HomeMy WebLinkAbout11-8156IN RE: KARLY SHELLENBERGER, IN THE COURT OF COMMON PLEAS
a Minor OF CUMBERLAND COUNTY,
PENNSYLVANIA
JAMES and JENNIFER
SHELLENBERGER, as parents
and natural guardians of n ' cc,, o w
E_
KARLY SHELLENBERGER, No.
a minor, y_
Petitioners'
PETITION FOR APPROVAL OF SETTLEMENT OF MINOR'S GIN1E-? '
1. Petitioners, James and Jennifer Shellenberger, are the parents and natural
guardians of Karly Shellenberger, a minor (hereinafter referred to as "Minor-Petitioner")
2. Petitioners reside at 414 Linden Street, Mechanicsburg, PA 17050, Cumberland
County Pennsylvania.
3. Minor-Petitioner was born on November 25, 2005, and is currently five (5) years
old.
4. Cumberland Apothecary, Inc. is a corporation duly organized under the laws of
Pennsylvania and authorized to do business in Pennsylvania, and currently does so at a business
address of 3300 Market Street, Camp Hill, PA 17011, Cumberland County, Pennsylvania.
5. Cumberland Apothecary operates a pharmacy.
6. At the time if the incident described more fully below, Cumberland Apothecary
was insured by Pennsylvania National Mutual Casualty Insurance Company ("Penn National").
7. On or about January 10, 2008, Petitioners filled a prescription for Minor Plaintiff
at Cumberland Apothecary.
8. Cumberland Apothecary mis-filled Minor-Petitioner's prescription, which lead to
temporary adverse health consequences, from which Minor-Petitioner has recovered.
4Qa.0o pA ATrf
Or r7q tow
r a
9. More specifically, Minor-Plaintiff was prescribed .1 mg/ML Clonazepam.
Cumberland Apothecary filled the prescription at 1 mg/ML Clonazepam.
10. Petitioner parents noticed a change in their daughter's behavior and condition
over approximately the five days following the filling of the prescription. Minor-Petitioner was
lethargic and cranky.
11. Minor-Petitioner was taken to the emergency room, where it was determined that
the prescription was incorrectly filled.
12. Minor-Petitioner was subsequently taken off of the incorrect prescription, and
Minor-Plaintiff essentially "returned to normal" within a matter of a few days.
13. Minor-Petitioner suffered no permanent, lasting, or ongoing effects or injuries
from the mis-filled prescription, and Petitioners have not been advised by any of Minor-
Petitioner's medical treatment providers that any long term or permanent injury or effect has or
will occur. See medical records attached hereto as Exhibit A.
14. Based upon information and belief, Petitioners had a $100 co-pay, and Capital
Blue Cross paid all other medical costs associated with Minor-Plaintiff's treatment related to this
incident. It is believed and therefore averred that there are no outstanding medical liens or
outstanding medical expenses.
14. On behalf of Cumberland Apothecary, Penn National has offered to settle this
claim for Ten Thousand Dollars ($10,000.00).
15. Petitioners have accepted said settlement offer.
16. Petitioners have opened an interest-bearing savings account in which the
settlement draft will be deposited, for the benefit of Minor-Plaintiff. Said Account is established
with their bank, Citizens Bank, account number 623-252-6876.
17. Petitioner Parents, James and Jennifer Shellenberger, believe this offer is fair and
in the best interest of Karly Shellenberger, Minor-Petitioner.
18. Penn National has retained the undersigned, Corey J. Adamson, Esq., to assist in
and facilitate the acquisition of Court approval of the aforementioned settlement.
19. It has been explained to Petitioners, and Petitioners understand, that the
undersigned does not represent them, and indeed has only been retained as referenced above.
Petitioners further understand that they are not responsible for the undersigned's legal fees, and
that the undersigned's legal fees shall be paid by Penn National. Petitioners further understand
that all of the fees and expenses associated with the instant Petition will also be paid by Penn
National, and, accordingly, none of the settlement proceeds referenced herein will be utilized for
the payment of counsel fees or expenses.
20. Petitioners and Penn National therefore respectfully request this Honorable Court
approve said settlement.
21. Additionally, Petitioners and Penn National respectfully request that Petitioners
be authorized and directed to execute a fill and final general release, releasing Cumberland
Apothecary and Penn National. The proposed Release is attached hereto as Exhibit B.
22. No Judge of this Honorable Court has ever ruled on any issue in this matter.
23. All interested parties referenced herein concur in this Petition.
WHEREFORE, Petitioners respectfully request this Honorable Court enter an Order in
the form proposed, approving the settlement of Minor-Petitioner's claims, and authorizing and
directing Petitioners to execute a full and final release, and authorizing the payment for the same
to be made, as outlined in the proposed Order.
