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Home My WebLink About09-3141THIS IS AN ARBITRATION MATTER ASSESSMENT OF DAMAGES HEARING NOT REQUIRED TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE Attorney I.D. #60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 VS JANET E. KUHNS 304 Nealy Road Newville, PA 17241 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA O . C NO. 69 -- 3IW c ut, 6z CIVIL ACTION COMPLAINT - CIVIL ACTION NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 (717)249-3166 or(800)990-9108 1. w COMPLAINT - CIVIL ACTION THE MILTON S. HERSHEY MEDICAL CENTER VS. JANET E. KUHNS 1. Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2. Defendant is an individual who resides at the address indicated in the caption hereof. 3. As the result of a certain medical condition, defendant was treated by the plaintiff on Aug. 15, 2008 thru Aug. 28, 2008. 4. The amounts, quantities and nature of said medical care, the dates on which said medical care was rendered, and the charges therefore are set forth in Exhibit "A" which is incor- porated herein as if set forth at length. 5. Said medical care was commensurate with the condition of defendant and was necessary for the health and welfare of defendant. 6. At or about the time of defendant's treatment by plain- tiff, implied, constructive and oral contracts arose between defendant and plaintiff by the terms of which defendant became obligated to pay plaintiff the charges for the medical care rendered by plaintiff to defendant. 7. Defendant refuses to pay the balance due although plaintiff has made demand that defendant do so. 8. As a result of the foregoing, there is due and owing from defendant to plaintiff the sum indicated in Exhibit "A". WHEREFORE, plaintiff demands judgment against defendant for the sum of $16,567.63 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS & ROSEN, P.C. LEWIS C. T FFER, ESQUIRE Attorney for Plaintiff MS HERSHEY MEDICAL CENTER PAGE: 1 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 01/07/09 at 02:59 PM Guarantor: KUHNS JANET E 304 NEALY ROAD NEWVILLE, PA 17241-0000 Patient: KUHNS JANET E Visit #: 10152372 ------------------------------------------------------------------------- Date Svc Code Description Units Debits Credits 08/15/08 46472 EMERGENCY VISIT, LEVE 1 692.00 08/15/08 46620 ROUTINE VENIPUNCTURE 1 20.00 08/15/08 46716 NONINVAS PULSE OX, SI 1 74.00 08/15/08 46777 URINE HCG 1 51-.00 08/15/08 104014 ALKALINE PHOSPHATASE 1 17.00 08/15/08 104016 BILIRUBIN TOTAL 1 17.00 08/15/08 104097 LIPASE 1 54.00 08/15/08 104156 SGPT (ALT) 1 18.00 08/15/08 104433 BASIC METABOLIC PANEL 1 50.00 08/15/08 105657 CBC W/PLT/DIFF AUTO 1 57.00 08/15/08 106011 URINALYSIS-BASIC & MI 1 45.00 08/15/08 249175 LEVOTHYROXINE SODIUM 1 3.00 08/15/08 250092 OXYCODONE APAP 1TAB 4 6.00 08/15/08 251072 CIPROFLOXACIN 250 MG 2 3.00 08/15/08 272199 ONDANSETRON 2MG/ML 2M 4 3.00 08/15/08 308039 US TRANSVAGINAL NON P 1 164.00 08/15/08 308237 US DOPPLER ABD/PEL/RE 1 361.00 08/15/08 310519 CT ABDOMEN ENHANCED 1 1274.00 08/15/08 310567 CT PELVIS ENHANCED 1 1448.00 08/15/08 310703 OMNIPAQUE 300MG/ML 10 1 65.00 08/15/08 621055 _KIT -ER---IV START . 