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HomeMy WebLinkAbout06-12-09IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: WALTER PATTERSON O.C. No. QCp _~~?~ PETITION FOR APPOINTMENT OF A COURT AUTHORIZED REPRESENTATIVE Filed on Behalf of: Perini Servicea/Southampton Manor Limited d/b/a Shippensbarg Health Care Center Counsel of Record for This Party: SCHUTJER BOGAR LLC Livia F. Langton ~p N ~ ;=_, PA. LD. #91548 ~ ~? ~n~c-~ ~ z c~ ca <-~~ (412)281-3710 ~~~ ii;-~ i Marijane E. Treacy '~'~ c`~ rv ~ c-• ca PA. I.D. #84070 c->cn?~ ~ _'-' -pia (412) 281-3535 ~~ s; ~~" U.S. Steel Tower ~ k''~'+; 600 Grant Street, Suite 3290 w Pittsburgh, PA 15219 Fax (412)281-0530 Chadwick O. Bogaz PA. I.D. #83755 (717)909-5920 417 Walnut Street, 4`" Floor Harrisburg, PA 17101 Fax (717) 909-5925 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ~~ `° ~ m 8 ORPHANS' COURT DIVISION co v ~ ~ n ~~~ z - t? ~,, ~; fi Iv~~ ro ~_ v nO~i = 'YYi IN RE: WALTER PATTERSON O.C. No. p C ~ ~£:_ "~" a r is~ W , PETITION FOR APPOINTMENT OF A COURT AUTHORIZED REPRESENTATIVE Petitioner, Perini Services/Southampton Manor Limited d/b/a Shippensburg Health Caze Center ("Shippensburg HCC"), by and through its attorneys, SCxuT.~R BOGAR LLC, files the within Petition for Appointment of a Court Authorized Representative and, in support thereof, avers the following: I. BACKGROUND 1. Petitioner is a domestic corporation, licensed to do business in Pennsylvania, and operates a skilled nursing facility located at 121 Walnut Bottom Road, Shippensburg, PA 17257 ("Facility"). 2. Walter Patterson ("Resident") is a 58 yeaz-old individual currently residing at Petitioner's skilled nursing facility located at 121 Walnut Bottom Road, Shippensburg, PA 17257. 3. On or about February 3, 2007, Resident was admitted to Petitioner's skilled nursing facility. 4. Since Resident's admission to the Facility, Petitioner has provided him with skilled nursing services without remuneration and is cun•ently owed over $97,556.68, which balance increases each month. A copy the Resident's account statement is attached hereto as Exhibit A. 2 (i) Acourt-authorized representative will be as acceptable to the Department as acourt-appointed guardian to act in behalf of a person adjudged mentally incompetent. (ii) Acourt-authorized representative will have the same legal authority as acourt-appointed guazdian to act in respect to public assistance matters for a person adjudged incompetent. Regulations related to acourt-appointed guardian will also relate to a court- authorized representative. (iii) The decision as to whether a guazdian is appointed or a representative authorized rests with the court. The conditions under which a representative may be authorized for a person adjudged incompetent will be as follows: (A) The net value of the entire real and personal property of the incompetent is $10,000 or less. (B) A person or institution maintaining the incompetent is available to act as representative. Maintaining in this context means spending the income of the client for his benefit, and seeing to it that the client gets the care he needs. 18. Therefore, Petitioner requests that an independent third party be appointed as the Court-Authorized Representative, who can ensure that the Resident's best interests aze protected. 19. The appointment of acourt-Authorized representative is a less restrictive alternative than a Petition for Guazdianship or the like. 20. Petitioner nominates Shaun O'Toole, Esquire, 403 North Second Street, Harrisburg, PA 17110, to serve in the capacity as the Resident's Court-Authorized Representative. 