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HomeMy WebLinkAbout05-28-10 NDEX TO WITNESSES FOR PETITIONER Linda Black Davis FOR RESPONDENT Orv~ile G. McBeth, Jr., M.D. Laverne C. Black DIRECT CROSS REDIRECT RECROSS 8 21 -- -- 32 55 59 62 2 NDEX TO EXHIBITS FOR PETITIONER IDENTIFIED ADMITTED Ex. No. 1 - Dr. McBeth Deposition 6 6 Ex. Nc. 2 - medical records 7 ~ Ex. No. 3 - Dr. Moser letter 7 '7 Ex. No. 4 - will 61 61 FOR THE DEFENDANT Ex. No. 1 - Dr. Mo s er letter 36 5` Ex. No. 2 - medical records 36 6`~ Ex. No. 11 - map 65 °~' 3 0:00 a.m. THE COURT: Please be seated. Than-; you. 3 This is the time and place for a hearing on a Peti~,ion Sur _ Appeal from Probate in the matter of the Estate of Glenn W. 5 Black at No. 21-09-0360 Orphans' Court. The Petitioner, I 5 believe, is present in court with counsel, Thomas :~. Flower, 7 Esquire, and the Respondent is represented by, I believe, Susann Morrison, Esquire. Mr. Flower. MR. FLOWER: Your Honor, we deposed a medical C witness, the decedent's treating physician, and I move to 11 enter the deposition transcript pursuant to Rule 4020 as an 12 exhibit. ~~ THE COURT: All right. Ms. Morrison, do you 14 have any objection to that exhibit? 1~ MS. MORRISON: I don't necessarily have an -- 16 well, Dr. McBeth is going to be testifying at 10:30 by l~ telephone today. You know, we are going to have r~_is ,g testimony here, you know, and the chance for cross ~~ examination. I think if there is anything differEnt in the 20 deposition than his testimony, then certainly he could be 2.~ cross-examined with the transcript. However, I don't see, 22 you know, a reason to enter the transcript at thi:~ time. 23 So, yes, I would -- I guess I would say I would object. 24 THE COURT: What authority do you _zave for 2~ entering a transcript of a deposition when the wi-ness is 4 going to be testifying? 2 MR. FLOWER: Rule of Civil Procedur=~ 3 4020(a)(5) says that the deposition of a medical w-mess car. 4 be entered -- can be used at trial for any purpose, whether 5 or not the witness is available. And during my deposition I 6 primarily had him authenticate his clinical notes. I went 7 through them point by point. It would purely be repetitive, 8 and I also consented to having him testify by~teleohone so that Ms. Morrison could supplement any questions she failed 10 to ask during the deposition. When we were both 11 face-to-face with the doctor, Orville McBeth, it was much 12 easier for us to engage him in questioning and in l~ cross-examining. 1` I don't think there is any useful purpose in 15 going over the same ground we went over during our I6 deposition, assuming that the Court is going to allow us to 1? brief the matter at the close of the hearing and refer to 13 the record. ~9 THE COURT: Okay. Ms. Morrison, do you sti~,~ 20 have an objection to the admission of that item? 21 MS. MORRISON: I guess, Your Honor, it is not 22 so much -- I don't anticipate that there's going to be any 23 different testimony here, but I would like you to hear 24 directly from the doctor, you know, all of the ke~~ points 25 that are pertinent to this hearing. 5 To the extent that counsel -- he did go 2 through and clarify some notations in the Doctor's notes. I 3 am certainly not going to go over that, and I thiniL that 4 would be a waste of your time. So I don't really =lave a 5 problem with that being entered in for your clarification as 6 you go through the evidence so... ~ THE COURT: All right. We will have that 8 marked as Petitioner's Exhibit 1. g (Petitioner's Exhibit No. 1 was marked for 10 identification.) 11 THE COURT: Petitioner's Exhibit 1 is 12 admitted. 13 (Petitioner's Exhibit No. 1 was admitted into 14 evidence.) 15 THE COURT: Mr. Flower. 16 MR. FLOWER: At the deposition, Your Honor, 17 Dr. McBeth authenticated a brief excerpt from his clinical 18 notes concerning the decedent. There are probably less than 19 ten pages. They were attached as an exhibit to tr.e 20 transcript, but I would like to enter these as an exhibit. 21 These were also previously provided to us by the Respondent. 22 THE COURT: Ms. Morrison. 23 MS. MORRISON: That is not a problem. We 2~ wiil be presenting it as an exhibit as well. 27 THE COURT: All right. We will ha,re that 6 narked as Petitioner's Exhibit 2. 2 (Petitioner's Exhibit No. 2 was marl~~ed for 3 identification.) 4 THE COURT: Petitioner's Exhibit 2 ~s 5 admitted. 6 (Petitioner's Exhibit No. 2 was admitted into 7 evidence.) g THE COURT: Mr. Flower. G MR. FLOWER: The last item from the medical 10 record, which was authenticated by Dr. McBeth, was a letter 11 from a consulting physician in which he had meant to include 12 in his clinical file but didn't, and I think they are going 1? to use this one as well. 14 MS. MORRISON: Yes. That is not a problem. 15 MR. FLOWER: This is a letter from 16 Dr. Moser, Jeffrey Mosser, dated May 18, 2004, regarding 17 Glenn W. Black and addressed to Dr. McBeth. lg THE COURT: All right. We will hay%e that lti marked as Petitioner's Exhibit 3. 20 (Petitioner's Exhibit No. 3 was marked for 21 identification.) 22 THE COURT: Petitioner's Exhibit 3 is 23 admitted. 24 (Petitioner's Exhibit No. 3 was admitted into 25 evidence.) 7 THE COURT: Mr. Flower. 2 MR. FLOWER: Now I will call to the witness 3 stand Linda Black Davis. 4 THE COURT: All right. 5 Whereupon, ~ LINDA BLACK DAMS ~ having been duly sworn, testified as folloc.~s: g DIRECT EXAMINATION c BY MR. FLOWER: 10 Q Will you state your name for us? ~l A Linda Black Davis. , 2 Q What is your relationship to the decedent, 1 13 Glenn W. Black ? 14 A I would be his daughter, one of his 15 daughters. ,.E Q How many children did he have in all? 17 A He had five total. 18 Q All right. And the Respondent, Lai-erne 19 Black, is one of those children? 20 A Yes. He is the youngest. 2- Q What year did your mother die? 22 A In April of 1996. 2_s Q Okay. Did you socialize with your father 24 following your mother's death? 25 A We did. Dad was depressed, and we spent ti~r.e 8 with him. He didn't like to eat by himself so oftentimes my 2 husband and I would take him out to eat. 3 THE COURT: And where do you live? 4 BY MR. FLOWER: 5 Q What's your address? 6 A My address, 4363 Carlisle Road, Gardners, 7 Pennsylvania, 17324. g THE COURT: And where did your father live? g BY MR. FLOWER: 10 Q Where did your father live? 11 A It was on State Road. I don't know the 12 actual number of the house. 13 THE COURT: State Road where? 14 THE WITNESS: Gardners, Pennsylvania. 15 THE COURT: In Gardners. So he liti~ed near 16 you? 17 THE WITNESS: Yes, across the road. lg THE COURT: And is that Cumberland County? ly THE WITNESS: Yes, it is. 20 THE COURT: Okay. Mr. Flower. 2-~ 3Y MR. FLOWER : 22 Q You mentioned your husband. What's your 23 husband's nam e? 24 A My husband's name is Tony. 25 Q And when did your father remarry? 9 A He married Jean in -- I believe it ~~~as August 2 of 1997. 3 Q Okay. And did you and Tony continue to go 4 out to dinner with your father periodically after ae 5 remarried? 6 A We did. Even before they got married we went 7 out quite often to eat, sometimes every week, sometimes 8 every couple weeks, but we did often eat with them. 9 Q What was your father's personality like? ZO A He liked to talk. He could get in the car 11 when we'd go out to eat, even before Jean, and he would talk 12 clear to Carlisle. He started on a subject, and he had a 13 point for what he was going to talk about, but he would talk 14 about other things related to it, until you got to Carlisle 15 to your destination though he would come back to the 16 original subject, and finish what his intentions were to 17 say. It was simply amazing to me how he could do that. lg Q Moving ahead, during the fall of 2003 you 19 were still going out to dinner periodically? 20 A Yes, we were. 21 Q And who would drive? 22 A Dad used to drive, but Tony got very nervous 23 because dad would make a lot of bad decisions whe~i it came 24 to his driving. It was getting worse. On one occasion I 25 know -- and it wasn't because he was talking or d-istracted, 10 it just -- he almost drove through a stop sign. And when we 2 came home I remember Tony saying, we're not going t_.o let h~r.1 3 drive anymore when we go out to eat. I don't want to be 4 involved in an accident. 5 Q Do you have a medical -- were you 6 hospitalized in that year? ~ A I was. In November, early November of that 8 near, I was hospitalized at Holy Spirit for a week. Toward 9 the end of the week I know that dad and Jean planned to come 10 down and. visit me on Saturday in the hospital. Ho•Never, 11 late Friday they had told me they were probably going to 12 discharge me, and when I got my discharges on Saturday I3 morning, I called to let them know, don't come down, I won't l~ be there. And Jean answered the phone, and so she said, 15 okay, I'll tell your father. 16 But after I was home, I believe it was Monda-ti~ 1? evening, I called over to talk to dad, and I said, dad, did la you know I'm home from the hospital now? He says, yes, 19 somebody told me, but I don't remember who it was. Well, we 20 didn't talk for very long, and I got off the phone and 21 immediately the phone rang, and it was Jean. 22 She had been listening on the extension, and 23 she was very angry because she said, I told your clad you 24 came home from the hospital. And I told her, Jean, we all 2~ know dad's mind is not what it used to be, and he probably 11 should see a doctor because he can't remember thinGS like he 2 used to. 3 Q Jean died when? ~} A She died in March -- I think it was the 2nd 5 of 2004. 5 Q And where did she die? ~ A She died in Florida. They were on ,~ mini 8 vacation. g Q Your father and Jean? 10 A Yes. 11 Q And how did your father get back tc 12 Pennsylvania? 13 A My little brother, when he was alerted -- 14 alerted to the fact that Jean had died, he immediately took 15 his son, and they flew to Florida to be with dad, to help 16 him make the final arrangements and bring him home. l~ Q And what -- 18 THE COURT: How old -- what's the date of I9 birth of your father? 20 THE WITNESS: September -- I don't know, but 21 I think he was 83 when he passed away. 22 THE COURT: You don't know his data of birth? 23 THE WITNESS: It is probably in th=e 24 paperwork. 25 THE COURT: Okay. Go ahead, Mr. Flower. 12 ~Y MR. FLOWER: 2 Q Without the year, do you know his birthday? 3 A It was September the -- let's see, nine's the 4 22nd, so I believe his was the 18th. 5 Q Shortly after Jean died, do you remember any 6 occasion where you and Laverne and his wife -- what's the 7 first meeting you can remember between the three of you 8 after Jean's death? 9 A It was after he brought dad home. We were 10 all -- we all went over to the house because dad was upset, 11 and that is when he started talking about the fact that 12 someone took Jean's purse while they were in Florida, but 13 her purse was there, and you couldn't reason with him. So I 14 just figured the best thing to do is not argue, but we were 15 all over there at his house after he came home. 16 Q And what took place other than that story? ~-;~ A Well, we talked about all of that, and I 18 believe that was whenever the discussion was to take dad's 19 checkbook. Shirley would take the checkbook and work on the 20 checkbook to take care of dad's bills. 21 Q Was there an occasion when Jean's daughter 22 came by to pick up some of her mother's things after Jean's 23 death? 24 A There was a time when Jean's son and his 25 wife, so it would be her daughter-in-law, came to the house 13 ro collect a lot of the possessions. I was there. Shirley 2 was there. Laverne was not able to be there, he had a prior 3 appointment, but his son Jason was there, and dad U.as there, 4 and I believe at one point -- I can't remember what her name 5 ~~~~as -- but she flew off the handle at Shirley because Shirley was following her around. ~ Q When you are talking about she, you mean who? g A Shirley was following the daughter-in-law g around the house as she was trying to collect things that 10 belonged to Jean, and she was upset because Jean's 11 daughter-in-law was taking Longeberger baskets than she i2 thought dad had paid for. So there was an argumen~ there. 13 It was -- ,,q Q How did the argument end? 1J A Jason, which is the eldest son of Laverne ar_d 16 Shirley, stepped in and had his mother go outside and get 1? away from the situation. My dad sat there througr: that and 18 never said a word. That was not like him. He would have 19 stood up for Shirley if he was able to, but he didn't, and 20 that wasn't like him. 21 Q Did your dad go on a trip of any k~~nd in the 22 weeks following his return from Florida and Jean's death? 23 A He did. He went to Arizona, and t_zat was ~A_ 24 July. 25 Q Before July -- before July was there any 14 rips in the spring that your father took? 2 A He took a bus trip. 3 Q That would be a day trip? ~ A No, it was not a day trip. It was a bus trip 5 that he took, and I think it was Tennessee, for a few days. 6 It was a prior trip that Jean and he had planned to go on, 7 and we did send him on that trip. g We had to give our name and phone numbers and 9 put it in his pockets because we were concerned that he 10 wouldn't be able to take care of himself on that trip, but 11 the bus driver assured me when I dropped him off they would 12 make sure dad was taken care of and notify us if there was 13 any issues. 14 THE COURT: Was your father living alone at 15 that point? 16 THE WITNESS: He was. 11 THE COURT: Okay. And how long dic he 1.8 continue to live at the house alone? 19 THE WITNESS: I believe it was in February -- 20 sometime in February or early March of 2006 when w.e decided 2~ to move dad to an assisted living facility. 2~ THE COURT: But before that he was living 23 alone and taking care of himself? 24 THE WITNESS: Actually between Shirley and 25 myself, we took turns feeding dad -- going over, Nicking him 15 up, making sure he got his medicine, and making sure that he 2 toad his dinner and meals. 3 THE COURT: And when did that start 4 happening? 5 THE WITNESS: Right away. 6 THE COURT: After his wife's death? ~ THE WITNESS: Yes. g THE COURT: So you fed him -- physically fed 9 him or just took a meal to him? 10 THE WITNESS: We would bring him over to our 11 house to eat with us, and we would make dinner, an~~ he would 12 visit for a while, watch a little TV, and then he -would go 13 home. 14 THE COURT: Okay. Mr. Flower. 15 BY MR. FLOWER: 16 Q To clarify, Laverne Black and his wife 1. Shirley and you both lived in close proximity to your 18 father? 19 A We did. 20 Q So you were giving him pills. What. pills 21 were you giving him? 27 A Aricept. There were vitamins. I l_~elieve 23 there was blood pressure medicine. There was a lot of 24 pills. 25 Q And how did you keep track between you and 16 2 3 4 5 6 7 8 9 10 ly 12 i3 14 15 16 17 18 19 20 ~~ ~ 22 23 24 25 Shirley? A She would make sure I got a fair share of it t.o last for so long and I would let her know when I was getting out of pills. So she would give me more, and she would tell me which ones he had to have. Q So you both had a supply of pills? A We did. We both had a supply. THE COURT: Now, when did you start monitoring his medicine? THE WITNESS: You mean as far as measuring it out to make sure that he was getting it? THE COURT: Yes. THE WITNESS: I'm not sure of the exact r.imeframe that that was because -- it was in the summer. It was early in that year. I would say maybe a few weeks after that because I know -- THE COURT: I don't know what year we're talking about. THE WITNESS: 2004. THE COURT: The summer of 2004? THE WITNESS: Yes. THE COURT: Okay. THE WITNESS: But I'm not sure exactly when we started that. THE COURT: Okay. Mr. Flower. 17 HY MR. FLOWER: 2 Q So during the spring of 2004 nobody :~~elped 3 your father to see that he took his pills each day? 4 A Not that I am aware of. 5 Q We know that your father went to see 6 Mr. Hughes dur ing that period, May and June of 2004"? 7 A Yes. 8 Q Did your brother Laverne say anything to you 9 before your fa ther's visit? 10 A He told me that he wasn't going to take dad "_1 because he did not want to influence him. ~_2 Q And now going back to in July of 2004, your ~3 father took a trip? i4 A He did. "~5 Q As you described earlier. Where did he go? ,~6 A Jean's sister lived in Arizona, and she ,~7 ;~~~anted dad to come out and visit for awhile. She was fond ~8 of dad. "may Q How was he planning to get there? 20 A He told Tony and I that he was going to drive ?1 out there, and that he could do it in a day. And we tried 22 to explain to him that that wasn't possible. Tony gook it 23 upon himself - - every time dad would come over for ~ meal, 24 he would work on him about that. He would get a mao out, 2.5 and he would s how him how far away Arizona was. And he got 18 a calculator, and he showed him how many miles per dour he 2 would have to drive in order to get there in one da1J. And 3 dad said, well, I'm not going to drive that fast, but the 4 bottom line is he -- we could not convince him that it was 5 out of the question for him to be able to drive. 6 THE COURT: How long did he continue to 7 drive? 8 THE WITNESS: It was -- I would say ~t least 9 into 2005, the end of 2005 that dad was still drivi_~Zg. 10 THE COURT: Okay. Mr. Flower. ~l BY MR. FLOWER: 12 Q How did he ultimately get out to Arizona? ,~3 A Shirley made him airplane reservations. We ~4 also had them take care of getting him, as in the airport "~5 staff, getting dad to the airplane by way of a wheelchair, ,~6 and when he got to Arizona, to get him off so he could meet ,~7 Jean's sister. So he was accompanied by airport staff. 18 Q Okay. Did you see your father's personality ~9 changing from what you had described earlier, how he was a 20 talker? 21 A Yes. Before Jean died I noticed that dad 22 stopped talking. When we went out to eat, he would say very 23 little, and you could try to prompt him into making L4 conversation, but it was yes, no. It was not like -- it was 25 not engaging like it used to be. 19 Q All right. Now, I'm going to take you back 2 to a period between 1996 when your mother died and 1997 when 3 he married Jean, and this is before the will -- prior to the 4 will we are challenging. Do you remember Laverne talking to 5 you about his father's estate plan? 5 A I do. I didn't know what the will read. It 7 was the will that my mother and my father had established 8 prior to my mother's decease. My mother had an illness so 9 it became necessary for them to make sure that they took 10 care of that. 11 During the process of that will, what I was 12 told was that the business -- the water conditioning 13 business that my dad had with my brother, they were partners "14 half and half, that his half of the business was going to be l~ split five ways between his five children, and my little 16 brother Laverne would have to pay his brother and three 17 sisters 1/10th each of the business. And he came to my 18 house. 19 Q Who? 20 A Laverne came to my house during that. summer 21 at least two times, and he complained that he would have to 22 pay us, and he didn't know how dad expected him to come up 23 with that kind of money. It was very upsetting. ~~o I 24 ~~NOUldn't forget something like that. 25 MR. FLOWER: I don't have any other questions 20 on direct examination. 2 THE COURT: Okay. Ms. Morrison. 3 MS. MORRISON: Thank you, Your Honor. 4 CROSS EXAMINATION 5 BY MS. MORRISON: 6 Q Linda, you would agree that your dad's 7 personality, he was a very strong-willed man? g A Yes. g Q Very -- I don't know if stubborn's t;he right 10 word, but when he got something in his head, he was going to 11 stick it to it, from what everybody has told me, is that ~2 about correct? 13 A That is correct. 14 Q And it was very difficult to sway his mind if 15 he had his mind and his heart set on something? 16 A Yes. l~ Q It was difficult to try to change his mind? ig A Yes. ~l, Q And now as far as -- it sounds like, from 2G your description here, that you had spent a good mount of 2~ time with your dad. You lived near him, and you and your 22 husband had meals with him; is that correct? 2~ A That's correct. 24 Q And you would describe it -- would you 25 describe it as a loving, caring relationship? 21 A Yes. 2 Q Would you say that you two were close? 3 A Yes. 4 Q In his later years? 5 A Yes, more so than before. 6 Q You would also agree that your dad was very 7 close to Lavern e; is that correct? g A Yes. g Q And, you know, of course, you are aware that 10 your dad worked with Laverne for 30 some years? 11 A Correct. 12 Q Is that correct? Ever since Lavern~° was out 13 of high school, they worked together in the Black's water 14 conditioning -- the family business; is that right? 15 A Correct. 16 Q And they did recreational things together 17 too; is that right? Hunting, fishing, that sort cf thing? 18 A Correct. 19 Q Did any of the other siblings work in the 20 family business, Black's Water Conditioning? 21 A No. 22 Q So Laverne was the only of the five children 23 to work in the business? 24 A He's the only one that was, yes, involved in 25 the business. 22 Q Sure. And Laverne also helped your dad out 2 with the farm; is that correct? 3 A Yes. 4 Q And did any of the other children work on the 5 farm like Laverne did and put as much time in help~ng your 6 dad with the farm as Laverne did? ~ A When we were younger, yes. g Q How about when your younger -- how .about the 9 duration. I mean from what I understand Laverne w,~rked with 10 the farm with your dad ever since he can remember, and all 11 the way through his adulthood; is that correct? 12 A We did until we got out on our own, yes, we 13 helped. I helped with tomatoes. We picked fruit. So, yes, 14 we all helped with the farm as we grew up and were under my 15 father and mother's care. Yes. 16 Q Sure. And now Laverne though, on the other 17 hand, helped your dad and continued to work the farm with 18 him through adulthood; is that correct? 