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HomeMy WebLinkAbout12-2391SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, Pennsylvania 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiff IN RE: ELIZABETH McCLEEREY, a minor. =1L: f_ FFIUH_ 01: '! F; ?FrfJTFl?ftl r"'' 2012 APR 17 PM 3: 54 C AND COUNT' MI YLVA,NfA ms's f?K IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. a6(a D' _39 j Cis' PETITION TO APPROVE COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS AND NOW, comes the Petitioner, EARL W. McCLEEREY, Jr., parent and natural guardian of Elizabeth McCleerey, a minor, by and through their attorneys, SHOLLENBERGER & JANUZZI, LLP, and respectfully represents the following: 1. The Petitioner is Earl W. McCleerey, Jr., of 804 Kent Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050. 2. The Petitioner is the parent and natural guardian of Elizabeth McCleerey, a minor, who was born on May 20, 1996. 3. The Respondent is Christopher McCleerey, of 804 Kent Drive, Mechanicsburg, Cumberland County, Pennsylvania. The vehicle operated by Mr. McCleerey was insured by Encompass Indemnity Company, P.O. Box 16203, Reading, Pennsylvania 19612, and carried bodily injury liability limits in the amount of $100,000.00/$300,000.00. A copy of the Encompass Declarations page is attached hereto as Exhibit "A." 4. The minor, Elizabeth McCleerey, was a rear-seat passenger in a vehicle operated by Respondent that was involved in a serious three-car collision in Silver ?9) QuA %1i1 7SM Ck 14 t -) &3 PO a_? S9 `-l I Spring Township, Cumberland County, Pennsylvania, on October 22, 2010. A copy of the Police Report is attached hereto as Exhibit "B." 5. Elizabeth was one of five minor occupants of the vehicle, all of whom were injured to varying degrees. Four of the injured minors have presented bodily injury claims under the Encompass policy, as have the drivers of the other two vehicles involved in the collision. 6. As a result of the aforesaid collision, Elizabeth was flown by helicopter to Penn State Hershey Medical Center, where she was admitted as a critical trauma patient suffering from the following injuries: A. Severe closed-head injury; B. Left anterior pneumothorax; C. bilateral pulmonary contusions; D. Grade 1 splenic laceration; E. Left clavicular fracture; F. Multiple pelvic and sacral fractures requiring surgical stabilization; G. Soft tissue contusion to left buttock/flank. Copies of relevant portions of Elizabeth's medical records documenting her transport and early treatment following the collision are attached hereto as Exhibit "C." 7. Following more than a week of inpatient treatment at Hershey Medical Center, Elizabeth was transferred to Penn State Hershey Rehab Hospital on October 29, 2010, where she underwent inpatient therapy for her multiple neurological and orthopedic injuries. Copies of medical records documenting Elizabeth's condition at the time of transfer are attached hereto as Exhibit "D." 8. Elizabeth remained in the Hershey Rehab Hospital until her discharge to home on December 22, 2010. 9. After her discharge, Elizabeth has continued physical and occupational therapy three times per week, and has undergone follow-up care with Jeanette C. Ramer, M.D., and Carol E. Copeland, M.D., of Penn State Hershey Medical Center, both of whom have noted Elizabeth's ongoing progress. Copies of Drs. Ramer and Copeland's January office notes are attached hereto as Exhibit "E." 10. As of February 14, 2011, Dr. Ramer has permitted Elizabeth to return to school for one class per day in preparation for her eventual transition back to full-time education. A copy of Dr. Ramer's February 14, 2011, office note is attached hereto as Exhibit "F." 11. As a result of the above-referenced incident and the injuries sustained therein, medical bills were incurred on behalf of Elizabeth that totaled in excess of $200,000.00. As of this date, all medical bills have been paid, no amounts remain outstanding, and no subrogation liens have been asserted. 