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HomeMy WebLinkAbout11-6059C o -0 3 =' IN THE COURT OF COMMON PLEAS OF r'n CO CUMBERLAND COUNTY, PENNSYLA rCC„ CIVIL C,6r- tV ? DIVISION te k o r- Plaintiff(s) & Address(es) (ZD t -0 LUCILE HAMILTON and GARY 5;c:: rv HAMILTON, wife and husband, -- 109 Booz Road Shippensburg, PA 17257 Case No. l? y Civil Term VS. Civil Action - Medical Professional Liability Defendant(s) & Address(es) CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER 361 Alexander Spring Drive Carlisle, PA 17015 PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY/CLERK OF SAID COURT: Issue summons in the above case Writ of Summons shall be issued and forwarded to Attorn IS eri ease Circle choice Date : 7/29/1 i e of Attorney Print N Karl J. Januzzi, Esquire rT7 --t ZZ, ?Rq Address: 2225 Millennium Way Enola, PA 17025 Telephone #: 717-728-3200 Supreme Court ID Number: 65575 101166 pd 010-k 0-"; C? ? !ta ? 1 S WRIT OF SUMMONS k4? ?S I TO: CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER YOU ARE NOTIFIED THAT THE ABOVE-NAMED ACTION AGAINST YOU. Date: .-r? SHERIFF'S OFFICE OF CUMBERLAND Ronny R Anderson t? ? 15 ? Sheriff x owti??t?, ci 4Yiatt rF?i?? ,Ut9$Ei?L?t?J llt. Jody S Smith aT''a Chief Deputy Richard W Stewart Solicitor Lucile Hamilton I Case Number vs. 2011-6059 CT Corporation System SHERIFF'S RETURN OF SERVICE 08/01/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and bailiwick. t He therefore deputized he Sheriff of Dauphin County, Pennsylvania to serve the wthinem in Writ of Summons according to law. 08/04/2011 08:40 AM - Dauphin County Return: And now August 4, 2011 at 0840 hours I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do hereby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center c/o CT Corporation System by making known unto Sandra Schwalm, Corporate Operations Specialist for CT Corporation System at 116 Pine Street, Suite 320, Harrisburg, Pennsylvania 17101 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $37.44 August 11, 2011 SO ANSWERS, ter?r)))) RON R ANDERSON, SHERIFF "Cl Couuys"01 Sheriff ieiensoff, 111 i POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 LUCILLE HAMILTON and GARY HAMILTON, wife and husband Plaintiffs vs. CARLISLE HMA, LLC d/b/a CARLISLE REGIONAL MEDICAL CENTER Defendant C n -? 7_1 ATTORNEYS FOR DEFENDR&T rv C' IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 11-6059 CIVIL ACTION -- MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED ENTRY OF APPEARANCE/JURY TRIAL DEMAND TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center, in the above-captioned matter. Also, please enter at this time my demand for a trial by twelve jurors. POST & SCHELL, P.C. Dated: ? I" By: K'?>' C,'_ Andr . Briggs I.D. 9-753072 John W. Croumer I.D. # 208170 Attorneys for Defendant CERTIFICATE OF SERVICE I, Sandra Morales, an employee of the law offices of Post & Schell, P.C., do hereb, certify that on the date set forth below, I did serve a true and correct copy of the foregoing document upon the following person(s) at the following address(es) by sending same in thf United States mail, first-class, postage prepaid: Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millenium Way Enola, PA 17025 C? SANDRA MORALES DATE: -2- POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 ATTORNEYS FOR DEFEND c u7 LUCILLE HAMILTON and GARY HAMILTON, wife and husband Plaintiffs vs. CARLISLE HMA, LLC d/b/a CARLISLE REGIONAL MEDICAL CENTER Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 11-6059 CIVIL ACTION -- MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED PRAECIPE FOR RULE TO FILE COMPLAINT TO THE PROTHONOTARY: c r°, Please enter a Rule upon the Plaintiffs to file a Complaint within twenty (20) days hereof or suffer the entry of a judgment of non pros. POST & SC L, P.C. By: Dated:] I Ial?? ?, -AND W BRIGGS 1. D7.# 2 JOHN W. CROUMER I.D. # 208170 Attorneys for Defendant RULE TO FILE COMPLAINT AND NOW, this PS day of a4 U S ? , 2011, a Rule is hereby granted upon the Plaintiffs to file a Complaint herein within t)=altz (20) days after service hereof or suffer the entry of a judgment of non pros. PROTHONOTARY r CERTIFICATE OF SERVICE I, Sandra Morales, an employee of the law offices of Post & Schell, P.C., do hereby certify that on the date set forth below, I did serve a true and correct copy of the foregoing document upon the following person(s) at the following address(es) by sending same in the United States mail, first-class, postage prepaid: Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millenium Way Enola, PA 17025 da"'S? C SANDRA MORALES DATE: 2 l / _i4l -2- !m:1-J"O--d: F IGE ri JTHONOTAR SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY HAMILTON, wife and husband, I:1IIS'-e AM 13 ,.?-, BERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 11-6059 CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 800-990-9108 717-249-3166 SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY HAMILTON, wife and husband, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED COMPLAINT AND NOW come the Plaintiffs, LUCILE HAMILTON and GARY HAMILTON, wife and husband, by and through their attorneys, Shollenberger & Januzzi, LLP, and respectfully represent the following: 1. Plaintiffs, LUCILE HAMILTON and GARY HAMILTON, wife and husband, are adult individuals who currently reside at 109 Booz Road, Shippensburg, Pennsylvania 17257. 2. Defendant, CARLISLE HMA, LLC, is a Pennsylvania Limited Liability Company with a mailing address of 5811 Pelican Bay Boulevard, Suite 500, Naples, Florida 34108. 3. Defendant, CARLISLE HMA, LLC, conducts business as CARLISLE REGIONAL MEDICAL CENTER, and is engaged in providing health and human care services to the public with its principal place of business at 361 Alexander Spring Road, Carlisle, Cumberland County, Pennsylvania 17015. 4. Plaintiffs are asserting a professional liability claim against Defendant CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER (hereinafter referred to as the "Medical Center"), alleging that the Medical Center is liable to Plaintiffs for the negligent actions and/or omissions of its nursing staff. 5. On July 31, 2009, Plaintiff, LUCILE HAMILTON, presented to her family doctor, Baxter D. Wellmon, D.O., with complaints of lower extremity swelling, progressive weakness and an inability to care for herself. 6. Following a physical examination, Dr. Wellmon admitted Plaintiff to Carlisle Regional Medical Center for further evaluation and treatment. 7. At the time of her admission to the Medical Center, Plaintiff was taking prescription medications which included K-Dur, Zofran, Ambien, Xanax, Cymbalta and MS Contin. 8. Plaintiff was subsequently evaluated by neurologist Mohammad K. Ismail, M.D., who noted Plaintiffs state of generalized weakness and inability to ambulate, and ordered Plaintiff to undergo additional testing and evaluation. 9. Plaintiff's fall risk at the time of admission was rated as "high." 10. On August 1, 2009, the day after her admission, Plaintiff continued to complain of increased pain and swelling in her lower extremities, and medical records confirmed the presence of pitting edema of the lower extremities. A Doppler study performed later that day was inconclusive for deep vein thrombosis. 11. At approximately 9:50 p.m. on August 1, 2009, Plaintiff received dosages of Cymbalta (duloxetine), MS Contin (morphine sulfate), K-Dur (potassium chloride) and Ambien (zolpidem tartrate). 12. At all times relevant hereto, the nurses involved in Plaintiff's care were agents, servants and/or employees of Defendant Medical Center. 13. Plaintiff advised the nursing staff, both prior to and at the time of administration of the medication, that she has had episodes of sleep walking, particularly after taking the drug Ambien. 14. Plaintiffs next contact with the nursing staff occurred when she was found at approximately 10:45 p.m on August 1, 2009, on the floor of her hospital room after having fallen out of bed. 15. At that time, Plaintiff was complaining of right hip pain and was noted to have an abrasion in the area of her left upper back and right knee. 16. As a result of Defendant's negligent and liability producing conduct, Plaintiff, LUCILE HAMILTON, sustained right basicervical femoral neck fracture which required surgical repair. 17. As a result of the negligent and liability producing conduct of the Defendant named herein, Plaintiff, LUCILE HAMILTON, has incurred or may incur medical bills and expenses for her care and treatment that are not covered by a private or public benefit or gratuity that she received prior to trial other than a source set forth at 40 P.S. Section 1303.51(d) for which damages are claimed. 18. As a result of the negligent and liability producing conduct of the Defendant named herein, Plaintiff, LUCILE HAMILTON, has sustained a permanent diminution in her ability to enjoy life and life's pleasures for which damages are claimed. 19. As a result of the negligent and liability producing conduct of the Defendant named herein, Plaintiff, LUCILE HAMILTON, has undergone, and in the future, will undergo great physical and emotional pain and suffering, for which damages are claimed. 