Respectfully submitted,
Date: Corey
Tho as, omas and Hafer, LLP
920068.1 3 . ront St.
POB 999
Harrisburg, PA 17108
717-255-7639
717-237-7105 (fax)
cadamson@tthlaw.com
414 Li
Jekifer Shellenberger
Me h sburg, PA 17050
71 - -1611
VERIFICATION
We, James and Jennifer Shellenberger, as Parents and Natural Guardians of Karly
Shellenberger, a Minor, do hereby verify that we are the Petitioners in the above-captioned
action and further verify that we have read the foregoing document and that it is true and correct
to the best of our knowledge, information and belief. We understand that false statements herein
are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to
authorities.
Date: ?_' (-//
Date: IY/
James llenberger, as Parent and Natural
Guardi of Karly Shellenberger, a Minor
..ger, as Parent and Natural
Shellenberger, a Minor
ze7/fi?'g /, r
. PENNSTATE
Milton S Hershey Medical Center
College of Medians
Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055
Penn State College of Medicine
Health Information Services, HU24
500 University (hive
P.O. Box 850
Hershey, PA 17033-0850
Patient Name: SHELLENBERGER, KARLY E PSUHMC MRN: 1603594
Patient Sex: Female Date of Birth: 11125/2005
Patient Location: EMER,, Visit Number: 09375657
Visit Type: Emergency
E m e r g e n c y D e p a r t m e n t N o t e
D o c u m e n t
Modified
Document Electronically Signed by: per contribution
per contribution
Signed By: Lysenko, Lyudmyla M (1/20/2008 11:26:13 AM); Meador, Steven A (1/19/2008 7:37:40 AM)
ED SUMMARY
Name: SHELLENBERGER, KARLY E
HMC Number: 1603594
DOB: 11/25/2005 r
Date of Service: 01/17/2008
CHIEF COMPLAINT: Medication overdose.
HPI: Two-year-old female with history of seizures taking Topamax and clonazepam for last year unintentionally was given
ten times higher dose than was prescribed by the neurologist due to pharmacy mistake. The pharmacist did give mixture
which is ten times more concentrated than was prescribed. The patient was given the dose for last six days. The parents
noted that the patient is more sleepy and when she steeps she is difficult to arouse, and they were concerned. After
contacting their neurologist, they found out that the dose was ten times higher than it is supposed to be and they were
advised to come to the Emergency Department for evaluation.
REVIEW OF SYSTEMS: The patient denies any pain, no weight change, no fever or chills, weakness or shortness of
breath. She did have a period of deep sleep today in afternoon when she was difficult to arouse, but parents never noticed
any change in her respirations or color change or mental status change otherwise.
On exam in the Emergency Department, she is very active and alert close to her baseline. She did not complain of any
vision change or photophobia nor chest pain. No nausea or vomiting, constipation or diarrhea, no rashes, no lesions, no
leg swelling, no back pain, no headache, no numbness, tingling, seizure, or syncope. She has normal good appetite and
normal urination and bowel movements.
PAST MEDICAL HISTORY: Seizures and mild developmental delay.
FAMILY HISTORY: No cardiac, diabetes, cancer, or seizures.
MEDICATIONS: Topamax, clonazepam, topirimate.
Date Printed: 712212008 Time Printed: 6:11 AM
PENNS TATS
MtnSHasheyMedical Center
® College of Medid>ee
Patient Name: SHELLENBERGER, KARLY E PSUHMC MRN: 1603594
E m e r g e n c y D e p a r t m e n t N o t e
D o c u m e n t
Modifteotf
Document Electronically Signed by: per contribution per contribution
Signed By: Lysenko, Lyudmyla M (1/20/2008 11:26:13 AM); Meador, Steven A (1/19/2008 7:37:40 AM)
ALLERGIES: Dilantin.
SOCIAL HISTORY: Lives with two parents, no smoking exposure.
PHYSICAL EXAM: Vital signs: Weight is 8.6 kilos, temperature 36.7 axillary, heart rate 124, oxygen saturation 98 on
room air, respiratory rate is 24. Patient is alert, active, normal skin color and turgor, no rashes or lesions. Head
atraumatic, normocephalic. Cranial nerves grossly intact. Neck is supple, no cervical lymphadenopathy. Lung sounds
clear bilaterally to auscultation. Heart regular in rate, no murmurs, gallops, or rubs. Abdomen: Bowel sounds
normoactive, soft nontender, nondistended. No back tenderness, no stepoff, no focal neurologic deficits. Sensations are
intact. Capillary refill to less than two seconds. Peripheral pulses 2+ all four extremities.
