl7 don~. ~
~ ~ Da ly weight.
~ Vit ~1 signs Q 1 hour for 24 b)um, then Q 2 houm if stable.
~ 8o p~teativedeviaes.
~ Nu fitional 8up~ team to ~e notifi~ aker 48 bourn.
~ Dr. to manage Ventilator care.
Na ~i~ immediately with ventilator chan~es (~ yes ~ no)
~ Dis:continue daily PGxR andABG u~n e~ubation. ~-.~
PHYSI~IA~XYURE
~ ~ k' /' j~ ' DATE
Date
Date
Authorization is ~ereby given to dispense the generic equivalent unless otherwise indicated by the physician. T 4 0 0 3
Time Complete to~ portion with each Level of Care change. Indicate order with a Check Mark.
[] Outpatier~t Procedure:
i (procedure) for (medical reason).
[] Place in Outpatient Observation Services for
__~ .~~J [] Admit as~?patient for -- (medicalreason).
~ Signature: ! (medicalresson).
Time Additional Or rs: (Dates/Times required)
~/.
Physicianh
T4003 Rev4/00 (RC#
Orders
CHART DO NOT WRITE
ORDERS UNLESS
RED # APPEARS
N 630,c
Date Time I Each Entry Requires Physician's Signature
PATIENT IDENTIFICATION
,~ CF~Ar~£, SHIRLEY A
H1 LDLN, MICHAE RM 00~1 A
~ F O6i AD~ 02/29/2004
Physician's Progress N~)tes oo~ 1~/27/x942 F/C H
N6302-T 11/,,8 CR ~C 000 l
CARLISLE PA
~ N6302
Date Time Each Entry Requires Physician's Signature
V- .~..~r~d. ' ~/,n/~r' ,g~ ~ ~ ~,./~i.
'1
I,
- ~',-~Y COMF LETE
I
~)~~
, ,DR~'~[, SHIRLEY
Physici~,n's Progress N, ,tea ~~~OEu, .ICHAL
O6i AD~ 02129/2004
N6302-T 11/9 OO~ [2/27/ [94 2
C*~LISL.
, N630;
Date Tine Each Entry Requires Physician's Signature
'~X. RAY. COMPLETED"
TYPE
~DATE 3~~ BY ~
~ 1~ ff~,~·
' ~ PATIENT IDENTIFICATION
E:~E, SHIRLEY
( r 061 AD~ 02129/2004
OO~ ~2/27/19~2
Physiciarfs Progress Not s c ~. C 0 o 0
N~O~-~ lV~ C ~ R L I 5L [
N6302
Date Time Each Entry Requires Physician's Signature
~ I
!
~ / ~ ~ ~ ~ PATIENT IDENTIFICATION ' /
( ' -' ' '" qa~bO~~
HILDEN, ~ZCHAE RH 0011
c F O61
~ DOB 1~/~?/1942 F/C
CR~C O001022~72
CARLZSLE
Physici~n's Progress Nqtes
N6302-T 11/98
! N6302
Date Tilne Each Entry Requires Physician's Signature
· ryPE ~ PATIENT IDENTIFICATION --
__ D~(ANE, Sh~IRkEY A
HILOEN, ~I~iCHAE~ R~i 0011 A
C F 061
000 IO22(~72
Physician's Progress Note~
N6302-T 11/98
N6302
Date/ Tile i Each Entry Requires Physician's Signature
//~ .... ,,/// -- . . .
~ L. DEN, ~[CHAE
C ¢ 06 I ADH 02/29/200~
~ ~ 008 ~2/~7/J942
CA~L;SLE PA
Physic an'~ Progress N,mtes
N6302-T 11/t8
! N6302
Date Ti ne Each Entry Requires Physician's Signature
X-I:LA_y COMPL ETE
'~. 'D" 02/29,2004
x DOB 12t27/19~2
% ~ C~Mc
~+~~ OOOIO22~72
CARLisLE PA
Physician's Progress Notes
N6302-T 11/98
i N6302
I
,"
Date Ti ne j Each Entry Requires Physician's Signature
/
lC-RAY COMI~LETE
D&~~By
I"~ k~ C~ { 1~ / '6 ~I PATIENT"DENTIFICATION
'/ C ~' 06 ~ ADH 02/29/200~
Physician s Progress Notes c u ~c ooo
N6302-T 11/98 C AR L I SI ~ PA
I N6302
r
Date Time ~ Each Entry Requires Physician's Signature
I
~: , ~- ,-.
,
I
PATIENT IDENTIFICATION
~I LDEN, MICMA~ RM 00l I A
6 F 06 I ADM 02129/2004
JOB 12/27/1~42 F/C M I
Physicia ~'s Progress Notes c~ .c ooo
N6aO2-T ~/98 C AR L
(ir
Date Time j/7.~ Each Entry Requires Physician's Signature ..............
!
X-~-~~-CO~LETE '
~p,-~~ . ~ ......
DA~ / ~ By~
PATIENT IDENTIFICATION
u'~ Lg[~, ~ICHA[ ~ OO
( F O~ I AO. 02/2
Physician's ProgressN,)tes ooa 12/~7f11~2 FIC ~
N6302-T 11/)~8 C R ~C 000 l 02
N6307
9t2004
I
26'/2
Carli
Laboz
Carli
DRANE
MRN: 0
DOB: 1
Physi
s~e Regional Mea~cal Center
atory, 246 Parker St.
sle, PA 17013 i Henry S Crist, M.D
i CUMULATIVE REPORT
i Temporary Copy
SHIRLEY A ' i
601022672 Loc~tion:ICU-0011-A Admitted: 02/29/04
2/27/1942 Age:i61 Sex:F Discharged:
cian: HILDEN, iMICHAEL
Duckkyu Chang, M.D., Pathologist
Pathologist
, HEMATOLOGY
.................. +---3907C ]26 .... + ...............
COLLECT',~D 03/07/04 06: 15 I REFERENCE RANGE
BLOOD CELL COUNT
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
PLT
AUTOM
Neut%
Lymph%
Mono%
Eos%
Baso%
Neut#
Lymph#
Mono#
Eos#
Baso#
Key fo~
DR3~NE
7.7
3.12
9.7
31.4
101.0
31.1
30.9
15.2
322
%TED DIFFERENTIAL
81.9
4.7
8.8
3.7
0.9
6.32
0.36
0.68
0.29
0.07
H
L
H
3.8-11.0 x10^3
3.40-5.30 x10^6
10.9-14.7 g/dl
33.0-43.0 %
80.0-96.0 fl
26.0-34.0 pg
31.0-36.0 g/dl
11.0-16.0 %
140-400 xl0A3
40.0-80.0 %
15.0-50.0 %
1.0-8.0 %
0.0-6.0 %
0.0-2.0 %
1.30-8.80 x10^3
1.00-4.20 x10^3
0.00-0.60 x10^3
0.00-0.40 x10^3
0.00-0.20 x10^3
Abnormal Column (L-Low H-Hiqh AB-Abnormal C-Critical T-Toxic)
SHIRLEY A
ICU- 0011-A
10 of 19,
11 of 20
continued
HEMATOLOGY
PRINTED 03/07/2004 23:42 Page: 1 of 2
Temporary Copy
Carlisle Regional Medical Center
LaboIatory, 246 Parker St. Duckkyu Chang, M.D., Pathologist
Carlisle, PA 17013 Henry S. Crist, M.D., Pathologist
CUMULATIVE REPORT
Temporary Copy
DRAN~, SHIRLEY A
MRN:G001022672 Location:iCU_0011_A Admitted: 02/29/04
DOB:12/27/1942 Age:~61 Sex:F Discharged:
Physician: HILDEN, !MICHAEL
! CHEMISTRY
....... ~ .......... +---3907q026 .... +---39040040 .... +---39030227 .... + ...............
C0LLECT~D 103/07/04! 06 ~S 103/04/04 0S:~0 103/03/04 ~1:2~ IR~E~C~ m~
.................. + ....... + ............... + ............... + ...............
ROUTI NE CHEMISTRY
Sodium 139 , I 136 I 139 1136-145 mmol/1
lm 4.4 [4.5 [4.4 [3.5-5.1 mmol/L
~02 ' I ~0~ I 99 [9~-~07 mmo~/~
ioxide 31.6 i
~ I ~ [ ~1~ ~ [ ~o3 ~ [?o-~oo m~/dl
asting Glucose Inte~r~tation.
Normal fasting gluco!e: 70-100
Impaired fasting glucose: 101-125
(Patient may benefit from a 2hr Glucose Tolerance Test)
Diagnostic for diabetes: >=126
I ~.1 L I ~.3 L I ~.o ~ I~.s-~o.~ rog/al
.ne I 0.5 D I 0.3 n I 0.4 5 10.6-1.0 rog/al
.m I I I 1.8 [1.8-2.4 rog/al
~normal Column (L-Low H-Hiqh ~-~normal C-Critical T-Toxic)
SHIRLEY A ICU-0011-A
Temporary Copy
continued
CHEMISTRY
~ of 20 P~INTZD 0~/0~/~00~ 2~:~ Page: 2 of 2
Potassi'
Chlorid,
Carbon
FBS
Mi:
Calcium
Creatin2
Magnesit
Key for
DRANE
11 of 19,
Carli
Labor
Carli
DRANE
MRN:0
DOB:i
Physi,
,~le Regional ~edlcal Center
~tory, 246 Pairker St. Duckkyu Chang,
~le, PA 17013 Henry S. Crist,
CUMULATIVE REPORT
Temporary Copy
SHIRLEY A
01022672 Location:iCU_0011_A
/27/1942 Age:61 Sex:F
~ian: HILDEN, ~ICHAEL
....... ~ .......... +---39060~96---
COLLECT
PATIE]
Site
FIO2
02 Devic
Total Re
Vent Rat
Tidal Vc
CPAP/PEE
Allen Te
ARTER:
pH, ArtE
PC02
PO2
O2Hb
COHb
MetHb
HC03
BEb
O2ct
aA-Ratio
~ Key for
DRANE,
17 of 26,
Admitted: 02/29/04
Discharged:
RESPIRATORY
-+---39040133 .... +---39030100 .... + ...............
D 103/06/04i15:04 [03/04/04 07:11 [03/03/04 07:06 [REFERENCE RANGE
.......... + ........ ~ ...... + ............... + ............... + ...............
~T DATA
H
L
H
H
H
· L
R Radial
60
V.Cont.
14
14
600
5
Positive
7.406
47.4 H
83.0
9.8 L
94.1
0.9
1.0
30.1 }I
5.4 H
12.9 L
0.23
R Radial
60
V.Cont.
