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HomeMy WebLinkAbout04-24-09COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF PLENARY CO-GUARDIANS OF THE ESTATE AND NO. 21-09- ~~I PERSON OF TAMMY LEIGH DOUGHERTY, AN ALLEGED INCAPACITATED PERSON PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA CSA SECT. 5511; FOR WAIVER OF BOND; FOR APPOINTMENT OF COUNSEL; CERTAIN NOTICE REQUIREMENTS; AND FOR AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH ~ o THE ESTATE OF THE ALLEGED INCAPACITATED PE~ -v ~ :.'~~~ ~~~ N ~ TO THE HONORABLE JUDGES OF THE SAID COURT: ~_'t~-~'' ~ ~ t~ ~ "5.,~ ~.) i. m. `~ And now comes, MILTON M. DOUGHERTY, JR. and DORIS S. DOUGHERTY~his wife, and DEBORAH DOUGHERTY KNAUB and SANDRA L. DOWNEY, the daughters of the aforesaid MILTON and DORIS DOUGHERTY, and the sisters of the alleged Incapacitated . `-' -- _ 5 r"': C:.' ~~ _ "i ~,,') -'_, ., l f'. Person, by and through their attorney, CHARLES E. SHIELDS III, who files this PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS and respectfully represents as follows: RE: JURISDICTION 1. Jurisdiction lies in the Orphans' Court Division under 20 Pa. C. S. Sect. 711 (10) which states that the administration and distribution of the real and personal property of the estates of incapacitated persons is to be exercised through the Orphans' Court division. RE: NO PREVIOUS ADJUDICATIONS 2. There have been no previous adjudications involving the alleged incapacitated person nor has any judge acted on any petitions or motions involving her. RE: PETITIONERS 3. Petitioner, MILTON M. DOUGHERTY, JR., residing at 220 West Keller Street, in the Borough of Mechanicsburg, Cumberland County, Pennsylvania 17055, is an adult individual aged eighty-three (83) years, and is the natural father of TAMMY LEIGH DOUGHERTY, an alleged Incapacitated Person. Said Petitioner is a United States citizen and is able to speak, read, and write in the English language. 4. Petitioner, DORIS S. DOUGHERTY, also residing at 220 West Keller Street, in the Borough of Mechanicsburg, Cumberland County, Pennsylvania 17055, is an adult individual aged eighty-two (82) years, and is the natural mother of TAMMY LEIGH DOUGHERTY, an alleged Incapacitated Person. Said Petitioner is a United States citizen and is able to speak, read, and write in the English language. She is also the wife of the said MILTON M. DOUGHERTY, JR. 5. Petitioner, DEBORAH DOUGHERTY KNAUB, residing at 225 Indian Creek Drive, in the Township of Hampden, (Mechanicsburg), Cumberland County, Pennsylvania 17050, is an adult individual aged fifty-four (54) years, and is the natural born sister of the whole blood of TAMMY LEIGH DOUGHERTY, an alleged Incapacitated Person. Said Petitioner is a United States Citizen and is able to speak, read, and write in the English language. 6. Petitioner, SANDRA L. DOWNEY, residing at 127 Victoria Drive, in the Township of Lower Allen, (Mechanicsburg), Cumberland County, Pennsylvania 17055, is an adult individual aged fifty-one (51) years, and is the natural born sister of the whole blood of TAMMY LEIGH DOUGHERTY, an alleged Incapacitated Person. Said Petitioner is a United States Citizen and is able to speak, read, and write in the English language. 2 RE: ALLEGED INCAPACITATED PERSON 7. TAMMY LEIGH DOUGHERTY was born December 8, 1961 at the Seidle Memorial Hospital in the Borough of Mechanicsburg. She is currently forty-seven (47) years of age. 8. TAMMY has two (2) Siblings, the aforementioned two (2) Petitioners, DEBORAH and SANDRA. 9. TAMMY has always been and remains a single woman. 10. TAMMY has always resided and currently resides with her parents at 220 West Keller Street, in the Borough of Mechanicsburg. RE: TAMMY'S INCAPACITIES, INJURIES. AND LIMITATIONS. 11. TAMMY was born with severe mental retardation. The level of her retardation is considered to be "profoundl" classification. Tammy is unable to say yes or no and is unable to communicate the location of any of her various pains by pointing. She lacks any real capacity to communicate. 12. TAMMY'S delivering physician was Dr. Newton W. Hershner, of Mechanicsburg, who is now deceased. 13. Among TAMMY' S early treating physicians was Dr. John J. Hanlon, of Mechanicsburg, who is also now deceased. However, a diagnosis letter prepared and signed by Dr. Hanlon as 1 Taber's Cyclopedic Medical Dictionary (15th ed., 1985) at p. 1031 provides the following concise but helpful definition: "MENTAL RETARDATION. Below normal intellectual function that has its cause or onset during the developmental period and usually in the first years after birth. There is impaired learning, social adjustment, and maturation. The causes may be but do not have to be genetic. Rubella in the first trimester of pregnancy may be associated with mental retardation. Intrauterine trauma or infection may also cause this condition. The degree of intellectual impairment is classed on the basis of the Wechsler I.Q. Scale as follows: 1. Mild, I.Q. 69-55. These children are educable. 2. Moderate, I.Q. 54-40. These children are trainable. 3. Severe I.Q. 30-25. 4. Profound. I.Q. Below 25." early as November 13, 1979, is still in existence. A true and correct copy of it is attached hereto as "Exhibit A." 14. Also among TAMMY'S early treating physicians was a pediatrician, Dr. ROSEMARIE TURSKY, of Harrisburg, who is also now deceased. Unfortunately, her records relating to TAMMY were wiped out by the Agnes flood in 1972. 15. TAMMY' S current primary and treating general practitioner is Dr. James S. Thompson, of the Pinnacle Health Family Center. A diagnosis and prognosis letter recently prepared by him is attached hereto as "Exhibit B." 16. TAMMY suffers from severe limitations such that she cannot handle toilet facilities by herself nor can she perform even very simple tasks. More importantly, she cannot feed herself, dress herself, bathe herself, or attend to other usual personal hygiene. (See the PSYCHOLOGICAL REPORT, dated October 25, 2005, prepared by Riverside Associates, P.C., attached hereto as Exhibit C.) 17. TAMMY has been determined by Riverside Associates, P.C.'s Valerie A. Lemmon, Psy.D., and G. David Smith, Ph.D., BCBA, to be clearly suffering from Mental Retardation. (See aforesaid Exhibit C.) 18. TAMMY's I.Q. level is not subject to any reasonable prospect of improvement. 