ED COURSE: The patient remained alert and active close to her baseline. Vital signs remained normal on monitor.
Toxicology consult was obtained from Pinnacle Hospital, and they advised to discharge patient home with the
recommendation for close observation by parents for decreased mental status, decreased respiratory rate. For those
signs, they should bring the patient back. Otherwise, as soon as she is back to showing normal activity, they restart her
cionazepam at regular dose.
IMPRESSION: Clonazepam overdose resolved. ?,.
235071
ED ATTENDING NOTE: I independently examined this patient and supervised her management. I agree with Dr.
t
V t ,.
Date Printed: 712212006 Tune Printed: 6:12 AM
PENN
. S; .
Milton S Hershey Medical Cater
College of ' ' e
Patient Name: SHELLENBERGER, KARLY E PSUHMC MRN: 1603594
E m e r g e n c y D e p a r t m e n t N o t e
D o c u m e n t
Modified
Document Electronically Signed by: per contribution per contribution
Signed By: Lysenko, Lyudmyla M (1/20/2008 11:26:13 AM); Meador, Steven A (1/19/2008 7:37:40 AM)
Lysenko's documention. (SAM)
ti;
Review/Sign: Lysenko, Lyudmyla M, MD
Review/Sign: Meador, Steven A, MD
LML/JMS DD: 01/18/08 DT: 01/18/08 05:57
. 1,
Date Printed: 712212008 rune Printed. 6:12 AM
+J1/LL1Ll1U0 ut.101 fl/L.34JLL4 I-KNKLL MIJ & F15Wi- rlAut 01
CARL A. FRANKEL, M.D., F,A"C.S:
Practice Limited tofedia'b'ic Ophthalmology & Adult Strabismus
o Carl A. Frankel, MD, ophthalmologist
Agnieszka Gradzka, M.D.
• i'ediatfic Ophttlah»obgy 2025 Technology Pkwy.
Suite .108
• Adult Strabismus Mechanicsburg, PA 17050-9497 January 21, 2008
• Eya Movement Disomim
• Diplo?via Karly E. Shellenberger
DOB: 11125/05
• Pediatrto & Adokkwent
RaffaCtioms and Dear Dr. Gradzka:
Proventft Eye Cars -
'
• Orblu pVc Evahration
a Peatment I recently had the opportunity to examine Karly sooner`ftn initially pldtined due.to
her mother's concern with respect to tearing and discharge from OS with some
. OphOwWo Evaluation • puffiness of the left upper and lower eyelids.
of Chifdm with Leaming
ftabWas 7.
: ) WRESSION:
• Speciallzlrrg In Frtting. _. ' _ ..__ ... .. _ . _--... _.._......._. _...._...,
FMbwesfortrrfants
tluoughYormgAdu/ts ,- _
Left Nasolacrimal Duct Obstruction (375.55)-improved following silicone tube
placement
No evidence of acute infection
lErntropion left lower eyelid-possible cause of tearing and discharge
RECONJ NMNDA77ON:
A one-week course of Polytrim is indicated to be certain that this is not a prodromc.
iaoounpfesto..,•
snwre 0 0n
44.
for infection. In the near-future, silicone tubes will be removed with consideration
Abmtftm Fammyhokwo t71io for surgery if the entropion persists.
(717; 2W-50W
(7177 sss"" ?x
cadfrankelmd0doctorsoMice.org A follow-up appointment has been scheduled for February 4, 2008 though this can
www.cartfrartkelmd.medam.com be canceled if her symptoms resolve as she has a pending appointment for March 5
,
2008. I will keep you informed of her progress.
_ ..Sincere]
Carl A Frankel, MD.
CAF/d s
Confidentiality Note: Thin letter cmteins information intended for the specific h4vidsal(s) noted on this letter
and is privileged, conf dentinl and/or otherwise protected from disclosure pure t to the Health ftum
me
'
a
f
ortMlity and Accountability Act (1'.1I'AA) and/or other applicable law(s). Any inapptnpriate use, distribution or
copying of thin information is strictly prohiNted and may subject you to crimituh and/or civil penalty
ou Bove
It
.
y
received this information in error, please immediately call my office indicating the error swd slued this letter.