20. As a result of the negligent and liability producing conduct of the Defendant named herein, Plaintiff, LUCILE HAMILTON, has or will incur medical bills from the date of trial onward for which damages are claimed. COUNTI LUCILE HAMILTON v. CARLISLE HMA. LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER 21. Paragraphs 1 through 20 of the Plaintiffs' Complaint are incorporated by referenced herein as if set forth in full. 22. Defendant Carlisle HMA, LLC, d/b/a Carlisle Regional Medical Center, rendered negligent medical treatment and deviated from the standard of care by failing to assure the safety of Plaintiff, LUCILE HAMILTON, in the following particulars: a. Failure of the nursing staff to adequately consider and appropriately assess Plaintiff's fall risk based upon her complaints of bilateral lower extremity swelling and weakness, and a general inability to care for herself when admitted to the Medical Center; b. Failure of the nursing staff to adequately consider and appropriately assess Plaintiff's fall risk based upon the medications being administered during her stay and her specific reports of known side effects; C. Failure of the nursing staff to ensure that Plaintiffs call bell was located within a distance that would allow Plaintiff to reach it safely; d. Failure of the nursing staff to ensure that Plaintiffs personal belongings were located within a distance that would allow Plaintiff to access them safely; e. Failure of the nursing staff to ensure that Plaintiff was placed in a room in proximity to the nurses' station due to her fall risk; Failure of the nursing staff to ensure placement of a bed alarm that would alert the staff in the event Plaintiff tried to get out of bed. g. Failure of the nursing staff to ensure that the bed rails on Plaintiffs bed were raised and locked in an upright position to prevent Plaintiff from leaving her bed. WHEREFORE, Plaintiff LUCILE HAMILTON, demands judgment in her favor and against the Defendant, CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER, for compensatory damages in excess of the amount requiring compulsory arbitration. COUNT II GARY HAMILTON v. CARLISLE HMA. LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER 23. Paragraphs 1 through 22 of the Plaintiffs' Complaint are incorporated by referenced herein as if set forth in full. 24. As a further result of the injuries sustained by his wife, Plaintiff, LUCILE HAMILTON, Plaintiff, GARY HAMILTON, has been and will be deprived of the assistance, companionship, consortium, and society of his wife, all of which has been and will be to his great detriment and loss. WHEREFORE, Plaintiff, GARY HAMILTON, demands judgment against the Defendant, CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER, for compensatory damages in an amount in excess of the amount requiring compulsory arbitration. Respectfully submitted, SHOLLENBERC?ERj& JANUZZI, LLP By: squire Karl rorPlaintiffs AttornSupre D. #65575 2225 Way Enola, PA 17025 717-728-3200 Dated: September 2, 2011 SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY HAMILTON, wife and husband, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CARLISLE HMA, LLC, d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendants NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW this 2nd day of September, 2011, 1 hereby certify that I have served a true and correct copy Plaintiffs' Complaint in the United States mail, postage prepaid, addressed to: Andrew H. Briggs, Esquire POST & SCHELL, P.C. 1857 William Penn Way P.O. Box 10248 Lancaster, PA 17605-0248 BY *1 POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, Plaintiffs, vs. CARLISLE HMA, LLC D/B/A CARLISLE REGIONAL MEDICAL CENTER, Defendants '!LCD-OFFICE "E i PROSHQNOTAP, r 2N12 JAN 31 AMID: 24 fUMBERLAND COUNTY PENNSYLVANIA Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Lucile Hamilton and Gary Hamilton, wife and husband c/o Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millenium Way Enola, PA 17025 YOU ARE HEREBY NOTIFIED to plead to the within New Matter within twenty (20) days of service thereof or a default may be entered against you. POST & SCHELL, P.C. ';? L/\?? By: Dated: January 30, 2012 AND H. BRIGGS I.D. # V 2 JOHN W. CROUMER I.D. # 208170 Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY Plaintiffs, vs. CARLISLE HMA, LLC DB/A CARLISLE REGIONAL MEDICAL CENTER, NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY Defendants JURY TRIAL DEMANDED ANSWER AND NEW MATTER OF DEFENDANT CARLISLE HMA. LLC DB/A CARLISLE REGIONAL MEDICAL CENTER Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center (hereinafter "Answering Defendant"), by and through its counsel, Post & Schell, P.C., hereby files this Answer and New Matter to Plaintiffs' Complaint and aver as follows: 1. Denied. After reasonable investigation, Answering Defendant is without the knowledge or information sufficient to form a belief as to the truth of the allegations in the corresponding paragraph and, therefore, said allegations are denied and strict proof is demanded. 2. Denied as stated. It is admitted only that Carlisle HMA, LLC is located in 361 Alexander Spring Road, Carlisle, Pennsylvania 17015 with a mailing address of 5811 Pelican Bay Boulevard, Suite 500, Naples, FL 34108-2711256. 3. Admitted. 4. Denied as stated. Answering Defendant admits only that Plaintiffs' Complaint states that it is setting forth a professional liability action against Answering Defendant. 5. Denied. After reasonable investigation, Answering Defendant is without the knowledge or information sufficient to form a belief as to the truth of the allegations in the corresponding paragraph and, therefore, said allegations are denied and strict proof is demanded. 6. Denied pursuant to Pa. R.C.P. 1029(e). 7. Denied. After reasonable investigation, Answering Defendant is without the knowledge or information sufficient to form a belief as to the truth of the allegations in the corresponding paragraph and, therefore, said allegations are denied and strict proof is demanded. 8.-15. Denied pursuant to Pa. R.C.P. 1029(e). 16.-20. Denied. Answering Defendant is advised and therefore avers that the allegations in the corresponding paragraph of Plaintiffs' Complaint are conclusions of law to which no response is required. To the extent that a response is required, all allegations of negligence, carelessness and/or malpractice are specifically denied. As to any allegations of damages and/or injuries, after reasonable investigation, Answering Defendant is without information or knowledge sufficient to form a belief as to the truth or falsity of these allegations and they are therefore denied and strict proof is demanded. COUNTI LUCILE HAMILTON V. CARLISLE HMA, LLC D/B/A CARLISLE REGIONAL MEDICAL CENTER 21. Paragraphs 1-20 of the Answering Defendant's Answer are incorporated herein as though the same were fully set forth. 2 22. Denied. Answering Defendant is advised and therefore avers that the allegations in the corresponding paragraph of Plaintiffs' Complaint are conclusions of law to which no response is required. To the extent that a response is required, all allegations of negligence, carelessness and/or malpractice are specifically denied. As to any allegations of damages and/or injuries, after reasonable investigation, Answering Defendant is without information or knowledge sufficient to form a belief as to the truth or falsity of these allegations and they are therefore denied and strict proof is demanded. WHEREFORE Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center, respectfully requests judgment in its favor and against all parties, together with such other relief as this Honorable Court may deem just and appropriate. COUNT II GARY HAMILTON V. CARLISLE HMA, LLC DB/A CARLISLE REGIONAL MEDICAL CENTER 23. Paragraphs 1-22 of the Answering Defendant's Answer are incorporated herein as though the same were fully set forth. 24. Denied. Answering Defendant is advised and therefore avers that the allegations in the corresponding paragraph of Plaintiffs' Complaint are conclusions of law to which no response is required. To the extent that a response is required, all allegations of negligence, carelessness and/or malpractice are specifically denied. As to any allegations of damages and/or injuries, after reasonable investigation, Answering Defendant is without information or knowledge sufficient to form a belief as to the truth or falsity of these allegations and they are therefore denied and strict proof is demanded. 3 WHEREFORE Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center, respectfully requests judgment in its favor and against all parties, together with such other relief as this Honorable Court may deem just and appropriate. NEW MATTER 25. The responses contained in paragraphs 1 through 24 of Answering Defendant's Answer are incorporated herein by reference as though the same were fully set forth. Plaintiffs' have failed to state a cause of action upon which relief may be granted. 26. Answering Defendant was not negligent. Any acts or omissions of Answering Defendants alleged to constitute negligence were not substantial causes or factors of the subject incident and/or did not result in the injuries and/or losses alleged by the Plaintiffs. 27. The incidents and/or damages described in Plaintiffs' Complaint may have been caused or contributed to by the Plaintiffs. 28. If Plaintiffs sustained the injuries alleged, proof of which is specifically demanded, said injuries may have been the result of the negligent or careless acts and/or omissions of Plaintiffs and/or other persons and/or entities over which Answering Defendant exercised no control. 29. The incident, injuries and/or damages sustained by Plaintiffs were not proximately caused by Answering Defendant. 30. Plaintiffs' claims may be barred by the Doctrine of the Assumption of Risk. 31. Plaintiffs' claims may be barred by the Doctrine of Contributory Negligence. 