1 _ 17_ 00 09/04/08 930126 SP SETTLEMENT HOSP -1 887.80- 10/03/08 900011 PATIENT PAY CHECK -1 1392.00- 12/29/08 930126 SP SETTLEMENT HOSP 1 539.80 12/31/08 980090 HOSPITAL BAD DEBT W/O -1 2699.00- 12/31/08 980091 HOSPITAL BAD DEBT PLA 1 2699.00 * - Not posted Balance: 2699.00 ------------------------ A-1 MS HERSHEY MEDICAL CENTER PAGE: 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 01/07/09 at 03:00 PM Guarantor: KUHNS JANET E 304 NEALY ROAD NEWVILLE, PA 17241-0000 Patient: KUHNS JANET E Visit #: 12005138 --------------------------------------------------------------------------------- Date I Svc Code I Description I Units Debits I Credits --------------------------------------------------------------------------------- 08/25/08 10156 P PRIVATE MED/SURG RM 1 1464.00 08/25/08 20048 PREGNANCY TEST 1 51.00 08/25/08 191024 LVL5 SURGICAL PATHOLO 1 118.00 08/25/08 192072 SELECT CELL ENHANCEME 1 43.00 08/25/08 202000 ANESTHESIA TIME-HOSPI 15 1325.00 08/25/08 202005 1 TO 1 1/2 HOURS-RECD 1 489.00 08/25/08 207132 POST OP CARE 1 131.00 08/25/08 210001 OR TIME<=lHR EACH 15M 4 2692.00 08/25/08 210002 OR TIME>lHR EACH 15MI 11 3388.00 08/25/08 246223 INDIGOTINDISULFONATE 1 10.65 08/25/08 246400 PROMETHAZINE 25 MG/ML 2 6.00 08/25/08 246493 DEXAMETHASONE 4 MG/ML 4 3.00 08/25/08 246705 MORPHINE SULFATE 4 MG 1 3.00 08/25/08 246708 MEPERIDINE HCL 25 MG 1 3.05 08/25/08 246836 FENTANYL CITRATE 2 ML 3 9.00 08/25/08 247786 MORPHINE SULFATE 10 M 1 3.15 08/25/08 250577 PROPOFOL 20ML 1 5.75 08/25/08 250667 KETOROLAC TROMETHAMIN 2 3.00 08/25/08 272129 ROCURONIUM BROMIDE 5M 1 167.85 08/25/08 272425 MIDAZOLAM 1MG/ML 2ML 2 3.00 08/25/08 272628 MORPHINE 1MG/ML BAG - 10 3.0..810_ 08/25/08 272979 FAMOTIDINE 20MG PRE-M 1 10.35 08/25/08 274218 CEFAZOLIN SODIUM BAG 2 14.20 08/25/08 398230 SUTURE, SINGLE ARM 12 108.00 08/25/08 398232 SUTURE, MULTIPACK 2 64.00 08/25/08 398641 PBDS MAJOR ABDOMINAL 1 128.00 08/25/08 398857 CLIP LIGATING 1 10.00 08/25/08 503128 BAIR HUGGER UPPER BOD 1 50.00 08/25/08 600520 SPIRO INCENTIVE ADULT 1 12.00 08/25/08 621044 I V SODIUM CHLORIDE 0 1 2.00 08/25/08 621054 IV LACTATED RINGERS 1 2 6.00 08/25/08 622023 IRRIGATION SOD CHL 0. 6 12.00 08/25/08 626080 IV DILUENT NML SALINE 1 3.00 08/25/08 631516 CATHETER FOLEY SILIC 1 11.00 08/25/08 667765 SCD SLEEVES, KNEE LEN 1 83.00 08/25/08 670334 IV INFUSION SET, UNIV 2 6.00 08/25/08 670727 PCA ST INTEGRAL NOSIP 1 44.00 08/26/08 10156 P PRIVATE MED/SURG RM 1 1464.00 08/26/08 104049 TROPONIN 2 122.00 08/26/08 105036 HEMATOCRIT 1 21.00 08/26/08 246621 DOCUSATE SODIUM 100 M 2 6.00 08/26/08 247811 IBUPROFEN 400 MG 2 3.00 - Continue - 4 -t)-/ MS HERSHEY MEDICAL CENTER PAGE 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 01/07/09 at 03:00 PM Guarantor: KUHNS JANET