01/23/08 JONES, DALY, COLDREN ASSOCIATES Acct#: 8689
Karly E Shellenberger DOB: 11/25/2005 Sex: F Age: 2 years
Nurse Note:
SYMPTOMS: 2YR RC- MOM NEEDS A RX FOR OCCUPATIONAL THERAPY
Triage: 01/17/08 - Too Much Mad
Labs:
? Refer to HRQ
FORM: OCompleted OPaid OMailed OPicked Up
Su0jective
CC: Patient presents for a scheduled 2 year well child visit.
Accompanied by mother. KARLY HAD A CLONAZEPAM OVERDOSE-LAST WEEK-THE PHARMACY
MIXED THE MED 10X STRONGER AND SHE WAS GETTING IT FOR 5 DAYS, SEEN IN HMC,
RECOVERED SINCE, ALSO 4 DAYS AGO, SHE FELL OFF OF BED AND BRUISED HER
NOSE,SEENIN HMC AS WELL.
Parents have no specific concerns.
Diet: Drinks whole milk. Eats cheese, eats yogurt. Child's home has city water with flouride.
Currently eating finger foods, cereal, meat and vegetables daily. Usually eats a balanced diet,
manages weight by making healthy food choices, PARENTS DOING GREAT WITH MAINTAINING
CARLYS GROWTH, SHE GETS CARNATION BRAEKFAST TOO BOOST HER CALORIC INTAKE,
KARLY IS ABLE TO FEED HERSELF NOW WITH FINGER FOOD Diet is appropriate for age, child is
using utensils and family is attempting to avoid excess junk food.
Voiding/Stooling: Voiding regularly. Stooling regularly. No difficulties with constipation or diarrhea.
Sleep: Sleeps in crib. Sleeps through the night most nights and goes to bed without a bottle. Naps
a few times a day. No sleep disturbances experienced.
Behavior: Described as alert. Patient has no behavior problems. Rare temper tantrums. Using age
appropriate discipline.
Development:
CRAWLS WELL, AND PULLS TO KNEELING POSITION IN AFOS, ATTEMPTING TO PULL UP TO
STANDING, BUT HAS NOT MASTERED IT YET.
IN SPEECH THERAPY NOW, MAKES MORE SOUNDS, NO WORDS YET
FEEDS SELF
Personal-Social: Child does imitate activities and use spoon or fork.
Activities: Physical activity: active.
Anticipatory Guidance:
Nutrition/Feeding: Discussed 3 meals a day with snacks, feeding tips, healthy eating, self feeding
and avoiding whole milk.
Health: Discussed fluoride supplements if indicated, immunizations, sunscreen, teeth brushing and
tylenol dosing.
Social/Developmental: Discussed independence, reading together and speech dysfluency.
Discipline/Behavior: Discussed discouraging the pacifier, spoiling and terrible two's.
Safety: Discussed car seat in back facing front, street/road safety, climbing, injury prevention and
sunscreen.
HPI:
ROS:
Current Meds: Topamax 15 mg, Topamax 15 mg, Klonopin Wafers 0.25 mg, Diastat Pediatric 4.4
CM 2.5 mg
Allergies: Dilantin
PMH:
Immun/Inj. Record:
90723-Pediarix (Ipv,Hepb And DPT) 06/14/06 04/12/06 04/12/06 01/27/06 01/27/06
90710-Proquad (Varicella, MMR) 04/26/07
Karly E Shellenberger DOB 11/2512005 Page #2
90700-DTaP Vaccine Younger Than 7 08/30107 08130107
90669-Prevnar Vaccine Under 5Yrs 01/19/07 06/14/06 04/12/06 01/27/06
90647-Hib (3 Dose)PRP-Omp Conjugate 01/19/07 04/12/06 01/27/06
90633-Hep A 00100/00.
Chronic Diagnosis: Epilepsy Unspec W/O Intractable, Chromosomal Anomaly Other Conditions.
Medical Problems:
Developmental Delays, Epilepsy
Deletion 4P (Chromosome Abnormalities) - (1/19/2007)
(Surgeries)
Hospitalizations:
Bronchiolitis Due To RSV
Seizures - (1/1/2007)
Patient Birth Info:. (Gestation) (Delivery Type). (Apgar) (Birth Weight). (Discharge Weight).
(Length). (Head Circum). (Blood Type). (Newborn Hearing Screen). (Complication). (HepB)
Reviewed, no changes.
FH:
Cancer.
Mother:.
Birthdate:.
Migraine.
Reviewed, no changes.
Obiective
Wt: 18110 Wt Prior: 1815 as of 12/12/07 Wt Dif: +015 Wt%: <3th Ht: 33" 27 Ht%: 15th HdCir:
17 HdCir%: <3th BMI: 12.0 BMI%: <3th
Pediatric Exam:
Const: Appears healthy, well nourished and well developed. Weighs within the normal range for
stated age AND HER SYNDROME. No signs of acute distress present. Mucous membranes are
moist and pink.