19. In addition to the above=stated mental retardation and its associated limitations, TAMMY also suffers from SCOLIOSISZ. z Taber's. at pp. 1532-1533 defines "SCOLIOSIS" as follows: "[GR. skoliosis, curvature]. Lateral curvature of the spine. Usually consists of two curves, the original abnormal curve and a compensatory curve in the opposite direction. NURSING IMPLICATIONS: Make provisions to assist the adolescent and family to meet the psychosocial needs associated with the illness. Teach the patient and family concerning treatment modality (cast, brace, or traction), exercises, activity level, skin care, prevention of complications, and breathing exercises..." 20. TAMMY's Scoliosis is so severe that it causes her to lean heavily to her right side. 21. TAMMY also suffers from OSTEOPOROSIS3. 22. TAMMY's bones are so brittle that she has suffered from multiple fractures including both of her legs and her hip. 23. TAMMY also has suffered fractures while undergoing physical therapy at the hands of highly trained and skilled persons. 24. TAMMY's problems may be the result of a genetic mutation of some sort. 25. There does not appear to be any reasonable prospect of improvement from the above- stated condition. (See in this respect a report of December 13, 2005 prepared by William J. Polacheck, M.D. attached hereto as Exhibit D, and a report of Apri125, 2006 prepared by Gerald D. Podskalny, D.O., of the Milton S. Hershey Medical Center College of Medicine, attached hereto as Exhibit E.) RE: POWER OF ATTORNEY 26. TAMMY has no Power of Attorney. She has had no formally appointed Guardians at any time. Her said parents have always acted as her Guardians by virtue of their natural guardianship and by virtue of being her natural parents. At the current time and under the current circumstances as set forth more fully herein at large it is highly advisable to have a formal appointment of Plenary Guardians. s Taber's at p. 1188 defines "OSTEOPOROSIS" as follows: [Gr. osteon, bone & poros, a passage & osis, condition ]. Increased porosity of bone seen most often in the elderly. See osteomalacia. Taber's at p. 1187 provides the following definition [Gr. osteon, bone & malakia, softening]. Softening of the bones. A disease marked by increasing softness ofthe bones, so that they become flexible and brittle, thus causing deformities ..." RE: NEXT OF KIN AND PROPOSED PLENARY GUARDIANS 27. TAMMY' S only living next of kin are the Petitioners herein. 28. All of the said next of kin, being the Petitioners herein, are aware of this Petition and in favor of it. 29. The names and addresses of the proposed permanent Plenary Guardians are the same as are set forth above in Paragraphs 3, 4, 5 and 6. 30. It is proposed that the said prospective Guardians of the person and the Estate of TAMMY LEIGH DOUGHERTY be permitted, authorized, and empowered to act in such capacity either jointly or individually. 31. Petitioners, through their attorney, CHARLES E. SHIELDS III, and upon his advice, have determined to petition your Honorable Court for their appointment as permanent Plenary Guardians not only of the person but of the Estate of their daughter and sister based upon the now nearly universal practice of banks in the immediate area to decline guardianships involving very small estates when capable relatives are available to act in such capacity. 32. Therefore, the proposed Plenary Guardians of the person and Estate of TAMMY LEIGH DOUGHERTY are her two parents and her two sisters, to wit: A.) MILTON M. DOUGHERTY, JR. 220 West Keller Street Mechanicsburg, PA 17055 B.) DORIS S. DOUGHERTY 220 West Keller Street Mechanicsburg, PA 17055 C.) DEBORAH DOUGHERTY KNAUB 225 Indian Creek Drive Mechanicsburg, PA 17050 D.) SANDRA L. DOWNEY 127 Victoria Drive Mechanicsburg, PA 17055 33. The proposed Guardians have no interest adverse to that of TAMMY LEIGH DOUGHERTY. None of them is an officer or an employee of a corporate fiduciary of an estate in which he or she has an interest. Additionally, none of them is a surety or officer or employee of a corporate surety of such a fiduciary. Their acceptances to serve as such Guardians are attached hereto. RE: ESTATE AND PROPERTY OF TAMMY 34. The gross value of any single name property in the name and ownership of TAMMY is zero. 35. TAMMY'S parents currently hold a number of accounts and financial instruments in "IN TRUST FOR," fully revocable, designations "for the benefit of TAMMY L. DOUGHERTY, as follows, to wit: (A.) Citizen's Bank: (i) six (6) month Certificate of Deposit: $32,436.30. (ii) three (3) year, increasing rate, Certificate of Deposit: $27,718.61. (iii) three (3) year, increasing rate, Certificate of Deposit: $17,509.08. (iv) Statement Savings Account, $13,079.66. (B.) Sovereign Bank Certificate of Deposit $18,643.39 (values are based upon the most recent data readily available at the time of preparation of this PETITION). 7 36. As part of a revamped and coordinated estate plan, it is most likely that TAMMY'S parents will revoke the "IN TRUST FOR" status of the abovementioned accounts and financial instruments and proceed to establish a "Special Needs Trust" to be implemented in a manner consonant with the requirements and recommendations of assorted governmental departments and various caregivers, both current and potential. RE: NO FORMER ASSUMPTION OF JURISDICTION. GUARDIANSHIP OR THE LIKE 37. No other court has ever assumed jurisdiction in any proceeding to determine the capacity, or the lack thereof, of TAMMY LEIGH DOUGHERTY, an alleged Incapacitated Person. 38. TAMMY has no Guardian hertofore appointed and has no Power of Attorney. 39. Although not in an emergency situation, the prompt appointment of official Guardians will help prevent any possibly irreparable harm to TAMMY' S person and any estate that she might possibly inherit if changes to assorted accounts and financial instruments and the like are not quickly made. RE: PROPOSED POWERS OF GUARDIANS 40. It is proposed that the said prospective Guardians of the person and estate, if any there be, of TAMMY LEIGH DOUGHERTY, be permitted, authorized, and empowered to act in such capacity either jointly or individually as permanent Plenary Guardians. RE: PROPOSED WAIVER OF BOND REQUIREMENT 41. As above mentioned, in Paragraph 31, it is virtually certain that no bank or trust company will agree to serve as guardian of TAMMY'S essentially non-existent current estate as is more fully set forth above in Paragraphs 34 through 36. 