12. Encompass Indemnity Company has made a global settlement offer to all six claimants for the division of the $300,000.00 policy limit in order to resolve their bodily injury claims. All offers have been accepted pending final approvals and releases. 13. Encompass has offered to resolve Elizabeth's claim for the sum of Ninety Thousand ($90,000.00) Dollars. A copy of Encompass's offer is attached hereto as Exhibit "G." 14. Petitioner believes the offer of settlement is fair and reasonable, and, if approved, agrees to place the funds into a restricted account in the name of the minor in a bank, building and loan association or savings and loan association, deposits of which are insured by a federal governmental agency. Said account shall be titled in the name of the minor, and shall be marked "No withdrawals prior to age 18 without prior court approval." 15. Petitioner is represented by the law firm of Shollenberger & Januzzi, LLP, who is requesting approval of attorney's fees in the amount of 25 percent. A copy of the Contingent Fee Agreement is attached hereto as Exhibit "H." 16. The law firm of Shollenberger & Januzzi, LLP, has incurred litigation costs that were advanced on behalf of the minor. The amount of the recoverable costs incurred to date on behalf of the minor total $1,085.79. Petitioner requests this amount be deducted from the recovery and paid to Shollenberger & Januzzi, LLP. An itemization of all costs is attached hereto as Exhibit "I." 17. The Petitioner requests the court approve the compromised settlement in order to distribute the proceeds as follows: Shollenberger & Januzzi, LLP (attorney's fees) $22,500.00 Shollenberger & Januzzi, LLP (reimbursement of costs advanced) 1,085.79 Earl W. McCleerey, Jr., parent and natural guardian of Elizabeth McCleerey, a minor, for deposit into a $66,414.21 restricted bank account 18. Petitioner requests that, upon approval of the proposed compromised settlement and receipt of the proceeds thereof, he be authorized to execute a good and sufficient release of any further liability against the Respondent named herein. 19. Petitioner agrees to provide the court with an Affidavit of Deposit of Minor's Funds within ten (10) days of the date of the Court's Order. WHEREFORE, Petitioner requests this Honorable Court approve the Compromise Settlement and Distribution of Proceeds as set forth herein. Respectfully submitted, SHOLLENBERGER & JANUZZI, LLP BY: KFfA 2 Millennium Way Enola, PA 17025 717-728-3200 Dated: April jb, 2012 ?????? r 0 cmov Encompass pie -, - .. ..-???.NWC? ?r .-,. ,.Yw. ?. ? ?.. ?(.r k. ...w SS.':.?(..?\.. _.tiVSR?l...C. _.L. ,. .. '?h?:?.:n .. - i 1.ti'.:t:. Periicyholder: Agent: EARL W MCCLEEREY JR MOTOR CLUB AGENCY, INC. T/A AAA INS. 5845 ASPEN LN PO 'BOX 1354 ENOLA PA 17025-3308 HARRISBURG PA 17110 PHONE; 800-853-8915 470.020698-0000 Policy Nwnbsr: Poky Period: Pakyltoider Since: 280943453 03/36/2010 to 03/26/2011 14:01 AM Standard Thne 03/2006 Insurance ProvidM! By: Encompass Indmnity Company 24 HOUR CLAIM REPORTING 800-588-7400 2775 sanders Rd.; Northbrook, IL 60062-6127 YOM POLICY HAS BEEN CHA D A change in insurance coverage for your 2006 LINCOLN L9 Added Stacking to Uninsured & Underinsured Motorists coverage Revised Annual Policy Premium 3,744.00 Additional Premium for Coverages From 05/07/2010 to 03/26/2011 8 48.00 "ft 0gvelt PowMlll' p >". 