Head/Face: Normal on inspection.
Eyes: EOMI. Conjunctivae Gear. No discharge from the eyes, L EYELID ENTHROPION, TEERING
PERRL and no iris abnormalities. Normal eye movement.
ENMT: External ears WNL. Auditory canals are patent. Tympanic membranes translucent, with
good landmarks bilaterally. Nares are patent. Nasal mucosa shows moistness and normal color, NO
SEPTAL HEMATOMA, BRUISING OF THE BRIDGE OF THE NOSE. Dentition is appropriate for age.
Oral mucosa: pink, smooth and moist.
Neck: Symmetric and supple. Thyroid exhibits no thyromegaly.
Resp: Respiration rate is normal. No wheezing. Lungs are clear bilaterally.
CV: Rate is regular. Rhythm is regular. S1 normal. S2 normal. No heart murmur. Femorals 2+
bilaterally.
GI: Abdomen is nondistended, nontender and soft. Bowel sounds normoactive. Normal muscular
activity sound in the abdomen. No palpable hepatosplenomegaly.
Lymph: No palpable or visible regional lymphadenopathy.
Musculo: Walks with a normal gait for age.
Skin: Warm and dry with no rash.
Neuro: Alert and oriented x3. Reflexes are present and symmetric.
Psych: Mood is appropriate for encounter. Interacted appropriately affect.
Assessment #1:
Plan for #1:
Assessment #2:
Plan for #2:
Med Current
758.89 Deletion Of 4P
345.90 Epilepsy Unspec W/O Intractable
Topamax 15 mg 2 po bid
Topamax 15 mg 1 po qd at 2 pm
Klonopin Wafers 0.25 mg 1 po bid
Diastat Pediatric 4.4 CM 2.5 mg 1 pr pm seizure
Karly E Shellenberger DOB 11/25/2005
Page #3
Assessment #3: V20.2 Routine Infant Or Child/Teen Health Check Up To 18 Yrs
Plan for #3:
Comments PROGRESSING WITH GROWTH AND DEVELOPMENT, SEIZURES CONTROLLED ON
CURRENT REGIMEN. CONT CURRENT CARE.
Plan Other :
Advised: Time factor:
Seen by
PEN
Penn State Milton S. Hershey Medical Center Tel: (717) 531-8521
Penn State College of Medicine
Health Information Services, HU24
500 University Drive
P.O. Box 850
Hershey, PA 1 70 3 3-085 0
RE: SHELLENBERGER, KARLY E
February 5, 2008
Name: SHELLENBERGER, KARLY E
HMC Number: 1803594
DOB: 11/2512005
Date of Service: 01/31/2008
Robert L. Coldren, M.D.
2025 Technology Parkway
Suite 108
Mechanicsburg, PA 17050
Dear Dr. Coldren:
I saw Karly Shellenberger in the Pediatric Neurology Clinic for followup with regards to seizures. She was previously
followed by Dr. Nichter. She was accompanied to the office by her parents.
Interim History: Karly is 2 years 2 months old. She has had no seizures for at least 1 year. She is gradually making
some slow developmental progress. She is crawling on her belly and getting somewhat to hands and knees. She is
actually able to pull up to her knees. She is not yet pulling to stand. She is playing actively with toys and is
interested in investigating things. She is much more interactive. She taps when she wants things.
She has been generally well without any recent illnesses or fevers. She has been eating well. She has not had any
choking or gagging. She is able to take slightly bigger chunks of food. There have been no respiratory problems.
She sleeps well overnight and takes a nap during the day. She picks things up with her hands.
In terms of her language, she is saying mom, dad, and she is using dad specifically.
This document has been electronically signed.
Patient Name: SHELLENBERGER, KARLY E Patient Number: 1603594 Page 1 of 3
For information about ourphysidans and services, contact the AdD Network 1-800-233-4082 www.ponnstatehershey.com
She recently experienced an overdose of her Klonopin. She had been becoming gradually lethargic and irritable.
Apparently they found that the Klonopin dose had been changed from 0.1 mg per mL to 1 mg/mL, but they were
administering the same volume. When the change was made, she returned to her baseline.
She is in an early intervention program. She gets PT 2 times per week, developmental therapy once per week, and
speech therapy once per week, and occupational therapy once per month. She just recently was given AFO under
the direction of the physical therapist.
