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Home My WebLink About03-0668IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Rodney Pickett respectfully represents that: 1. Your Petitioner, Rodney Pickett, is an adult individual residing at 22402 North Jermain Lane, Colbert, Washington 99005. Your Petitioner is also the son of the alleged incapacitated person, Ruth A. Marples. 2. The alleged incapacitated person is Ruth A. Marples, a divorced woman, age 62, whose residence address is 6986 SW Old Clifton Road, Port Orchard, Washington 98367. 3. The alleged incapacitated person resides in Washington state with a male friend, Dan. On or about August 5, 2003, the alleged incapacitated person was stopped by the Pennsylvania State Police on the Pennsylvania Turnpike for weaving and driving at a slow rate of speed. She was subsequently taken to Carlisle Hospital and then pursuant to a Section 302 Involuntary Commitment under the Mental Health Procedures Act, she was committed to Holy Spirit Hospital on the same date. On or about August 8, 2003, following a Section 303 hearing, her involuntary commitment was extended for an additional 20 days and she continues to be a patient at the Holy Spirit Hospital Community Mental Health Center. 4. The known relatives of the alleged incapacitated person are: A. Rodney Pickett, Your Petitioner. B. Malinda Rew, her daughter, who resides at 4501 Addy Street, Lot 137, Washougal, Washington 98671. 5. Since her admission to Holy Spirit Hospital, Ruth A. Marples has been uncooperative, has refused both medical treatment and mental health treatment, and will not take any prescribed medicines or submit to any diagnostic testing. She has refused to communicate with physicians, nurses and staff who have been unable to address her medical needs. 6. Ruth A. Marples has a history of psychiatric hospitalizations in Washington state and has been diagnosed with paranoid schizophrenia. She denies that she has any mental illness. 7. While at Carlisle hospital, blood was drawn and her hemoglobin level was 5.7 grams percent (normal range is 35 to 50), and numerous abnormal red cell formations, including microcytes and hypochromia, target cells and ovalocytes. Based upon this diagnostic test, she has been diagnosed with severe anemia consistent with iron deficiency. Her medical doctor believes that the anemia is most likely caused by gastric bleeding and has recommended she undergo a complete evaluation with further medical testing to determine the cause of the anemia. Her medical doctor, Richard Schreiber, M.D., has stated: It is my feeling that this patient is in severe jeopardy of losing her life or jeopardizing her cardiac and neurological function due to her severe anemia. She does not understand that, and from a medical point of view, it is appropriate to seek guardianship for her or to formulate a way of having someone make her medical judgments for her in a way that she can accept. 8. After repeated attempts, the patient has refused any medical diagnostic testing or treatment for her physical problems. 9. Ruth A. Marples is an incapacitated adult person who needs a court appointed guardian for her person and her estate. 10. It is believed and therefore averred that Ruth A. Marples does not have a Power of Attorney. Her income at this time is undetermined and she resides with a male friend, Dan, in the state of Washington. 11. A guardian is necessary to facilitate Ruth A. Marples' needed medical care and treatment, and to handle her personal and financial affairs in a responsible fashion. 12. Petitioner believes and therefore avers that Ruth A. Marples does not have the capacity to care for her affairs of daily living and needs a guardian appointed to handle her person and her property. 13. It' is believed that no other court has assumed jurisdiction in any proceedings to determine the capacity of Ruth A. Marples, except that the Cumberland County Mental Health Hearing Officer entered a Section 303 Involuntary Commitment Order for 20 days beginning on August 8, 2003. 14. Rodney Pickett, the alleged incapacitated person's son, is willing to accept the appointment of guardian of the property and person of Ruth A. Marples. Attached is an Acceptance signed by the proposed guardian. WHC~R~ZI:ORE, your Petitioner prays that a Citation be issued to Ruth A. Marples to show cause why she should not be adjudged to be incapacitated and a plenary guardian for her estate and person be appointed, and that the Court schedule a hearing on this Petition. Date: August 12, 2003 Attorney I.D. #41687 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner, Rodney Pickett :217075 VERIFICATION I, Rodney Pickett, verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. / Rod n"ey ~icket'{ ' Dated: ~//?-.//?.. ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE ACCEPTANCE BY PROPOSED GUARDIAN I, Rodney Pickett, hereby agrees to accept the appointment of plenary guardian of the person and estate of Ruth A. Marples, if she is adjudged to be an incapacitated person by the Cumberland County Orphans' Court. // Rodn~'y Pickett AUG Z 003 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY · ~ ~ ~'(~ ORPHANS' COURT NO. ESTATE OF RUTH A. MARPLES PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE PRELIMINARY DECREE AND NOW, this ~ day of August, 2003, upon consideration of the annexed Petition, it is ORDERED AND DECREED that a hearing on this matter is set for the//~/~ day of /~~'~'- , 2003, in Courtroom No. //' , at ~':00 o'clock A-.M. at the Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania, and that a Citation be issued to Ruth A. Marples commanding her to show cause why she cannot appear at the aforementioned hearing pursuant to the Petition of Rodney Pickett to have Ruth A. Marples adjudicated an incapacitated person and to have a plenary guardian appointed for her person and her estate. Hct!c_'z of +h~ he?!n~, she!! bs ~!':en +n R~,~ 2. BY THE COURT: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE FINAL ORDER OF COURT APPOINTING A PLENARY GUARDIAN AND NOW, this __ day of ., 2003, a hearing in this case having been held on ,2003, and it appearing to the Court that Ruth A. Marples was properly served with a Citation and Notice of this hearing, and based upon the testimony presented at the hearing, the Court further finds from the testimony: 1. That Ruth A. Marples suffers from paranoid schizophrenia, the conditions or disability which impairs her capacity to receive and evaluate information effectively and to make and communicate decisions concerning her management of financial affairs or to meet essential requirements for her physical health and safety. 2. That there exists no other less restrictive alternative mechanism for decision making. 3. That based on the total incapacity of Ruth A. Marples to receive and evaluate information and to make or communicate decisions, a plenary guardian of the person and a plenary guardian of the estate are required on a permanent basis. NOW, THEREFORE, based on the clear and convincing evidence supporting the foregoing findings it is ORDERED, ADJUDGED and DECREED that Ruth A. Marples be and is hereby adjudged an incapacitated person and Rodney Pickett is appointed Plenary Guardian of the Person and the Estate of Ruth A. Marples. A Report by the Plenary Guardian shall be filed on an annual basis with the Court. No bond shall be required of the Plenary Guardian named herein. The Plenary Guardian is hereby authorized to make decisions on Ruth A. Marples' behalf concerning her medical care and treatment including her admission to nursing homes, personal care facilities, hospitals and other healthcare providers, as well as to consent to and authorize medical treatment; and the Plenary Guardian herein appointed is further authorized to handle all of the assets of her Estate including the principal and interest, and to conduct her business affairs on her behalf, including the sale or transfer of any of her assets, payment of bills and expenses, investment of assets and all matters related thereto. BY THE COURT: IN RE: Ruth A. Marples : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-2003-0668 IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our fight to manage money and property and to make decisions. A copy of the petition which has been filed by Rodney Pickett is attached. You are hereby ordered to appear at a heating to be held in Court Room No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania, on August 14 ,2003, at 9:00 A._:.M. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the heating, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or girl of your money to other property. If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the heating (either in person or by an attomey representing you) the court will still hold the heating in your absence and may appoint the Guardian requested. By: [~ ~/ Clerk, Orphans Court Division Cumberland County, Carlisle, PA My Commission Expires 1st Monday, January, 2006 IN RE: ESTATE OF RUTH A. MARPLES IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE ORDER OF COURT AND NOW, this 13th day of August, 2003, is ordered and directed that Frederick I. Huganir, Esq., be appointed to represent the alleged incapacitated person, Ruth A. Marples, at the hearing scheduled for August 14, 2003, at 9:00 a.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, David W. DeLuce, Esq. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Petitioner V'~sley Ole~., J. ~ Frederick I. Huganir, Esq. 1822 Market Street Camp Hill, PA 17011 Court-appointed attorney for ,uth A. Marples IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-03-668 ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION FOR THE APPOINTMENT OF EMERGENCY GUARDIAN OF THE ESTATE AND PERSON OF RUTH A. MARPLES IN ACCORDANCE WITH 20 PA. CONS. STAT. §5513 PETITION TO EXTEND EMERGENCY GUARDIAN FOR TWENTY (20) DA YS TO THE HONORABLE, THE JUDGES OF SAID COURT: AND NOW, comes your Petitioner, Rodney Pickett, by and through his attorneys, Johnson, Duffle, Stewart & Weidner, and respectfully represents in support of this Petition as follows: 1. Your Petitioner has filed a Petition for Appointment of a Guardian and Emergency Guardian in the above captioned matter, and following a hearing on August 14, 2003, this Court entered an Order appointing your Petitioner as the Emergency Guardian of the person of Ruth A. Marples for a period of 72 hours pursuant to 20 Pa.C.S.A. §5513. 2. The purpose of the Emergency Guardian was to permit your Petitioner to consent to necessary and appropriate medical treatment as recommended by Ruth A. Marples' treating physicians. 3. The treating physicians have indicated that it will take more than 72 hours to fully diagnose and properly treat Ruth A. Marples' life-threatening medical problems, and more time is necessary. See attached letter from James A. Tyndall, M.D. 4. In order for Ruth A. Marples to continue to receive necessary and appropriate medical treatment to protect her life, Petitioner requests this Honorable Court extend the Emergency Guardian Order for an additional twenty (20) days from the expiration of the initial Emergency Order, which will expire on August 17, 2003. WHEREFORE, Petitioner respectfully requests this Court to enter the attached Order to extend the appointment of your Petitioner as the Emergency Guardian of the person of Ruth A. Marples for an additional twenty (20) days from August 17, 2003. Date: August 15, 2003 JOHNSON, DU~RT/~IDNER I~'~vid W. DeLuce / Attorney I.D. No. 4~687 Robert M. Walker Attorney I.D. No. 86340 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner, Rodney Pickett :217199 VERIFICATION I, Rodney Pickett, verify that the statements made in the foregoing Petition are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. Dated: August 15, 2003 CERTIFICATE OF SERVICE AND NOW, this 15th day of August, 2003, the undersigned does hereby certify that he did this date serve a copy of the foregoing Petition to Extend Emergency Guardian upon the other parties of record by causing same to be transmitted via facsimile as follows: Fax- 737-9215 Frederick Huganir, Esquire 1822 Market Street Camp Hill, PA 17011 JOHNSON,By:. ~ EIDNER RobErt M. Walke~' ADM, DATE: 0811512003 We have been asked to see Ruth Maples in consultation. This 62-year-old female from Washington had presented to the Cadisle Regional Medical Center with a hemoglobin of 5.7. She refused treatment; ultimately she ended up in Holy Spidt Hospital in the Mental Health Unit. The court has given temporary guardianship to her son. We are petitioning the court to request additional days in order to allow us to evaluate and treat the cause of her anemia. She has severe microcyl:ic anemia, most likely due to iron deficiency. In her age group, the odds are extremely high that we are dealing with a malignancy. We need time to do the testing that will be necessary to determine the cause of the anemia and then time to treat the cause of the anemia, it is very possible that one of the treatments will entail surgical interven~on. We are requesting that the court will allow us the time to pursue and treat this life-threatening process. We are requesting 20 (twenty) days in order to allow us to do the testing, find the cause, and treat the cause, If you have any further questions, please do not hesitate to contact me. JT/lh DOC #: 366023 D: 08/14/2003 T: 0811512003 8:33 A 002677 cc: JAMES A TYNDALL, MD JAMES A TYNDALL, MD HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 HISTORY AND PHYSICAL EXAMINATION Pa~e I of 1 NAME: Marples, Ruth A MR#: 506325 ROOM: CMHC119 01 DR.: JAMES A TYNDALL, MD IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-03-668 ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION FOR THE APPOINTMENT OF EMERGENCY GUARDIAN OF THE ESTATE AND PERSON OF RUTH A. MARPLES IN ACCORDANCE WITH 20 PA. CONS. STAT. §5513 MOTION TO AUTHORIZE PRIVILEGED TESTIMONY AND RELEASE OF MENTAL HEAL TH RECORDS TO THE HONORABLE, THE JUDGES OF SAID COURT: Petitioner, Rodney Pickett respectfully represents that: 1. Your Petitioner has filed a Petition for Appointment of a Guardian and Emergency Guardian in the above captioned matter, with a hearing scheduled on the Emergency Guardian Petition for August 14, 2003 at 9:00 a.m. 2. Your Petitioner is seeking to present the testimony of employees of Holy Spirit Hospital Community Mental Health Center and portions of the mental health records of Ruth A. Marples, all of which are relevant in determining her competency in this matter. 3. Mental health and medical records are protected and privileged under applicable state law, and can only be released upon a Court Order or the consent of the patient. 50 P.S. §7111. 4. Ruth A. Marples has not consented to the release of this information and it is relevant to the issues to be presented in these guardian proceedings. 5. Specifically, the Guardian Act requires that: "To establish incapacity, the petitioner must present testimony, in person or by deposition, from individuals qualified by training and experience in evaluating individuals with incapacities of the type alleged by the petitioner, which establishes the nature and extent of the alleged incapacities and disabilities in the person's mental, emotional and physical condition adaptive behavior and social skills." See 20 Pa.C.S.A. §5518. 6. In order to establish incapacity, Petitioner must present the testimony of employees of Holy Spirit Hospital Community Mental Health Center including a psychiatrist. 7. The mental health regulations allow the non-consensual release of mental health information upon the issuance of a Court Order. See 55 Pa. Code §5100.32(a)(7) and 55 Pa. Code §5100.35(b)(1). 8. The Emergency Guardian Petition alleges that unless recommended medical treatment is provided to Ruth A. Marples, her present medical condition is life-threatening and must be addressed. 