19 A Correct. 20 Q And none of the other children continued in 21 that manner? 22 A Correct. 23 Q Now, you had mentioned at one point. here the 24 checkbook, and that after Jean had died it was dec~ided that 25 Shirley, Laverne's wife, would handle your father's 23 heckbook; is that correct? 2 A She decided to. I don't recall her asking 3 dad, but I remember her saying she was going to tal~:e the 4 checkbooks, and she did. She gathered them up and took them 5 home. 5 Q Now, when your mom was alive, who handled the 7 checkbook? g A My mother. g Q When Jean was alive and your dad was married 1G to Jean, who handled the checkbook? 11 A I believe that they both did. 12 Q And Jean didn't -- Jean didn't take care of 13 most of the checkbook? 14 A I'm not sure, to tell you the trutr. 1~ Q Okay. You're not sure. So this trip to 16 ~:'ennessee that you mentioned, you said it was June or July 17 of 2004? lg A No. It was right after dad came home after 19 Jean had passed away. They had had a bus trip planned. 20 Q Okay. 2~ A And it was decided to let dad go. We thought 22 it might be good for him. 23 Q So what would you say -- Jean died in March; 24 is that correct? 2~ A Yes. 24 Q 2004. This would maybe be April or May? 2 A No, I believe it was still in March. 3 Q Still in March. And Jean's death -- Jean's 4 health, this was an unexpected death, was it not? 5 A Yes. 6 Q It happened completely out of the blue. She 7 didn't have li ngering health issues, it was sudden and 8 unexpected; is that correct? G A Correct. 10 Q And I'm sure it was very traumatic for your 11 father, wouldn 't you say? 12 A Yes. 13 Q Now, how did you find out or when did you 14 find out about the current will that is being contested 15 here, the 2004 will that your dad had written? 16 A My brother told me. l~ Q Which brother? lg A Laverne. 19 Q Laverne told you. And it sounds like, I 20 imagine that y ou were very upset about the contents of the 2,~ will and your father's distribution; is that correct? 22 A All he said to me was, because we talked 23 regularly, we worked together -- 24 Q Excuse me. I'm asking what your reaction was 2~ to the will. Were you upset by the distribution ghat your 25 father had written in his will? 2 A If you mean when Laverne talked to me, all I 3 knew was that he said dad gave me the house. This was prior 4 to dad dying. 5 Q Now, I'm asking you when you found out -- 6 after your father had passed away? ~ A Yes. g Q And the will -- yeah, you saw the actual will 9 that your dad had written, you were very upset wit'n the 10 distribution; is that correct? 11 A Yeah, because it wasn't the way dad had 12 explained it to me. 13 Q And in your opinion the will should have been 14 more evenly distributed among the siblings; is that correct? 15 A All I know is what dad asked me to do earlier 16 back in the year -- it was between 2000 and 2002 when dad 17 talked to me about the rental properties. He never talked 18 to me about a will prior to that, but he did contact me 19 about how he was going to handle it. 20 Q But you think that the will should be more 21 evenly distributed among the children; is that correct? 22 You are upset with the current will because Laverne gets an 23 additional amount? 24 A I am only upset because the one an:~ only time 25 that dad discussed what he wanted to do with his -.gill is 26 hat he did when he did it in 2002, but he changed it, and n't know wh 2 do y• 3 Q Now, we talked about your father, and you 4 mentioned some times when he may be forgetful and ghat sort 5 cf thing. You do agree that before 2004, in 2000, 2001, 6 2002, 2003, that there were no issues or no concerns with 7 your father's memory or anything at that time; is ghat 8 correct? A We, as in my husband and I, were concerned ~C about dad and the fact that his mind wasn't as sharp as it 1~ should be, and this was in 2003. And the reason why I knew 12 that is because it was in the same timeframe when I was in 13 the hospital, and the fact that he didn't know who told him. 14 Q Okay. But 2000 -- 15 THE COURT: I need to interrupt for a moment. 16 I think there was a doctor -- X17 MS. MORRISON: Yes. 13 THE COURT: -- who was going to be called at 19 about 10:30? 2C MS. MORRISON: Yes, and, Your Honor, this is 21 actually my last question. So we should be just on time 22 here if that is okay. 23 THE COURT: Go ahead. 24 MS. MORRISON: Okay. Thank you. 25 BY MS. MORRISON: 27 Q So just to clarify though, you did riot have 2 any concerns with regard to his memory in the 1990x, 2000, 3 2001, maybe in 2003 you started to have some conce}-ns; is 4 that correct? 5 A Yes. 6 MS. MORRISON: Okay. Thank you. That is all 7 of the questions then, Your Honor. Thank you. g THE COURT: For the moment you can step down. g I think Mr. Flower may have more questions later. Which 10 counsel is going to call the doctor? 11 MS. MORRISON: That would be me, Your Honor, 12 and it is Dr. Orville McBeth, and I do have a telephone l~ number. I am not sure how we go about calling him. 14 THE COURT: The stenographer can help you. 15 You will use this phone here. 16 (A phone call was 17 Dr. Orville McBeth ) ~g THE COURT: We'll 19 Okay. Ms. Davis, if you want to 20 few questions if you will resume 21 (Linda Black Davi attempted to be ~.~laced to call back in 15 minutes. resume the stand. I have a the stand. s resumed the stand.) 22 BY THE COURT: 23 Q I think you mentioned a wheelchair at one 24 pcint. Was your father able to walk, and, if not, when did 25 he stop walking? 28 A He was able to walk. 2 Q I see. 3 A It was a way to get him assistance. 4 Q A way to what? 5 A For him to be assisted, to get to t_~le airport 5 and to his destination. ~ Q And this family business, I gather it is a g water condition ing business? g A It is. 10 Q How big is it or was it? Do you have any 11 idea of the size of the business? 12 A As far as the value of it? 1< Q Yes. 14 A I would say probably close to a half a 15 million. 16 Q And was he a partner in it or -- l~ A My brother or my father? lg Q Your father. 19 A He started the business, and as my brother, 20 my little brother Laverne, got older and got out of school, 21 he joined dad in the business, and then he became a partner 22 half and half. 23 Q And were they the only partners in the 24 business? 25 A Yes. 29 And were you aware that your father was going 2 to go to Mr. Hughes to change his will? 3 A I didn't know why. I assu med it was because 4 Jean had passed away, and that perhaps he needed -- I knew 5 there was some instances in the will that he might want to 6 change be cause of Jean passing. That is why I thou ght he 7 ~.aent . Q So you were aware that he was going to change 9 the wi~l in some way? 10 A I didn't know what he was changing. I just 11 know that he had -- 12 Q I understand you didn't know how, but you 13 were aware that he was going to an attorney to charge the 14 will? 15 A I don't know what he was changing. I knew i6 that he was going to the attorney to change something. 17 Q Now, did you tell Mr. Hughes that you felt i8 that he was not competent to change the will? 19 A You mean after dad passed away? 20 Q No, at the time that he went to Mr. Hughes. 21 A I wasn't there. I did not go. 22 Q No, I understand, but you knew he was going? 23 A Yes. 24 Q And -- okay. And you didn't -- 25 A I trusted my brother would make sure that was 30 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 i7 18 19 20 21 22 23 24 25 taken care of correctly. Q I see. And I gather there was a prior will; is that right? A Yes. Q And is that available at this point? I gather that will be an exhibit? MS. MORRISON: Yes, Your Honor. THE COURT: Okay. Mr. Flower, any further questions? MR. FLOWER: No, Your Honor. THE MS. THE %ou. Mr. Flower. MR. testimony, I may o rebuttal. COURT: MORRISC COURT: FLOWER: zly call Ms. Morrison? N: No, Your Honor. Thank you. Okay. You may step down:. Thank Aside from my deposition one witness, if necessary, on THE COURT: Okay. All right. Are you resting then, Mr. Flower? MR. FLOWER: Yes. THE COURT: Or did you want to wait for ~~r. McBeth's testimony? MR. FLOWER: I have a question for Dr. McBeth. THE COURT: So you do want to wait? 31 MR. FLOWER: I think, yes, I want tc wait. 2 THE COURT: Okay. We will take a short 3 recess, and then resume in about 10 minutes. 4 (A r ecess was taken at 10:40 a.m.) 5 AFTER RECESS 6 THE COURT: Please be seated. 7 MS. MORRISON: Your Honor, we do have 8 Dr. McBeth on the phone. 9 THE COURT: All right. Doctor, this is Judge 10 Oler in Cumberland County Court. Thank you very mu~~h for 11 being available. C an you hear me? 12 THE WITNESS: Just barely. 13 THE COURT: All right. Would you raise your 14 right hand, please? 15 THE WITNESS: Yes, sir. i6 THE COURT: Do you swear or affirm that the ,~7 statements you make today will be the truth, the whole 18 truth, and nothing but the truth, subject to the penalties ,~ 9 of perjury? 20 THE WITNESS: Yes, sir. 21 THE COURT: All right. Thank you. 22 Ms. Morrison. 2.3 Whereupon, 24 ORVILLE G. McBETH, JR., M.D. 25 having been duly sworn, testified as follows: 32 DIRECT EXAMINATION 2 MS. MORRISON: Your Honor, before we get 3 started, if it is okay with counsel to give the Court, since 4 we're taking witnesses out of turn, a frame of reference, if 5 I may just give you two dates, the date that Mr. Black went 6 in and met with Jim Hughes to change his will, and the date 7 that the will was executed so you have a frame of reference? 8 THE COURT: If you can stipulate to them that 9 ~~~ould be helpful. 10 MR. FLOWER: Yes. May 13th and June 9. 11 MS. MORRISON: May 13th, 2004, Glen r_ Black 12 met with Jim Hughes to discuss changing his will, and on 13 June 9th, 2004, he came back in and signed the will with Jim 14 Hughes. 15 THE COURT: All right. 16 BY MS. MORRISON: 17 Q Okay. Dr. McBeth, could you please state 18 your full name and your business address? 19 A Okay. My full name is Orville Glenr_ McBeth, 20 Jr. My address at my office is 3375 Carlisle Road, 21 Gardners, Pennsylvania, 17324. 22 Q And what is your occupation? 23 A I am a family physician. 24 Q And could you briefly go over your 25 qualifications, where you went to college, medical school, 33 and your experience? 2 A Okay. I went to Penn State University 3 undergrad and also for medical school, graduated in 1981 and 4 became board certified, and I retook my boards again this 5 past summer, as we need to be recertified every seven years, E and I am still board certified in family practice. ~ Q And have you been in family practice since 8 -,you graduated in 1981? g A Yes, ma'am. 10 Q And the practice that you have there in 11 Gardners, have you been in that location with that practice 12 since then? ~3 A Yes, ma'am. ~_4 Q Okay. And the individual that we a_-e here 15 talking about today is Glenn Black. Could you tel. the 16 Judge when you first met Mr. Black? 17 A I first met Mr. Black in 1984, whic~n is when 18 I started my practice here in Adams Cumberland Med;._cal 19 Center. 20 Q Okay. And I imagine you met him as his 21 physician because you were his treating physician. or his 22 family physician? 23 A Yes, ma'am, I was. 24 Q And so you have known him since 1984. Could 25 you describe to the Judge a little bit about his 34 personality, and, you know, when you think of Glenn Black 2 what do you -- what do you remember of his personality and 3 the kind of man he was? 4 A Glenn was a business owner, and he managed 5 his water conditioning business for several years until he 6 gave that over to his son, but Glenn was a very 7 authoritative type of individual who really desired certain 8 things and was able to obtain those things that he desired. 9 He had a strong will to do and to get what he set his sights 10 on, and that is how I saw him. It was difficult to get him 11 sometimes to be convinced that he needed to do X, Y or Z 12 because of health issues because he wasn't convin~~ed that 13 that is necessarily what he needed to do. 14 Q Okay. So even you had trouble convincing h:im 15 sometimes with regard to medical issues? 16 A Yes, ma'am. l~ Q Okay. And at some point in I think early 18 2004, perhaps late 2003, did his family express some 19 concerns with regard to his memory? 20 A Yes, ma'am. 21 Q And I'm going to -- you have his medical 22 record there in front of you? 23 A I have pulled it up. 24 Q Okay. Great. I'm going to give tc the Court 25 as well, if you would like to follow along, Exhibits 1 and 35 2, if you wouldn't mind. 2 THE COURT: Has the stenographer narked these 3 exhibits? 4 MS. MORRISON: Yes, these are marked by the 5 stenographer, and I didn't know if the Court would like a 6 copy to follow along with the testimony. ~ THE COURT: All right. And they are marked 8 as Respondent's Exhibits 1 and 2? 9 MS. MORRISON: Yes, that's correct. 10 THE COURT: Mr. Flower, do you have any 11 objection to my seeing them? 12 MR. FLOWER: No, Your Honor. 13 THE COURT: All right. 14 MS. MORRISON: If I may approach, ':'our Honor. 15 THE COURT: Certainly. 16 BY MS. MORRISON: 17 Q Okay. Dr. McBeth, the Judge and both counsel 18 have a copy of the medical record in front of us as well, 19 and if you could, let's see, let us know, you know, in 2004 20 there if there were any notations with regard to Mr. Black's 21 memory in the record. 22 A Okay. I am scrolling back to 2004, forgive 23 me. I put some other information ahead of that. okay. 24 Okay. What date are we at in 2004? 25 Q I guess maybe we would go to the January 7, 36 2004, entry. There are numbers up at the top right corner 2 of the medical record which I am not sure who put. them 3 there, but maybe we can use those as a reference, page 12-A. 4 A Okay, 12- A. Yes, I have 12-A here. Okay. ~ Q And on January 7, 2004, it looks like -- was 6 there a concern with regard to memory? 7 A Okay. Yes. It is the first line, patient 8 seems to me as if he is having more difficulty wish his 9 memory. However, I did question him at that time, and he 10 denied any issue with that, and that is all I commented on 11 at that particular point. 12 Q You did make a notation there too hat the 13 patient was still working one day a week; is that correct? 14 A Correct. 17 Q And how old would he have been at this time 15 in 2004? 17 A Well, his birth date is 1925 so... 18 Q So approximately 78, 79? 19 A Right. 2G Q Okay. 21 THE COURT: Was his birthday Septenber 16, 22 1925? 23 THE WITNESS: Correct. 24 THE COURT: All right. Thank you. 25 BY MS. MORRISON: 37 Q Okay. And as we move along here, January 2 12th it looks like you -- Mr. Black was in to see you again, 3 of 2004, Janu ary 12? 4 A Uh-huh. 5 Q Was there any notation there with regard to 6 his memory? ~ A January 12th, 2004. Sorry, I went the wrong 8 direction. 9 Q That's okay. 10 A Okay. January 12th, 2004, was just 11 documentation of a refill of a prescription. 12 Q Okay. It looks like February 6, 2004, there 13 is another mention here about some confusion with Mr. Black.; 14 is that correct? 15 A Right. 16 Q With an appointment? 17 A Correct. That he was out at a hunting shop 18 the day prior to and had missed his employment, which was 19 the previous d ay. 20 Q Okay. 21 A That is the comment that I made there. 22 Q And then it looks like February 23rd, 2004, 23 he was back in again, and it doesn't look like there's any 24 notation there with regard to his memory; is that correct? 25 A Correct. 38 Q Okay. Now, as we move forward, March 4th, 2 2004, as you have noted here, that is when his wife Jean had 3 passed away; is that correct? 4 A Correct. 5 Q And on April 2nd, 2004, it looks like there 6 was an exam given to Mr. Black. Could you describe to the 7 Court what exactly this mini mental status exam i_-ZVOlves? 3 A A mini mental status exam involves 30 9 questions in reference to the memory, and it is a 10 standardized test, and questions that are asked on that 11 include your date of birth, where you live, the county in 12 which you live, the state, et cetera. 13 Also they are asked to spell world backwards. 14 They are asked to remember three objects which they are 15 given, and then later on asked to recall those, also to draw 16 a diagram that is already drawn on the sheet of paper, just 17 to repeat that in the drawing, and he scored 24 out of 30. 18 Thirty being a perfect score. Above 19 would be considered 19 mild dementia, and below 19 would be moderate, and below 9 20 would be severe. 21 Q Okay. So this exam is given when there is 22 concerns with regard to someone's memory; is that correct? 23 A Correct. 24 Q And so 30 is perfect? 25 A Correct. 39 Q And I think you mentioned above L~? 2 A Is mild. 3 Q Is mild. Mild what? Mild dementia? Is that 4 what you woul d say? 5 A Correct. 6 Q Okay. So there is a range there from 19 to 7 30, which is perfect, that all of that is conside}~ed mild 8 dementia? An ywhere between 19 and 30? A Correct. 10 Q Okay. And he scored a 24? I~ A Correct. 1~ Q Okay. 13 THE COURT: And what day was that again? 14 THE WITNESS: I'm sorry, I could nct hear. 15 THE COURT: What day was that? 16 THE WITNESS: That date was April 2nd, 2004. 17 THE COURT: Thank you. 18 BY MS. MORRISON: 19 Q Okay. And you make a notation in your office 20 note here that -- let's see, he thought the year w~_~s 1940? 21 A Correct. 22 Q Now, was that factored into the scope? 23 A Yes. 24 Q Of the mini mental status exam? 25 A Yes, ma'am. 40 Okay. So did he lose a point or something? 2 A Yeah, he lost one point for that incorrect 3 answer. 4 Q Okay. So that was factored into this 24 out 5 of 30? 6 A Correct. ~ Q Okay. And now what would you -- how would 3 you describe, and what would you consider the typ-~cal 9 affects of mild dementia in general, in your medical 10 practice, in your experience of someone that would score 24 1~ out of 30, how would you describe that would affect their 12 mental capabilities? 1~ A It really would be of minor significance, 14 such as forgetting his appointment or not remembering where l~ he placed the keys, the car keys, or something along that 16 line. He was able to drive and get to where he wanted to go 17 at this point, and do that without difficulty for actually 13 another year. So it would be minor issues of just 19 forgetting things associated with just our normal ~'ifestyle. 20 Q Okay. And would you consider these minor 21 things at this stage and at this level, 24 out of 0, mild 22 dementia, occurring frequently or how would you characterize 23 the frequency? 24 A Well, what we find is that sometimes 25 individuals -- and it is variable, and it could be within 41 the same day -- they are on, and they can answer some of 2 these questions easily and appropriately, other times that 3 they are actually off, and they can't answer them. 4 appropriately. So it would be variable from one part of the 5 day to another. 6 Q And would you consider the affects and this 7 forgetfulness as sporadic or would you consider it more 3 persistent, I guess, as in general? A Well, I think a score of 24 out of 30, in 10 general, most likely not just sporadic per say, bt.it li certainly sporadic is possible with anybody. As I just 12 said, they could be on one time and off the next time, but 13 if you are going to make me decide, I would probably say ir: 14 general some confusion there. 15 Q Okay. And as far as -- okay. So we have 1E some forgetfulness? 17 A Correct. 18 Q That comes along with this level of mild 19 dementia. Would you expect any changes with regard to 20 someone's personality, determination, that sort of thing? 21 A No, ma'am. In fact, unless you are really 22 questioned hard, you won't pick it up, that they have a 23 memory issue. 24 Q Okay. So you may not -- otherwise -- 25 otherwise you may not even be able to tell, their 42 personality would remain about the same? 2 A Correct. 3 Q And how about like activities of daily a living, is that somethin that g you would expect with regar 5 to -- how would this mild dementia affect his activities of daily living? ~ A It should not really affect it muc_1 at all. 3 He should be able to do the normal things that they have 9 done and continue to do that pretty well. 10 Q Okay. So you would consider this =ike mild 1~ dementia, 24 out of 30, sort of the beginning states? It 12 seems to me that this is sort of a gradual process of -- yc~u 1? know, the dementia would gradually, you know, beccme more 14 and more prominent, I guess? 15 A Yes, I would say that is correct. It would 16 be more of a gradual issue. 17 Q And this level here would be considered 18 somewhat the beginning stages? 19 A Correct. 20 Q Okay. Now, you met with Mr. Black. You have 21 known him for 20 years. He has been your patient. You know 22 his personality. April 2nd, 2004, when you gave this exam 23 ro him, did you notice any changes in his personality or 24 demeanor? 25 A No, ma'am. 43 Q Him in particular. Was he still strong 2 willed? Was he still the same Glenn Black that you always 3 knew? 4 A Yes, ma'am. 5 Q Do you think that he still was, you know, at 6 this time, when you gave him this exam, still this same ~ person that was firm in his opinions? ~ A Yes, ma'am, I would say so. 9 Q And as far as the impact on him in i0 particular, with this mild dementia and his activities of 1,- daily living, I think you mentioned that he was stall 12 driving; is that correct? 13 A That is correct. 14 Q And I think if we look in your office notes 15 here on the date April 23rd of '05, which let me try to give 16 you a page here -- it looks like it's -- well, it's hard to 17 read. It looks like 16-B up at the top right? 13 A Okay. 19 Q There's an April 23rd '05, entry. 20 A Okay. And what was the date again? 21 Q April 23rd '05. 22 A Oh, okay, 16-B, yes. Drove to Charn~~ersburg 23 last evening, lost and had accident not -- not -- it's 24 pretty bad when I can't read my own handwriting. 