Medications: Topamax 30 mg in the morning, 50 mg in the afternoon, 30 mg at night, and clonazepam 0.25 mg twice
a day (dose mixture 0.1 mg/mL).
Allergies: Dilantin
Pain: None
Physical Examination: Weight 9.08 kg, height 85.3 cm, head circumference 43.7 cm, blood pressure 83/69, heart
rate of 95. The skin examination was unremarkable. The sclerae and conjunctivae were clear. The oral mucosae
were pink and moist. The lungs were clear with full breath sounds. The cardiac exam revealed normal heart sounds
and no murmurs. The abdomen was soft and nontender. The extremities and spine were without deformities. On
neurological examination, she was alert, active. She would regard the examiner well. On cranial nerve examination,
the pupils were 4 mm bilaterally and equally reactive to light. The extraocular movements were full without
nystagmus. Facial expression was symmetrical. Tongue was in the midline. Motor examination revealed
generalized hypotonia but otherwise symmetrical movements of all extremities. She would put weight on her legs,
and she was able to upright stand on her knees. She was able to reach for objects without any ataxia or tremor. Her
deep tendon reflexes were 2+/4 and symmetrical in the biceps, triceps, brachioradialis, and patellar tendons..
Diagnoses:
1. Epilepsy, well controlled.
2. 4p minus syndrome.
Impression: Karty is relatively stable from the perspective of seizures. She is making good developmental progress.
At this juncture, I think it would be worth trying to gradually taper the Klonopin. I would continue with the Topamax at
the present dose.
Taper Klonopin by 0.125 mg every month until discontinued. Follow up in 4-6 months or sooner if needed.
Thanks for allowing me to participate in Karly's care. If you have any questions, please do not hesitate to contact me
in Division of Pediatric Neurology at 717-531-8790.
This document has been electronically signed.
Patient Name: SHELLENBERGEP, KARLY E Patient Number: 1603594 Page 2 of 3
For in
about our physdans and services, contact the MD Network 1-800-233-4082 www.pei7nstatehershey.com
269355
CC: Coldren, Robert L, MD
2025 Technology Parkway
Suite 108
Mechanicsburg, PA 17050
w
Sincerely,
Trescher, William H, MD
WHT /CO DD: 02/05108 DT: 02/06/08 03:55
This document has been electronically signed.
Patient Name: SHELLENBERGER, KARLY E Patient Number: 1603594 Page 3 of 3
For bijormation about our phpidans and servimr contact the MD Network 1-800-233-4082 www.pennstatehershey.com
PENNSTATE
® ll of NIe?Medical Curter
Co
Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055
Penn State College of Medicine
Health Information Services, HU24
500 University Drive
P.O. Box 850
Hershey, PA 17033-0850
Patient Name: SHELLENBERGER, KARLY E PSUHMC MRN: 1603594
Patient Sex: Female Date of Birth: 11/25/2005
Patient Location: PEDS, , Visit Number. 09261431
Visit Type: Clinic
O u t p a t i e n t L e t t e r D o c u m e n t
Final
Document Electronically Signed by: Trescher, William H
February 5, 2008
Name: SHELLENBERGER, KARLY E
HMC Number: 1603594
DOB: 11/2512005
Date of Service: 01/3112008
Robert L. Coldren, M.D.
2025 Technology Parkway
Suite 108
Mechanicsburg, PA 17050
Dear Dr. Coldren:
3/8/2(}08 3:41:59 PM
I saw Karly Shellenberger in the Pediatric Neurology Clinic for followup with regards to seizures. She was previously
followed by Dr. Nichter. She was accompanied to the office by her parents.
Interim History: Karty is 2 years 2 months old. She has had no seizures for at least 1 year. She is gradually making
some slow developmental progress. She is crawling on her belly and getting somewhat to hands and knees. She is
actually able to pull up to her knees. She is not yet pulling to stand. She is playing actively with toys and is interested in
investigating things. She is much more interactive. She taps when she wants things.
She has been generally well without any recent illnesses or fevers. She has been eating well. She has not had any
choking or gagging. She is able to take slightly bigger chunks of food. There have been no respiratory problems. She
sleeps well overnight and takes a nap during the day. She picks things up with her hands.
In terms of her language, she is saying mom, dad, and she is using dad specifically.
She recently experienced an overdose of her Klonopin. She had been becoming gradually lethargic and irritable.
Apparently they found that the Klonopin dose had been changed from 0.1 mg per mL to 1 mg/mL, but they were
administering the same volume. When the change was made, she returned to her baseline.