14
14
600
5
Positive
7.389
48.6 H
91.0
10.1 L
93.7 L
2.6 H
0.9
29.7 H
4.7 H
13.2 L
0.25
7.350-7.450 pH
35.0-45.0 mmHg
70.0-100.0 mmH9
14.0-18.0 9/dl
94.0-100.0 %
0.5-1.5 %
0.0-1.5 %
22.0-26.0 mmol/1
-2.0-2.0 rmuol/1
15.7-21.6 Vol%
R Radial
60.0
e V. Cont.
spiratory 14
14
600
5
t N/A
~AL BLOOD GAS
rial 7. 448
48.5
87.0
10.5
94.1
1.6
1.0
34.0
9.4
13.8
0.24
AB-Abnormal C-Critical T-Toxic}
continued
S P I R A T 0 R
Page:
bnormal Column (L-Low l-Hiqh
SHIRLEY A
R E
of 27 PRINTED 03/06/2004 23:42
Pathologist
Pathologist
ICU-0011-A
Temporary Copy
Y
1 of 1
Carl~
Labor
Carli
DRANE
MRN:0
DOB:ll
Physi(
le Regional ~,adical Center
tory, 246 Parker St.
le, PA 17013
SHIRLEY A
01022672 Loca~ion:ICU-0011-A
/27/1942 Age:Si Sex:F
ian: HILDEN, MICHAEL
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
CUMULATIVE REPORT PERMANENT COPY
Admitted: 02/29/04
Discharged:
* Key for
DRANE,
21 of 27,
7.4
3.07
9.6
31.3
102. 0
31.2
30.6
16.1
252
rED DIFFERENT/
78.1
10.7
8.7
1.5
1.0
5.76
0.79
0.65
0.11
0.07
'.OGY
sis
ia
-" Stippli
asia
L
H
L
H
8.2
3.35
11.1
34.6
103.0
33.1
32.0
16.7
215
81.4 H
6.4 L
8.5 H
2.9
0.8
6.67
0.52 L
0.70 H
0.24
0.06
7.6
3.46
10.6
35.6
103.0
30.7
29.8
17.2
223
80.2 H
8.1 L
10.8 H
0.1
0.8
6.13
0.62 L
0.82 H
0.01
0.06
1+
1+
1+
1+
H
7.3
3.47
10.9
36.3
104. 0
31.5
30.2
15.9
207
82.9
7.8
7 4
1 0
0 9
6 06
0 57
0 54
0.07
0.06
Moderate
1+
H
L
3.8-11.0 x10^3
3.40-5.30 xl0A6
10.9-14 7 g/dl
33.0-43 0 %
80.0-96 0 fl
26.0-34 0 pg
31.0-36 0 g/dl
11.0-16 0 %
140-400 x10^3
40.0-80.0 %
15.0-50.0 %
1.0-8.0 %
0.0-6.0 %
0.0-2.0 %
1.30-8.80 x10^3
1.00-4.20 x10^3
0.00-0.60 x10^3
0.00-0.40 x10^3
0.00-0.20 x10^3
bnormal Column (L-Low ~-Hiqh AB-Abnormal C-Critical T-Toxic)
SHIRLEY A I
ICU-0011-A
PERMANENT COPY
t continued
HEMATOLOGY
of 28 PRINTED 03/04/2004 23:43 Page: 1 of 3
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
RDW
PLT
AUTOM~
Neut%
Lymph%
Mono%
Eos%
Baso%
Neut#
Lymph#
Mono#
Eos#
Baso#
MORPHO
Anisocytc
Macrocyt(
Hypochro~
BasophilJ
Polychro~
! HEMATOLOGY
........ · ......... +---390400~0 .... +---39020029 .... +---39010049 .... +---38290084 .... + ...............
COLLECTE] 03/04/04 b5:30 I03/02/04 05:15 103/01/04 o5:oo 102/29/04 03:45 IREFERENCE RANCE
........ ~ .............. + ....... · ........ + ............... +-7 ............. + ...............
BLOOD CELL COUNT
Carli~
Labor~
Carlil
DRANE
MRN: 01
DOB: 11
Physi~
~ze Regional ~=dical Center
~tory, 246 Parker St. Duckkyu Chang, M.D., Pathologist
~le, PA 17013 Henry S. Crist, M.D., Pathologist
CUMULATIVE REPORT
Temporary Copy
, SHIRLEY A
)01022672 Locakion:ICU-0011-A Admitted: 02/29/04
~/27/1942 Age:61 Sex:F
2ian: HILDEN, MICHAEL
Discharged:
CHEMISTRY
.................. +---39040~40 .... +---39030227 .... + ...............
COLLECTi D 03/04/04105:30 103/03/04 11:25 IREFERENCE RANGE
....... 4 ........................... + ............... + ...............
ROUTI
;E CHEMISTRY
13
136
m 4.5
102
ioxide 30.2
113 H
asting Glucose Interpretation:
Normal fasting glucos~:
14
139
4.4
31.8
103
7-18 mg/dl
136-145 mmol/1
3.5-5.1 mmol/L
98-107 mmol/1
21.0-32.0 mmol/L
70-100 mg/dl
70-100
Impaired fasting glucose: 101-125
(Patient may benefi~ from a 2hr Glucose Tolerance Test)
Diagnostic for diabetes: >=126
I 8.3
ne t 0.3
m I
Abnormal Column (L-Lob
SHIRLEY A
23 of 28
8.0 L 18-5-10.1 mg/dl
0.4 L 10.6-1.0 mg/dl
1.8 11.8-2.4 mg/dl
BUN
Sodium
Potassit
Chlorid,
Carbon
FBS
M1 ~
Calcium
Creatin~
Magnesil
* Key foz
DRANE
22 of 27,
H-Hiqh AB-Abnormal C-Critical T-Toxic)
ICU-0011-A
Temporary Copy
continued
CHEMISTRY
~NT~ 03/04/200~ 23:4~ Page: 2 of 3
Carli
Labor
Carli
DRANE
MRN: 0
DOB: 1
Phys i
Regional Meuacal Center
~tory, 246 Parker St.
~le, PA 17013 i
SHIRLEY A
01022672 Location:iCU_0011_A
/27/1942 Age:61 Sex:F
ian: HILDEN, MICHAEL
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
CUMULATIVE REPORT PERMANENT COPY
Admitted: 02/29/04
Discharged:
BUN
Sodium
Potassi~
Chloride
Carbon
FBS
M1 ~ F
CHEMISTRY
.................. +---39020~29 .... +---39010049 .... +---38290101 .... +---38290084 .... + ...............
COLLECTI D 103/02/04 06:20 103/01/04 05:00 02/29/04 08:30 102/29/04 03:45 IREFERENCE RANGE
.......... + ............... + ................................ + ............... + ...............
IE CHEMISTRY
Calcium
Creatini
Protein,
Alkaline
AST
Albumin
ALT
Bilirubi]
Bilirubi]
CARD IA
CPK
CKMB
Troponin
THERAP
Valproic
ENDOCR
Cortisol
* Key for
DRANE,
11
142
3.9
102
Dxide 28.5
125
I 143
I 35.2 H
~{ I 123 I{
sting Glucose Interpretation:
Normal fasting glucos~: 70-100
Impaired fasting gluc~,se: 101-125
{Patient may benefi~ from a 2hr Glucose Tolerance Test)
Diagnostic for diabet~{s: >=126
7.8 i L 7.9 L
0.3 ~
Le
Total
Phosphata
27 of 44,
, Total
Direct (A
~ STUDIES
gUTIC DRUGS/TO
~cid
CNOLOGY
Dnormal Column (L-Low]
SHIRLEY A
8 of 45
L 0.4 L
XICOLOGY
19.5
-High AB-Abnormal C-Critical T-Toxic)
14 17-18 mg/dl
137 1136-145 mmol/1
5.0 [3.5-5.1 mmol/L
89 L 198-107 mmol/1
>45.0 CH 121.0-32.0 mmol/
7~ 17O-lOO ~/d~
8.7
0.3
6.7
79
23
2.3
24
0.3
0.1
72
1.1
<0.04
continued
CHEMISTRY
PRINTED 03/02/2004 23:43 Page: 2 of 4
8.5-10.1 mg/dl
0.6-1.0 mg/dl
6.4-8.2 g/dl
50-136 U/L
15-37 U/L
3.4-5.0 g/dl
30-65 U/L
0.0-1.0 mg/dl
[0.0-0.3 mg/dl
21-215 U/L
0.5-5.0 ng/ml
0.04-1.00 ng/ml
8o.o 15o.o-~oo.o us/m
[ ug/dL
ICU-0011-A
PERMANENT COPY
Carli
Labo~
Carli
DRAN~
MRN: 0
Regional M=dical Center
.tory, 246 Parker St.
le, PA 17013
SHIRLEY A
.01022672 Loc~tion:ICU-0011-A
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
CUMULATIVE REPORT Temporary Copy
Admitted: 02/29/04
DOB:I /27/1942 Age:61 Sex:F Discharged:
Physii '.ian: HILDEN, iMICHAEL
RESPIRATORY
....... ~ .......... +---390401133 .... +---39030100 .... + ...............
COLLECTi".D 03/04/04! 07:11 103/03/04 07:06 IREFERENCE RANGE
............................ I ....... + ............... + ...............
PATIE.~T DATA i
Site
FID2
02 Devi
Total R~
Vent Ra
Tidal Vi
Allen T!
ARTER
pH, Artl
PCO2
PO2
O2Hb
COHb
MetHb
HCO3
BEb
O2ct
aA-Rati
* Key fo
DRANE
23 of 27
~spiratory
)1.
~.p
R Radial
6O
V. Cont
14
14
600
5
PositiVe
IAL BLOOD GAS
.~rial 7.406
47.4
83 .0
9.8
94.1
0.9
1.0
30.1
5.4
12.9
0.23
Abnormal Column (L-Lo~
SHIRLEY A
24 of 28
R Radial
60
V.Cont.
14
14
600
5
Positive
7.389
48.6 H
91.0
10.1 L
93.7 L
2.6 H
0.9
29.7 H
4.7 H
13.2 L
0.25
7.350-7.450 pH
35.0-45.0 mmHg
70.0-100.0
14.0-18.0 g/dl
94.0-100.0 %
0.5-1.5 %
0.0-1.5 %
22.0-26.0 mmol/1
-2.0-2.0 mmol/1
15.7-21.6 Vol%
r H-Hiqh AB-Abnormal C-Critical T-Toxic)
ICU-0011-A
Temporary Copy
continued
RESPIRATORY
PRINTED 03/04/2004 23:43 Page: 3 of 3
Carli le Regional Mealcal Center
Labor~tory, 246 Parker St.
CarliSle, PA 17013
DRANE0
MRN:0(
DOB:12
Physic
Duckkyu Chang, M.D.,
Henry S. Crist, M.D.,
CUMULATIVE REPORT
PERMANENT COPY
SHIRLEY A
01022672 Loca~ion:ICU-0011-A
/27/1942 Age:~l Sex:F
ian: HILDEN, MICHAEL
Pathologist
Pathologist
Admitted: 02/29/04
Discharged:
DATA
R Radial
60
V. Cont.
piratory 14
14
600
5
Po s i t ire
BLOOD GAS
ial 7. 399
47.0
95.0
11.4
93.8
2.5
0.9
29.4
4.5
14.9
0.26
......... + ......... ~ ..... + ................
· bnormal Column (L-Low
SHIRLEY A
0 of 45
L Brach
60.0
V. Cont.
18
14
600
5
7.461 H
46.8 I{
73.0
11.3 L
92.4 L
2.0 }{
1.0
33.7 H
9.4 H
14.5 ~,
0.20
................ + ............... + ............. z_
R Brach
100.0
V.Cont.
