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HomeMy WebLinkAbout11-7960 r FICE i._ 1 .. Y n s r•^. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: JOZELL STONER, NO. 1- ty 601 a Minor PETITION FOR COURT APPROVAL OF MINOR'S SETTLEMENT PETITION FOR COURT APPROVAL OF MINOR'S SETTLEMENT COMES NOW, Petitioner, Kim Wells, as parent and natural guardian of Jozell Stoner, by and through Griffith, Strickler, Lerman, Solymos & Calkins, and Michael B. Scheib, Esquire, and files a Petition for Court Approval of Minor's Settlement, and in support thereof avers as follows: 1. Jozell Stoner ("Jozell") is a minor who has a date of birth of May 12, 1995, and is currently 16 years of age. 2. Jozell resides with her mother, Kim Wells, at 21 Country View Estates, Newville, PA 17241. 3. This matter arises out of a motor vehicle accident that occurred on April 3, 2011, 2011 at which time Jozell was 15 years old. 4. On the aforesaid date, Jozell was an unrestrained back seat passenger in a motor vehicle driven by Brandon L. Barrick and owned by Stanley and Mary Barrick. ak-? gka.M Pa p ?Y C?4 ?DoB lZ. µ aLW-7y 46 The accident occurred on Mohawk Road, Lower Mifflin Township, Cumberland County and resulted in Brandon Barrick losing control of the vehicle, striking a safety fence and rolling over, resulting in Jozell being ejected from the vehicle. 6. As a result of the aforementioned accident, Jozell was taken by Newville EMS to Carlisle Regional Medical Center 7. At Carlisle Regional Medical Center Jozell was evaluated with concussion without loss of consciousness, acute contusion, acute dislocation, acute fracture, pneumothorax, traumatic liver laceration, traumatic splenic laceration. Due to the Jozell's condition it was recommended by Dr. Adam Braze that Jozell be transported to Hershey Medical Center. A true and correct copy of the report of Carlisle Regional Medical Center is attached hereto as Exhibit "A„ 8. Jozell was admitted to Hershey Medical Center on April 3, 2011 where she was diagnosed with head injury as well as fracture of the processes of lumbar and cervical vertebrae, a right scapula fracture, fracture of an upper right molar (tooth #3), and a chipped maxillary incisor (tooth #8). A true and correct copy of the Consult report is attached hereto as Exhibit «B„ 9. On April 3, 2011 Jozell underwent surgery for the removal of a obliquely fractured lingual cusp of tooth #3. A true and correct copy of the Operative Report is attached hereto as Exhibit "C". 10. On April 5, 2011 Jozell was discharged from Hershey Medical Center with a discharge diagnosis of left C7 transverse process fracture, right L1 transverse process fracture, right comminuted scapular fracture and right pulmonary contusion. A true and correct copy of the Discharge Summary and ED Summary are attached hereto as Exhibit "D". 11. There was a follow-up visit on April 27, 2011 with Dr. Mark S. Dias, MD of Hershey Medical Center in which Dr. Dias discharged Jozell from his care and advised to follow-up on an as-needed basis. A true and correct copy of pages 1 and 2 of the Outpatient Letter is attached hereto as Exhibit "B" 12. Jozell does not currently have any doctor appointment scheduled due to the accident and has not received any additional medical treatment as a result of the accident. 11. At the time of the accident, Stanley and Mary Barrick were insured by Encompass Insurance Company Insurance with bodily injury limits in the amount of $100,000.00 per person and $300,000.00 per accident. A true and correct copy of Stanley and Mary Barrick's declarations page is attached hereto as Exhibit 'IF". 12. There are currently no unpaid medical bills incurred because of the accident. 14. Kim Wells, as the parent and natural guardian of Jozell Stoner, has presented a claim to Encompass Insurance Company. 16. Kim Wells, as the parent and natural guardian of Jozell Stoner, and Encompass Insurance Company, have agreed to a settlement of the claim in the amount of $40,750.00, which shall be payable to Kim Wells as guardian of Jozell Stoner. 17. Pursuant to Pa.R.C.P. 2039(2) the amount $40,750.00 is to be deposited in a savings account in the name of Jozell Stoner, a minor, with proof of deposit to be filed within fourteen (14) days from the date of the approved settlement. 19. Kim Wells, as parent and natural guardian of Jozell Stoner, understands that Attorney Michael B. Scheib was retained by Encompass Insurance Company to obtain court approval of the minor's settlement. Attorney Scheib were not involved in the decision to settle this claim. Attorney Scheib will not be paid from the settlement funds. 20. Kim Wells, as parent and natural guardian of Jozell Stoner, believes that this settlement is fair and reasonable compensation for the injuries suffered by her daughter Jozell Stoner. 21. Kim Wells, as parent and natural guardian of Jozell Stoner, understands that if the Court approves the settlement, Jozell Stoner will be barred from filing any other type of claim or lawsuit as a result of the April 3, 2011 accident. 22. Kim Wells, as parent and natural guardian of Jozell Stoner, understands that if the Court approves the settlement, she will be required to execute a document which releases Stanley and Mary Barrick and Encompass Insurance Company as a result of the April 3, 2011 accident. 