21. Shaun O'Toole is skilled in the Medical Assistance benefits process, has no interests adverse to the Resident, and is willing to act in the capacity of acourt-Authorized Representative. See the Acceptance of Appointment, attached hereto as Exhibit E. 22. Petitioner is specifically requesting that Shaun O'Toole be authorized by this Court to act for the Resident with regazd to the Appeal to be filed on his behalf and his underlying application for MA benefits, with such action to encompass and authorize obtaining and submitting the necessary financial information to ensure the Resident's eligibility for MA 5 5. However, upon information and belief, and to the extent of Petitioner's knowledge, it is averred that the net value of the Resident's real and personal property is less then ten thousand dollars ($10,000.00). 6. Therefore, an application for Medical Assistance ("MA") benefits was filed on the Resident's behalf. 7. The application for MA benefits was denied by the Cumberland County Assistance Office ("CAO") of the Pennsylvania Department of Public Welfare, and a penalty period of ten months was imposed due to improper transfers from the Resident's assets and resources. A copy of the PA-162 denying MA benefits is attached hereto as Exhibit B. 8. The penalty period imposed by the CAO has now expired and the Resident currently is receiving MA benefits. A copy of the PA-162 authorizing MA benefits is attached hereto as Exhibit C. 9. However, the CAO has indicated that Resident's MA benefits are about to be discontinued for failure to provide the CAO with additional and current verification information as part of the annual re-application process. 10. The Resident lacks mental capacity, and his condition is such that he is incapable of providing the needed verifications to the CAO or performing the machinations necessary to establish his continued eligibility for MA benefits. 11. The Resident resides in Petitioner's Alzheimer's unit, and his treating physician, Dr. Yogrinda Balhara, has diagnosed him with cerebral vascular accident with hemiplegia. 12. In Dr. Balhaza's professional opinion, the Resident cannot manage his own fmancial affairs or take the steps ~iecessary to maintain his qualification for MA benefits by submission of the requisite financial information. Please see the Affidavit of Dr. Balhaza 3 attached hereto as Exhibit D. 12. The Resident's friend and agent by Power-of-Attorney, Eddie L. Collins, has proven unwilling and/or incapable of collecting the information about the Resident's finances that is required to complete his re-application for MA benefits, and has not responded to Petitioner's efforts to gain his cooperation with the same. 13. Upon information and belief, neither Larry Patterson, Resident's brother, nor Gloria Patterson, Resident's mother, or any other next of kin have the required legal authority and willingness to assist him with the MA application process. 14. This Petition derives from the need for the Resident to obtain a willing and qualified representative to handle the MA benefits appeal and application on his behalf and to ensure that appropriate steps will be taken to determine and protect his eligibility for MA benefits. II. PURSUANT TO 55 Pa Code § 1633 (Bx3), THIS COURT IS AUTHORIZED TO APPOINT A REPRESENTATIVE TO ASSIST WALTER PATTERSON FOR MEDICAL ASSISTANCE ELIGIBILITY PURPOSES 15. Resident's MA benefits aze about to be discontinued for failure to provide the CAO with verification information, which discontinuance will result in Petitioner filing an Appeal with the Bureau of Hearings and Appeals ("BHA"). 16. The Appeal and the underlying application for MA benefits will be iaeversibly denied, if the requisite verification information is not gathered and submitted to the CAO and BHA within the prescribed timeframe. 