V.Cont.
14
14
7OO
Positive
L Radial
5.00
40.0
Cannula
Positive
7.491 ~{
60.6 H
253.0 H
10.9 L
97.5
1.5
1.0
46.8 I{
21.2 }{
14.8 L
0.40
7.253 L
123.9 H
66.0 L
10.1 ~
89.6 L
0.2 L
0.4
55.4 H
24.1 H
12.6 L
0.51
7.350-7.450 pH
!35.0-45.0 mmHg
70.0-100.0 mmHg
14.0-18.0 g/dl
94.0-100.0 %
0.5-1.5 %
0.0-1.5 %
22.0-26.0 mmol/
-2.0-2.0 retool/1
15.7-21.6 Vol%
i-Hiqh AB-Abnormal C-Critical T-Toxic)
ICU-0011-A
PERMANENT COPY
continued
RESPIRATORY
0~/02/200~ 2~:4~ Page: 4 of 4
29 of 44,
* Key for
DRANE,
PATIE~
Site
Flow
FIO2
02 Devic
02 Devic
Total Re
Vent Rat,
Tidal Vol
CPAP/PEE
Allen Te~
ARTERI
pH, Arte~
PCO2
PO2
O2Hb
COHb
MetHb
HCO3
BEb
O2ct
aA-Ratio
, RE S P I RATORY
................. +---390201~0 .... +---39010050 .... +-- -38290092 .... +---38290077 .... + ...............
COLLECTE 103/02/04 ~7:18 103/01/04 06:49 02/29/04 04:27 102/29/04 02:06 IREFERENCE RANGE
Carli
Labor~
Carli
DRANE
MRN: 0
DOB: 11
Reque~
Ile Regional
Ltory, 246 Par
~le, PA 17013
SHIRLEY A
101022672 Loca
1/27/1942 Age:
:ted by: HILDEi
~dical Center
[er St.
~ion:ICU-0011 A
il Sex:F
[, MICHAEL
Copy ~o: HILDE
Order~ : 38290096
Sourct : Respirator"
AntibJotics at colll
Cul tul'e Respiratory
03/01/04 Many Normal Flor,
Isolate 01 Pseud,
MICHAEL
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
Admitted:02/29/04
Discharged:
Few
FINAL
03/02/04 08:15
Isolat(
Antibi(
Ceftaz~
Ciprof]
Gentam~
S=Suscept
likely.
Gram
02/29/04
DRANE,
24 of 27,
tic
dime
oxacin
cin
P, aerug
MIC Int
-'=8 S
~=4 R
2 S
SHIRLEY A
~5 of 2~
PRINTED 03/04/2004 23:43
ble I=Intermediate R=R~
rain
Many Epithelial
Few WBC
~oderate Gram Po
Rare Gram Positi~
~sistant. SYN=S synergy with Penicillin is likely. SYN=R synergy with a Penicillin is not
.~ells
F I NAL
~itive Rods suggestive of diphtheroids
~e Cocci
02/29/04 07:30
ICU- 0011 A
MICROBIOLOGY
Page: 1 of 2
~monas aeruginosa
MICROBIOLOGY PERMANENT COPY
Collected: 02/29/04 00:01
Tract Trach Received : 02/29/04 06:53
~ction :
Carli~
Labor~
Carli
DRANE
MRN:
DOB:
Reque~
Copy
Order
Sourc
Antibi
,Cul tu
o3/o~/o4
03/02/04
03/03/04
03/04/04
DRANE
25 of 27,
~le Regional M~dical Center
~tory, 246 Parker st.
~le, PA 17013
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
SHIRLEY A ~
i01022672 Loca ion:ICU-0011 A
~/27/1942 Age:~l Sex:F
~ted by: HILDE~, MICHAEL
HILDE~, MICHAEL
: 38290094
: Blood Peri'
otics at coll'
i:e Blood
No Growth at 1 D
No Growth at 2 D
No Growth at 3 D
No Growth at 4 D
SHIRLEY A
26 of 28
Admitted:02/29/04
Discharged:
MICROBIOLOGY Temporary Copy
Collected: 02/29/04 08:30
,heral Received : 02/29/04 08:39
.~ct ion :
~¥(s)
~y(s)
~y(s)
~y(s)
PRELIM
03/04/04 09:00
ICU- 0011 A
MICROBIOLOGY
PRINTED 03/04/2004 23:43 Page: 2 of 2
Carlil
Labor~
Carli
DRANE
MRN:01
DOB:Ii
Reque:
Copy
Orderi
Sourc~
Antib~
Cul tu:
o3/ol/o~
03/02/04
03/03/04
03/04/04
03/0S/04
DRANE
24 of 33,
31e Regional Medical Center
~tory, 246 Parker St.
~le, PA 17013
, SHIRLEY A
)01022672 Location:ICU-0011 A
~/27/1942 Age:61 Sex:F
~ted by: HILDEN, MICHAEL
HILDEN, MICHAEL
Duckkyu Chang, M.D., Pathologist
Henry S. Crist, M.D., Pathologist
Admitted:02/29/04
Discharged:
MICROBIOLOGY PERMANENT COPY
: 38290094 ! Collected: 02/29/04 08:30
: Blood Peripheral Received : 02/29/04 08:39
otics at collection :
:e Blood
No Growth at 1 D y(s)
No Growth at 2 D~y(s)
No Growth at 3 D.~y(s)
No Growth at 4 D~y(s)
No Growth at 5 D~y(s)
FINAL
03/05/04 09:00
SHIRLEY A
25 of 34
ICU- 0011 A
MICROBIOLOGY
03/05/2004 2~:42 Page: 2 of 2
PATIENT NAME:
X-RAY#:
EXAM DAN ~E:
ORDERIN(;:
ATTEND I~ [G:
CONSULTi NG:
CARLISLE REGIONAL MEDICAL CENTER
~DIOLOGICAL ~TERPRETATION
DRANE SHIRLEY A
1022672~
3/07/2004
PHILIP!D CAREY,MD 243-7444
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
HISTORY
POR5
A sJ
chan
endc
tube
fiel
infl
be p
SUMM
stud
REVIEWED
GEORGE BI
INTERPRE[
DATE D I C~.
DATE TRA2
DATE SIG~
TRA_NS CR I !
6985307
C}~EST PORTABLE
RESP FAIL
ABLE CHEST, 0530 HOURS
ngle portable ifilm of the chest demonstrates no essential
ge as compared with our previous study of 3-6-04. An
tracheal tube!is again noted in place with the tip of the
lying above ~he carina. Note hypoaeration of both lung
ds. The lung ifields appear grossly free of active
ammatory disease. A small left pleural effusion appears to
resent.
ARY: No essential change as compared with our previous
y of 3-6-04.
AND SIGNED
iODER, MD
'ING PHYSICIAN
'ATED: 3/(
'SCRIBED: 3/(
'ED: 3/(
TIONIST: DLL
FL~
7/2004
7/2004 11:32
7/2004 11:56:06
OR
PAGE 1 OF 1
PATIENT NAME:
X-RAY#:
EXAM DAr, 'E:
ORDERIN(
ATTENDI! 'G:
CA~LISLE REGIONAL MEDICAL CENTER
RAu£OLOGICAL IN iERPRETATION
DRANE SHIRLEY A
10226721
3/06/2004
PHILIPiD CAREY,MD 243-7444
MICHAEL F. HILDEN, MD 245-5505
CONSULTING: KENNETH HARM,MD LAB-
HISTORY] RESP FAIL
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B. : 12/27/1942
ROOM: 0011
SUPZ
The
o3/(
The
The
conc
due
may
endo
righ
pneu
IMP~
Pooz
Top
Densi
or P
ET t
Righ
NE PORTABLE CHEST AT 0530 HOURS
study is compared to the previous studies, the last dated
5/2oo4.
current study!was made with a poor inspiratory effort.
heart remains islightly enlarged. Slight pulmonary vascular
estion is noted, presumably secondary to elevated diaphragms
to a poor insPiratory effort. Densities at the left base
represent atelectasis, pneumonitis or pleural effusion. The
tracheal tube lis seen about 1.5 inches above the carina. A
t subclavian Catheter is seen in the superior vena cava. No
~othorax is noted.
ESSION:
inspiratory effort.
2ormal sized ~eart.
£ties at the lleft base may represent pneumonia, atelectasis
leural effusioh.
~be about 1.5 !inches above the carina.
subclavian c~theter in the superior vena cava.
REVIEWED AND SIGNED
CHARLES ~ LOH, MD
INTERPRE[ING PHYSICIA_N
DATE DICTATED: 3/
DATE TR3~SCRIBED: 3/
DATE SIG~ED: 3/
TRANSCRI~TIONIST: JND
6985308 FL'
CHEST PORTABLE
6/2004
6/2004 9:46
6/2004 9:55:01
'OR
PAGE 1 OF 1
PATIENT NAME:
X-RAY#:
EXAM DB 'E:
ORDERINC~,:
ATTENDI~'G:
CONSULT] NG:
CARLISLE REGIONAL MEDICAL CENTER
RAbzOLOGICAL IN'~mRPRETATION
DRANE SHIRLEY A
1022672
3/05/2004
PHILIP D CAREY,MD 243-7444
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
HISTORY RESP FAIL
POR:
HIS~.
Comp
life
sari
base
the
vis~
IMP]
Ches
REVIEWE£
CHRISTO~
INTERPR5
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
ESSION:
t film without
AND SIGNED
HER LADD,MD
rING PHYSICIA~
DATE DIC
DATE TR~.
DATE SIG
TRANSCRI
6985309
CHE~ PORTABLE
rATED: 3 /
.~SCRIBED: 3 /
.~ED: 3 /
PTIONIST: JNE
FL
definite change.
05/2004
05/2004 12:16
05/2004 13:30:37
OOR
PAGE 1 OF 1
'ABLE CHEST AT 0435 HOURS
'ORY: Respiratory failure.
arison is made to chest films of the three days prior. The
support and monitoring hardware are unchanged and
sfactory in position. There is no pneumothorax. Left lung
atelectasis and/or infiltrate is again seen silhouetting
left hemidiaphragm. The lungs are otherwise clear as
alized.
PATIENq
X-RAY#:
EXAM D~
ORDERI~
ATTENDI
CONSULT
HISTORY
POR
Bec
due
the
see:
bon,
IMP
REVIEWE[
CHARLES
INTERPR5
DATE DIf
DATE TR~
DATE SIC
TRANSCRI
6986081
ABDOMEN 1 V~W
CARLISLE REGIONAL MEDICAL CENTER
TE:
,g:
NG:
ING:
iRA~ZOLOGICAL Ih.ERPRETATION
NAME: DRANE ISHIRLEY A
1022672
3/04~2004
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
MUST BE PORTABLE
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
FABLE ABDOMEN i- TWO SUPINE FILMS AT 0900 AND 0850 HOURS
~use of the portable technique, the study is quite limited
to the patient's body habitus. Gas is seen in a portion of
colon showingi no abnormal dilatation. No abnormal gas is
1 in the smalll bowel. No gross mass lesion is noted. The
~s of the abdomen and pelvis show diffuse demineralization.
~SSION: Nothing remarkable seen.
