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HomeMy WebLinkAbout04-20-09IN THE MATTER GEORGIA D. JOHNSTONE, AN ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAANS' COURT DIVISION PETITION TO ADJUDICATE INCAPACITY PURSUANT TO 20 Pa.C.S. 5511 and FOR THE APPOINTMENT OF PLENARY GUARDIAN OF THE PERSON AND ESTATE OF GEORGIA D. JOHNSTONE To The Honorable Judges of the Cumberland County Court: n C~ a `° - -z_ ~~~~ .- , .i7 ~p f ' , ; _ _ - -- ~..y r'r t N ~ / ~ ~ v _ ~ ~- ~ y c,a . ~ `- ut =' 1. Petitioner Gary J. Muccio resides at 6 Derbyshire Drive, Carlisle, Pennsylvania 17015. 2. The Petitioner is the cousin of Georgia D. Johnstone, the alleged incapacitated person ("Ms. Johnstone") 3. Ms. Johnstone was born on Apri16, 1937 in Clearfield County, Pennsylvania. She is currently 72 years of age and unmarried. 4. Ms. Johnstone resides at Bethany Village, 5225 Wilson Lane, Mechanicsburg, Cumberland County, Pennsylvania. 5. Ms. Johnstone is not currently represented by Pennsylvania counsel, however she is represented by court-appointed counsel in California: Leona Shapiro, Esq., of Beverly Hills, California. 6. Ms. Johnstone's living next-of--kin are listed on Exhibit "A" attached hereto and by this reference made a part hereof. 7. The whereabouts of certain members of Ms. Johnstone's paternal family are unknown; however, other members of the same class of heirs at law are aware of these proceeding and will receive proper notice. 8. Until March 22, 2009, Ms. Johnstone was a resident of the State of California, residing at 1010 Hilldale Avenue, West Hollywood, CA 90069. 9. In the latter part of 2005, following a period of decline of her cognitive capacity, Ms. Johnstone was determined to be in need of a Conservator of her person and estate. A temporary Conservator was appointed on December 15, 2005, subject to a hearing for appointment of a Permanent Conservator, by the Superior Court of California, Los Angeles County (the "California Court"). 10. Following the March 30, 2006 hearing for appointment of a Permanent Conservator, the California Court appointed Julia C. Nelson as Permanent Conservator of Ms. Johnstone's Person and Estate by Order dated May 1, 2006, a copy of which is attached hereto as Exhibit "B" and by this reference made a part hereof. 11. Following the appointment of the Conservator, Ms. Johnstone continued to reside in her home with full time caregivers and other household assistance. 12. In 2008, it was determined that the cost of providing quality residential and medical services for Ms. Johnstone in her home had become prohibitive. 13. In order to conserve Ms. Johnstone's assets, the Conservator petitioned the California Court to permit (i) Ms. Johnstone to be moved to a residential nursing facility in Pennsylvania, (ii) the Petitioner, Gary J. Muccio, to be appointed as a guardian for Ms. Johnstone's person and estate under the laws of Pennsylvania, and (iii) her home to be sold and 2 the assets turned over to the Pennsylvania guardian to be invested for the continued expenses of Ms. Johnstone's health, maintenance and support. 14. Attorney Shapiro, the court-appointed attorney for Ms. Johnstone, recommended that the Conservator's petition be granted and that Ms. Johnstone be moved to Pennsylvania, subject to Gary J. Muccio, the Petitioner herein, commencing guardianship proceedings for Ms. Johnstone. A true and complete copy of the Declaration of PVP Attorney Leona Shapiro dated January 9, 2009 is attached hereto as Exhibit "C," and by this reference made a part hereof. 15. The Conservator's Petition was granted at a hearing on January 15, 2009. A true and complete copy of the Court's Order to such effect is attached hereto as Exhibit "D" and by this reference made a part hereof. 16. Pursuant to the California Court's Order of January 15, 2009, the Petitioner has six (6) months from the date of such Order to commence guardianship proceedings in Pennsylvania. 17. Ms. Johnstone moved to Pennsylvania on March 22, 2009 and began residing at Bethany Village, Mechanicsburg, Pennsylvania. 18. The Petitioners believe and therefore aver that Ms. Johnstone's ability to receive and evaluate information effectively and to communicate reasonable decisions is impaired to such a significant extent that she is totally unable to manage her financial affairs or meet essential requirements for her physical health and safety. 19. On September 29, 2008, Ms. Johnstone underwent a comprehensive evaluation at Olympia Medical Center in Los Angeles, California. The report from such evaluation, attached hereto and by this reference made a part hereof as Exhibit "E," concludes that Ms. Johnstone suffers from advanced cognitive dysfunction compatible with primary degenerative process, likely Alzheimer's disease, a history of seizure disorder, hypothyroidism and other ailments. 20. More recently, Ms. Johnstone has been examined by her primary physicians at Bethany Village, Harinidevi Krishnan, M.D. and Namata Haldipur, M.D. Dr. Krishnan and Dr. Haldipur's report dated March 25, 2009 is attached hereto and by this reference made a part hereof as Exhibit "F." 21. Drs. Krishnan and Haldipur have concluded and one or the other will testify that Ms. Johnstone suffers from advanced cognitive dysfunction, likely resulting from Alzheimer's disease, and is in need of plenary and permanent guardianship services. 22. Drs. Krishnan and Haldipur have concluded and one or the other will testify that because of Ms. Johnstone's physical and mental condition, her presence in court would be detrimental to her welfare. 23. The proposed Plenary Guardian of the Person and of the Estate is the Petitioner, Gary J. Muccio. 24. The Petitioner is Ms. Johnstone's first cousin, once removed, and has been a close personal friend of Ms. Johnstone's since the mid-1980s. The Petitioner caused the Conservatorship proceedings to be commenced in California and engaged Julia C. Nelson who was ultimately named as Permanent Conservator. 25. During Ms. Johnstone's Conservancy in California, the Petitioner continued to visit Ms. Johnstone regularly and was in regular communication with her Conservator and caregivers. 4 26. The Petitioner resides in Carlisle, Pennsylvania, a short drive from Bethany Village. He arranged for Ms. Johnstone's residency at Bethany Village and has assumed the management of Ms. Johnstone's care since she arrived in Pennsylvania. 27. Petitioner believes that Ms. Johnstone is being cared for in the least restrictive fashion and, given her cognitive capacity and her inability to care for her own basic medical and financial needs, that the appointment of a Plenary Guardian of her Person and Estate is the only available alternative for her future care and treatment. 28. The probability that Ms. Johnstone's incapacities will significantly lessen or change over time is virtually nil. 29. The proposed Plenary Guardian has no interest adverse to the alleged incapacitated person. 30. As Ms. Johnstone's closest living relative who resides locally, the Petitioner is best suited to act as Guardian of her Person and Estate. The consent of the proposed Plenary Guardian is attached hereto as Exhibit "G." 31. To the extent known by Petitioner, Ms. Johnstone's financial assets and income are set forth as Exhibit "H" attached hereto. 32. Ms. Johnstone was not a member of the armed services of the United States and is not receiving benefits from the United States Veterans' Administration. 33. No other Pennsylvania court has ever assumed jurisdiction in any proceeding to determine the capacity of Ms. Johnstone and no other guardian has been appointed for the Estate or Person of Ms. Johnstone in the Commonwealth of Pennsylvania. 5 WHEREFORE, Petitioner respectfully requests that this Honorable Court award a citation directed to Georgia D. Johnstone, the alleged incapacitated person, and to such other persons as this Court may direct, to show cause why she should not be adjudged incapacitated and why Petitioner, Gary J. Muccio, should not be appointed Plenary Guardian of her Person and Estate. RESPECTFULLY SUBMITTED, & Nurick LLC iz P.1V1~i~au I~i Supreme Court I.D.: 76397 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108 (717) 237-5243 Attorney for Petitioners Gary J. Muccio DATE: April ~, 2009 6 IN THE MATTER IN THE COURT OF COMMON PLEAS OF GEORGIA D. JOHNSTONE, CUMBERLAND COUNTY, PENNSYLVANIA AN ALLEGED ORPHANS' COURT DIVISION INCAPACITATED PERSON NO. VERIFICATION I, Gary J. Muccio, hereby verify that the facts contained in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsification to authorities. Gary J. cio DATE: April ~ ~''J , 2009 EXHIBIT A IN THE MATTER IN THE COURT OF COMMON PLEAS OF GEORGIA D. JOHNSTONE, CUMBERLAND COUNTY, PENNSYLVANIA AN ALLEGED ORPHANS' COURT DIVISION INCAPACITATED PERSON NO. EXHIBIT A The following persons are the heirs at law of Georgia D. Johnstone, the alleged incapacitated person: Anthony Muccio, First Cousin Nick Dilullo, Jr., First Cousin Alex Rosman, Uncle P.O. Box 155 R.D. #3, Box 251B Veterans House of CA -Barstow Weedville, PA 15868 Dubois, PA 15801 100 E. Veterans Parkway Barstow, CA 92311 Esther Nelson, First Cousin Lorraine Longwill, First Cousin Edward Rosman, Uncle 325 Sheridan Avenue 100 Dilullo Road Whereabouts unknown Dubois, PA 15801 Penfield, PA 15849 John S. Muccio, First Cousin Tommy A. Muccio, First Bill Rosman, Uncle 437 Cherry Avenue Cousin, once removed whereabouts unknown Weedville, PA 15868 22631 Jennings Drive Springdale, Arkansas Antoinette Haraburda, First Michael J. Muccio, First Cousin, Edward Matula, First Cousin Cousin, once removed once removed 20120 Mildred Avenue 7933 Autumnwood Street 60536 C.R. 113 Torrance, CA 90503 North Canton, OH 44720 Elkhart, Indiana 46517 Dennis Cardin, First Cousin, Gregory P. Muccio, First Janice Roussa, First Cousin once removed Cousin, once removed 200 Hermitage Boulevard 5 Concord Drive 3232 Shadow Trail Oak Ridge, TN 37830 Pittsford, NY 14534 Denton, Texas 76207 Paul Rosman, Jr., First Cousin Linda Van Der Pool, First Robert Matula, First Cousin Whereabouts unknown Counsin, once removed 2539 S. Holmes Place 140 Manor Drive Ontario, CA 91761 Northumberland, PA 17857 Laurie Rosman, First Cousin Whereabouts unknown U O ~ ~ c0 ~ '~ C .. ~.a 'p` ~ - c'3 (1 c c~ cn ~ ~ ~c ~rn ~ ~~ ~'a Z ~ JJ ~-a ~_ DU ~ - a~ v ,c ~ ~ m N U Q U ~ Z ~ ~ ~ ~ U ..