32. Plaintiffs' claims may be barred or reduced by the provisions of the Pennsylvania Comparative Negligence Act, 42 Pa. C.S. § 7102 et. seq., the relevant portions of which are incorporated herein by reference as though same were more fully set forth at length herein. 4 33. At all times material hereto, Answering Defendant provided care and treatment in accordance with the applicable standards of care at the time and place of care and treatment. 34. Plaintiffs failed to mitigate any damages allegedly sustained. 35. Plaintiffs' claims and/or request for damages are barred, limited and/or precluded by the Doctrines of Res Judicata and/or Collateral Estoppel. 36. Plaintiffs' claims may be barred by the Doctrine of Release. 37. The Plaintiffs' claims may be barred by the applicable Statute of Limitations. 38. Plaintiffs' claims may be barred in whole or in part by the Medical Care Availability and Reduction of Error Act and/or the Health Care Services Malpractice Act. 39. Plaintiffs' Complaint fails to set forth sufficient facts to warrant the imposition of punitive and/or exemplary damages. WHEREFORE Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center, respectfully requests judgment in its favor and against all parties, together with such other relief as this Honorable Court may deem just and appropriate. POST & SCHELL, P.C. By: Dated: January 30, 2012 A H. BRIGGS I.D. 3072 JOHN W. CROUMER I.D. # 208170 Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center Re. Lucile Hamilton and Gary Hamilton, wife and husband v. Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center VERIFICATION I, JOHN W. CROUMER, ESQUIRE, hereby state that I am the attorney for the Defendant in this action and verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S., Section 4904, relating to the unsworn falsification to authorities. JOHN /W. CROUMER, ESQUIRE DATE: January 30, 2012 CERTIFICATE OF SERVICE I, JOHN W. CROUMER, ESQUIRE, attorney for Defendant, CARLISLE REGIONAL MEDICAL CENTER hereby state that a true and correct copy of the foregoing document(s), sent by first-class mail, postage prepaid on the date set forth below, was served upon the following individual(s): Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millenium Way Enola, PA 17025 POST & SCHELL, P.C. By: Dated: January 30, 2012 John . C oumer, Esquire Atto ey F Defendant Carlisl ional Medical Center POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, Plaintiffs, Vs. CARLISLE HMA, LLC DB/A CARLISLE REGIONAL MEDICAL CENTER, Defendant. ATTORNEYS FOR DEFENDAN C.? CARLISLE HMA, LLC DB/A Cg LI SPE =- REGIONAL MEDICAL CENTE 'r m MF - 0:7 i Or C:); Dp © cam„ c) IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED PRAECIPE TO SUBSTITUTE VERIFICATION TO THE PROTHONOTARY: Kindly substitute the attached Verification of Amy Trimmer for that of counsel attached to the Answer and New Matter of Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center which was filed January 31, 2012. POST & SCHELL, P.C. By: Dated: February 1, 2012 A REW H. BRIGGS I. # 53072 JOHN W. CROUMER I.D. # 208170 Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center VERI FI CA TI ON 1, AMY TRIMMER, hereby verify that the statements made by Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center contained in the foregoing document are true and correct to the best of my knowledge, information and belief. 1 understand that any false statements contained herein are subject to the penalties of I8 Pa.C.S., § 4904, relating to unsworn falsification to authorities. I certify that I am a duly authorized representative of Carlisle HMA, LL,C d/b/a Carlisle Regional Medical Center and, as such, am authorized to make this Verification on its behalf. By: MIfRIMMER Dated: 6 //z CERTIFICATE OF SERVICE I, JOHN W. CROUMER, ESQUIRE, attorney for Defendant, CARLISLE REGIONAL MEDICAL CENTER hereby state that a true and correct copy of the foregoing document(s), sent by first-class mail, postage prepaid on the date set forth below, was served upon the following individual(s): Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millenium Way Enola, PA 17025 POST & SCHELL, P.C. By: Dated: February 1, 2012 John ',V'. C oumer, Esquire Attorne'}'f`or Defendant Carlisle Regional Medical Center 2 LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, Plaintiffs, vs. CARLISLE HMA, LLC DB/A CARLISLE REGIONAL MEDICAL CENTER, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. 11-6059 CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED ORDER / AND NOW, this 020 day of vl 2012, upon consideration of Defendant's Motion to Compel Plaintiffs' Responses to Defendant's Request for Written Discovery and any response thereto, it is hereby ORDERED and DECREED that said Motion is GRANTED. It is further ORDERED that Plaintiffs provide full and complete written responses to the below requests for written discovery within thirty (30) days or upon failure to do so, suffer appropriate sanctions: 1) Medical Malpractice Interrogatories of Defendant Carlisle Regional Medical Center Addressed to Plaintiffs; 2) Request for Production of Defendant Carlisle Regional Medical Center Addressed to Plaintiffs; 3) Expenses Interrogatories of Defendant Carlisle Regional Medical Center Addressed to Plaintiffs; c 4) Expert Witness Interrogatories of Defendant Carlisle z`M Regional Medical Center Addressed to Plaintiffs. ,r- r= zo BY THE COURT v c , J. ViarI S. Ms, nuLZ, N 71 ?. CO p,&S iwa:iedf 31a11 o- LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, PLAINTIFFS V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CARLISLE HMA, LLC d/b/a CARLISLE REGIONAL MEDICAL CENTER, DEFENDANT 11-6059 CIVIL TERM ORDER OF COURT AND NOW, this ?C7 day of March, 2012, a Rule is issued on Plaintiffs to show cause with the Defendant's motion to compel Plaintiffs to execute authorizations for the release of medical records should not be granted. Rule returnable twenty (20) days after service. By the Court, Karl J. Januzzi, Esquire For Plaintiffs Albert H. Masland, J. Andrews H. Briggs, Esquire For Defendant c6 #ta le-?P :saa Ca m z? 56 rat p cp w POST & SCHELL, P.C. BY: ANDREW H. BRIGGS, ESQUIRE I.D. # 53072 BY: JOHN W. CROUMER, ESQUIRE I.D. # 208170 1857 WILLIAM PENN WAY P.O. BOX 10248 LANCASTER, PA 17605-0248 717-291-4532 LUCILLE HAMILTON and GARY HAMILTON, wife and husband Plaintiffs Vs. CARLISLE HMA, LLC d/b/a CARLISLE REGIONAL MEDICAL CENTER Defendant ATTORNEYS FOR DEFENDANT N w C r? IN THE COURT OF COMMON -FILEA? CUMBERLAND COUNTY, PENNSYLVANIA NO. 11-6059 CIVIL ACTION -- MEDICAL PROFESSIONAL LIABILITY ACTION JURY TRIAL DEMANDED PRAECIPE FOR WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Kindly withdraw my appearance on behalf of Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center, in the above-captioned matter. Dated: 17 POST & SCHELL, P.C. By: drew H. Briggs, qui John W. Croumer, Esquire Attorneys for Defendant c- f_, r ? ?jo ! 11+ WEBER GALLAGHER SIMPSONji STAPLETON FIRES & NEWBn4 f ri 13 PH : L By: Marc T. Levin ID# 70294 ` d_l xEtL,`t'? [®?t} Fulton Bank Building ?,? ?.? S ? ? ? ?t?, 200 North Third Street, Suite 9A [ar Harrisburg, PA 17101 (717) 237-6940 Attorneys for Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center LUCILE HAMILTON AND GARY HAMILTON, WIFE AND HUSBAND, Plaintiffs V. CARLISLE HMA, LLC d/b/a CARLISLE REGIONAL MEDICAL CENTER, Defendant IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 11-6059 CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter our appearance on behalf of Defendant Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center in the above-captioned action. DATE: y 11 ZJ WEBER GALLAGHER SIMPSON STAPLETON FIRES & NEWBY By: 7/1 L Marc T. Levin, Esquire I.D. #70294 CERTIFICATE OF SERVICE I, Marc T. Levin, Esquire, of Weber Gallagher Simpson Stapleton Fires & Newby, LLP, hereby certify that I am serving a true and correct copy of the foregoing document on the following: Karl J. Januzzi, Esquire Shollenberger & Januzzi, LLP 2225 Millennium Way Enola, PA 17025 WEBER GALLAGHER SIMPSON STAPLETON FIRES & NEWBY LLP By: Marc T. Lev n, Esquire Attorney ID# 70294 Date: Y///?( Attorney for Defendant, Carlisle HMA, LLC d/b/a Carlisle Regional Medical Center lurtOiltRY SHOLLENBERGER & JANUZZI, LLP 71'113 DEC 1 r 1I, 2225 Millennium Way Cii?.<N ►tnin, CQ -Y Enola, PA 17025 f EFL,4�YLVAI� Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs NO. 11-6059 v. CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED PETITION TO APPROVE COMPROMISE SETTLEMENT AND DISTRIBUTE PROCEEDS PURSUANT TO 20 PA.C.S.A. §§3102 AND 3323 AND NOW comes the Petitioner, Gary Hamilton, by and through his attorneys, Shollenberger & Januzzi, LLP, hereby petitions the Court as follows: 1. The Petitioner, Gary Hamilton, is an adult individual who currently resides at 109 Booz Road, Shippensburg, Pennsylvania 17257. 2. The Petitioner is the surviving spouse of Plaintiff, Lucile Hamilton, ("Decedent"), who died on January 19, 2012, while domiciled at 109 Booz Road, Shippensburg, Cumberland County, Pennsylvania. A copy of Decedent's Death Certificate is attached hereto as Exhibit "A." 3. This petition is filed in accordance with the provisions of 20 Pa.C.S. §§3102 and 3323. 4. The Decedent died intestate, and no Letters of Administration have been granted or applied for. 5. The Decedent is survived by her husband and two adult daughters, neither of whom are the issue of Decedent's surviving spouse. Therefore, pursuant to Pennsylvania Intestate Law, the heirs are entitled to take from Decedent's estate in the following manner: • Gary Hamilton, surviving spouse — 50 percent • Katrina Keesler, adult daughter of Decedent— 25 percent • Sabrina Ofenstein, adult daughter of Decedent—25 percent 6. During her lifetime, the Decedent sustained a fractured hip in a slip-and- fall incident on August 1, 2009, at Carlisle Regional Medical Center, which gave rise to the above-captioned cause of action. 