00 40hpiells Polo N. *o1M0ft iM wwoe chow. ow Vw 0"00" *W100" In, 6%4 IMPORTANT INFORMATION ABOUT YOUR POLICY WE PROVIDE COLLISION COVERAGE FOR A MON-OWNED PRIVATE PASSENGER MOTOR VEHICLE RENTED BY YOU, DURING THE TERM OF THIS POLICY, IF AT LEAST ONE OF YOUR AUTOS SWWN SMOW HAS COLLISION COVERAGE. (THE COLLISION COVERAGE WE PROVIDE IS SUBJECT TO THE LOWEST APPLICABLE DEDUCTIBLE.) PLEASE REVIEW YOUR POLICY FOR COVERAGE DETAILS. There is not a hunpoSne located on your props . You do not have a woodburnhn stove. MOTOR VEHICLE PROTECTION - DELUXE (Came apon only N a preen wn or Bruit Is shown) Vehicle 2 VehkN 3 Deecriptlon: VIN: Rated Dri-wer. Use: Class Code: BODILY INJURY (per person/per accident) PROPERTY DAMAGE (per accident) LIMITED TORT OPTION 280943453 2006 LINCOLN LS 2010 FORD FUSION 1LNHM87A36Y600229 3FAHPODC6AR115597 EARL W MCCLEEREY JR JAMIE A MCCLEEREY Pleasure Work 3.1-9.9 2300 2302 wm" "W~ 61" .; 1.11.11 3 100,000/300,000 99.00 E 100,000/300,000 4 110.00 # 50,000 84.00 3 50,000 $ 92.00 Applies ?1 -;?" PnwWwm Gnntinijad nn °NPvt Pslne Applies MOTOR VEHICLE PROTECTION - DELUXE (Cow w appNes only N a prw wn or Nmit Is ahem) Vehicle 2 , .. Vehicle 3 I? UNINSURE MOTORISTS- 4 100,000/300,000 25.00 $ 100,000/300,000 25.00 STACKED LIMITS (per person per accident) UNDERINSURED MOTORISTS- i 100,000/300,000 p 76.00 s? 100,000/300,000 s 76.00 STACKED LIMITS (per permVper accident) FIRST PARTY BENEFITS (FPS) COVERAGE; ADDED FPS COVERAGE 24.00 ¢ 33.00 Medical Expense Benefit 4 10,000 10,000 Work Loss Benefit : 1,000/S,000 1,000/5,000 (per month/maximum) Funeral Expense Benefit a# 1,500 8 1,500 Accidental Death Benefit Excluded Excluded COMPREHENSIVE (Comp) 100 Deductible 8 78.00 4 100 Deductible a 121.00 COLLISION (Coll) 500 -Deductible $ 259.00 $ 500 Deductible a 398.00 AIR BAG REPLACEMENT Per Endorsement $ Included Per Endorsement s Included COVERAGE ACCIDENTAL DEPLOYMENT DEDUCTIBLE WAIVER Deductible will be waived If your windshield Is repaired, not replaced. REPAIRIREPLACEMENT VALUE Per Endorsement $ Included TOWING 50 s# 11.00 ; 50 11.00 EXTENDED TRANSPORTATION Rental Reimbursement +fr 30/900 # 30/900 Per Day/Maximums 30.00 Per Day/Maximum s 30.00 Trip Interruption s 100/500 8 100/500 Per Day/Maximum $ Included Per Day/Maximum s Included Emergency Transportation ¢ 20 4 Included 20 $ Included Pramium Per VehkA* 8 686.00 s 896.00 Vehk% 4 Vehkde Desaipdon: 2001 VOLKSWAGEN JETTA VIN: 3VWSK69MI1M098236 Rated DrIw. CHRISTOPHER M MCCLEERE Use: Pleasure Class Code: 2100 BODILY INJURY (per person/per accident) PROPERTY DAMAGE (per accident) LIMITED TORT OPTION 280843453 4 100,000/300,000 5 271.00 50,000 s 218.00 Applies Continued on Next Pane _ OEncompass- cr"*v.P060M W%XW you t _t MOTOR VEHMU PROTECTION - DELUXE (Coverage applies only If a premium or ft* is shown) Vehicle 4 Vehicle ?-'_- UNIN$URED MOTORISTS. 