17. Pursuant to 55 Pa Code §163.3(b)(3), this Court is authorized to appoint a representative to assist an incapable party with regazd to public assistance matters as follows: (3) Court-authorized representative. Court authorized representatives will conform with the following: 4 EXIIIBIT A 717-536-6364 Shlppanshurg Health Car 69:56:56 21-OS-2669 5/31 STATEMENT SHIPPENSBURG HEALTH CARE CTR Facility Phone: T17-530-8300 121 WALNUT BOTTOM RD SHIPPENSBURG, PA 17257 Resident: WALTER M PATTERSON Statement Date: 05/05/09 Ed Collins P.O. Box 2105 Harrisburg, PA 17105 Data Service Through Qty Description Sub Total as of 03!31/09 Total Amount Due Payment due within 15 days_ We accept Asa and Mastercard. Amount 97,556.88 97,55ti.68 Page 1 EX~IIBIT B P.o. Box s9s . -NOT.EUGIBLE - 33 ,t168TkxxsTBR DRIye - NOTICE , CARLIST~B PA 17013-0599 ~ ~ CAO RETUFW ADDRESS CSLD 0036 21 0116611 I101~ TJN o0 ~oloeooooooo• SHCC WORKER J PBIPBR ATTN: DOROTHY ABBOTT TELEPHONE (coo) 269-0173 1710 UNDBRPA33 WAY 3TE 201 MAIL DATE: 12/15/2006 HAG$R3TOWN MD 21740 NOT: 985 OPT: J TYPE N Vou have been daterminW not eligible for benef ita based on your application Dated 11/11/2008 You disposed of a torsi of f 89000.00 in aeasta without receiving fair market vsl w. This trsnafar raautto in a period of lrwlig ibtllty for payment of Medicetd/Servlcea to a Long Tara Cara (LTC) fac silty. You era not aliplbl• for psynant towards tM cost of Medicaid/Servlcaa 1n an LTC facility bapinntnp on 05/01/08 and antllnp on 02/2,7/09. During this period, you w111 be reaponstbl•'to pay tM LTCfactlity~for'tM LTC services you raeetw. Vou are sltglbl• for all other Metliesid beMfits.' Vbu can request an urxiua hardship waiver if the denial dfp~ylneint of~'Modtcsid/Services to an LTC facll ity woultl deprive you of medical care which would endargsr your Matth or life or 1f the dental of payment of Medicatd/Sarvicas to an LTC fseiltty would deprive you of food, clothing, sMlter, or otter nacaasitiea of l1fe. Citations: Pub. L. 109-171, 8011 and 601678.104 (d) Pub. L. 31, No. 21 41.5 and 68 Pe. Coda 178.104 (d) decision, You have the right to appeal ou re Y currently racaNing bsnafks an your oral request fora Haring is received in the County Assistance Office a your written request is postmrked w npWad on or before 12/28/aooe your assishncs wig contlnus pending the hearing decision, except when the change Is due to Stets or Federal law. HALTER M PATTER80N SHIPPHN8IlORG HBALTHCTR 121 NAI.HOT BOITOM ROAD 9HIPP8<7SBt62G PA 17257 rnim~eLAND cAo P.O. 80x599 33 NHBTNINBT®t DRIVH CARLIBLH PA 17813-0599 FAGS 1 OP 1 MIDPBNN LHGAL BBRVICBB 401-405 IADTBBR BTRSBT CARLISLH PA 17013 (717) 243-9400 Notias ID•. e953971.1 ~~ 21 0116611 0 TJN 00 WORKER: J PHIPER - AppEAL: iz/26/2ooe TELEPHONE-- (800) 269-0173 MAIL DATE 12/35/2006 ` 9es oPr. J TYPE N Nor: PAMAID2A CONTINUED ON REVERSE SIDE PArMA ia2lxroa EXIIIBIT C 777-530-8304 Shlppenshurg Heahh Car 09:57:02 21-OS-2009 33 N88TNW8TSR D1iiVa v~rrt,~~ar QARLISLB PA 17013-D599 (NOTICE I CAO AETURN ADDRESS CSLD oau n 0116611 0 751N o0 *oloaooooooo* ~ Q, 3HIPP8NBBDRG BBALTB CRATER V ~ WPDRKEA: D 1~fTRSSa. ATTN. BILLING OI MS TELEPHONE (eDDI ass-0373 121 litAI,NOT BOTTOM ROAD ~-~~ MAIL DATE a3/o9/1DD9 SEfIPPffi1SBDRG PA 17257 NI41 NOT. 996 , OP7^ J TYPE cY Action hoe been taken to change your beneffte ePfectiVa 09/of/1009. You are eligible for Services in a Long-Tern Care (LTC) Facility. This change in benefits is because your inelfg1b111ty period for LTC Services has exp lretl. You wilt be required to sake a aonthiy peynent towards your coat of