23. Kim Wells, as parent and natural guardian of Jozell Stoner, believes that the approval of this settlement is within the best interest of her daughter, Jozell Stoner. WHEREFORE, Petitioner, Kim Wells, as parent and natural guardian of Jozell Stoner, respectfully requests this Honorable Court approve the minor's settlement of this matter. GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS By: MICHAEL B. HEIB, ES IRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Telephone: (717) 757-7602 Iiiiiiii 411 REPRINT Carlisle Regional Medical Center REPRINT 361 Alexander Spring Drive, Carlisle, PA 17013 (717)960-1695 Patient: STONER, J©ZELL A DOB: 511211995 Patient #: 9492240 MRN: 0008775387 Date In: 4312011 CHIEF CONIPLA.INT/MSTO.RY OF PRESENT ILLNESS: PF3 04/03/201 1 05:05 STONER. 30ZELL A is a 1.5 year old.F that presented to the Emergency Department at 04:50 by ALS- W Shore. The patient was triaged at 04:50 with the following vital signs: T: 97.7 TA, P: 68 Regular, R: 24 Unlabored, BP: 120/068, SP02: 97 Amt. RA, Pain: 10 Upper Arm. The patient's primary care physician is ROSARIO, E.LISEO. Chief Complaint - 1*v1VA - AMBULATORY AT SCENE Exam Time: 05:05. History obtained from: patient. Onset of symptoms was immediately prior to arrival in the Emergency Department. Symptoms came on suddenly. Symptoms are present now. Accident was Patient's car rolled over at least one time. At time of impact, patient was seated in rear seat on driver's side. Patient was unrestrained. Damage to vehicle was severe. Symptoms located in the right arm, neck. On 0 to 10 pain scale, patient rates pain as 10/10 at this time. Symptoms are severe. 15 year old female unrestrained back seat passenger brought in from rollover mva. REVIEW OF SYSTEMS: PF3 04/03/201108:12 All (other) systems have been reviewed and are negative. Neurological: negative headache. Musculoskeletal: positive back pain, positive extremity pain, positive neck pain. Constitutional: positive chills. PAST MEDICAL AND SURGICAL HISTORY: PF3 04/03/201106-49 Past DvIedical History: positive none. Reproductive History: LMP: 1 WK AGO. Tetanus Status: unknown. Immunizations: up to date. FAIMILY AND SOCIAL HISTORIES, ALLERGIES AND WETS: PF3 04/03f2011 06:49 Allergies: nkda Medications: none Social History: Child's primary caregiver is mother. Physician Documentation (Pro-MED Clinical Systems, L.L.C.) Printed on: 04/031201109:03 Page 1 of 4 REPRINT REPRINT PAGE 2J5* RCVD AT 5/1012011 1:36:30 PM [Central Daylight Time]* SVR:A0185-XFX0006-S115 * DNIS:51381 * CSID:7179603524 * DURATION (mm-ss):02.18 REPRINT Carlisle Regional medical center REPRINT 361 Alexander Spring Drive, Carlisle, PA 17013 (717)960-1695 Patient: STONER, JOZELL A DOB: 511211995 Patient #: 9492240 MRN: 0000775387 Data In: 41312011 PHYSICAL EXAMINATION: PF3 04/03/201108:13 General: Vital signs noted. Pulse Oximetry results noted. Patient arrived in ED on backboard, with C- collar in placer HEE`aT: loose tooth Neck: C-collar in place. abrasion under c collar with localized discomfort Respiratory: Lung Sounds: cleat bilaterally. Cardiovascular: Heart rate is normal. Abdomen: No evidence of: guarding, mass, rebound tenderness. Musculoskeletal/Extremity: Right Upper Extremity: Shoulder -- Pain in right arm, holds in flexion, avoids movement Skin: Location: bath arms. Neurologic: l4lental Status: awake and alert. Psychiatric: anxious DIAGNOSTIC TEST RESULTS: PF3 04/03/201106:49 ....... ....... ........ ._ ...... --- ........................ ........... ................. ....-............. . Pulse Oximetry -- ........ .._._... -- - ................. ._........... Fi02: room air 02 Saturation: 97 % ...... ... Interpretation: Interpretation: Normal . ............ .... Radiology: Computerized Tomography Scan: Brain -- No acute disease. Cervical Spine -- No acute fracture. Chest -- contusion of right lung, no pneumothorax, fractures of the right scapula, fracture of the right transverse process of L 1 Abdomen/Pelvis -- No acute disease. LABORATORY.• Orders/Procedures PF3 Ur Bact = LARGE reviewed as Abnormal PF3 Ur LE = 500/ul reviewed as Abnormal PF3 Ur WBC = 2540 reviewed as Abnormal ED COURSE AND TREATMENT: PF3 04/03/201108:12 Treatment & Reevaluation: Patient has received: intravenous fluids, 20 mL/kg normal saline intravenous bolus. Note: Reviewed films with patient and her family. Treatment & Reevaluation: Patient has been medicated with: Rocephin 1000 mgs intravenously. Physician Documentation (Pro-MED Clinical Systems, L.L.C.) Printed on: 04103/201109:03 Page 2 of 4 REPRINT REPRINT PAGE 315 * RCVD AT 511012011 1:36:39 PM [Central Daylight Time]' SVR:A0185-XFX0006•S115 * DNIS:51381 * CSID:7179603524 * DURATION (mm-ss):02-18 REPRINT REPRINT Carlisle Regional Medical Center 361 Alexander Spring Drive, Carilsie, PA 17013 (717)960-1695 Patient: STONER, JOZELL A DOS: 5112!1995 Patient #: 9492240 MRN: 0000775387 Date [n: 41312011 CONSULTATION & CRITICAL THINKING: PF3 04/03/201 1 08:20 The following diagnoses were considered based on the patient's clinical presentation: Concussion Without Loss of Consciousness, Acute Contusion, Acute Dislocation, Acute Fracture, Pneumothorax, Traumatic Liver Laceration, Traumatic Splenic Laceration. Case discussed with Dr. BRAZE, ADAM J. Time of consult: 08:40. S/Ile agrees that patient°s condition merits admission to hospital S/He recommends transfer of patient. Case discussed with Dr. "NONSTAFF, PHYSICIAN. Time of