9. Therefore, the testimony of the mental health and medical professionals at Holy Spirit Hospital Community Mental Health Center are necessary for Petitioner's case and to preserve the life of the alleged incapacitated person. WHEREFORE, your Petitioner requests this Honorable Court to enter the attached Order and allow the testimony of any employee of Holy Spirit Hospital Community Mental Health Center in this proceeding as it pertains to the medical and mental health history, diagnosis and treatment of Ruth A. Marples, and for the disclosure of her medical and mental health records. Date: August 13, 2003 :217133 Attorney I.D. No. 41687 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner, Rodney Pickett VERIFICATION I, Rodney Pickett, verify that the statements made in the foregoing Motion are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities. / "l~odney ~ickett CERTIFICATE OF SERVICE AND NOW, this 13th day of August, 2003, the undersigned does hereby certify that she did this date serve a copy of the foregoing Motion to Authorize Privileged Testimony and Release of Mental Health Records upon the other parties of record by causing same to be transmitted via facsimile as follows: Fax. 737-9215 Frederick Huganir, Esquire 1822 Market Street Camp Hill, PA 17011 JOHNSON, DUFFLE, STEWART & WEIDNER - IristeeK. Myers ~' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 21-03-668 ORPHANS' COURT ESTATE OF RUTH A. MARPLES PETITION FOR THE APPOINTMENT OF EMERGENCY GUARDIAN OF THE ESTATE AND PERSON OF RUTH A. MARPLES IN ACCORDANCE WITH 20 PA. CONS. STAT. §5513 ORDER OF COURT . _ , LI AND NOW, this ~ day of August, 2003, upon consideration of the attached Petition of Rodney Pickett, Petitioner, it is hereby ORDERED that all employees of Holy Spirit Hospital are permitted to testify in the above captioned guardian proceedings and release confidential and privileged mental health and medical information in this case, and Holy Spirit Hospital is permitted to disclose medical records and mental health records. BY THE COURT: ,~ ~ ADM. DATE: 08/05/2003 PA: The patient admits to having two psychiatric hospitalizations in Tacoma, Washington State Psychiatric Hospitals "about 20 years ago." IDENTIFYING DATA: Ruth A. Maples is a 62 year-old white female, divorced, with a residence at 6986 SW Old Clifford Courtyard, Washington, 98367, who wes transferred and admitted to the Holy Spirit Hospital Behavioral Health Center Psychiatric Unit on the night of 08/06/03 from Carlisle Regional Medical Center Medical Floor, where she was admitted on 08/05/03 with chief complaint of "fatigue." CHIEF COMPLAINT: "1 feel very tired." HISTORY OF PRESENT ILLNESS: The patient relates that she was taking a vacation and she traveled by car from Washington state. She said that she was going to Kentucky. However, she was found by the State Police traveling on Turnpike 76 and that she was described as traveling at 35 to 40 miles per hour and was also described her car weaving on the read. She was obstructing traffic flow. She was taken to Carlisle Regional Medical Center ER where she was found to be very anemic with a hemoglobin of 5.7 grams percent. According to the notes of a medical doctor attending to her in Carlisle Regional Medical Center she initially agreed to a blood transfusion but later changed her mind and she refused a blood transfusion. A colonoscopy was also recommended but she also refused this to determine what the cause of the anemia is. She was diagnosed there with microcytic anemia. Dr. Tarng, a hospitalist at Carlisle Regional Medical Center spoke with me on the phone requesting transfer to a Psych Unit after Dr. Marchiondo and Dr. Schlimmer of Carlisle Regional Medical Center petitioned for a 302 involuntary commitment. Dr. Marchiondo in the 302 petition papers states that she is "hemodynamically unstable and technically is in shock secondary to her anemia. Dr. Marchiondo stated that with her severe anemia she could go into hypoxia of the brain. Dr. Schlimmer states "patient found weaving on the turnpike at 35 miles per hour at 2:00 in the morning by State Police and believes she is a danger to self and others. The patient presents as a pleasant lady but her insight into her mental illness (family reported to the medical doctor in Carlisle Regional Medical Center that she has a diagnosis of chronic paranoid schizophrenia) is absent. She used to be on antipsychotic, either Loxitane or olanzapine but she stopped taking her psych medication three years ago. She refuses to take any meds, refuses blood work here and refuses blood transfusion recommended by the Internal Medicine consultant, Dr. George Azizkhan who saw her early this morning in the unit. The patient admits to hearing "gibberish voices" in the past but not currently. She denies any grandiose delusions or any persecutory delusions. She also denies any visual hallucinations. She has cotton balls "in her ears." When asked why she did that she said she does not want the "pollution in the air" going into her ears. She denies any suicidal or homicidal thoughts. Her answers to direct questions are sometimes tangential but most of her replies are goal directed. When asked why she is refusing treatment and blood transfusion she claims it is against her Page 1 of 4 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 HISTORY AND PHYSICAL EXAMINATION NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: SYLVESTRE DE LA CRUZ, MD ORIGINAL ' 'NAM~i Maples, Ruth A · - MR#:'~'' 506325 religion (she is Jewish), 'and because an aunt had a blood transfusion in the past and who ended up having dialysis. PAST MEDICAL HISTORY: The patient has no known drug allergies. Her family physician is Dr. McEarhearn and Dr. Gigenfeld of Pod Orchards, Washington. The patient denies any history of seizures and/or convulsions. She denies any history of peptic ulcer disease or any rectal bleeding. Dr. Tarng of Carlisle Regional Medical Center said that her "stool occult blood test was negative." ' The patient admits to taking aspirin two to three tablets per day. She denies any other major medical and/or surgical problems. However, on admission to the unit her blood pressure was taken at 184/96. The patient is not taking any meds currently. According to the notes in Carlisle Regional Medical Center the patient refused to take any medications there as well. FAMILY HISTORY/SOCIAL HISTORY: The patient denies any family history of mental illness. The patient is divorbed. She has two children who are both living. She admits that she has four siblings, two of whom are deceased. Both parents of patient are deceased. Father died of "old age." Mother died of a "head problem." As stated earlier, patient is divorced. The patient admits to drinking about four bottles of wine per year. She denies any use of street drugs. According to the notes in Carlisle Regional Medical Center, the patient also has hypovolemia. One of the patient's sons is supposed to come to Pennsylvania to see her. More of the family and social history will be gathered by the Social Service. REVIEW OF SYSTEMS: Review of systems positive for anemia, high blood pressure on admission. MENTAL STATUS EXAMINATION: The patient is dressed in casual clothes, looks fairly kempt, oriented to person. She knows the month and the year but does not know the day of the week or the date. She also does not know the name of the hospital she is in. She is able to mention three out of three words immediately and three out of three after five minutes. Her proverbs interpretation is abstract. She appears not to be a very reliable historian. She denies any suicidal thoughts or homicidal thoughts. She denies any history of suicide attempts or violent behaviors. She is able to mention seven names of past U.S. presidents when asked to mention seven. Intelligence appears to be within average range. Her arithmetical skills are fairly good. Page 2 of 4 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 HISTORY AND PHYSICAL EXAMINATION NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: SYLVESTRE DE LA CRUZ, MD ORIGINAL · ' NA ~.IV~ Ma'ples, Ruth A . MR¢i. 506325 She says that she finished two years in college. Her historical judgment is grossly impaired, however, her hypothetical judgment is sound, her insight is absent. She denies any auditory or visual hallucinations currently