~ N +-. N O C p ~ O ' O U Q O C .-. U ~ O ~ ~ C 0- ~ V U ~ ~ ~ 'd Q 3 ~ ~ Z ~. N ~' ~ m a~ N N ~ u i ~ ~ N cn C L L ~ ~ U c a Z' U o N V c a c o E N (~ . N V~ p N C ~~ c~ t N C o ~-p -~ W Q ~~ Q~ ~~ N ~ ~ ... c0 .-. v O ~, N C ~p ~ ~ 3 O N N '~ Q ~~ ~ ~ ~ ~ N ~ N ~ F'' ~ ~ ~ O ~ ~ N ~ ~ E ~ 'p N ~ ~ U ~ .-. A W ~ ~ N ~ cd Y ~- c ~ .~w ~~U ~ ~ ~ 0 ~~~ ~ _. v a~ N m U c N ca Q v c ca U' m .~.. N a v ~ N vii saE~ ~o~°a~i C ~ N ~ a `. -~ E ~ a~ ~ ~ f/1 ~~ ° '% ~ o a ~ J ~ c c~ c E (~ O N ~ ~ ~ x' ~ v Q t! W ~ N G ~ (U N N N tU N c~ v ~ ~ ~ cv a~ vii = VJ ~~ O ~ ~U U ~ ~ ~` C _ O cu d ~ ~ J ~ ~ O ~ ~U ~ U ~~ .o o ~ H~ EXHIBIT B 10/27/2008 14:41 8185089767 LAW OFC MITCHELL A KAkASOV . ~.~ , #4320 P.003 /007 GC-340 ATTORNEY OR PARTY WmrOUT ATTORNEY (Nrm0. ~~ Bu ~+~ and add~rtsa): FOR COURT USE ONLY TOMOHIRO J. KAGAMI ESQ., SBN 219744 LAW OFFICES OF MITCHELL A. fCARASOV 5352 LAUREL CANYON BOULEVARD, SECOND FLOOR CA 91607 FILED GtP1A1 ~ NORTH HOLLYWOOD, - . QR; ior Cotut TELEPHONE Noy 818-508-7192 FAx No. toprbr»o: 81$-508-9767 Angeles Super E-MA1 AooRESS (OpNorrq: ATTORNEY Foa (Nrvns}: JULIA C. NELSON AY O ~ S ANGELES SUPERIOR COURT L SUPERIOR COURT OF CALIFORNIA, COUNTY OF O SYLMAR AVENUE CLErgC tpRKE sTr~ETAOORess: 6230 , ,p, G MAICINGAODR6S3: SAME crTY ANO z~P cooE: VAN NUYS, CA 91401 ~ ~~~ GS,,pgj, D~~ 9RANCHNAME;: NORTHWEST DISTRICT . CONSERVATORSHP OF GEORGIA JOHNSTONE lN~)~ CONSERVATEE ORDER APPOINTING SUCCESSOR PROBATE CONSERVATOR OF THE cASENUM9ER: X PERSON ESTATE limited Conservatorshl LP 011407 I WARNING: THIS APPOINTMENT !S NOT EFFECTIVE UNTIL LETTERS HAVE ISSUED. j The petition for appointment of ~ successor conservator came on for hearing .as follows {check boxes c, d, e, and f or g fo indicate persona! presence}: a. Judicial Officer (name): MICHAEL R. HOFF b. Hearing date: MARCH 30, 2006 Time: 10:00 a.m. xQ Dept.: A Q Room: c. ® Petitioner (name): JULIA C. NELSON, PRIVATE PROFESSIONAL CONSERVATOR d. XQ Attorney for petitioner (name}: TOMOHIRO J. KAGAMI, ESQ., SBN 219744 e. © Attorney for XQ .person cited Q the conservatee on petition to appoint successor conservator: (Name}: LEONA SHAPIRO, ESQ. {Telephone): 310-285-1584 (address): 433 N. CAMDEN DRIVE, SUITE 400 BEVERLY HILLS, CA 90210-4408 f. ©Person cited was © present. [~ unable to attend. ~ able but unwilling to attend. ~ out of state. g. ~] The conservatee on pet-tion to appoint successor conservator was Q present. ~ not present. THE COURT RNDS 2. All notices required by law have been given. . 3. (Name}: GEORGIA JOHNSTONE a. X~ is unable properly to provide for his or her personal Heads for physical health, food, clothing, or shelter. b. © is substantially unable to manage his'or her financial resources or to resist fraud or undue influence. c. ~ has voluntarily requested appointment of a conservator and good cause has been shown for the appointment. 4. The conservatee a. QX is an adult. b. 0 will be an adult on the affective date of this order. c. ~ is a married minor. d. Q is a minor whose marriage has been dissolved. 5. © There Is no form of medical treatment for which the conservatee has the capacity to give an informed consent. The conservatee is an adherent of a religbn defined in Probate Code section 2355(b). 6. Q Granting the Q successor conservator powers to be exercised independently under Probate Code section 2590 is to the advantage and benefit and in the best interest of the conservatorship estate. 7. ® The conservatee is not capable of completing an affidavit of voter registration. 8. ®-The cor-servatee has dementia as defined in Probate Code section 2356.5, and the court finds ail other facts required to make the orders specified in item 27. Do NOT use this form for a tern orarY conservatorship. ~sw ~ a s Form AdoMed for Mtrnddgy UN `N,~~ Probate Cod0. ~$ 1830.26@9 .kwiuaic«maiacaroonw ORDERAPPOINTINC3 PROBATE CONSERVATOR x,3,0 ~~,. ~a,w,,,, t, ~ (Probate-Guardianships and Conservaforships) ~ ~ 10/27/2008 19:42 8185089767 LAW OFC MITCHELL R KARASOV #4320 P.004 /007 ' GC-340 CONSERVATORSHIP OF (Name): GEORGIA JOHNSTONE ~"~~ LP 011407 _ CQNSERVA7EE 9. ®Attomey (name): LEONA SHAPIRO, ESQ. has been appointed by the court as legal ~unsel b represent the conservatee in these proceedings. The cost for representation is: $ 15,383.50 The conservatee has the ability b pay QX ail ~ none Q a portion of this sum (specify): $ 10, ~ The conservatee need not attend the hearing. 11. 0 The appointed court investigator is (Hama): JEANETTE APPLEGATE (Address artd telephone): 111 NORTH HILL STREET, ROOM 250, LOS ANGELES, CA 9001 Z, 213-974 12.0 (For limited conservatorship only} . The limited conservatee Is developmentallyJisabled as defined in Probate Code section 1420, 13. XQ The ~ successor conservator is a private professional conservator as defined by Probate. Code section 2341 who has filed with the court the confidential statement required by Probate Code section 2342. 14. The 0 successor conservator (check a or b}: a. ~ is currently registered with the Statewide Registry of Private Conservators, Guradians, and Trustees maintained by the California Department of Justice under Probate Code sections 285P-2855. b. ~ is exempt from statewide registratwn under Probate Code sections 2850-2855. 15. (Either a, b, or c must be checked): a. xQ The Q successor conservator is not the spouse of the conservatee. b. O The [~ successor conservator is the spouse of the conservatee and is not a party b an action or proceeding against the conservatee for legal separation, dissolution, annulment, or adjudigtion of nullity of their marriage. c. Q The ~ successor conservator is the spouse of the conservatee and is a party b an action or proceeding against the conservatee #or legal separation, dissolution, annulment, or adjudication of nullity of their marriage. It is in the best interests of the conservatee b appoint the spouse as [~ successor conservator. 16. (Either a, b, or c must be checked): a. ~ The 0 successor conservator is not the domestic partner or former domestic partner of the conservatee. b. Q 'The ~ successor conservator is the domestic partner of the conservatee and has ne"tther terminated nor intends to terminate their domestic partnership. c. Q The ~ successor conservator is the domestic partner or former domestic partner of the conservatee and intends to terminate or has terminated their domestic partnership. !t is In the best interest of the conservatee to appoint the domestic partner or former domestic partner as [~ successor conservator. THE COURT ORDERS 17. a. (Name): JULIA C. NELSON, PRIVATE PROFESSIONAL CONSERVATOR (Telephone): 818-353-6117 (Address}: 10039 PLAINVIEW AVENUE TUJUNGA, CA 91042 is appointed Q successor ®conservabr ~ limited conservator of the PERSON of (name): GEORGIA JOHNSTONE and Letters of Conservatorship shall issue upon qualification. b. {Name): JULIA C. NELSON, PRIVATE PROFESSIONAL CONSERVATOR (Telephone): 818-353-6117 (Address): 10039 PLAINVIEW AVENUE TUJUNGA, CA 91042 is appointed ~ successor ®conservabr [] limited conservator of the ESTATE of (name): GEORGIA JOHNSTONE and Letters of Conservaforship shall issue upon quaification. 18. ~ The conservatee need not attend the hearing. 19. a. Q Bond is not required. b. ~ Bond is fixed at: $ 1,800,000.00 b be furnished by an authorized surety company or as otherwise provided by law. c. [] Deposits of: $ are ordered b be placed in a blocked account at (specrfy institution and location): and receipts shall be filed. No withdrawals shall be made without a court order. Q Additional orders in Attachment 19c. d. ~ The ~ successor conservator is not authorized to take possession of money or any other property without a specific court order. oc-3+at~~~•n~r~.~1 ORDER APPOINTING PROBATE CONSERVATOR P+oiza~ (Probate-Guardianships and Conservatorships) 10/27/2008 14:42 8185089767 LAW OFC MITCHELL A KARASOV #4320 P.005 /007 . ~ GC-340 CONSERVATORSHIPOF (Name): GEORGIA JOHNSTONE cASeNUMS~: LP 011407 20. ~] For legal services rendered, [~ oonservatee ®conservatee's estate ~ parents of the minor [~ minor's estate shall pay to (name): LEONA SHAPIRO, ESQ. the sum of: $ 15,383.50 XQ forthwith [] as follows (specify farms, including any cambinatiorr of payors): Continued In Attachment 20. 21. ®The oonservatee is disquaUfied from voting. 22. ©The conservatee lacks the capacity to give informed consent for medical treatment and the Q successor conservator of the person is granted the powers speafied in Probate Code section 2355. The treatment shall be performed by an accredited practitioner of a religion as defined in Probate Code sectbn 2355(b). 23. [] The Q successor conservator of the estate is granted authorization under Probate Code section 2590 to exercise independently the powers specified in Attachment 23 0 subject to the conditions provided. 24. [] Orders relating to the capacity of the conservatee under Probe#e Code sections 1873 or 1901 as specified in Attachment 24 are granted. 25. D Orders relating to the powers and duties of the Q successor conservator of-the person under Probate Code sections 2351-2358 as specified in Attachment 25 are granted. (Do not include orders under Probate Code section 2356.5 relating to dementia.) 