AND SIGNED
K LOH, MD
TING PHYSICIA~
~ATED: 3
NSCRIBED: 3
NED: 3
iPTIONIST: JN
FI
04/2004
04/2004 15:36
04/2004 18:09:28
OOR
PAGE 1 OF 1
PATIENT
X-RAY#:
EXAM DA'
ORDERI~
ATTENDI]
CONSULT
HISTORY
The
03/(
The
cone
The
A rJ
the
IMP~
Litt
NAME:
?E:
[G:
[NG:
CARLISLE REGIONAL MEDICAL CENTER
RAoiOLOGICAL IN~ERPRETATION
DRANE SHIRLEY A
10226721
3/04/~004
WILLIAM W TARNG,MD-
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
MUST BE PORTABLE
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
NE PORTABLE C~EST AT 0850 HOURS
study is compared to the previous study, the last dated
3/2004.
heart remainslenlar e~
i g ~. Slight pulmonary vascular
estion with hazy densities at both bases is again noted.
endotracheal &ube is seen about 1.5 inches above the carina.
ght s~bclavia~ catheter'is again seen in the mid portion of
superior vena icava.
ESSION:
le or no interval change°
REVIEWED AND SIGNED
CHARLES
INTERPRE[ING PHYSICIAN
DATE DICTATED: 3/')4/2004
DATE TRANSCRIBED: 3/I)4/2004 15:15
DATE SIG~ED: 3/I)4/2004 15:30:43
TRANSCRI]~TIONIST: JND
6986087 FL)OR
CHEST PORTABLE
PAGE 1 OF 1
PAT I ENT NAME:
X-RAY#:
EXAM DA7 ~E:
ORDERIN( .:
ATTEND II 'G:
CONSULT]NG:
H I S TORY
PORq
HISq
A pc
the
witt
inc~
left
per~
REVIEWEE
CHARLES
DATE DIC
DATE TRA
DATE SIC
TRANSCRI
6989201
C~IEST PORTABLE
CARLISLE REGIONAL MEDICAL CENTER
RAb~OLOGICAL IN'~mRPRETATION
DRANE SHIRLEY A
10226721
3/03/200~
MICHAEL F. HILDEN,MD 245-5505
KENNET~ HARM,MD LAB-
VENT
MED REC #:
ACCOUNT #:
D.O.B.:
ROOM:
ABLE CHEST
ORY: Respiratory failure.
rtable view of the chest obtained on 3-3-04 is compared to
examinations Of the prior day. An endotracheal tube is seen
the tip approximately 2 cm above the carina. There is
easing left pleural effusion. There may be an element of
lower lobe at.electasis. A patchy density at the right base
ists.
AND SIGNED
K LOH, MD
FATED: 3 /
~SCRIBED: 3/
~ED: 3 /
PTIONIST: DLI
FI
JAY ROSENBLUM, M.D.
DICTATED BY
03/200A
03/200A 11:A9
03/200A 17:32:57
OOR
PAGE 1 OF 1
1022672
9276093
12/27/1942
0011
PATIENT
X-RAY#:
EXAM DA
ORDERIN
ATTENDI
CONSULTI
HISTORY
POR
HIS
Com]
lif,
satl
hyp~
the
IMP]
REVIEWED
CHRISTOP
INTERPR5
DATE DIi
DATE TRA
DATE SIG
TRANSCRI
6995490
CHEST PORTABLE
NAME:
FE:
~G:
lNG:
U~L±SLE REGIONAL MEDICAL CENTER
i~DIOLOGICAL ~TERPRETATION
DRANE iSHIRLEY A
10226721
3/02/2004
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
TRACH
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
?ABLE CHEST ATI 0400 HOURS
?ORY: MechaniCal ventilation.
~arison is made to chest films of the two days prior. The
~ support and monitoring hardware are unchanged and in
.sfactory position. There is no pneumothorax. Bibasilar
,ventilatory change ms again present and appearing similar to
day prior. ~
~SSION: Chest film without definite change.
AND SIGNED
{ER LADD,MD
~ING PHYSICIA~
?ATED: 3/
~SCRIBED: 3/
~ED: 3/
~TIONIST: JND
FL
02/2004
02/2004 10:31
2/2004 12:41:45
,OR
PAGE 1 OF 1
PAT I ENT NAME:
X-RAY#:
EXAM DA :E:
ORDERIN, ~:
ATTENDIi [G:
CONSULT lNG:
H I S TORY
U~ib'mLE REGIONAL MEDICAL CENTEP
RADIOLOGICAL INTERPRETATION
DRANE SHIRLEY A
10226721
2/29/2004
GEP~ALDi FRONKO,MD,PHD 245-5500
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
SHORTNESS OF BREATH
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
POR[
HIS7
Com·
COM
is %
nas(
mar}
Thei
pnet
12/C
IMP]
INTI
DEN,
'ABLE CHEST ATi0315 HOURS 02/29/04:
'ORY: RespiratOry failure.
arison is mad~ to chest film of 12/03/03
iENTS: The patient is intubated. The endotracheal tube tip
ithin good position approximately 3 cm. above the carina. A
gastric tube ends below the radiograph. Increased perihilar
ings are seen!with consolidated appearance about both hila.
e is no peripheral lung infiltrate, pleural effusion, or
mothorax evident. The chest film appears similar to
3/03.
ESSION:
BATION AS DES(
ITY OTHERWISE
REVIEWED AND SIGNED
CHRISTOPtER LADD,MD
INTERPRE
DATE DIC'
DATE TPJf
DATE SIG[
TRA/~SCRIi
6995537
CPIE~PORTABLE
?ING PHYSICIAN
?ATED: 2/
~SCRIBED: 2/
~ED: 3/
PTIONIST: DJC
FL~
,IRIBED. PERIHILAR INFILTRATES OR INCREASED
PRESENT AND UNCHANGED AND SIMILAR TO 12/03/03.
9/2004
9/2004 13:30
1/2004 10:05:55
)OR
PAGE 1 OF 1
PATIENq
X-RAY#1
EXAM D~
ORDERI5
ATTENDI
CONSUL%
HISTORY
NAME:
rE:
.~G:
lNG:
VENTE
ER]
The
day
The
is~
inf
on
and
1.5
sub,
IMP]
Sli~
liti
REVIEWEE
CHARLES
INTERPR]
C~RLISLE REGIONAL MEDICAL CENTER
iRAuiOLOGICAL IN~ERPRETATION
DRANE iSHIRLEY A
1022672
3/01~2004
MICHAEL F. HILDEN,MD 245-5505
KENNETH HARM,MD LAB-
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B.: 12/27/1942
ROOM: 0011
2T PORTABLE CHEST AT 0525 HOURS
study is compared to the previous studies, the last done one
ago at 1310 hburs.
heart remains! top normal in size. The pulmonary vascularity
;ithin normal limits. Bilateral basilar parenchymal
.ltrates are again see, unchanged on the right and progressed
:he left and sUggest progressing subsegmental atelectasis
'or pneumonitib. The endotracheal tube again is noted about
inches above ~he carina. A gastric tube is again seen. A
~lavian catheter is again noted in the superior vena cava.
~SSION: I
'ht progressioh of the left basilar infiltrates, otherwise
le or no interval change.
AND SIGNED
K LOH, MD
rING PHYSICIA~
DATE DI(
DATE TPJ
DATE
TRANSCRI
6995492
CHESTPORTABLE
rATED: 3
~SCRIBED: 3
~ED: 3/
?TIONIST: JNE
FL
ol/2oo4
01/2004 8:30
01/2004 10:32:54
OOR
PAGE 1 OF 1
PATIENT
X-RAY# :!
EXAM DA'
ORDERIN,
ATTENDIi
CONSULT
HISTORY
The
sam~
Sin,
bee]
cav~
car[
inf
sub,
IMP]
Sin~
pla~
Bil
sub
exar
REVIEWE]
CHARLES
INTERPR]
DATE DI(
DATE T~
DATE SI(
TRANSCR
6995173
CHEST PORTABLE
NAME:
FE:
~G:
lNG: KENNE%
CHECK CENTR
CARLISLE REGIONAL MEDICAL CENTER
RAuz0LOGICAL IN~ERPRETATION
DRANE SHIRLEY A
1022672'
2/29/]2004
MICHAEL F. HILDEN,MD 245-5505
H HARM,MD LAB-
AL LINE PLACEMENT
MED REC #: 1022672
ACCOUNT #: 9276093
D.O.B. : 12/27/1942
ROOM: 0011
IT PORTABLE ~ST AT 1310 HOURS
study is comphred to the previous study done earlier the
day.
e the laterali examination, a right subclavian catheter has
placed with ~ip near the mid portion of the superior vena
The endotrhcheal tube is seen about 1.5 inches above the
na. A gastrid tube is again noted. Bilateral basilar
_ltrates are s6en, suggestive of pneumonia and/or
~egmental atel~ctasis.
~SSION:
~e the last examination, a right subclavian catheter has been
~ed in the superior vena cava. No pneumothorax is seen.
~teral basilar parenchymal disease suggests pneumonia and/or
~egmental atel6ctasis, new interval since the last
]ination.
) AND SIGNED ~
K LOH, MD ~
:TING PHYSICI~.
!TATED: 3~01/2004
SCRIBED: 3k01/2004
NED: 3 01/2004
PTIONIST: J~OOR
8:27
10:32:34
PAGE 1 OF 1
T:
DRA
CON
ATTE
DATE
JE, SHIRLEY A
~ULTATION TO:
NDING PHYSICIAN:
ICU 0011 A
Gregory L. Lewis, M.D.
HILDEN, MICHAEL F
1022672
3f 1
OCUMENT IS NOT A
Page
THIS
C:
Gregory L. Lewis, M.D.
LEGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
CONSULTATION
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
Gregory L. Lewis, M.
Christina Collins, M.[
GeorgeAnn Reilly
TYPE OF CONSULTATIONS: Bioethics.
|
HIST*)RY OF PRESENT ILLNESS: This 61 year-old female is a long-time resident of Claremont Nursing
and F ehabilitation Center arid is cared for by Dr. Harm. She has severe mental retardation as well as
seve. r~ chronic obstructive p~lmonary disease. This has resu ted n recurrent admissions to Car sle
Regic~nal Medical Center in ~spiratory failure requiring ventilatory support. I have reviewed multiple
prevk~us admissions and it h~s been pointed out that patient does not have a guardian or surrogate
decisln maker and discussion has arisen about appointing one but to this point it has not happened.
The p~atient has multiple pasl medical problems. In addition to severe mental retardation she has
endst;~ge chronic obstructive~ pulmonary disease, she has coronary artery disease, she has retinal
deger eration and apparently~ has history of some form of chronic psychosis.
/
PHYSICAL EXAMINATION
On examining the patient sh~ is sedated on a respirator. She has skin breakdown over her nose from a
BiPAF mask. She has a fee<ling tube in her abdomen and she is unresponsive. Apparently, her skin
integrily has been maintaine, other than in the area on the nose.
Additk~nal information is that :he patient was hypoxic for some period of time recently in the nursing home
and may have sustained adz tion anoxic damage to her brain.