consult: 08:47. S/He recommends transfer of patient. Dr. Kass CLINICAL IN PRESSION: PF3 04/03/201 1 06:48 1. Motor Vehicle Accident 2. Fractures of the right scapula 3. Fracture of the right transverse process of L.1 4. Minimal contusion of the right middle lobe and right upper lobe 5. Urinary Tract Infection DISPOSITION: PF3 04/03/201 1 08:39 Disposition: Patient will be transferred to: Hershey Medical Center. Transfer forms completed. Disposition date/time: 04/03/201108:44. Discussed care with patient and family. Explained findings, diagnosis, and need for follow-up care. Critical Care Services Rendered: 30-74 minutes.Note:Total critical care time documented does not include time spent on separate procedures. PHYSICIAN ORDERS (1) CT Scan Head w/o Contrast [PF3] sent at 4/3/2011 5:19 (1) CT Scan C-spine w/o contrast [PF3] sent at 4/3/2011 5:19 (1) CT Scan Chest w./ contrast [PF3] sent at 4,13/20115:19 (1) Shoulder, Trauma, 3v [PF3] sent at 4/3/20115:19 (1) Elbow 3 view [PF3] sent at 4/3/20115:19 (1) Urine Dip [PF3] sent at 4/3/20115:30 (1) Urine Preg Dip [PF3] sent at 4/3/2011 5:30 (1) Urinalysis (Send to Lab) [PF3] sent at 4/3/20115:53 (1) Urine Culture [PF3] sent at 4/3/2011 5:53 (1) CT Scan Abd/Peivis w/o contrast [PF3] sent at 4/3/2011 7:57 [by: MAL, Verbal] (1) **IV Insertion [PF3) ordered at 4/3/20115:17 (1) Pulse Ox-Continuous [PF3] ordered at 4/3/2011 5:17 (1) Blood Pressure Monitor Only [PF3] ordered at 4/3/20115:17 (1) Normal Saline Bolus one liter iv [PF3] ordered at 4/3/20115:17 (1) Urine Dip [PF3] ordered at 4/3/20115:45 [by. DMR, Verbal order read back] Physician Documentation (Pro-MED Clinical Systems, L.L.C.) Printed on: 04103/201109:03 Page 3 of 4 REPRINT REPRINT PAGE 4151 RCVD AT 511012011 1:36:39 PM [Central Daylight Time] * SVR:A0185-XFX0006-S115 * DNIS:51381 * CSID:7179603524 * DURATION (mm-ss):02.18 REPRINT Carlisle Regional Medical Center REPRINT 361 Alexander Spring Drive, Carlisle, PA 17013 1 Patient: STONER, JOZELL A DOB: 611211995Pat ent #:9492240 MRN: 0000775387 Date in: 413/2011 (1) Urine Preg [PF3] ordered at 4/3/20115:45 [by: DMR, Verbal order read back] (1) Cath Collection [PF3] ordered at 4/3/20116:16 [by: DMR, Verbal order read back] (1) Bacitracinidsg [.PF3] ordered at 4/3/2011 7:30 [by: GAO, Verbal order read back] (1) IV Rocephin 1000 mg [PF3] ordered at 4/3/2.0118:39 PATRICIA L *FRrERSON NID MD All text in this document clearly marked by PF3 has been authored and legally signed by use of electronic device, 04/03/201109:03 Physician Documentation (Pro-MED Clinical Systems, L.L.C.) Printed on: 04/03/2011 08:03 Page 4 of 4 REPRINT REPRINT PAGE 515 * RCVD AT 5/10/2011 1:36:39 PM [Central Daylight Time] * SVR:A0185-XFX0006-8115 * DNIS:51381 * CSID:7179603524 * DURATION (mm-ss):02-18 _N?NI )SATE HERSHEY IFM. Milton S. Hershey Medical Center Patient Narr e: STONER, JOZELL A AIRN: 7509408 Date of Birth: 5/12/1995 Patient Gender: Female F ESULT STATUS: COCUMEN-' SUBJECT: ELECTRONICALLY SIGNED BY: Name: STONER, JOZELL A HMC Number: 7509408 DOB: 05/1211995 Date of Service: 04/03/2011 Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 10509408 Visit Type: Inpatient Patient Location: 7MBE; 7224; 01 Consult CONSULT Final Clougherty, Marianna (4/5/2011 14:30 EDT) HPI: The patient is a 15-year-old Caucasian female who was reportedly an unrestrained rear seat passenger in a rollover MVA from which she was ejected. She was seen at Carlisle Hospital and evaluated, then transferred to Hershey Medical Center. She reportedly has head injury as well as fracture of the processes of lumbar and cervical vertebrae, a right scapula fracture, fracture of an upper right molar (tooth #3), and a chipped maxillary incisor (tooth #8). She remains in a cervical collar and is currently reportedly refusing MR[ due to claustrophobia. PAST MEDICAL HISTORY: noncontributory. She is not diabetic to my knowledge, has no history of heart murmur or valvular heart disease, and is not on any anticoagulants. ALLERGIES: NKDA. EXAM: Head and neck exam is within normal limits except for an Ellis Class II fracture of tooth #8, her maxillary right central incisor, and an Ellis Class III fracture of tooth #3, her maxillary right first molar which has a large pulp exposure. There is no evidence of mandibular or alveolar fractures. Her occlusion is within normal limits without any stepoffs. She has no trismus and her TMJs are normal on palpation with no crepitus noted, with a normal range of movement, and without deviation of the mandible. She has no facial or intraoral edema or suppuration. She has no lacerations of her lips either intraorally or extraorally. There is no palpable lymphadenopathy. DIAGNOSTIC IMAGING: Periapical radiographs were taken of teeth # 3 and #8. The periapical radiograph of tooth #8 reveals a fracture that extends into the dentin and is small, approximately 1 mm X 2 mm. Periapical radiograph of tooth #3 reveals an Ellis Class III fracture with a lingual cusp that is obliquely separated from the tooth and only attached to gingiva. There is a large pulp exposure here. ASSESSMENT AND PLAN: Because the fractured lingual cusp on tooth #3 poses an aspiration risk and because this fractured portion of tooth is non-salvageable, removal of the fractured portion of tooth #3 is recommended with local anesthesia. The patient and her mother (via phone) were advised that the patient should follow up with her regular dentist on discharge. Both patient and mother were advised that endodontic (root canal) treatment and a crown or extraction of Date/Time Printed: 5/19/2011 18:42 EDT Page 1 of 27 Printed By: Collin's,Nikki L t PENN STATE HERSHEY 1 Milton S. Hershey IV Medical Center Patient Name: STONER, JOZELL A MRN 7509408 ..............?....... ?.._...?....?._.....?...........................?..?.................?............ cons ulr ...?.....?......?................................................................... ...................., tooth #3 will be necessary due to the large area of nerve exposure. Consent was obtained from the patient's mother over the phone with Nurse, Rachel, present. After discussing the options, risks, benefits, cost, and alternatives of all treatment options, mother gave consent for administration of local anesthesia and removal of the obliquely fractured lingual cusp or tooth #3. Mother's questions were answered. The patient has no known indication for SBE prophylaxis. No post-op antibiotics are recommended at this time for the patient upon discharge from a dental standpoint since she has no intraoral or extraoral facial lacerations. 160284 Electronic Signature on Fite Electronically Reviewed/Signed by: Marianna Clougherty, DDS Author Signature Dt/Trn:05.04.2011 02:30 PM MC /DKW DD: 04104111 DT.' 04/05/11 06.43 Date/Time Printed: 5/19/2011 18:42 EDT Page 2 of 27 Printed By: Collins,Nikki L - PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: STONER, JOZELL A MRN 7509408 ...........................................................................................Operattve? Report ..._......__............_._.__............_...._._._......_.w...___..__._.__..._ RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Clougherty, Marianna (4/5/2011 14:38 EDT) OPERATIVE REPORT Name: STONER, JOZELL A HMC Number: 7509408 DOB: 05/12/1995 Date of Service: 4/3/2011 SURGEON: Marianna Clougherty, DDS ASSISTANT(s): Peds Nurse, Rachel PREOPERATIVE DIAGNOSIS: The patient is a 15-year-old Caucasian female who was the unrestrained rear seat passenger in a rollover MVA. She has multiple injuries including a reported head injury, lumbar and cervical vertebrae process fractures, right scapular fracture, fracture of upper right molar #3 and chipped tooth #8, her maxillary right central incisor. POSTOPERATIVE DIAGNOSIS: Same OPERATION PERFORMED: Removal of obliquely fractured lingual cusp of tooth #3. ANESTHESIA: Local using 1 carpule of 2% lidocaine with 1:100,000 epinephrine (1.7 ml) FINDINGS: The patient is a 15-year-old female who requires removal of the obliquely fractured portion of tooth #3 because it is an aspiration risk and is only slightly attached to the palatal gingiva. No premedication or postoperative antibiotics are required as the patient has no intraoral or extraoral lacerations and no indication for SBE prophylaxis. OPERATION: The patient remained in her bed on the 7th floor and in her cervical collar for the duration. The anesthesia used was 1 carpule of 2% lidocaine with 1:100,000 epinephrine. A 2 x 2 gauze was unfolded and placed in the distal portion of the patient's oral cavity to act as a throat pack. The lingual cusp of tooth #3 which was obliquely fractured was removed without complication. The throat pack was removed. Bleeding was minimal with negligible blood loss. Consent was obtained from the patient's mother prior to the procedure over the phone with nurse, Rachel, present. Spoke with patient's mother, Kim Wells, and discussed options, risks, benefits, cost and alternatives of all treatment options, and mother had consented to this procedure prior to commencement of the procedure. 160287 Date/Time Printed: 5/19/2011 18:42 EDT Page 3 of 27 Printed By: Collins,Nikki L - VENN STATE HERSHEY M1 Milton S. Hershey Medical Center Patient Name: STONER, JOZELL A ............... ........................ ....... ....«..-.-....-....Operative Report ................... Electronic Signature on File MRN 7509408 Electronically Reviewed/Signed by. Marianna Clougherty, DDS Author Signature Dt/Tm:05.04.2011 02:38 PM MC /AMO DD: 04104111 DT.• 0410511107.09 Date/Time Printed: 5/19/2011 18:42 EDT Page 4 of 27 Printed By: Collins,Nikki L PENN STATE HERSHEY Milton S. Hershey Medical Center Patient Name: STONER, JOZELL A RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Su MRN 7509408 Final .D/C Summary Santos, Mary C (4/6/2011 (4/5/2011 17:07 EDT) DISCHARGE SUMMARY Name: STONER, JOZELL A HMC Number: 7509408 DOB: 05/12/1995 Date of Admission: 04/03/2011 Date of Discharge: 04/05/2011 Reason for Discharge: Stable for Discharge Physician: Santos, Mary C Service: Peds Surgery Discharge Diagnoses: Left C7 transverse process fracture Right L 1 transverse process fracture Right comminuted scapular fracture Right pulmonary contusion Other Diagnoses: UTI on arrival Concussion with amnesia to event Chipped right maxillary molar Surgical Procedures: Right maxillary molar extraction Vaccinations Received This Hospital Stay: No vaccinations were given this hospital stay. 14:42 EDT); Albright,William B Discharge Medications: Acetaminophen-oxycodone (acetaminophen-oxycodone 325 mg-5 mg tablet) TAKE 1-2 TABLETS BY MOUTH EVERY SIX HOURS AS NEEDED FOR PAIN. Brief History of Present Illness: This is a 15-year-old female who was transferred from Carlisle hospital for definitive pediatric trauma care. She arrived at their hospital at approximately 0430 in the AM following a rollover MVA. She was not wearing a seat belt. It was reported that she was ejected and found some distance away. It was also reported that the car did catch fire after the incident. The outside hospital did a urinalysis which reportedly showed a UTI. She was treated with IV Rocephin. Hospital Course: Date/Time Printed: 5/19/2011 18:42 EDT Printed By: Collins,Nikki L Page 5 of 27 PENN STATE HERSHEY I Milton S. Hershey Medical Center Patient Name: STONER, JOZELL A ...... `......