26. ~ Orders relating to the conditions imposed under Probate Code section 2402 upon the 0 successor conservator of the estate as specified in Attachment 28 are granted. 27, ®a. Q The ~ successor conservator of the person is granted authority to place the conservatee in a care or nursing facility described in Probate Code section 2356.5(b). b. © The ~ successor conservator of the person is granted authority to authorize the administration of medicatbns appropriate for the care and treatment of dementia described in Probate Code section 2356.5(c). 28. ~ Other orders as specified in Attachment 28 are granted. RQ$~T F - 1N1'CHINSON 29. 0 The probate referee appointed is (name and address): RYA PROBATE j~i~~ 23245 SYLVAN ST., 5.103 WO©DLAND HTL1,S, CA 9167 R * •,....~.... (818)888.8175 30. ~ (Forlimifed conservatashlp only) Orders relating to the powers and duYses of the Q successor limited conservator of the person under Probate Code section 2351.5 as specified in Attachment 30 are granted. 31. ~ (For limited conservatorship only) Orders relating to the powers and duties of the [~ successor limited conservator of the estate under Probate Code section 1830(b} as specified in Attachment 31 are granted. 32. [~ (Forllmited conservatorship only) Orders limiting the civil and legal rights of the limited conservatee as specified in Attachment 32 are granted. 33. ®This order is effective on the © date signed Q date minor attains majority {specify): 34. Number of boxes checked in items 17-33: 13 35. Number of pages attached: 2 Date: JUDICIAL OFRCER ® SIONATUREFOLLOWSLASTATTACHMEIiT OC-34~ I~• ~^~' ~• ~- ORDER APPOINTING PROBATE CONSERVATOR Pape 3 of 3 (Probate--Guardianships and Conservatorshlps) 10/27/2008 14:43 8185089767 -. .-. .~:±~t LAW OFC MITCHELL A KARASOV #4320 P.006 /007 !~ ~~ COI~RRPA'~'~!! Olr (~: li3;0ilIGlal J0~'ISZDI~tx Crae Na • •- ~• CtaaM'eatik 120If~0'! .~~t~r~r za AIlIlITi~NA_iy(j~~i 2. Lno~ra 3laapaca, ~isq , pVP Attotsrry c~'t~, is aAt diacd. boz s~ cq~nae to actin the best iaierescs of~he Gbmservatee. ~. 't1mragn~st for Attorrlay'a and Cor~ecvatar's des at~d ooeCs fltod 6YDiedre Wa~bxit. 8e~. c~a b,ls~' of hae Ctioat, raraat L.a~sgR, io doaiod u~itko~t pa~ajudica . OYSri ~ TO R~Rlti~ A1~Pri Cpl ~~~ ~ ~ ~ ~ 4oasa~vazce DP-1Y.U: - - SIGNED IN COUNTERPARTS }aivd~a Wadabt~ 8eq., esq., Attorney £a~7~meat I.arxgc, Temporary Conactvatar ~a~aT~: nrrx~ nF ~ SLTP~tiOA C~QLlRr ~ ~ vctt~uc~ vrr: c- nnv i c~z~idvh~ ~ivr ~~,~•„ ~~ uL aye 10/27/2008 14:43 8185089767 LAW OFC MITCHELL A KAkASOV .- ___ ~ #4320 P.007 /007 CONSljtV A7ORSN[P OF (aa~nex G.B'O7tG1A iDHNSTONF. Case Na CAnw•rayCb Y,P O11~07 nrrac~Errr ~s ~~~SZN~- 1. Trwna Shiro, Esq., MVP Attoraay of record, is nAt discb~god, but shall continue tD act in the brat ~ntarsts of tho Co~crvsstee. 2. The zngetest far Attorney's and CansaYSio~r's fees and casts Sled try DLEdlC WachbriE, Esq on behalf of her Qient, ]antt L.aenge, is denied without prejudice. APPItOVLD AS TQ FURM CONTENT• DATED: SIGNED IN COUNTERPARTS. Leona Shapiro, Esq., PVp Attorney for the Corsservates: DATED: ~rt1 _?$' ~ ~ Ca D~edro waclltxit, Eaq., $sq„ Attorney for Janet 7e~~y ca~~r DATED: ~Y 0 1 ~04~ el R. Hoff JUDGE OlF THE S[J'PBRIOR CDURT EXHIBIT C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2i 22 23 24 25 26 27 28 LEONA SHAPIRO, ESQ. [SBN 146851] KATZ & SHAPIRO 433 N. Camden Drive, # 400 Beverly Hills, Ca 90210-4408 Tele: 310-285-1584 Fax:310-285-1587 Attorney for Conservatee, Georgia Johnstone [SPACE BELOW FOR FILING STAMP) SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF LOS ANGELES In re the Matter of } CASE NO.: LP011407 Conservatorship of ~ } GEORGIA JOHNSTONE } DECLARATION OF PVP ATTORNEY, } LEONA SHAPIRO AND REQUEST FOR FEES; RE PETITION FOR; (1) CHANGE OF CON~ERVATEE'S RESIDENCE TO THE STATE OF PENNSYLVANIA; AND {2) INSTRUCTIONS TO PLACE CONSERVATEE'S PETS Date: January 15, 2009 Time: 9:40 a.m. Dept: H I, Leona Shapiro, declare and say: I am an attorney duly licensed to practice law before all courts in the State of California, and on December 2, 2005, I was appointed by the Honorable Robert G. Kolostian Sr., Judge of the Superior Court, to act as the attorney for Georgia Johnstone, the proposed Conservatee. I am personally familiar with the folEowing facts herein stated, and if called to testify, I could and would 1 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO 1 2 3 4 5' 6 7 g 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 do so competently from my own personal knowledge.. I am an active member of the State Baz of California. Further, no disciplinary actions are pending and none filed against me. I have professional liability inswance coverage in effect. I have not represented any party to the proceeding except as otherwise stated in my report. REVIEW OF THE FACTS 1. Georgia Johnstone, the conservatee suffers from dementia, the Alzheimer's type. She is 70 years of age. She has no children or close family members who live in the State of California. Ms. Johnstone was previously married but had no children. Her remaining family members reside in Pennsylvania. 2. At the time of the hearing on the Permanent conservatorship December 15, 2005, Julia Nelson was appointed Permanent Conservator of the Person and Estate of Georgia Johnstone and has performed her duties in that capacity since that time. 3. Georgia Johnstone `s primary diagnosis is dementia - Alzheimer's type. She was diagnosed approximately 3 years ago. Her date of birth is April 6, 1938. Ms. Johnstone had a very successful interior design business. When she was sixty five she decided to retire as she was beginning to exhibit bouts of forgetfulness as well as a slight change in personality. The proposed conservatee resided alone at her home at 1010 N. Hilldale Avenue, Los Angeles, Ca., 90069. In June 2005, Georgia was reported to the DMV by William Chow, M.D., her newologist. She cost her ability to drive at that time. She was still functional in other respects. She was forgetful, but she could communicate. She continued to live alone until July 2005 when she became ill with acute renal failure. She was transported to Cedars Sinai Hospital and then to Beverly Hills Rehabilitation Centre. She suffered some mild seizures at the Centre, was readmitted to Cedazs, and finally sent home in August, 2005. 4. She now resides in her home with care givers on a twenty fow how/seven day a week basis. Since the onset of the Permanent conservatorship, the care giver agency has been changed, however, Ms. Johnstone continues to live in her home with 24/7 care. 2 DECLARATION OF PVP AT3rORNEY, LEONA SHAPIRO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CURRENT UPDATES REGARDING GEORGIA JOHNSTONE'S CONDITION 5 Over the last twelve months Ms. Johnstone's condition continued to deteriorate. She sometimes needs an overlap of two care givers to move and bath her. 6. Georgia has a physical therapist coming to the home three times per week to exercise her and retain her mobility. In addition, she receives treatments from a message therapist twice weekly. Because of escalating costs in heron going care, The Conservator Juiia Nelson and I felt that a nee physical, psychological and emotional assessment needed to be made. At the hearing On November 18, 2008 an order was made regarding this assessment and a new Conservator's Care Plan was ordered at that time. ~ REASSESSMENT OF CONSERVATEE AND RECOMMENDATION OF PVP 7. Pursuant to Court Order, the Conservator arranged for an all day assessment of the Conservatee on September 30, 2008. This assessment was done at Olympia Medical Center, located at 5901 W. Olympic Blvd., Suite 303, Los Angeles, Ca 90036. The assessment was conducted by a tem of physicians, including Robert Wang, M.D., Loretta Mulokas, M.D., and Cyrus Mody, M.D. 8. The focus of the reassessment was on the level of care and comfort appropriate for the Conservatee given her medical condition and history, and whether the CONSERVATEE might be to receive the same level of comfort and care at a facility - a place other than her own home. . In addition, a great amount of thought was given to the ability of the Conservatee to adjust to new surroundings and living conditions. 9. The physicians diagnosed the Conservatee with advance cognitive dysfunction, Alzheimer's disease, small vessel cerebrovascular disease, and a history of seizure disorders 3 DECLARATION OF PVP ATTmRNEY, LEONA SHAPIRO 1 2 3 4 5 6' 7, 8 9 10 11, 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 The group of physicians assessments resulted in reports which covered Geriatric Medicine, Geriatric Psychiatric, and Neurology. Lab tests were also given. The Conservator has filed Confidential information regarding the results of this assessment with her petition. 10. Dr. Wang concluded based on his assessment that "Given the patient's present cognitive function, it appears highly unlikely that she is sufficiently capable of understanding her surroundings to an extent where relocation from her home to different setting would present a significant emotional challenge." In addition the report points aut that "The kind of care the patient required could be delivered at least equally as well in a facility-type setting as at home, and in the facility there would be additional back up0 with more personnel available and also technical capacbiliti4es, including laboratory work and possible invasive therapies if desired" 11. Although the initial thinking was to keep Georgia in her own home environment as long as possible, the recent deterioration of her condition, and her ability to fathom whether she is in fact `At home', makes us reevaluate whether it is in her hest interest to remain there. In addition to the economic drain that was taking place regarding her finances because of increased medical cw needs. 