and she denies any grandiose delusions. She is delusional in the sense that she put two cotton balls into her ears so that the pollution in the air cannot go into her ears. She said that she just wants to treat her anemia by using multivitamins and minerals. However, according to the notes in Carlisle Regional Medical Center she was given ferrous sulfate tablets, but again she refused that according to the notes from Carlisle Regional Medical Center. DIAGNOSTIC AXIS I: AXIS I1: AXIS II1: AXIS IV: AXIS V: IMPRESSION: Schizophrenia, chronic paranoid (according to a family member). No diagnosis. Chronic microcytic anemia with a hemoglobin count of 5.7 grams percent. High blood pressure on admission to Holy Spirit Hospital Inpatient Psych Unit; blood pressure 184/96. Tachycardia on admission to the Unit with pulse rate of 104 beats per minute. Psychosocial stressors: chronic mental illness, acute stressors are not identifiable. Current GAF: 50-55. .. TREATMENT PLAN: Discussed with the patient that she needs a therapeutic trial of an antipsychotic Abilify tablets 5 milligrams AM and 5 milligrams at bedtime, and Ambien 10 milligrams at hs p.r.n, for sleep. The patient said that she refused to take any medications because she doesn't need any meds; this is due to her absent insight saying that she has no mental illness. She will also have individual counseling and she will attend therapeutic programs assigned to her by the treatment team. Risks versus benefits of meds are explained to her. Blood work will also be done but she also refused to have her blood drawn. Social Worker will contact family members about her admission here. A 303 involuntary commitment will be pursued and a mental capacity evaluation will be requested and to be done by Dr. David Petkash on 08/07/03 and Mini-Mental status exam will also be performed by the Inpatient staff. Page 3 of 4 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 -HISTORY AND PHYSICAL EXAMINATION NAME: Maples, .Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: SYLVESTRE DE LA CRUZ, MD ORIGINAL "' ' Maples, Ruth A " 506325 PHYSICAL EXAMINATION: VITAL SIGNS: On admission to the Unit her height is 5'4", weight 190 lbs, temperature 98.9, PR 104, RR 20, BP 184/96. Physical examination was done at the Carlisle Regional Medical Center and the result of the exam is also on her chart. Please refer to that for further details. SD/jrs .' DOC #: 364094 D: 08/06/2003 T: 08/07/2003 1:59 P 008549 cc: SYLVESTRE DE LA CRUZ, MD SYLVESTI~E D~ CRUZ, MD Page 4 of 4 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 " HISTORY AND PHYSICAL "' ' EXAMINATION NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: SYLVESTRE DE LA CRUZ, MD ORIGINAL p,r :' C;v;L ~00~ [~004 08,/0?/03 T]~_T 11:,30 F,iX 717 240 6573 Cl. gJlB CO PR0~ONOT,~Y , ;'i~]',. , . ',' :' ~ ' ' . ........ 7 .... '" " . i .' ,.'~" ' ' ; '~ :; ' ": - ' .," . ~,,' ' , . ; , .. , ., ~ · "' '" :':"-~ ' , · ~.~.~'.~.k_: · . ~': I i ;, ~ ?,'. ': ~:. ., '~"~"~ . .. , . , . ''...., , ;~ ', . ...... ~., ..... . ........~s.~.~c~ ..... y~:. ~ , ~ · ~cr~y ~ :. ' ~,;:.. .otl~6 ~,~of:' '. ' ' ' ?,, ' ' :. · : : .: :r ',: 'jI [, "' , , ., ~;~?,,, ;'.,;. . '.,,', . . ,'; . /', ,~, ..... :' . ' " '"~'~ 9 ' '" "" '"'" ... ':,~., ~';.' ;. ': ' , .'l '. ' ' '*: ,~. . ?:. ,,; . ~005 T,~i' nent Needed: .ecessary.) (Describe the treatment ~ed by the patient. Continue on additic ' '~ sheets In my opinion: (Check A or B) A. [~"ffe patient continues to be severely mentally disabled and.in need of treatment. B. ~ The patient is not severely mentally disabled and in need of involuntary treatment. , ~r/~"~} A UR~=-OI~XAMh~ING OR T"~ATING PHYSICIAN) / {DATE) k ixF~k~'- CERTIFICATION BY THE COURT FOR EXTE~ED INVOLU~ARY In the ~urt of ~~o,q %~ of ~C~~Oa County In re: No. term, 19__ Certification for Extended Treatment A This ~ day of .:/~'C~.~t.t_~"f' , ~ atter nea~.,~t-A-:-" and consideration of: (Details of findings. Include details as to'hat type and why treatment is needed. Attach reports, testimony, etc.) · The comx Finds that the patient [ ~' is F I is not] severely mentally disabled and m need of treatment. Accordingly, the court orders that: (Check A or B) - (NAM& OF PATIENT~ --]partial hospitalization, [patient treatment which is the least restrictive treatment setting appropriate for the patient at ~ (t_ %(5~ F t-~' ~-a~l~ as a severely mentally dlsabled ~ (NAME OF FACILITY)' person pursuant to the provisions of Section 303 of the Mental Health Procedures Act of 1976 for a period of Lr~/~ ~//a,, x . (N~"~ TC~/E~CEED 20 DAYS) B. [--] The person is not subject to involuntary treatment. I have explained to the patient that if his/her conference was before a Mental Health Review officer he/she may petition the court for a review of any decisions reached at this conference. (Check appropriate block) [~The patient was represented by (NAME AND ADDRE~ OF ATTORI~EY) The patient declined representation. for the court (TITLE) PAGE ,4 of 4 MH 784 - 7-82, ADM. DATE: '08/05/2003 SS #: 999-06-2141 REASON FOR CONSULTATION: Severe anemia. HISTORY OF PRESENT ILLNESS: This is a 62 -year-old woman, who is currently confined in the mental health section of the hospital because of schizophrenia. We are asked to see her because her hemoglobin test drawn at Carlisle Regional Hospital showed a hemoglobin of 5.7. While she was at Carlisle Hospital, according to the records available on the chad, she refused further testing and treatment. I spoke with Dr. DelaCruz, reviewed his written H&P and the typed H&P, and thus I am aware of the following history. According the patient nothing is wrong. She does not feel that she is anemic. She has no symptoms of that Or any'other ailment as far as she is concerned, and she knows that nothing is wrong. She does acknowledge taking two or three aspirin a day periodically, though not every day, she says she does this "to get rid of any pollution". When I ask her to clarify this she refers to environmental things that could be out there that might be hurling her. She does not get specific. She states that she has not bled. She has never seen any blood. When I asked her to describe her bowel movements she did not wish to do so. She did not want to answer any fudher questions in that regard. I asked her if she any symptoms of anemia and she said she did not. Specifically she denies any chest pain, shodness of breath, lightheadedness, ease of fatigue, pallor, changes in her appetite, changes in her weight, nor has she seen any bruising. She denies feeling any swollen glands. She is not aware of any fever. According to the objective findings at Carlisle Regional Medical Center and in this chad, the patient was brought to that hospital because she was driving along the Turnpike and the police apparently found her traveling at 35 to 40 mph and her was described as weaving on the road. As stated, her hemoglobin was found to be 5.7 and her mean corpuscular volume is Iow at 58, mean corpuscular hemoglobin is Iow at 16, but the white blood count and platelet count are normal. The blood smear shows a normal distribution of the white cells, but there are numerous abnormal red cell formations, including microcytes and hypochromia, target cells and ovalocytes. In addition, her potasium is 3.1, though her other chemistries are normal. Her prothrombin time and padial prothrombin time are normal. Her electrocardiogram shows artifact with some narrow, inferior Q waves, but no acute process evident. There may be some left atrial enlargement. According to the records the patient initially refused treatment, but then repodedly was going to accept transfusion, but then decided against it. Dr. DelaCruz tells me that the patient is Jewish. The patient herself would not discuss this fudher. Apparently she is not a Jehovah's Witness. She was offered colonoscopy, but refused that as well. She was transferred to this hospital to the mental health division under a 302 petition. Page 1 of 3 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 CONSULTATION REPORT NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: RICHARD