E 304 NEALY ROAD NEWVILLE, PA 17241-0000 Patient: KUHNS JANET E Visit #: 12005138 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units Debits I Credits -------------------------------------------------------------------------------- 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/26/08 08/27/08 08/27/08 08/27/08 08/27/08 08/27/08 08/27/08 08/27/08 08/27/08 08/27/08 08/28/08 08/2.8/08 08/28/08 08/28/08 08/28/08 08/28/08 08/28/08 08/28/08 08/28/08 12/31/08 12/31/08 249175 LEVOTHYROXINE SODIUM 249219 ENALAPRIL 5MG 249441 FAMOTIDINE 20MG UD 250092 OXYCODONE APAP 1TAB 250667 KETOROLAC TROMETHAMIN 272199 ONDANSETRON 2MG/ML 2M 272347 MYLANTA GAS 80MG UD 272979 FAMOTIDINE 20MG PRE-M 274369 MYLANTA ORAL SUSP 275011 FERROUS SULFATE 325MG 521211 12 LEAD ELECTROCARDIO 621054 IV LACTATED RINGERS 1 10156 P PRIVATE MED/SURG RM 246621 DOCUSATE SODIUM 100 M 249175 LEVOTHYROXINE SODIUM 249219 ENALAPRIL 5MG 249441 FAMOTIDINE 20MG UD 250092 OXYCODONE APAP 1TAB 272347 MYLANTA GAS 80MG UD 273788 HYDROCODONE C APAP 5/, 275011 FERROUS SULFATE 325MG' 246128 DIPHENHYDRAMINE 50 MG 246621 DOCUSATE SODIUM 100 M 247811 IBUPROFEN 400 MG 247831 ACETAMINOPHEN 325 MG 249175 LEVOTHYROXINE SODIUM 249441 FAMOTIDINE 20MG UD 272347 MYLANTA GAS 80MG UD 273788 HYDROCODONE & APAP 5/ 275011 FERROUS SULFATE 325MG 980090 HOSPITAL BAD DEBT W/0 980091 HOSPITAL BAD DEBT PLA 1 3.00 1 3.00 2 6.00 8 12.00 4 6.00 4 3.00 1 3.00 1 10.35 1 10.48 2 6.00 1 138.00 1 3.00 1 1464.00 2 6.00 1 3.00 1 3.00 2 6.00 2 3.00 2 6.00 6 9 00 2 6.00 1 3.00 1 3.00 2 3.00 2 3.00 1 3.00 1 3.00 1 3.00 4 6.00 1 3.00 -1 1 13868.63 13868.63- -------------------------------------------------------------------------------- * - Not posted Balance: I 13868.63 h -.3 KUHNS, JANET E. #1761999 $16,567.63 VERIFICATION LINDA SCHLADER hereby states that she is the Team Manager, Customer Service of the Milton S. Hershey Medical Center and verifies that the statements made in the foregoing pleading are true and correct to the best of her knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. LINDA CHLADER DATE:( Q4R T; ' ?,A ?y 2009 13 PH 3' 00 c T l $7s.so r??L A44,j eK? roar P--a- azszs? Sheriffs Office of Cumberland County Thomas Kline p of tumbprEdward L Schorpp Sheriff Solicitor Ronny R Anderson r ` Jody S Smith Chief Deputy OFFICE OF r'+E SHERIFF Civil Process Sergeant SHERIFF'S RETURN OF SERVICE 05/19/2009 08:20 M - Steve Bender, Deputy Sheriff, who being duly sworn according to law, states that on May 19, 2009 at 2020 hours, he served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Janet E. Kuhns, by making known unto herself personally, defendant at 304 Nealey Road N wville, Cumberland County, Pennsylvania 17241 its contents and at the same time handing to hei personally the said true and correct copy of the same. SHERIFF COST: May 20, 2009 .00 SO ANSWERS, R THOMAS KLINE, SHERIFF Deputy Sheriff 2009-3141 Milton S. y Medical Center V P. Kuhns M r CsJ r l ...j ? C- n Yryy J C J