Ethic; issues are multiple. 'rhis patient has many chronic and severe medical issues that cannot be
clearl be cured or significantly improved. Although one could use medical futility as a justification for
stopp ~g treatment there is n
~ Pennsylvania State Medical Futility Statute. Also the patient does not
have -- surrogate or legal gut rdian. As I fee the patient needs to have a legal guardian appointed by the
courts and further and contir uing medical treatment should occur until there is additional medical and
legal i~put about possible wi' ~drawal of treatment. The eth cai standards to apply to decision making
shoulc~ be what is in the best interests of this patient, since I doubt that substituted judgment would apply.
GLL/jr~ [
D: 03/03/2004 14:23:02/
03/03/2004 22:13:51
.' I ON~ULTATION
D R A N , SH ~' RL EY A · Consultation to: ....
Hi LO
C F ~ 5 t AD~ 02/~9/2C ' .....
DOB
CRHC
O0t02~fi?~
Signature Attending Physician *Date
Typ~Cons~ltatio~: ~heck One: Consultation O~ly
C'lmical Ev,aluatiom"~(to include imPression~ ~d recommendations) , ,,
,,
....
DS o~30
!
ADUL'~ ,UTRITION ASS, 3MENT & CAR, ~LAN
Wt Change: t Herbals/Vitamins/Supplements:
Food Prefere ices:
Allergies/Into erances I~ ~ [~" (..~ I N/V Diarrhea / Cons~pation
~her: ~.~¥~ ~ I~ ,~ ~
Swallowing P'oblems: Y N I Chewing Problems: Y N I skin ImegriW: WNL ~ompromised
Diagno~ic/Oi ~erative Repo~s: ~-~
Pre-AIb g/dL Chol mgZdL Phos mg~dL
Alb__'g/~L Trig mg/dL Mg__ mg/dL ~, I ~ ~ H
Hgb~ 01 ~ ~ ./dL HDL mg/dL Ca mg/dL
H~ __ % ~L mg/dL
HBgA1C % VLDL mg/dL WBC
~her:
A: Total Calo~ ic Needs: k( al/day Protein Needs:~ gm/aay Fluid Needs: ml/~ay
~ h~: B been educ~ed ~ needs eduction B needs rein~rceme~
Appmpri~en )ss of Diet Order: ~O C
Level of N~ri :ion Risk: D Not at Ri~ k ~ Low Risk ~ Moder~e Risk ~gh Risk
P: RECOMMI [NDATIONS: INTER~NTIONS:
~ SUPPLE ME~S: g 3-day calorie Coum
A~er~io ~ in di~: ~ Diet lnmrumions provided
~MonRor for pote~ial n~rition~l problems
~Reasses, in: ~7'~ ,i~' .5 days
~ ~her:
Q~9~,J~,,~Q~',~,U~¢ ~ I ¢~ 0 C, r 06l ADH 02/29/2004
~J Signed' uate/lime
ADUL ~ N~ITION ASSE~SMEN T & CARE
;er. 02103)
f
RLISLEoNAL
MEDICAl., CENTER
NURSING CONSULTATION
Type Consullation: Check One [ ] Consultation Only
[ ] Consultation and Follow Patient
[ ] Consultation and Write Nursing Orders
Clinical Eval~lation: (to include aursi~g impressions and reco~endations)
/ ~
Signature: Date:
PATIENT IDENTIFICATION
Consultation Fo:
Consultation ~eg~d~g: q 8: b 0 q 3
DRANE, SHIRLEY A
~) LOEb, MICHAE RM OOl
Initiated By: t r 06 I AOM 0~/~9
DOB le/~?/19~ ~/C M
Date: C ~ mC 000 10~ ~6
NO 0314 (07/01) C Aa L I $L[ PA
DRA
CHIE
HIST~
resid(
retarc
wee rs
BiPAF
transP
was n~
stimuli
from ti
PAST
1.
2. Er
3. CI'
4.
5.
6. Al
7. Ar
8.
10. HE
11.
12. G~
MEDI(
hrs., P
ALLE!
SOCI,a
unobt.
FAM
REVIE
GENE
VITAL
rate
HEEN'I
pupil is
Page
THIS
E, SHIRLEY A '
ICU 0011 A 1022672
COMPLAINT: Unrelponsive'
,RY OF PRESENT ILl'NESS: Mrs. Drane is a very unfortunate 61-year-old Caucasian female who
s at Claremont Nursin~l Home and receives her medical care from Dr. Harm. She is mentally
.~d and has severe chronic obstructive pulmonary disease and is a chronic CO2 retainer. She
a BiPAP during the ev~ening. Apparently this evening the nurse wa ked i,n_to the room, found the
off. The patient was f~accid and blue and her saturations were in the 50 s. The patient was then
orted to the Emergenc~¢ Department. In the Emergency Department the patient's pulse oximetrv
)ted to be 84% on 15% liters nonrebreather. She was not very responsive to verbal or tactile --
· She was intubated b~ Dr. Fronko and is now on the ventilator. All of my history was obtained
le medical records.
MEDICAL HISTORY: ~
vere mental retardatioN.
d-stage chronic obstrdctive pulmonary disease.
ronic hypercapnia.
sphagia.
ronary artery disease
hasia.
emia.
teoarthritis.
final degeneration.
aring loss.
tchotic psychoses.
stroesophageal reflux
ATIONS: Reglan 5 m
evacid 30 mg q day.
:GIES: No known dru~
L HISTORY: The pat
nable.
HISTORY: Unobtair
OF SYSTEMS: Un,
:AL - The patient is sE
;IGNS - Temperature
labored.
- She has anisocoria
approximately 3 mm a
1 of 3
D DCUMENT IS NOT A
status post myocardial infarction.
disease.
q 8 hrs, Prosource 40 cc b.i.d., Valproic Acid 750 mg q 8 hrs, Duo-Neb q 4
allergies.
~nt is a long-term resident of Claremont Nursing Home. Otherwise
able.
,btainable.
PHYSICAL EXAMINATION
dated on the ventilator. She does withdraw to painful stimuli.
@6.8°F. Blood pressure initially was 124/56. Heart rate 109. Respiratory
~f her right pupil. It is approximately 3 mm and sluggish to light. Her left
~d sluggish to light. She has a 7.5 ET tube in place at 21 cm.
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
.EGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
DRAN
NECK
LUNG
rhonc[
CARD
gallops
ABDOI
no pal
EXTR
LABO
DATA
blood c
PCO2
V4, V,~
perihil~
ASSE,~
1. Re
2. Re
3. ME
4. Dy
5. Se'
PLAN.
1. Th
se~
mc
be,
Iw
2. Th
Do
pa~
3. Re
Thi
dr¢
Fee
co(
MFH/bI:
D:
T:
Page 2
THIS D(
E, SHIRLEY A
- Supple. There is no
- She has diminishe~
)VASCULAR EXAM
ICU 0011 A
1022672
visible JVD. There is no lymphadenopathy or thyromegaly.
breath sounds with scattered rhonchi. I do not appreciate any wheezes or
She is tachycardic but regular. I do not appreciate any murmurs, rubs or
IEN - She has a PEGItube in place on her left side without any surrounding erythema. There are
able masses or hepattsplenomegaly. Bowel sounds are hypoactive.
:MITIES - Warm. Thete is no clubbing, cyanosis or edema.
/
b~.TORY
-White blood cell cour~t 7.3, hemoglobin 10.9, hematocrit is 36.3, platelets 207,000. Initial arterial
as shows a pH of 7.25~, PCO2 of 123, PO2 66. A second arterial blood gas shows a pH of 7.49,
f 60, PO2 of 253. 12-~ead EKG shows sinus tachycardia with some mild ST elevations in leads
and V6. Chest x-ray~hows the heart within normal limits. She has some hazy infiltrates in the
r region that could beatelectasis versus infiltrate.
SMENT - on
~piratory failure.
~piratory acidosis sec dary to hypercarbia.
ltal retardation.
~phagia.
'ere chronic obstructiv~ pulmonary disease and a known CO~ retainer.
/
patient will be admitted to the Intensive Care Unit. She will be mechanically ventilated and
ated with Versed. Considering that her pH was 7.25 with a CO= of 123 indicates that her CO2 is
st likely in the 80s to 9~)s on a regular basis. We have to be careful not to over vent ate her
'.ause it would be diffic~]lt to extubate. I think that we need to allow for permissive hypercapnia and
)uld aim to keep her P 302in the 80 to 90 range.
~re are no obvious sigr
)amine at the present
culture her and start
larding the patient's c~
; issue was raised dur
~ped and there still is f
Jested that the patient
e.
02/29/2004 05:03:14
03/01/2004 09:48:57
if 3
)CUMENT IS NOT A
s of infection although her blood pressure is a bit on the Iow side requiring
ime. I suspect all of her problems are respiratory related. I will however
~er on empiric Levaquin.
de status, she apparently does not have any surrogate decision makers.
ng her last hospitalization in December of 2003. Apparently the ball was
~o surrogate decision maker. The risk manager was contacted and
be a full code for the time being. In that regard, the patient is to be a full
This document was authenticated by Christina Collins, M.D.
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
EGAL COPY UNLESS SIGNED.
3ARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
DRA
C:
Page
THIS
IE, SHIRLEY A
Michael F. Hilden, M.D.
ICU 0011 A 1022672
for Michael F. Hilden, M.D. on 03/01/2004 17:50:44.
Michael F. Hilden, M.D.
of 3
OCUMENT IS NOT A
LEGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
DR/~
CHI!
HIST~
'E, SHIRLEY A
COMPLAINT: UnrE
'RY OF PRESENT ILl
resid( s at Claremont Nursin,
retarc .~d and has severe ch~
wears~a BiPAP during the e~
BiPAFr off. The patient was 1
transl~orted to the Emergenc
was n~)ted to be 84% on 155
stimult. She was intubated b
from the medical records.
PASTIMEDICAL HISTORY:
1. S(~vere mental retardatio
2. Er~d-stage chronic obstn
3. Cl~ronic hypercapnia.
4. D~sphagia.
5. Cd~ronary artery disease
6. Al~hasia.
7. Ar~emia.
8. O~teoarthritis.
9. R(
10. HE
11. P.~
12. GE
MEDI(
hrs., P
ALLE!
SOCl.a
unobt.
FAMI
REVIE
GENEf
VITAL,
rate 24
HEEN'I
pupil is
Page 1
THIS D
tinal degeneration.
aring loss.
fchotic psychoses.
stroesophageal reflux
ATIONS: Reglan 5 m
evacid 30 mg q day.
:GIES: No known dru(
HISTORY: The pati
nable.
Y HISTORY: Unobtair
OF SYSTEMS: Un,
(AL - The patient is s(
.~IGNS - Temperature
labored.
- She has anisocoria
approximately 3 mm a~
of 3
::)CUMENT IS NOT A
ICU 0011 A
1022672
3onsive.