`..._._..-..',.... ...............................Discharge Summary ------------- -- ----- MRN 7509408 She was a level 2 trauma transfer. Studies revealed a right clavicle fracture, left transverse process of C7, right transverse process fracture of L 1, concussion with amnesia (unknown loss of consciousness), pulmonary contusion, chipped right maxillary molar which was extractec'., She was admitted to the 7th floor after studies were completed. Miami J collar remained on. T/L spines were cleared. An MRI was ordered of the cervical spine, however she was not able to remain still and it was reordered for 4/4 in the later am. Anesthesia was consulted for assistance with the MRI. She had started clears but was subsequently was made NPO. Sling was on for comfort due to the right clavicle fracture. PT/OT therapies were ordered and she was passed for home. OI' did note some loss of memory regarding the accident and some confusion. This began to clear as the day went on. MRI of the C spine showed edema around C7 tp without evidence of cord injury, and incidental finding of Chiari I malformation. The Cervical spine was cleared by Neurosurgery. The patient's diet was advanced and tolerated well. Pain was controlled with oral pain meds. Rocephin treatment was completed for the UTI diagnosed at the outside hospital. At the time of discharge the patient had normal bowel and bladder function. The patient was deemed stable for discharge with appropriate follow up appointments and medications. Exam on Discharge: NAD/AAOx3 Neck: Supple, non tender, hall ROM, collar removed CIA13 RRR, no murmurs R arm in sling (for comfort), neurovascularly intact, normal 515 motor Abd: Soft, NT/ND, normal bowel sounds Care Instructions: 1. R arm - sling to comfort. Use as tolerated. 2. See the head injury care instructions. The key to getting better after a head injury is to rest when tired, avoid overstimulation and overtiredness. If ANY activity increases symptoms, stop and rest in a quiet area. 3. Pain medications can cause constipation. Take an over-the-counter laxative (like Senokot or MiraLax) as needed. Please do not operate motor vehicles while taking pain medications. Diet Guidelines: Regular diet. Encourage plenty of liquids. Activity Guidelines: Avoid activities that may lead to falls/impact for the next 6-8 weeks. No jumping, climbing, sports, PE, riding things with wheels, etc. Return to school - at parents' discretion once paia/mobility are improved, and return of normal energy level - likely up to a week. Upon return, parents, pt and school staff should monitor for return/increased symptoms (headaches, fatigue, difficulty concentrating or processing information). If this occurs, it may signal that it is too soon to return, or a modified school attendance schedule may be needed. Please call to let us know if this occurs. Call your doctor if: Please call 717-531-8521 (operator - ask for the pediatric surgery resident on-call): fever greater than 101F, increased severe pain, persistent vomiting, increased swelling/pain or color changes to RUE (blue/grey/white); and mental status changes. For routine questions during the weekdays, please call the pediatric surgery office at 717-531-8342. Please call the number above and ask for the neurosurgery resident on call if you develop confusion or headaches/vomiting. Date/Tirne Printed: 5/19/2011 18:42 EDT Page 6 of 27 Printed By: Collins,Nikki L - PENN_ TATE HERSHEY X;M Milton S. Hershey 4V Medical Center Patient Nante: STONER, JOZELL A Summary MRN 7509408 Other Instructions: Penn State Hershey Children's Hospital Injury Prevention Tips: Teen Driver Safety 1. ALWAYS travel with your lap and shoulder seat belt, snugly fastened. 2. Never ride or drive under the influence of alcohol or drugs. 3. Obey posted speed limits. 4. Avoid distracted driving - using cell phone or texting, eating, adjusting the climate or music controls. 5. Limit the number of passengers riding with teen drivers. You will need to notify your dentist of the right molar extraction. You will need to be evaluated for any follow up treatment for this molar injury. Follow-Up Appointments: Scheduled) Penn State - Hershey Appointments Within the Next 90 Days. Follow-Up with Dias, Mark at Pediatric Bone & Joint and Neuroscience East Campus on 04/27/2011at 01:15 pm 160999 Electronic Signature on File CC: Eliseo Rosario, Jr, MD 804 Belvedere Street Carlisle PA 17013 Electronically Reviewed/Signed by: William B Albright, MD Author Signature Dt/Tm:05.04.2011 05:07 PM Electronically Rewewed/Signed by: Mary C Santos, MDCosigner Signature Dt/Tm: 06.04.2011 02.42 PM Pediatric Surgery: Drs. Robert Cilley, Peter Dillon, Brett Engbrecht Kerry Fagelman, Dorothy Rocourt, Mary Santos Coleen Greecher MS RD CNSD, Janet Shields MSN CRNP, PNP-BC, Lynn Simmons MSN CRNP WBA /JJR DD: 