42. Petitioner, MILTON M. DOUGHERTY, JR., is eighty-three (83) years old and is retired from the former Commonwealth National Bank system where his duties included both management and supervision of operations and employees. He has been acting as natural Guardian of TAMMY and providing for her needs since her birth. 43. Petitioner, DORIS S. DOUGHERTY, is eighty-two (82) years old and is quite capable of managing funds and maintaining a budget. She has been acting as natural Guardian of TAMMY and providing for her needs since her birth. 44. Petitioner, SANDRA L. DOWNEY, is fifty-one (51) years old. She has assisted her parents in caring for her sister since she has been old enough and mature enough to do so. Her work experience includes working at the Pennsylvania Medical Society Liability Insurance Company for eight years, leaving there in 1995 to begin a family. While at the Society she was Assistant Director of Policyholder Services. She currently holds an active Pennsylvania Insurance license in Life, Accident and Health Insurance. 45. Petitioner, DEBORAH DOUGHERTY KNAUB, is fifty-four (54) years old. She has assisted her parents in caring for her sister since she has been old enough and mature enough to do so. Her work experience includes having worked for Farmers' Trust Company of Carlisle and having worked for EDS for 29 years, ending January 2007. Her duties at EDS as an Administrative Assistant, included oversight of various accounts, including government services, the Pennsylvania Senate, DPW/Medicaid and the like. 46. Petitioner's believe and aver that paragraphs 34 through 36 and 41 through 45 contain sufficient facts that justify and enable your honorable to decree that no bond need be entered. RE: NOTICE REQUIREMENTS 47. It is inherent in the powers of your Honorable Orphans' Court to permit abbreviated Notices in cases where circumstances dictate that such is reasonable and sensible. 48. TAMMY is realistically incapable of comprehending any Notice which might be served upon her. 49. It is respectfully believed and averred that circumstances as presented herein and as to be presented at the hearing make it reasonable to wholly waive any formal Notice. In the alternative, it is respectfully represented that circumstances dictate that it would be reasonable and sensible to merely have the Notice and Petition read to TAMMY by any responsible adult who can read and speak English after having it hand delivered by any one of the Petitioners. RE: APPOINTMENT OF COUNSEL 50. TAMMY is incapable of understanding or responding to any potential conversations with any personal or court-appointed counsel. She can be of no help or assistance in preparing any representation of herself. It is inconceivable that any honorable or responsible counsel would do anything to appose this Petition. 51. By the terms of the instant Petition, it should be rima acie obvious that TAMMY has always been and remains in need of help and that she is not the victim of designing persons who desire to have her declared incapacitated for their own personal gain. 52. In view of the above-stated facts petitioners aver that appointment of counsel would serve no useful purpose and would merely work to deplete TAMMY'S parent's resources which could be put to much better use in otherwise providing for TAMMY' S needs. 53. Petitioners aver and believe that sufficient facts exist and have been set forth herein to fully justify your Honorable Court to decree that no counsel need be appointed. RE: HOLDING OF ONE HEARING ONLY 54. In view of all of the above facts and averments, Petitioners respectfully request that only one hearing be held on the instant Petition. Petitioners believe no necessity exists to require the 10 holding of both a separate emergency hearing and an additional final hearing. Such separate hearings would only needlessly burden the court's time and would work to unnessarily deplete the funds of TAMMY' S parents. RE: RELIANCE ON PHYSICIANS AND CONSULTANTS STATEMENTS 55. In view of the nature of the incapacity of TAMMY, it is respectfully suggested that the Exhibits A through E attached hereto, to wit: (A) Dr. John J. Hanlon's letter of November 13, 1979; (B) Dr. James Thompson's letter of May 19, 2008; (C) Psychological Report of Riverside Associates, P.C. of October 25, 2005, signed by Valerie A. Lemmon, Psy.D. and by G. David Smith, Ph.D., BCBA, Psychologist; (D) Dr. William J. Polacheck's letter of December 13, 2005; and (E) Dr. Gerald D. Podskalny's letter of Apri125, 2006 when considered in their totality, if introduced under oath by Petitioner's at a hearing as part of their standard file-keeping practices and habits, under the circumstances of this case, and in the discretion available to your Honorable Court, should be deemed to meet the requirements and to fulfill the purposes of 20 Pa. CSA Sect. 5518 regarding proof of incapacity. In view of the nature of the incapacity of TAMMY, it is respectfully suggested that the Exhibits attached hereto is sufficient to meet the requirements and purposes of 20 Pa. CSA Sec. 5518 regarding proof of incapacity.4 4 20 Pa, CSA Sect. 5518 Evidence of incapacity. To establish incapacity, the petitioner must present testimony, in person or by deposition from individuals qualified by training and experience in evaluating individuals with incapacities of the type alleged by the petitioner, which establishes the nature and extent of the alleged incapacities ad disabilities and the person's mental, emotional and physical condition, adaptive behavior and social skills. The petition must also present evidence regarding the services being utilized to meet essential requirements for the alleged incapacitated person's physical health and safety, to manage the person's financial resources or to develop or regain the person's abilities; evidence regarding the types of assistance required by the person and as to why no less 11 To require payment of costs of a stenographer, typing and other associated costs of a formal deposition would merely work to deplete the resources of TAMMY"S parents and would provide no real additional protection and it has been suggested to your Honorable Court that the appointment of any counsel would be a waste of fmancial resources. Therefore, we respectfully aver that there is no practical need for, or benefit from, a deposition or cross-examination. RE: AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH THE ESTATE OF THE ALLEGED INCAPACITATED PERSON 56. Petitioners, in an abundance of caution, and in an effort to try to eliminate any necessity for additional petitions from time to time apply for comprehensive powers such as are typically granted to Plenary Guardians of Incapacitated Persons and their estates. 