.NESS: Mrs. Drane is a very unfortunate 61-year-old Caucasian female who
] Home and receives her medical care from Dr. Harm. She is mentally
)nic obstructive pulmonary disease and is a chronic CO2 retainer. She
ening. Apparently this evening the nurse walked into the room, found the
laccid and blue and her saturations were in the 50's. The patient was then
~, .,Departmen, t. In the Emergency Department the patient's pulse oximetry
, [ers nonreDreather. She was not very responsive to verbal or tactile
Dr. Fronko and is now on the ventilator. All of my history was obtained
ctive pulmonary disease.
status post myocardial infarction.
disease.
q 8 hrs, Prosource 40 cc b.i.d., Valproic Acid 750 mg q 8 hrs, Duo-Neb q 4
allergies.
~nt is a long-term resident of Claremont Nursing Home. Otherwise
~able.
,btainable.
PHYSICAL EXAMINATION
:lated on the ventilator. She does withdraw to painful stimuli.
96.8°F. Blood pressure initially was 124/56. Heart rate 109. Respiratory
)f her right pupil. It is approximately 3 mm and sluggish to light. Her left
ld sluggish to light. She has a 7.5 ET tube in place at 21 cm.
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
.EGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
DRA
NE(
LUN(
rhone
CARl
gallo
ABD,
no pa
EXTR
LAB(
DATI
blood
PCO2
V4, V,~
perihil.
ASSE
1. RE
2.
3. M~
4. D~
5. SE
PLAN
1.
s6
m,
Iv
2. TI'
Dc
pa
3.
Th
dr(
re(
co
MFH/b
D:
T:
Page
THIS
IE, SHIRLEY A
- Supple. There is n
S - She has diminish~
hi.
~IOVASCULAR EXAM
S.
~MEN-She has a PE(
)able masses or hepa'
ICU 0011 A
1022672
visible JVD. There is no lymphadenopathy or thyromegaly.
breath sounds with scattered rhonchi. I do not appreciate any wheezes or
- She is tachycardic but regular. I do not appreciate any murmurs, rubs or
tube in place on her left side without any surrounding erythema. There are
osplenomegaly. Bowel sounds are hypoactive.
=MITIES - Warm. ThTre is no clubbing, cyanosis or edema.
RATORY
-White blood cell count 7.3, hemoglobin 10.9, hematocrit is 36.3, platelets 207,000. Initial arterial
~las shows a pH of 7.25, PCO2 of 123, PO2 66. A second arterial blood gas shows a pH of 7.49,
of 60, PO2 of 253. 12-.ead EKG shows sinus tachycardia with some mild ST elevations in leads
;, and V6. Chest x-ray shows the heart within normal limits. She has some hazy infiltrates in the
~r region that could be atelectasis versus infiltrate.
BSMENT -
~spiratory failure.
~spiratory acidosis sec~
;ntal retardation.
sphagia.
vere chronic obstructi~
~e patient will be admit
dated with Versed. C<
)st likely in the 80s to !
cause it would be diffi(
,ould aim to keep her f
ere are no obvious sis
,pamine at the present
n culture her and s!art
,garding the patient s ¢
is issue was raised du
)pped and there still is
luested that the patien
:Je.
)m
02/29/2004 05:03:14
03/01/2004 09:48:57
2 of 3
BOCUMENT IS NOTA
}ndary to hypercarbia.
e pulmonary disease and a known CO~ retainer.
ad to the Intensive Care Unit. She will be mechanically ventilated and
nsidering that her pH was 7.25 with a CO~ of 123 indicates that her CO2 is
Os on a regular basis. We have to be careful not to over ventilate her
ult to extubate. I think that we need to allow for permissive hypercapnia and
CO2in the 80 to 90 range.
is of infection although her blood pressure is a bit on the Iow side requiring
time. I suspect all of her problems are respiratory related. I will however
ler on empiric Levaquin.
)de status, she apparently does not have any surrogate decision makers.
lng her last hospitalization in December of 2003. Apparently the ball was
lo surrogate decision maker. The risk manager was contacted and
be a full code for the time being. In that regard, the patient is to be a full
.EGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
Michael F. Hilden, M.D.
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
DRAI
C:
Page
THIS
4E, SHIRLEY A
Michael F. Hilden,
of 3
OCUMENT IS NOT A
ICU 0011 A
.EGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
1022672
9276093
DRANE, SHIRLEY A
ICU 0011 A 1022672
02/29/2004 12/27/1942
HILDEN, MICHAEL F
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
: DOCKET NUMBER: 21-04-221
:
: GUARDIANSHIP
And now this ]~day of/~- '~ ~ ~,$~ ,2004, it is hereby ORDERED and
DECREED that The Area Agency on Aging, in and for Cumberland County, Pennsylvania
is appointed as permanent plenary guardian of the person and estate of Shirley Drane for
the purpose of providing medical decision-making authority.
BY TH :
LT:: tT\f 6t ~'d ~0.
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER: 21-04-221
:
: GUARDIANSHIP
PETITION FOR PERMANENT PLENARY GUARDIANSHIP OF THEliERsON~
AND THE ESTATE
AND NOW comes Carlisle Regional Medical Center, by and through its counsel,
Farrell & Ricci, P.C., by Joseph A. Ricci, Esquire, and requests that this Honorable Court
enter an Order granting a permanent plenary guardianship of the person and estate Ms.
Shirley Drane for the following reasons:
1. The alleged incapacitated person is Ms. Shirley Drane, an adult female aged
61, who has a permanent residence at the Cumberland County Nursing Home, Clairmont
Road, Carlisle, Cumberland County, Pennsylvania.
2. Ms. Drane is currently a patient at SCCI, in Harrisburg, Dauphin County,
Pennsylvania, a long-term acute care facility whose goal is to return patients to their
residence after a period of rehabilitation.
3. Prior to her current hospitalization, Ms. Drane was a patient of the Carlisle
Regional Medical Center, Carlisle, Cumberland County, Pennsylvania.
4. Ms. Drane has no known relatives.
5. Prior to her admission to the hospital, Ms. Drane was receiving medical care
at the Cumberland County Nursing Home and was receiving assistance from the
Cumberland County MH/MR office.
6. On or about March 5, 2004 this Honorable Court appointed the Area Agency
on Aging in and for Cumberland County, Pennsylvania as the Emergency Plenary
Guardian of the person of Ms. Shirley Drane.
7. Beverly Christ, R.N., a representative of the Area Agency on Aging in and for
Cumberland County, Pennsylvania has been providing guardianship services for Ms.
Shirley Drane pursuant to the Order of this Court.
8. The conditions which led to the need for an emergency guardianship of the
person persist, and Ms. Drane is in need of an ongoing and permanent plenary
guardianship of the person and estate for the following reasons:
a) Ms. Drane is an elderly woman who lives as a resident at the Cumberland
County Nursing Home.
b) Because of her limited financial means, Ms. Drane lacks the ability to seek
private placement for her medical needs.
c) Ms. Drane has no known family members or friends; accordingly, there are
no family members or friends who can provide for surrogate decision-making
on Ms. Drane's behalf.
d) The Cumberland County Nursing Home has relinquished direct
responsibility for the care of Ms. Drane upon her admission to the Carlisle
Regional Medical Center, however, the Cumberland County Nursing Home
has retained a bed for Ms. Drane's anticipated return to their care.
e) At this time, there is no other reasonable alternative to effect the proper
care of Ms. Drane besides the appointment of a plenary guardian of the
person and estate.
f) Ms. Drane suffers from recurrent respiratory collapse. As a result of her
respiratory condition, Ms. Drane will potentially suffer from numerous
medical complications, which will require an ability to understand the nature
of the complications and how they will be treated. The treatments necessary
will include the need to provide informed consent to permit the medical
treatments.
g) Ms. Drane is both severely mentally retarded with psychotic behavior and
is unable to speak; therefore, she is unable to participate in medical decision
making on her own behalf. See Affidavit of Dr. David Albright. (Ms. Drane's
attending physician) attached hereto as Exhibit "A."
h) Ms. Drane is currently suffering from severe end-stage Chronic
Obstructive Pulmonary Disease, a condition which renders her oxygen
dependant. Ms. Drane's carbon dioxide levels are chronically at dangerous
levels of two times normal. Ms. Drane's chronic medical condition required a
tracheosotomy, a surgical procedure which provides direct access to the
trachea for purposes of providing mechanical ventilation of the patient.
i) Although Ms. Drane has now been successfully weaned from a mechanical
ventilator, she continues to suffer from severe end-stage chronic obstructive
pulmonary disease and will likely require invasive care in the future.
j) Because Ms. Drane's condition is permanent and untreatable, she will
require medical care for the remainder of her life.
k) Ms. Drane is incapable of participating in appropriate medical decision
making because she remains non-communicative and unable to speak or
Date:
write. Further, Ms. Drane suffers from mental retardation with psychotic
features and is therefore unable to comprehend the nature of her medical
care.
1) Beverly Christ, R.N. has been providing guardianship services to Ms.
Drane and is prepared to provide continuing services in the future. See
Affidavit of Beverly Christ, R.N. attached hereto as Exhibit ~'B."
9. A plenary guardianship will permit the appropriate decision-making to take
place in the short and long term and potentially avoid the premature and unnecessary
death of Ms. Drane.
WHEREFORE it is respectfully requested that this Honorable Court issue an Order
appointing a representative of the Area Agency on Aging in and for Cumberland County,
Pennsylvania as guardian of the person and estate of Shirley Drane for the purpose of
providing medical decision-making authority.
FARRELL & RICCI, P.C.
(717) 230-9201
Counsel for Carlisle Regional Medical Center
EXHIBIT "A"
AND NOW this
and affirm:
1.
AFFIDAVIT OF DAVID ALRRIGHT~ M.D.
{~ day of April, 2004, I, David Albright, M.D., do hereby swear
I am a physician licensed to practice medicine in the Commonwealth of
Pennsylvania.
2. My medical practice is limited to the specialty of internal medicine.
3. I was the attending physician for Carlisle Regional Medical Center patient
Shirley Drane.
4. Ms. Drane became a patient of the Carlisle Regional Medical Center on
February 29, 2004.
5. Ms. Drane is a patient suffering from severe end-stage Chronic Obstructive
Pulmonary Disease. She is severely mentally disabled, displays psychotic behaviors and is
non-communicative.
6. At the time of her admission to the Carlisle Regional Medical Center, Ms.
Drane required breathing support with a ventilator and was in need of the use of an
endotracheal tube.
7. The long-term use of an endotracheal tube will cause a patient to suffer
painful pressure ulcerations of the throat and lips, therefore, Ms. Drane underwent a
tracheostomy with the consent of Beverly Christ, R.N., a representative of the Area Agency
on Aging in and for Cumberland County, Pennsylvania, appointed as Emergency Plenary
Guardian by the Cumberland County Court of Common Pleas.
8. Since the placement of the tracheostomy tube, and the continued use of
mechanical ventilation, Ms. Drane's medical condition stabilized allowing her admission to
a long-term acute care facility for purposes of rehabilitation and return to her home at the
Cumberland County Nursing Home.
9. Currently, Ms. Drane is receiving care at SCCI, an acute long-term care
facility in Harrisburg, Dauphin County, Pennsylvania.
10. Upon information and belief, Ms. Drane was successfully weaned from her
mechanical ventilator on or about March 27, 2004.
11. Since Ms. Drane was successfully weaned from the ventilator, with additional
rehabilitation, she will be able to return to her home at the Cumberland County Nursing
Home.