7. Decedent's death on January 19, 2012, was unrelated to the injuries sustained on August 1, 2009. 8. Defendant, Carlisle Regional Medical Center, through its third-party administrator, Sedgwick Claims Management, has offered the sum of Twenty Thousand ($20,000.00) Dollars in settlement of the above-captioned claim. One-third (1/3) of this amount has been allocated to Plaintiff Gary Hamilton's loss of consortium claim. A copy of the proposed Releases is attached hereto as Exhibits "B" and "C." 9. The Petitioner believes that said offer of settlement is fair and reasonable and should be accepted. 10. Prior to her death, the Decedent and Petitioner retained the services of the law offices of Shollenberger and Januzzi, LLP, to represent them and had entered i into a Fee Agreement with counsel to pay a 33 1/3% contingency fee for any recovery obtained in the above-captioned matter. Counsel for the Petitioner has reduced that fee to 25%. A copy of the Fee Agreement is attached hereto and incorporated herein by reference as Exhibit "D." 11. The Fee Agreement also provided for reimbursement of any and all costs incurred or advanced in pursuing the litigation of the above-captioned matter, which total $3,488.41. An itemization of all costs is attached hereto and incorporated by reference herein as Exhibit "E." 12. The Central Pennsylvania Teamsters Health and Welfare Fund has asserted a subrogation lien for medical bills paid in connection with Decedent's hip injuries in the negotiated amount of $5,000.00. Verification of the compromised lien amount is attached hereto as Exhibit "F." 13. The Decedent was not employed at the time of her death and, therefore, there are no wages payable to any beneficiary. 14. With the exception of the personal injury settlement, the Decedent had no other probate assets. 15. There are no other outstanding claims against the Decedent known to the Petitioner. 16. Following approval of this settlement and the distribution of the proceeds, the Petitioner authorizes counsel to file the Pennsylvania Inheritance Tax Return. A copy of the Pennsylvania Inheritance Tax Return to be filed is attached hereto as Exhibit "G." 17. The Consent of each beneficiary is attached hereto as Exhibits "H," "I," and "J." WHEREFORE, the Petitioner, Gary Hamilton, respectfully requests this Honorable Court enter a Decree approving the settlement, authorizing execution of the attached Releases and distributing the proceeds as follows: Shollenberger & Januzzi, LLP (atty. fees —25%) $ 5,000.00 Shollenberger & Januzzi, LLP (costs) 3,488.41 Teamster's lien 5,000.00 Cumberland County Register of Wills —filing fee 15.00 Balance remaining for distribution $ 6,496.59 Gary Hamilton (loss of consortium) $ 2,165.53 Gary Hamilton (50% of residuary) 2,165.52 Katrina Keesler (25% of residuary) 1,082.77 Sabrina Ofenstein (25% of residuary) 1,082.77 Respectfully submitted, SHOLLENBERGER & JANUZZI, LLP BY: Karl J. Ja u i, Es4,17- &A/L.-- Attorney for Petitioner Dated: November2.6 , 2013 ,wawke .805 REV(9/11) t LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ;e for this certificate, $6.00 -- This is to certify that the information here given is ,ttrtl�tip,�TH OF pFyy�` correctly copied from an original Certificate of Death �t o �G; duly filed with me as Local Registrar. The original 34 za certificate will be forwarded to the State Vital ?w t. • • ' a; Records Office for permanent filing. i " O Ott P 18 . 51213 �~I t i .t �99jMfN1��r ii_it)ttt ���y.I �,...,.. .Z 9/4 Certification Number °""/"" L;ei Registrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH x VITAL RECORDS Pefrt1anent CERTIFICATE OF DEATH Black Ink State File Number: 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Vr)(Spell Mo) Lucile A . Hamilton -Female 181-50-7121 January 19, 2012 Sa,Age-Last Birthday(Vrs) Sb.Under 1 Year Sc.Under 1 Day 6.Data of girth(Mo/Day/Year)(Spell Month) 7a.Birthplace(City and State or Foreign Country) Months + Days Hours Minutes Washington 0.C. 54 1 April 1 4, 1957 7b.Birthplace(County) N//2 Be.Residence(State or Foreign Country) 8b.Residence(Street end Number-include Apt No.) Sc.Did Decedent Live In a Township? PA (arias.decedent lived In Hopewell ga.Residence(County) 109 Booz Road twa. Cumberland Be.Residence(Zip code) 1 725 7 O No,decedent lived within limits of city/born. 9.Ever in US Armed Forces? 10.Marital Status at Time of Death e'Nrarrled 0 Widowed 11.Surviving Spouse's Name(If wife,give name prior to first marriage) j s 0 No 0 Unknown I 0 Divorced 0 Never Married 0 Unknown I Gary L. Hamilton 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last) John Ofenstein, Sr. Joanne M. Florence 148.Informant's Name I14b.Relationship to Decedent 14c.Informant's Mailing Address(Street and Number,City,State,Zip Code) Gary. L. Hamilton husband 109 Booz Road, Shippensburg, PA 17257 b 15a.Place of Death Check only one) cc If Death Occurred in a Hospital: IT Inpatient If Death Occurred Somewhere Other Than a Hospital: tN Hospice Facility =Decedent's Nome a 0 Emergency Room/Outpatient 0 Dead on Arrival 1 O Nursing Home/Long-Term Care Facility 0 Other(Specify) 1 1Sb.Facility Name(if not Institution,give street and number; •150.City or Town,State,and Zip Code lad.County of Death M S_ Hprshpy Medical Cent Fs He.rchey�a 1JORR' foss srshin 165.Method of Disposition 0 Burial Cremation SBb.Date of Disposition 165.Place of Disposition(Name of cemetery,crematory,orppothe'r place) 0 Removal front State 0Donation 1-24-2012 Hollinger Crematorium, Mt. HAAll 12065 0 Other(Specify) 9 y p r n g s, 168.Location of Disposition(City or Town,State,and Zip) 178.Signature Fu ere I Service Licensee or Person in Charge of Interment�17b,License Number - Mt. Holly Springs, PA 17065 T Y-3..R� F0-012984-L 175.Name end Complete Address of Funeral Facility Fogelsanger-Bricker Funeral Home Inc. , 112 West King Street, Shippensburg, PA 17257 $ Se.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE races to indicate what .2 highest degree or level of school completed at the time of death. box that best describes whether the decedent the d edent considered himself or herself to be, 0 8th grade or Ices Is Spanish/Hlspenie/Latino. Check the"No" Ice 0 Korean 0 No diploma,9th-12th grade bot.IJ/ cadent is not Spanish/Hlspenic/Latino. 0 Black or African American 0 Vietnamese 0 High school graduate or GED completed L�r1Q not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 OtherASien 0,Some college credit,but no degree 0 Yes,Mexican,Mexican American,Chicano 0 Asian Indian 0 Native Hawaiian Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican 0 Chinese Q Guamanian or Chamorro 0 Bachelor's degree(e.g.BA,AB,BS) 0 Yes,Cuban 0 Filipino El Samoan 0 Master's degree(e.g.MA,MS,MEng.MEd,MSW,MBA) 0 Yes,other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander 0 Doctorate(e.g.PhD,Edo)or Professional degree (Specify, 0 Other(Specify) (e.g.MD,DOS,DVM,LLB,JD) 21.Dec$$SS�ient's Single Race Self-Designation-Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22e.Decedent's Usual Occupation-Indicate type of,work [�•E�Site 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islander Circulation M a n a e r o 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure g .'g, 0 Asian Indian - 0 Other Asian 0 Refused 22b.Kind of Business/Industry 0 Chinese 0 Native Hawaiian []Other(Specify) 0 Filipino []Guamanian or Chamorro News Chronicle ITEMS 21%-23d MUST BE COMPLETED 23a.Date Pronounced Dead(Mo/Day/Y�rjt 23b.Signature of Person Pronouncing Death(Only when applicable) 23c.License Number CERTIFIES DEATH PRONOUNCES OR ,n`^1 'a V tot, aoIp- 23d.Date Signed(Mo/Dey/Vr) 24,Time of Deatyh� l S; "'f y'p '1 25.Was Medical Examiner or Coroner Contacted? 0 Yes 0 No 1_ CAUSE OF DEATH I Approximate 26.Part I. Enter the chain of events-diseases.Injuries,or complications-that directly caused the death. DO NOT enter terminal events such as cardiac arrest 1 Interval: respiratory arrest,or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line.Add additional lines If necessary 1 Onset to Death IMMEDIATE CAUSE - --> a. CCti'" 0' ' AYYc-3'E- (Final disease or condition Due to(or as a consequence of): resulting In death) • b. )r V ewe_ r5t t r .C�.-'k"e'l4'ti,,tn , Sequentially list conditions, Due to(or as a consequence of): If any,leading to the cause / �^ . .--...fisted on line a. Enter the c. 4-\v Q.--r Ti�\ e_ 4 UNDERLYING CAUSE Due to(or as•consequence of): i{ 3 (disease or Injury that € EInitiated the events resulting d. £ 1 g in death)LAST. Due to(ores a consequence of): 1 8 26.Part II. Enter other pianificent conditions cotnlributlne to death but not resulting in the underlying cause given in Part I 27.Was utopsy performed? g �ti Y-1_ .ic... AT-1 e-rn 5o� e, ra 26 findings available to complete the cause of death? 0 Yes 0 No 29.if Fe�^' Ic: 30.Did Tobacco Use Contribute to Beath? 31.Manner of Death • - E ) 'Not pregnant within past year 0 Yes 0 Probably Natural 0 Homicide 8 0 Pregnant at time of death 0 No • ,Unknown o Accident Q Pending Investigation sea 0 Not pregnant.but pregnant within 42 days of death 0 Suicide 0 Could not be determined .- 0 Not pregnant.but pregnant 43 days to 1 year before death 32.Date of Injury(Mo/Day/Yr)(Spell Month) ...) 