SCHREIBER, MD ORIGINAL '-""~ I Maples, Ruth A ¢~ ~ MR#:' " 506325 PAST MEDICAL HISTORY: She says she is fine. PAST SURGICAL HISTORY: She says she has had none. CURRENT MEDICATIONS: Aspirin, refer to above. She also denies taking any supplements or herbal products, except what she can buy in the supermarket. She denies using any illicit drugs or street drugs, "except what rdight be in the air". ALLERGIES: None known. FAMILY HISTORY: According to the chart her father had died of old age and her mother had heart problems. SOCIAL HISTORY: Please see the detailed notes under Dr. DelaCruz's H&P. The patient says that she used to smoke, and that she occasionally will have some alcohol. REVIEW OF SYSTEMS: Not deemed relia.ble, since she denies absolutely everything. PHYSICAL EXAMINATION: PHYSICAL EXAMINATION: CONSTITUTIONAL: General: The patient is seen first sitting in her chair in her room, quietly, looking comfortable. She is markedly pale, though she denies that. She did not appear to be in any physical distress. VITAL SIGNS: Her pulse yesterday was recorded at 88 with respirations at 20 and a blood pressure of 160/90. She has refused vital signs since then. I asked her if she would permit me to examine her and she said "no". I asked her if there was a particular reason and her response was that "there is nothing wrong" and she does not think there is any need for the exam. I described what I would do on the examination, including listening to her heart and lungs and examining her abdomen and she again refused. Naturally, I did not examine her. IMPRESSION: Severe anemia. It is microcytic and microchromic consistent with iron deficiency and therefore most consistent with blood anemia. The patient denies that she has this, and states even that she believes that the blood samples were mislabeled. The most likely cause of her anemia, based on the history that we have, is gastric bleeding from aspirin usage. This of course is only a presumption. She should undergo a complete evaluation with further blood tests, including iron levels, B12 and folate, serial hemoglobin evaluation and of course a complete gastrointestinal evaluation. Page 2 of 3 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 CONSULTATION REPORT NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: RICHARD SCHREIBER, MD ORIGINAL NA ' MR~ Maples, Ruth A ~ ~ 506325 o Psychiatric diagnosis per Dr. DelaCruz. It is apparent to me also that the patient does not have a clear understanding of her current condition, the nature of her problem or the consequences of her decision making. Specifically, I asked her that if she were anemic if she was aware of what could happen. Since she denies being anemic she said that those things are not going to happen. I then asked her to "make believe" that she could be anemic and I wondered out loud if she realized that severe anemia.can lead to heart attack, stroke, further bleeding, kidney failure, collapse and death. She said "1 understand, but that's not what I feel". In short, I feel'that she is not of sound mind to understand the consequences of her decisions and that her judgment is poor. Hypertension, at least on one or two occasions. Incomplete data base due to the patient's refusal to allow examination and further testing. DISPOSITION: At this juncture if the patient would not allow transfusion, another option would be Procrit injections. She certainly had no interest in this. It is my feeling that this patient is in severe jeopardy of losing her life or jeopardizing her cardiac and neurological function due to her severe anemia. She does not understand that, and from a medical point of view, it is appropriate to seek guardianship for her or to formulate a way of having someone make her medical judgments for her in a way that she can accept. Since the patient refuses any further intervention at this time, we will not continue to see the patient, unless you ask otherwise. Please then contact us in that event. Thank you for the consultation. I hope this information is helpful to you in the psychiatric care of this patient. RS/lb DOC #: 364348 D: 08/07/2003 T: 08/08/2003 11:12 A 549009 cc: SYLVESTRE DE LA CRUZ, MD RICHARD SCHREIBER, MD RICHARD SCHREIBER, MD Page 3 of 3 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 CONSULTATION REPORT NAME: Maples, Ruth A MR#: 506325 ROOM: CMHC113 01 DR.: RICHARD SCHREIBER, MD ORIGINAL APPLICA'I tON FOR INVOLUNTARY EMERGENCY EXAMINATION AND TREATMENT Mental Health Procedures Act of 1976 Section 302 THE BLANKS BELOW MAY BE COMPLETED FOLLOWING ADMISSION.) NAME LAST F I RST MIDDLE AGE SEX NAME OF COUNTY PROGRAM NAME OF BS~ BSU NO. Cumberland & Perry CountSes Hental Health Nest NAME OF FACILITY ADMISSION DATE ADMISSION NO. INSTRUCTIONS Part I must be completed by the person who believes the patient is in need of treatment. If this person is not a physician, police officer, the County Administrator or his delegate, he or she must request authorization or a warrant through the County Admifiistrator. i'f the authorization or a warrant through the County Administrator is required, call or visit the Office of the County Administrator. Authorization to take a patient for examination without a warrant is to be documented in Part II. If a warrant is required, Part III must be completed by the County Administrator or a person designated by the Administrator to sign the warrants. When the patient is taken to the examination facility, the rights described in Form MH 783-A must be explained. Part IV should be signed by the person who explains these rights to the patient. Part V is to be completed by the County Administrator (or representative) or by the Director of the Facility (or representative) upon arrival of the patient at the facility. 5. Part VI is to be completed by the examining physician. If additional sheets are required at any point in completing this form, note on this form the number of additional sheets which are attached. 7. If the patient is subject to criminal proceedings/detention, briefly describe below. PAGE 1 OF 7 MH 783 10/91 IMPORTANT NOTICE ANY PERSON WHO PROVIDES ANY FALSE INFORMATION ON PURPOSE WHEN HE COMPLETES THIS FORM MAY BE SUBJECT TO CRIMINAL PROSECUTION AND MAY FACE CRIMINAL PENALTIES INCLUDING CONVICTION OF A MISDEMEANOR. Part I APPLICATION I believe that / iPER$ON'S NAME) is severely mentally disabled: (Check and complete all applicable for this patient.) A person is severely mentally disabled when, as a result of mental illness, his/her capacity to exercise self-control, judgment and discretion in the conduct of his/her affairs and social relations or to care for his/her own personal needs is so lessened that he/she poses a clear and present danger of harm to others or to himself or herself. Clear and present danger to others shall be shown by establishing that within the past 30 days the person has inflicted or attempted to inflict serious bodily harm on another and that there is reasonable probability that such conduct will be repeated. A clear and present danger of harm to others may be demonstrated by proof that the person has made threats of harm and has committed acts in furtherance of the threat to commit harm; or Clear and present danger to himself shall be shown by establishing that within the past 30 days; the person has acted in such manner as to evidence that he/she would be unable, without care, supervision and the continued assistance of others, to satisfy his/her need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded under the act; or (ii) the person has attempted suicide and that there is reasonable probability of suicide unless adequate treatment is afforded under this act. For the purpose of this subsection, a clear and present danger may be demonstrated by the proof that the person has made threats to commit suicide and has committed acts which are in furtherance of the threat to commit suicide; or [----] (iii) the person has substantially mutilated himself/herself or attempted to mutilate himself/herself substantially and that there is the reasonable probability or multilation unless adequate treatment is afforded under this act. For the purposes of this subsection, a clear and present danger shall be established by proof that the person has made threats to commit multilation and has committed acts which are in furtherance of the threat to commit mutilation. PAGE 2 OF 7 MH 783 - 10tgl DeSCribe in specific within the days which suppor your belief (in location, date {ind. time whenever possible, and state who observed the behavior): I unders~d mat I ma~ ~ r~uir~ to t~tify at a ~urt On the b~is of ~e ~formation I gave a~ve, I believe · is ~ n~ of Mvol=mu exmMation ~d tr~tment I r~u~t ~a~ (~k A or B - Notice ~at B can only be cheek~ by a physici~, a ~lice offi~r, ~e ~unty AdmM~trator or his/her dele~te). '~lity for examination and treatment. . V , 'ONATURE OF APPL' 0ATE A. [~ The County Administrator issue a warrant authorizing a policeman or .... aomeone representing the County Administrator or take the patient to a PRINT NAME AND ADDRESS OF APPLICANT ~ //That this facili he ~ treatment. TELEPHONE NO. patient to determine his/her need for DATE TELEPHONE NO. I ~IGNATURE.OF PHYS!