12. Because Ms. Drane suffers from a chronic medical condition which cannot be
cured, she will require ongoing medical care.
13. Ms. Drane's mental impairment, coupled with her lack of ability to
communicate, prevents her from being able to provide her informed consent to any medical
care which she may require.
14. Failure to obtain the necessary consents for continued medical care will
subject Ms. Drane to unnecessary suffering and harm.
Date:
Respectfully submitted,
David Albright, M.D.
EXHIBIT "B"
AND NOW THIS
and affirm:
1.
o
AFFIDAVIT OF BEVERLY CHRIST, R.N.
! Day of April, 2004, I Beverly Christ, R.N. do hereby swear
I am employed by the Area Agency on Aging, in and for Cumberland County,
Pennsylvania as the Supervisor of Case Management.
Prior to my employment with the Area Agency on Aging in and for
Cumberland County, Pennsylvania, I was employed as a nurse at the
Cumberland County Nursing Home.
On or about March 9, 2004, I was appointed by the Cumberland County
Court of Common Pleas to act as Emergency Plenary Guardian of the person
and estate of Shirley Drane.
Since my appointment as Emergency Plenary Guardian of the person and
estate of Shirley Drane I have been involved in the medical decision making
necessary for the care and welfare of Shirley Drane.
As Emergency Plenary Guardian, I have been in close communication with
the nurses and doctors responsible for providing medical care and treatment
to Shirley Drane.
I have been advised that Ms. Drane suffers from severe, end-stage chronic
obstructive pulmonary disease which renders her unable to properly
oxygenate her tissues.
I have been advised that the condition from which Ms. Drane suffers is
permanent and cannot be cured.
o
o
11.
12.
13.
14.
15.
Ms. Drane is also mentally retarded and displays psychotic behaviors. As a
result of her mental condition, she is unable to comprehend her medical
condition and cannot meaningfully participate in necessary decision making.
Ms. Drane lacks the ability to communicate and can neither speak nor write.
Since my appointment as Emergency Plenary Guardian of the person and
estate of Shirley Drane, she has undergone the surgical placement of a
tracheostomy tube to facilitate her breathing by mechanical ventilation.
Since the placement of the tracheostomy tube, Ms. Drane has experienced a
stabilization of her medical condition which has allowed her to be transferred
to SCCI, a long-term acute care facility in Harrisburg, Dauphin County,
Pennsylvania.
Since her transfer to SCCI, Ms. Drane's condition has improved to the point
where she is not currently in need of the continued use of a mechanical
ventilator.
Upon information and belief, the Cumberland County Nursing Home has
maintained a bed for the use of Ms. Drane upon her discharge from SCCI.
Upon information and belief, the healthcare providers at SCCI are confident
that Ms. Drane will be able to return to her home at the Cumberland County
Nursing Home.
Despite the planned return of Ms. Drane to the Cumberland County Nursing
Home, her medical condition is such that she will require ongoing medical
care and treatment.
16.
17.
18.
19.
20.
Despite the planned return of Ms. Drane to the Cumberland County Nursing
Home, her mental condition is such that she is incapable of participating in
her medical care and treatment.
I have become familiar with Ms. Drane and her medical needs.
I have developed a rapport with Ms. Drane's healthcare providers.
Based upon my training and experience I have the ability to continue to
provide guardianship services through the auspices of the Area Agency on
Aging in and for Cumberland County Pennsylvania.
It is necessary for the benefit of Ms. Drane's ongoing medical needs that a
proper guardian is appointed for the purposes of providing decision-making
in regard to her ongoing medical treatment.
Respectfully submitted,
Date:
Supervisor Case Management
Area Agency on Aging in and for
Cumberland County, Pennsylvania
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER: 21-04-221
: GUARDIANSHIP
And now this I ~4~'~ day of_~.~~, 2004, it is hereby ORDERED and
DECREED that The Area Agency on Aging, in and for Cumberland County, Pennsylvania
is appointed as permanent plenary guardian of the person and estate of Shirley Drane for
the purpose of providing medical decision-making authority.
Je
5l
:i? ;'1
IN RE: Shirley Drane
· IN THE COURT OF COMMON PLEAS
· CUMBERLAND COUNTY PENNSYLVANIA
· DOCKET NUMBER:21-04-221
· GUARDIANSHIP
STIPULATION OF COUNSEL RE.' GUARDIANSHIP OF THE PER~N ANbi~:'.i'
ESTATE OF SHRLEY DRANE ...... ~
AND NOW COMES, Petitioner, Carlisle Regional Medical Center by and thro~hi~its
counsel, Joseph A. Ricci, Esq. and Respondent, Shirley Drane, by and through her counsel
Harold S. Irwin, III, Esq. and hereby stipulate and agree as follows:
1. Shirley Drane is an adult individual with a residence at the Cumberland County
Nursing Home, Clairmont Road, Carlisle, Cumberland County, Pennsylvania.
2. The Cumberland County Court of Common Pleas on March 5, 2004 appointed
Harold S. Irwin, III, Esq. as counsel for Shirley Drane.
3. The Cumberland County Court of Common Pleas on March 5, 2004 appointed the
Area Agency on Aging, in and for Cumberland County Pennsylvania as
Emergency Plenary Guardian of Shirley Drane.
4. On March 9, 2004 the Cumberland County Court of Common Pleas held a
hearing pursuant to 20 Pa.C.S.A. §5513 in which an Emergency Plenary
Guardianship was ordered with a final hearing to be held on April 20, 2004.
5. The conditions for which the Emergency Plenary Guardianship were sought
remain and Shirley Drane is in need of a guardianship for the remainder of her
life.
6. Counsel for the Petitioner will file the attached Motion for Appointment of
Guardian and the supporting affidavits. See Motion with attachments attached
hereto as Exhibit "A."
7. Counsel for the Respondent concurs in the attached motion.
WHEREFORE, it is respectfully requested that this Honorable Court enter an order
appointing the Area Agency on Aging, in and for Cumberland County, Pennsylvania
guardian of the person and estate of Shirley Drane.
Respectfully submitted,
Date:
/~F6~ph A.~ci, Es~.
4423 North Front Street
Harrisburg, PA 17110
Counsel for Petititioner
64S~~
Carlisle, PA 17103
Counsel for Respondent
EXHIBIT "A"
IN RE: Shirley Drane
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY PENNSYLVANIA
DOCKET NUMBER: 21-04-221
GUARDIANSHIP
And now this day of ., 2004, it is hereby ORDERED and
DECREED that The Area Agency on Aging, in and for Cumberland County, Pennsylvania
is appointed as permanent plenary guardian of the person and estate of Shirley Drane for
the purpose of providing medical decision-making authority.
BY THE COURT:
ge
IN RE: Shirley Drane
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
:
: DOCKET NUMBER: 21-04-221
..
:
: GUARDIANSHIP
PETITION FOR PERMANENT PLENARY GUARDIANSHIP OF THE PERSON
AND THE ESTATE
AND NOW comes Carlisle Regional Medical Center, by and through its counsel,
Farrell & Ricci, P.C., by Joseph A. Ricci, Esquire, and requests that this Honorable Court
enter an Order granting a permanent plenary guardianship of the person and estate Ms.
Shirley Drane for the following reasons:
1. The alleged incapacitated person is Ms. Shirley Drane, an adult female aged
61, who has a permanent residence at the Cumberland County Nursing Home, Clairmont
Road, Carhsle, Cumberland County, Pennsylvania.
2. Ms. Drane is currently a patient at SCCI, in Harrisburg, Dauphin County,
Pennsylvania, a long-term acute care facility whose goal is to return patients to their
residence after a period of rehabilitation.
3. Prior to her current hospitalization, Ms. Drane was a patient of the Carlisle
Regional Medical Center, Carhsle, Cumberland County, Pennsylvania.
4. Ms. Drane has no known relatives.
5. Prior to her admission to the hospital, Ms. Drane was receiving medical care
at the Cumberland County Nursing Home and was receiving assistance from the
Cumberland County MH/MR office.
6. On or about March 5, 2004 this Honorable Court appointed the Area Agency
on Aging in and for Cumberland County, Pennsylvania as the Emergency Plenary
Guardian of the person of Ms. Shirley Drane.
7. Beverly Christ, R.N., a representative of the Area Agency on Aging in and for
Cumberland County, Pennsylvania has been providing guardianship services for Ms.
Shirley Drane pursuant to the Order of this Court.
8. The conditions which led to the need for an emergency guardianship of the
person persist, and Ms. Drane is in need of an ongoing and permanent plenary
guardianship of the person and estate for the following reasons:
a) Ms. Drane is an elderly woman who lives as a resident at the Cumberland
County Nursing Home.
b) Because of her limited financial means, Ms. Drane lacks the ability to seek
private placement for her medical needs.
c) Ms. Drane has no known family members or friends; accordingly, there are
no family members or friends who can provide for surrogate decision-making
on Ms. Drane's behalf.
d) The Cumberland County Nursing Home has relinquished direct
responsibility for the care of Ms. Drane upon her admission to the Carlisle
Regional Medical Center, however, the Cumberland County Nursing Home
has retained a bed for Ms. Drane's anticipated return to their care.
e) At this time, there is no other reasonable alternative to effect the proper
care of Ms. Drane besides the appointment of a plenary guardian of the
person and estate.
f) Ms. Drane suffers from recurrent respiratory collapse. As a result of her
respiratory condition, Ms. Drane will potentially suffer from numerous
medical complications, which will require an ability to understand the nature
of the complications and how they will be treated. The treatments necessary
will include the need to provide informed consent to permit the medical
treatments.
g) Ms. Drane is both severely mentally retarded with psychotic behavior and
is unable to speak; therefore, she is unable to participate in medical decision
making on her own behalf. See Affidavit of Dr. David Albright. (Ms. Drane's
attending physician) attached hereto as Exhibit
h) Ms. Drane is currently suffering from severe end-stage Chronic
Obstructive Pulmonary Disease, a condition which renders her oxygen
dependant. Ms. Drane's carbon dioxide levels are chronically at dangerous
levels of two times normal. Ms. Drane's chronic medical condition required a
tracheosotomy, a surgical procedure which provides direct access to the
trachea for purposes of providing mechanical ventilation of the patient.
i) Although Ms. Drane has now been successfully weaned from a mechanical
ventilator, she continues to suffer from severe end-stage chronic obstructive
pulmonary disease and will likely require invasive care in the future.
j) Because Ms. Drane's condition is permanent and untreatable, she will
require medical care for the remainder of her life.
k) Ms. Drane is incapable of participating in appropriate medical decision
making because she remains non-communicative and unable to speak or
write. Further, Ms. Drane suffers from mental retardation with psychotic
features and is therefore unable to comprehend the nature of her medical
care.
1) Beverly Christ, R.N. has been providing guardianship sergices to Ms.
Drane and is prepared to provide continuing services in the future. See
Affidavit of Beverly Christ, R.N. attached hereto as Exhibit "B."
9. A plenary guardianship will permit the appropriate decision-making to take
place in the short and long term and potentially avoid the premature and unnecessary
death of Ms. Drane.