0 Unknown If pregnant within the past year 33.Time of Injury -�j ,r/ 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of injury(Street and Number,City,State,Zip Code) ... . . .. 36.Injury at Work 37.If Transportation injury,Specify: 38.Describe How Injury Occurred: 0 Yes in Driver/Operator 0 Pedestrian I C 0 No 0 Passenger 0 Other(Specify) 39e.Certifier(Check only one): ..r 0 Certifying physician-To the best of my knowledge,death occurred due to the c•use(s)and manner stated ! al Pronouncing&Certifying physician-To the best of my knowledge,death occurred at the time,date,and place,and due to the causes)and manner stated annex 2ro• 0 Medical Examiner/Corona On the b a s i s f exa 1 Lion,and/or Investigation,in my opinion,death occurred at the time,date,and place,and due to the causets)and m stated "'-. . Signature of certifier �C(� Title of certifier: /14•D License Number:Kurt)`f lo el i 2 _ _-'F- 39b.Name,Address and Zip Code of Person Completing Cause of Death(Item 26) 39c.Da a Signed(Mo/Day/fr) 1�CkV(ACT.< E,c dlr,n14 M.S. Hershey Medical Center, Hershey, Pa.17033 i� let ( ( 2- 1t 40.Registrar's District Number 41.Registrar's Signature 42/ g atrer file Date(Mo/Day/fr) 43.Amendments , . Z (�( C Disposition Permit No. O ` 1 '- v REV 07/2013 'a! F DRAFT FULL AND FINAL RELEASE FOR AND IN CONSIDERATION of the total sum of Thirteen Thousand($13,333.34) Dollars to the undersigned,receipt of which is hereby acknowledged;the undersigned, THE ESTATE OF LUCILE A. HAMILTON,Deceased, does fully release and fully discharge Carlisle Regional Medical Center, Sedgwick Claims Management Services, Inc., Health Management Associates, Inc., Weber Gallagher Simpson Stapleton Fires &Newby, LLP, and all other persons, employers, employees, agents, consultants, governmental entities, associations, subsidiaries,principles and corporations,whether or not named herein,their heirs, executors, administrators, attorneys, successors, assigns and insurers, their respective agents, servants and employees, both known and unknown,whether named herein or not, (hereinafter referred to collectively as "Releasee"), from any and all causes of action, claims and demands of whatsoever kind, on account of all known and unknown injuries, losses and damages, from any claims or joinders for sole liability, contribution, indemnity or otherwise as a result of, arising from, or in any way connected with any injuries or damages allegedly sustained by THE ESTATE OF LUCILE A. HAMILTON and/or its heirs, executors, beneficiaries, successors and assigns, and on account of which Legal Action was instituted by the undersigned in the Court of Common Pleas of Cumberland County, No. 11-6059. Of the Thirteen Thousand Three Hundred Thirty- Three and 34/100 Dollar($13,333.34)settlement, Defendant Carlisle Regional Medical Center, is responsible for payment to the Plaintiffs the full amount of the settlement or Thirteen Thousand Three Hundred Thirty-Three and 34/100 Dollars ($13,333.34).All sums set forth herein constitute damages on account of physical injuries and sickness,within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. The undersigned does understand, and agree,that the acceptance of said sum is in full accord and satisfaction of a disputed claim and that the payment of said sum is not an admission of liability by any party named herein. This further acknowledges that all actions presently in suit against Releasee are to be appropriately marked as settled, discontinued and ended. It is expressly understood and agreed that this release and settlement is intended to cover and does cover not only all known injuries, losses and damages, but any further or future injuries, losses and damages which arise from, or are related to, the occurrences set forth in the Legal Action noted above. The undersigned hereby agrees, on behalf of the Estate, and on behalf of its, executors, beneficiaries, successors and/or assigns,to indemnify and save forever harmless the Releasee named in this document from and against any and all claims, demands, liability, damage, cost, expense, or actions, known or unknown, made against the Releasee by any person or entity on account of, or in any manner related to or arising from the Legal Action noted above, or the injuries allegedly sustained by THE ESTATE OF LUCILE A. HAMILTON, its heirs, executors,beneficiaries, successors and/or assigns. The undersigned hereby agrees, on behalf of THE ESTATE OF LUCILE A. HAMILTON, its heirs, executors, successors, and/or assigns, to satisfy any and all valid liens that have been asserted and/or which could be or may be asserted for reimbursement of any medical benefits or other benefits provided by a third party as a result of the injuries claimed in the Legal Action referenced herein. Further,the undersigned shall satisfy,by way of payment, reduction, and or compromise, any and all Commonwealth of Pennsylvania Department of Public Welfare and/or Medicare and/or other statutory liens and conditional payments that have been, or may be, asserted against the plaintiffs or the proceeds of this settlement. The undersigned shall satisfy and otherwise comply with any requirement for a Medicare Set-Aside and/or statutory and/or regulatory provision or requirement regarding the protection of assets from these settlement proceeds for future medical care and treatment. In the event court approval is required for the settlement,compromise or resolution of this claim, this settlement is conditioned upon plaintiff promptly undertaking any and all necessary action to obtain same. If this settlement is ever determined by any court to be without effect because some necessary court approval was not obtained, or if the released parties are subjected to further legal action or claims which could not have been instituted or presented had proper court approval been obtained by plaintiffs,then plaintiffs will indemnify the released parties for any future loss, cost, or expense, including but not limited to,reasonable attorneys' fees for defending, litigating and settling any such claims or action, and for any judgment resulting from any such claims or action. It is further understood and agreed that this is the complete release agreement, and that there are no written or oral understandings or agreements, directly or indirectly, connected with this release and settlement,that are not incorporated herein. This agreement shall be binding upon and inure to the estate, successors, assigns,heirs,beneficiaries, executors,administrators, and legal representatives of the respective parties hereto. It is further understood and agreed and made part hereof,that the undersigned, family, representatives and attorneys) shall not comment, either directly or indirectly, on any aspect of this case or settlement to any member of the news media, or in any way publicize or cause to be publicized in any news or communications media, including,but not limited to newspapers, magazines,journals,radio,television, online computer systems and law-related publications,the facts of this case, the existence of this settlement and the terms and conditions of this settlement. If the undersigned, family, representatives and/or attorneys) file any court document(s) identifying the terms and/or conditions of this settlement,the Estate shall request that the court immediately seal such document(s) and take whatever reasonable steps are necessary to seek to assure that such document(s) are not accessible or disclosed to anyone. This paragraph is intended to become part of the consideration for settlement of this claim. THE UNDERSIGNED HEREBY DECLARES that the terms of this settlement have been completely read; and that the terms of this settlement have been discussed with legal counsel of choice; and said terms are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims on account of the injuries and damages above mentioned, and for the express purpose of precluding forever any further or additional suits arising out of or related to the aforesaid claim. IN WITNESS WHEREOF, I hereunto set MY hand and seal this day of 2013. WITNESS: THE ESTATE OF LUCILE HAMILTON By: SSN: DATE: SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 2013. NOTARY PUBLIC 1 \1\, I r n FULL AND FINAL RELEASE D R A F T FOR AND IN CONSIDERATION of the total sum of Six Thousand Six Hundred Sixty- Six and 66/100 Dollars($6,666.66) to the undersigned, receipt of which is hereby acknowledged; the undersigned, GARY L. HAMILTON, does fully release and fully discharge Carlisle Regional Medical Center, Sedgwick Claims Management Services, Inc., Health Management Associates, Inc., Weber Gallagher Simpson Stapleton Fires &Newby, LLP, and all other persons, employers, employees, agents, consultants, governmental entities, associations, subsidiaries,principles and corporations,whether or not named herein, their heirs, executors, administrators, attorneys, successors, assigns and insurers, their respective agents, servants and employees, both known and unknown,whether named herein or not, (hereinafter referred to collectively as "Releasee"), from any and all causes of action, claims and demands of whatsoever kind, on account of all known and unknown injuries, losses and damages, from any claims or joinders for sole liability, contribution, indemnity or otherwise as a result of, arising from, or in any way connected with any injuries or damages allegedly sustained by GARY L.HAMILTON and/or his estates,heirs, executors,beneficiaries, successors and assigns, and on account of which Legal Action was instituted by the undersigned in the Court of Common Pleas of Cumberland County,No. 11-6059. Of the Six