~CIAN,'gOLICE OFFICER, UNTY ADM INI STRA R3~O.R.~J;~R REPRESENTAT I VE PRINT NAME AND TITLE OF PHYSICIAN, POLICE OFFICER, COUNTY ADMINISTRATOR OR REPRESENTATIVE PAGE 3 OF 7 MH 783 - 10191 Authorization for Transportation to-an Approved Facility for Examination Without'a Warrant (Under Section 302(a) (2)) For use in emergency situations when the Administrator orally authorizes a responsible person to take a patient to a designated facility for examination 'without a warrant. When such authorization of a County Administrator or designee is obtained by telephone, the documentation below is required: ' NAME OF PERSON REQUESTING AUTHORIZATION DATE/TIME OF CALL/AUTHORIZATION REASON FOR ORAL AUTHORIZATION NAME AND TITLE OF PERSON GIVING THE AUTHORIZATION I swear or affirm that I porsonally obtained authorization for transporting the patient to Carl isle Reoional Medical Center from the above-named (FACILITY) Administrator or his/her representative and that I was advised that documentation of this telephone call is maintained in the Administrator's files. NAME AND ADDRESS Cumberland & Perry Counties Crisis Intervention (West) Carlisle Regional Medical Center 246 Parker Street Carlisle, PA 17013 Crisis Intervention RELATIONSHIP TO PATIENT 01948D PAGE 4 OF 7 (Check .4, or B) P [I WARRANT Based upon representations made to me by (NAME OF APPLICANT) shall be taken to I hereby order that (NAME o~ PERSON) and examined at and if required, (NAME OF FACiLiTY) shall be admitted to a facility designated for treatment for a period of time not to exceed 120 hours. Name of facility designated for treatment if other than the facility conducting the examination: SIGNATURE OF COUNTY ADMINISTRATOR OR HIS/HER REPRESENTATIVE DATE PRINT NAME OF COUNTY ADMINISTRATOR OR HIS/HER REPRESENTATIVE DENIAL OF WARRANT The request of the petitioner for a warrant is denied: SIGNATURE OF COUNTY ADMINISTRATOR OR REPRESENTATIVE DATE PART IV THE PATIENT'S RIGHTS Carlisle Regional Medical Center I affirm that when the patient arrived at (NAME OF FACILITY) I explained his rights to him/her. These rights are described in Form MH 783-A. I believe that ~r~ does understand these rights. ~D0{/dt'~ ~O//~./~ ~_~jt~_. ~Y-~ ~¢/z/d'l'r~e/~'~t~// ~-~ does not understand S IGNAT[,JRE~F PRINT NA ME,~ F,~ ACTIONS TAKEN TO PROTECT THE PATIENT'S INTEREST I affirm that to the best of my knowledge and belief the following actions which were taken constituted all reasonable stel~ needed to assure that while the patient is detained the health and safety needs any of any his/her dependents are met and that his/her personal property and the premises he/she occupies are secure. Describe the actions taken below. Use additional sheets if required. / DATE I affirm that and was examined by me at 'INDINGS: (Describe PA. VI PHYSICIAN'S EXAMINATION I0' if)/. (EXACT 3'IME) RESULTS OF EXAMINATION in detail. Use additional ~heets if {EXACT TIME) N~.I)ED· (Describe the treatment oeeded b~ the patient. Continue on additional sheets if n~_.?~ary). TREATMENT In my opinion: (Check A or B) A. ~ The patient is severely mentally disabled and in need of treatment. He should be admitted to a facility designated by the County Administrator for a period of treatment not to exceed 120 hours. Bo The patient is not in need of emergency involuntary treatment. He shall be returned to a place which he shall reasonably designate. SIGNATURE OF EXAMINING pHYSICIAN DATE PRINT NAME OF EXAMINING PHYSICIAN PAGE 7 OF 7 MH 783 10191 019480 IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS OF RUTH A. MARPLES : CUMBERLAND COUNTY, PENNSYLVANIA : : ORPHANS' COURT DIVISION : NO. 21-03-668 IN RE: PETITION FOR APPOINTMENT OF EMERGENCY GUARDIAN OF THE ESTATE AND PERSON OF RUTH A. MARPLES IN ACCORDANCE WITH 20 PA. CONS. STAT. SECTION 5513. BEFORE OLER, J. OPINION and ORDER OF COURT OLER, J., August 14, 2003. At issue in the present case is whether Ruth A. Marples should be adjudicated an incapacitated person on an emergency basis and, if so, whether Petitioner, Rodney David Pickett, should be appointed emergency plenary guardian of her person and estate. A hearing was held in this matter on August 14, 2003. The allegedly incapacitated person was present and represented by her court-appointed counsel, Frederick I. Huganir, Esquire. Based upon the evidence presented at the hearing, the following Findings of Fact, Discussion, and Order of Court are made and entered: FINDINGS OF FACT 1. The allegedly incapacitated person is Ruth A. Marples, who presently resides at the Holy Spirit Hospital in Cumberland County, Pennsylvania. 2. Petitioner is Rodney David Pickett, an adult individual residing at 22402 North Jermain Lane, Colbert, Washington, 99005. Petitioner is a son of the allegedly incapacitated person. 3. Ms. Marples suffers from schizophrenia. 4. As a consequence of this illness, Ms. Marples' ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that she is totally unable to manage her financial resources and totally unable to meet essential requirements for her physical health and safety. 5. Ms. Marples~ symptoms have unfortunately reached the point that, given the absence of supportive resources, she is in need of a limited guardian of her person with respect to decisions regarding medical treatment for a serious condition of anemia on an emergency basis. 6. The failure to appoint such a guardian will result in irreparable harm to the person of Ruth A. Marples. 7. The duration of the necessary guardianship of the person to be provided for herein shall be as long as permitted by law, but, because the guardianship has been requested on an emergency basis, by statute the emergency guardianship of the person may not extend beyond 72 hours in the absence of further order of court (and in no event may continue for more than 20 days thereafter). 8. The foregoing Findings of Fact are made on the basis of clear and convincing evidence. DISCUSSION Under Pennsylvania law, an emergency guardian of the person and/or estate may be appointed in the case of a person alleged to be incapacitated "when it appears that the person lacks capacity, [the person] is in need of a guardian[,] and a failure to make such appointment will result in irreparable harm to the person or estate of the alleged incapacitated person." Act of June 30, 1972, P.L. 508, Section 2, as amended, 20 Pa. C.S. Section 5513 (Supp. 2003). An "incapacitated person" means an adult whose ability to receive and evaulate information effectively and communicate decisions in any way is impaired to such a significant extent that he [or she] is partially or totally unable to meet his [or her] financial resources or to meet essential requirements for his [or her] physical health and safety. Id. Section 5501. Proof in such a case should be by clear and convincing evidence. Id. Sections 5511(a), 5513. In the present case, Petitioner has demonstrated by clear and convincing evidence that an emergency adjudication of incapacity and appointment of a limited guardian of the person on an emergency basis are appropriate. For this reason, the following order will be entered: ORDER OF COURT And now, this 14th day of August, 2003, upon consideration of Petitioner's Petition for the Appointment of Emergency Guardian of the Estate and Person of Ruth A. Marples in Accordance with 20 Pa. Cons. Stat. Section 5513, and following a hearing, it is ordered, adjudicated, and decreed as follows: 1. Ruth A. Marples is adjudicated an incapacitated person on an emergency basis. 