57. Petitioners are private individuals and not professional fiduciaries. 58. Petitioners may be required from time to time by certain insurance companies, banks or agencies to show proof of their appointment and authorizations to do certain acts requisite to the proper handling of TAMMY LEIGH DOUGHERTY' S estate. 59. Petitioner's may need to do the following which are listed by way of example only and not as a specific set of limitations: A. Complete and submit claim applications for insurance, welfare, medical assistance, subsidies, special programs and other similar benefits. B. Disclaim an interest in property or an inheritance. C. Establish a Special Needs Trusts or similar Trusts. D. Close out and open bank accounts or similar accounts. restrictive alternatives would be appropriate; and evidence regarding the probability that the extent of the person's incapacities may significantly lessen or change. 12 E. Sell any property real or personal and convert it to cash to make such funds available to creditors or other service providers, or to make deposits into or to make additions to Trusts. F. Immediate and unlimited ability and power to use and invade principal and corpus of property of TAMMY LEIGH DOUGHERTY held by her in her own right, if any there be from time to time. G. Pay bills immediately as they come due. H. Open separate accounts if such are required by any government agencies for direct deposit or otherwise. I. File an Inventory. J. Hire tax accountants to aid with preparation of tax returns and the like which might now, previously or in the future be due. K. Hire consultants to help with making applications to medical institutions, similar facilities, or any other matters for which Petitioners are or might reasonably be in need of consultants. L. Establish a separate funeral fund. M. Make all other decisions and do any and all other acts of whatsoever nature as may reasonably be necessary in the management of the estate of TAMMY LEIGH DOUGHERTY. N. To have full and unfettered access to medical, hospital, and similar records, including any and all records defined and described in the Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191, 110 Stat. 1936) more commonly referred to as HIPAA, and/or any similar Acts or regulations as may be passed or amended from time to time. This power shall be full and absolute and shall include the power to grant Releases for the dissemination of such information to others. This power shall be exercisable despite anything to the contrary in any current privacy acts or similar acts or regulations or such as may be passed or adopted from time to time in the future. O. In addition, in general, to make all healthcare and medical treatment decisions which shall include but not be limited to the following: 13 1. To authorize TAMMY' S admission to or discharge from a medical, nursing, residential or similar facility and to make agreements for her care and for health insurance for her care, including hospice and/or palliative care. This power shall include the power to enter into agreements for her care at the expense of her Estate; to execute any consent or admission forms required by such facility which are consistent with this paragraph, and enter into agreements for her care by such facility or elsewhere during her lifetime or for such lesser period of time as her Guardians may designate. This power shall also include the power to retain nurses for her. 2. To hire and fire medical, social service and other support personnel responsible for her care. 3. To take any legal action necessary to do what is hereinabove authorized and empowered. P. To do all such acts either jointly or individually. WHEREFORE, your Petitioner's pray your Honorable Court as follows: A. To determine that only one hearing on the issues raised by this Petition is necessary and to appoint MILTON M. DOUGHERTY, JR. and DORIS S. DOUGHERTY, his wife, DEBORAH DOUGHERTY KNAUB, and SANDRA L. DOWNEY, as permanent Plenary Guardians of both the person and the estate of TAMMY LEIGH DOUGHERTY, with the power to act as the same either jointly or individually. B. To decree that no bond shall be required by said Petitioners to administer the estate of TAMMY LEIGH DOUGHERTY. C. To decree that no counsel need by appointed at this time for TAMMY LEIGH DOUGHERTY under the circumstances of this case. D. To decree that no medical testimony need be taken under the circumstances of this case. 14 E. To decree that it is unnecessary to have service of Notice of this Petition upon TAMMY LEIGH DOUGHERTY. F. To decree that Petitioners are authorized and empowered to take all such actions as are outlined in Paragraph 59 above and to do any other acts which may be reasonably necessary to the management of the estate and to the care of the person of TAMMY LEIGH DOUGHERTY. Respectfully submitted by, ,- Charles E. Shields, III, Esquire 6 Clouser Road Mechanicsburg, PA 17055 (717) 766-0209 PA S. Ct. ID No. 38513 15 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF PLENARY CO-GUARDIANS OF THE ESTATE AND NO. 21-09- PERSON OF TAMMY LEIGH DOUGHERTY, AN ALLEGED INCAPACITATED PERSON VERIFICATION I, MILTON M. DOUGHERTY, JR., Petitioner in the attached Petition concerning PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA CSA SECT. 5511; FOR WAIVER OF BOND; FOR APPOINTMENT OF COUNSEL; CERTAIN NOTICE REQUIREMENTS; AND FOR AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH THE ESTATE OF THE ALLEGED INCAPACITATED PERSON, hereby verify that the facts recited are true and correct to the best of my knowledge, information and belief. I make this verification subject to penalty for unsworn falsification to authorities (18 Pa. C.S.A. Section 4904). ~, Witness MILTON M. DOUGH TY, COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF PLENARY CO-GUARDIANS OF THE ESTATE AND NO. 21-09- PERSON OF TAMMY LEIGH DOUGHERTY, AN ALLEGED INCAPACITATED PERSON VERIFICATION I, DORIS S. DOUGHERTY, Petitioner in the attached Petition concerning PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA CSA SECT. 5511; FOR WAIVER OF BOND; FOR APPOINTMENT OF COUNSEL; CERTAIN NOTICE REQUIREMENTS; AND FOR AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH THE ESTATE OF THE ALLEGED INCAPACITATED PERSON, hereby verify that