Thousand Six Hundred Sixty-Six and 66/100 Dollars ($6,666.66)settlement, Defendant Carlisle Regional Medical Center, is responsible for payment to the Plaintiffs the full amount of the settlement or Six Thousand Six Hundred Sixty- Six and 66/100 Dollars ($6,666.66). All sums set forth herein constitute damages on account of physical injuries and sickness,within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended.' The undersigned does understand, and agree,that the acceptance of said sum is in full accord and satisfaction of a disputed claim and that the payment of said sum is not an admission of liability by any party named herein. This further acknowledges that all actions presently in suit against Releasee are to be appropriately marked as settled, discontinued and ended. It is expressly understood and agreed that this release and settlement is intended to cover and does cover not only all known injuries, losses and damages, but any further or future injuries, losses and damages which arise from, or are related to,the occurrences set forth in the Legal Action noted above. The undersigned hereby agrees, on his behalf,and on behalf of their his, executors, beneficiaries, successors and/or assigns, to indemnify and save forever harmless the Releasee named in this document from and against any and all claims, demands, liability, damage, cost, expense, or actions,known or unknown, made against the Releasee by any person or entity on account of, or in any manner related to or arising from the Legal Action noted above, or the injuries allegedly sustained by GARY L. HAMILTON, and/or his estate,heirs,executors, beneficiaries, successors and/or assigns. The undersigned hereby agrees, on his behalf and on behalf of his heirs, executors, successors, and/or assigns,to satisfy any and all valid liens that have been asserted and/or which could be or may be asserted for reimbursement of any medical benefits or other benefits provided by a third party as a result of the injuries claimed in the Legal Action referenced herein. Further, the undersigned shall satisfy,by way of payment,reduction, and or compromise, any and all Commonwealth of Pennsylvania Department of Public Welfare and/or Medicare and/or other statutory liens and conditional payments that have been, or may be, asserted against the plaintiffs or the proceeds of this settlement. The undersigned shall satisfy and otherwise comply with any requirement for a Medicare Set-Aside and/or statutory and/or regulatory provision or requirement regarding the protection of assets from these settlement proceeds for future medical care and treatment. In the event court approval is required for the settlement, compromise or resolution of this claim, this settlement is conditioned upon plaintiff promptly undertaking any and all necessary action to obtain same. If this settlement is ever determined by any court to be without effect because some necessary court approval was not obtained, or if the released parties are subjected to further legal action or claims which could not have been instituted or presented had proper court approval been obtained by plaintiffs, then plaintiffs will indemnify the released parties for any future loss, cost, or expense, including but not limited to,reasonable attorneys' fees for defending, litigating and settling any such claims or action, and for any judgment resulting from any such claims or action. It is further understood and agreed that this is the complete release agreement,and that there are no written or oral understandings or agreements, directly or indirectly,connected with this release and settlement,that are not incorporated herein. This agreement shall be binding upon and inure to the estate, successors, assigns,heirs, beneficiaries, executors, administrators, and legal representatives of the respective parties hereto. It is further understood and agreed and made part hereof,that the undersigned,his family and representatives and his attorney(s) shall not comment, either directly or indirectly, on any aspect of this case or settlement to any member of the news media, or in any way publicize or cause to be publicized in any news or communications media, including, but not limited to newspapers, magazines,journals, radio,television, online computer systems and law-related publications,the facts of this case, the existence of this settlement and the terms and conditions of this settlement. If the undersigned,his family,representatives and/or attorney(s) file any court document(s) identifying the terms and/or conditions of this settlement,he shall request that the court immediately seal such document(s) and take whatever reasonable steps are necessary to seek to assure that such document(s) are not accessible or disclosed to anyone. This paragraph is intended to become part of the consideration for settlement of this claim. THE UNDERSIGNED HEREBY DECLARES that the terms of this settlement have been completely read; and that he discussed the terms of this settlement with legal counsel of his choice; and said terms are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims on account of the injuries and damages above mentioned, and for the express purpose of precluding forever any further or additional suits arising out of or related to the aforesaid claim. IN WITNESS WHEREOF, I hereunto set MY hand and seal this day of , 2013, WITNESS: GARY L. HAMILTON SSN: DATE: SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 2013. NOTARY PUBLIC -�. I 7.M. 7.7-_, , I Power of Attorney and Conti gent Fee Agreement I , 1ueilfe-l-lamilton , do her by retain Shollenberger & Januzzi, LLP of Enola, Pennsylvania, as my attorneys to negotiate for me a settlement or to institute for me in my name any legal actions that in their judgment are necessary in connection with my claim for compensatory and/or punitive damages against the following health care providers: 1) Carlisle Regional Medical Center I As well as any other health care provider who may be liable for such damages as a result of medical care that was rovided to me on and after August 1, 2009. I hereby give to my attorne s a Power of Attorney to execute all documents connected with the clim, including pleadings, contracts, commercial papers, settlement agreements, compromises and releases, verifications, discontinuances, orders and settlement checks. I agree not to settle or adjust this claim or any legal action arising from it. I agree to fully cooperate with my attorneys in the handling of the claim. This includes, but is not limited to attending depositions, legal proceedings and conferences; keeping my attorneys informed as to my current mailing address, phone number and medical condition I agree that my attorneys qhall not be required to continue to represent me should they be unable to secure an opinion from an appropriate medical expert that would permit them to file a Certificate of Merit. I warrant that the information which I have supplied and will supply during the course of the representation has and will be true and accurate,and has not been and will not be obtained through fraud or illegal activities. I agree to pay attorneys'foes from the total amount recovered from any source, including but not limited to the Pennsylvania M-Care Fund and any excess policy of insurance: I 1 Shollenberger&Januzzi.LLP 2225 Mil mien Way,Enole,Pennsylvania 17025 Tel. 717)728-3200 Fax(717)728-3400 ) Settlement of third party tort claim prior 33 and 1/3% of total sum recovered to filing of legal action Settlement of third party tort claim on or 40% of total sum recovered after filing of legal action in the event that no recovery is obtained on my claim, I will not be responsible to pay anything to hiy attorneys for their time or services. Pre and post litigation cost and expenses will be advanced by my attorneys but are to be repaid to t em from my share of the recovery. Pre and post litigation costs and expenses include, but are not limited to: photocopies; fax charges; postage; notary fees, long distance telephone charges; mileage for attorneys and staff; investigation charges; photographs; court costs; WEST LAW research charges; medical records costs; deposition costs; expert witness fees; mediator fees; stenographer costs; and video deposition fees. in the event that no recovery is obtained on my claim, I am only responsible for repayment of pre and post litigation costs and expenses if i fail or refuse to follow my attorneys' advice regarding settlement of the claim. In the event that the amount of the recovery is less than the amount of the pre and post litigation costs and expenses advanced by my attorneys, my attorneys will make no charge for their time or services and the amount of the recovery will be accepted by my attorneys as a full and final repayment of all such costs and expenses, but only if I follow their advice regarding settlement of the claim. If I do not follow their dvice regarding settlement, I remain responsible for payment of the fees set forth above as well as all pre and post litigation costs and expenses advanced on my behalf. My attorneys shall have a security interest in any amounts recovered on my behalf that are subject to a fee under the terms and conditions of this agreement. I As one possible settlement option, I authorize my attorneys to explore the possibility of a structured settlerr,ent through the use of deferred periodic payments. I agree that if my claim is settled through such structure, the attorneys' fees on the part that is structured shall be calculated in the percentages as set forth above based upon the cost of the structured settlement. I I authorize my attorneys to repay my medical caregivers for all outstanding medicai bills and expenses incurred as a result of the negligent medical care from my share of the recovery, Unless paid or payable by another source. j Shofte berger&Januzzi,l.lP 2225 M um Way,Enota,Pennsyl en a 17025 Tel.