2. Her son, Rodney David Pickett, is appointed emergency limited guardian of Ms. Marples' person for the purpose of authorizing such medical treatment as he deems appropriate, after consultation with medical professionals, for the purpose of alleviating a life-threatening condition of anemia. 3. This limited guardianship of the person shall extend for a period of 72 hours subject to the guardian's right to apply for an extension of 20 additional days. By the Court, /s/ J. Wesley Oler, Jr. J. Wesley Oler, Jr., J. David W. DeLuce, Esquire For the Petitioner Frederick I. Huganir, Esquire Court-appointed for Ruth A. Marples :lfh IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS OF RUTH A. MARPLES : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 21-03-668 ORDER OF COURT And now, this 14th day of August, 2003, upon consideration of Petitioner's Petition for the Appointment of Emergency Guardian of the Estate and Person of Ruth A. Marples in Accordance with 20 Pa. Cons. Stat. Section 5513, and following a hearing, it is ordered, adjudicated, and decreed as follows: 1. Ruth A. Marples is adjudicated an incapacitated person on an emergency basis. 2. Her son, Rodney David Pickett, is appointed emergency limited guardian of Ms. Marples' person for the purpose of authorizing such medical treatment as he deems appropriate, after consultation with medical professionals, for the purpose of alleviating a life-threatening condition of anemia. 3. This limited guardianship of the person shall extend for a period of 72 hours subject to the guardian's right to apply for an extension of 20 additional days. By the Court, IN RE: ESTATE OF RUTH A. MARPLES IN THE COURT OF COMMON PLEAS OF CUMBERLAND cOUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE ORDER OF COURT AND NOW, this 13th day of August, 2003, the Cumberland County Sheriff's Office is authorized to transport Ruth A. Marples between Holy Spirit Hospital and the Cumberland County Court House, Carlisle, Pennsylvania, on August 14, 2003, for a hearing in the above-captioned matter. BY THE COURT, David W. DeLuce, Esq. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Petitioner Frederick I. Huganir, Esq. Law Offices of William E. Miller, Jr. 1822 Market Street Camp Hill, PA 17011 Court-appointed attorney for Ruth A. Marples Sheriff's Office IN RE: ESTATE OF · RUTH A. MARPLES · IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE ORDER OF COURT AND NOW, this 19th day of September, 2003, the hearing previously scheduled in the above matter for 2003, at 9:30 a.m., Pennsylvania. September 19, 2003, is rescheduled to Monday, September 22, in Courtroom No. 1, Cumberland County Courthouse, Carlisle, BY THE COURT, David W. DeLuce, Esq. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Petitioner Frederick I. Huganir, Esq. Law Offices of William E. Miller, Jr. 1822 Market Street Camp Hill, PA 17011 Court-appointed attorney for Ruth A. Marples Sheriff's Office IN RE: ESTATE OF · RUTH A. MARPLES · IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE ORDER OF COURT AND NOW, this 19th day of September, 2003, the Cumberland County Sheriff's Office is authorized to transport Ruth A. Marples between Holy Spirit Hospital and the Cumberland County Court House, Carlisle, Pennsylvania, on September 22, 2003, at 9:30 a.m., for a hearing in the above-captioned matter. BY THE COURT, David W. DeLuce, Esq. 301 Market Street P.O. Box 109 jLemoyne, PA 17043-0109 Attorney for Petitioner Frederick I. Huganir, Esq. X,, Law Offices of William E. Miller, Jr. 1822 Market Street Camp Hill, PA 17011 Court-appointed attorney for Ruth A. Marples Sheriff's Office IN RE: ESTATE OF · RUTH A. MARPLES · IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-668 PETITION PURSUANT TO SECTION 3511 OF THE PROBATE, ESTATES AND FIDUCIARY CODE TO ADJUDICATE RUTH A. MARPLES TO BE INCAPACITATED AND TO APPOINT GUARDIANS FOR HER PERSON AND HER ESTATE PRELIMINARY DECREE AND NOW, this 27th day of August, upon consideration of the above petition, it is ordered and decreed that a hearing on this matter is scheduled for Friday, September 19, 2003, at 9:30 a.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania, and that a Citation be issued to Ruth A. Marples commanding her to show cause why she should not be adjudicated an incapacitated person pursuant to the Petition of Rodney Pickett to have Ruth A. Marples adjudicated an incapacitated person and to have a plenary guardian appointed for her person and her estate. Notice of the hearing shall be given to Rule A. Marples in accordance with 20 P.S. §5511(a) not less than twenty days prior to the hearing. BY THE COURT, fDavid W. DeLuce, Esq. 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Petitioner Frederick I. Huganir, Esq. Law Offices of William E. Miller, Jr. 1822 Market Street Camp Hill, PA 17011 Court-appointed attorney for Ruth A. Marples IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS OF RUTH A. MARPLES : CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES, AND FIDUCIARIES CODE TO ADJUDICATE RUTH A. MARPLES TO BE AN INCAPACITATED PERSON AND TO APPOINT GUARDIANS FOR HER PERSON AND ESTATE BEFORE OLER, J. OPINION and ORDER OF COURT OLER, J., September 22, 2003. At issue in the present case is whether Ruth A. Marples should be adjudicated an incapacitated person, and, if so, whether her son, Rodney David Pickett, should be appointed permanent plenary guardian of her person and estate. A hearing was held on this matter on September 22, 2003, which incorporated the testimony and exhibits from a hearing held on August 14, 2003. Based on the evidence presented at the hearing, the following Findings of Fact, Discussion, and Order of Court are made and entered. FINDINGS OF FACT 1. The allegedly incapacitated person is Ruth A. Marples, who presently resides at the Holy Spirit Hospital in Cumberland County, Pennsylvania. 2. Petitioner is Rodney David Pickett, an adult individual residing at 22402 North Jermain Lane, Colbert, Washington, 99005. incapcitated person. 3. schizophrenia. Petitioner is a son of the allegedly Ms. Marples suffers from chronic paranoid 4. As a consequence of this illness, Ms. Marples' ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that (1) she is unable to manage her financial resources with respect to her medical and mental health treatment and (2) she is totally unable to meet essential requirements for her physical health and safety. 5. Ms. Marples' symptoms have unfortunately reached the point that she is in need of a permanent limited guardian with respect to her estate and a plenary permanent guardian with respect to her person. 6. The duration of the necessary guardianships of the person and estate are at this time of an indefinite nature and must therefore be considered permanent. 7. The foregoing Findings of Fact are made on the basis of clear and convincing evidence. 