25 Q Could it be not involving anybody else? 44 A Yes, not involving anybody else. 2 Q Okay. 3 A So family had taken his keys at that point in 4 time, and we did also some blood work I ordered t:~ere just 5 to make sure there wasn't anything acute going on that we 6 could treat, and also as you see in the next note on 5/25 I 7 ordered a CAT scan of the brain to make sure there wasn't 3 any tumor or problem along that line. 9 Q Okay. So according to your note here, 10 correct me if I'm wrong, it looks like Mr. Black continued 11 to drive on h is own for over a year since you had given him 12 the mini mental status exam; is that correct? l~ A That is correct. 14 Q And at the time you gave him that exam, he 15 was living on his own, is that true as well? 16 A That is correct. l~ Q And I think, if I could direct you to page 18 19-A, there's a note dated February lst, 2006. 19 A Okay. Okay. Yes. 20 Q And if you wouldn't mind just taking a look 21 at that note, I believe your notes here say that -- is this 22 the point when he then went to an assisted living facility? 23 A Correct, and I state that he is to coo to 24 assisted living tomorrow, which would have been February 25 2nd, 2006. 45 Q Okay. And to your knowledge was r.e still 2 living on his own from the date of the mini mental status 3 exam in April of 2004, until this date in 2006? 4 A Yes, ma'am. 5 Q Okay. And at the time that you gave him this 6 mini mental status exam, we're just trying to get a glimpse 7 into Glenn Black and his mind at that time, would you have 8 any concern that he would have what we call in the law a 9 weakened intellect in April of 2004? 10 A No, I would not consider it weakened. lt- Q And I will give you a couple of otr~ier 12 describing words, I guess, of how that term weakened 13 intellect is described in the law. Would you consider his 14 condition in April of 2004 as persistent confusion, 15 forgetfulness and disorientation? 16 A No, ma'am. l~ Q Would you consider his cognitive abilities a 18 substantial impairment? 19 A No, ma'am. 20 Q Would you say in April of 2004 that he would 21 have been susceptible to manipulation? 22 A No, ma'am. 23 Q And knowing his personalit y, would ~,rou 24 believe at that time that he would have been able to be 25 influenced to do something that he otherwise would not want 46 A Correct. 2 Q And that was the date of the evaluation. 3 Did Dr. Mosser give Mr. Black a mini mental status exam? 4 A Yes, he did. He scored a 25 out cf 30 by his 5 office. 6 Q Okay. So this is over a month after you had 7 given Mr. Black the exam, and he actually scored a little 8 bit higher with Dr. Mosser; is that correct? ~ A Correct. 10 Q And what was the diagnosis that Dr. Moser 11 had stated in this letter to you? 12 A He actually stated -- and down on the bottom 13 of the second page where his signature is located, he gave 14 him a diagnosis of mild cognitive impairment. 15 Q Okay. And in your opinion, and in accordance 1E with Dr. Mosser's letter here, is that I guess a stronger 17 opinion or diagnosis than yours or one that is a little bit 18 more favorable? 19 A Well, certainly more favorable to Glenn at 20 the time he states in the last -- next to the last paragrap_~ 21 that at least there is some mild cognitive impairment, and 22 phis may be a predecessor to or of dementia. So in his 23 viewpoint, and what I raised from Dr. Mosser's comrlent, that 24 I had made a diagnosis of mild dementia, and Dr. Mosser, who 25 was the specialist, actually placed him a little b-t above 48 that or a more mild condition. 2 Q Okay. So he's saying it doesn't suite reach 3 dementia, but it could very well be close to that? 4 A Correct. 5 Q Okay. Now, Dr. McBeth, during the office 6 visits in the 20 some years that you had treated ~~Ir. Black, 7 did Laverne Black ever come to those office visits to 8 accompany his dad? ~ A Yes, he did. ~'~ Q And, in fact, Linda -- Linda, his daughter, 1, did she accompany him as well on occasion? 12 A Yes, ma'am. 13 Q And so you had -- did you have an opportunity 14 to observe the interactions between Glenn Black and Laverne 15 Black, his son, during those office visits? 16 A Yes, I did. l~ Q And could you give the Court I guess your 18 impression of the type of relationship between father and 19 son, Glenn Black and Laverne Black, from your observations? 20 A Observations, again, just as you would expect 21 any sibling. He basically came along and listened. The 22 interchange wasn't between Laverne and myself, but was 23 between Glenn and myself. Glenn was still the person in 24 charge, so to speak, and that is the person that I addressed 25 when Laverne was along with him. 49 Q And did you get that impression up to and 2 including April of 2004 when you gave him that exam? 3 A Yes, ma'am. 4 Q And did you ever get any indication that 5 Laverne had some type of, I don't know how to phrase it, 6 power or leverage over his father? ~ A No, I never got that opinion at a11. 3 Q And would you say that opinion wou~~d still stand even through April 2004 when there were these memory 10 issues? lI A Yes, ma'am. 12 Q And, Doctor, all of the opinions you have 13 given here today, would you state that those were within a 14 -- to within a reasonable degree of medical certainty based 15 on your experience, training, and education? 16 A Yes, ma'am. l~ MS. MORRISON: Thank you very much. That is 18 all the questions, Your Honor. 19 THE COURT: Mr. Flower, do you mind if I ask 20 a couple of questions? 21 MR. FLOWER: No. 22 THE COURT: All right. 23 BY THE COURT: 24 Q I gather at some point you were treating 25 Mr. Black for his mental lapses. When did you begin giving 50 him medication for it? 2 A I would have to go back here and look. I 3 remember at one note starting Namenda, and I thought that 4 was close to the time of the actual nursing home admission, 5 but let me go back and try to locate that for you. And 6 please realize my medical record is on computer, and I have 7 to scroll through things, not as simple -- 8 Q I see. 9 A So I'm still looking here. Okay. Apparently 10 on February 8th, 2006, I started Namenda, five mi=ligrams 11 once a day for one week at that time. And I am looking back 12 further to see if I had started anything else prior to that. 13 So far I'm back to 2005, December. I don't see anything 14 there. Okay. And let me slip out of this window. 15 Apparently I had had him on Aricept, 10 1E milligrams, which is used for dementia. I refilled that in 17 July of 2005. And now I am trying to discern when I started 18 that. I am going to flip out of this window and look at 19 another list I may have had at that point in time that will 20 give me a better idea to speed this process along a little 21 bit. 22 MS. MORRISON: Your Honor, if I may help out, 23 I may be able to pinpoint it in the record here. April 24 12th, 2004, I believe was the first time samples of Aricept 25 were given. 51 THE WITNESS: Yes. I actually have my med 2 list. In 2004 I believe that it is listed here in March, 3 but at any rate, I can go back to that note now and tell you 4 specifically. So let's see, page 76, okay. For 2004, okay. 5 Okay. I'm getting there. I'm sorry about that. I started 6 April 12th, 2004. Yes, it does look way. April I gave him 7 samples at that point in time. That is what my note says, 3 and I'm just looking for that now to see if there was any 9 indication I started before that. I'll go back another few 10 months here just to make sure. 11 Okay. So I would say based on my note Apri,~ 12 12th, 2004, I started Aricept, 5 milligrams, once a day, and 13 that is a medication used for dementia. 14 BY THE COURT: 15 Q All right. And is there any other medication 16 that was prescribed for him to deal with the dementia? 17 A I'm sorry. Did you ask if there was another 18 medication that went along with that for dementia? 19 Q At any point, yes. 20 A I had mentioned the Namenda previously. 21 That was started a while later in a lower dose, but they are 22 commonly used together. 23 Q And do you know when that was start_~d? 24 A I will go back through my record and see when 25 that was. I had already told you. So I don't kno~~~ if 52 - anybody can -- 2 Q Does either counsel remember wher_ that 3 medication was started? 4 MS. MORRISON: Namenda? 5 MR. FLOWER: That wasn't in the frame of time 6 that I was looking at. ~ THE WITNESS: It was -- if I remember 8 correctly, it was 2006 once he was in the nursing home. 9 BY THE COURT: 10 Q All right. And I see he was getting l1 Risperdal, at least as of August 2004. Is that also for hi_s 12 mental condition? 13 A Yes, sir. That is used for folks u;ho are 14 confused, and really specifically not confusion, but who are 1~ having some hallucinations. 16 Q Do you know when that was started? l~ A I will go back here and again look in the 18 rotes . 19 MR. FLOWER: It might be June 30th. 20 THE WITNESS: It was close -- by my memory, 21 close to the time of admission into the nursing home. 22 THE COURT: All right. 23 THE WITNESS: Okay, 2005. He's on ghat in 24 January of 2006. Let me again go look at the med =ist here. 25 MS. MORRISON: Your Honor, there's a notation 53 2 THE COURT: Let the Doctor -- 3 THE WITNESS: It was in 2004, and he was 4 started on Risperdal, and I will have to go back and look 5 specifically at the month. And again -- okay. Okay. I 5 increased it in February of 2005. July 30th, 2004, I have 7 down delusional thinking, making advances to daughter, a calling her to get some lovin, making advances at 9 sister-in-law, and that is when I started the Risperdal, 10 July 30th, 2004. 11 BY THE COURT: 12 Q All right. Thank you. And Ms. Morrison 13 asked you some questions about weakened intellect on the 14 part of Mr. Black. Would your answers be any different from 15 what you gave as of the date of May 13, 2004? 16 A As to what date? 17 Q May 13, 2004? 18 A May 13th? 19 Q Yes. 20 A No. My answer would not be differe_t 21 because, again, this delusional thinking that he had was 22 acute in nature and was not going on for days befoy~e they 23 gave me a call, and it happened fairly quickly. So my 24 thoughts would be the same. 25 Q And the same question for June 9, 2004. 54 A That would be correct as well. 2 THE COURT: All right. Mr. Flower. 3 CROSS EXAMINATION 4 BY MR. FLOWER: 5 Q Yes. Dr. McBeth, you weren't sure whether you started medication in 2006, 2005 or 2004. Is it safe to 7 say that your clinical notes are likely to be more accurate 8 than your recollections? 9 A Well, I found them. I spent all of that time 10 finding them. I told you the dates that were started, and 11 they were according to my clinical notes. 12 Q But before you scrolled through to 2004, 13 where did you first look to find out when prescriptions 14 began? 15 A I went to a medication list, also from the 16 old chart, and I say the old chart because we've been 17 computerized for 2 1/2 years. So all of this is basically 18 on the computer, and I have got to scroll through pages, and 19 I went through a medication list that I had put dates on for 20 start dates. 21 Q Excuse me, Doctor. You went througr~_ these 22 records in a deposition about a week ago, and you were able 23 to look then and to see that you began him on Aricept in 24 April of 2004, about the time you did the mini mental status 25 exam. I am not trying to critique your memory, but would it 55 be safe to say that your clinical records are likely to be 2 more accurate than your recollection is now? 3 A My clinical records should be more accurate 4 than my memory, and I did not understand what you said than 5 I said back two weeks ago because I could not hear you well. '' Q Okay. I will try to speak louder. ~ THE COURT: I think if you would come ~ forward, Mr. Flower, it would be easier for the Doctor. 9 BY MR. FLOWER: 10 Q Would it be -- I believe you said ghat the 11 beginning -- the early dementia that he had under your 12 assessment in April of 2004 was a progressive kind of an 13 illness? 14 A That is correct. 15 Q And on January 7th you noted on your own that. 16 he was having more trouble with his memory? 17 A Correct. 18 Q On February 6th you noticed that he seemed to 19 be confused? 20 A Correct. 21 Q That was the date that he asked you if your 22 apples were off yet? 23 A Correct. 24 Q What time do your apples usually fall off the 25 tree? 56 A We pick them in October and November. 2 September, October, and November. 3 Q When Dr. Moser asked him what the year was 4 and he said '32, Dr. Moser took 3 points off. W~~zy did you 5 take only one for him thinking it was 1940? ~ A Because with that date, if you wane to get 7 specific about it, Dr. Moser would have taken one point of_f 8 for 1932, but there were other dates associated with that, 9 like the day of the week or the month, and because a mini 10 mental status exam is the same standardized across the 11 world, and there is only one point taken off for a missed 12 year, one point for a missed day, one point for a missed 13 month. So I can assume that Dr. Moser again had she three 14 points because the three dates were wrong. 15 Q Is there a question regarding the time of L6 year, spring, fall, winter, summer? 17 A There is. I will pull it out here and tell 18 you specifically. One is the year, season, date, and month. 19 Q Okay. ~0 A So, yes, sir, there is a question fcr season. 21 Q So he thought that it was fall during April 22 or May, even with prompting, and he thought that ycur apples 23 were still on the tree or wondered if they dropped off in 24 February? 25 A That is correct. 57 Q That would indicate some factual 2 misunderstandings, wouldn't it? 3 A I'm sorry. That would indicate what? 4 Q Factual misunderstandings? 5 A Factual? Q Yes. ~ A Yes, sir. That is what the mini mental 8 status exam is about, factual information. 9 Q And when you said that Dr. Mosser's opinion 10 of at least some mild cognitive impairment was actually less 11 severe than your assessment of beginning dementia, I didn't 12 understand you when you said that -- in answer to 13 Ms. Morrison's questions, that he wouldn't have had a 14 weakened intellect even though he had at least some 15 cognitive impairment. Is there something I am not 15 understanding there or is it just a conclusion? l~ A No. His will and his drive to do X, Y, and Z 18 is different than his intellect. He still has a st_.rong 19 willpower. He was still the Glenn who did not want. to take 20 medication or did not want to do X, Y, and Z. That had not 21 changed. 22 Q But he did have some cognitive impairment? 23 A Yes, sir. 24 Q On May 24th of 2004, you said he still is 25 able to drive short distances, and then you said his son is 58 okay with that. Why did you care what the son felt about 2 that? 3 A It is important, as you talk with parents and 4 children, that the family is in agreement with your 5 decision, and he was in agreement with that decision. 6 MR. FLOWER: Okay. No further questions. ~ THE COURT: Ms. Morrison, do you have g anything further? 9 MS. MORRISON: Just real quick, You~~ Honor. 10 REDIRECT EXAMINATION li BY MS. MORRISON: 12 Q Dr. McBeth, when you began giving Mr. Black l3 Aricept in April of 2004, I believe it says 5 milligrams. 14 A Um-hum. 15 Q What kind of dosage is that for Ari:~ept? 16 A That is the smallest dosage. Usually it is 17 given for a month, and then it is increased to 10 milligrams lg if they are tolerating it well. 19 Q And I think, if we look at your notes, April 20 12th, 2004, is when that 5 milligrams began. If we can move 21 forward in time, let's say May 24th of '04, how much Aricept 22 was being given at that point? 23 A Okay. 24 Q Based on Dr. Mosser's report. 25 A Based on Dr. Mosser's report -- I wil,~ pull 59 it up here. Okay. Depending on how much better he is on 5 2 -- okay. He was on 5 milligrams at that time as well. 3 Q So May 24th he was still on 5 milligrams, the 4 minimum dosage? 5 A Correct. 5 Q Okay. ~ A And he suggested waiting six weeks or so on g that dose before increasing. 9 Q Okay. ~0 THE COURT: Anything further, Ms. Morrison? 11 MS. MORRISON: No, that's all. Thank you 12 very much, Doctor. 13 THE COURT: Mr. Flower, anything further? 14 MR. FLOWER: No, thank you. 15 THE COURT: All right. Doctor, I just had 16 one question. I gather that you did not report Mr. Black to 17 the State as being unqualified to drive, at least as of June l~ 9, 2004; is that correct? l~ THE WITNESS: That is correct. 20 THE COURT: All right. I want to thank you 21 very much for your testimony. I know we took a lct of your 22 time, and we really appreciate it, and you are excused. 23 THE WITNESS: All right. Thank yol.i very 24 much. 25 THE COURT: Thank you. Now, Mr. r-ower, did 60 you have any further evidence that you wanted to present? FLOWER: I was planning to question MR 2 . 3 Mr. Hughes, but I believe he is going to be called on 4 direct, and I will question him at that point. 5 THE COURT: So are you going to be resting 6 your case? ~ MR. FLOWER: I rest. THE COURT: Now, is there another will that 8 g you would want me to say was in effect if this will is not? 10 MR. FLOWER: I was going to introduce that by 11 having Mr. Hughes identify it, but yes, this will be the 12 exhibit, a February 2002 will. THE COURT: I believe that has been marked as 13 14 Petitioner 's Exhibit 4. (Petitioner's Exhibit No. 4 was marked for 15 16 identification.) 17 THE COURT: Ms. Morrison, do you agree that 18 that's the immediately prior will that Mr. Black had? 19 MS. MORRISON: Yes, Your Honor. 2C THE COURT: All right. And do you have any 21 objection to the admission of that item? 22 MS. MORRISON: No, Your Honor. 23 THE COURT: Petitioner's Exhibit 4 is 24 admitted. (Petitioner's Exhibit No. 4 was admitted into 25 61 evidence.) 2 THE COURT: Mr. Flower has rested, and we 3 will continue on until about 10 of 12, and then we will have 4 to resume another day. Ms. Morrison. 5 MS. MORRISON: Your Honor, we would call 6 Laverne Black to the stand. 7 Whereupon, 8 LAVERNE BLACK g having been duly sworn, testified as follows: 10 DIRECT EXAMINATION 11 BY MS. MORRISON: 12 Q Mr. Black, would you please state your full 13 name and your address? 14 A Laverne C. Black, 4375 Carlisle Road, 15 Gardners, PA. 16 Q And, Mr. Black, when did your father pass 17 away? 18 A March 29th of last year. 19 Q And could you describe 'co the Judge a little 20 bit about your dad, his personality, and how you remember 21 him? 22 A He was very warm to people. He got: along 23 with most everybody. He could have a conversation with 24 anyone, and he was well liked and renowned. He w~_~s very 25 opinionated. I mean he had a strong will, and when he 62 believed in something, he stood his ground. 2 Q And when he did believe in something and 3 stood his ground, was it pretty difficult to sway his 4 opinion? 5 A Unless you really like arguing, yes, there is 6 no sense arguing with dad. ~ Q And your relationship with your dad, were you g close to him? 9 A I was close, yes. 10 Q And as far as, you know, where you~ived, you 11 gave us your address, and your father lived, did you live in 12 close proximity to your dad? i3 A Yes. 14 Q And we talked about -- we heard a little bit 15 of testimony about the business, Black's Water Conditioning. 16 How often did you see your dad? l; A Every day. 18 Q Every day. And are we talking your lifetime 19 or -- 20 A (inaudible) 2, THE COURT REPORTER: Wait. You are both 22 speaking at once. 23 THE COURT: Start the question aga_n, 24 Ms. Morrison. 2~ BY MS. MORRISON: 63 Q How often did you see your father, and just 2 define if it i s, you know, over your lifetime or what 3 timeframe we a re talking about. 4 A During my lifetime practically every day. 5 Maybe Sundays not so much or maybe Saturdays, but other than 6 that every day. ~ Q So you saw your dad every day. You worked g with your dad in the business, correct? g A Yes. ~0 Q And would you characterize your relationship 11 with your dad as, you know, a traditional father, son 12 relationship? How would you characterize that? 13 A I would think it would be a traditional 14 relationship. 15 Q And I guess when I think of that I ;=pink -- 16 was there a level of respect to your father? l~ A Yes, there was. lg Q Was there deference if, you know, your father 19 said, this is the way it is going to be, you know, would you 20 defer to his decisions -- 21 A Yes, I would. 22 Q -- in certain matters. You have other 2~ siblings, whi ch was alluded to earlier, four other children 24 in the family; is that correct? 25 A That is correct. 64 Q And you are the youngest? 2 A That is correct. 3 Q How many years difference is there between 4 your oldest sister Caroline and you? 5 A She's probably sixty-some years old. 6 Probably 8 years maybe. I'm not sure. I don't rem=ember her 7 being at home when I was growing up. She was married when I g was single. g Q Okay. And the next closest sibling in your 10 family is Linda; is that right? 11 A The next closest -- 12 Q I guess in order you are the younge:~t and 13 then -- ~4 A It would be my sister Jane. 15 Q Oh, I'm sorry. Jane and then Linda:' 16 A Yes. l~ Q Okay. And how many years between you and 18 Jane? 19 A I believe 6 to 7 years. 20 Q Okay. So you are significantly younger than 21 your other siblings? 22 A Right. 23 Q Let's look at -- let's just look at Exhibit 24 -- Respondent's Exhibit 11. 25 (Respondent's Exhibit No. 11 was marked for 65 ~dentification.) 2 MS. MORRISON: And if I could approach the 3 witness, and if the Court would like to see to follow along. 4 THE COURT: Mr. Flower, do you have any 5 objection to the Court's seeing this exhibit? 6 MR. FLOWER: No. ~ THE COURT: All right. g BY MS. MORRISON: 9 Q Okay. Mr. Black, I am showing you what's ~0 been marked -- if I can approach -- been marked as 11 Respondent's Exhibit No. 11. Take a look at that m.ap. It ,~2 is from the Cumberland County Tax Mapping Website. Does ,~3 .hat look like an accurate depiction of the area ir: which 14 your property is, where the business is, your father's 15 residence, that sort of thing? 16 A Yes. l~ Q Okay. And if you could sort of -- think 1g there is some numbers on there? 19 A Right. 