WHEREFORE it is respectfully requested that this Honorable Court issue an Order
appointing a representative of the Area Agency on Aging in and for Cumberland County,
Pennsylvania as guardian of the person and estate of Shirley Drane for the purpose of
providing medical decision-making authority.
FARRELL & RICCI, P.C.
( Attorney I.D.'~No. 49808
'%~. 4~3 N~ont Street
~I~ar~s u~rg, PA 17110
(717) 230-9201
Counsel for Carlisle Regional Medical Center
AND NOW this
and affirm:
1.
AFFIDAVIT OF DAVID ALBRIGHT, M.D.
[ ~. day of April, 2004, I, David Albright, M.D., do hereby swear
I am a physician licensed to practice medicine in the Commonwealth of
Pennsylvania.
2. My medical practice is limited to the specialty of internal medicine.
3. I was the attending physician for Carlisle Regional Medical Center patient
Shirley Drane.
4. Ms. Drane became a patient of the Carlisle Regional Medical Center on
February 29, 2004.
5. Ms. Drane is a patient suffering from severe end-stage Chronic Obstructive
Pulmonary Disease. She is severely mentally disabled, displays psychotic behaviors and is
non-communicative.
6. At the time of her admission to the Carhsle Regional Medical Center, Ms.
Drane required breathing support with a ventilator and was in need of the use of an
endotracheal tube.
7. The long-term use of an endotracheal tube will cause a patient to suffer
painful pressure ulcerations of the throat and lips, therefore, Ms. Drane underwent a
tracheostomy with the consent of Beverly Christ, R.N., a representative of the Area Agency
on Aging in and for Cumberland County, Pennsylvania, appointed as Emergency Plenary
Guardian by the Cumberland County Court of Common Pleas.
8. Since the placement of the tracheostomy tube, and the continued use of
mechanical ventilation, Ms. Drane's medical condition stabilized allowing her admission to
a long-term acute care facility for purposes of rehabilitation and return to her home at the
Cumberland County Nursing Home.
9. Currently, Ms. Drane is receiving care at SCCI, an acute long-term care
facility in Harrisburg, Dauphin County, Pennsylvania.
10. Upon information and belief, Ms. Drane was successfully weaned from her
mechanical ventilator on or about March 27, 2004.
11. Since Ms. Drane was successfully weaned from the ventilator, with additional
rehabilitation, she will be able to return to her home at the Cumberland County Nursing
Home.
12. Because Ms. Drane suffers from a chronic medical condition which cannot be
cured, she will require ongoing medical care.
13. Ms. Drane's mental impairment, coupled with her lack of ability to
communicate, prevents her from being able to provide her informed consent to any medical
care which she may require.
14. Failure to obtain the necessary consents for continued medical care will
subject Ms. Drane to unnecessary suffering and harm.
Date:
Respectfully submitted,
AND NOW THIS
and affirm:
1.
4
AFFIDAVIT OF BEVERLY CHRIST, R.N.
~ Day of April, 2004, I Beverly Christ, R.N. do hereby swear
I am employed by the Area Agency on Aging, in and for Cumberland County,
Pennsylvania as the Supervisor of Case Management.
Prior to my employment with the Area Agency on Aging in and for
Cumberland County, Pennsylvania, I was employed as a nurse at the
Cumberland County Nursing Home.
On or about March 9, 2004, I was appointed by the Cumberland County
Court of Common Pleas to act as Emergency Plenary Guardian of the person
and estate of Shirley Drane.
Since my appointment as Emergency Plenary Guardian of the person and
estate of Shirley Drane I have been involved in the medical decision making
necessary for the care and welfare of Shirley Drane.
As Emergency Plenary Guardian, I have been in close communication with
the nurses and doctors responsible for providing medical care and treatment
to Shirley Drane.
I have been advised that Ms. Drane suffers from severe, end-stage chronic
obstructive pulmonary disease which renders her unable to properly
oxygenate her tissues.
I have been advised that the condition from which Ms. Drane suffers is
permanent and cannot be cured.
o
o
11.
12.
13.
14.
15.
Ms. Drane is also mentally retarded and displays psychotic behaviors. As a
result of her mental condition, she is unable to comprehend her medical
condition and cannot meaningfully participate in necessary decision making.
Ms. Drane lacks the ability to communicate and can neither speak nor write.
Since my appointment as Emergency Plenary Guardian of the person and
estate of Shirley Drane, she has undergone the surgical placement of a
tracheostomy tube to facilitate her breathing by mechanical ventilation.
Since the placement of the tracheostomy tube, Ms. Drane has experienced a
stabilization of her medical condition which has allowed her to be transferred
to SCCI, a long-term acute care facility in Harrisburg, Dauphin County,
Pennsylvania.
Since her transfer to SCCI, Ms. Drane's condition has improved to the point
where she is not currently in need of the continued use of a mechanical
ventilator.
Upon information and belief, the Cumberland County Nursing Home has
maintained a bed for the use of Ms. Drane upon her discharge from SCCI.
Upon information and belief, the healthcare providers at SCCI are confident
that Ms. Drane will be able to return to her home at the Cumberland County
Nursing Home.
Despite the planned return of Ms. Drane to the Cumberland County Nursing
Home, her medical condition is such that she will require ongoing medical
care and treatment.
16.
17.
18.
19.
20.
Despite the planned return of Ms. Drane to the Cumberland County Nursing
Home, her mental condition is such that she is incapable of participating in
her medical care and treatment.
I have become familiar with Ms. Drane and her medical needs.
I have developed a rapport with Ms. Drane's healthcare providers.
Based upon my training and experience I have the ability to continue to
provide guardianship services through the auspices of the Area Agency on
Aging in and for Cumberland County Pennsylvania.
It is necessary for the benefit of Ms. Drane's ongoing medical needs that a
proper guardian is appointed for the purposes of providing decision-making
in regard to her ongoing medical treatment.
Respectfully submitted,
Date:
Beverly Chris~,/~.N. !
Supervisor Cas~ Management
Area Agency on Aging in and for
Cumberland County, Pennsylvania
AO OR,W CO0 ' APPO,N EO COONSEL 9 004 !
t. COURT 2. VOUCHER
[] District Justice ,r~cOmmOn Pleas [] Appellate [] Other N-0 - ' 6 6 2 7
3. FOR (D.J., C.P., APPELLATE) 4. AT (CITY/STATE) 5. BUDGET COD-E ' ' -
6. IN THE CASE OF ' 7. CHARGFJOFFENSE (PU~ ~>~.~ N (~iTATtON) ' ', 8. [3 P,~r f~ OFFENSE
9. PI~6(~EED~N~S (Describe briefly) ~ 1. PERSON REPRESENTED 12. CIVIL DOCKET ~O.
1 ~ De~endant- Adult
~~z~~ '04 ~P~ ~ ~ o.,..~..~ 22 F'2:25 z/- o~ - ~/
4 ~ Appellee 13. CRIMINAL DOCKET NO.
(~ ~:;, 5 ~ Hab~elitioner
6 Q MerCifulness
(]1 ~I~ ~ O ~a,o[~a~:W~ Violation
10. PERSON REPRESENTED (Full Name) 8 ~ Proba,oner Charged With Violation "14. APPEALS DOCKET NO.
MAILING ADDRESS
NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE C4 S
17. TELEPHONE No.
CLAIM FOR SERVICES OR EXPENSES
19. SERVICE HOURS DATES AMOUNTS CLAIMED
a. Arraignment anODe Plea MultiDly rate ~r hour times total
b. Prelimina~ Head~ hours to obtain "In Cou~" com-
~ Motions and Re~uests ~nsation. Enter total below.
~ ~ Bail Hearings
e. Sentence Hearings
Z f. Trial
~. Rev~ation Hearings
h. Juvenile Hearings
i. AoDeals Cou~ 19~ TOTAL IN COURT COMP.
20. & Intemiews and conferences ~ O O Multiply rate ~er hour ~imes total
b. Obtaining and reviewing r~ords ~ hours. Enter total "Out of Cou~"
"' ~ com~nsation ~low.
~ ~ L~al research and bdef writing
~ ~ ~. Invesfigaa~ ~d o~er work (S~ ~ addi~ ~ee~) 20~ TOTAL OUT OF COURT
COMP.
TOTAL HOURS = X ~ER~R
21. I~MI~TION OF REIMBURSABLE EXPENSES AM~ PER I~M
Mileage $.25 ~r mile x
0 21~ TOTAL ITEMIZED EXP.
22. CERTIFICATION OF A~ORNEY/PAYEE 23. GRAND TOTAL C~IMED
Has compensation ancot reimbumemenl f~ ~ in this ~e pmvloue~ ~en a~lled fo~ ~ YES ~ NO
Ifyes, were you paid? ~ YES ~ NO Ifye~by~reyou~l~ Howmuch?.
Has the person represent~ paid any money to [O~r kn~le~e anyone else, in ~nnection w th the maffer for 24. DEDUCT. P~IOR PYMTS.
which you were a~pointed to provide repre~n? O ~E~ ~ye~ve details on add tional sheets = $
I swear or affirm the truth or co~ne~ [~ ~ / * ~~ ~ ~,~
of the above statements · / yea ~ 25. N~ AMOUNT C~IMED
Copy I - Mail to Court Administrator at completion of service
HUMAN SERVICES BUILDING
16 West High Street, Carlisle, PA 17013
[717] 240-6110 or 697-0371, Ext. 6110
532-7286, Ext. 6110 Fax: 240-6118
website: www.ccoa.net/a~in~
e-mail: a~,in~(~,cc~a.net
FINAL GUARDIANSHIP REPORT
FOR SHIRLEY DRANE
June 28, 2004
Report from Guardian of Person & Estate
Cumberland County Office of Aging
and Community Services
Beverly Christ, RN
Aging Care Management Supervisor III
Bruce Barclay
Chairman
G a r~i cEei c~ labi re~gaenr
Richard L. Rovegno
Secretary
Terry L. Barley
Director
On:~pril 19, 3004 a permanent plenary guardian of person and estate for Shirley
Drane was"grante4::t~the Cumberland County Office of Aging and Community Services by
Judge Edgar B. Bayley for the purpose of providing medical decision making authority.
Miss Drane had been a long term resident at Claremont Nursing and Rehabilitation
Center. She required multiple hospitalizations at Carlisle Regional Medical Center for
exacerbations of end stage chronic obstruction pulmonary disease. She suffered from severe
mental retardation with psychotic behavior and was non-communicative.
On February 29, 2004 she was admitted to Carlisle Regional Medical Center in
respiratory failure and was placed on a ventilator through an endotracheal tube. On March
12, 2004 a tracheostomy was performed due to the need for long term placement of the
ventilator. Miss Drane was transferred to SCCI at Poly Clinic in hopes of weaning her off
the ventilator.
On March 30, 2004 Miss Drane was finally weaned off the ventilator. After a
discussion with her two primary care physicians and the agency consulting physician a
decision was reached not to place the consumer back on a ventilator if her condition should
deteriorate. She was also made a DNR (do not resuscitate).
Miss Drane was transferred back to Claremont Nursing and Rehabilitation Center on
April 17, 2004, where she remained until April 28, when she went into severe respiratory
failure and died.
Miss Drane had no immediate family member to notify. Miss Drane was cremated.