Date Printed: 712212008 Time Printed: 6:11 ?tM
PENNSTATE
® M11ton S Ekshey Medical Carter
College of Medicine
Patient Name: SHELLENBERGER, KARLY E
PSUHMC MRN: 1603594
1 O u t p a t i e n t L e t t e r D o c u m e n t
Final
Document Electronically Signed by: Trescher, William H
3/8/2008 3:41:59 PM
She is in an early intervention program. She gets PT 2 times per week, developmental therapy once per week, and
speech therapy once per week, and occupational therapy once per month. She just recently was given AFO under the
direction of the physical therapist.
Medications: Topamax 30 mg in the morning, 50 mg in th"fternoon, 30 mg at night, and clonazepam 0.25 mg twice a
day (dose mixture 0.1 mg/mL).
Allergies: Dilantin.
Pain: None.
Physical Examination: Weight 9.08 kg, height 85.3 cm, head circumference 43.7 cm, blood pressure 83/69, heart rate of
95. The skin examination was unremarkable. The sclerae and conjunctivae were clear. The oral mucosae were pink and
moist. The lungs were clear with full breath sounds. The cardiac exam revealed normal heart sounds and no murmurs.
The abdomen was soft and nontender. The extremities and spine were without deformities. On neurological examination,
she was alert, active. She would regard the examiner well. On cranial nerve examination, the pupils were 4 mm
bilaterally and equally reactive to light. The extraocular movements were full without nystagmus. Facial expression was
symmetrical. Tongue was in the midline. Motor examination revealed generalized hypotonia but otherwise symmetrical
movements of all extremities. She would put weight on her legs, and she was able to upright stand on her knees. She
was able to reach for objects without any ataxia or tremor. Her deep tendon reflexes were 2+/4 and symmetrical in the
biceps, triceps, brachioradialis, and patellar tendons.
Diagnoses:
1. Epilepsy, well controlled.
2. 4p minus syndrome.
Impression: Karly is relatively stable from the perspective of seizures. She is making good developmental progress. At
this juncture, I think it would be worth trying to gradually tapers the.Klonopin. I would continue with the Topamax at the
present dose.
Taper Klonopin by 0.125 mg every month until discontinued. Follow up in 4-6 months or sooner if needed.
Thanks for allowing me to participate in Karly's care. If you have any questions, please do not hesitate to contact me in
Division of Pediatric Neurology at 717-531-8790.
Dare Printed: 712212008 Time Printed: 6:11 AM
PENNSTATE
® Milton S. Hershey Medical Cdr
Call F of Medicim
Patient Name: SHELLENBERGER, KARLY E PSLTIIMC MRN: 1603594
1 O u t p a t 1 e n t L e. t t e r D o c u m e n t - 1
Final
Document Electronically Signed by: Trescher, William H 3/8/2008 3:41:59 PM
269355
CC: Coldren, Robert L, MD
2025 Technology Parkway
Suite 108
Mechanicsburg, PA 17050
•
Sincerely, r'
Trescher, William H, MD
WHT /CO DD: 02/05/08 DT: 02/06108 03:55
r . . 1_
Date Printed: 711111008 Time Printed: 6:11 AM
11?9
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT FOR AND IN
CONSIDERATION OF Ten Thousand Dollars ($10,000.00), payable to James and
Jennifer Shellenberger, the receipt and sufficiency of which is hereby acknowledged,
James and Jennifer Shellenberger, individually and as parents and/or natural guardians
of Karly Shellenberger, for themselves and each of their respective heirs, executors,
administrators, assigns, and representatives, if any, do hereby release and forever
discharge Cumberland Apothecary, Inc., Pennsylvania National Mutual Casualty
Insurance Company, and all affiliated or related predecessors, successors, assigns,
present and former parents and subsidiaries (whether or not wholly-owned and whether
or not directly owned), former, present, and subsequent partners, shareholders, officers,
directors, attorneys, agents, representatives, insurers, and employees and any and all
other persons, firms, corporations, and entities, their heirs, executors, administrators,
successors, assigns, and employees)(hereinafter collectively referred to as
"Releasees"), and all other persons and firms, from any and all actions, claims for
contribution and/or indemnification and/or subrogation, causes of action, demands,
claims, damages, liens, judgments, suits, costs, fees, consequential damages, punitive
damages, or any other thing whatsoever on account of all known and unknown losses,
interest, attorney fees, costs, personal injuries, death, property damage, damages,
debts, or loss of any nature which James and Jennifer Shellenberger, individually and
as parents and/or natural guardians of Karly Shellenberger, a Minor, now have or may
hereafter have, including all matters which were raised or which could have been raised
in or in connection with, or anything whatever on account of, related to, or in any way
growing out of, or incident to, be it directly or indirectly: the mis-filling of a prescription
that occurred on or about January 10, 2008, involving Karly Shellenberger.