20 Q Tell the Judge, you know, where your house is 21 located, where the business is, and where your fat~er 22 resided before he went to the nursing -- or to the assistant 23 living facility? 24 A Okay. The business is number 1, and where my 25 dad resided was number 2, and I resided and still do at 66 number 3. 2 Q Okay. So your house, your father's 'aouse, 3 and the business are all right there together, and ~~ imagine 4 that -- you said you saw your dad almost every day, and I 5 think we can see why, you are in close proximity heVe. Can 6 you give us just a little bit of information about Tacks 7 Water Conditioning, what kind of business it was? 8 A It's a water treatment, water conditioning g softening filtration purification. 10 Q And did your father start this business? 11 A Yes, in 1967. 12 Q Okay. And when did you get involvea in the ,y3 Business with your dad? 14 A I came on board full-time in 1977 when I 15 graduated from high school, but before that I was Helping in 16 the summers. Actually my last year of high school I was on 17 the co-op program where you go to the school in the morning, 1g and you go home in the afternoon and you work with -- I 19 worked with dad. He actually graded me on different things. 20 Q Okay. So since 1977, when you graduated from 21 high school, you were in the business with your father? 22 A Yes. 2~ Q And what was your capacity? I guess soon 24 after you graduated from high school, what was yot.r role ire 25 the business, and what was your dad's? How did tr,.at work? 67 A Well, we became partners shortly after I got 2 out of high school, but I mainly assembled equipment and 3 made sales as well, installation service work. Dad took 4 more charge of dealing with the customer calls at what time. 5 Q Okay. And as time went on did your role and 6 participation in the business increase? ~ A Yes, it did. g Q And you said you were partners with your dad, g you know, soon after you joined. The percentages, I 10~magine, changed over time depending on your 11 responsibilities? 12 A Yes. 13 Q Okay. And on January 1st, 1993, do you 14 recall entering into a partnership agreement with your 15 father? 16 A Yes. 17 Q And you used Attorney Jim Hughes to work out 18 that business plan; is that right? 19 A That's right. 20 Q Okay. And at that time, this is 1993, what 21 was your percentage in the business? What was your dad's? 22 A I believe it was around 50/50. 23 Q Okay. And that was later amended ice, do you 24 recall, December 31st, 1998? Does that ring a bell? 25 A Not offhand. 68 Q Okay. Well, I'm going to show you -- 2 THE COURT: I'll tell you what, why don't we 3 recess at this point. You can step down. 4 THE WITNESS: All right. Thanks. 5 THE COURT: Ms. Morrison, did you wa?~t ~o 5 move the admission of Respondent's Exhibits 1, 2, and 11? ~ MS. MORRISON: Yes, we can go ahead with that 8 ncw. Yes, Your Honor. Thank you. g THE COURT: Mr. Flower, do you have any 10 objection to the admission of those exhibits? 11 MR. FLOWER: No, Your Honor. 12 THE COURT: Respondent's Exhibits 1, 2, and 13 -~1 are admitted. i4 (Respondent's Exhibits 1, 2, and 11 were 15 admitted into evidence.) 16 THE COURT: Does either counsel wart a copy 17 of the notes of testimony from today's proceeding? lg MS. MORRISON: I guess. Your Honor, are you 19 anticipating this being rescheduled for sometime ire the 20 distant future? 21 THE COURT: I don't know about dist<_~nt, but 22 sometime in the future. 23 MS. MORRISON: Yeah. I think that .could be 24 fine. 25 THE COURT: You are requesting a cony? 69 MS. MORRISON: Well, I guess it depends. If 2 this is going to be in short term here with the continuation 3 of the hearing I think we would be fine to go with ~~~hat we 4 have, but if it is months from now it might be good to be 5 able to refresh the memory of what transpired here °,oday. 6 THE COURT: All right. Well, I'm sure it 7 will not be within the next two weeks. g MR. FLOWER: I request the notes. G THE COURT: Okay. And do you also, 10 Ms. Morrison? 11 MS. MORRISON: If they are being prepared 12 anyway, that would be fine. Yes, please. ,3 THE COURT: So you are both requesting them? -~4 Yes? 15 MS. MORRISON: Yes, Your Honor. i6 THE COURT: Okay. We will enter th~.s order: l~ AND NOW, this 26th day of April, 20_'0, upon 18 consideration of the Petition Sur Appeal from Probate in the 19 above-captioned matter, and following an initial period of 20 hearing, which has not yet been completed, the record shall 21 remain. open, and counsel are requested to contact ,_he 22 Court's secretary for purposes of scheduling an ad:~itional 23 day of hearing in this case. 24 It is noted that at the time of adjournment 25 on today's date the Petitioner had completed presentation of 70 her case-in-chief, and the Respondent was subjectinci to 2 direct examination his first witness in the person of 3 }iimself, Laverne C. Black. It is noted further that-: at the 4 time of adjournment Petitioner's Exhibits 1, 2, 3, and 4 had 5 been identified and admitted, and Respondent's Exhi:~its 1, 2 6 and 11 had been identified and admitted. No other exhibits ~ had been identified or admitted. 8 Both counsel have requested that the y stenographer transcribe and file the notes of testimony from 10 today's proceeding. 11 (End of order.) 12 THE COURT: Court is adjourned. 13 (The proceedings adjourned at 11:55 a.m.) 14 15 16 17 18 19 20 21 22 23 24 25 71 ERTIFICATION I hereby certify that the proceedings are contained fully and accurately in the notes taken by me on the above cause, and that this is a correct transcript of same. ,,, _. J ' Mic;ele A. Eline Official Court Reporter The foregoing record of the procee:~ings on the hearing of the within matter is hereby approv:~d and directed to be filed. ~~1~ 1 1~ 2~~~ Date / /,. j~.~ //~ir - / ~, -- - ,7. Wesley 1 r, Jr., J. N~nth Judicial Dis'~rict 72 ~ s . _ - ~; _... _ i~::` - _ 3 qti a.~1 =-~. ~~ . .~..-~`~ _ - 8. ~y.~.'T. _. ".ky2 'T ~-~~~ ` ~x ~~''~~ ~• ~ ~~~. 3.~i2` r -.. ~y.r'.~.,r'~'yy ~~ F. ~~ ~~ t ~ ,, -.~ ~ x°~K ~~~ " .~{3~ ~ ~'~ ~ ~~~ ~ ~~y~ '~',~~ /~~~ ~ „~ ~ `.r~ ? . ~;, ~~ r ;~~ v ~~~~ ` ...~" ~ ~ w i:. t y~ ~~. /~F ~- fi f ; y.f~f -1 ,LSa _r,s _ y.~..,. N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL`JANIA ORPHANS' COURT DIVISION . . . . . . . . . . . . . . IN RE: No. 21-09-0360 ESTATE OF GLENN W. BLACK, Orphans' Court deceased . . . . . . . . . . . . . . Deposition of: ORVILLE G. McBETH, JR., M.D. Date April 16, 2010, 2:00 p.m. Place 3375 Carlisle Road Gardners, Pennsylvania Before Bethann M. Schoneman, Notary Public Registered Professional Reporter APPEARANCES: SAIDIS, FLOWER & LINDSAY By: THOMAS E. FLOWER, ESQ. For - Linda Davis SALTZMANN HUGHES, P.C. By: SUSANN B. MORRISON, ESQ. For - Laverne C. Black I N D E X WITNESS Direct Cross Redirect Recross ORVILLE G. McBETH, JR., M.D. By Mr. Flower By Ms. Morrison McBeth Deposition Exhibit Numbers 1. Office Notes 3 - 19 - - 13 - - EXHIBITS Page Marked 3 Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 1 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 STIPULATION It is hereby stipulated by and between counsel for the respective parties that reading, signing, sealing, certification and filing are hereby waived. (McBeth Deposition Exhibit #1 marked for identification) ORVILLE G. McBETH, JR., M.D., called as a witness, having been duly sworn, testified as follows: DIRECT EXAMINATION BY MR. FLOWER: Q. Dr. McBeth, I'm going to start, and I'm just going to ask you a few questions about what I think are your clinical notes. A. Um-hum, these are. Q. And I don't know whether these are your numbers or the other attorney's office numbers, but this front says -- top page says 11A? A. Yes, sir. Q. I asked for a few months before and after June, and if you would just turn to the third page which is 12A as shown, your visit dated January 7th, '04. Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 4 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 A. Yes, sir. Q. Where you have printed here patient seems to me as if he is having some difficulty with his memory, is that something you read into your tape recorder after seeing him and then your staff transcribed for you? A. Yes, sir, it's correct. Q. Had he been a patient of yours for some time, I mean over a period of years before that, do you remember? A. He had been a patient since 1984. Q. Okay. So you knew him pretty well.? A. Yes. Q. Do you know what would have made you comment -- or can you interpret your comment it seemed to you as if he were having some difficulty with his memory? A. I can't since I didn't-- Q. Just a note as you wrote it? A. Yeah. And-- Yeah. And as I state, upon question he denied such. Q. Is that ordinary for people having memory problems that they would deny it? A. Yes, sir. Q. Let's go to near the top of the next page, 12B, Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 51 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 looks like you had a routine visit. on the 12th of January, prescribed some Lipitor. On the 2nd of February can you tell me what those handwritten notes up there say? A. What page are you on? Q. 12B. I'm talking about at February 6th '04. A. February 6th, that's checkup, doing fine, no complaints, no chest pain, shortness of breath, edema, no nausea, vomiting, diarrriea, constipation. Q. Okay. Thank you for translating that. A. That's the nurse's signature to the right. Q. Oh, I see. She made those queries initially. A. Right. And then I dictated the rest. Q. May I just ask what your categories are here? A. 0 is objective. That would be the physical exam part. Assessment is A, and P is plan. Q. Okay. And you note under plan, patient after the fact seems fairly confused today. Can you read those three sentences? A. Sure. Patient after the fact seems fairly confused today. He asks me if my apples are all off. I have an apple farm, by the way. Q. I was going to ask you about that. A. So he knows that. Then he went up to the desk Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 61 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 and asked me that-- I'm sorry, I skipped a line. Then he went up to the desk and asked thinking he was scheduled in another week or so, and he just told me that he missed his appointment yesterday, which he did, will continue to observe, and that's continue to observe his confusion. Q. Okay. Thank you. So on the 23rd you saw him about some ear wax. And then on the next page, 13A, and that April 1 notation-- A. Yes. Q. --can you read the first sentence, patient was? A. Patient was away recently and called neighbor in next room at 2:00 in the morning, family concerned regarding Alzheimer's, would like B12 to see if help. Q. Next room was the word I couldn't read. A. Right, right. Q. So then you saw him the next day, I take it? A. Yes, sir. Q. Looks like 4/2. A. 4/2. Q. You note that his wife died. All right. Now, here's where your notes say that you gave the mini mental status exam. Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 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 A. Um-hum. Q. And would you read the next two sentences? A. Patient was able to get 24 out of 30. He thought the year was 1940. He was -- has not had a CAT scan. Q. So he was not oriented to time very well there? A. Correct. Q. And you mentioned a CAT scan because why? A. Because that's-- I'm just making a mental note to myself at that time as far as a workup for confusion is a CAT scan and some blood work including thyroid, B12, and-- Q. And under assessment on this one what does R/O mean? A. Rule out early dementia. Q. That would be the purpose of the assessment? A. Correct. Well, no, rule out early dementia is what the assessment says. And then the plan follows through with workup of dementia which is CAT scan, CBC, the RPR, TSH, B12, SED rate, and CAT scan was done at Belvedere Medical Center is what that stands for in Carlisle. Q. Okay. And now on the 12th you are summarizing the CAT scan results. Is that correct? A. Correct. Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 itect/Flower - McBeth 81 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 Q. Now, when you assess him as early dementia, can you elaborate on what that means? Is there a layman's term? Are there layman's terms for that? Is that a technical term, cr is that what you and I both understand to mean onset of dementia, early dementia? A. Well, I based that on the score of 24 out of 30 on the mini mental status exam. Above-- Between 20 and 30 is mild, and between 9 and 20 or 19 is moderate. And below 9 is severe dementia. Q. Did he lose points for thinking it was 1940? A. Yes, sir, one point for that. Q. So Dr. Moser, what kind of a doctor is he you're referring him? A. He is a neurologist. Q. All right. You have his letter. Do you want to just summarize what he tells you? A. Well, he says that he explained -- and this is dated May 18th, 2004 -- that the -- he has at least some mild cognitive impairment, and that's what he makes his final diagnosis, mild cognitive impairment, and that this may be a predecessor of dementia. So he felt that it was actually a mild cognitive impairment at this Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 91 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 point and not true dementia. But he agreed with the use of Aricept but had concerns about whether the patient would be reliable to take that. Aricept is a medication that helps to treat memory issues. Q. Is it used for all sorts of dementia? A. Yes, sir. Q. Dementia can be vascular or Alzheimer's type. This was way-- His CAT scan wasn't designed to-- A. Define it per se, but just to rule out a stroke or tumor or something along that line that could cause dementia. Q. All right. So he finds mild cognitive impairment? A. Correct. Q. I guess I'll probably ask you for a copy of that before we go. A. Oh, I thought you had one. MS. MORRISON: I would like a copy, too. I don't think that was in the records we received. A. Oh, really. Well, that's -- that's the computerized medical record. You get to the different sections. Actually that was part of the chart, the old chart which is in the bottom, Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 10 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 so I'll Xerox that off the book. BY MR. FLOWER: Q. So May 24th, that's also on Page 13B-- A. Yes, sir. Q. --his son came with him. That would be Laverne. Do you remember? A. Correct, oh, yeah. Q. Laverne was one who generally brought him? A. Correct. Q. So he can drive short distances. His son feels comfortable with that. He eats with the son or daughter each day for supper. These are all your notes? A. Correct. Q. And somewhere it says in here HS. A. Hour of sleep. Q. Hour of sleep, okay. Thank you. A. Bedtime. Q. Then the next page, 14A, we're already past June into the beginning of July. What were the Motrin and Toprol for? A. Motrin, he had osteoarthritis, and that was a chronic med that he had been on. So those are just refills he had called in and we -- and actually a pharmacy had faxed them. So we Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 11 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 refilled Motrin, an anti-inflammatory for arthritis, and Toprol, a blood pressure medicine he had been on previously as well. Q. Then July 30th. A. July 30th, delusional thinking, making advances to daughter, calling her to -- calling her to get some loving, make advance at sister-in-law -- making advance at sister-in-law. And then that Risperdal is an antipsychotic medication. Q. Does that differ from-- How is that different from the-- What was the other one? A. Aricept. Q. Aricept. A. Risperdal is used for delusional thinking, hallucinations, psychotic behavior, or psychosis. And the Aricept is purely used for memory issues, dementia or memory issues, to help with getting memory back on line. Q. So that covers the period that I was most interested in, and I wonder if you feel that there's anything that you should explain to me that the bare record doesn't show. Am I misinterpreting dementia, delusional thinking, or any of these expressions? Is there a Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 irect/Flower - McBeth 12 I 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 technical meaning that I'm not understanding? A. No. I guess the only thing I'll say as I think about that with the questions that you've asked, dementia is in my viewpoint is really an issue of gradual memory loss and then less of -- gradual loss of activities of daily living and forgetting how to do things. That's a progression of dementia. The neurologist commented that really felt it was a cognitive memory -- cognitive -- mild cognitive impairment which is more of a function of just your brain and a mild impairment of the cognitive-- Q. Not thinking clearly? A. Yeah. Q. If I read this phrase, inferior tc normal minds in reasoning power, factual knowledge, freedom of thought and decision and other characteristics of a fully competent mentality, is that another way of saying dementia? A. I would disagree with that because early dementia folks can be on target one day and off the next day. They can be on target the morning, off in the afternoon. They can get set off easily by stress, or they can set off by infection. And that's why it's difficult to Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ross/Morrison - McBeth I3 I I 2 3 4 5 6 7 8 9 10 11 12 13 14 I5 16 17 18 19 20 21 22 23 24 25 pick up initially because they -- if you catch them at the right time, they seem completely normal. Q. Right. A. But if you catch them at another time, it's easily -- it's easy to see. So I don't really agree with that definition that you just-- Q. That implied it was a constant state? A. Yes, correct. Q. I got it. I got it. A. Early it's not constant. That's why it's difficult to pick up. Q. The one time you're calling your neighbor at 2:00 in the morning and-- A. The next time you're sleeping the night through like you're supposed to be. MR. FLOWER: I'm going to reserve five minutes, but I don't have any more questions for you now. I'll just try to remember to get a copy of that. A. We'll get her. MR. FLOWER: Thank you very much. CROSS-EXAMINATION BY MS. MORRISON: Q. Doctor, I'm going to ask you a few questions as Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ross/Morrison - McBeth 14 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 well mostly in the event that for some reason you're unable to come testify that. we have a complete record here of, you know, questions that I would like answers to as well. You had stated that you had treated Glenn Black since April of 1984. Is that correct? A. Yes, ma'am. Q. Could you describe-- You've known him for a long time -- or you knew him for a long time. Can you describe his personality either generally, whether he was a strong-willed person, whether he was someone that was rather mild or, you know, any indication you can give to us of his personality. A. Okay. Yeah, I did know him for several years and actually saw him through his first wife's death and made several home visits. He is a strong-willed man who knew what he wanted and was a businessman himself, water conditioning, and ran that business for several years. So he actually was able to demand and command authority with -- in his lifestyle. Q. And the-- Let's see, the mini mental status exam that was given-- And I don't. have the date right here. Let's see. I believe it was Filius & McLucas Reporting Service, Inc. Harrisburg 717-23G-0623 York 717-845-6418 PA 1-800-233-9327 ross/Morrison - McBeth 15 I 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 April of '04. Yeah, on Page 13A. A. April 2nd, '04. Q. You explained that the 24 out of 30 would in your mind be what you would call mild dementia? A. Correct. Q. Or mild-- And as far as that's concerned and that result of 24 out of 30 and the mild dementia assessment, how would that level of impairment affect someone's personality? A. Oh, that should not affect their personality. Q. And, like you said, it's a progressive type -- you know, as that number would decrease, you know, the impairment increase I would imagine it-- A. Right. When you get to moderate or severe, your personality is affected because you're starting to-- It spills over. Q. So at the level of 24 out of 30, you would not expect a change in someone's personality? A. No, ma'am. Q. You would expect, correct me if I'm wrong, some occasional memory lapses. Is that correct? A. Yes. Q. But how would you describe the memory lapses at this stage of 24 out of 30? Filius & McLucas Reporting Service, Inc. Harrisburg 717-23G-0623 York 717-845-6418 PA 1-800-233-9327 ross/Morrison - McBeth 16 I 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 A. Well, it's usually those things that are not actually frankly important such as the date, the time. He was able to drive during this time period and actually drove for another year after this time period. And we-- And the son and I had agreed that it was able -- he was able to drive at this point. So it's really-- That's where it's tricky to catch it early because they are so skillful at covering up. Just as the neurologist comments here, if he asked him the day of the week, he looked at his watch and told him it was Tuesday, and he was right. So, see, he knew how to do it. He knew how to get the answer, but he didn't know how to give the answer unless he looked at the watch, so. Q. And as far as someone's determination or their free will at a level of 24 out of 30, what would your opinion be of the impact on that? Would they be easily manipulated if someone was especially determined or, you know, that sort of thing? A. Right. No. I would say this for anybody, and I have another patient just like it now -- like him now, but their personality doesn't change at Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ross/Morrison - McBeth 1~ ~ 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 this level, and their will, their drive to do whatever doesn't change. They're pretty-- He was strong-willed, and he was -- got what he wanted, and he still did at this point in time. Q. And that was my next question. Him in particular and at the time this exam was given, did you believe that his will, his determination, or his personality had changed? I mean, you had treated him for a very long time before then. When you gave him this exam, did you notice any changes in his personality or his determination and free will? A. No, I would say not. Q. And, like you said, you would not expect it in the population in general with a 24 out of 30, too. Is that correct-- A. Correct. Q. --in your opinion? And one month mast this exam would you expect any marked changes in someone's personality or determination and free will one month past an exam like this? A. No. In fact, Dr. Moser saw him May 18, 2004 and thought that again it was just mild, so, no, I would say without a doubt no change with personality. Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA i-800-233-9327 ross/Morrison - McBeth 1 Q. So Dr. Mosser's evaluation one month after yours 2 would you characterize that as basically the 3 same or similar? 4 A. Actually-- I actually got a kick out of this. 5 I think that he feels that he is better than I 6 had pointed out in my notes or that my notes ~ led. But that's what he leads us to believe in 8 this document. 9 Q. And we talked a little bit about Mr. Black's 10 son, Laverne, being present during some of the 11 examinations and office visits. Is that right? 12 A. Right. 13 Q. Did you get any indication that Laverne had any 14 type of control over Mr. Black or, I don't know, 15 there was some type of uneven -- uneven la p ying 16 field, I guess, where Laverne had an advantage 17 over Mr. Black? 18 A. No, I never got that idea. He was just along to 19 be a support and transportation. He came along, 20 too, to find out what was going on basically. 21 Then I met with both Laverne and-- I forget his 22 sister's name. 23 Q. Linda. 24 A. --Linda in August. And I did meet with them a 25 couple more times thereafter. But l,zp until 18 Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 edirect/Flower - McBeth 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 then, it was primarily Laverne that I remember. Q. And if I were to give you some words, some legal terms as well like Mr. Flower did, would you consider Mr. Black's mental capacity I guess April of 2004 into May 2004, would you characterize that as persistent confusion, forgetfulness, and disorientation? A. No. Q. Would you believe based on the exam -- the mini mental status exam you gave him and your own examination and experience with Mr. Black that he would be able to be influenced to an extent that his free will would have been restrained? A. No. MS. MORRISON: That's all the questions I have. Thank you. MR. FLOWER: Quick follow-up. REDIRECT EXAMINATION BY MR. FLOWER: Q. When she was asking you whether the son, Laverne, was in any way dominating of his father during those visits, of course not, and I have no doubt whatsoever of course he was there out of his concern for his parent as you observed. But Laverne would have scored a 30 on that mini 19 I Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 edirect/Flower - McBeth 1 2 3 4 5 6 7 8 9 10 l1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 mental status exam, wouldn't he? A. I trust so, but not everybody does. Q. I tried spelling world backwards, and that's hard enough. A. Not everybody does. Q. Comparing them if they were two people in an arm's length transaction, do you think it would be an even playing field? A. Knowing Glenn, yes. He was of strong enough character, he got what he wanted. Q. His confusion, his memory lapses would not have put him at a disadvantage if he were negotiating at arm's length with a person who had a fully intact mentality that was unimpaired? A. Again, I'd say no because he-- If he knew what he wanted, he got it. And that was his life. He was head of the water conditioning business, and he was -- he was that way with me. It was, you know-- Q. Stubborn? A. --stubborn to get him to take heart medicine when he had known heart disease and cholesterol medicine when he had known cholesterol issues. It took months to a couple years. So if he had an opinion about something, he stuck to his 20 ~ Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 edirect/Flower - McBeth 1 L 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 opinion. So with Laverne, Laverne, you know, would have to be quiet. Q. Would you think a person who had a mild cognitive impairment as described by I think that was the term that Dr. Mosser used, would their opinions tend to be accurate at all times? A. Their opinions? Q. You said if he had an opinion he would carry it out. A. Right. Q. I'm trying to figure out how a person who was impaired cognitively would be disadvantaged in our world today. Apparently from the way you described it not at all. A. Well, I'll throw that question back to you. Is he impaired when he has known heart disease and doesn't take heart medicine? And that's in the 1980s and '90s. I'm just being totally truthful with you. So this is relative. Q. It's truly-- It is relative, and that was kind of the point I was trying to get at. In relation to a young and totally intact mentality, is there any difference between }hat as a practical matter and somebody who has a mild cognitive impairment or a mild dementia or 21 I Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 edirect/Flower - McBeth L 9 G E 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 early dementia? A. And I would have to say to that it really does depend on the day and the time. Honestly it does. MR. FLOWER: I'm satisfied we got our testimony. MS. MORRISON: Yes, that's fine. (The deposition concluded at 2:24 p.m.) 22 I Filius & McLucas Repotting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ,,. 23 t..• COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK I, Bethann M. Schoneman, Reporter and Notary Public in and for the Commonwealth of Pennsylvania and County of York, do hereby certify that the foregoing deposition was taken before me at the time and place hereinbefore set forth, and that it is the testimony of: ORVILLE G. McBETH, JR., M.D. I further certify that said witness was by me duly sworn to testify the whole and complete truth in said cause; that the testimony then given was reported by me stenographically, and subsequently transcribed under my direction and supervision; and that the foregoing is a full, true and correct transcript of my original shorthand notes. I further certify that I am not counsel for or related to any of the parties to the foregoing cause, or employed by them or their attorneys, and am not interested in the subject matter or outcome thereof. Dated at York, Pennsylvania this 22nd day of April, 2010. ~---~ BETHANN MNSCCHONEM AN Not ry pu Conewago Twp., York County PAy Commission Expires August 15, 201 thann M.-Schoneman gistered Professional tary Public Reporter The foregoing certification of this transcript does not apply to any reproduction of the same by any means unless under the direct control and/or supervision of the certifying reporter. - F1L1US &,Y(cLUC.1S REPORTING SE12VlCE,INC. - H~arrisbvrg 717-236-0623 York 717-845-6418 PA 1-800-~33_g3?7 AWYER'S NOTES CCT. NC) )DF:L• SS ;~; ,~~ - ~... /~. ~ PATIENTS` ":A..r _`_.~_.___. ..-- i, BIf2TH UA~1'F ..,~ ~~ t/~h ~ ~~ ~~' r~:tTE; ,_,V TG L. NO. RE}=CR}2~D BY ~ ,... JC,GUI'ATiUN AGB .,~_:L;i: -- 3, M. W, D. I'±;. is ju;~t ;ar~r~:i_71? nota mice ~ ~~r1~~, iI:~ ; BP n•w~ ;-u~,>>•o~rc:d 1~~hcl~ ~ ~ r, IIe 1,..~.;- "l.~:sion.; on 1~is orea~:~•n~~.~ ~l;iia~t a~• ~ co7is ' ;:.r~~~~:, ~s~:7.~t,~~ ac~t~.i i_i ,, i_~ . ~ ~>;; i;~ but just n~.c~ so,ne sun dama~;E; . ~( t•r~,,.ia rt. l.~l-«,~ ~,~, ~,,h.at '~,h~.rir~~ I ~ • ~ ~_,. ~,f"t;~=~r ,h~ti c).ears . 0, Inliit;~° a1•c; clear. COR i ~ ..•e~;ulrz T ~;s .-i ~ ~emr.,. ~1. L~t:~ti ),'L;GC1 C%110~('.S~~,F,~'O1S~ (~,~~i? .pit?..}~~E' lJl.li?1 ~j i. 1~,>1.71~, T~7.tl"'~~~ ~; , .: ;I. I1C;e las;; V:LS:t.t, tiCt1.717-(' I',C'l't3~',OSP , ~r~:' ~1.~: 071 }"1:1.:, r ho .~ib1;v rar,r~~ thszn :C ,.us ~r_;~L. IIia ' ~ ?~,, ! ,, ~, i i_ ,'rl ~•r~~x . .~ , . ~ 1 r~r t;o ~.rrz ~txte, f,h~.t today bii t forgot. _ -- P: 7;, Lo rccii~;c~~ in '1-?_. uro7ls. to have; Iii;; .;,'~~,,,; .I'.~:•ozon `~G~he~ro fi.c- ~~ ~:17i1r ~cerr~to~;,ie ,.hots are present. 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TfLEGYJAItri° DUPLtCATC COPY PHYSICIAN MESSl1(~i'S _ _~. 1 ,' For f;or.tor~. . ~ .~ I _. , _ ~ d~~ -- ~ Ttmr r ~ 1 I ~ _L/ f/S ' S. - J'_ '" `.rr) r~_r"~Vr--.1_C./L]/t~__'~I,.G.G~ 1~~.,.. _. .. Nlrursa-rCJ ltV~"/~ ~/,..//_' ~ I , Cnlter lcl. ~ I ,'Ubrptes: .~ lSl~~~ '. •fexafe~adine HCi 60m~Ps rr ~: ~ <.; .U 1~ ~ u~ y,. ~. _w .. ~ y i ; 1 ~ ~ ' _ „ . ~ ~ + ~ ! -..- a , s _" ,.. 1' ,,-.., _ _ //'// ~> I ~ Iltl I ~ROlurnod PI©asu Will C n ~ HU II Ur y I Call ^ Ckltl ^ Agrdr ~ I ~~ ~ , _ ~ _ ~ Q r' L' j ti ,.-. ~-___ _ , ;, i ;,_ , ~r? 1. ' ,~ ~ ACCT. NO. i ~ATIEt"lT~., ~,~,~.",~ ~~~, f __~ _ , li CJRF_'SS _ ~ LllizYH Gnrr. ----~--.--~~ - 'y 1_ .__-_ nA~lt~ __ _ ("C L. N(7. ` F"ZEFGR~tED CiY c>CCUPAT{O~l AGE: c_x (~. h1 `,V. t7. (~ ~ [ ~ ~ ~(" _~t )~S-~C,~~ rte,"^~-~ ~I\~ ~: =C-~ ._ .~/) Z . ~ ;_ ~ ~ ~ _-~.,, - >C :a ~!. r~. ~ ';`~-~ _ "' ~_ r~ - - _ _ 1: - ~~ ~ ~ ~~ "~ , C): ~.;~T'.l' reve~.~J_ ~ a r, ed TI~I act•1~r~11j- on '~,he ~'.~,~:- mi,~.•r;F~~h, ,.r~.=; ~~r'~~ ~f,i; ;, - er,y-~hema. Beck i~enign , i:,un~;s ~,re• r;1~~t~~.:r . !:: 0~:, ~l;i;~ a,nd f3roncl_?i~is F': 7i~a~~romax l~F'ake~ I+'orcc Fluids. Ur. villa I/cL~e~t;e, , M. ~ ~~i~ ~ r ~ ;I _ • :, t,-.._ ~~, • ~ ~ ~ ~J ....- ' ~- ;~ ~~ - ;, ,,u~~ ~~t-". .>f:`2 „l ;, GG Jib .~5 J_~ ~'LP~ 1c~~ ~1 ~",_?l~r _T1G]"~~ ~:7._~~1•] !_t a.~.~,~~. •[1'l.,° .~ Ho~ae ver upon ~a~-ie;~t; i.~ii; tip; he d~;r~. ~;; .~~zci~.~ I~Ic; ~. _ ~ ;;, '_ . >>r~:i.1~~r tc ~~loz• iae. __ ~te~° ~n i~ri.s ,~r~ar. l~Ja_ ...., 1 ~1,; a ~,~i< . ~,c: ~ :;1_J, clz~l; h~ ;~r:i.tt~ ~h .=~ businuc~. ~Ie is a~;~~--r~<,t,lU to ~;oin~, . .,-. ~~ Jr~~iica+~_.~_. _ t;ni..~ r~<~ ~-nt i.n ~Li_.r~e .for. hi..> BP t~r't~i.c~i I t,l~linl~ Sri !~ _~r;~~'1ri:i~tr:j.~~= '-~- ~ Y]7.,~ ClG? ~, ~: Z'., l:*~'L.L ~lt"~lOLl~t1 ~1P, C1 E'. X11 G'S t3Yi,;' C~T'~. __. :L 17. `l~G ~ ~ ~_l~ aee-d of '.l~~vin; hip pros{~~~e ch~;cl~ed ~t,o-~1_s,jr. ~:): See i~':i,ow. ~'ro_-fate is .~ u.:i.i;e~ laz Vie. ido ~ ,n;.., ~~~. ,, t;h~~u~i1. ;~ : f3r'Ii ,;' D P: R'1'C~ .n 1 .rlon. I3eein Toprc~.l ~~..ti 5C "7r-;~ "11~i~ ~ 'Ji~;r-:~~;1,~ ;a ~PSr Lir , i'~ Par_ea.:n~ Go:nplet~: i"i~~:i~,~~bo1_i.c ?'rot'~_`:.:I_,~- . , ~cc~r, rao. ~ _ ~ ~.~; ~, ~ - -- PATICN. N. la~.l- _ ~1~ ~v~~C1 ~~ ~~1 ~ , _._-_ . ~ ~ :_~ ~i SIUriCF:gUL'NT VIEIITft ANU '-.N I?1NC9, (. Jt~_ ~ ._ J c -~ i/~~~ i~~.. . ._~, -o ~_ ~~ J ~~ _; ~ ~~ ~-., gib'-- tititi~. , ~5 ~. -~ ~..I~ ~ 1_°~~~`-~` ~~° ~,~~f~ ~~~ ~-- ~ ~ ~/ \. ~ `~ ~ i n ~~1 ~~ / ~~~,; ;'~ ~, Pt. also complairLS n: errciiil.e dysi-unct:~:>li. ~1?aga_a }lus ;IC~'~ ,i worked for }tim recr,ntl.y. He would lilcE, CI> t:r~~ olte I;f t: Ixc~: n~~~, aiedicaLi.orls. He. was at a large t4unting ._.~,>p ~,r~<;t;e:rd~~y anc? r.l:i: 111.5rij)[)1:, ~t~l(?r471-SP_ F18 lli'n1_~: att}' C<11"Clif~± ;-~~(~L~L(~'flS. ~Ir~ .--t ' even- use,c aditr.og7.ycerine. 0: bungs ;are clear. (;Ot; is regu~_ar, l.c~~r_: c~r~+~h nu r~d~~m:_- ~: Hypert.ens:i.pl~ I7iproverl, CAli Stab?.e, 1?Y-: t:i:!,= Uysf~inc.i~.vu. !~;::~ st.~:d Cholesterol. w:i.f~h hipJ (.ox Just: in•~rc:;~:.~~.~~ P: 'J.'i: ia1 ;~f T~ev:it.ra t~~i.ti~ i nstrtccti-on~.a ,, ~ :~I ; f1 mg .i , i ~; and i.~1~ ~~ dclesn`L iiel.t, Llse :'.. L'Tb :i. I: ;,,r;~;. for hS. Pt. _ifter t:hF: fact ""1 ~a:} f ca: ~,oi;i ~ •.i c,~l~:ti', ?ie ~I_,. ~~ s a= ii ~:nl :jppl.es ~rP al'1. _. 113e~~~ he ~„~ ._~_ ct; i.o i_l.t, r1,~.~: •-•II th~i_nl<ing hw~ c~;as scheci ._ed -~.n ;:n~;t:llcr _..~~1~ cr sc5 and :,,,~ ~~ ~ i ~~ ne ;liar he m;sseo h:.~ nl,t ,~: r ~' ,, ._ _..~ uc c~_d. Or-,- : -:,.~=~ tag,. i? _ ,. (~ . h?. D ~, ~ ~, y , ~ ,__ _- ~~w ~~~~ ~- ~ f , I 1 ~; ~ t~`C' ~'!-- -(?-~'_1~ , r.., ~~ ~~ Ire v'1 t- j ~~_ ,. ~-, ~ y ~,, ~ .}~{,. r` ~ S~ ~,.>~ L~ ,-Icy h ~ ~~ J a v:~ ~~ _ , ~ ~::~~j-` ` :),'~\~'. ..4, ~ `~ ~' ~~~ .~- I W 4- Glel~n cornplainU oi~ L~t. ear. ..~,~~~um~r and i~7~t~:a~:, ~ _ curl . `i'tier-e ~;~~:~ ,. ~[TIOllT1T O~ Wc]}; I:~1eC!'. G:'11;~"11-{, h,~_=; g1G'C~ l1FJ ~~~d1_I1,^,> ~.: ~l~I'.G ~~ :'. W( l~(it'! ~:O c~@t otl'L ~JOfT1E; Chi t:h~ V,c:;: „'_~.r7 ~Opa.OUS al[1(; ~.;.. -'- Ly1 i_Clc:l-:.~'~:~. However tt,~~re was "ti:L1 porn: g,~:rsis~teirt cva :. d:: Ce~~ umc n :I: ~r-puc l,.i_i~n , Lie-k~_'CCr,r-r?rT~~z3~1_ ~lt;i%~r:`. , ;.o ,, ~: ._, ~.:ItlO'V^-.. CrP~z<~~; r:c.T :CL;It_ion. ?!t:!igt1~, _ -__ ACCT. NO. I PA.TlEN'!';, t!AD,+r ___, ~DFZC:55 ~ . _ t7CRTH C~F.'3 F: ._--___ ~~ t `r -'='~~ _._.__..... i!_7 E' ~_..,.._ TCL. NO. REF6C-t C2ED BY OCCIJ I'ATI OIV AGE: `~`_: is tS. M. V4'. I1. r i ~ ~~ ~ - qq ~~ (CAN _~j . ~ ~ -! ~ .- Y_ . ~ w .~ _ f~ ~ U ~~. ~ ~ ( J G // 1 /vl (L ~~~~~r~~ ~.E-~ C~i ~ ~ ~(_-~~-I" ~~~ ~ (~tD ~~tn~a~- ~Y~~ ~ _-c.~~ t o'~ ~~ C! l.~tu/ ~~--~ ~~!'.~c' •.,~, • ~ C''~a~, t'u ~-G'~~-C.r•hr.~~ r r. r! ~~~.»...r': r^ 1-~ .i ,,.. t.cC ~E~{;,.; ~~j ' ' ~,.c <_ ~~ ~ ~ ~~~ C _ ~ % ~: ~i~ ~~~, r / ~~ ~/ /~~OC~ ~/W ~ ~ ~~ /l.c~hL{ Son ~•~~.~ a~.on~ „~LrE Est. Ll~~~,.-. .,~n ~1~-t,;,~;~1~ EE __. ~,I~ ~'_c,~Ec~~~_~n~ ~~::::.. , need r~t~i].3_ed. Gave the m7.n~i- Ine]:~;:~.t _~~:ai-.us ,---:Ir .. -.a_is .1 ~-~ ?!I - r,~it vi 3C~. Iic i:houghl: fair ;~t.ar ~~;::: 7.~34ii. He ~~<~~ loot lzad :~~- _ ~ rl. 0: SF~e I~'1ow. aral-lial- nerve:: ,-1- % i-n'~<;l~:t, !-r;,- ~_s :i.rEtac',; ~ ,- dnd .L0~4c'r 2.i:i;l calllt>_C.S. C1: cIynel ~(_I1~1.OT] ~ ~.I_P..VaLC'C~ C~l:>.].GSf:i3:C0_I. ~ t~~J L''ll_ ~11r I)Gfllt"",n~::2.2, P: CA's' Scan. C13C, Complet~_ i~ic~t:abo7__c i?ro£_i- :I-c, I,~.J>:i_d ~Panca, I,I)~~ " - ~SH, £~12, 5cd I'ctl1;~. CA`i' ~~can :i-~ ,. 1:. l3~IC;. ..7.'0 ~lf`~er tt'Eai. _.: _ •~, a1-e any ci]]nge ~n medicr,:~on. 1 ,~. 42E~~RRALS SERVICES FOR ~L^~.._:'~~.r'~. _-_-------_. _____~___.____.___.___ . _._ _ .. _. 1-305PTTAL ~~n~C._ __-. _.`'ROl/~DER. __ -_-.~___~.....~._._._.__ _ __ ~,~~~r~osTs ~rr ~ ,,, ~_ -- ---- l -= -~ ~~ ~ ` ~ hf ` ' ~` _--- - - OU ~fUEgU EN7 VtUfT© ANU F: NI>INCai, ... __. ._ _ .._...`-.. __-.._._....-ti~..~ :e~%i.ewt-,d l: .s •°est~lt.s f~-orn r?~~ . CC.T ~-~r~n a.t7~t ! . ~s~~~~v:-k wi.ta~t ?'' ~ ~ for . i) ; ht-, abovi, . P: ~ ~ i.c:ept ~~ rugs l~day ar.IC' ,~:;npl.e~• <>:i.ven. i'.':~':'~ :i.n ,~~ mon . L'E:fe1' ,t0 ~I". 1`'1nuS2L" S'O," '~~!TY11P.r '~~~t7fl711c+•t~ i ran ,'aY~CI CC~nj'a.1'~„-' f- ~ <~r Uri>' 'i.le i~3c1je1:i~ , i~1. Y 1~_/ . R~~~RRALS { NaME ~ ~-~ ._ G PROVzDERr~ ~y~_Q~~S~_~"._._...i., (~ ~,4~~~t^C~; {-{OSPITAL __. __ __ _ - ~ ~'~ ~~ DOS, ~1~°~`-~-_- TIME. ~-~-~ ---~- --------- - I SCHEDULED BY:-~.i~- -_ _--_---- ------- _ __-- ; 1 - _ _....__ . . _-. ~;~': -,'~ ~ 0 ~ C,~CL t~ 1 ~- ` S<~n ., a1on,. 1't. had fo: at.ten to L Ic~~ ' • ~ ~icr~pL' ~~ ~' r. `~ -,' „ ;,1.-~ ~ ~'~` ' at h. sand i)r. i~1o ,sF~~-' concura°ca wit. r `~ m s . t. h~ mcdxcal ~,, l , . ~' ~~.5- -- - -- , <, eatment aL' this point: 7.t: dine aa.thoug~r 1 t: r _ t~Iavc~ not rece:i.;-~.::; ~ . 1_etter from br_ . h'iosser, i~~.1.so tal.lcr~~d abo~I! . Ili z; BP w1.5.e1-i :i.~ _ _ . . ~.~,ci t ,,~~.,~~ ~ He ~:~,ici L11at he. was oti~t ir~o;,,>1.1~g. T~Ic: did nc t- ~.r.:l~t to do :~~•~~S +11`•_~ ~~.i;n,~t t•,tat at- this time in pa~i-t_i-cL~lar s:i-ice h~; ~~r,.~s uut mowa_ns;. •)::~- ~ ~i,.~ den~i.es chc t: tighi.ness, SCit3, na~zsea, ~Y<~m~ ! _~.rlg, cii.arrhe:z yr -,,., ' -~-pr~!1.~ I~~r,. 0: wee Flow. ~ Demc~nl:a.a, C:AD ;,,i*i, ~.: Ilypertcnsion, lsa?'1y ou'-~ any r~~ngiita7 ,~~~Ir~t ?ms ~: I)i.scu>s:i.c>r. in r.eferenc~: t:o hi.s meal::, +:~_s c'r.iv.~r~~;. ;iE .. ,. ~~ ~, _...~ i:ir:c: ~s ab:l.e to dz,ive short- da.s t_•anc_es :anci :>on eels comf r>,- ~~ ~~ ~~ ~ ;: i_ t-h that. Ile does go 1.0 ~ .>on or daught.r._ '~: ~clou; ~:~?c~ ?~:.~~ _~,t -;.,r,~~ 1•Iil1 cont:inuE A~:i.c~~pt; Ic,w s?:GrLec~ ag ~.i n ,a ,. nlgs by __... rt.,~~ ~.;r.~- ]tlsf: .. P:r~e1: O'_" SO ~ ;3f~0. ~?_'~1Hn CJi~°n th^:" .~ ^ ! F~„- ,,. ' _>s at: supper. So3~~ ;zx~d dauE,rlter 1-0 m; i_' ~;ee. tliat hc' -. ~ ~ ' . ~,, -- _ .n ~ :nor.>. at ~~rh_"te>'i L.mr lie ne.~c.1s 4~:i ~~l.cl: d•;~I~.-1~. ~- - -- CCT. NO. :DDRESS 1 TEL.. NO, REF)~RRf"17 t3Y /1 Pr/A~,TIENT~H~-NAP'T.._.Y~ -_..~ H1RTN Df+TG ~~ r` I.IJ •^~ G~ ~. ~~n~rr ~_~~ OCCUhATIQN AGE v;CiX. E3. M, W, ~~ .~. ~}']o~-~r~ ~ UCH ~~ ~~=IDG ~ ~'~ ~~ -~~-?~~~ .~ ; ~~ ~~~'~~.. ;, ~, ~.- c~ C.~ (.J C F ~t,,c-c.2c ct.-~ ~~ 1..~~, .- h" ~J, f,7ti ~ ~~ ~ ~ GLL~-ter-,~G~d..~ c~Z.~ -,N.r . // c~ - C~L /L.C 1~ ~~ - . -- .mss ~~ -~`,~ . ~GC,~.. ~~ v - - >~~~_~~ ~ /' ~ 'Et~) ~,~ ~l~ ,~-~.- . __-___ . _ _ / _ __ _ .. -2O-04 (1lertiz ~31ac~ Mr. Blach's son azid daughtez~ sire iii, the ofr~ce llerf; + , ,,,;0i t _ui ert,~tic anet al;~ r ,, .:.:: bct~<zvi,ol by tI~e hatiellt, 1-Ie has l0si leis tei7ipe~~ i~, tirl >;,111:. l~~sl i~>is terrier 1~,~iii:~ i,,. He feels ihathis son is stealin;= fAo>~7 h>m. Family ;< >r~i~~ ~,i~ n~~ .?S :ill; of I~_<~~~~ ,~,,, j tablet at h.s; I gave diem s~i>~,hl~ ~ 01.5 mg to use at I r ,x~~{; ;=~~ the patient ir; and also the family is to call c~~ zl~er next week ix iae 1 ~,-~; ,r,~t~.vvin~~ ozi th„ .:~~ I~,~-. l0 conti~?uc ~-icel.>t 7U rng h.:;. ~ ,~ -- -- ._._ _ Or-vine ~-:. i`~~Ich~atl~i, .l~z~., ~tit.T~. ~ - ~ .,, _ _ ~~ ~ ,~ ~~ ~ ~ C~ i G ~~ { ~ _ ~ ? ~' ' ~ ~ u ~. , ..., ce, ~ ~.a , t ~~ , ~. ;» Sr~<,_ms ~z•ct'c ~ _inc~.7e to t ~ day. t~_ ]c is _ c. . ~, a~1 i ~ r thol~t any n~_ oi" S~T3, natl~~.~:I, ~romiti n~;, r_l I.~nc~a oi- r,c}~:"! <.,~i_oe~. III, si _._ hi.nlselL. k'le does not car.rv i~'i~ro~:Lvcc .Line r~ri t:_m. ~ti.ccoi-~i_i~i ciau,~h~..~°, E?IsT~rr.daJ_ :is t~~or.l:_i_,F, ;ec~77_ ,:~' _ n, ~-1.:'. ~: '.lil~~- ~i7"E? i:1.eElZ' ~ ~i)r a. ;. '~?LL2:17'_ t :j'; ..~i llU ut:`nii. iICI71lcT1t7.3~ ~'~j~]~ !~a: ~~t'.).J~ E?]'~.(?T1 ~C)Ci :1 _'CIC ,. ., i'!1"f: T1f-;: ~: ~.:L1C 1:~: ~:I> >... _ ' .~. U~ ) '.1i?i°b7l .,f C' it ~_Cj~~ .'.17,i.OI~"i. (,11."'C~: `1'. ~:~:~i. _ ~.~lOJ _. ,. ,..1 i ~`~:,,.. n i^t y~~ `~~ ~"~~,~C~~,~,` , _ . -r. _ ,~,~ i:_, i~ nr:,,. CT, NG ' /.. t/~ , !~ ~ / ~ I FAT1E?NT'r ~~f+!v!='. .__l~-t~.a [n T ~( '~. j ~ ~ Y h ~ /~---j~ r ~ r~.~ ~ ~ - .... , OUppf;QU1ZNT ViDITt3 ANA 1°IhDING9, ~~01dT7:t~lUr;~~ ?': AL'T fast=ink soJnei~ime tJr_•.xt ~-,~~rir~ ' T'(,fTl('IT1~E'TS LO rj<") t:~lC?i:, n -._._.. _ ____ _. - -- ..._ tC~/ --- ~ For lloc!oi• -t-~ ---- --- _ _ _•,-~~~ _ ~~~~ ~-•~(/ ~_ n' At,1 ~ col I t~: ~~~1'l ~~~L(G ~~''r'rmuc,Tcl. ., ~ ! n,e doy ~` '.^ _ ' ~) ~ het ~- ~~~ -3l 1 ~~ ~ nJJcrgics __ ___ __ ~_ i 1~~~ t ; , I , ~ r - - ~ • ~ _ -----; _ ~~ k ! OriB effective -~~~,'v~_r~ -- tic, +-(-. f,-- ~., _._ therapy for ~~ ,~ ~~~ - --~~ -- _` - and anxiety ~ --- _-~- ~~-~~-'r~~,- - - , ,~_ l ~~ ~ ~I ~~ esci~alopr,rn ox~latc~_ ~~ -T ~ _ _ Irr~ i„~aiy -'" VVe1[-tolerated stle x tl~ - _ -__. ._ _ C~?~ ~ r~--, 1 .1 _^ ~Rcuuncd ,_--tFlcuc ~ iViJi r.nJl ~~Rctt!1 ~~'~ 11111 _7 1. ~ ~ ' urr „r __.. ____ _ . _ .._l .l _ ~. ~ ~y '~~~~ r_ "1'1=r;I~{iI~ItT?" T:,c ";,otic:l)n F;rl,u))t~F(.ion,~ystem i ~ P- ' '4 t For 1)r inr: --_ _. - ---- _-___.._-._- .._ .., ___-----~ ::l ~Vy. 'i..~ `\rl-into: N I ~ ~ .. ~'~) _ ~`/~.~ c~ I 1 i a >-~~ ~ 1. ~ ';~ ~ ~JUVy~n_,. . t { ~~o- ~c aJ- ,~ -rxr-: .ter----'-----.____ _. _/~ ~~ - _-_ -- _ ____ _ __^ -- I ~,r~ __ _ _ -- ~_ _ .- -- __..-- .~ - _._. y ~_~C - '-~=~'C'~-'fit=~ ~ _I ,. ! j ---' -' _ --- ---- i r Gf lti7i Jf~.rT ~t}+, alt )frt1O (1[lil3J 7-(r ?TV1~.,US'7~f-'i; . lr' ~h -- ~ ~-_.~~-'~. ~~ C,JI ~ ,for.' - ~ „ti ~ i .:, _ t J i _. _ __~._ .___ ~_.~ ._..... _.. I"-- ----__-- -..-_..__ _.-- ---_._.----------- CGT. r~CJ. ___ AhDf;L'.SS 'T'EL. NO. ltCi:'CFtRE:L7 ElY O L' AGE; C; L">; ~~ ~ _ _ ~ 1 ,,1 ~ (~~ ~, ,~ 'I t~f_ ~" ~ , Pt„ nd I ;: ix .lied about, ~~s ~!c~._I I as ta:'.t.h h! >vn, his m~rnory ~ ;i.~ ~ -- `}"=~,-~4 Tn ~ r~t=ci~cnce to his dem~ntira. ~~te warltt',d ~ rv h~.inting l:lt.is } c..:; ~ ~:~; 1 I { s : nce ize or :Lns tang got in ~ t~rorl; va>~ torl~av attr' d7-o~re it !~~~.ne ~c~t_ t,;;.i.r,~, it: was his c.~t~. I strongly r.e.com;rtended ,gat he tzct ?zunt, c ~~~;r< c.~<,le Lo that now. £'ortunately his son was al.otlf, ~<r }lclp remiztd hit, ~.>~-:eti .i t: comps to hunt:9.ng season. ~: xis ears t-rere i,rrigat-ed un1:i1. s, 7.~:az. ';'i1o ~L,t. ortc: requ~.:~cr, ;~,;.t,:;;~Y~-i7_ of hard ta_rm t~iax with specu7.um. A: ~c.rutaten ?m~~acLion, A~.~}~ei.rnc?-'s Pt r":s <above. Or~rilic ~~1cBetl-., M. I). r--- - ~,'; '--L; TI:I,rCxUARk]° I]UP!_ICATF Ccll'Y P}-lYSICIAh f ;~'`' `~ ~~i~~~~lY^ ~LJ ror uoc~or ~~, (~ \~ i ~// {~.~ v>,r%~ic i,. Gy,~« Patient l ~C~11fTc1Z~l i 1 .. 'r' ~ ~ w, ~ _ -~ --- C'~."-- /~ _ _ _ -I gyp.-~~Y~' ~ - ~ ~r° % ,~l'„d~/J / ~ ~ . :.atlerlef. -- N~amias ~_.---. ..I ,t f a r ~f 1 :J " _ ,,J/ ~J ~j~ ~ / :~ / c t t Syr . ~~ - (S/.~~>t-GCN `;t.~.w". ~ ~..~t~ S!/~ ~ ~ _ _I _ / , ti - ._.. ~.••~~ .! ~% l ~:- , ~- ~~~ jI ._.. ,_N~J - ~ ... .:. - - P!o e rFad ~ ,r_omponyinr_. -_... ~ _ __ ._i..~24-« _ _..__I iL!! Pr@SCflf)InC7 ~nfOrnlilflOn Folurned ~~-^^tt Ploa o 1WAI CuB Ro111 w,; ^_rt - Call LJ La ~~ 1fga~n ~~ ! ~ [~ ' . __._ .. ___-_~._____ .. J _.__ .W... .. .._ _.__-..