the facts recited are true and correct to the best of my knowledge, information and belief. I make this verification subject to penalty for unsworn falsification to authorities (18 Pa. C.S.A. Section 4904). ~~~ ~~ Witness DORIS S. OUGHERT 2 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF PLENARY CO-GUARDIANS OF THE ESTATE AND NO. 21-09- PERSON OF TAMMY LEIGH DOUGHERTY, AN ALLEGED INCAPACITATED PERSON VERIFICATION I, DEBORAH DOUGHERTY KNAUB, Petitioner in the attached Petition concerning PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA CSA SECT. 5511; FOR WAIVER OF BOND; FOR APPOINTMENT OF COUNSEL; CERTAIN NOTICE REQUIREMENTS; AND FOR AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH THE ESTATE OF THE ALLEGED INCAPACITATED PERSON, hereby verify that the facts recited are true and correct to the best of my knowledge, information and belief. I make this verification subject to penalty for unsworn falsification to authorities (18 Pa. C.S.A. Section 4904). fitness DEBORAH DOUGHE Y KN COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: APPOINTMENT OF PLENARY CO-GUARDIANS OF THE ESTATE AND NO. 21-09- PERSON OF TAMMY LEIGH DOUGHERTY, AN ALLEGED INCAPACITATED PERSON VERIFICATION I, SANDRA L. DOWNEY, Petitioner in the attached Petition concerning PETITION FOR THE APPOINTMENT OF PERMANENT PLENARY CO-GUARDIANS OF THE ESTATE AND THE PERSON IN ACCORDANCE WITH 20 PA CSA SECT. 5511; FOR WAIVER OF BOND; FOR APPOINTMENT OF COUNSEL; CERTAIN NOTICE REQUIREMENTS; AND FOR AUTHORIZATION TO DO ASSORTED ACTS IN CONNECTION WITH THE ESTATE OF THE ALLEGED INCAPACITATED PERSON, hereby verify that the facts recited are true and correct to the best of my knowledge, information and belief. I make this verification subject to penalty for unsworn falsification to authorities (18 Pa. C.S.A. Section 4904). Witness ANDRA L. DOWNEY MECHANICSBURG MEDICAL CLINIC and PRACTICE 400 WEST MAIN STREET MECHANICSBURG, PA. 17055 Jonathan B. Tocks, M. D. John J. Hanlon, M. D. Oscar G. Hoerner, M. D. Bradford K. Strock, M. D. Danlel H. Collar, M. D. l~;ovember 'I?, 'IU7~ Ite: Tammy Dougherty To 'tahom It i°"la,y Concer. n This is to certify that Tammy has been severely mentally retarded since birth. Sae reQUires constant supervision. Sincerely, - John J. ~-ianlon, Ni.D. JJ1; rl Exhibit A 05/19/2008 Doris and Milton Dougherty RE: DOUGHERTY, TAMMY DOUGHERTY DOB: 12/08/1961 Dear Doris and Milton: I am dictating this letter to discuss your daughter's condition. The patient has a significant movement disorder with severe developmental handicaps and no language skills. By report, your daughter was able to walk independently until age 20, but she has not walked since that time. She suffers from severe osteoporosis, and she has severe developmental handicaps that prevent her from really making decisions for herself. Tammy has been evaluated in the past at other places, and it is felt that her current developmental handicaps are the result of a genetic abnormality, but to my understanding that has never been fully clarified. At this point in time, she is not an individual who is able to take care of herself or make decisions for herself. If there are any further questions, do not hesitate to contact me at (717) 506-4720. Sincerely, THOMPSON, III, MD rrh/sgg c: File D#: 2381422 Exhibit B Riverside Associates, P.C. 2818 Green Street, Harrisburg, PA 17110 (717) 238-6880 PSYCHOLOGICAL REPORT Date of Report: OCbober 25, 205 CLIENT PROFILE Name: babe of girth: Ethnitit)r: Halyht/Weight: Gender: Admiltii~g Diagnoses: Curratt Medications: Referral 9ouroe: Case Manager: Residence: Tammy Dougherty December B, 1961 Caucasian Five feet, nine inches, approximately 11)0 pounds Female None Chloral hydrate Cumberland-Perry Mil/MR Amanda Kreeger Lives with family in Mechanicsburg, PA EVALUATION Clinical Interview and Behavioral Qbservations: 10/19/05 Scales of Independent Behavior-Revised (SIB-R.); 10/19/05 REFERRAL AND BACKGROUND INFORMATION Tammy Dougherty was referred by her Cumberland-Perry MH/MR Case Manager on October 3, 2005 to determine if she has Mental Retardation, Tammy is a 43-year-old Caucasian female. She was born on December 8, 1961. She lives with her parents (Milton and Dolly) in Mechanicsburg, Pennsylvania. Mr. and Mrs. Dougherty reported that Tammy began walking when she was approximately two years old, However, she is currently in full leg casts due to two bmken legs. Shc broke one leg several month ago, and recently broke the other leg during a physical therapy session. Reportedly she has said only a few words since the age of three of four when she began speaking. She never completed toilet training. They reported that Tammy previously ate and drank a regular diet, but she is currently being fed with pureed food. Tammy previously attended nursery school, but did not attend public school. According Exhibit C to Mr. and Mrs. Dougherty, Tammy was evaluated at the Institutes for the Achievement pf Human Potential in Philadelphia, and she participated in physical therapy from l 964 to 1967. Tammy has been diagnosed with scoliosis, a spastic hip, and osteoporosis, She takes a hypnotic (sleep inducing} depressant medication, chloral hydrate, as prescribed by her primary care physician, Dr. Unicke. She also takes tetracycline for recurrent bladder infections. BEHAVIORAL OBSERVATIONS AND MENTAL STATUS Tammy has brown hair and brown eyes, She appeared her stated age. She weighs approximately 100 pounds at five feet, nine inches. She was casually and neatly dressed. Her grooming and attire were unremarkable. Her eye contact was limited. She is currently confined to a hospital bed due to having two broken legs. She was largely unresponsive to this interviewer, but she responded to her name and appeared interested in the interview, Tammy was pleasant', but it was difficult to establish rapport due to her limited social and language skills. According to Mr. and Mrs. Dougherty, Tammy has chronic difficulty falling asleep, but that she sleeps eight•hours per night when taking the hypnotic medication. Her appetite is reportedly good, She is currently fed a pureed diet. Her. mood is reported to be stable. During the session, her affect was full in range. Other than responding to her name, Tammy's orientation could not be assessed due to her limited verbal skills. Due to Tammy's limited communication skills, including pointing, standardized intellectual assessment could not be completed. However, the results of the