12. Once it was determined that a facility setting would enable Georgia to enhance her `world' and avail herself of a facility's resources, it became a matter of researching what would be the best faciiit that could be found to insure the best quality of life possible for one in her condition. PETITION TO MOVE CONSERVATEE'S RESIDENCE TO THE STATE OF PENNSYLVANIA 13. The petitioner request the authority to move the conservatee's residence to the state of Pennsylvania pursuant to Probate Code Section 2352 within 6 months from the date of the Order. Petitioner is a Professional Conservator. She is very well aware ofwonderful facilities which specialize 4 DECLARATION OF PVP ATTORNEY, LEONA SHAP]RO 1 2 3 4 5 b 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 in the care of patients with Alzheimer's Disease as well as other of Georgia's diagnosed ailments. The weather here is a milder climate which Georgia enjoyed since moving to California many years However, Georgia's family lives in the state of Pennsylvania. They have kept in contact with the Conservator and Conservatee for all these years. Gary Muccio, an adult cousin has made it his business to come and see Georgia at least once or twice a year. 14. When Mr. Muccio and the rest of the relatives heard that Georgia might be moving to a facility to better serve her immediate health care and financial needs, they requested that she be moved so that they might visit her on a regular basis and enswe a constant family element to an Alzheimer's patient that they deeply care for. 15. It may be emotionally challenging for the Conservatee to change her residence, but the fact that she has family available who are anxious and willing to provide a friendly smile and additional love and support is what tips the scales in favor of the move to Pennsylvania. lfi. At the current moment, Georgia's `world' consists of a friend or two, care givers, and the present Conservator and case manager.. What she is being offered is a family ready to embrace her in her present condition for the rest of her natural life. FACILITY IN MECHANICSBURG, PA 17. Mr. Muccio has researched facilities and living environments which would accommodate the level of care that Georgia needs. The Petition describes the facility, the level of care, the facility staff, and the price range. And encloses detailed information regarding Bethany Village, (Exhibit B Petition for Change of Residence of Conservatee) It seems to be a nice facility with several cats ~ in residence. After personal discussions with Gary Muccio, I agree that it will provide an excellent level of care while being geographically close to all those relatives who intend to visit often. 5 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 l8 19 20 21 22 23 24 25 26 27 28 PETITION FOR GUARDIANSHIP/CONSERVATORSHIP IN PENNSYLVANIA 18. Gary Muccio, who has the most immediate relationship with Georgia is willing to initiate proceedings in Pennsylvania as soon as this Court acts favorably in regazd to the Petition . 19. He is most anxious to take on the responsibility of Georgia's raze, describing their love for one another as a life time love. In addition, Gary noted that Georgia was always the one who took ca of family -she did it her whole life with caring and concern. Now, he wanted to do the same for Georgia in these final years of her illness. PETITION FOR INSTRUCTIONS TO PLACE CONSERVATEE'S PETS 20. Georgia has always loved cats. She currently has 10 of them in her home. When she thought of making provisions for her estate which she did in a May 5, 2005 letter to her estate pl. attorney„ she indicated that her cats should always be cared for.. (See Exhibit C and D} 21. Julia Nelson, the Conservator, has diligently pursued a solution to where the cats would be housed, if Georgia were moved. She found Save -A-Life, anon-profit cat and dvg rescue and adoption organization located on a 10 are ranch in northern Los Angeles. It is an all-volunteer, all donation run organization with a no-kill policy. 22. Ms. Nelson was informed that Save-A-Life are willing to receive all ten cats with a donation of five thousand dollars ($5000.00) per cat. This donation will set up life time care for each cat at it's no-kill shelter. Ms. Nelson has researched other facilities who want as much as $40,004.00 per animal . In addition other facilities euthanize many animals if they are not adopted, which would contrary to every intention of Georgia Johnstone regazding her beloved pets.. 6 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO 1 2 3 4 5 6 7 8 9 10 11 12 'I 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PHYSICAL RELOCATION OF GEORGIA JOHNSTONE BY MEDI-VAC 23. I had asked the petitioner to look into alternative means of transporting Georgia from California to Pennsylvania. Georgia has a certain level of paranoia as well as other ;'over stimulation' issues, which I felt were important to be addressed. If she were to be moved by commercial airplane) it would necessitate a change of planes and overnight in a hotel/motel, which could have a devastating effect on her health and well being. 24. Ms. Nelson's reseazchregarding a Medi-Vac move with an Air Ambulance, resulted in three price quotes ranging from approximately $15,900.00 to approximately $33,000.00 moving Georgia from Los Angeles, CA to Harrisburg, PA. All flights include a two member medical transpc team capable of meeting a wide range of medical needs. All quotes include an ambulance on both ends of the journey. In addition, one familiar care giver would accompany Georgia, to minimize her fears and make her more comfortable. Ms. Nelson is continuing to fine tune the information available and to check with the FAA to make sure the best choice is made on Georgia's behalf. RECOMMENDATION OF PVP REGARDING PETITION 25. After much research, review of medical assessments, and interviews with all those involved in her care as well as family members who wish to take on the responsibilities of future care, it is my opinion that this petition should be granted and is in the best interest of Georgia Johnstone. 26. It is also my opinion that the request for $50,000.00 be used to provide continual care for Georgia's beloved cats be approved as following her express wishes. 26. In addition, I would recommend that the court allow up to $40,000.00 to effect the transport of Georgia in the most efficient, least traumatic way possible. 7 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO PVP FEES 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 27. I am experienced in probate and conservatorship matters. My regular hourly rates vary from a low of $300.00 per hour to $400.00 depending on the complexity and nature of the matter. 28. I have expended a total of 14.2 hours regarding matters concerning my appointment, I am requesting the sum of $3195.00 in fees at the PVP rate of $225.00 per hour and $30.00 in costs for a total of $3,225.00. 29. The proposed Conservatee will have sufficient assets and income from which I can be paid Therefore, I am requesting that this court order that my fees be paid by the Conservatorship Estate 30. The following is a breakdown of the time I expended on this matter: Date Description Time 9-10-08 Receipt and review correspondence T. Kagami,ESq. Re order and assessment information for September 0.30 9-11-08 Correspondence to T. Kagami re order ~ 0.30 9-15-08 Teleconference T. Kagami re inability to be at assessment because of religious holiday;necessity to contact Dr. For results of assessment 0.30 9-16-08 Teleconference office of Dr. Robert Wang re information re assessment 0.30 10-16-08 Review assessment information; 1.00 11-6-08 Teleconference Tommy Kagami re petitions, care plan, concerns 0.60 12-3-08 Receipt and review petition re change of residence to Pennsylvania 1.00 12-15-08 Teleconference Tommy Kagami re concerns and necessity to Interview family members regarding potential move 0.40 1-2-08 Teleconference Gary Muccio re location of Conservatee, costs, how to proceed; family relationships O.bO 1-2-09 Teleconference Dianne Gabriel; she will contact me next week with pertinent information re air transportation 0.10 1-5-09 Teleconference Dianne Gabriel re doing intake with facility in Pennsylvania regarding Georgia's present condition Other information re Medi-care possible reimbursement of portion of costs 0.40 1-5-09 Teleconference Gary Muccio . There is room at facility presently for Georgia. Will apprise if that changes. Cannot finalize until after court hearing 0.20 1-6-09 Teleconference Sharon Cohen. Re care givers 0.60 1-7-09 Teleconference Gary. Left message 0.10 8 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO 1 2 3 4 5 6 7 8 9 10 i 1 ~' 12, 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1-7-09 Receipt and review information from Conservator re 0.40 costs of Medical Air Ambulance to transport Conservatee from Los Angeles, Cato Pennsylvania 0.60 1-8-09 Teleconference Julia Nelson, Conservator re range of estimates, person to accompany Conservatee; future issues left regarding personal and real property 0.40 1-9-09 Teleconference Julia re costs to move Georgia, other issues 0.40 1-9-09 Teleconference Tommy Kagami,Esy. Re petition, appearance, cost of transportation, etc. 0.50 1-9-09 Teleconference Gary Muccio re above issues 0.40 1-9-09 Preparation of declaration to court 2.30 1- i 5-09 Anticipated court appearance 3.00 Total hours I4.2 hrs@$225.00 $3195.00 Costs 30.00 Total fees and costs $3,225.00 I declare under penalty of perjury that the foregoing is true and correct, except as to those alleged on information and belief and as to those facts I believe them to be true. Executed this 9th day of January, 2009 at Beverly Hills, California ona S piro PV 9 DECLARATION OF PVP ATTORNEY, LEONA SHAPIRO EXHIBIT D 1 2 3 4 5 5 7 8 9 10 11 l2 13~' 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 LAW OFFICES OF MITCHELL A. KARASOV Mitchel! A. Karasov, Esq. -SB #133733 Tomohiro J. Kagami, Esq. -SB #219744 5352 Laurel Canyon Blvd., Suite 100 Valley Village, California 91607 Telephone Number: 818) 508-7192 Fax Number: 818) 508-9757 ' Attorneys for Julia C. Nelson, Conservator o.