___ 6• M. VV. G. able 7:3 14:21 16:3 16:6,6 19:12 accurate 21:6 activities 12:6 advance 11:7,8 advances 11:5 advantage 18:16 affect 15:9,10 afternoon 12:23 agree 13:7 agreed 9:2 16:6 Alzheimer's 6:15 9:8 and/or 23:24 answer 16:14,15 answers 14:4 antipsychotic 11:10 anti-inflammatory 11:1 anybody 16:23 Apparently 21:13 APPEARANCES 1:18 apple 5:23 apples 5:22 apply 23:23 appointment 6:5 April 1:11 6:10 14:6 15:1,2 19:5 23:16 Aricept 9:2,4 11:13 11:14,17 arm's 20:7,13 arthritis 11:2 asked 3:22 6:1,2 12:3 16:11 asking 19:20 asks 5:22 assess 8:1 assessment 5:17 7:13,16,18 15:8 attorneys 23:14 attorney's 3:19 August 18:24 authority 14:22 B B 1:22 back 11:19 21:15 backwards 20:3 bare 11:23 based 8:7 19:9 basically 18:2,20 Bedtime 10:18 beginning 10:20 behavior 11:16 believe 14:25 17:7 18:7 19:9 Belvedere 7:21 Bethann 1:13 23:3 23:20 better 18:5 bit 18:9 Black 1:5,23 14:5 18:14,17 19:11 Black's 18:9 19:4 blood 7:11 11:2 book 10:1 bottom 9:25 brain 12:11 breath 5:8 brought 10:8 business 14:20 20:17 businessman 14:19 B12 6:15 7:12,20 C 1:23 call 15:4 called 3:9 6:13 10:24 calling 11:6,6 13:13 capacity 19:4 Carlisle 1:12 7:22 carry 21:8 CAT 7:5,8,11,20,21 7:24 9:9 catch 13:1,5 16:8 categories 5:15 cause 9:13 23:8,13 CBC 7:20 Center 7:21 certification 3:4 23:22 certify 23:4,7,12 certifying 23:24 change 15:19 16:25 17:2,24 changed 17:8 changes 17:11,19 character 20:10 characteristics 12:18 characterize 18:2 19:6 chart 9:25,25 checkup 5:7 chest 5:8 cholesterol 20:22 20:23 chronic 10:23 clearly 12:13 clinica13:16 cognitive 8:21,23 8:25 9:14 12:9,10 12:10,12 21:4,25 cognitively 21:12 come 14:2 comfortable 10:11 command 14:21 comment 4:14,15 commented 12:9 comments 16:10 COMMON 1:1 Commonwealth 23:1,3 Comparing 20:6 competent 12:18 complaints 5:8 complete 14:3 23:8 completely 13:2 computerized 9:23 concern 19:24 concerned 6:15 15:6 concerns 9:3 concluded 22:8 conditioning 14:19 20:17 confused 5:19,22 confusion 6:7 7:11 19:6 20:11 consider 19:4 constant 13:8,11 constipation 5:10 continue 6:6,6 control 18:14 23:24 copy 9:17,20 13:20 correct 4:7 7:7,17 7:24,25 9:16 10:7 10:9,14 13:9 14:6 15:5,21,22 17:16 17:17 23:10 counsel 3:3 23:12 County 1:1 23:2,4 couple 18:25 20:24 course 19:22,23 Court 1:1,2,5 covering 16:9 covers 11:20 Cross 2:2 CROSS-EXAML.. 13:23 CUMBERLAND 1:1 D 2:1 daily 12:6 date 1:11 14:24 16:2 dated 3:24 8:20 23:16 daughter 10:12 11:6 Davis 1:20 day 6:19 10:12 12:21,22 16:11 22:3 23:16 death 14:17 deceased 1:5 decision 12:17 decrease 15:12 Define 9:11 definition 13:7 delusional 11:5,15 11:24 demand 14:21 dementia 7:15,17 7:19 8:1,6,6,11,24 9:1,6,8,13 11:18 11:24 12:4,8,19 12:21 15:4,8 21:25 22:1 denied 4:21 deny 4:23 depend 22:3 deposition 1:10 2:11 3:7 22:8 23:4 describe 14:8,10 15:24 described 21:4,14 designed 9:9 desk 5:25 6:2 determination 16:17 17:8,12,20 determined 16:21 diagnosis 8:22 diarrhea 5:9 dictated 5:14 died 6:23 differ 11:11 difference 21:23 different 9:24 11:11 difficult 12:25 13:12 difficulty 4:3,16 direct 2:2 3:12 23:23 direction 23:9 disadvantage 20:12 disadvantaged 21:12 disagree 12:20 disease 20:22 21:16 disorientation 19:7 distances 10:10 DIVISION 1:2 doctor 8:14 13:25 document 18:8 doing 5:7 dominating 19:21 doubt 17:24 19:23 Dr 3:14 8:14 17:22 18:1 21:5 lrive 10:10 16:3,7 17:1 trove 16:4 July 3:10 23:8 E 1:19 2:1 gar 6:9 early 7:15,17 8:1,6 12:20 13:11 16:8 22:1 easily 12:24 13:6 16:20 easy 13:6 eats 10:11 edema 5:9 either 14:10 elaborate 8:2 employed 23:13 especially 16:21 ESQ 1:19,22 ESTATE 1:5 evaluation 18:1 event 14:1 everybody 20:2,5 exam 5:16 6:25 8:8 14:24 17:6,10,18 17:21 19:9,10 20:1 examination 3:12 19:11,18 examinations 18:11 Exhibit 2:11 3:7 EXHIBITS 2:10 expect 15:19,21 17:14,19 experience 19:11 explain 11:22 explained 8:19 15:3 expressions 11:25 extent 19:12 F fact 5:19,21 17:22 factua112:16 fairly 5:19,21 family 6:14 far 7:10 15:6 16:17 farm 5:23 father 19:21 faxed 10:25 February 5:3,6,7 feel 11:21 feels 10:10 18:5 felt 8:24 12:9 field 18:16 20:8 figure 21:11 filing 3:5 Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 LEAS 1:1 point 8:13 9:1 16:7 17:4 21:21 pointed 18:6 points 8:12 population 17:15 power 12:16 practical 21:24 predecessor 8:24 prescribed 5:2 present 18:10 pressure 11:2 pretty 4:12 17:2 previously 11:3 primarily 19:1 printed 4:2 probably 9:17 problems 4:23 Professional 1:14 23:20 progression 12:8 progressive 15:11 psychosis 11:17 psychotic 11:16 Public 1:13 23:3,21 purely 11:17 purpose 7:16 put 20:12 P.C 1:21 p.m 1:11 22:8 queries 5:13 question 4:21 17:5 21:15 questions 3:15 12:3 13:18,25 14:3 19:15 Quick 19:17 quiet 21:2 R ran 14:20 rate 7:20 read 4:4 5:20 6:12 6:17 7:2 12:15 reading 3:4 really 9:22 12:4,9 13:6 16:7 22:2 reason 14:1 reasoning 12:16 received 9:21 record 9:23 11:23 14:3 recorder 4:5 records 9:21 Recross 2:2 Redirect 2:2 19:18 referring 8:15 refilled 11:1 refills 10:24 regarding 6:15 Registered 1:14 23:20 related 23:13 relation 21:22 relative 21:19,20 reliable 9:4 remember 4:10 10:6 13:19 19:1 reported 23:9 reporter 1:14 23:3 23:20,24 reproduction 23:23 reserve 13:17 respective 3:3 rest 5:14 restrained 19:13 result 15:7 results 7:24 right 5:12,14 6:18 6:18,23 8:17 9:14 13:2,4 14:25 15:15 16:13,23 18:11,12 21:10 Risperdal 11:9,15 Road 1:12 room 6:14,17 routine 5:1 RPR 7:20 rule 7:15,17 9:11 R/O 7:13 SAIDIS 1:19 SALTZMANN 1:21 satisfied 22:5 saw 6:8,19 14:16 17:22 saying 12:19 says 3:20,20 7:18 8:19 10:15 scan 7:5,8,11,20,21 7:24 9:9 scheduled 6:3 Schoneman 1:13 23:3,20 score 8:7 scored 19:25 se 9:11 sealing 3:4 sections 9:24 SED 7:20 see 5:13 6:16 13:6 14:23,25 16:13 seeing 4:5 sentence 6:12 sentences 5:20 7:2 set 12:23,24 23:5 severe 8:10 15:15 short 10:10 shorthand 23:11 shortness 5:8 show 11:23 shown 3:24 signature 5:12 signing 3:4 similar 18:3 sir 3:21 4:1,7,24 6:20 8:13 9:7 10:4 sister's 18:22 sister-in-law 11:8,9 skillful 16:9 skipped 6:1 sleep 10:16,17 sleeping 13:15 somebody 21:24 someone's 15:9,19 16:17 17:19 son 10:5,10,11 16:5 18:10 19:20 sorry 6:1 sort 16:21 sorts 9:6 spelling 20:3 spills 15:17 staff 4:6 stage 15:25 stands 7:22 start 3:14 starting 15:16 state 4:20 13:8 stated 14:5 status 6:25 8:8 14:23 19:10 20:1 stenographically 23:9 stipulated 3:2 STIPULATION 3:1 stress 12:24 stroke 9:11 strong 20:9 strong-willed 14:11 14:18 17:3 stubborn 20:20,21 stuck 20:25 subject 23:14 subsequently 23:9 summarize 8:18 summarizing 7:23 supervision 23:10 23:24 supper 10:12 support 18:19 supposed 13:16 Sure 5:21 SUSANN 1:22 sworn 3:10 23:8 T take 6:19 9:4 20:21 21:17 taken 23:4 talked 18:9 talking 5:6 tape 4:5 target 12:21,22 technica18:4 12:1 te115:3 tells 8:18 tend 21:6 term 8:3,4 21:5 terms 8:3 19:3 testified 3:10 testify 14:2 23:8 testimony 22:6 23:5 23:8 Thank 5:11 6:8 10:17 13:22 19:16 thereof 23:14 thing 12:2 16:22 things 12:7 16:1 think 3:16 9:21 12:2 18:5 20:7 21:3,4 thinking 6:3 8:12 11:5,15,24 12:13 third 3:23 THOMAS 1:19 thought 7:4 9:19 12:17 17:23 three 5:20 throw 21:15 thyroid 7:12 time 4:8 7:6,10 13 :2 13:5,13,15 14:9,9 16:3,3,5 17:4,6,9 22:3 23:5 times 18:25 21:6 today 5:19,22 21:13 told 6:4 16:12 top 3:20 4:25 Toprol 10:21 11:2 totally 21:18,22 transaction 20:7 transcribed 4:6 23:9 transcript 23:10,23 translating 5:11 transportation 18:19 treat 9:5 treated 14:5 17:9 tricky 16:8 tried 20:3 true 9:1 23:10 truly 21:20 trust 20:2 truth 23:8 truthfu121:18 try 13:19 trying 21:11,21 TSH 7:20 Tuesday 16:12 tumor 9:12 turn 3:23 two 7:2 20:6 type 9:8 15:11 18:14,15 -- _U_ Um-hum 3:17 7:1 unable 14:2 understand 8:5 understanding 12:1 uneven 18:15,15 unimpaired 20:14 use 9:2 usually 16:1 V vascular 9:8 viewpoint 12:4 visit 3:24 5:1 visits 14:17 18:11 19:22 vomiting 5:9 W W 1:5 waived 3:5 want 8:17 wanted 14:18 17:4 20:10,16 wasn't 9:9 watch 16:12,16 water 14:19 20:17 wax 6:9 way 5:23 9:9 12:19 19:21 20:18 21:13 week 6:3 16:11 went 5:25 6:2 We'll 13:21 we're 10:19 whatsoever 19:23 wife 6:23 wife's 14:16 witness 2:1 3:10 23:7 wonder 11:21 word 6:17 words 19:2 work 7:11 Filius & McLucas Reporting Service, Inc. Harrisburg 717-236-0623 York 717-845-6418 PA 1-800-233-9327 ~~ _ _ c~ _ _ . ACCT. NO. PATIENT'S NAME ADDRESS BIRTH DATE ~/~"" ~ ~ ~ DATE TEL.. NO. REFERRED BY OCCUrATiON AGE SEX g, M. W. D, 5-8;-03 CONTINUED Pt. is just working now once a wk. His BP was improved when T took it. He has Lesions on his forearms that are consistent with actinic keratosis but just had some sun damage. I would Like to sae what things Look like after this clears. 0: Lungs are, clear. COR is regular. Legs are with no edema. A: Elevated Cholesterols, CAD Stable with just using 1 Nitroglycerine since last visit, Actinic Keratoses are present on hi•s'forearms but possibly more than T suspect. His Lt. ear is with wax. I was going to irrigate that today but forgot. P: Is to recheck in 1-2. mons. to have his arms frozen •'~rhe•re the actinic keratotic spots are present. If he hasn't taken, care'of his ears by then, we will proceed with irrigation on the Rt. s.ide.~ ' Orville McBeth, M. D. ~,'/ 1 `~ ~ t~i t ~--pC' ~ C`u`e-~ ~ C~ _~ ,~ 1L ~ P ~ ~., ~ , "~brU ~ i~U ~ V r~ mar k.S Or1 Cc.~'m S Q Q, n -~- P P /sk~~ ~'a ©~ ~hcs-~ . nO ©~he~' com 1 a ~ nos 9 '~ .~ (~~bi~.s 1n~ ~Pt. had 6 actinic keratotic lesions on his hand and forearms, 3 on each side and then one on his Rt. posterior temporal area. He had a skin tag on his Lt. anterior chest, that was frozen as well. ~... . A: Actinic Keratoses, Skin Tag . P: Freezing as above. RTO at usual appt. ,[ Crville McBeth, M. D, ~ ~~ N ~ n~n~ FJ ~~ ~~~ . c(6 v~ c~ G~~~~~ ~~r~a~-1~-~~~ ~ ~ :~. ACCT. NO. pATIF_NTS NAME v!/n'' ~~'Q BU88EQUHNT VISIT>i AND FINDINGS, Pt. is not having *sny significant arthritic pain. He is doing well with his pr.,~state~ taking the Saw Palmetto. He stall uses Vaagara prn. Otherwise•re~riewed has cholesterol. His LDL could be a little bit lower but will not change his medication right now. We discussed this. 0: Lungs are clear. COR is regular. Legs with no edema. A: CAD Stable, Erectile Dysfunction, Arthritis, BPH P: Check LDL, Triglycerides and HDL and ALT at next visit..:: RTO in /~ mons. Continue w3.th the same medications for now. Did review his a~m;~ and did not see any other areas of actinic keratoses to freeze. ' Orville McBeth, M. D. TELEGUARD® DUPLICATE COPY PHYSICIAN MESSAGES ' ® For Doctor ~ ` - 1 7 1 ~~lWl// Date Time aM w PM Patient PharmacyT I. ~` 69m [ „ ~ Caller Tel, . . Allergies capsu~es fexof enadine HC G E M E S S A ' / E -- -^ I ~ V~ .~ .~. ~ : y,r- ~g .t r' i. _. .. ,ti.. lµ:. ~. _._ . J ed Returned Please ~ ~ 911a Hall ~ Refill ^ Utgent O CaR ~~ E`- ~ 1-.03 ~ ~~ s~rn~C g`~~ ~~ ~ ~~ S mod. - 5~.= ~ ACCT. NO. ADDRESS BIRTH _ca. ,. ~~~ ~ i c~c~~ ' ` - ~L.. PATlENT~S NAME ~( ` DATE 7t ~ ~ ~'~-+ DATE TEL. NO. ~ REFERRED BY dCGUI°ATION ~,a ~~S ~rad~-~ n S C~O~~`~ ~ ~ G ~~ ll ~~~ L ~~ ~~ ` Poo-~.~~cx--~-~ ~-~c~~ ~ ~~So ~~ 0: ENT reveals a red TM actually on the Rt. Throat was with some erythema. Neck benign. Lungs are clear. A: Otitis and Bronchitis P: Z~.thromax Z~Pak.~ Force fluids. Orville McBeth, M.D .'~~ . ~~~~~`~ ~ d C~ ~~96~ ~~ i cQa, ~wl~ ~~U~a ~~ 0~ ~v-~. ( ~~ . li ~~ . Pt. see,ns to one as if he~ is ha.vin~ more difficulty with his ,ne.nory. However upon questioning he denies sucli.~ He is planning to 'go to Florida later on this gear. j~7orks 1 day a wk. to help out his son with the business. He is agreeable to going back on medication at this point in tiate for his BP which 1 think will definitely help his heart as well although he denies any cardiac pain. H~e is in need of Navin; his prostate checked today. 0: See Flow. Prostate is quite large. No'~nasses though. A: BPH, CAD, Hypertension P: RTO in 1 ,non. Begin Toprol XL 50 ~ngs 1/day. Check a PSq, Lipid Panel and Complete Metabolic Profile. ACyE SEX g, M. W. D. ~~l~ll~'P11 Orville McBeth, M. D.~~ ^ -' ~J ACCT. pt0. -- - - PATIENT'S NAME ~ b ~J ` ` ` ~4\ A~ 1l . - - - - - , ~~~~ ~~ 9U1l6EgUENT YISITi AND FINDINC33, ~., ~-- ~~ _ ~ ~ ~~ `~- ~ r ~~~~~~~ Pt. also complains of erectile dysfunction.. Niagara has not worked for him recently. He would like to try one of the new medications. He was at a large hunting shop yesterday and missed his appt. Otherwise he denies any cardiac symptoms. He rarely ever uses Nitroglycerine. 0: Lungs are clear. COR is regular.. Legs with no edema. A: Hypertension Improved, CAD Stable, Erectile Dysfunction, Elevated Cholesterol with Lipitor just increased P: Trial of Levitra with instructions given 10 cogs 1;. initially and if 1 doesn`t help use 2. RTO in 3 coons. for his bloodwork- Pt. after the fact seeus fairly confused today. He asked me if cop apples are all off. Then he went up to the desk and asked thinking he was scheduled in another week or so and he just told ne that he missed his apps. yesterday which,he did. Will continue to observe. Orville McBeth, M. D.~ ~- ~ ~ ~ Y ~~ r ' C1 ~ ~-`e ~f'" -e.~Y-, ~ GI ~.~ vt'e.c~ 1,..) i ~ ~ t(r i t--c~ ~ ~ a o C~ v,` ~- ~, r.4 r Q t...~ ~'~~ aL.,~ .~• - ~ Se~M moo{ ~ h r ~~ J o ~- ~ . ~ - ~ r~ Glenn complains of Lt. ear cerumen and impaction. There was a fair amount of wax there withit pushed up against the ear. We were able to get out some of the wax with copious amounts of irrigation.. However there was still some persistent wax. A: Cerumen Impaction, - io ..e.l-~i P: As above. Debrox ear Solution. Orville McBeth, M.D ~~ ACCT. NO. - - ~ - -- - - - -- ~ - PATIHNT•S NAME ~' - BIRTH DATE ' . (~ ~ DA'L'E ADDRESS TEL.. NO. REFERRED HY OCCUtAT10N AGE SEX g, M, W, D. ~~~ ~ o,~a.. F~ ~,.,~~--~.~ rte: c f- a -~ ~ /~-t/ ~ gyp, ~ s ob ~ o ~ ~ J ~~~~? ~ -~d.~~.~, , /~„~ ~~~ ~~ ~ ~ Son was along with pt today. Son brought his medications which will need refilled. Gave the mini mental status exam. Pt. was able to~get 24 o~it of 30. He thought the year was 1940. He has not had a GAT Scan. 0: See Flow. Cranial nerves 3-12 intact. Motor is intact for upper and lower extremities. A: Hypertension, Elevated chalesteral, R/0 Early Dementia -P: CAT Scan. CBC, Complete Metabolic Profile, Lipid Panel, LDL, RPR, TSH, B12, Sed Rate. CAT Scan is at BMC. RTO after that if there are any changes in medication. ..' Orville McBeth, M. D. ~•- r r------ ~ --- - ---- y REFERRALS , ' NAME' 1 Dr SERVICES FOR ~~CDTTdI ~y, DOS DTA SCHEDULED BY: ATE ~ ..a' rvu~ ~~ ~~ ~~ ate, -- - - ~~ ~1~-~~ ~1a~..tc.~ AGGT. NO. PATlEN7"5 t~lAME - Q- ~~- a~ BUBBEgUENT YIHITH AND FIN DINGe, Reviewed his results from his CAT Scan and bloodwork with Pt. and son. 0: As above. A: Early Dementia P: Aricept S mgs 1/day and samples given. RTO in .1 mon. Refer~,to Dr. Mosser for further evaluation and confirmation. ' Orville McBeth, M. D. .(~...- 3. _.. REFERRALS AME Inn ~~C~C~-- DATE '~a~~ N p~ SERVICES FOR PROVIDER ~ 5S~ ~~`~~ HOSPITAL DO5.~1~-d TIME ~ DIAGNOSIS ~ SCHEDULED BY: ~ C~ -~j "~"~~ ~~ NiG JOiC~d, Son is along. Pt. had forgotten to take his Aricept ~~~, 5 mgs at h.s.and Dr. Mosser•concurred•witht he medical Q.-•~~~= treatment at this point in time although I have not xeceived a letter from Dr. Mosser. Also talked about his BP which is elevated today. He said that he was out mowing. He did not want to do anything abou t that at this time in particular since he was out mowing. Otherwise denies chest tightness, SOB, nausea, vomiting, diarrhea or constipation. 0: See Flow. A: Hypertension, Early•Dementia, CAD without any anginal symptoms P: Discussion in reference to his meals, his driving. He at this time is able to drive short distances and son feels comfortable with that. He does go to a son or daughter's house each day for supper. [,Ii11 continue Aricept now started again at S mgs by Dr. Mosser . just a'week or so•ago. Then when that is all for a month go up to 10 mgs at supper. Son and daughter wi11 see that he gets that. RTO in 3 mops. at which time he needs his bloodwork. Orville McBeth, M. D. ~ PATIENTS NAME ACCT. No. ~ -l / - ^a ADDRESS BIRTH DATE ~l1 DATE , 'flrl.. NO. REFERRED BY OCCt7rAT10N AGE SEX g, M. W. m ~ 7o ro ~ x~ 5v m ~~ ~~~0. ~d ~ - ~ ~ ~ .1~. k Cam` ~~ ~ ~ ~~~. l~b~< ~ - ~ ~,c~.,,, ~„-~, ~ .~,~ ~ ~ U ~ ~ ~ +' 8-20-04 G1ennBlack T ~_~__ ----- ----- --- -__------ ----- ---- Mr. Black's son and daughter are in the office here to report on erratic and aggressive behavior by the patient. He has lost his temper in the bank, lost his temper with his son. f He feels that his son is stealing from him. Family is only giving .25 mg of Risperdal % ~ tablet at h.s: I gave them samples of .5 mg to use at h.s. I will seethe patient in a week and also the family is to call earlier next week if he is not improving on the .5 mg. He is to continue Aricept 10 mg h.s. Orville G. McBeth, Jr., M.D, ~ - ------Oi""" -- ~ ~ ~ c~ ~ ~-~`~~ G ~-Gso~,C-~~~jID~ ~P ~~E vo~~~~ W' ~ Seems pretty docile today. He is feeling fine without any chest tightness or SoB, nausea, vomiting, diarrhea or constipation. He still lives by himself. He does not carry Nitroglycerine with him. According to his daughter, Risperdal is working well. at 5 mgs q.d. 0: Lungs are clear. COR is regular. Legs with no edema. A: CAD, Dementia, Hypertension P: Check Prostate next time ~~~hi_ch will be 4 mops. Otherv7ise continti same medication. Check LDL, HDL, Cholesterol and Metabolic Profile and - -- --- _) - - - ---- _ 1~.~ 1 ~LI..L~ ~C7. NO• rAT1EtJT"S NAME ~ ~ tl//o~~J) (/n r ~ w ^~ BU88EgUEIVT Vi8IT8 AND FINDINGS, 8'27'04 CONTINUED P: ALT fasting sometime next week. We will see if he remembers to do that. Orville McBeth; M. D • For Doctor ~S _~~ (1 Time AM , A , (• 1 ' '~ Patient ~ Phi ~~ ~ C ~ Pharmacy Tel. ~c ~ • ~JoS'~5 '` the de ' ~IFrTcl~at_ 3/j7 Al1c yes , ( llUV `~ .. ' ~.s,..~.Q. _ ~ ~ ~ ~ ~ i' ~ T I S~.r~ Gre U Gc_~ i s ,- S IJ ~ r L 1` in p ~. One effective '~~~ F~~-~--~~-- S~ e~ ~~ urn therapy #or Q ~, ~t~ ~ ~,.~~ C~ti.~n 4 a ~ ~s a ~ depression ~ ~ ,~~. ~~, { ~ ~ ~ and anxiety ~ `" ~`" ' l ~ - t t K., , c- Lexapro~ ~ e ~ ~ ~ ~ PSGf8l0(]faf(1 OX2~8tB Well-tolerated stren th _... _'~- _.....~_ Recefv dBy ~ g Returned _. _ ..... _ vtP,<,. _ ,,,:,: ,._,: ~ _. J ~ - - -- - - - __ - - mQ ~.:~~ - -- ~l 0.C--ic. - ACCT. NO. PATIENTS NAME ADDRP55 BIRTH DATE ~^~ `y ~~ pATE TEL. NO. REFERRED BY OCCUtAT10N AGE SSX S. M. W. D. ~~ ~~~ ~ ~ ~fl ~ Pt. and I talked about, as well as with his son, his memory issue. ~~ In reference to his dementia. He wanted to go hunting this year and since he for Instance got in a work van today and drove it home thinking it was his car. I strongly recommended that he nct hunt. He is agreeable to that now. Fortunately his son was along to help remind him ~~ihen it comes to hunting season. ~~ His ears were irrigated until clear. The Lt. one required removal of hard firm wax with speculum. A: Cerumen Impaction, Alzheimer's P: As above. Orville McBeth, M. D. C~ TELEGUARD° DUPLICATE COPY PHYSICIAN MES P jy Q9j~p1~~~~s~D G , ,' m ! 6 j ' ~ ' C Forpoclor' Dala ~Time . n ~ ^ ,Y iC ~ +P,70Pae(aa'.a )1 mMHC! di 11:( c z ~ PaGenl ~e )`y U/ / P a 2d a-- L f ~ - CauerTe . pl ~~ ~a ® I MESSAGE ~ • }- ~ ~u~ ~ D l~ .1 . •.. CA .?., ~r ~ ' _ , S ' ~~ , ~ r ~ ~~ _ . ys2i~: k _ ;,~~~, az ~L~sN {~ f ,yC.~~/,~~b~f~~.,~ r! Rec d8y d Al i ease rea accompany ng full Prescribing Information Returned ~ Plaaso ^ w~i caa ^ aetai ^ rpent - cau- calf Agah i ~, MEDFORD Pi{OFESS{ONAL CTR. 2200E S. GEORGE ST. YORiC~ PA 17409 (717) 741-4697 JEFFREY F. MOSSER, M.D. NEUROLOGY GETTYSBURG MEDICAL BUILDING SUITE #12 455 3. WASHINGTON ST. GETTYSBURG, PA 17325 (7t7) 334-1415 May 18, 2004 Orvi{le G. McBeth, Jr., M.D. 3375 Carlisle Road Gardners, PA 17324 RE: Glenn W. Black DOB -- 9/16125 Daar Doctor i'vicBeih: I am writing with regard to your patient, Mr. Black, who was seen in the Gettysburg office in consultation today accomQanied by his son, Laverne. As you know, Mr. Black is aright-handed gentleman who has a water conditioning business for many years that his family continues. He was referred for "ea v dementia'- When_asked why he is here,__e has no idea and when asked specifically_if he has any problems with memory he says "no, not really°._ He does correctly _y-_.._ - __ -- ----- "~eport~ia-t~fie has three daughters and two sons but is not certain about how many grandchildren he has and estimates eight or nine. He also reports that he has agreat-grandchild or two. He tends to be a little irritable and resentful about questions throughout the exam. His neurologic review of systems is completely negative according to him. His medical history,is negative and he reportsahat his.blood pressure•and, chest pain, ~re•not really a-problem.:He is uncertain of;his•: medicines and, did not bring a•lis't. From your,;dictated~note:~ it is nof.cfear.whether he'is.takmg folic~acid but_fie,is,adamant that:-}je is not taking,Motriri or any pill three times;a.tlay. ` He also'reports;fhat.he is,not taking ;asplriri'currently including; .•. Ecotrin.. He.does report taking Glucosamihe and~Lipitor anc{ saw palmetto arid_zinc, though~the.latte~ tv/o,have not; . . Secentiy been takeh. He may be taking metoprolol but is not certain of;the.riame., He,does repoi•t,takiri~ "the frst,bafch" of Aricept 5 mg. tabletsand has others he has+not yet startetl.~ If he is referring, tb.a.severi-day.pacK; he may,have•orily taken them.for a week since you started him around April 12'h.~ He~reports having several packs'leftand, depending upon how many~you gave him, l suspect that his compliance may be fairly low. Historically his .weight isdn~the 140's range. His social history is significant for the sudden, unexpected demise of his second wife on March 2 in Florida when she apparently had a pulmonary embolus from a deep venous thrombosis that was not recognized. He is living alone and looking after his meds and meals himself. His daughters were apparently concerned about his increased problems with memory or confusion. He has no known drug allergies. There is a remote history of smoking and no history of alcohol abuse. His family history is benign or negative or at least unknown. Both of his parents lived into their sixties, and he is uncertain about what they died from. He did have a CT of the brain in April that was normal as well as benign laboratory studies including a CBC and Sed. Rate and blood sugar, chemistry profile, B12 level, cholesterol, TSH, and RPR. He denies any family history of dementia and his son is not aware of any. , is son_verifies that he was having some subtle change in memory ar~ersonalit eyen~rior to the. death of his wife. _ On examination in the office today, Mr. Black had a blood pressure of 164174 in the right arm in the sitting position. No carotid or supraclavicular bruit or precordiai murmur or radial pulse asymmetry is noted- He is alert and oriented and tolerant of the H & P but not en#husiastic about being here by any means. Formal mini I shat a~ estin _~elds a score of a maximum of 25 out of 30. He ios~es three points in orientation to time b~cafling the year"32". He correctly identifies the month after scrolling down from the beginning of the year to the correct one when he recognizes it. I~ insists that this is the fall ar~d even_after suggesting that that is a little_ear{y for May tends to defandhis decision., He is , _., __ - corr~about tFle day but cheats by using his watch to identify. it, as Tuesday He misses, the date tiy, one, but claims that . he misread his watch- He..loses one point in orientationao. place by thinking that he is on.the,first,floor,,of the building; ~, w,,, when he is;on the second.