100,000/300,000 * 25.04 STACKED LIMITS (per person/per accident) UNDERINSURED MOTORISTS- # 100,000/300,000 $ 76.00 STACKED LIMITS (per person/per accident) FIRST PARTY BENEFITS (FPB) COVERAGE: ADDED FPB COVERAGE # 71.00 Medical Expense Benefit p 10, 000 Work Loss Benefit $ 1 000/5, 000 (per month/maximum) Funeral Expense Benefit 8 1,500 Accidental Death Benefit Excluded COMPREHENSIVE (Comp) p 500 Deductible $ 66.00 COLLISION (Coll) 750 Deductible 3 471.00 AIR BAG REPLACEMENT Per Endorsement 9 Included COVERAGE ACCIDENTAL DEPLOYMENT DEDUCTIBLE WAIVER Deductible will be waived if your windshield is repaired, not replaced. TOWING d 50 $ 11.00 EXTENDED TRANSPORTATION Rental Reimbursement a_ 30/900 Per Day/Maximum j 30.00 Trip Interruption $ 100/500 Per Day/Maximum ¢ Included Emergency Transportation 20 i included Premhmh Per Vehicle 9 1,239.00 1 ?. Lou Free Discount Applied Applied Youthful Good Student Discount Applied Anti-Lock Brake Discount Applied Applied Applied Passive Restraint Discount (Driver and Applied Applied Applied Passenger side) Anti-Theft Discount (Passive Device) Applied Applied Applied Encompass Easy Pay Plan Discount Applied Applied Applied Tor" VOW" PfW14 Wo -AM 4IN"t11 Dbmxsats And Charges For AN Vehicles Package Discount Applied Your Tool Premium For AN Vehicles 8 2,821.00 280843453 l r"nnfiniiari nn Navt Dana' MOTOR VEHICLE PROTECTION - DELUXE (Coverage applies only if a prw t or Nneit Is shown) IMPORTANT INFORMATION ABOUT YOUR MOTOR VEHICLE COVERAGE Below are annual pnmhsns for Uw mhelmwn required coverages ahd limits for Umlled Tart. Pleme note that the LhniMd Tort option may not be available on corlain vehicles. Vehicle 2 Vehicle 3 Vehicle 4 Bodily Injury $15,000/Person $30,000/Accident $ 67.00 $ 73.00 $ 166.00 Property Damage $5.000/Accident 76.00 $ 85.00 $ 196.00 First Party Benefits Medical Expense $5,000 $ 4.00 $ 10.00 $ 35.00 DRIVER II1111'ORMATION Name Date L.icensmd Dols of Birth 01 EARL W MCCLEEREY JR 10/01/1978 10/01/1961 02 JAMIE A MCCLBERSY 09/17/1977 09/17/1961 03 CHRISTOPHER M MCCLEERE 04/29/2010 10/10/1993 Loan Nom ON W Type of interest Lienholder INTERESTED Vahkle 1 FORD MOTOR CREDIT COMPANY (RETAIL) P O Box 390910 MINNEAPOLIS MN 55439.0910 Vehicle 3 CITIZENS AUTO FIN PO BOX 25587 SCRAMENTO CA 95865 Lose umber Type of I Rent Lienholder HOME PROTECTION - ELITE (Coverep applies only If e promhoo or Omit Is shown) Residemm 1 Description: 5845 ASPEN LN, E OLA, PA 17025 of 0"Opow Pl2faiERTY LOCATION iaMIT 0 628 , 200 923.00 Property Deductible 500 Your location limit is 200 % of the estimated residence value of $ 314,100 The location limit is the total amount of insurance on your dwelling, contents and other structures at this location. 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I i f z ? } E 4 < Matal! _ lII011? t MICHAEL SEAVERS 6 KEYSTONE DRMECHANIC'SBURG PA 17050 7176975717 2 Silver Spring Township Police were dispatched to an auto accident in the area of 6853 Wertzvile Rd for an auto accident with unknown injuries. Upon my arrival I saw'there were 3 cars involved. There were several people standing around a blue Volkswagen Jetty that was severely damaged. It was sitting facing southwest in the middle of the roadway. I approached the wreckage and saw there were 5 people in the Jetta. There was a silver BMW that had heavy front end damage that was sitting in front of the Jetta in the eastbound lane (mostly) of travel, There was a female in the drivers seat. On the opposite side of the road was a cream eolored? SUV. The rear drivers side door of the SUV had a large dent and blue paint on it. There was an older female standing outside of it. I advised county of the situation and requested more EMS units as well as aero-medical. There were a total of 5 people in the car. The front seat passenger was awake and looking around. He looked really dazed and did not say too much. There were three people in the back seat, The rear passenger side passenger was leaning over the center passenger which was a female. The female was bent over at the waist with her head stuck between the front bucket seats. I cut the side curtain airbag with my knife in an attempt to get better access to the occupants. I tapped the male that was slumped over the female to try and get a rm.Sa"..rarae KMOOT COPY i http://www.dot6 state.pa.us/crsapp/Printlmages/XmiFiles/2010102644201011 180907427... 