adaptive behavior evaluation are considered to be valid, TEST RESULTS AND INTERPRETATION Mr. and Mrs. Dougherty served as the informants on the Scales of Independent Behavior- Revised (SIB-R). The SIB-R assesses overall adaptive behavior, Tammy demonstrated very limited to negligible overall adaptive behavior (see the attached table). First, Tammy's motor skills are very limited to negligible. When presented with age- level tasks, her gross-motor skills are very Limited to negligible. Although she can sit without support for more than 30 seconds and stand by holding on to another person, she does not engage in other age-level tasks involving balance, coordination, strength, and endurance {e.g., standing and walking alone). Her fine-motor skills are very limited to negligible. She does not engage in age-level tasks requiring eye-hand coordination using the small muscles of the fingers, hands, and arms (e.g., picking up objects with her hands, transferring small objects from one hand to another, putting small objects into containers). Second, Tammy's social interaction and communication skills (social adaptive skills) are very limited to negligible. Her social interaction skills are very limited to negligible. Although she differentiates between familiar and unfamiliar people, she does not consistently reach for a person wham she wants. When presented with age-level tasks, Tammy's language comprehension skills are very limited to negligible. She has significant difficulty with most age- level tasks involving understanding signals, signs, or speech and obtaining information from spoken and written language, For example, she turns her head when her name is called and watches television, but she does not point to pictures in a book or fallow simple spoken Exhibit C directions. Tammy's language expression skills are very limited to negligible. Whereas she makes sounds or gestures to get attention, and she looks at people talking to one another, she does not expresses herself by shaking or nodding her head in response to simple questions, Furthermore, she has a limited expressive vocabulary. Third, Tammy's personal living skills (practical adaptive skills) are very limited to negligible. Age-level adaptive behaviors related to eating and meal preparation are very limited to negligible. Although she is currently eating only pureed food, she previously ate solid foods. She needs assistance with drinking from a glass. Age-level tasks involving the toilet and bathroom are very limited to negligible. She shows discomfort when wet or soiled, and she often stays dry for three hours, but she does not use the toilet. Fier dressing skills are very limited to negligible in that she needs complete assistance to dress. She often holds out her arms while being dressed. Her personal self-care skills are very limited to negligible. She needs assistance with all personal self-care tasks (e.g., brushing her teeth, bathing, washing her hands). Tammy's domestic skills are very limited to negligible. She is physically unable to complete all household chores. Fourth, Tammy's community living skills (conceptual adaptive skills) are very limited to negligible. Her time and punctuality skills are very limited to negligible. She has no understanding of the purpose of calendars and clocks. Tammy's money and value skills are very limited to negligible. She has no understanding of the purpose of money..Her vocational work skills are very limited to negligible. She does not work on even simple tasks. Tammy's home and community orientation skills are very limited to negligible. Although she was previously . able, she is currently unable to find her way around even in familiar buildings. SUMMARY AND RECOMMENDATIONS Tammy is a 43-year-old woman who lives with her parents in Mechanicsburg, Pennsylvania. She was referred for evaluation to determine if she has Mental Retardation, According to the American Association on Mental Retardation (AAMR; 2Q02), the current definition of Mental Retardation includes the following three criteria: significant deficits in intellectual functioning; significant deficits in conceptual, social, and practical adaptive skills; and the disability originating before age 18. Fennsylvania's ©ffice of Mental Retardation has mandated that in order for an individual to be eligible for services in the mental retardation system, intellectual and adaptive skill deficits must have been incurred by the individual's 22"d birthday. The purpose of the present evaluation is to make a diagnosis and detezmine the level of needed support, which may contribute to a governmental agency's decision regarding classification and eligibility for services. First, Tammy's intellectual functioning was unable to be assessed using standardized assessment instruments. However, based on behaviors] observations, it appears that Tammy's intellectual functioning is significantly subaverage. Second, Tammy's overall score on the SIB-R is very limited to negligible. Her practical, social, and conceptual adaptive skills are also very limited to negligible. Her overall and Exhibit C individual adaptive skills scores represent significantly subaverage adaptive behavior, Third, there is evidence that Tammy had a developmental disability before age 18 based on her delays in talking, walking, and toilet training, Therefore, Tammy currently meets the diagnostic criteria for Mental Retardatiatt, Severity Unspecified, with pervasive support needs {see attached table), V* rie A. I.emmon, P R. Date Psychologkal5e Asraciate Reviewed and Approved . ~~ G. David &mith, Ph.D., BCBA PsydfologisC Date cc: Tammy Doupha~ty Amanda Kreeger-Cumberland-Perry MH/MR Riverside Associaties dini~l fiie Exhibit C SUMMARY PROFILE ANC? INTENSITIES OF NEEDEip SUPPl7RT (AAMR): ~trlEr-StbWnRE~ ~. of rnrrt~smEs Communiptbn P~vaslMe FtxlCtlOnal Aesdeml[s Pervb~lre Work PelvasNe Se~--Care Pervasive Health anC SaFety Pervasve home tJving ~SI"e Communhy Use ~SI"e Salal SidILS PervasNe ~~ Pervasve r~.pl~~ Pervasve Appropriate and timely individual supports are crucial to Tammy's ultimate success in the community. in addition to obtaining them from specialized (mental health or mental retardation) service agencies, individual supports can be provided by family, significant others and ~gcneric community resources. Supports may be provided with differing levels of intensity. These include: o Intermittent -Provided on an "as needed" basis. o Limited -Provided on a regular basis for a short period of time to achieve a particular defined goal or milestone, o Extensive » Characterized by regular, ongoing involvement {e.g. daily} in at least some environments {i.c, worksite). Extensive supports are not time-limited. o Pervasive -Characterized by their constancy and high intensity, Pervasive supports are provided in several environments. 