~~~v Nor~w~AL F~, f~~ ~`,~IS~C~ 1(~y ~Up S A~G~~,~ ~~~~R CUR T SUPERIOR COURT OF CALIFORNL~ COUNTY OF LOS ANGELES CONSERVATORSHIP OF THE PERSON AND ESTATE OF GEORGIA 30HNSTONE, CASE NO. LP 011407 ORDER APPROVING PETITION FOR: {i) CHANGE OF CONSERVATEE'S RESIDENCE TO THE STATE OF PENNSYLVANIA; AND (2) INSTRUCTIONS TO PLACE CONSERVATEE'S PETS Conservatee. ~ Hearing Date: January 15, 2009 Department: H ~ Time: 9:00 a.m. The verified Order Approving Petition For; (1) Change of Conservatee's Residence to the State of Pennsylvania; and (2) Instructions to Place Conservatee's Pets, carne on regulazly for hearing on p January 15, 2009, in Department H, at 9:00 a.m., the Honorable Frank J. Johnson Judge presiding. Present at the hearing were Tomohiro J. Kagami, Esq., Attorney for the Conservator Julia C. Nelson; Julia Nelson, the Conservator; Leona Shapiro, Esq., PVP Attorney far the Conservatee; Diedre ~~ Wachbrit, Esq., Attorney for Janet Lange; Gary Muccio, and Dianne Gabriele. Janet Lange's opposition through her attorney was noted; however, no objections were filed. After reviewing the evidence, the Court finds that: 1. All Notices of hearing have been given pursuant to statute. 2. Any Notices not given are deemed waived. 3. The Court finds that good cause exists to grant the Petition as prayed. ORDER APPROVING PETITION FOR: (1) CHANGE OF CONSERVATEE'S RESIDENCE TO THE STATE OF PENNSYLVANIA; AND (2) INSTRUCTIONS TO PLACE CONSERVATEE'S PETS -1- d 1 4. Opposition made by Janet Lange is noted; however, no objections were filed. 2 5. Pursuant to Probate Code Section 2352, Petitioner should be authorized to movc and change the 3 Conservatee's residence to the State of Pennsylvania and to commence a Guardianship or 4 Conservatorship proceeding in Pennsylvania within six (6} months from the date of the Order. S 6. Pursuant to Probate Code Section 2403, Petitioner should be authorized to place the 6 Conservatee's ten (10) pet cats in the pet sanctuary at Save-A-Life, with a five thousand dollaz 7 ($5,000) donation to the pet sanctuary per cat. 8 7. Petitioner should be authorized to spend an amount not to exceed $40,000.00 for Medi-Vac and 9 transportation of the Conservatee to Pennsylvania. 10 8. The status hearing regarding the change of Conservatee' residence and commencement of i 11 Guardianship proceedings in Pennsylvania should be scheduled for July 14, 2409 at 9:00 a.m. 12 in Department C. 13 9. Petitioner should be authorized to pay Leona Shapiro, Esq., PVP Attorney, the sum of X3,225.00 14 for services rendered to the Conservatee, and the PVP Attorney is not discharged. 15 16 IT IS ORDERED, ADJUDGED AND DECREED that: 17 1. The Petition For: (1) Change of Conservatee 's Residence to the State of Pennsylvania; and (2) 18 Instructions to Place Conservatee's Pets aze approved. 19 2. Pursuant to Probate Code Section 2352, Petitioner is authorized to move and change the 20 Conservatee's residence to the State of Pennsylvania and to commence a Guardianship or 21 Conservatorship proceeding in Pennsylvania within six {6) months from the date of the Order. 22 3. Pursuant to Probate Gode Section 2403, Petitioner is authorized to place the Conservatee's ten 23 (10) pet cats in the pet sanctuary at Save-A-Life, with a five thousand dollar ($5,000) donation 24 to the pet sanctuary per cat. 25 4. Petitioner is authorized to spend an amount not to exceed $40,000.00 for Medi-Vac and 26 transportation of the Conservatee to Pennsylvania. 27 5. The status hearing regarding the change of Conservatee' residence and commencement of 28 Guardianship proceedings in Pennsylvania is scheduled for July 14, 2009 at 9:00 a.m. in ORDER APPROVING PETITION FOR: (1) CHANGE OF CONSERVATEE'S RESIDENCE TO THE STATE OF PENNSYLVANIA; AND (2) INSTRUCTIONS TO PLACE CONSERVATEE'S PETS -2- Y71/1b/L17l77 tG:40 JaVtovaavr ,~,.,,` ~ ~•Fw ~.•~ nt; i«;/L`y~9 1H:19 81A5099767 ,LA1~ OFC M1•tl:nELL ~ FtA1V-90'~ 199eB D.4g5 laa5 t 2 3 4 5 6 7 8 91 10 11 12 13 14 1S I6 17 18 19 ~~ Z1 22 23 24 25 26 27 28 De~artmaat C. 6. 1'ctitioner is sa~orimd to pay I,aas~s , Ep-, p'VP Atsorney, the Imo of 53,225.00 for servioea seodorad to Ilse Cos~s~cvatee, t~ YVP Aty is Wert diselaegal. . ~jj OVt~D /l~ TO ~R11d~ANI~,-,CQL~I'I'ENT• ' r• ~. ._r. `nATEO: ~FEB 0 2 Z~9 OF P~NI'IS~LVAM/l; AND ('~ f t pVP Agootaay !or tke If ... •. V ~ R !~ 1 n . 1 i , 1 r~.nCS o4tr~>~-~~rrae•s r~s ,z_ EXHIBIT E 01/15/2009 14:47 8185089767 LAW OFC MITCHELL A KARASOV L 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 LAW OFFICES OF NIITCHELL A. KA.RA~OV Mitchell A. Karasov, Esq. -SB #133733 Tomohiro J. Kagami, Esqq. -SB #219744 53-52 Laurel Canyon Bivd., Suite 100 Valley Village, California 91607 Telephone Number: (818) 508-7192 Fax Number: (818} 508-9767 Attorneys for Julia C. Nelson, Conservator #4953 P.002 /017 1~~L' QED CSR Q~~,est pls~' NpV ~ ~. 2448 S L°S ANG GO RT s~PER1O~ SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES CONSERVATORSHIP OF THE PERSON AND ESTATE OF CASE NO. LP 011407 CONFIDENTIAL INFORMATION - CONSERVATEE'S REASSESSMENT RESULTS FROM OLYMPIA MEDICAL CENTER GEORGIA JOHNSTONE, Conservatee. Hearing Date: November 18, 2008 Department: H Time: 9:00 a.m. Attached to this cover sheet are the reports and examination results from Olympia Medical Center for the reassessment of the Conservatee on September 30, 2008, including Robert Wang MD's Geriatric Medicine Consultationreport, LoretaMulokas MD's Geriatric Psychiatric Consultation report, Cyrus Mody MD's Geriatric Neurology Consuultation report, and lab test results. /// /// /// /// /// /// CONFIDENTIAL INFORMATION - CONSERVATEE'S REASSESSMENT RESULTS FROM OLYMPIA MEDICAL CENTER . 01/15/2009 14;48 8185089767 rt Center For Geriatric Health st Ob+a~pie 1sad~ad Cenca ComPr'aherrsros Coordi~rcaed ~ c core Gerlaprk Dey Horpitat Garietric M«~ae Ger~soric Psyahoshy ~ ~ s90i wo~co~csoa~.~a s~ 303 I.os Mgclas, C~fifarnis 90036 (323) 932.3333 LAW OFC MITCHELL A KAkASOV #4953 P.003 /017 _ ~ ~r>~ATR1C ~ICIN~CONS~3LTATiON Patiwrt: 3OHNS11'ONE, GEORGIA Patient No.: 340471 E)i'ctated ]3y: ROBERT WANG, MD Seca and examinod: F~micx t.oe, cINP, Robtrt wa,~g, MD, eyrus lvlody, NID, Loreto Mutoicas,lvID and Bat~bara Hanuut, LCSW. Datie of Consulteaioa: 09129/'.008 DIAGNOSES: I . Advaneod cognitive darsfim~etiam compatx'ble with pruaatay deg~erative Pi,gooss Alzbeimer"s disease. Consider element of small vessel crarebmv~scular disease. 2. I~istory of seizure disordar. 3. HypoRltytoidism. 4. History of urinary tract infoctions. 5. Status post hry-sterecwmy 6. Histozy, of episode oi`acu~e renal failure trea!Ood with sleet plat and dialysis. rosolved. 7. Distant history of ahi~gics. . 8. Roceirt history of simplex. DISCUSSION: Ms. 3ohnstone presents with a history of cogcdtive changes, fast noted in 2002 which Dave gradually progtra.~ecl. Pravious evaluation has included brain imaging with MRI and also with a PET scan. T'he reports on those evaluation suggest that the patient had a process oons~nt with A}zheimafs diseasC, but ~ that there had bees evidoace of small vessel caebmvascular disease with white mattzr lacuaes. Gbrr~tly tha patient bas a pa+eseata~tion where she is apracfiic and utaable to initiate movements on her own. She also is verbally not responsive to direct qutstio~as, although the caregivers report that at timFs, espeaaliy in the morning, she will verbalize some brief phrases which may reprrsaat an sutomaticc speoch ~ some extent. The patieaa~t aLgo has increased tone throughout, although she dos appear to have sl;~ly brisker reflcxas on we le8 side. Time fiadir;gs overall an with probable porimary diagnosis of Alzheimer's disease with possible sup<aimposod conog~onmt of small vessel cerebmvascuiar disease with posssbly a discreet rigTnt hemispheric fiocas, In addition, the patient's recent coiuse has beau complic~t~ed by tho onset of seizures. & is n+at clear vvhather this represents endrstage Alzheimer's sequels or perhaps is due to specific scar focus from vascular disosse. In any event, the patient is currently taking Depalcote, winch appears to have prevented rocurr~tt SC1ZW'CS at L1nS point. Given the panent's presenR cognitive fvactioa, it appeals highly unlikely that she is sufficiea#iy capable of understanding her s~uro~tadings to an extent where relocation from her home to a different Page l of 3 01/15/2009 14:48 8185089767 LAW OFC MITCHELL A KARASOV #4953 P. 004 /017 .-. COASUIt8t1oJ1 l~1Ort patient: soxxsTONE, t~,oRGu~ Page 2 setting would present a significant emotional daalleage. i; sar~aus may, even. the way the patient intmacts, that the primarS+ it>ptrt she rotxives is based oat ado-to-o~ae gi'atores and global movemads sinc~c it seems uahlccly she is able to finch ~ say signa$c~nt err follow a story line or any complex process beyond at moat a single stop. 