cars. A separate notice showing you the tlatal la of this coaputatlon 1a enclosed. Contact the CAD 1t you have questions or changes to report. when cohtacting the CAO, pisses provide your record number, which is toonted on the iop antl bottom Of this not1G. Cifationa: Pub. L. 709-171, BO11 antl 6016 Pub. L. 37, No. 2i 41.3 and 96 Pa. Coda 178.704 (d) If you County Asaistaice Office or your written n before 03/21/1009 ypfs assistance wd except when the dtange Is due to Efate or the right to appeal a hering fa received to the fshneked ar received on or re~g the hosing dadsion, ID1L17;R N PATTBR90N RaZPP@18BtDl6 88ALTH C1A lal NALND7! B011@I ROAD RRIPPBNSBORG PA 17157 OOtBSBLARD coo P.O. '1~8 599 33 IIRRTlmlaTlSR OBPrR CAREI6Z13 PA 17013-0599 ramptDar raaAS aBRVicea col-cos cooTtislt aTRaRT CARLI9LR PA 17013 (7171 aa3-saoo Notice Rk 9a273311 11 0116611 0 Ti71i DO WORIO=AR: D FnratEBB A~pp~L o3/22/aoo9 TEI.EPHDNE (600) a69-0173 MAR. DATE 03/09/2009 NOT. 996 OPT: s TYPE C 6 /37fp i PAMAteaq CONTINUED ON REVERSE SIDE PaMA tee tafo3 717-530-8304 Shlppensburg Haahh car 09;57;30 21-OS-2009 7/31 THE FOLLOWING PERSON IS AFFECTED BY THE ACTION ON THE FAONT OF THIS NOT7CEJ~y NAME ~ ACCESSlINDIVIOWL NUMeEa P.4 030479]13 9 THE FOLLOWING AMOUNTS WERE USED 70 COMPUTE YOIAt MONTHLY CONTRIBUTION TOWARDS YOIBf COST OF ®LON6 TEAM CARE LTCt. on of Gross Monthly Inooms Calculation of Contribution toward Cost of Cars ncome lary 03/01/2009 . oo B in Oats Goss Monthly Income Total Earned Ineoms 03/01/1009 . 00 ,ymenl _oo Total Unearned Income azsa.zl ,me .oo Income available fkst momh .oo .oo Deductfona mad .oo Personal Needs Allowance as.oo i GuardlansNP Fee .oo urdy ,ea Total Allowance for Spouse / endant .00 .oo Home Mahtbnancs .oo 3enefits .00 COIltriieutiOn tOWard6 Coat of Cara: x211.11 1zss,sa The LTC faalily wRl deduM the foilowi,e msdlwl expense fran y0w coMrB,utlon towards Cost of Cars mstns ,DO Medicare Premium .00 t Comp . oo Other hsurance Premium . 00 .0e Ths LTC faollity may deduct additional medloal bills inaludtr~ suppltsmental health htsttrance premiums, ,st .oo Drovlded they ere verified 7h4dend .as tel. afc.i .oo learned alss.za WISH TO APPEAL, PLEASE COMPLETE APR) RETi1RN THE BOTTOM PORTION OF THt3 FORM, ~ mtdi a3tE --- ackone ofthe btuoes to ahow which type of hearing you want• a tebphone Hearing. I and ny wMessea end anyone helping me wR be at this phone dumber. a Telephone Hearing. I and my wltnessea end anyone helping me wdl be at the County Assistance ONice (CAOJ. a Face to Face Hearing. i and my witresses and anyone helping me wit ba in the hmrMg roan with the Judge end the caseworker ~AO atafl. a Fie to Face Hearing. I and rnlf witnesses and anyone helping me wl be in the heating room with the Judge. The casearodcer and staff wN be on the phone iron the CAD, g they deride not to twrrte to the hearing mom. :HECK BELOW IF YOU NEED HELP BECAUSE OFA HEARING PROBLEM OR DISABIIJTY OR YOU NEED AN INTERPRET 5='• e a hearing impeirmem or disabtliy. I will need special help. 1 an kdetprater. Theta will be no cast m me. What language? ~` ~' IONATURE ADDRESS TELEPHONE NO. DATE RE CLIENT REP. ADDRESS TELEPHONE NQ DATE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: WALTER PATTERSON O.C. No. AFFIDAVIT TO APPOINT ACOURT-AUTHORIZED REPRESENTATIVE FOR WALTER PATTERSON I, Dr. 