04105111 DT. 04105111 15:37 DateMme Printed: 5/19/2011 18:42 EDT Page 7 of 27 Printed By: Collins,Nikki L - PENNSTATE HERSHEY 1 Milton S. Hershey iW Medical Center Patient Name: STONER, JOZELL A MRN 7509408 ED Summary -------------- ---------- -- - ----- - - - - ----------- RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Motor vehicle crash - major Kass,Lawrence E (4/3/2011 11:27 EDT) Motor vehicle crash - major Patient: TRAUMA, 7509408 MRN: 7509408 OOS: FIN: 10509408 Age: 111 years Sex: Unknown DOB: 1/1/1900 Associated Diagnoses: None Author: Kass, Lawrence E Basic Information Time seen: Immediately upon arrival. History source: Patient. Arrival mode: Ambulance. History limitation: None. History of Present Illness The patient presents following motor vehicle collision. The onset was before 5 AM. The Collision was unknown. The patient was the passenger and in the rear seat. There were safety mechanisms including no seat belt. multiple abrasions. Fracture of scapula and spinous processes.. The degree of pain is minimal. The degree of bleeding is minimal. Risk factors consist of alcohol abuse. Therapy today: none. Associated symptoms: none. Additional history: unrestrained RS pass in rollover. Seen at Carlisle hospital and evaluated. Transferred here for further mgt. Given Toradol just prior to transfer. Transfer uncomplicated and without intervention.. Review of Systems Constitutional symptoms: Negative except as documented in HPI. Additional review of systems information: All other systems reviewed and otherwise negative. Health Status Allergies:. No allergies have been recorded. Past Medical/ Family/ Social History Medical history Negative. Surgical history: Negative. Physical Examination Vital Signs Per nurse's notes. General: Alert, no acute distress. Skin: multiple abrasions to elbows and back. Head: Atraumatic. Date/Time Printed: 5/19/2011 18:42 EDT Printed By: Collins,Nikki L Page 8 of 27 PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: STONER, JOZELLA MRN 7509408 ...................................................................?_.............._........... ................... ...... .... '...................._...._...k......._.......................ED.Summary w ........................................................................................... ...._...._.......__.._........._.? Neck: Trachea midline, no tenderness. Eye: Pupils are equal, round and reactive to light, normal conjunctiva. Ears, nose, mouth and throat: Tympanic membranes clear. Cardiovascular: Regular rate and rhythm, No murmur, Normal peripheral perfusion. Respiratory: Lungs are clear to auscultation, respirations are non-labored, breath sounds are equal, Symmetrical chest wall expansion. Chest wall: On exam: Right, tenderness, no crepitus, no subcutaneous emphysema. Musculoskeletal: Normal ROM, normal strength, no tenderness. Gastrointestinal: Soft, Nontender, Non distended, Normal bowel sounds. Neurological: Alert and oriented to person, place, time, and situation, No focal neurological deficit observed. Psychiatric: Cooperative. Medical Decision Making Trauma team: Trauma criteria met, trauma team assembled, trauma surgeon present. Differential Diagnosis: Motor vehicle collision, head injury, trunk injury, internal hemorrhage, spinal injury. Impression and Plan Plan Condition: Stable. Disposition: Patient care transitioned to: Time: 04/03/2011 11:27:00, Santos, Mary C. Addendum Signatures: Lawrence E. Kass, MD, FACEP, FAAEM Associate Professor, Department of Emergency Medicine ViceChair for Education, Residency Director Hershey Medical Center PO Box 850, MC H043, Hershey, PA 17033 (717)531-1443 Fax:(717)531-4441 DatelTime Printed: 5/19/2011 18:42 EDT Page 9 of 27 Printed By: Collins,Nikki L PENNSTATE HERSHEY Milton S. Hershey Medical Cuter Patient Name: MRN: Date of Birth: Patient Gender STONER, JOZELL A 7509408 5/12/1995 Female RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: April 27, 2011 Name: STONER, JOZELL A HMC Number: 7509408 DOB: 05/12/1995 Date of Service: 04/27/2011 Eliseo Rosario, Jr, MD 804 Belvedere Street Carlisle, PA 17013 Dear Dr. Rosario: Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 15853691 Visit Type: Clinic Patient Location: HD10 ........................................................................................................................ Outpatient Letter .......................................................................................................................: Final Dias,Mark S (4/29/2011 17:21 EDT) Jozell returns to Pediatric Neurosurgery on 4/27/11 in follow-up of her motor vehicle crash. She was a rear seat passenger, unrestrained, and was ejected from the vehicle. The vehicle burst into flame. She came in with a modest head injury with a fracture of the transverse processes of C7 and L1 . She recovered quickly from her minor head injury, and did well while in the hospital. She had some other injuries to her dentition and scapula, but was able to be discharged to home without further incident. Mom tells me that she is pretty much back to her usual state of mind. She has underlying ADHD and some mood swings, which predated the accident. She is back to her usual, somewhat dysfunctional self. She has no intellectual decline, and has not had any headaches, nausea, vomiting, seizures, change in behavior or intellect, or other signs or symptoms