'Therofazr~ is tzama;of the level of care the patient requires, she o>xtaiuoly requires 24h~r c$r+e with saparvision sa all timaa, both i~ safety and for personal cart; however, cxrnplax activities, such as leaving het hove fvr as acclivity, are unldcely to provide any major' emotio~nai benefit to the gatieat at this time, ju fact, it wojald probably be to the patient's bor>afit to have very routiaa repetitive activities ast a regularr basis to rrtinjnmize any confusion or anxiety. The triad of car+c the patient requires ouwld be delivered st least equally as well in a fecilit~type setting as at home, and in tha fiua"lity.there would ba additional bade up witlumore peaaona<d avmTable and arse techaicstl tia, iaeluding'labotstory wa>dc and possible invasive therapies if desired. The patient's pacaonal care could pr+obsbly be optimized with the availability ofona-to-aaa private attandaat auring the appr~opaiate limas. Paztiailar arcs whore this would bo bmefieial would be with respect m feeding and around mealtime. In a+ddiUcnt, a apoa8c target of mobfii~aag the patient arsd doing range of motion oua a regular basis during the day would also be sotnething the parsonai att,~dazit could opbmir~e, evdn in the facility setting. With respect to the patience medical c~ititon, sevoural topdca wore raised sad discusstd with the patient's ~vator, IY!<s. Ndsoa, as wall as her acuremt care mamjager, Diane. The patient's rocurr®t w~inary tract infodioas are cxxtainly of coac~in, both in teams of theiz possible associated mo~rbidit3- amd also t~ potential four developing antibioti~rearistaat bacterial Sore Ciuidelmes about appropriate m~aaagoinatt of the patients possible urinary trod infoctitma were diawesed, inchxling the aeoossity to obtain relatively cultxues, perhaps using catheterization cultures ret times, in stela m appropriately evaluate wh~ethex the patient in fact has a urinary tract iafadioa. ~t was also >rato~ed that bunoad-specarum empirical auh'biotics be avoided and that nanow~ap~n targeeod tc+eatme~nt be vtilizad es much as possible to decxease the likelihood of resis~taace sad also w diminish the liksl'hood of oomoplicatioas, such as C. difficile. It ie iilcety, given tlu patient's rdatinne immobility, that progressive ca®plicaticros in terms of uriaa~y tract infections, stasis, ~otiirumie, elan issues sad deep veunous tbromboss would become nacre frequc>rt and more complex as tl~e patioatis cornea pavgressea. A question was raised whdher~the gatimt might be a candidate for zostar vao~atioA-and at least in theory, the pabiaat probably does fall is the t that would benefit in omelet to prCVeat a zostcr episode from beovming more psinfiil or more symptonnatic than necessary. The patiuit's camtatt medications wouce reviewed sad thioy all appear quite apprvpriata in cams of managing the patient's vascvlsr risk -foe seizure disorder sad hat hypothyroidism. Tbc use of demetrtia modicationa in this cvarmt setting is probably of liavitod beaoHt and not necessarily iadicatod, although soma practitioners would still possfbly attempt the use of amaauadiae if there are behavioral problems; ~wever, this does not seem to bathe case. The patient's laboratory results ate fairly urrr~rkable. Additional us~dies are p~ding and. specific recommendations will be made if there is say Zmexpeatcd sxgoific~xt abanormality. The patient is noted to have somewhat elevated diolesterol and triglyraides; hocvevea', ag~dn, given the patient's ovcxall staves, it appears uinlticely that aggresarive tn~nent of those rink factors would provide any significant cvexall benefit Page 2 of 3 01/15/2009 14:49 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.005 /017 Consoltaxion Report Patierrt: JOHNSTONE, GEORGIA Page 3 aspects of the patia~a csarent cane program was also discussed. Certainly the patient wi11 benefit from oae-t~-atte oamnnuaic~tioo and care, slthou$h again, oo~mplaa iapt~t wz~l not be uatdli~ble to Ms. 7ohnstone's stage of demcatia. Range of motion'and to mobilize the patiaet on a frequcc~t basis wr7l be helpful to- maintain c~ardiovaswtar tone, muscle tons end to diminish the si4ac of stasis; however, skilled physical therapy is unlikely to be of major bare&t,•aad skilled nnassage therapy may not be wasraated as well. h was disaissed that given the patieuifs primary i~ui ie probably on one~to-one ooanta~ct. with lror caregiver, that a caregiveu sufficiently trained in range of motion cad massage socl>~qu~es would pxbably be able to admmnista the ~ treaUlnents as well ar pcabaps bcttex than additional practitioner, since this care could be integrated with the daily care for activities of daily living. It was also discarsaed that in the near futare difficulty with feeding, because of pos~ble dysphagia, would be a uk~ly area of concern and that this should be watched for with appropriate response depending an the level of irrterventian fxlt to be desirabiq for Ms. Johnstone. Overall aggres®v~ of care, in terms of the types of it~arvendons necessary, were also n~viewal, although certainly decisions in this arcs are dependant om various values held- by the decision maker. The patieurs prognosis is certainty one of the contributing factors as Hated that statistically the paticat's life cxpecta~ncy would c~tamly be ices than s years in her carreat state and perhaps considerably shorter, however, tha+e ranaina a wide variation in actual survival sa that financial planning based on the life expectsacy and may be somewhat probleaatia ROBERT WANG, lVID RW/FN/cps D: 09/29/2008 18:24 T: 09/29/200819:18 JOl3#: 67759 Page 3 of 3 01/15/2009 14:49 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.006 /017 Center ,C~RIA'TRIC pSY~ilATR~C CONS~,,,TATTON For Patierrt: ~p~iSTONE, t3EORGIA GerlatClC Patient Na: 340471. He8ttZ1 Dictated By: LORETA MUTAKAS, IKD Seen and examained: 092912008 at olympia~~ cane REFERRING PHYSICIAN: L4RETTA MULOKAS, A+fD YDENIITFYING DATA: This is a 71-year-old Caucasian woman brought in by cart providor for fuU gcristric asseammcatt including gsgchiatric Covaprel~ra!-~a ~ evalue~ asst of functional Icwe! and further reconnmcndations cart. CoordB~arad REASON FOR PSYCHIATRIC: P baseline mental status asaessmcat. Comiiereou* Gerfawic Carr ffiSTORY OF PRESENT ~LLI..NRSS: Apl~~y. the patiart has shown decline in her mental functioning for the last 5 to 6 years. In the .last several months, she is esse~ially nonverbal and dcpendmg on the foil care by cam providers. The patient was rcferrod for evaluatiion by eonseri-ator becat>se sire was concernod that the gaunt gets care at , which might exceed her • futancial ca~pecity, and she was questiianin8 Poss~~bility of ~ticnt's plactment Gariatrte ~ to as assisted living f~ity or stcilled Horning care facility. PRESENT MF,,NTAL STATUS E7LANIINATION: Basically, could not Gaistric Medicine be tested because the patietrt is nonvesbal: Slu was just stating at aie and not getting any answers. No atatbe behavioral ~oblems, no in major mani-erisms Geriatric PsY~' or movement disorders notmd. The staff caring for the patient does not t^eport any behavioral probleans. Though about year and a half ago, the patient was adtaittcd to the psychiatric unit at USC Hospital. where sire was treated for Casa Mrumgemaa psychotic behavior oognitxve-decline mad agitation. She was discharged with Depakote and Serogttel. Saroquel was discontinuod several months ago without significant changes or worsening of her mcr~tal functioning or bchaviar. s9ot won o Eoutcrom~a WORKUVG DIAGNOSIS: soave 303 Axis 1: Dementia syndrome with history of behavioral psoblcros, advanced ios aa~, caiitocais 911036 stage. Axis II: Deferred. (323)932.5333 ~~ 111: Medical conditions include dementia, hypertensioq unbalancod gain. seiziae disorder, and a history of cerehi+ovaseulsr accidents (CVAs). Axis IV: Severe. Page l of 2 01/15/2009 14:49 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.007 /017 t Consult~tio®Rcpozt Patient: JOHNSTONE, GEOR0IA Page 2 Axis V: GAF at the timt of evaluation is 15 to ?A. RECp1~MENDATTONS: No acute intervantioet with psyelaotro~ic maUcations that I reoon0naendtd that the prenmt time. 'fhe patient's metal condition, doea not pravent ber from propcs care and treamrieat in any give+a testing sz the present tinge, though the patient delxs-ds on the iii care, and stability of her physical condition on care p~ovid+ers since ~ is not able to txprtss her nceds are gay discomfort. If you have any finther questions, please contact me. LM/FNlrrn D: 09/29/200814:44 T: 09/29200815:07 J013#: 67715 ~age2of2 01/15/2009 14:49 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.008 /017 ~. Center For GCTlStt'1C Health. n o>y~ i cksmer Coiupralrsrsive Coordb+caad Contirir~ous Ger3arrte Care ^ Geriatric >~ ~~ Gar;atsic Medicine Geriatric Pay~chiatry Casa Ma~CmCat s9ot wwc ot~ic souievara Suite 303 Los Astge}es, CaHfarma 90036 (323) 932-5333 ~,~i,~RICNEURO~OGY COIVSLTLTATIOi~ Patient: JOI3NSTONE, GEORGIA patient No.: 340471 Dictated By: t:YRL3S K MODY, MD Seen and exsanined: CYRUIS K MODY, tviD Attending physician: ROBERT WANG, M.D. Date of Consultation 09/29/008 ffiSTORY OF PRESENT ILLNESS: Ms. Georgia Johnstone is s 7l -year- ald lei=hastded Caucasian lady who does have a past history of hypene.nsion at and dyslipid+amia. She was functioning well tmtil the y~ 2002 when she' was noted to have some mild cognitive impairment. She was seal by a neurologtsi, Dr. William Chow, who worked her up for dementia and no treaxabic causes were found At that time an MR.1 scan was done which was reportedly nortnat. She then had a PET scan dAnc which revealed findings compatible with Alz~hcimer's disease and some asymmetrical decreased uptake in the left irtmtal area. Ovu the n~act few years her dementia continued to progress. In July 2005, she apparaidy drove off in ber car and was found by the paramedics and taken to a hospital. About two motrths prior to that her license bad beet: revoked. When slte was found, she was dehydrated and had significant kidruy problems. She had to have a kidney operation and had w be on bemodialysis for a brief pcciod of time. In addition sire also was so sick that she needod a gashnstomy. She had a prolonged hospital stay and following that was able to ga home. In August 2005, she had two new onset ge~neraliud tonic clonic seizures. She was ax first started on Dilaatin r"or it and then Depakote was added to her therapeutic regimen. In April 2007, she had a psychotic break. She apparently became confused, agitated, and was i]SI111C1nStiYlg. Sha was taken to ZJCLA Hospitat and IwSpitalized there for sometime and then seat back home. This cansultatioa was requested to evacuate the patient from a,neurologica! point of view for her cognitive and motor decline. At this paint in time, Ms. Johnstone rarely talks. She is sig>if~csatly impaired cognitively. She walks very little with. a lot of help and the only thing she enjoys doing is eating. PAST MEDICAL HISTORY: Significant for hig.