8. The subject of these proceedings, Ruth A. Marples, chose not to attend the hearing on September 22, 2003, in person, but was represented by her court-appointed attorney, Frederick I. Huganir, Esquire, at the hearing. DISCUSSION The provisions respecting an adjudication of incapacity are contained in 20 Pa. C.S. Sections 5501 et seq. Petitioner has substantially complied with these provisions, and based upon the foregoing Findings of Fact the following order of court will be entered. ORDER OF COURT AND NOW, this 22nd day of September, 2003, upon consideration of the Petition Pursuant to Section 5511 of the Probate, Estates, and Fiduciaries Code To Adjudicate Ruth A. Marples To Be Incapacitated and To Appoint Guardians of Her Person and Estate, and following a hearing on the issues presented, Ruth A. Marples is adjudicated an incapacitated person and, pursuant to the foregoing findings of fact, her son, Rodney David Pickett, who resides at 22402 North Jermain Lane, Colbert, Washington, 99005, is appointed permanent limited guardian of her estate for purposes of authorizing all expenditures deemed necessary for medical and mental health treatments, residency and transportation of Ms. Marples and is appointed permanent plenary guardian of her person. The guardian is directed to file reports in accordance with the provisions of the Probate, Estates, and Fiduciaries Code applicable to such guardianships. case. No bond shall be required of the guardian in this Ruth A. Marples is hereby notified of her right to appeal to the Pennsylvania Superior Court from the adjudication herein and to petition at any time for a modification or termination of the order herein. By the Court, /s/ J. Wesley Oler, Jr. J. Wesley Oler, Jr., J. David W. DeLuce, Esquire For the Petitioner Frederick I. Huganir, Esquire Court-appointed counsel for Ruth A. Marples : lfh IN RE: ESTATE OF RUTH A. MARPLES : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION : NO. 21-03-668 IN RE: PETITION PURSUANT TO SECTION 5511 OF THE PROBATE, ESTATES, AND FIDUCIARIES CODE TO ADJUDICATE RUTH A. MARPLES TO BE AN INCAPACITATED PERSON AND TO APPOINT GUARDIANS · FOR HER PERSON AND ESTATE BEFORE OLER, J. ~ ORDER OF COURT · AND NOW, this 22nd day of September, 2003, upon consideration of the Petition Pursuant to Section 5511 of the Probate, Estates, and Fiduciaries Code To Adjudicate Ruth A. Marples To Be Incapacitated and To Appoint Guardians of Her Person and Estate, and following a hearing on the issues presented, Ruth A. Marples is adjudicated an incapacitated person and, pursuant to the foregoing findings of fact, her son, Rodney David Pickett, who resides at 22402 North Jermain Lane, Colbert, Washington, 99005, is appointed permanent limited guardian of her estate for purposes of authorizing all expenditures deemed necessary for medical and mental health treatments, residency and transportation of Ms. Marples and is appointed permanent plenary guardian of her person. The guardian is directed to file reports in accordance with the provisions of the Probate, Estates, and Fiduciaries Code applicable to such guardianships. No bond shall be required of the guardian in this case. Ruth A. Marples is hereby notified of her right to appeal to the Pennsylvania Superior Court from the adjudication herein and to petition at any time for a modification or termination of the order herein. By the Court, ~___j~/~ J. Wesley Qle'~ David W. DeLuce, Esquire ~ . For the Petitioner ~.-.-~.' Frederick I. Huganir, Esquire '~ Court-appointed counsel for Ruth A. Marples :lfh AUTHORITY TO PAY COURT APPOINTED COUNSEL SEP 2 4 2003 0 District Justice ]~Common Pleas 0 Appellate [] Other _ 8 2 3. FOR (D.J., C.P., APPEl_LATE) 4, AT (CITY/STATE) 5. BUDGET CODE n'l ~. T Carlisle, PA 6. IN THE CASE OF .... ~ ~ ' 7. CHARG~OFFENSE (PURDON CITATION) 8. 0 P~ OFFENSE Estate of ~tONY ~ ~MD~NOm 9. PROCEEDINGS (Describe briefly) 11. PERSON REPRESENTED 12. CIVIL DOCKET NO. ,o o.,..u..,-*u.,, 21-03-668 Petition for Plena~ ~ardian of ~ o 3 Q ao~ellan~ 13. CRIMINAL DOCKEY NO. 4 ~ Estate and Person ~ $ ~ ~ Material W~lnes~ ~ O Parolee Cba~ged Wi~h Violation 10. PERSON REPRESENYED (Full Name) 80 P,ob,~one, Cbs,ged Wilh Violation 14. APPEALS OOCKEY NO. Ruth A. ~rples ~ ~ 13 Aug 2003 ~s~ ~A~ o~ A~Om~W~AV~ A~ Da~e MAILING ADDRESS J. Wesley Oler, Jr. ~R ~ OFFICES P.O. Box 308 NAME OF COMMON PLEAS JUDGE ASSIGNED TO CASE Carlisle, PA 17013-0308 CLAIM FOR SERVICES OR EXPENSES 19. .. SERVICE HOURS DATES ~ ~, AMOUNTS CLAIMED a. Arraignment an~o~ Plea M~ply rate ~r ho~r times lolal h~-s to oblain "In CouP" com. b. Prelimina~ Hearing ~nsation. Enter total below. c Motions and R~ue~ls ~ ~ Boil Hearing~ e. Sentence Hosings ~ f. Trial Z g. Rev~alion Hearings h. Juvenile Hearings · · i.Ag~eals Cou~ I~k~TOTAL IN COURT CO~P. 20. la. Inte~iews and conferences Multiply rate ~er hour times total hours. Enter total "Out ol Coup" ~ Obtaining and reviewing r~ords com~nsation ~low. ~~ ~ c L~al research and ~ief writing ~ ~ d. In~sdgad~ ~d o~er w~k (S~ ~ addi~n~ ~eem) .. ~ 20~ TOTAL OUT OF COURT 7.4 ~ TOTAL HOURS = ~PERH~R = s $333 2~. I~MIZATION OF REIMBURSABLE EXPENSES AMI PER I~M Mileage $.25 ~r mile x Z 21k TOTAL ITEMIZED EXP. O 22. CERTIFICATION OF A~ORNEY/PAYEE/~ 23. GRAND TOTAL C~IMED Has oompensalion ancot reimbumemenl f~ ~0~ Ilyes. were you paid? ~ YES ~ NO Ifye~bywho~e~l~ Howmuch?. Has the person ,eDresent~ ,aid any money to yo~~~le~e ~e elae. In connection wit~ the ma,er for whic~ you were appointed to ~ovide representa~? 0 ~S 0 ~ If ye~ give details on~d~a~heets = $ , swear or affirm the t~th or co,~n., ~ ~ ~//ZZ/~ 7 25. N~ Ap~ C~IM ED 26 ~,.,,,Ov~ bi ' Z f 27. AMT. APPROVED C;py I - Mail to Court Administrator at completion of service HUGANIR LAW OFFICES P.O. Box 308 Carlisle, PA 17013-0308 (717) 249-6272 Invoice submitted to: Cumberland County Court Administrator Cumberland County Courthouse 1 Courthouse Square Carlisle PA 17013 September 22, 2003 Professional Services 8/12/2003 8/13/2003 8/14/2003 8/15/2003 9/2/2003 9/18/2003 9/22/2003 Telephone conference with Ruth Coulson; travel; review documents at Clerk of the Orphan's Court; review documents from Ruth Coulson; legal research regarding plenary guardians under the Code; telephone conferences with David DeLuce. Marples, Ruth A. Travel; consultation with client at Holy Spirit Hospital (refused), meet with witness at hospital. Review records served by Atty DeLuce. Marples, Ruth A. Pre-hearing conference with Atty DeLuce and Judge Oler; Court emergency hearing. Marples, Ruth A. Review documents FAXed from Dave DeLuce Marples, Ruth A. Review court order; correspondence from Atty DeLuce; review petition and proposed order. Marples, Ruth A. Telephone conference with Atty. Deluce; telephone conferences with Judge Oler's chambers. Marples, Ruth A. Review documents Marples, Ruth A. Pre hearing conference with Arty DeLuce; court hearing before Judge Oler. Marples, Ruth A. For professional services rendered HrslRate 4.40 45.00/hr 2.10 45.00/hr 2.00 65.CO/hr d45'.1)0 0.20 45.00/hr 0.20 45.00/hr 0.40 45.00/hr 0.10 45.00/hr 1.00 10.40 Amount a-/6g. O0 Cumberland County Court Administrator Balance due Page 2 Amount .',l b ~. ~ o (Rev. January 2003) Department of the Treasury Internal Revenue Service Name Q. c- O Request for Taxpayer Identification Number and Certification Give form to the requester. Do not send to the IRS. HUGANIR LAW OFFICES Business name, if different from above Individual/ Check appropriate box: [] Sole proprietor Address (number, street, and apt. or suite no.) 36 S. Hanover St, P.O. Box 308 ~---] Corporation [] Partnership City, state, and ZIP code Carlisle, PA 17013-0308 List account number(s) here (optional) Tr~r Identification Numbe~ I Exempt from backup [] Other I~ .................. [] withholding Requester's name and address (optional) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note: If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. ~ Certification or Employer idenUfication number Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the iRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not app y. For mortgage interest paid, acquisition or aban~l~nment of secured property, cancellation of debt, contributions to an individual ret rement arrangement (IRA), and generally, payments ~er than ntc, r. est and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See t~s on page~ ~ Purpose of Form/ / - '~onresident alien who b~/ome~/a' ~--esi-~ent alien. · . /. /... . //./ //~. Generally only a nonresident alien individual may use the .A. pa. r~s~on who ~s. re.qu~re¢l ~e'file an ~nformat~on re~rn~ith terms of '- .......... [ne INs, must obtain yofl~'correct taxpayer identification d tax Lrea[y [o re(3uce or e~m~nate U.S. tax on number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Cat. No. 10231X Form W-9 (Rev. 1-2003)