James and Jennifer Shellenberger, individually and as parents and/or natural
guardians of Karly Shellenberger, a Minor, and Releasees understand that this
settlement is the compromise of doubtful and disputed claims and represents a full
accord and satisfaction of such claim or claims and that the payment is not to be
construed as an admission of liability on the part of anyone, including Releasees, by
whom liability is expressly denied.
James and Jennifer Shellenberger, individually and as parents and/or natural
guardians of Karly Shellenberger, a Minor, hereby acknowledge and assume all risk,
chance, or hazard that the said injuries or damages may be greater or more extensive
than is now known, anticipated, or expected. No promise or inducement which is not
herein expressed has been made to James and Jennifer Shellenberger, individually and
as parents and/or natural guardians of Karly Shellenberger, a Minor, in executing this
Release. The undersigned do not rely upon any statement or representation made by
any person, firm, or corporation, or other entity hereby released or any agent or any
other person representing them or any of them concerning the nature, extent, or
duration of said damages or losses or the legal liability therefor.
1
In consideration of the payment stated above, James and Jennifer
Shellenberger, individually and as parents and/or natural guardians of Karly
Shellenberger, a Minor, agree to hold Releasees harmless, and to defend and
indemnify them against any suits, claims, actions, cross claims, judgments, liability,
costs, demands and suits for damages, contribution, indemnity, subrogation, loss of
service, attorney fees, expenses, or compensation which anyone or any entity may
have on account of or in any way growing out of the damages and injuries which James
and Jennifer Shellenberger, individually and as parents and/or natural guardians of
Karly Shellenberger, a Minor, now have or may hereafter have, all matters which were
raised or which could have been raised in or in connection with, or any other thing
whatever on account of, related to, or in any way growing out of, or incident to, be it
directly or indirectly, the mis-filling of a prescription that occurred on or about January
10, 2008, involving Karly Shellenberger.
Since freedom from costs of future litigation represents an important item of
consideration bargained for in this agreement, it is agreed that damages recoverable for
breach of this GENERAL RELEASE shall include reasonable attorney's fees and other
costs incurred as a consequence of such breach.
James and Jennifer Shellenberger, individually and as parents and/or natural
guardians of Karly Shellenberger, a Minor, further declare that they have a full
understanding of the terms of this settlement and GENERAL RELEASE, and that they
had the benefit of legal counsel who has explained the terms of this instrument to them
and its legal consequences, that the amount stated herein is the sole consideration of
this GENERAL RELEASE, and they voluntarily accept said sum and consideration for
the purpose of making a full and final compromise, accord and satisfaction, adjustment,
and settlement of all claims for injuries, losses, and damages resulting and relating to
the aforementioned incident.
This GENERAL RELEASE shall be construed and applied under the laws of the
Commonwealth of Pennsylvania.
This GENERAL RELEASE contains the entire agreement between the parties
hereto and the terms of this GENERAL RELEASE are contractual and not a mere
recital. It is further understood and agreed that there is no written or oral understanding
or agreement directly or indirectly connected with the parties settlement agreement
and/or this GENERAL RELEASE that is not incorporated herein.
2
The undersigned certify that they are eighteen (18) years of age or older, are of
sound mind, and FURTHER STATE, JAMES AND JENNIFER SHELLENBERGER,
INDIVIDUALLY AND AS PARENTS AND/OR NATURAL GUARDIANS OF KARLY
SHELLENBERGER, A MINOR, THAT THEY HAVE CAREFULLY READ OR HAVE
HAD READ TO THEM THE FOREGOING GENERAL RELEASE OF ALL CLAIMS AND
KNOW THE CONTENTS THEREOF AND SIGN THE SAME AS THEIR OWN FREE
ACT.
WE, James and Jennifer Shellenberger, individually and as parents and/or natural
guardians of Karly Shellenberger, a Minor, have hereunto set our hands
this day of , 2011.
Signature of James Shellenberger
Signature of Jennifer Shellenberger
920374.1
Date
Date
3
CERTIFICATE OF SERVICE
I, Corey J. Adamson, of the law firm of Thomas, Thomas & Hafer LLP, hereby state that a true and
correct copy of the foregoing document was served upon all counsel of record by first class United
States mail, postage prepaid, addressed as follows, on the date set forth below:
James & Jennifer Shellenberger
414 Linden Street
Mechanicsburg, PA 17050