- He repeats three items'peifiectly; . He has difficulty with'math,and,gets.93 but'ttien'=85,~or 84. When.testing the non-mathematics calcuiatioiis.test, he comes up with:'d,i,o,w° and misses•the,"~"; ; He~does~recell alkfive items at-five minutes at~the.entl of the.entire.exam and the.rest:of h'ss score is perfect:.•,Hisscore;of 22~to ~25;depending; upon how one grades it puts him just below fhe~normal~range for his,~age and~high school education. The,average score ,:.:~` Dr. McBeth Page 2 May 18, 2004 RE: Glenn W. Black fora 78-year-old gentleman with a high school education would be 27 with a range of 25 to 29 for the lowest and highest quartiles. There is no aphasia or dysarthria or unilateral neglect or extinction demonstrated. His crania! nerve exam is completely normal and the optic fundi are benign. His motor examination including coordination and gait is normal. Sensation is symmetrical and intact with some decreased vibratory sense distally. His reflexes are normal and symmetrical and Babinski signs are negative. He does have bilateral palmomental reflexes with poor extinction of the reflex. There is no grasp or traction reflex elicited and Myerson's sign is negative. I have explained to Mr. Black and his son that he has at least; some mild cognitive impairment and that this may be a predecessor of dementia. Historically it has been an insidiously progressive henomenon and is ~s_ an acug. situational disturbance from his second wife's early demise. I would agree with the use of Aricept, a though I question ow goo his compliance is based on his report. pit would be worth recruiting the family to.be certain that he is taking the medication faithfully at night judging by his prescriptions or sample packs. Depending upon how much better he is on 5 mg. a day, it may also be worthwhile increasing it to 10 mg. after six weeks or so. If there is enough recovery or improvement of function on 10 mg, of Aricept a day; 1 would suggest continuing that far a time. If there is inadequate response or if his symptoms progress in the future, then fVamenda should be considered. He denies any sleep disturbance or change in weight or any other symptoms to suggest that reactive depression is playing a rote, and based on my initial impression I believe this to be the case. Thank you for referring this patient for neurologic evaluation. Please feel free to contact this office for any questions you may have in his regard. Sincerely, ~~`~ J ffr F. Mosser, M.D. JFM/das DX: Mild cognitive impairment (294.8} ~ ~, y~ ~`~ ,~ :`~' _H, ~:~ . _ ~. I, GLLNN W. SLACK, of Dickinson Township, Cumb lard County.. Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby ~ke, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Ca ils heretofore made by me. ONL. I direct my Executor or Execute ,. as t case rr>~ay~ b ; to pay all o`~~y debts, funeral art admi ' trative expenses as soon as onvenie ~ after m decease. Furthernlore, I direct that all state, inhen ance, successio an r t taxes imposed or payable by reason l of my death~and interest and penalties thereo w h r s ect to all property composing of my gross i ~'` estate for death tax purpose , wh he not uch perry passes under this Will, shall be paid by the Executor or xecutri~ of m tae m the residuary hereof. ~,` TWb. xecutor Executrix may, at his or .her discretion, compromise claims, borrow. money, re ain property for such length of time as he or she may deem proper; lease and sell property for su h prices, on such terms, at public or private sales, as he or she may deem proper; and invest estat - property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor or Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor or Executrix. • yam. -~, ~ .~ ~--~ ~ ~~ j ,~~~ HREE. I give, devise and bequeath all of my estate of whate~ er nature and wherever situate to be distributed as follows: .A. I hereby give and bequeath a sum of $5,000.00 to the BIBLE BAPTIST CHURCH, Shiremanstown, Pennsylvania; B. I hereby give and bequeath a sum of $5,000.00 to BAPTIST BIBLE COLLEGE, Clarks Summit, Pennsylvania; C. I hereby give, devise and bequeath any and all interest that I may have at the time of my decease in those real properties, including all improvements thereon, free and clear of all encumbrances, which are known and numbered as li0 Old State Road, 134 Old State Road, and lib Old State Road, Gardners, Cumberland County, Pennsylvania, in equal shares to my daughters, CAROLYN McFEATERS, LINDA BLACK and JANE YOUST, per stirpes, provided however, that within ninety (90) days of the date of my decease all of my said daughters as stated above agree to the equal division of these three (3) properties. In the event that all of my said daughters are unable to agree upon the equal division of these properties within the said ninety (90) days, then in that event, all of the real properties are to be sold and the proceeds thereof divided equally between my daughters, CAROLYN McFEATERS, LINDA BLACK and JANE YOUST, per stirpes. D. It is my intent that my spouse, JEAN H. BLACK, continue to have a life estate in that real property located at 142 Old State Road, Gardners, f ~~~ umberland County, Pennsylvania, in accordance with that Life Estate Agreement dated February 8, 1999. At such time as my spouse, JEAN H. BLACK, relinquishes her life estate as provided under said Life Estate Agreement, I hereby grant unto my son, LAVERNE C. BLACK, the right to purchase the aforementioned real property for a purchase price of Eighty Thousand Dollars ($80,000.00) within ninety (90) days after the relinquishment of the life estate of my spouse, JEAN H. BLACK, ~~ith all of the proceeds from this purchase being distributed to my son, LARRY G. BLACK, per stirpes. In the event that my son, LAVERNE C. BLACK, does not exercise his option to purchase this real property as stated aboz-e, then the real property shall be sold as soon as practically possible with all of the proceeds therefrom being distributed to my son, LARRY G. BLACK, per stirpes. E. All of the rest, residue and remainder of my estate I hereby give, devise and bequeath in equal shares to CAROLYN McFEATERS, LARRY- G. BLACK, LINDA BLACK and JANE YOUST, per stirpes, which provides that the child or children of any deceased child shall take the share their parent would have taken if living; provided however, that if any beneficiary inheriting under this paragraph is under the age of twenty-one (21) years at the time of my decease, then this share shall be held in trust and distributed in accordance with Paragraph Four hereof. FOUR. If any of my grandchildren or other beneficiary under Paragraph Three of this my Last Will and Testament is under the age of twenty-one (21) years at the date of my death ~ ~ ~ ~~~ ~~ f twenty-one (21) years, then whatever remains of income or principal of the said heir's or beneficiary's divided share under this trust estate shall be distributed to said heir or beneficiary, per stirpes, which provides that the child or children of airy deceased heir or beneficiary shall take the share their parent would have taken if living. In the event that any said heir or beneficiary becomes deceased prior to the final distribution hereunder without leaving surviving issue, said deceased heir's or beneficiary's share shall be divided equally between aII of the heirs and beneficiaries who are a part of this trust and distributed in accordance with this Paragraph. For whatever reason there are no heirs and beneficiaries remaining as apart of this trust, then in that evert, the rest, residue and remainder hereof shall be distributed in equal shares to the residual beneficiaries set forth in Paragraph Three E. above. FIVE. I hereby nominate and appoint my son, LAVERNE C. BLACK, to be the Executor of this my Last Will and Testament If he has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint my daughter, LINDA BLACK, to be the Executrix of my estate. In the event that she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, then in her place I hereby appoint my daughter, JANE YOUST, to be the Executrix of my estate, whereby both substitute Executors shall have the same rowers as the original Executor hereunder. SIX. I hereby nominate and appoint SHIRLEY D. BLACK, or if she is not able or does not serve for ~~7hatever reason, I then appoint JASON A1~~DREV~' BLACK to serve as Trustee of the trust created in Paragraph Four hereof. ,moo EVEN. No person(s) shall benefit hereunder unless such beneficiary- shall survive me by sixty (60) days. IJIGHT. No Executrix, Executor, or Tnistee acting hereunder shall. be required to post bond or enter security in this or any other jurisdiction. NINE. No beneficiary may assign or anticipate his or her interest in any income or principal held or distributable hereunder; and no beneficiary's creditors may attach or otherwise reach any such interest. TEN. The validity and administration of any trust established hereunder and any question or disputes relating to the construction or interpretation of any said trusts shall be governed and construed in accordance with the laws of the Commonwealth of Pennsylvania. ELEVEN. If any person or institution entitled to share in any distribution under the terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its entire interest inherited hereunder and all provisions in favor of such person or institution shall be declared void and of no effect. The share of such person or institution so forfeited shall be distributed as part of the residue pursuant to Paragraph Three E. hereof except that if such person or institution is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary distributees. TWELVE. The Trustee, as well as my Executor or Executrix, shall have the following powers, in addition to those vested in it by law, for my property held for the benefit of my beneficiaries, whether income or principal, exercisable without court approval and effective until the distribution of all property under the terms of the trusts set forth in Paragraph Four above: ~' :. MEDFORD PROFESSIONAL CTR. 2200E 5. GEORGE ST. YORK, PA 17409 (717) 741-4897 JEFFREY F. MOSSER, M.D. NEUROLOGY GETTY56URG MEDIGAL BUILDING SUITE X12 455 S. WASH[NGTON ST. GETTYSBURG, PA 17325 (717) 334-7415 May 18, 2004 Orvi{le G. McBeth, Jr., M.D. 3375 Carlisle Road Gardners, PA 17324 RE: Glenn W. Black DOB - 9/16/25 Daar Doctor McBeth: I am writing with regard to your patient, Mr. Black, who was seen in the Gettysburg office in consultation today accompanied by his son, Laverne. As you know, Mr. Black is aright-handed gentleman who has a water conditioning business for many years that his family continues. He was referred for "early dementia". When asked why he is here, he has no idea and when asked specifically if he has any problems with memory he says "no, not really'. He does correctly report that he has three daughters and two sons but is not certain about how many grandchildren he has and estimates eight or nine. He also reports that he has agreat-grandchild or two. He tends to be a little irritable and resentful about questions throughout the exam. His neurologic review of systems is completely negative according to him. His medical history,is negative and he reports;that his..blood pressure.and chest pain ~re•not really,a-problem.,He is uncertain of;his•: medicines and did not bring a.lis##.~ F,rom you rdictated~note~ it i5 ~nof.c(ear...whether iie'is,t~king folic,acid'~tiut.tie,is adamant ttiak-fje is not takiiig,Motrin or any pill three times a.aajr:,` He also'reports.thaf.he.is,not faking :aspiriri'currently including , . Ecotrin.. He. does report taking Glucosamine and`LipiEar and~saw.pelmetto and; zinc, though~fhe.latter two,have-not; ~' . {eceiitly.beeri taken. ,He,may be takirig metoprolol 6ut:is:net certain of the:riame., Fie,does report,takiri~;"the ,first batch" of Aricept 5 mg. tablets~and has others he has not yet started. If he is referring, to,a.seven-day,pacK;'he may;have-only taken them.for a week since you started him around April 121h. He~reports }iavirig several packs ;leftand, depending upon how mahy~you gave him, l suspect that his compliance may be fairly low, Historically his weight is in~the 140's range. His social history is significant for the sudden, unexpected demise of his second wife on March 2"d in Florida when she apparently had a pulmonary embolus from a deep venous thrombosis that was not recognized. He is living alone and looking after his coeds and meals himself. His daughters were apparently concerned about his increased problems with memory or confusion. He has no known drug allergies. There is a remote history of smoking and no history of alcohol abuse. His family history is benign or negative or at least unknown. Both of his parents lived into their sixties, and he is uncertain about what they died from. He did have a CT of the brain in April that was normal as well as benign laboratory studies including a CBC grid Sed. Rate and blood sugar, chemistry profile, B12 level, cholesterol, TSH, and_RPR. He denies any family history of dementia and hIs son is not aware of any. His son verifies that he was having some subtle change in memory ar personality even prior to the death of his wife. On examination in the office today, Mr. Black had a blood pressure of 164174 in the right arm in the sitting position. No carotid or supraclavicular bruit or precordial murmur or radial pulse asymmetry is noted. He is alert and oriented and tolerant of the H & P but not enthusiastic about being here by any means. Formal mini mental status testing yields a score of a maximum of 25 out of 30. He loses three points in orientation to time by calling the year "32". He correctly identifies the month after scrolling down from the beginning of the year to the correct one when he recognizes it. He insists that this is the fall and even after suggesting that that Is a Tittle early.for May tends to defend his decision. He,is , correct about the day but cheats by using his watch to~ identify.it_ as Tuesday. , He misses the date l;y, one, but claims that . he misread his watch. He..loses one point in orientation;to. p/ace by thinking that he is on.the frst.floor,,of the buildjng; ; ,,,,. when he is;on the second. He repeats three jtems,'pe'rF,ectly...He has difficulty with'math.a~nd~gets 93 but'tfie~85;or 84.' ' VVhen,testing the non-mathematics calculatioris.test, tie comes up with.:'d,l,o,w" and misses.ttle "r",.^; He~does recall all:;five ~ifems.at-five minutes at the.end of the.entire.exarri and the.rest,of his score is perfect:.~His~score:,of 22•fo~25;depending: , upon how one grades it puts him just below fhe~normal~ralige for,his~age~and~high.school education. The,average~score EXHIBIT ~~-fir:; , ~ ~ ^ I~r~n`31ac~.. ~Q ~-tit~ as - --- .- - GLENN BLACK DOB: 9/16/25 --. .._ _ __._.. l 05/24/0.7 i CC: Routine visit. i S: Patient has lost 29 pounds in one year. He apparently doesn't eat.: all his meals. He sometimes gets nasty so the staff leaves him in bed. He does not have any chest pain today, shortness of breath, edema, nausea, vomiting, diarrhea or constipation. ' Patient otherwise is feeling good. He seems to be in a good mood today. He smiled actually for me for the first time, however, he did not name who I was nor his daughter-in-law or any of his children's names. He was amenic in January and he •seems short of breath today. He is still in complete heart block and certainly this will give shortness of breath, but Y wondering if the anemia could be contributing more to that. j 0: See flow. Heart rate was slow in the 40's. i A; ~.. Anemia. 2. Hypertension. , 3. Complete heart block. . F ... _ _._ __ _ _. _ _ .. 4. Weight loss. _ p; 1. CBC, B-12, folate acid and iron saturation. 2, Recheck in 4 months. 3, if appropriate with the labs, will be treated through the facility that patient stays in. Orville McBeth, M.D. ~'"~ OM/wst/ # 422519 j EXHIBIT N d ~~ y:~c~ ~ ~ ~ - -~'-r - __" __--- _ ----_-- _._~ _ ____.--_------- .~._ :.. --~ - - ~- - ~___ . _ __ ~ _ -. _ - -- - _ _ ~ ,~a~ _ ± ~ BLACK, GLENN DOB: 9/16/25 --- ---.-_.. _._ _ I 5/15/06 -- - - - _ -_ ._ I ~ CC: Routine visit ~ 3: The patient's daughter-in-law brought him from Outlook Pointe at Dillsburg where hell is a resident in the dementia unit. He reports feeling fine without any chest pain; shortness of breath, nausea, vomiting, diarrhea or constipation. He does sleep a t 1 lot during the day now and T had increased his Risperdal last time to 0.5 mg t.i.d. He is getting his medication on a regular basis. The daughter-in-law and T I ~ discussed the patient's blood pressure which is still elevated but not terribly so ~ j and his quality of life and his heart rate of 30's to 50's with complete heart blocs and decided not to proceed any further with treatment of his blood pressure at this point in time. 0: Lungs are clear. Cor is regular but slow in the 40's. Legs are with no edema. ~ A: 1. Complete heart block ' z. Alzheimer's ' ~ 3. Hypertension 9. Elevated cholesterol ~ P: 1. Decrease Ris erdal secondar to fati ue to 0.5 m o b.i.d. given for 180. p y g g P Prescription 1 z. Recheck in two months, f Orville McBeth, M. D,/OM/sls/#2 89 05/16/2006 !' ~ {~5 l t~-e ~. h ~ ~ ~~-n c~-r- ~ _ ~ ~ -r ~o ~ ~ ~ ~ to ~.~ j 5Yt-~ F~ ~ ~ ... . _..-- GLENN BLACx Dos: 9/16/25 j . ~/zo/o6 CC: Routine visit. S: Patient has dementia. His daughter and daughter-in-law are along today to discuss possible withdrawal of some coeds. We talked about keeping Aricept and Lomenda on board. He himself denies any chest pain, shortness of breath, nausea, vomiting, diarrhea, constipation. His daughter desired to have his ears checked as he has some difficulty with hearing. He is a resident in a personal care home. 0: Lungs are clear. Cor is regular, 40. Legs with no edema. Tympanic membranes are blocked by wax bilaterally, and was irrigated by the nuxse and then I used a speculum for about 4 minutes to remove wax from both ears. A: 1.' Complete heart block. 2. Alzheimer's. 3. Cerumen impaction. 4. Hypertension. P: 1. For now, since son is not present today, we will continue with the same medication as before. 2. Recheck in one to two months. ' 3. Removal of wax as above. Orville McBeth, M. D. ~.--/ JI OM/wst/#293336 ._... - . __ - - .. .a ~~eaag GLE13hI Bz,ACK DOB: 9/16/25 8/25/06 CC: Itching. S: Patient reports no itching or scratching, but the home from which he comes reports f that he is itching a lot. He is also voiding at inappropriate places such as the hallway or waste cans. He has no particular rash. He seems more short of breath today. He does respond to questions, but certainly cannot be certain as to whether ~ he is appropriate or accuxate with his response. He is not coughing~or sneezing. Family has not decided yet to stop all his medications as I had a family conference ~ with them in the last month, and they wexe thinking about the like. daughter-in-law ~ is along with patient today. 0: Lungs are clear. Cor is slow at 40's. Legs are with no edema today. ENT is ' ~ negative except cerumen is present in both canals. A: 1. Continued confusion, dementia. 2. Third degree heart block. 3. Skin is without rash or places of excoriation, but itch is apparently a complaint. 9. Patient appears quite restless today, moving his legs all the time, so I ~ wonder if restless leg syndrome is not a part of this issue as well. ' P: 1. Increase Risperdal to 0.5 mg B.I.D. 2. Begin Requip 0.25 mg B.I.D. for 2 days, then 0.5 mg B.I.D. for 5 days, then 1 mg po B.I.D. 3. Use Benadryl prn. i 9. Recheck in one month. • Orville McBeth, M.D.~ ' OM/wst/~ 309992 _ ~ GLENN BLACK DOB: 9/1.6/25 ~ J.0/5/06 ~ CC: Check--up. S: Patient is doing fine in the Alzheimer's unit. He is breathing heavy today, but i denies shortness of breath, no chest pain. He has no cold symptoms, no edema, , nausea, vomiting, diarrhea or constipation. His medications were brought along that ~ he is on. He is off Requip. He is just using Risperdal prn and he seems actually more alert today. 0: Lungs are clear. Cor is regular. Legs with no edema. , A: 1. Elevated cholesterol. `• 2. Dementia. 3. Coronary artery disease. 4. BPH. ~5. Complete heart block and hypertension. ' ~ P: 1. Recheck in 3 months at which time I will do blood work and he is supposed to ~ be fasting to do that. ~ 2. No other ~}~j~ges in his medications for now. Orville McBeth, M.D. ~"" OM/wst/ #330150 ~I it ICS ! ~oC~ Scc~., cva~l.CCe&,~y o-a~dc~a~ ~ ~w.~..1,~. ~e P) ~ sub ~.~,~~d x r~ ~, T~~B~ ~glt~b~ sx~~n~ ~~~ ~l~sfi~ ~o ~~ ~~'~~ ~-~w~ s~S ~ ~~e~c~ 7`t~' ~~ BLACK, GLEI3Ai DOB:9/16/25 4/3/06 Chief Complaint: Routine visit. S: The patient is doing well at the assisted living. He though probably has wax in his ears, as his daughter in-law asked to have those looked at. His blood pressure at the assisted living facility is 160s and 170s, sometimes 180s systolic. The patient also has been voiding in the fireplace and other corners and places that obviously he should not be. He is also now starting to get undressed in the dining hall. 0: See Flow. Ears were both occluded by wax. They were both irrigated and I removed more wax with a speculum from the left ear canal. A: 1. Hypertension. - - 2. Alzheimer's. - 3. Cerumen impaction. 