of elevated intracranial pressure. The patient's interim past medical history and review of systems are.otherwise noncontributory. On examination, the patient is awake, alert, and engaging. Funduscopic examination shows no papilledema. Extraocular movements are full without limitation of up gaze, extraacular palsies, or nystagrnus. Facial movements are symmetrical. Facial sensation is intact and symmetrical in all three divisions of the trigeminal nerve. Hearing is intact to finger rub bilaterally. Tongue and uvula are midline. Sternocleidornastoid and trapezius strength is 5/5 and symmetrical. Muscle strength is 5/5 in all groups tested without pronation or drift. Tone and bulk are normal. Rapid alternating movements are performed well. Gait and station are normal for heel and toe walk. Balance and coordination are age appropriate. Date/Time Printed: 6/30/2011 00:04 EDT Page 1 of 15 Printed By: Collins,Nikki L PENNSTATE HERSHEY 1! Milton S. Hershey Medical Center Patient Name: STONER, JOZELL A MRN 7509408 ------------------------- ?ufpafien Letfer - ...................._......._... --------------------- I reviewed her MRI scan performed while in the hospital. Of note, she has a Chiari malformation with about 9 mm of tonsillar descent below the rim of the foramen magnum, but without any other issues, and no syringomyelia. Mom and I discussed the issue of her Chiari, which I think is a complete incidental finding. She has no symptoms referable to this. She and her mother and I briefly discussed some of the symptoms of Chiari malformation. She is actually the one child in the family who does not have chronic headaches, than God. She has no scoliosis by history or examination. There are no sensory motor symptoms. She has no swallowing dysfunction or dysphonia. At this point I think this is an incidental finding, and unless she were to develop symptoms, I would not recommend any further follow-up imaging or treatment. I will discharge her from my care to follow-up on an as-needed basis. Thanks again for allowing me the opportunity to care for her. #207347 Electronic Signature on File CC: Eliseo Rosario, Jr, MD 804 Belvedere Street Carlisle PA 17013 Sincerely, Mark S Dias, MD, FAAP Author Signature Dt/Trn. 29.04.2011 05:21 PM Professor and Vice Chair of Clinical Neurosurgery Chief of Pediatric Neurosurgery Penn State Millon S_ Hershey Medical Center PO Box 850 Hershey, PA 17033 MSD iCJK DD: 04127111 DT 04128/11 10:16 Date/Time Printed: 6/30/2011 00:04 EDT Page 2 of 15 Printed By: Collins,Nikki L Policyholder: STANLEY BARRICK MARY BARRICK 12 WEIST RD NEWVILLE PA 17241-8739 Policy Number: Policy Period: 240450543 03/2712011 to 03/27/2012 Insurance Provided By: Encompass Home & Auto Ins. Co. 2775 Sanders Rd.; Northbrook, IL 60062-6127 Agent: JEFFREY L BOUDER INS AGENCY 19 SOUTH HIGH ST NEWVILLE PA 17241 PHONE: 717-776-4051 470-114308-0000 Policyholder Since: 12:01 AM Standard Time 03/2008 24 HOUR CLAIM REPORTING 800-588-7400 YOUR POLICY HAS BEEN CHANGED Coverage Summary reissued due to backdated endorsement change. New annual premium will be indicated below. IMPORTANT INFORMATION ABOUT YOUR POLICY WE PROVIDE COLLISION COVERAGE FOR A NON-OWNED PRIVATE PASSENGER MOTOR VEHICLE RENTED BY YOU, DURING THE TERM OF THIS POLICY, IF AT LEAST ONE OF YOUR AUTOS SHOWN BELOW HAS COLLISION COVERAGE. (THE COLLISION COVERAGE WE PROVIDE IS SUBJECT TO THE LOWEST APPLICABLE DEDUCTIBLE.) PLEASE REVIEW YOUR POLICY FOR COVERAGE DETAILS. THIS POLICY DOES NOT PROVIDE PROTECTION AGAINST DAMAGES CAUSED BY UNINSURED/UNDERINSURED MOTORIST COVERAGE. PLEASE READ FORM G-15399-A ED.03-90 YOUR WAIVER OF UNINSURED/UNDERINSURED MOTORIST COVERAGE FOR DETAILS. MOTOR VEHICLE PROTECTION (Coverage applies only if a premium or limit is shown) Description: VIN: Rated Driver: Use: Class Code: BODILY INJURY (per person/per accident) PROPERTY DAMAGE (per accident) LIMITED TORT OPTION FIRST PARTY BENEFITS (FPB) COVERAGE: Vehicle 1 2005 FORD FOCUS 1FAFP34N25W288630 MARY BARRICK Pleasure 2321 1101 M $100,000/300,000 $98.00 $50,000 Applies 240450543 arA4? #. ylk? )Q? 10. 5?" President Secretary Continued on Next Page Vehicle 2 1999 FORD TRUCK F250 1 FTNX21 F6XEE09343 STANLEY BARRICK Work 3.1-9.9 2363 $100,000/300,000 $83.00 $72.00 $50,000 Applies $59.00 Page 01 of 05 MOTOR VEHICLE PROTECTION (Coverage applies only if a premium or limit is shown) Vehicle 1 BASIC FPB COVERAGE $10.00 Medical Expense Benefit $5,000 Work Loss Benefit Excluded (per month/maximum) Funeral Expense Benefit Excluded Accidental Death Benefit Excluded COMPREHENSIVE (Comp) $100 Deductible $39.00 COLLISION (Coll) $500 Deductible $185.00 DEDUCTIBLE WAIVER Deductible will be waived if your windshield is repaired, not replaced. Premium Per Vehicle $404.00 $334.00 Loss Free Discount Applied Applied Anti-Lock Brake Discount Applied Passive Restraint Discount Applied Passive Restraint Discount (Driver and Applied Passenger side) Anti-Theft Discount (Passive Device) Applied Homeownership Discount Applied Applied Future Effective Date Discount Applied Applied Preferred Protection Discount Applied Applied Your Total Premium For All Vehicles $738.00 IMPORTANT INFORMATION ABOUT YOUR MOTOR VEHICLE COVERAGE Below are annual premiums for the minimum required coverages and limits for Limited Tort. Please note that the Limited Tort option may not be available on certain vehicles. Vehicle 1 Vehicle 