{757)725.3200 Fax 717)728 340a I wrm,ehouianiaw.an 1 This Power of Attorney and Contingent Fee Agreement applies to all proceedings up to and including verdict or decision at trial or arbitration. If, in the discretion of my attorneys, post-tral proceedings, including appeals, are warranted, they will not be covered by this Contingent Fee Agreement and a new fee agreement will be required. I further authorize my attorneys to destroy my file three (3)years after the file is closed. in Witness hereof 1 have hereunto set my hand and seal this 0".1 day of A► . .. �� ,2009. A Iii (Seal) e. f IPA MIL MIL, -a1) (Seal) (Seal) And Now, this c1 day of c-, .dtf , 2009, the above Contingent Fee Agreement and Power of Attorney has been read, approved, and understood by me and the receipt of a copy thereof acknowledged. The terms set forth re agreeable. ly —(Seal) (Seal) !._.._ _ ..:.� �.�. I (Seal) (Seal) 3 Shdlanberger&Januzzi L LP 2225 M>f�ennium Way Ent Pannayl,anta 17025 Tel.,(717)726.3290 Faa(717)728.3400 twllianlaw.com Oct/31/2013 Shollenberger & Januzzi, LLP Page: 1 Client Ledger ALL DATES Date Received From/Paid To Chq# I General I Bld I Trust Activity Entry # Explanation Rec# Rcpts Diaba Fees Inv# Acc Ropts Disbs Balance 2182 Hamilton, Lucile 092345 S&F, DOI: 8/1/2009, SOL: 8/2/2011 , FEE: 331/ Resp Lawyer: RJJ Sep 14/2009 Karl J Januzzi 145586 Mileage/Parking misc. 14501 17.60 Sep`30/2009 Expense Recovery 144689 Postage Recovery Sept. 09 01384 0.88 Oct 31/2009 Expense Recovery 145455 Photocopies Recovery 01386 6.75 Oct 31/2009 Expense Recovery 146892 Postage Recovery Oct. 09 01390 0.88 Mar 6/2010 Appalachian Orthopedic Center, LT 149427 Medical Records - L. Hamilton 15015 51.14 Acct.#5994 Apr 28/2010 Expense Recovery 151429 Postage Recovery 01409 0.44 Jul 12/2010 Rehab Medicine Associates, PC 153738 Medical Records - L. Hamilton 15403 25.84 Sep 28/2010 Expense Recovery 156285 Postage - JULY, 2010 L. HAMILTON 01430 0.44 Oct 28/2010 Expense Recovery 157962 Photocopies 6/18/10 TO 10/27/10 01445 9.75 - LUCILE HAMILTON Nov 3/2010 Expense Recovery 158243 Facsimilies 6/18-10/27/10 01450 2.50' LUCILE HAMILTON Dec 17/2010 Appalachian Orthopedic Center, LT 159805 Medical Records - Lucile A 15993 30.24 Hamilton #5994 Dec'21/2010 Rehab Medicine Associates, PC 159897 Medical Records - LUCILA 16020 23.28, HAMILTON Dec 29/2010 Expense Recovery 160331 Photocopies BLACK & WHITE 01464 149.50 NOVEMBER, 2010 LUCILE HAMILTON Dec 31/2010 Expense Recovery 160880 Facsimilies & Scans DECEMBER, 01475 5.00 2011 LUCILE HAMILTON Jan 31/2011 Expense Recovery 162265 Photocopies BLACK & WHITE 01482 4.50 JANUARY, 2011 LUCILLE HAMILTON Mar 16/2011 Rehab Medicine Associates, PC 163877 Telephone Conference with DR. 150.00 $ARSFIELD - LUCILE HAMILTON #092345 Apr 1/2011 Expense Recovery 164461 Postage -MARCH 2011-L. HAMILTON 01497 10.94 Apr 6/2011 Expense Recovery 164933 Photocopies 01505 0.50 -03/24/11-04/05/11-L HAMILTON May 19/2011 Expense Recovery 166814 Photocopies April 20- May 19 - 01517 163.75 L. HAMILTON Jun 1/2011 Fedex 167344 Postage - Overnight Shipping 29.57 Charges- Hamilton Jun 3/2011 Thomson Reuters - West 167539 Research West Law Charges for 61.60 04/01-04/30/11- Hamilton Jun 13/2011 Pennsylvania Physicians for Legal 167866 Outside Professional - Expert 2000.00 Review Aug 1/2011 Cumberland County Prothonotary 169411 Filing Fees - Prothonotary - 92.00 Lucile Hamilton Aug 1/2011 Cumberland County Sheriff 169414 Sheriff Fees - Lucile Hamlton 150.00 Aug 1/2011 Dauphin County Sheriff 169417 Sheriff Fees - Lucile Hamilton 41.25 Aug 2/2011 Fedex 189912 Postage HAMILTON 75.04 Aug 2/2011 Fedex 189913 Postage HAMILTON- CREDIT WAS -75.04 GIVEN DUE TO PACKAGE NOT BEING DELIVERED OVERNIGHT Aug 9/2011 Camels Mazeski 169717 Mileage/Parking 16823 15.30 Aug 16/2011 Thomson Reuters - West 189921 Westlaw - HAMILTON 129.83 Aug 17/2011 Expense Recovery 170013 Telephone - July 2011- HAMILTON 01528 1.98 Aug 22/2011 Cumberland County Sheriff 170101 RET - Refund - Sheriff fees - L115626 112.56 Lucile Hamilton Aug 31/2011 Expense Recovery 170541 Postage JUNE 2011 01536 0.44 Oct 5/2011 Fedex 189158 Postage Postage- fed ex charges- 17.83 Oct 13/2011 Expense Recovery 172140 Photocopies as of Sept 30 2011 01543 6.75 Oct 19/2011 AAJ Exchange Oct/31/2013 Shollenberger & Januzzi, LLP Page: 2 x Client Ledger ALL DATES Date Received From/Paid To Chq# I General I Bld I Trust Activity I Entry # Explanation Rec# Rcpts Disbs Fees Inv# Acc Rcpts Disbs Balance 172478 Nursing Errors in Hospital 017115 332.50 Packet Nov 9/2011 Expense Recovery 173245 Postage - Sept 2011 01550 2.60 Nov 15/2011 Expense Recovery 173543 Postage - Oct 2011 01556 1.32 Nov 21/2011 Thomson Reuters - West 173717 Westlaw Oct 1-Oct 31 6.53 Nov 30/2011 Expense Recovery 174844 Photocopies Oct 2011 01561 4.75 Dec 19/2011 Expense Recovery 175066 Photocopies November 2011 01564 1.50 Feb 27/2012 Expense Recovery 179764 Photocopies JANUARY 2012 01596 1.00 May 7/2012 Expense Recovery 182532 Postage - April 2012 01609 0.90 Jul 1/2012 Expense Recovery 185246 Photocopies - June 2012 01616 0.75 Jul 1/2012 Expense Recovery 185955 Postage - June 2012 01617 1.35 Aug 2/2012 Expense Recovery 186285 Photocopies - July 2012 01620 1.00 Aug 7/2012 Expense Recovery 186577 Postage - July 2012 01621 0.45 Apr 15/2013 Thomson Reuters - West 198073 Westlaw - March 2013- L Hamilton 42.32 Jun 1/2013 Thomson Reuters - West 200724 West Charges - May 2013 - L 1.22 Hamilton Aug 5/2013 Expense Recovery 202345 Postage - July 2013 01672 1.38 Sep 4/2013 Expense Recovery 203386 Postage - Aug. 2013 01678 0.92 I UNBILLED 1 I BILLED I I BALANCES I TOTALS CHE + RECOV + FEES = TOTAL DISBS + FEES + TAX - RECEIPTS = A/R TRUST PERIOD 3218.05 382.92 0.00 3600.97 0.00 0.00 0.00 0.00 0.00 0.00 END DATE 3218.05 382.92 0.00 3600.97 0.00 0.00 0.00 0.00 0.00 0.00 General Retainer 112.56 I UNBILLED I I BILLED I I BALANCES 1 FIRM TOTAL CHE + RECOV + FEES = TOTAL DISBS + FEES + TAX - RECEIPTS = A/R TRUST PERIOD 3218.05 382.92 0.00 3600.97 0.00 0.00 0.00 0.00 0.00 0.00 END DATE 3218.05 382.92 0.00 3600.97 0.00 0.00 0.00 0.00 0.00 0.00 General Retainer 112.56 REPORT SELECTIONS - Client Ledger Layout Template Default Advanced Search Filter None Requested by csholley Finished Thursday, October 31, 2013 at 12:05:04 PM Ver 12.0 SP2 (12.0.20121108) Matters 092345 Clients All Major Clients All Client Intro Lawyer All Matter Intro Lawyer All Responsible Lawyer All Assigned Lawyer All Type of Law All Select From Active, Inactive, Archived Matters Matters Sort by Default New Page for Each Lawyer No New Page for Each Matter No No Activity Date Dec/31/2199 Firm Totals Only No Totals Only No Entries Shown - Billed Only No Entries Shown - Disbursements Yes Entries Shown - Receipts Yes Entries Shown - Time or Fees Yes Entries Shown - Trust Yes Incl. Matters with Retainer Bal No Incl. Matters with Neg Unbld Disb No Trust Account All Working Lawyer All Include Corrected Entries No Show Check # on Paid Payables No Show Client Address No Consolidate Payments No Show Trust Summary by Account No Show Interest No Interest Up To Oct/31/2013 Show Invoices that Payments Were Applied to No Display Entries in Date Order I (--------.--..--- 7 s ) .. Camala Mazeski Subject: FW: Lucille Hamilton Attachments: 20130802095432935.pdf PDF®. 201308020954 ?35.pdf(184 KB From: Sabatino, Frank C. [mailto:FCS @stevenslee.com] Sent: Friday, August 02, 2013 10:56 AM To: Cindy Eppinger Cc: ladelong @centralpateamsters.com Subject: FW: Lucille Hamilton Karl J. Januzzi, Esqure Dear Mr. Januzzi: : Attached you will find the Fund's revision of the subrogation claim, valued at $8, 658.59. I assume that you will inform me if you believe that the claim exceeds the amount justified by the records. The Fund does not accept your offer of $2, 000 and, instead, counter-offers $5,000 as a lump sum settlement. The 20o allowance for attorney's fees provided by the plan documents would allow the Fund to demand almost $7, 000. Viewed another way, if the Fund received ! /3 of the $20, 000 recovery, the lump .m p. ent would amount to about $6, 700. Under these circumstances, the Fund conside.s $5,000 :minently reasonable. Please contact me if you wish to discuss this case in more detail. Frank C. Sabatino Original Message From: Lou Ann DeLong [mailto:ladelong @CentralPaTeamsters.com] Sent: Friday, August 02, 2013 10:03 AM To: Sabatino, Frank C. Subject: Lucille Hamilton Frank, I have deleted the claims that Mr. Januzzi objected to. Some claims were part of the admission for the hip but patient was seen for other problems. Some of the claims had one service for the hip and another service for non-hip treatment. I cannot break the claim apart for the report and I have deleted those claims for discussion purposes. The current claim total is at $8, 658.59 based on the changes. Lou Ann Original Message From: ricohh&w @centralpateamsters.com [mailto:ricohh&w @centralpateamsters.com] Sent: Friday, August 02, 2013 9:55 AM To: Lou Ann DeLong Subject: Message from "RNP0026731A688F" This E-mail was sent from "RNP0026731A688F" (Aficio MP C300) . Scan Date: 08.02.2013 09:54:32 (-0400) Queries to: ricohh&w @centralpateamsters.com This email may contain privileged and confidential information and is solely for the use 1 F 1 150.5610105 REV-1500"(02-1"'") Department of Revenue P ytvanfa OFFICIAL USE ONLY PA De p enns Bu BOX of Individual Taxes �DEPARTMENT Fa"�"U` County Code Year File Number B Bu BOX fIndi i INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 181-50-7121 01/19/2012 04/14/1957 Decedent's Last Name Suffix Decedent's First Name MI HAMILTON LUCILE A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI HAMILTON GARY L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 204-60-6807 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW alp 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) m 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) Op 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KARL J. JANUZZI, ESQUIRE (717)728-3200 REGISTER OF WILLS USE ONLY First Line of Address 2225 MILLENNIUM WAY Second Line of Address City or Post Office State ZIP Code DATE FILED ENOLA PA ;17025 Correspondent's e-mail address:kjj @sholljanlaw.cOm Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: LUCILE A. HAMILTON 181-50-7121 RECAPITULATION 1. Real Estate(Schedule A). 