'T'hey are typically more intrusive and involve more specialized staff involvement than limited ar extensive supports. Exhibit C e w s REPORT OF ADAPTIVE BEI4AVIOR TESTING NAME: Dougherty, Tammy DATE OF TESTING: 1p/19/20D5 DATE OF BIRTH: 12/OB/1961 RESPONDENT: Mr. and Mrs. Doughtrty AdE: 43 years 10 months EXAMINER: Valerie Lemmon TABLE OF SCORES: Scales of Independent Behavior--Revised Developmental, Zone Skill with CLUSTER/Subsaale AE EaBY Riff PR SS SS Band RMI age-level tasks BROAD INDEPEND 0-6 a0-3 0-~.0 -- - -- -- very ltd to ngl MOTOR SKILLS 0-4 <0-3 0-6 -- -- -- -- very ltd to ngl dross-Motox 0-6 very ltd to ngl Fine-Motor <0-3 vexy ltd to ngl SOCIAL/COMM 0-10 0-6 1-2 -- -- -- - - very ltd to ngl Social Inter 0-7 very ltd to ngl Language Comp 1-1 very ltd to ngl Language Expr D-11 very ltd to ngl PERSONAL LIVING 0-B 0-3 1-0 -- -- -- - - vexy ltd to ngl Eating 0-6 very ltd to ng1 Taileting 1-8 very ltd to ngl Dressing 0-10 very ltd to ngl Self-Care c0-9 very ltd to ngl Domestic Skills [i-8 very ltd to ng1 COMM LIVING ~c0-9 <0-9 1-4 -- -- -- - - very ltd to ngl Time and Punc t2-9 very ltd to ngl Money and value t1-1o very ltd to ngl Work Skills <1-0 ~ very ltd to ngl Home-Community ~0-9 very ltd to ngl Exhibit C ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 c Patient: Tammy L. Dougherty Chart #: 21288706 DOB: 12/08/61 S5N: 166 46 3339 Page # 1 ------------------------------------------------------------------- 12/13/2005 WILLIAM J. POLACHECK, M.D. OFFICE VISIT Trindle Road Office CHIEF COMPLAINT: Tammy is seen in follow up for her right knee. HISTORY OF COMPLAINT: She continues to struggle with her ability to ambulate. She has sustained three fractures now. She has an intertrochanteric fracture of her right hip. She has had a left tibial shaft fracture and a right lateral tibial plateau fracture. The tibial plateau has settled a bit which has her knee go into slight valgus. She is able to bear weight, though. I had spoken to her therapist when she was getting therapy at home. Her leg is strong enough to allow weight bearing. Her problem is poor balance and loss of some motor control. REVIEW OF SYSTEMS: The patient's review of systems, past medical history, family history, and social history have been re-evaluated and reviewed. Her underlying pathology is still unclear to me. I had a discussion with the parents and her sister. She has mental retardation, but they are unsure of any more specific diagnosis. It is obvious that she has a fair amount of spasticity, yet the family was unaware of this being a problem. She has the osteoporosis. She maintains a marginal weight. PHYSICAL EXAM: I watched her walk with her sister today. She needs maximum support, and this is beyond the capability of her parents. She is developing a flexion contracture of the right hip and right knee. She is also developing an adduction contracture. She has no residual swelling from her fractures. DIAGNOSTIC TESTS: New films of her knee today show mild depression of the lateral tibial plateau. For her functional level, this should not be a problem. DIAGNOSIS: Fractures left tibia, right lateral tibial plateau, and right hip Progressive ambulatory dysfunction PLAN: After my discussion with the parents, it is apparent that she has not had any sort of comprehensive evaluation in recent history. The parents were under the impression that her ambulatory status is deteriorating because of her fractures. I explained that I believe her ambulatory status is deteriorating because of progression of her underlying neurologic problem. They were frustrated that her therapy was cut off because she had plateaued from her fracture healing. She would certainly benefit from a more comprehensive evaluation and perhaps support services that are not available in the community. I recommended that she have an evaluation at Hershey to see if there are any treatments or services that could preserve some ambulatory status and provide some guidance to the family. WJP/lam Exhibit D ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Tammy L. Dougherty Chart #: 21288706 DOB: 12/08/61 SSN: 166 46 3339 Page # 2 ------------------------------------------------------------------------------ 12/13/2005 WILLIAM J. POLACHECK, M.D. -CONTINUED- /~4TrT('~F tTT C.`TT cc: Brian Uniacke, M.D. via fax Exhibit D -. ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Tammy L. Dougherty Chart #: 21288706 DOB: 12/08/61 SSN: 166 46 3339 Page # 1 ------------------------------------------------------------------------------ 1/25/2006 4PILLIAM J. POLACHECK, M.D. TEL/MESG-MESSAGE TO CHART T A secretary from the Neurology Department at Hershey Medical Center called to inform us that Tammy's appointment with Dr. Podskalny has been rescheduled for February 27, 2006 at 3:00./lam Exhibit D ------------------------------------------------------------------------------ .!02!06 07:06:34 Hershey Medioal Center Page 2 of 4 AENNSTATE Milton S. Hershey MD+d.ii;,al Center College of Medicine Penn Stale Milton S. Hershey Medical Center Tel: (717) 53] -8521 Penn State College of Medicine Heahh Wormation Services, HU24 500 University Drive P.O. Box 850 Hershey, PA ]7033-0850 Patient Name; DOUGHERTI', TAMMY L Date of Service: 4/24/2006 Pa[ientLocation: PAF, April 25, 2006 Name: DOUGHERTY, TAMMY L HMC Number: 1535980 DOB : 12/08/1961 Date of Service: 04/24/2006 Dear Drs. Polacheck and Uniacke: Date of Birth: 12/8/1961 Sex: Female I had the pleasure of meeting Tammy Dougherty today in Movement Disorders Clinic for evaluation of gait disorder. As you are aware, Ms. Dougherty is a 45-year-old woman who has a lifelong history of severe developmental handicap. She has never developed language skills at all. Family reports that she was able to walk independently after delayed walking at around age 4. She was able to walk independently to age 20. She has not walked in the interceding 25 years. She has severe osteoporosis and has suffered two fractures of the tibial plateau from simply pivoting her weight. She also has a fracture of her right hip. The patient has had a profound scoliosis