2 Vehicle Bodily Injury $15,000/Person $30,000/Accident $84.00 $71.00 Property Damage $5,0001Accident $64.00 $52.00 First Party Benefits Medical Expense $5,000 $10.00 $4.00 DRIVER INFORMATION Name Date Licensed Date of Birth 01 STANLEY BARRICK 04/18/1964 04/18/1948 02 MARY BARRICK 05/24/1961 05/24/1945 240450543 Continued on Next Page Vehicle 2 $5,000 Excluded $4.00 Excluded Excluded $100 Deductible $60.00 $500 Deductible $128.00 Page 02 of 05 MOTOR VEHICLE PROTECTION (Coverage applies only if a premium or limit is shown) LIENHOLDER/OTHER INTERESTED PARTIES INFORMATION Vehicle 2 Loan Number Type of Interest SUSQUEHANNA VALLEY FEDERAL CR Lienholder UNION(RETAIL) P O BOX 25242 FORT WORTH TX 76124-2242 GENERAL POLICY INFORMATION The coverages and limits shown here are subject to the restrictions, conditions, and exclusion of the policy and its endorsements. YOUR POLICY IS SUBJECT TO THE FOLLOWING FORMS AND ENDORSEMENTS G1-72228-A (01-07) TRANSITION ENDORSEMENT - SPECIAL MOTOR VEHICLE SEGMENT G1-72244-A (01-07) DELETION OF TOWING COVERAGE G1-72245-A (01-07) DELETION OF TRANSPORTATION COVERAGE - SPECIAL G1-72254-A (01-07) INTRODUCTION G1-72262-A (01-07) GENERAL PROVISIONS G1-72267-A (01-07) SPECIAL MOTOR VEHICLE G1-72416-A (02-07) AMENDMENT OF MOTOR VEHICLE PROVISIONS - PENNSYLVANIA G1-72417-A (02-07) FIRST PARTY BENEFITS COVERAGE - PENNSYLVANIA G1-72437-A (02-07) WHAT LAW WILL APPLY AND WHERE LAWSUITS MAY BE BROUGHT PLEASE READ THIS IMPORTANT INFORMATION CONCERNING YOUR POLICY G1-40173-C (02-09) ENCOMPASS INSURANCE PRIVACY POLICY FOR CUSTOMERS G-15383-A (03-90) IMPORTANT INFORMATION FOR PENNSYLVANIA UNIVERSAL SECURITY POLICYHOLDERS G-15395-B (06-95) IMPORTANT INFORMATION ABOUT TORT OPTIONS FOR YOUR MOTOR VEHICLES G-15397-A (03-90) IMPORTANT INFORMATION ABOUT UNINSURED MOTORISTS COVERAGE WAIVER OF COVERAGE G-15398-A (03-90) IMPORTANT INFORMATION ABOUT UNDERINSURED MOTORISTS COVERAGE WAIVER OF COVERAGE G-15399-A (03-90) YOUR WAIVER OF UNINSURED/UNDERINSURED MOTORISTS COVERAGE G-15400-D (01-02) IMPORTANT INFORMATION REGARDING PREMIUM DISCOUNTS G-15401-B (06-95) NOTICE OF MINIMUM REQUIRED AUTOMOBILE 240450543 Continued on Next Page Page 03 of 05 GENERAL POLICY INFORMATION PLEASE READ THIS IMPORTANT INFORMATION CONCERNING YOUR POLICY COVERAGES *G-15402-A (03-90) IMPORTANT INFORMATION REGARDING YOUR MOTOR VEHICLE IDENTIFICATION CARDS G1-71197-A (10-04) IMPORTANT CLAIM REPORTING INFORMATION G1-72431-B (01-08) PENNSYLVANIA SURCHARGE DISCLOSURE STATEMENT G1-74503-A (08-09) IMPORTANT NOTICE ABOUT RENEWAL DOWN PAYMENTS G1-74515-B (01-10) IMPORTANT NOTICE ABOUT THE ENCOMPASS PREFERRED PROTECTION DISCOUNT *G-39558-H (05-07) PENNSYLVANIA FINANCIAL RESPONSIBILILTY INSURANCE IDENTIFICATION CARD I-LO910-A (01-81) PENNSYLVANIA NOTICE 9-23210-E (04-00) RENTAL AUTOMOBILE COVERAGE NOTICE The forms marked with -" reflect revised or new forms included with this coverage summary. SUMMARY OF YOUR POLICY'S PREMIUMS Motor Vehicle $738.00 Total For All Exposures $738.00 For any insurance need, or questions on your policy, contact your independent agent, whose name and number are shown on the first page of this Coverage Summary. 240450543 Page 04 of 05 AGENT'S USE ONLY Policy Level Renewal Number 3 Auto Tier Level Tier 122 Multi-Car Rating 38 Vehicle Level Veh 1 Veh 2 Territory 433 433 Symbol - Comprehensive N G Symbol - Collision N G Auto Merit Discount Level 000 000 Sex F M Marital Status M M SRM 4 4 Coverage Level Veh 1 Veh 2 Liability Rating Modifier Liability 1.130 1.000 Liability Rating Modifier 1.220 1.000 Personal Injury Protection Physical Damage Rating 1.320 1.000 Modifier Comprehensive Physical Damage Rating 1.570 1.000 Modifier Collision 240450543 Page 05 of 05 y IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: JOZELL STONER, NO. a Minor PETITION FOR COURT APPROVAL OF MINOR'S SETTLEMENT [I).71]-S AND NOW, thiseday of 2011, a hearing on the Petition for Court Approval of Minor's Settlement is hereby scheduled before the undersigned Judge on 2011, beginning at C( .m. at 1 . .r of the Cumberland County Courthouse. BY THE COURT, ? J. Distribution List Michael B. Scheib, Esq. d 110 S. Northern Way a l le E? York, PA 17402 Op- 7rD Kim Wells A 21 Country View Estates. W `; Newville PA 17241" - or - w Oki E t `- s? IN THE COURT OF OF CUMBERLAND COUNTY, NNSYLVANIA IN RE: JOZELL STONER, a Minor NO. 11-7960 Civil PETITION FOR COURT APPROVAL OF MINOR'S SETTLEMENT AFFIDAVIT OF DEPOSIT OF MINOR FUNDS The undersigned, hereby certifies that the net settlement amount of $40,750.00 BY PY& 4 as set forth in this Court's Order dated March 15, 2012, has been deposited in a savings account in the name of Jozell Stoner, a minor, pursuant to this Court's Order. Proof of Deposit is attached hereto as Exhibit "A". GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS Date: ` 1 , 2012 MIC EL B. S EIB, ESQUI Attorney I.D. 63868 Attorney for Plaintiff 110 S. Northern Way York, PA 17402 (717) 757-7602 _.?.;'.. _,.??. J ` Account Statement Page 1 of 1 . L AU Account Statement JOZELL A STONER 21 COUNTRY VIEW ESTATES NEWVILLE, PA 17241 For Account: 0000455840 Reporting Period: 3/29/2012 to 3/29/2012 0000 IMEMBER Post Date Transaction Despription 3129/12 Deposit Check Check Received 40,750.00 Amount New Balance $ 40,750.00 $ 40,750.00 EXHIBIT ?_ file://C:\ProgramData\Jac<. Henry and Associates\Episys For Windows\HTML\HTMLVie... 3/29/2012