4. Delusional thinking with his Alzheimer's. 5. Elevated cholesterol. P: 1. Increase Benicar to Benicar HCT 40/12.5 mg once a day. Increase Norvasc to 10 mg once a day. 2. Increase Risperdal 0.5 mg t.i.d. 3. Recheck in one to two months. Check a CBC, lipid panel, complete metabolic p'rofi/le and LDL. Orville McBeth, M.R. W OM/lkd 4/4/06 X242384 ~~ ~ ~ r~ t~. s~ ~S ~°-erg,., N Q~ ~ . a~ ~Diate: Time: l " AM PM Rec. By: F i'Y~ ~ ~ l Caller. ^ -~ // ~~ } ~ ~ P ame: Phone #: i.P ^ / Relationship to Patient: Message: ~ e ~-a, D Patient Chart No. Call Back Requested: Yes No Call Back At: AM pM Foltow-up Action: L~ . a~ ° . ~ s~. Date~ma Fol3ow•up Completed: nilials: AM G~ I I PM }-- - 0 ~ BLACK, GLENN DOB: 09-16-1925 03-02--06 CC: Hypertension recheck. S: The patient is now at a dementia unit and is doing well. He denies any chest pain. No shortness of breath. No edema. No nausea or vomiting, diarrhea or constipation. He has gained 6 lbs. His place of living sent along blood pressure readings which are high in the 170's and above. His pulse is 90's and 50's. Daughter-in-law brought patient, today, and he is quiet and reserved. He apparently had difficulty with sleeping initially but since Namenda has been started, 5 mg b.i.d., he has done we 11 with sleep,. now. 0: See flow. COR: Regular, but 40. A: 1. Hypertension. 2. Complete heart block. 3. Dementia with symptoms improved on Namenda. P: 1. Increase Norvasc to 10 mg once a day. Prescription given. Prescription also given for Rispexdal 0.5 mg q day, a total of six months' worth of medicines given. 2. Also, change to Nutriferon 2 po q day per daughter-in-law's request. Recheck in one month. Orville McBeth, M.D.~ oM/tjs/226763/ 03-03-06 ~~ C~~ ~ ~~1~ ~1~~G `~~tY~ ~ ~~ I ~ ~~ m { a~~ ~ x~ ~ z°. ~ ~ z U' a 52 '~ m O of ~ W ~ ccQ + pp Q G ~ ~ ~ 4 f J ~ ~ ~ A ~f ;~ ii o'~¢'`oS o ~Q~~~ `/ i~ yW } V Z~ z m ~~ a'Q. ti a t° ~ Fy "' u"i. ~n¢= `~ ~"'~ n d r \ ~ n \r\~ty~~ (4~a~ !v N ~ ~ o -1 Q a o ~ q ~ O _ p .Q , z a ~_~ ~ j i ~ a ~ n t 0. o. j ~~ 'JU a ~1 V O ~ l~\ j O ~~ S 3 n~ O F- ~' _ ~¢d m ~zw a ~ Z=Z '<' u'~i ~ Q j J ¢ ~~¢ ul ~~U m ~ 1 t1 Z OC O OLC~ wWZ -' N [L d m f ~ o , Z ~ Qa 0 ~m ~ U , D U z ~ ~ ~ ~ m n . g J W ~ O ~ ~ I O ~ ~ ?moo $ ; .._ . (~~ f~~~ ~~~ • ACCT. NO. PATiE?NT~S NAME ADDRESS BIRTH DATE ~~~~~ ~` DATE AGE SEX ,g, M, yy, p, TEL. NO. REFERRED BY OCCUlAT[ON___ _ '~e,-mss ~`.~-2.. ~~. ~~Q ~~ . 2-1-06 Glenn Black Patient has stopped the Toprol. His daughter-in-law brought him today. Denies any chest tightness, SOB, nausea, vomiting, diarrhea or constipation. He is to go _ to assisted living tomorrow. He will still come here for his visits. I have talked with his children. They are in agreement that even if his heart rate is not improved today that Pacemaker would not be appropriate to subject this man to at this point. He denies any leg swelling. He is able to converse with me as usual. He a little jovial at times. 0: Lungs are clear. COR is regular at a rate of 40-44. Legs are with no edema. Blood pressure is elevated. . A: Hypertension, Complete heart block, Dementia P: Continue Benicar 40 mgs l/day. Add Norvasc 5 mgs 1-day. RTO in 1 month. Orville G. McBeth, Jr., M.DG`^-'' :. ~ ~ ~ ~ ~ ~~!~ Gam. ~. ~` ~~-C7C o ~i~i ~heC~ S~ ~Lo~ ~~rne~~- . ~` ~~ c~ ~~'~s ~~~J ~~ ~a~ ~~~ ~i tC~~C~ ~a~ ~ba ~~~ ~k~ ~ i8~ ACC3'. NO. PATIENT`S/NAME BIRTH DATE ~ /~ /~ 7 ~ pATE ADDRESS 'fEl.. [.ip, REFERRED BY OCCUt"ATiON AGE SEX g, M, yy, p, I • ~:~ ~.~-~~ PPS ~ ~ - ~~~ ~~ ~~~~ ~~~~ ~~ ~ ~~~ ~~ 1 ~~,- ~~~ ~ ~ ~~. 12.23.05 Glenn Black Patient's daughter-in-law brought him toddoesn't want that over Christmas~oHe s today as she feels that he might get the flu and having difficulty with his hearing. He seems to be angry to me. 7 talked to lum about that but he denies that. His pressure has been up this time and last time. Denies any cardiac symptoms. Family is looking into Outlook Point permanently. 0: See Flow. Right ear was occluded by waxtensioned until clear. A: CAD, Dementia, Elevated Cholesterol, Hyp P: Begin Benicar 20 mg samples i/day in addition to his other medication. Irrigation of ear as above. Pt. will be rechecked in 1 month. ,, Orville G. McBeth, Jr., M.D ~/ __---------- -~--- --------___- I TELEGUARD° DUPLICATE COPY PHYSICIAN MESSAGES Dal Tlme AnS FDi Doctor /C pM • ® U pha Te Pali i Nte ~ S I f eXpfe~adi~e HCl capsu~ies Caber e. M E S 5 A G E t s ~- ~ yp ~ 5~ 2 ~- - ` 1(~ ~ ~" `e ~ . !~ 'T ~ n/~ ~ J LJS(v) ' 4 r l 11 7M " ~. . Cap road ^ Cara ^ glance ^ ggfitt ^ Urgent ^ ~~ ACCT. Nd. ADDRESS S1RTii (cPAT~IE~N,T,~S NAM>; DATE ~~~ ~ " ~- =- DATE TEL. NO. REFERRED SY OCCUtATiON AGE SEX 8. ~!. W. D. ~~~ c~c (o ~ ~- Pt. is having difficulty hearing today. He is very confused. He did not know the day of the week. He thought it was 1990's. He thought that he was already 82. He doesn't know 4 of his 5 children by name. He was only able to name his son. He was not even able to name his daughter after he looked at her. We discussed driving. Advised him that he could not drive any longer. This was discussed 3 times and the last time in front of his children. He does not want to go to an Alzheimer's Unit. He at the end of each discussion' in reference to the driving was agreeable to allow his children to~take him wherever. Tam sure though that 5 rains. after he walked-'.out~of this office he did not remember anything that I said. 0: Lungs are clear. COR is regular. Legs with no edema. Cerumen was impacted bilaterally. A: Cerumen Impaction, Alzheimer's, CAD, Elevated Cholesterol P: RTO in 2 mops. No bloodwork today. Irrigation of the ears as above. Note to Penn Dot in reference to his license removal. Orville McBeth, M. D. .~ P ~ ~~ S -a~ - n~ / per/ ,,~ ate- ate/ ~`~l ,/°'U U/n~-~o' Son is along today. Pt. still lives by himself. He goes to his son's house for meals. Has no chest pain, SOB, nausea, vomiting, diarrhea or constipation. Son just noticed that he has had some tvet pants recently but not frequently. 0: U.A. is dip neg. Ears are both occluded by wax. Lungs are clear. COR is regular. Legs with na edema. A: Dementia, Cerumen Impaction, CAD, Elevated Cholesterol P: Irrigation of both ears. Recheck Lipid Panel and Chem. Profile. RTO in 4 mops. Orville McBeth, M. D.~ AGCT. NO. PATt£i3TS NAM£ ~ ~ ~ ~ `~ ~ r ~ n ~Q ~~ 8UB$EQUENT YI81T9 AND FINpING3, C~ ~- ~ off`-- ~~ ~,--~ -~ CG~.~1~,~ ~ ~~' ~`fos~ ~ V ~ ~ ~~- ~- C~C~ r l,(,~ Mfrs, /~~-~ri~~ i ~"-~ ~~ .. ~ ~ ~ a~ ~ ~~~ f ,l i i i ~, l:) ~R ACCT. NO. ADDRESS BIRTH 1 PATIENTS NAME DA'T'E ~l ~ ~~r ~ DATE TEL. NO. REFERRED BY OCCtJhATION AGE SEX g, M, W. D. ~° `""" " `" },.,_ ~t~ ~ ~!?t/'GYtGl2.- ~ CC~~l.t~o -Q..t c~"7 ~ /b ~~ t~t(.~C.t~y . c ~ /3~( G d =/An ~ F--- I/// ~~ . J ~4 Issues that I discussed with anvil in reverse was the concern about driving and living by himself. They felt that he is still safe in those areas but we discussed then also down the road a Personal Care and eventually Dementia Unit for the pt. Brother than came in later on in the afternoon and reported that pt. will ca11 and ask if he is home and then eventually show up. He usually stays for about 3/4 hr. some days he seems right on target other days he doesn't. ' y- ~ 3-6~ c~e.~'`-~P o~ o~~ Orville McBeth, M. D. /,~~/ ~~~ e~ng ~ ~v~ ~SY~---~ . ~f~ Pt. is definitely confused. He says that he baths q.d. He never eats candy. He has gained 12 lbs. tae talked about cutting off candy and taking a bath daily. He denied any prosthatic symptoms. 0: Lungs are clear. COR is regular. Legs with no edema. Prostate is +Z. Stool is hem. neg. A: Dementia, Elevated Cholesterol, BPH, CAD, Hypertension P: Increase Lipitor to 80 mgs 1/day. Continue with hi_s other medicatirns. Encouragement of bathing and cutting out candy but he will not remember these issues. RTO in 4 mops. with,lab work including Lipid Panel, Chem. Profile and a PSA. Orville McBeth, M. D. /~ ~ v`'"'' . ~~ ACCT. NO, PATIENTS NAME ~ ~~~n ~~a-c.(L ~ ~ aar. • BU9II$QUENT VIHIT4 ANA FINDINGS, 1-5-05 Pt`s son basically cancelled the appt. today. Because he did not want him in the office with all the flu which tae have not seen yet in this particular office. tde rescheduled an appt. for April. However, he will have,his bloodwork of Lipid Panel, LDL, Chemistry Profile in the next day or so, Orville McBeth, M. D.~O~) ;~ ~~ ~ s ~-pa~~~ p~~~ ~ `~-/ . ~-~- ~ 1 ~ . .~TELEGUARD° pUPLKATE,COPY PFlYSIC1AN.MESSAGES~. - ~. • F D I ® or octor . _... ~ ~~• "' ~ Dete lit l LLC~ p a X fexofe~ad~r~e H~( ~m~2$ CallerTeL 11 Allergies ~ ^ I MESSAGE ~-~~^ t~ ~; ~ ~ r ~ r _ . y x P ~ A.Y'~.K" V S ~F~ ~raA-.'}:jam-' ~.:~r=Ty` _ I • Aece ~ -... Cali med ~ Call SB ~ Q WiA Call ~~~ Refill Urgent ' ~~~~.~5 CCT. NO. ADDRESS BIRTH MESSAGE TEL. NO. REFERRED BY OCCUtATION AGE SEX g, M, yy, p, ~~~ ~ ~~~ ~.~ ~~ ~~~ t ~~~ ~ ~ ~~ ~ . ~ ~-~-efil-~- Pt. and I talked about, as well as with his son, his memory issue. ~~ In reference to his dementia. He wanted to go hunting this year and since he for instance got in a work van today and drove it home thinking it was his car. I strongly recommended that he nat hunt. He is agreeable to that now. Fortunately his son was along to help remind him when it comes to hunting season. 0: Hrs ears were irrigated until clear. The Lt. one required removal of hard firm wax with speculum. A: Cerumeri Impaction, Alzheimer's P: As above. ONCE - A - D A Y ~F~i~~i~'C~D (di(tiazem HCQ~.~,Q~~a wilt xr• • Y _ Orville-McBeth, M. D. Cam' ~ r TELEGUARA° Dl1PLICATE CQPY PHYSICIAN MEN Please read accompanying a0t~~ned Pia full Prescribing Information can ^• ca~~ Ir'"' ~~ ~ ~. ~P(ATiE~}N7•S NAME DATE `~~ `` ~~ DATE -53a( ^ I Aalainan ^ I RerJl ^ I l7rgent ^ -- - ---- - ~ - - - - C ~.g `1 t ACT. NO. ~ATI£?JT"S NAM£ ~ `n ~"Q~ ~~ /rn a~ r ` W ~~i~J SUH86QU a7T VISITS AND FI rID ING9, 8-27-04 CONTINUED P: ALT fasting sometime next week. We will see if he • remembers to do that. Orville McBeth; M. D unr~A D sue' ' 1 ~ ~ ~~G Pharmacy °I~at~ -3~ i `/ Allergies -~ s ~~ -, SIJ~r Li'L In'k~ F~-~--C- ~r- .S~ e.^~ S _ ~~~~ ~ u.~~ Ce~ti.~ I a. v. li ~fi ~4~1 ~ ~~•-`(~ - C c_ ~ ~ l- ~- ~ K- ~~- __-- _ ~7~" g -~ -- -- Received By --- _-- l t rt a/ ~ ~~ _ _ _ ,_ I ~ Pieasc Nill Calf L-1 Refill ' I-y Urgenr G I1 -~ F, t• -- TELEGUARD~ RxPhone Documentation System - _ _, Forpoder. Cafe: ~~ime: `~J aht Pa6enL• /' n Pha TeJt/ Ce6er7e1: ~~~- oaf AI rgte l ~ ~ La. c~ a. J e ,,. I - r~ - ~ f.Y4 ~ 1 1 ' ~ ' ~ (/L~iYGC~%~St _ ReCe Retvmed Please Wdl Call Urgent CaU ~ Call ~ Agatn t ~ ACCT. NO. PATIENT~5~NAME ADDRESS BIRTH DATE ~ -~~ ^~ `-~ pATE TEL. NO. RBFERf2ED BY AGE SEX B. M. W. 7-4-~~ l~IfS ~X /Y?o~n Soo mc~ r~lo6 ~=~o.~'d l•'- ~ TD~rof XL ~Um~ ~k30 T~~.~d R~ s ~c~ k cam` ~ ~ ~ ~~~. l~~v~ ~ - ~ ~~ ~ .~.< . s ~' `~ n -lam,,, , ~', j2~-s~ G ~ . ~ ~ 8-20-04 Glenn Black - - _ _ __-- _ ____-- _ -- - --- -- -- - Mr. Black's son and daughter are in the office hereto report on erratic and aggressive behavior by the patient, He has lost his temper in the bank, lost his temper with his son. He feels that his son is stealing from him. Family is only giving .25 mg of Risperdal %Z tablet at h.s: I gave them samples of .S mg to use a# h.s. I will seethe patient in a week and also the family is to call earlier next week if he is not improving on the .5 mg. He is to continue Aricept 10 mg h.s. ~ ~, ~ so~~ ~ ~~`~ ~~~D~ Orville G. McBeth, J'r., M.D, ~v ~'2 ~ Seems pretty docile today. He is feeling fine without any chest tightness or SoB, nausea, vomiting, diarrhea or constipation. He still lives by himself. He does not carry Nitroglycerine with him. According to his daughter, Risperdal is working well at 5 mgs q.d. 0: Lungs are clear. COR is regular. Legs with no edema. A: CAD, Dementia, Hypertension P: Gheck Prostate next time which will. be 4 mops. Otherwise continu same medication. Check LDL, HDL, Cholesterol and Metabolic Profi~e and ~~ ~~ n ~0.~.,~C.> ACCT. NO. ~ PATlENT"S NAME ' ~ ~c~- a~ _ SUBSEQUENT VISITS AND FINDIN G9, ~-j-~f~-`~`( ~`-C ~-~e~c~ (~ Reviewed his results from his CAT Scan and bloodwork with Pt. and son. 0: As above. • A: Early Dementia P: Aricept 5 mgs 1/day and samples given. RTO in~1. mon. Refer~,to Dr. Masser for further evaluation and confirmation. ' Orville McBeth, M. D. .C~„•'" ~.• ... REFERRALS AME ~~nn ~J~G~-~ DATE ~-(o~~b~ N 0~ SERVICES FOR PROVIDER ~ SSA ~~`~~ HOSPITAL DO5,3~~~-d`~ TIME ~ DIAGNOSIS < SCHEDULED 8Y: ~ ~ Son is along. Pt. had forgotten to take his Aricept n ~~~ 5 mgs at h.s.and Dr. Mosser' concurred• witht he medical V..-~~.~•-" treatment at this point in time although I have not xeceived a letter from Dr. Mosser. Also talked about his BP which is elevated today. He said that he was out mowing. He did not want to do a~iything about that at this time in particular since he was out mowing. Otherwise denies chest tightness, SOB, nausea, vomiting, diarrhea or constipation. • 0: See Flow. A: Hypertension, Early Dementia, CAD without any anginal symptoms P: Discussion in reference to his meals, his driving. He at this time is able to drive short distances and son feels comfortable with that. He does go to a son or daughter's house each day for supper. TJill continue Aricept now started again at S mgs by Dr. Mosser just a'caeek or so•ago. Then when that is all for a month go up to 10 mgs at supper. Son and daughter will see that he gets that. RTO in 3 mops. at ~ohich time he needs his bloodwork. Orville McBeth, M. D. ACCT.. NO. - ADDRESS ~• i~~ ~~,>n ~1Qr .~, _-_ PATIENTS hiAME •'~ BIRTH DATE ` ' . (~ ' ~ DATB TEL. NO: i?EFEf2RED BY OCCUrATiON AGE 5EX g, M W D (/ ( ~~s O,~.o a , , ~ COn.`G''i...e,oC r c j7L,~r_ ( 5 ( /J'`~' tea''.. W Uw~aL t f YLt~ • /~' ~ Cpl ~ s db , o ~ C ~ /c.~~, ~ -~~~.~~. , Son was along with pt today. Son brought his medications which will need refilled. Gave the mini mental status exam. Pt. was able to•get 24 o~it of 30. He thought the year was 1940.. He has not had a CAT Scan. 0: See Flow. Cranial nerves 3-12 intact. Motor is intact far upper and lower extremities. A: Hypertension, Elevated cholesterol, R/0 Early Dementia .P: CAT Scan. CBC, Complete Metabolic Profile, Lipid Panel, LDL, RPR, TSH, B12, Sed Rate. CAT Scan is at BMC. RTO after that if there are any changes in medication. - ' Orville McBeth, M. D. •__ y REFERRALS NAME-~~1ea~_ ~~QG~ -- bATE_ ~#~a-b~ SERVICES FOR _~T_ helt n1. ~ HOSPITAL ~mC PROVIDER Dos ~ O rzME~ lo'~ Q!I'3 '~ DIAGNOSIS SCHEDULED BY: (Y1~-n'I lQm - ~ _ _ ~ _ - ~ ~~ _ AGCT. AtO. -. ~ - - - PATIENT'S ~ f`IAME ~ 4 y 1 ~ ` ` ~4\ A~ A . _ . --- - - , ~~i~ 2~ BUbEEQUENT YISIT>z AND FINDINGS, ~ ~~-- ~~ ~~~ ~~ ~~~~ f~. Pt. also complains of erectile dysfunction., Viagara has not worked for him recently. He would like to try one of the new medications. He was at a large hunting shop yesterday and missed his appt. Otherwise he denies any cardiac symptoms. He rarely ever uses Nitroglycerine. 0: Lungs are clear. COR is regular., Legs with no edema. A: Hypertension Improved, CAD Stable, Erectile Dysfunction, Elevated Cholesterol with Lipitor just increased P: Trial of Levitra with instructions given 1.0 cogs 1;. initially and if 1 doesn't help use 2. RTO in 3 coons. for his bloodwork. Pt. after the fact seers fairly confused today. He asked me if my apples are all off. Then he went up to the desk and asked thinking he was scheduled in another week or so and he just told ne that he missed his appt. yesterday which,he did. Will continue to observe. Orville McBeth, M. D.~ ~_~3 ~ Y 0.Y" p a ~~~~ ~.sY. ~ G~~.~~~~ ~Ji ~ ~ ~(ri ~-- Urfa QL,~ ,}~. ~ ~ S~~M moo{ ~ ~ c ~y, J a ~ ~ . ~ . ~ ,~ e,0. ti- .~ ~.i ~-. , Glenn complains of Lt. ear cerumen and impaction. There was a fair amount of wax there withit pushed up against the ear. We were able to get out some of the wax with copious amounts of irrigation.. However there was still some persistent wax. A: Cerumen Impaction, io •~~. P: As above. Debrox ear Solution. Orville McBeth M.D ~ ACCT. NO. ADDRESS TEE.. F70. ~ REFERRED BY AGE SSX B. M. W. D. C~ U ~a c~ ~_ ~~~-s c~~~ ~o ~~ ~~ ~~- ~~ ~'"~, 0: ENT reveals a red TM actually on the Rt. Throat was with some erythema. Neck benign. Lungs are clear. A: Otitis and Bronchitis P: Zithromax Z~Pak.~ Force fluids. Orville McBeth, M.D .'~~ . ~~ ~~~f ~~.~« ~ ~ c~ ~~.~ f~~ ~-- ~~~ d ~. r ~~ ~w~a- ~~~v-~. a rs~~~u`~ Pt. see.ns to ,ne as if he~ is having .nore~ difficulty with his ~ne,nory. However upon questioning he denies such. He is planning to 'go to Florida later on this gear. t+Iorks 1 day a wk. to help out his son with the business. He is agreeable to going b~.ck on medication at this point in tia~e for his BP which I think will definitel:~y help his heart as well although he denies any cardiac pain. H~e is in need of having his prostate checked today. 0: See Flow. Prostate is ,suite large. No',nasses though. A: BPH, CAD, Hypertension P: RTO in 1 ,non. Begin Toprol XL' 50 ~ngs 1/ds.y. Gheck a PSA, Lipid Panel s.nd Go.nplete Metabolic Profile. ~C~~::~ ~`~~d iz ' _' -,L.: PATIEDlT~S NfAME B1RTH DATE ~ * ` ~ ` ~~~ DATE Orville McBeth, M. D.~~ ~~Q ACCT. NO. PATIENTS NAME .i / ! n ~- 8U88EQUENT VISIT8 AND FINDINGS, Pt, is not having s~,ny significant arthritic pain. He is doing well with his prastate~ taking the Saw Palmetto. He stall uses Viagara prn, Otherwise•re~tiewed his cholesterol. His LDL ccsuld be a little bit lower but will not change his medication right now. We discussed this. 0: Lung3 are clear. COR is regular. Legs with no edema. A: CAD Stable, Erectile Dysfunction, Arthritis, BPH P: Check LDL, Triglycerides and HDZ and ALT at next visit..': RTO in !~. coons. Col~tinue with the same medications for now. Did review his a~m;~ and did not see any other areas of actinic keratoses to freeze. ' Orville McBeth, M. D. 10- a3•v3 N~~oC~v~-u~ D.y~ d.r~so~v~, =, ~- ~~ ~~~ ~~~ j~-11-,b ~~ _ ~'~ _ _ _ _ ACCT. NO. _ ~j~PATIENTS NAME BIRTii DATE ~/~"" ~ ~~ DATE ADDRESS ~~ NO REFERRED BY OCCUI'AT1ON ACE SEX g, M, yy, D. 5-803 CONTINUED Pt. is just working now once a wk. His BP was improved when I took it. He has lesions on his forearms that are consistent with actinic keratosis but just had some sun damage. I would like to sae what things look like after this clears. 0: Lungs are. clear. COR is regular. Legs are with no edema. A: Elevated Cholesterols, CAD Stable with just using 1 Nitroglycerine since last visit, Actinic Keratoses are present on hi~s~forearms but possibly more than T suspect. His Lt. ear is with wax. I was going to irrigate that today but forgot. P: Ts to recheck in 1_-2. mons. to have his arms frozen ~~.~rhere the actinic keratosic spots are present. Tf he hasn't taken, care~of his ears by then, we will proceed with irrigation on the Rt. side. ' Orville McBeth, M. D. ~/// 1 ~ ~ t~i i ~~ ~ ~~ d C~ 1~ ,~ ~L ~ P ~ ~ ~ ~ ~'lb`~ 3 ~U F ~ re~ mar k..S on ~rr,r, ~ 0 Q,"~ s --~- ~ P ~ k~~ ~'a on ~h~.S+ . no ©~~~' com 1 a E nos 9 Pt. had 6 actinic keratosis lesions on his hand and forearms, 3 on each side and then one on his Rt. posterior temporal area. He had a skin tag on his Lt. anterior chest, that was frozen as well. ~_..-. A: Actinic Keratoses, Skin Tag . P: Freezing as above. RTO at usual appt. Orville McBeth, M. D. ~/~, , ~~ ~-~ c(6 ~ ~ ~ ~ ~ C~ / ~-~ 1~~m ~~~' ~ /G6 :~ ~-1~., ~ k ACCT, NO. PATIENTS NAM£ q f / /~/~~~~ I QUBBEQUENT V181TG AND FINDINGS, I g-12-02 CONTINUED i 0: See Flow. A: CAD Stable with no increase in Angina, Osteoarthritis Stable, Elevated Cholesterol Stable, Hypertension, Refusing Toprol Treatment P: RTO in L,, mons. Encouraged further weight loss. Check Lipid Panel, and Complete Metabolic Profile. • Orville McBeth, M. D. i (f z r ~ o ~. U,._.i ~1n Qtt ~-.~vct, f~ ~ ~1~C~ YV' ~~~ C~ ~o ~~~ Pt. will be going to Florida in March. He still works 3 days a wk. His wife was concerned about Alzheimer's. However he was able to spell world backwards and tell me who the incoming governor was going to be in the state of Penna. as well as other facts that I would not expect him to remember if he had the beginning of Alzheimer's. Pt. is~not having any cardiac symptoms. He is getting Nitroglycerine refilled today to be fresh. 0: See Flow. Prostate is +1, smooth and no masses. .Stool is hem. neg. - . A: BPH, CAD, Elevated Cholesterol with reasonable values P: RTO in l~.. mons. Before his next appt. ha~re a PSA, Lipid Panel, Complete Metabolic Profile. Orville• McBeth, M,.. D/ CJ~`~' ~~ ~ s~~. ~ ~b o~~~ G~}- AGCT. NO. - - - - -- - ~--)~,~,~ ~ lark - - - -- - r/ PAT^IENT•5 NAME ADDRESS BIRTH DATE --_ ~~ l tl~ ~` c~~~ DATE ~„_~ T'Ei,. NO. REFERRED BY OCCUNATION AGI; SEX B. M. W. D. l-t0~ ~ J rt. still has some arthritic pain. He is He still has some neck, Lt. shoulder pain. Reviewed his Cholesterol Profile with him. 0: See Flow. taking Glucosamine. Was recently snowmob~ili He is still taking Lipitor A. Elevated Cholesterol, Osteoarthritis, CAD using Nitroglycerine prophylactically still P: RTO in 4 mons. at which time he will have a Lipid Panel, Liver Function Test and a PSA that was just missed with his prostate exam done last year. 20 mgs 1/da'~ C Orville McBeth, M. D.~~~7~ . `~ J Pt. has elevated pressure today and has had the last few times. He recently came back from Branson. Had a good time with his wife. Still working though 3 days a wt:ek• I:s agreeable to staring some BP medicine. - 0: See Flow. A: Elevated Cholesterol with his bloodwork just done this•a.m., Hypertension new, Arthritis P: Begin Toprol XL 100 mgs 1/2 tablet p.o. q.d• RT'0 in 4 mons, at which time he will have a Lipid Panel, Liver Function Test once again. Orville McBeth, M, b. . (~c~ q ~~~ ~ a tb~.~c-o-`~, goo ~, ~r ~ ~ -~ ~c~a (Z~ s . ~ ~ . ~ ~? ~ -~a~ a ~~ ~ ~' D c7. o ~ ~ ..~ ~. ~~Ls ~°~ ~s ~ ~ ~, Pt. and I discussed his not wanting to take Toprol XL. He reports his pressure is better but I also report that his weight is down as well. If he could continue to lase weight, he might be able to have a menstne.a~sonable BF'" Pt• is still working as above 3/wk. He does have some angzna off/on but not frequently. umberland County PA Address Candidates ~' Roads Ally -Minor Road -State Road =Interstate http://ccgis.ccpa.net/taxmapper/ Parcels Municipality ~. i Counties 0 2007 Orthophotography ®Red: Band_1 Green: Band_2 ®Blue: Band_3 Page 1 of 1 EXHIBIT „-~ - N - a ~ - ~~ „~.. . Cumberland County PA