~t blood g.~s~e, dyslipidemia, a hysterectomy and the above Ynenrioncc. Page ~ of 3 01/15/2009 14:49 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.009 /017 Consultaxion Report PaticnC 10HNSTONE, GEORGIA page 2 FAMILY HISTORY: Her brother died of HIV disease. PLRSOi~1AL ffiSTORY: HOME: She lives with caregjveas a~ her cat. 'WORK: She used to work as an inttrior designer. She is now retired. HABITS: There is no history of alcohol, tobacco or illicit drug use. MEDICATIONS: Pnseot medications include Dcpakc~e 250 tog q.a.m. and 500 mg q.h.s., aspirin 8I mg daily, Syathmid and muhivitarnins. PHYSICAL B;XAMINATION: GENERAL: Sheds swell-developed, well-nourished, sligfntly obese Caucasian Lady sitting up in a wheelchair in no acute distress. 'VITAL SIGNS: 1'tilse 72Ja>;n and regular. Blood prosstuc 107175 mmHg. Respirations l 8imin. TemperattQe 96.4°F. HEAD: Normocephalic and atratanatic. NECK: No neck rigidity was observed SENT: Betrign. NEUROLOGICAL EXAMINATION: MENTAL STATUS: She was aleR and awake. She was severely aphasia She was unable to cooperate for fiu~«' mental status testing. SPEECH: She had :z significant dysartltria when she did talk. LANGUAGE: She had problems with comprelxmsioz:, repetition, Harming and expression of language. CRANIAL NERVE EXAMINATION: Il: She did blink to threat, On one occasion she counted my fingers, burwas unable to coopetsie for confrontation toting. III, IV and VI: The external ocular movements were full and the pupils were ~ mm in diametea, equal, round, and regular and reactive to light. V: She had normal facial sensations in the temporalis. Masseters aril pteryg+aids fiinctioaed normally. vII: She had a mild left 7'° central facial paresis. v1II: She was able to hear weII b~7aterally and bad rro nystagwus. XI: The palace mov~l sytn~meaicslly or. phonation. X: She had no hoarseness of voice. XI: The stetnocleidomastoids and irape2ii fitnctioncd normally. XII: The tongue wen in the nudliae without any fasciculations or atrophy. MOTOR SYSTEM: The gone was increased in aA 4 extremities with a mild degree of gegenhaltetr. ExaminaAion of musde mesa revealed no fool westing. Examination ofpower was exccedingly difficult to perform becaL>Vge she was ta-able to cooperate far individual muscle group testing. However, when deep painful stimuli were applied, she did move all 4 extreanities well with possible wcaicncss more marked on the right sadc than on the left side SENSORY EXAMINATION: She had intact sca4ations w deep pain. Other sensory modaiides could not be tested. REFLE~{ES: 2++ an the right and 3Y on the left in T.lte biceps, triceps, brachial radialis and knees, 0 st both aJilclcs. The plantar responses were flexor bilaterally. COORDINATION: She was unable to cooperate for forger-to-nose and heel-to-shin tasting. STANCE: She stood uP with support on both sides. GAIT: She walks with an apracxic, :i~t greater than left paretic gait. DIAGNOSTIC IMPRESSION: I. Ms. Georgia Johnstone is a 71-year-old left-handed Caucasian lady with history Jf cogai•.ive dysfuaciion that stetted in the year 2002, which has prr3gressively worsened. Sa~c~ :hen ~e P2ge 2 02 3 01/15/2009 14:50 818508976"7 LAW OFC MITCHELL A KARASOV #4953 P.O10 /017 Consultation Report Patin 701iNSTONE, GEORChIA Page 3 pefioa-t bas bad ot]tar. problems iachtding a period !where she was in renal failure and a scizvre disorder. Her oogttitive problems have boen pmg~essively worsaring and mowric~y also she ites bear- declining 2. On neurological examination at this time, she has;sigaificant global cognitive dysfuntxion. signifte;ant aghasi$, dysarthria, left 7'a txntral facial paresis, right greater than left quadriparesis, left btistia then right reflexes, as apttietic stance and an apractic right greater than left paretic 3. The patient's history and neurological examination are most oompah'blt with a mixed dementia ptndatninantly Alzlteitna's disoase with a superimposed vascular componeau. RECOMMENDATIONS: 1. The gabeat should be wotlcod up titoaoughly far tteamble causes of cognitive dysf~ction with a CBC, ehrmistry panel, B121avd, falate level, Rh'R and glyoohemoglolrin. 2. A vatproio acid level should also be abtaitud to be certain that the patient's valproic acid is therapatttic for seizta~e praphylsus. . 3. An aeetylc~alinsetejffie inirilutar should be considered io stabilize the patient's cognitive dtxiine and in the future meanaatine should be added to lber therapeutic regiaten. 4. Physical and occupational therapy for strengthetring exercises and gait retraining will be exvcodiagly useful. 5. If the pstiamt is gaiag to be foIlowed in the day hospital, l would tike to see her back in approaitaately 6 weeks from now. Thank you for entrusting me with the care of Ms. Johnstone. Please do let me know if I ~n be of sny fiuther hdp in the interim. Zl~l~-.~ MODY, N!D ch~av~lvnyb D: 09!292008 11:41 T: 09/29200812:21 JOB#: 67670 ?~.ge 3 ai 3 01/15/2009 14;50 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.O11 /017 ..t RDIR Ds'1's s 10 / D1 / D 8: OL!l~Ii 1b6DIC8L ~'PAA P7Wi 1 1~liQ TTb~4s 2323 5900 Olym~i:~c 81vd • Los Aagolss, CA 9D036 • Phoate: f323) 932-5315. Tamar Haruch-Oren.M.D., I,a~borntory Medical Director Spec Braadcnst Report B7-TS146?1's JOLT&TONE,.G80RGIA D 1-CC:z' 9s VOD105116119 IACs GER/LAB II Ids i~30 00 3 404 7 1 ]litii/6Xt 71/F itOQ[s lvOS 09/29/08 1tsCi Dots WANG,ROSSRT DQ~s 04/b6/1937 8~t DTYs 8'1r1'1'Q8 s REG ' CLI TlaOt: s GER 8P3C ~s D929:RLD001DR Cpi.Ls 09/29/08-iD45 8'J.7-'PQSt R&S ~ #: 00265724 R9;GD: 09/29/D8-1150 SOBId DRs WA136,ROBERT NLTTffit]SDS 09/29/06-1055 O'1'A3t DRi MULORAS,LORETTA M.D. polD~tRps RPR, RF SCRN, FTA ANTI90DX, HOM08YSTINE QR', T3 FREE, VITD 1-25 Teat Result' Flag Refereaca " Psrformiag 3iter ¢USST DIAC~VOSTICS NSCfiOL6 TNSTITDTS SAAf JUAN CAPISZ'RANO, CA. 9?~75 _ i _ {.R anT L ~ CLIA:-.05D0643382 . :.,~.1,;;N . _. - - ~:~... ._.._. _ Test _Psrfarmelj}~$~sjgat: ' .. T S~"':~ :~1. •~ ~N }y.+i: ".v.~r~R: u-~~1rp~F"+4'1, y.~y •. ~~33608 ortwga 83ghmsy _ ry~y:: ~;;^".' 5.6~:.'3:qy; " r ~ .e ~.1~c~ry,.- w:'f~-,' ~~`9'~'T'~f'`t~"~ n=. ~:.~ •x - '~VCCC ~'•r .:s -~dYAR .. 4'- NR-.• .~r FTA ASS SEE TTOTB { NONREACTIVS .-.. '~+r ., ...~>. ~, ~T._i~•l'9TF~•~~~.~~.'•~~•.•-'"r-Y'~.it:9~' t•~••.. -' ••- ... ....• -r. . ".a....•. ~.~~~~'-.~~..-~ .. ~• j svidabca of Treponsmal irtf®etion, this test result shouldy~~b~e • { for •sarologic~ teatiug .- i '•+r ~.iy .;1~. .r rJ't 5. .i'_':. ,..~;. at? « '~ .: •'r''~'.+ir'a "'~~ ~~'•+~ >? ~ 1 ~ . ~ - 4 ~~•.¢u~est Dlagnoatics Nichols Institute _ _ _, `. Z, V.:. ~... ~~~, i ''. _. -.-...'r:. ,~'Tw".~•7;r';y'.. ~r •.. k~ ~r r 'd!. :-.. ~~• ' S ... <. .... 1~ • .F~ ) San Ju_sn_ C$pistraao, _GA_ 9?}6„ 90-61305R~e E Reitz MD 'Z '•~'.. ~30 '~~r. '•• _.'r=. }~.,•.s+C~~-~.i.'.:f~SY~~,.~~y." ~~.T~' fF""G"'' +~F.~r i w ,,.'T~:~:3 v ~.] .a'... ~.-`,.r~.. •_ .•.•, ~~~. «.•-~~'~^13 ~Y'•21^. •.~~yi-~ I •,s .i'.~~• ~;~. ;w7 ~..-f-i: T~'.'_r ~'~ #!"i'tr_ •+ri. b . _ Itefersnce Ramps: LESS' THAN 10 9 y ti ~ t' . -'-~.*:. ~.r?%'+•WCr'-'. ': .r'FS'.. .. ~.~. ~'.~': ~. .}r«'r !'r ~,~"sv>>s,+t ~,^~y. r ~•r~ ~. _ r i .• .. .:'~.... ....~; .~`.~~. "_ }v ±~• ,.F.. ~_. r.. •' _ ~.S~f."'.da5s. .•^••i'~.."•~f s ~rv3 1i~'•'~ ~••avm't~._.. ;.i .i~ .'1. # s.. .. _. fret: Artri. Is~tarts Med. :33 ~ y~-. .~ y ~ y.. •.F i+a."'.T ae.. i~• ,i}•n. :"v~.f'~ r..~~F..' "" -iJ~~~,~ ~,~ r ~ ~~ '_"S ,. ~ Quost D.taQno_stice Nicha~l'$ Institute . i :., . .~ 3 ~...~'.-r I?~fi~:~•~:, r"'''' ~ ~" a _1'.x .. ,'~.Ft'fi~', u~ ~'}i'2~ * - • ~ r, I San Juan Cax~zstxano, CA '~9?690-6130 •~ R. E.~ Rai to 1~ID x, • I Test Perfaxsnsd at: ~ ~ VIT ~D 1, 2 5 DIOH f ~ •. _ Patiaat: JOHNSTONE,GTORGIA D Locttion: - GER/'LrAB 1-aoonat~: V00105116I19 ** EIJD OP REPORT *" 01/15/2009 14:51 8185089767 LAW OFC MITCHELL A KARASOV #9953 P.012 /017 ~. ,- ~7D7 DAR'S; 09 /3 0 / 0$ ~+~~ '~~' C~Z'ER ~ TT1o;i 2325 S9aa olym~ip Blvd Los Angeles, GA 90036 Phonei E323) 932-b315 Tamar Baruch-Orea M.D., Laboratory Medical Director 1t7-D~ 1. 3peciinen Broadcast Report . ~•~~_ ,TpFOaTST(3rTE,GEpRGIA D 11,CC3' ~: V00105116119 LOG: GER/LAS V ~: M000360471 ]1~/8'Zi 7~/8 2tO01ai 4lBfie 09/Z9/OB Iii DRs WAN(3,ROSERT DOB: 04/06/1937 >~t DIBi Pl'1-TO8 a REG CLZ Tr,OC i GER . sp]6C ~i 0929:RLOOOlOR COLL: 09/29/0$-1045 S'P1lTQ8: AES $8Q is 002b5724 RECD: 09/29/08-1150 ~Bn87s DR: WANG, ROBERT El2Z'~i 09/29/08-1055 0"rlIIt DRi MIn+OKA9,LOREZTA M.A. OvA~Ds RPR, RF 3CRN, FTA ANTI80IIY, HOM~DSYSTSN$ QT, T3 FREE, VITD 1-25 Test Result Flag Reference ~~rt~erfosmsag S_iter Q[JEST DIARNOSTICS NICFIOL3 INSTITCTI'E ., SAN JfA.4N CA~P~ISTRAAIO, CA. ~ 92675 ~~ 1.'~ ~~ ~iw .-71`(, ~T.. ~~ ,~` ~.?:., s.~s ^.. ti'~s'~ ~ ` 4."~i'~. ua w!- ~•8fihlGr:ty , .}. '` ~ ( CLIA 05D06~43352 L ~ ... ,.. 