1. 0.00 2. Stocks and Bonds(Schedule B) 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) 5. 13,333.34 6. Jointly Owned Property(Schedule F) 0 Separate Billing Requested 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C3 Separate Billing Requested 7. 0.00 8. Total Gross Assets(total Lines 1 through 7) 8. 13,333.34 9. Funeral Expenses and Administrative Costs(Schedule H) 9. 6,784.61 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I) 10. 8,658.59 11. Total Deductions(total Lines 9 and 10) 11. 15,443.20 12. Net Value of Estate(Line 8 minus Line 11) 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) 14, 0.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0,0S2 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 0.00 16. 0.00 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX(H) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME LUCILE A. HAMILTON STREET ADDRESS 109 BOOZ ROAD CITY STATE ZIP SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ❑ U b. retain the right to designate who shall use the property transferred or its income El • c. retain a reversionary interest ❑ • d. receive the promise for life of either payments,benefits or care? ❑ • 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration? El • 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ❑ U 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ❑ • IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-15o8 EX+(o8-12) Rpennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LUCILE A. HAMILTON Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Settlement proceeds from personal injury action: LUCILE A.HAMILTON AND GARY L.HAMILTON,wife and husband vs.CARLISLE REGIONAL MEDICAL CENTER,Cumberland County Court of Common Pleas No.11-6059(see attached Release) 13,333.34 TOTAL(Also enter on Line 5, Recapitulation) $ 13,333.34 If more space is needed,use additional sheets of paper of the same size. REV-1514 EX+(08-13) j pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUCILE A. HAMILTON Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Attorneys fees and costs of litigation(see attached Fee Agreement and Cost Sheet) 6,769.61 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 15.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 6,784.61 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) R pennsylvania - SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUCILE A. HAMILTON Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Subrogation lien of Central PA Teamsters(see attached statement) 8,658.59 TOTAL(Also enter on Line 10,Recapitulation) $ 8,658.59 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER: LUCILE A. HAMILTON RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. SABRINA OFENSTEIN,7500 Molly Pitcher Hwy.,Shippensburg,PA Daughter 25% 2. KATRINA KEESLER,328 Central Avenue,Newark,OH Daughter 25% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1• GARY L.HAMILTON, 109 Booz Rd.,Shippensburg,PA 50% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed,use additional sheets of paper of the same size. SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 11-6059 CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED CONSENT OF BENEFICIARY I, GARY L. HAMILTON, surviving spouse of Lucile Hamilton, Deceased, hereby state that I am a beneficiary named in the attached Petition, that I have reviewed the foregoing Petition, that the statements made therein are true and correct to the best of my knowledge and belief, and that I hereby consent to the proposed settlement and distribution described therein. Date: i 0 l 24/13 GARY L. AMILTON C � t SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs NO. 11-6059 v. CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED CONSENT OF BENEFICIARY I, SABRINA OFENSTEIN, adult daughter of Lucile Hamilton, Deceased, hereby state that I am a beneficiary named in the attached Petition, that I have reviewed the foregoing Petition, that the statements made therein are true and correct to the best of my knowledge and belief, and that I hereby consent to the proposed settlement and distribution described therein. Imo► Date: s .� f j e ' .r1�rt__/r SABRINA OFE rCa'I ' 11 L • SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs NO. 11-6059 v. CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED CONSENT OF BENEFICIARY I, KATRINA KEESLER, adult daughter of Lucile Hamilton, Deceased, hereby state that I am a beneficiary named in the attached Petition, that I have reviewed the foregoing Petition, that the statements made therein are true and correct to the best of my knowledge and belief, and that I hereby consent to the proposed settlement and distribution described therein. Date: C I - 1 3 2', . KATRINA KEESLER + V VERIFICATION I Gary L. Hamilton , hereby acknowledge that I am a Plaintiff in this action and that I have read the Petition to Approve Compromise Settlement and that the facts stated herein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Date: 101241 SHOLLENBERGER&JANUZZI,LLP 1820 LINGLESTOWN ROAD!P.O.BOX 045!HARRISBURG,PA 17106-0545 (717)234-3700!FAX(717)234-8212 SEC-UPS.DOC\VERIFICATION SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY HAMILTON, IN THE COURT OF COMMON PLEAS OF wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs NO. 11-6059 v. CIVIL ACTION — MEDICAL PROFESSIONAL CARLISLE HMA, LLC, d/b/a CARLISLE LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW this /2- day ofb-CCi , 2013, I hereby certify that I have served a true and correct copy of the Petition to Approve Compromise Settlement and Distribution of Proceeds by United States mail, postage prepaid, addressed to: Katrina Keesler Sabrina Ofenstein 328 Central Avenue 7500 Molly Pitcher Hwy, Lot 71 Newark, OH 43055 Shippensburg, PA 17257 SHOLLENBERGER & JANUZZI, LLP By: qiCciut (4. Karl J. Juzz' E q (�'L CIF- _ FILED-OFFICE. SHOLLENBERGER & JANUZZI, LLP 2013 fEC 20 AM 9: 1 2225 Millennium Way 1 ,; Enola, PA 17025 CUMBERLAND COUNTY Telephone Number: (717) 728-3200 P sYLVANIA Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs NO. 11-6059 v. CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, Defendants JURY TRIAL DEMANDED ORDER AND NOW, this _I day of faee011442.0er , 2013, in consideration of the annexed Petition to Approve Compromise Settlement and Distribution of Proceeds, it is hereby Ordered and Decreed that Petitioner, Gary L. Hamilton, is hereby authorized to receive the sum of Twenty Thousand ($20,000.00) Dollars in settlement of the above-captioned personal injury claim, execute a Release settling and discontinuing the above-captioned action, and make distribution of the settlement proceeds as follows: • Shollenberger & Januzzi, LLP (atty. fees—25%) $ 5,000.00 Shollenberger & Januzzi, LLP (costs) 3,488.41 Teamster's lien 5,000.00 Cumberland County Register of Wills—filing fee 15.00 Balance remaining for distribution $ 6,496:59 ' Gary Hamilton (loss of consortium) $ 2,165.53 Gary Hamilton (50% of residuary) 2,165.52 Katrina Keesler (25% of residuary) •- 1,082.77 Sabrina Ofenstein (25% of residuary) 1,082.77 BY THE COURT: J. • • • 0" 11,1- Ur P.', SHOLLENBERGER & JANUZZI, LLP �'t4 FEB t if 2225 Millennium Way 1'/`i 3: 4 Enola, PA 17025 CUP r,BERL ND rr, Telephone Number: (717) 728-3200 ENNsy1 VA rUN I Y Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 11-6059 CARLISLE HMA, LLC, d/b/a CARLISLE CIVIL ACTION — MEDICAL REGIONAL MEDICAL CENTER, PROFESSIONAL LIABILITY ACTION Defendants JURY TRIAL DEMANDED PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY: Please mark the above-captioned action settled, ended, and discontinued with prejudice. Respectfully submitted, SHOLLENBERGER & JANUZZI, LLP By Karl J Januzzi, Esquire Attor ey for Plaintiff Dated: February 12, 2014 SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, PA 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiffs LUCILE HAMILTON and GARY IN THE COURT OF COMMON PLEAS OF HAMILTON, wife and husband, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 11-6059 CIVIL ACTION — MEDICAL CARLISLE HMA, LLC, d/b/a CARLISLE PROFESSIONAL LIABILITY ACTION REGIONAL MEDICAL CENTER, JURY TRIAL DEMANDED Defendants CERTIFICATE OF SERVICE AND NOW this 12th day of February, 2014, I hereby certify that I have served a true and correct copy Plaintiffs' Complaint in the United States mail, postage prepaid, addressed to: Marc T. Levin, Esquire Weber Gallagher Simpson Stapleton Fires & Newby, LLP Fulton Bank Building 200 N. 3rd Street Suite 9A Harrisburg, PA 17101 , BY: Karl J. Ja'u, ', squire