'Imffndri l~Qll.4gfa. , a licensed physician practicing in the Commonwealth of Pennsylvania, do hereby swear or affirm, within a reasonable degree of medical certainty, that my patient, Walter Patterson, a resident at Shippensburg Health Care Center ("Shippensburg HCC"), is incapable of taking the steps necessary to secure Medical Assistance benefits on his own behalf, including establishing his eligibility and/or filing appeals in order to secure such benefits to pay for his nursing home care being provided by Shippensburg HCC. To a reasonable degree of medical certainty, I also believe the ability of Walter Patterson to receive and evaluate information effectively and to communicate decisions is impaired to a significant extent such that the Court should appoint an authorized representative to assist in securing Medical Assistance benefits on his behalf. I have based my opinion on a personal examination of the person and/or an ennxamination of his medical records. I have diagnosed Mr. Patterson as suffering from `'nrQ,~9r~ VCSC.~I~ ~(' ~i12lt~ I believe that Mr. Patterson's rehabilitation potential is limited due to the physical and mental conditions identified. 1 SWORN TO AND SUBSCRIBED before me this y ~ day of ~-e , 2009. Notary"Public My Commission Expires: /O/1/aO/~. NOTARIAL SEAL ANGELA F LINGER Notary Public SOUTHAMPTON TWP, FRANKLIN COUNTY My Commission Expires Oct 7, 2012 Treating Physician Signature r~ ~i /~ 2 EDIT E ACCEPTANCE OF APPOINTMENT AS COURT AUTHORIZED REPRESENTATIVE I, Shaun O'Toole, Esquire, the Court-Authorized Representative for Medical Assistance Purposes proposed in the foregoing Petition for Appointment of a Court- Authorized Representative of Walter Patterson, an incapable person, agree to accept the appointment as Court-Authorized Representative for Medical Assistance purposes and aver that: 1. I, Shaun O'Toole, the proposed Representative, am experienced in the azea of Medical Assistance benefits. 2. I, Shaun O'Toole, am not a fiduciary of an estate in which Walter Patterson has an interest and I have no interests adverse to him. 3. My address is: Shaun O'Toole, Esquire 403 North Second Street Han•isburg, PA 17110 (717)695-0389 Dated: 06 ~ZS o 1 .~~,~vs~ aun O'Toole, Esquire VERIFICATION I do hereby verify that the facts contained in the foregoing petition are true and correct to the best of my knowledge, information, and belief; and that this verification is subject to the penalties of 19 Pa. C.S.A.§ 4904 relative to unsworn falsification to authorities. Dated: J~f o2~Oq By: Stephen Coetzee, Repre ntative Perini Services/Southampton Manor Limited d/b/a Shippensburg Health Care Center ~Iil~~IER ~aAli Email: Iaclaelanl@schufJerboyar.com Direct Dlal: (412) 281-0965 p?i-CYO-053 June I1, 2009 Via UPS Overnight Delivery Clerk of the Orphans' Court Division Attn.: Margie Cumberland County Court of Common Pleas I Courthouse Square, Room 102 Cazlisle, PA 17013 Re: Waster Patterson Deaz Margie: Schutjer Bogar LLC U.S. Steel lower 600 Grant Street 32"' Roor. Suite 3290 Pittsburgh, PA 15219 Fax (412) 281-0530 www. schutjerbogar. com Enclosed for filing in the above-referenced matter aze the original and one copy of the Petition for Appointment of a Court Authorized Representative; a Preliminary Order; and Order. Please date stamp the copies and return to me in the self-addressed, prepaid envelop provided herein. Pursuant to our telephone conversation today, enclosed aze mailing envelopes addressed to all involved parties. Also enclosed is our firm check in the amount of Thirty Dollazs ($30.00) which represents the fee for filing the Petition, the JCP fee and automation fee. Thank you for your assistance in the matter. Should you have any questions, or need additional information regarding this request, please do not hesitate to call me. Very truly yours, SCHUTJER BOGAR LLC Linda L. Scisciani Pazalegal enclosures H AHH15811RG. PA PHILADELPHIA, f+A PITISBUNGH, PA HERW VN. PA COLUMBUS. OH PRINGFTO N, NJ BALTIMORE, MD ARLINGT ON. VA DALI_A S, TX