5 f K °~' ~ F"TA-ABSw PEt3DII3G Reference Range: LESS TIDU_U ZO 4 . ,'`'~ _ .. x ~ i~~~ -q ~ ..w~'~f ,r3Fa ~a7CiA'{- ~..,1t ^a"~.F~f:f~" e- '?'~ y,. .^vy'i?t i~A. e~.,~•1.~ili'7>~w-.f~o'" ..a mac :.~':.~'i':. ~IEff'.. ~,•k-.e~+. e•.S` T~:'J'~_f."~ .-.7~.: .3::. . . (ref: Rt7t9 ~ Intern M6G~. 131:331 339 2999) ~ _ Quest Diagnostics Niohols Ineyt~~i,tute 'f. tam; '`f~.. a:~y.,'i• .~ r• ,5~~"~ dY 3F ~ +I. - ~ 4 {; San ,Itran Capistrano, ~ CA 9x690-6130 R~ E Rentz 1rID .~~1pyy_~~~J~` ,-y~.~_ 3~~.'~p ~s t Perfoxmad a t : ¢~~j ~} \. uPJ: .rv -• 33606 Ortega Highway " • `' =~ y' ~r L "~~:,,_ •. -sfy~: _~~.:`t = i ~~Y.. _ _ v._aa~NO1~B~fPS ~ ~ ~ ~~ . . -r.. ::Su.•,,'li~;-. ~-.?,S"~~+..aZ~!<dT1li ~IRS* .as+~ ~. -+sna, ~•.. .. .._ >..`$A~ ... VIT D, 1, 25 DIOIi ~ ~ PENDING patient i JaHNSTONE, GEpRGIA D Location: - GER/LAB ~-aao:mtik: V00105116119 " ~' END QF RBPOA'P "' 01/15/2009 19;51 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.013 /017 eve aa-za: 09 / s o / os - ~ oaGmaara wsatcu. c~ r~ 1 . tCfi ~YSt 2325 5900 Olympic Blvd Loy As~peles, .CA 90036 Phvae: (323) 932-5315 Tamar Baruch-Oren ~.D:, Laboratory Medical Director 9peciu~aoa Elroadcaat Report 87lTZEfi'1's JOT~I3TONE,GEORGIA D 7-CCP #t V001Q5116119 I.OC: GER/LAS II #: MD00360671 ~-OVC/szt 71/8 xoo~at xao: 09/29/08 R~fi D1t: WANG, ROBERT D0~ t 04 / 06 / 1'93 7 s9:D c DI6: BT]-TQS! R$(~, CI,I TZ.OC t GER SP3C 1kt 0929:RL00013R C07+Lt 09/29/08-1050 ST7-TDB: COMP R~Q #t 00265795 R7EC9t 09/29/08-1357. ~4A1t Ditt fVAIJG,ROHERT ~4RlEItSDi 09!29/08-1358 07.'RR DRt MULORAS,LORETTA M.D. : ANA sCREEN • Test• Result FIaQ Reference ~~• Perfosmzng 53 ter Q 9T DIAGNOSTICS IJICHOLS INSTITQR'E,~,; .• " ~ ~ • .S`AN Jt771N CA,pIS2'R,ANO, C.4. 92675 cr,sA: osno6a3ssa 8stieatt JOFIIJ5TONE,GEORGIA D iocat:3.oat - GERlLAS liccoaatis VQ010511fi119 *• END OF R$BORT «* 01/15/2009 14;51 8185089767 LAW OFC MITCHELL A KARASOV #9953 P.014 /017 R'0~ D7lTE t 0 9 / 2 9 / 0 8 ,~ ~~'~ ~~~ C9~ .~ pnGi 1 s~I TI1~s 1253 5900 Olyt~ic Slvd Los Angelt3s, ~A 90035 • Phone: 1323) 932-5315 Tamar Baruch-Oren 31Q.D., Laboratory Medical Director Specimens Sroad~ast Report 8k'1`I9B7Y'i JOfIIJ3TONE,GEORGIA D 71~CCT ~s V001051,I6119 IACs DER/LAB RY 4: MDDD340471 iwiE/QXs 71/F AOOACs ~'.Gs 09/29/08 1tEti pat: WANC3,ROSERT m8s 04/06/1937 SZDs DZSr BTA'1'R'S s REG CLI Tt.OC t GER SB~tG iFs D929:000l00R COLLs D9/29/08-1045 ~tT7-'1'tTBs COMP 7~Q is 00165724 Assess 09129/08-1124 ~ Dtts WANG, ROBERT s 09/Z9/08-1055 OT~t Dlt: MULOKAS,LORETTA t3.D. ORD~s CaQP, LIPID PANEL, $12, FOLAT$, FREE T4, TSB, VALPROIC ACID C0~1'8: Collected By: ELSE ' Couanents to Phlebotomist: GDH Te®t Result Flag Re£ere~rsve POTASSIUM 4.3 j 3 4-4.9 mEQ/L cot • -, , :'. .i,.... ~C3~~1 / JCY'y •Yt~•f x • ~ J, " _ .. .. ..!' r.r~~•., hY~ . ~ ~ ~« •~~ .. - ..r' ! ~ }~ ~ii~ r tom....: ~ .. '~L: sn"a~ ~ Y~~ ~~ . HFN 14 j 7 23 mq/d3. .. -. ....~ .. + ;. ~ ~ ,f .~ - :. _ » j-.. 1 ~ ~ ~ .fig. r•i~l~WiPf: ' -v~e ~ ~`l iiFis • Cafoxitin causes artificially high cr oatinlne results at the .:. ~~ .... - r. _ C3Li7CO5I5 RANDOM . 112 j A j 70-110 mg/au _ t ~ • ~, ,. .. TOTAL BILL ALT/SHPT ' ALBUMIN A/G RATIO .• __ wL. I ~' .. 1 .... CHOLESTEROL 00 ,.. _ w~ :.~:.i . r. fI FF,<,;,,,,,,.200 MG/DL id®Iinas. ..~ . ~ , .. ..- s _. .i^ ._. . _ - ~ ~ ~, : ~= Patieats ~TOfIIJSTONE,GEORGIA D I.oaat3ooas - GER/LA8 7-cCO~aatB: VOO1D5116119 ** CONTINUED OW NEXT PAGE ** '~~ ~ D.0 1 1 MG/DL r r r• . ., -~ ~ -, . 4.2 •r j 3 .5- 5.2 G/DI, . .. .,.-x. ~~ - FI.~Li~•iyta'~ill's :~^'''..~`•:::~.~ ~ .:-r: r'Y .'iwA7'4a~/r ~ w - _ 1.4 1 D 2.7 ,~... ; .~i ".y ,c't f+(k .7'-.mac. ~' ;:' t.D~:~ .?9=~{S•. :..~'+Z~ .s y^' "•ysc `Y'•'~~ ~•~S: ^YL•w ''. Classsfscation (NECP ATPIZI) gusdelinea: µ SP ai ~~ i / 1. yNo~xmal ,~i~' - < 150 mg/dl ' iYivh 200-499 rr~/d1 01/15/2009 14:52 8185089767 LAW OFC MITCHELL A KARASOV #4953 P.015 /017 uvs VATS t 09 / Z 9 / 0 8 ~ aax~xs. M,>eDIC~-L ®arraie ~ PAt~ 1 7tlR10 'i'ZIIi: 1330 59D0 Olymgic Blvd Lvs Aa~alea, CA 90036 Phone: .(323) 932-5315 Tamar Baz~uch-Oran M. D. , Laboratory Medical Director. . 9pacime~s BroadOast Rsport ga.T=SmTt J'OHNSTONE,GEORGIA D acct i~t V00105116119 LOCI 'GESR/LA8 II #t MODD340471 7-O~LSit 71/F ROOM: 7tsOt 09/29/08 R~ DRt WANG,ItO$ERT nOBt 04/06/1937 a3Dt Alai STA'i'C8 t REG CLI '!'I~t?C t GER DPlCC ~t 0929:H00075R CaI,Lt 09/29/08-1045 8't'7-~PGtts cam 7tsp •t 00265724 3tiCl~t 09/29/08-1124 SRSUt DRt WANC3,R0$ERT Sti7T~t 09/29/06-1055 OTSA DRti MOLORRS,LORS."I'I'A DQ.D. O~RSDt CAC. 8SR WESTERGRF.Ei CBt Collected. By: ELBE Cotrnner:te to Phlebotomists GDA Test Result F1nQ Raferenee ii. :~~ i.~jR ~'r:i'_..tin. .: T;::'7S_ ~. _ '~Y'...~ ... w 'i,e:v:.~!ki 'fir,;. , ~,.:F.. x.•~:~:.~'-'-n RBC 4.48. ~ ~ 4.20-5.40 M/VI, ..c.a b ~ '•`.~stf. • .: xcT I C'i 3=~.'~~fe :.x3tF-,? Nai _•~::* z'J'~.as::~.i1j.~a' 40 1 i"',~.'.:~.: ~ ..... ^~ -n.~ t • ..~.,~ ..~~y";2:s`'..'+ar°~. ~`?; r . .. -. 37.0-47.0 ~ 'j' 'f .K~ `R•j. ~: ~r'~,'~~-.~'... `a••^;sfRr, r!~'fi• a. ~ ''. ~:. ~.~'-;r•.~ ~• . ... 5s.. n. _~'.. ._ . ... ~ NiCH 30.8 , . 27.0-31.0 PG RDW 13.0 ~ 11~, 6-14.8 ~ Y:~~. .0-75.0 y~~ ~s,,~~y~~~ ~, NEIT!`ROPHILS ~ 68.1 MONOCrrss "~ 6 .~~i • ~ _ ~ t` ~ "~;' .mar +=='•` iF,fsi S SASOS~HSL5 ~ ~yy, 0.2 _' (~~s}Sy Ar.~'. +'.,.{~r q.5 J. ~'ivR T ~c ~~.+f'~- ~. Y... ' ~.. 1•.0-10.0 $ ~ ~ • 0.0-2,0 ~ Batiant t JOF~TS'PONE, GEORGIA D 7+oatatio:at - GER/LAS Accvonti: VOOSQ5116419 * * RATD bF REPORT "' 01/15/2009 14:52 8185089767 LA4J OFC MITCHELL A KARASOV #4953 P.016 /017 RVlq Da;~i: 0 9 / 2 9 / 0 $ ' ^~ • OL~@I.R 1t1ialCl 'qtr. GiIP'Jfalt ~ P~R$i 2 ~ sIP9t: 1253. ~ . 59.00 Olysa~ic Blvd Los A~agelss, CA 90036 Phoua: (323).932-5318 Tamar Bnrsich-Oran Id. D .. Laboratory Medical Direc~o= Spaci.mon Broadcast Report aativntt J'GHN3TONE.QE4RGIA. D' Loastioan: - GER/LAS t-aoo~sati: V00105116119 (Corot.) ~cimoas 0929s000100R Collvotvd: 09/Z9/08-2D45 iCcsaatiaswll) Te$t ReQUlt Flnq Rafarsrsce ~q ,yr,y.~~ Y ~^y~~~ f..y1}. `y~yyy',• _ 'arc' '~.. .{~x^.LC~~1 •:'.~ni'r'~TrH'-?L ~'e~ti~. 1. .. i.: .. .._ ~ T '~ lowering o ~I,DL~ below ~200mq/d1. ;:~rro•.~4 .:-R'''te: :"~T "~, .. ~ ... .-~. ,'-.LR«.~4~*T2`t':.: C... The calculated LDL is noC accurate far specimens with i .tom :4H'~,x ~ ~ .._ _. ~ ~_ .... ., ~ ..-~. _._ , - +¢'. shaving Type III ~AyBerlipoprateinemi.a _ _ ~~.,F , . Ott ??~.rt+.°w"xs -7q?~7's~a.,wr. .a '~yy,w • ... ~ _ 7~. c•~sr..,. .. ' KE^ ~., X "~ , ~~ 1~, a r ~;; .. ~~~ National ChoZestero.2 Sds:catjoa Program (NECP! ezzsdeli_nes I~~ 5 i 7l~' .s~,h 'r•L• ~ ~ _~ .L..G~-' ~.Ci'i _3"'pSY?~. ( '. - ~v ~~'... •~ yF - ,'!-t ".:'`''.~ri. `~'' H jl - a x r ' .~.. ~ ~ '~`~` 'Frs v: •:t"~ *-r~''i'.-~.3z : ,,,-...: .n ,.~ ~` c 40 mg/dl:Low HDL Cholesterol major risk factor for CFID :,.: •; .:~',.;' :.:~+• ~ ~.ryc • r: F.,': ~ tom:? ~?~f;; '~,~~ ~ ;~';`'' . CHOL/ILL RATIO + 6.5 H 3.3-4.4 -v~AM=N sZi izzi~'M x jii`'1~-946 PG/ML. ::•.:s~ .~ ~~•_. I ~- 1.22 ~ r ~ r0.86-1.85 •NG/DL FREE T4 '~ ~.~ ...,y. w:,..~u.. .. .. .an. i .. `~:'~;~C'. ,~i.~..+'~35 r~"°~ -'`iS~a'.cl'~ ~... ~+~?:L'~fi y~~~"~'~-.~..'.~i'I~'~:~{%,',{~ ~.~yy5~•- -'R~",: ~~:•z.~ .': .~ . _ .sF. ~ , ,. V'AIrPROIC ACID ~ 91 - _.. ~- -'~0-100 uglraG Pat3.aat s JQF~TSTONE, GEORGIA D Locatio~z - GER/~ Aaaosmtlit VOOI05116119 + t ENb 03~' REPORT " ~~ ~` ~. ~ ° $ " _ ~, r ~~ ~ ~~~~~ ~ ~_ ~g~;~ ~~ °~ m a~ N r a 0 0 a r r 4 ~~ r~ x~ ~~ z=~' ~~ ~ m ~`^z xx ~~~ A r ~~.~•Q ~ aQa°" 1 V+ ~ C~ t~1 , 1 > N h ~ ii~ ,. Z ~ ~~ .....--•~ v a°~o'~, ~ r°. z ~,°~a ~~ ~.o c p, u ~.: c 0 G ~. a ~. a a . x o s ~a s ~ ~ ~ ~ +f v ~ ~ '~ a ~• • Q v o ~ a u oc n y ~ n a w~~ua G '~ C F~ t`.O5'd~'d?I ~ ~'ISHOZILI 030 M'd`I L9L68058t8 85'6t b042(St -r n' d X566# EXIBIT F Bethan Villa e Retirement y ~~ 325 Wesley Drive. Mechanicsburg, PA 17055 (717) 591-8001 • Fax (717) 766-0870 www bethclnyuillage.org To Whom It May Concern: Center 3/25/09 Georgia Johnstone is currently a resident of Bethany Village skilled care. She does have dementia and presents with both long and short term memory deficits, and has severely impaired decision making skills. Because of this, staff have to anticipate all of her needs. If you have any questions, please do not hesitate to call me at 717-635-2073. Sincerely, ~VW~h~~~ Krishnan / Dr. Haldipur ~,...1 olnlro ~~~ _ ~ oNrrAVrxc AP ~D~TN)N J EODAL NDUBIN6 ~MHS~D~ OP-OflTUN1TT An Equal Opportunity Employer • An Equal Housing Opportunity Facility An Asbury Community EXHIBIT G IN THE MATTER IN THE COURT OF COMMON PLEAS OF GEORGIA D. JOHNSTONE, CUMBERLAND COUNTY, PENNSYLVANIA AN ALLEGED ORPHANS' COURT DIVISION INCAPACITATED PERSON NO. CONSENT OF GUARDIAN OF THE PERSON AND THE ESTATE I, Gary J. Muccio, certify that I am willing to serve as Plenary Guardian of the Person and of the Estate of Georgia D. Johnstone. My current residence is 6 Derbyshire Drive, Carlisle, PA 17015. I am a licensed real estate professional. I certify that I speak, read and write the English language. I certify that I do not have an interest adverse to the alleged incapacitated person I certify that I am not a fiduciary, or an officer or employee of a corporate fiduciary, of an estate in which the alleged incapacitated person has an interest, and that I am not the surety, or an officer or employee of a corporate surety of such a fiduciary. . `m~c~ G ccio DATE: April , 2009 {A 1471304:1 } EXHIBIT H IN THE MATTER GEORGIA D. JOHNSTONE, AN ALLEGED INCAPACITATED PERSON Listed below are the assE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. EXHIBIT H ;ts (as of February 28, 2009) and income of Georgia D. Johnstone, the alleged incapacitated person, as currently known to the Petitioner: Asset Approximate Current Value Real Estate, West Holl ood, California $750,000 Marketable Securities, Fidelit Investment Account $295,000 Fidelit IRA $135,000 Cash $19,000 Tan ible Personal Pro ert $20,000 Total $1,219,000 Income Social Securit er month) $1,050.60