as well. Tammy's parents who accompanied her report that they have had another child with severe neurologic impairment that died in childhood. They have two other children that are alive and in good health. There is no other family history of developmental or neurologic handicap. Tammy herself is unable to provide any history. She had been seen by Orthopaedic Surgery and referred for "neuromuscular dysfunction, spasticity, scoliosis with deformity". In speaking with the Dougherty's they have not noticed any increased muscle tone in the upper extremities. There is no difficulty maintaining any hygiene in any part of the body including the perinea) region. Tammy has not had any problems with respiratory embarrassment due to her scoliosis. There is no mention of serial x-rays to even determine if her scoliosis is now progressive. Current Medications include tetracycline 250 mg twice a day, Miacalcin nasal spray with calcium supplements. She is on chlorohydrate two tablespoons at bedtime. Allergies: She has no medication allergies. Her past medical history is remarkable for severe developmental and physical handicap. She has scoliosis, osteoporosis and arthritis. This document has been electr•onicalh~ signed. Patient IQame: DOUGHEIiTY, TAAgvIY L Patient Number 1535980 Pagc l of 3 Fariu/of•urolianaGGl/lU/U'FlhKT1CIO17S4 Exhibit E jpp-~33-4052 wNrvv,pennstatehershey.com i/02/D6 07:D6:34 Hershey Medical Center Page 3 of 4 She has no history of seizure. The patient is unable to communicate but there has been no loss of milestones other than her loss of the ability to walk some 25 years ago. Past surgical history is remarkable for a hernia repair, right hip fracture with ORIF. She has had a fracture of each tibial plateau. Both were treated conservatively. There has been resultant deformity in the right lower extremity. Family History: Tammy has one brother who died with similar developmental handicaps. There is no other family history on either side of the developmental handicap. The patient's mother and father are both living. The father is 81; the mother is 79. She has two sisters who are living 51 and 48; both are in good health. Review of Systems: Her 15-system review of systems is unobtainable. On physical exam: Her blood pressure is 110/76 with a heart rate of 104. Her head is normocephalic, atraumatic. Her neck is supple; there are no bruits. Examination of the eyes found her pupils are equal, round, and reactive to light, both direct and consensual. Extraocular movements were full. There was no nystagmus. Auscultation of the heart found a regular rate with no murmurs. Examination of the extremities found no clubbing, edema, or cyanosis. Examination of the back found a marked scoliosis convexed to the right affecting her mid-thoracic region. Her ribs are rotated posteriorly on the right side. On Neurologic Exam, mental status: The patient is alert; she is unable to speak and does not follow any commands. She does not gesture. Cranial Nerves, there is no visual field cut to threat, extraocular movements were full. The family reports no swallowing difficulty. There is no evidence of facial droop. On motor exam, the patient has no resting or postural tremor. Her fingers are held in a flexed position but they can be passively extended on both sides. Examination of tone in the upper extremities finds no evidence of spasticity and no evidence of rigidity. The patient voluntarily resists abduction of the legs however this can easily be overcome. There is no increased tone in the hamstrings, knee extensors, plantar flexors. Muscle stretch reflexes are depressed throughout. Plantar responses are downgoing bilaterally. There was no ankle clonus. Gait could not be tested. Finger-to-nose testing also could not be done because the patient is unable to cooperate. I suspect Tammy has some type of genetic mutation causing her current constellation of developmental handicap. Her family reports that she has developed secondary sex characteristics and she does have hair on the skin of her legs and axiltary hair. I do not know if she has had testing for hypothyroidism and cortisol. Her osteoporosis at her relative young age may in part be due to immobility but other causes such as panhypopituitarism should be excluded. At this point her scoliosis does not appear to be causing respiratory embarrassment although formal pulmonary function testing is likely not possible. There has been no attempt to measure her scoliosis radiographically and to follow it to see if it is progressing. In fact the family reports there have been no radiographs of her spine in their recent recollection. Recommendations: I described testing for genetic abnormalities for Tammy to both her parents and sister. They are not in favor of pursuing this unless it will yield benefit to Tammy. I agree with them on this point and also the fact that there are no other affected family members at this point makes it unlikely the gene has been transmitted in a dominant fashion. There is the possibility of recessive inheritance and I offered referral to our medical geneticists but they have declined. With regards to her scoliosis, since there is no evidence of progression or respiratory embarrassment, I will leave the decision to treat scoliosis to the Orthopaedic surgeon. There would be no role for botulinum toxin injections. The patient also does not have significant spasticity in her upper or lower extremities to demand treatment. I have no further recommendations regarding neurodiagnostic testing. I did offer neuroimaging of the brain to look for cerebral malformation to Tammy's parents and once again they had declined. This docmuunf has been electronically signed. Patient Tame: DOUC,HEP.TY, TAIvIIv0' L Patient Number: 153598h Page 2 of 3 Exhibit E _aoo-z3~-aos? wwuv. ennsfalehe~she .com For inforu~a~iun afoul oin• phuricim~.r P Y UUGIUb U/:Ub:3y rtersney lVletllcal Center Page 4 of 4 145953 CC: William J Polacheck, JR, MD 875 Poplar Church Road Camp Hill, PA 17011-0000 CC: Brian M Uniacke, MD 122 South Filbert Street Mechanicsburg, PA 17055 .. Review/Sign: Gerald D Podskalny, DO Associate Professor of Neurology Milton S. Hershey Medical Center Penn State College of Medicine GDP /BH DD: 04/25/06 DT: 04/26/06 08:07 v This docmnent has been electronically signed. Pnlienl ]vamc: DOUGHERTT, TAIvfIvfY L Yalienl 1~umUer: 153595(1 1'a~e 3 of 3 Furi~furn~Niunahu~uonrpln:cicim~s EXI11fJlt E -800-~33-QOSZ www~.pennsta(ehershey.cori~