11/18/2010 • Print CRS W0181360 Page 10 of 11 t90111i1MOii1!lry?N TM Of POINM AArMA 1MOM 0111" tvlOM'tOM4 POW O t+Mw o,.* .e M WO N AI-oN oar -----? go O W0181360 a www?,v??w PERU= Cc" http,//www.dotb.state.pa.us/crsapp/Printlmages/XrnIFiles/2010102644241011180907427... 11/18/2010 urn wrd a6l6wi l wfsw?c response and there was none. I then tried to pull him up to assess his Iffe status but was unable to I Wenf to the drivers side rear and saw the rear passenger looking out the window. His eyes were open; he *as bleeding from the mouth, moaning and unresponsive. The driver appeared to be trapped by the legs 'by the dash. His left arm was sticking out the window and he, too, was unresponsive. The passengers side of the car looked like it had been t-boned. I attempted to hold c-spine stabilization on the rear drivers side passenger. At I was doing this a firemen from Hampden arrived. He took over stabilization. I continued to attempt to get a response from the other occupants with no luck (except for the front seat passenger.) As I was doing this EMS personnel started to arrive. I made contact with the driver of the BMW and asked If she was ok. She said that she thought so. I asked if she remembered what had happened. She said she wasnt sure. I told her to remain in her vehicle, locate her drivers license, registration and insurance and that I would be back with her. I then approached the female that was standing by the SW I asked her if she was ok and she said that she was. I asked if she knew what happened. She said that she was stopped to make a left onto Beard Rd. (from Wertzviile Rd, Westbound). She looked back and saw the car flying up on her. She said that she knew he wasnt going to get stopped but she does not recall what she did after seeing him coming. While I was gathering information, the front seat passenger, Vincent Termin, was placed in the rear of my police car while EMS was extricating the rest of the occupants from the car, so that he could stay warm. Officer Walters had requested he provide names of the others in the car with him. While I was in the czar with him he was very talkative and believed he had a concussion. The nature of his talking was about 'his injuries. I did ask a few questions about the accident but he was not sure what happened. The county crash team was called to assist with the crash scene. On 10/24/10 1 spoke to Vincent Termin (front seat passenger) at his residence after he was released frdbrn the hospftal. He stated that he had some minor injuries, scratches & bruises, but nothing serious. I asked him to tell what happened on Friday morning, the best he could remember. He stated that he walked to Chriss house (driver) so they could ride to school together. This is not a normal occurrence and is, maybe, only the 2nd or 3rd time hes gone to school with Chris. The female, Chriss, sister, Elizabeth, (middle, rear passenger) got in the car at the house as did Pez. (Anthony Pesavento. drivers side Print CRS WO 181360 Page 11 of 11 I:ti>Iib'pifitl?lli?AL101 of tlOt M1MV POW MtIN Ittl?ORTt G POW +'•r O NM o.?i t?wir l i GNWOl813tsi) M SOO N ,,wow Q L 4--1 I v lbIgNx rear passenger). They then went to the other and of the development and picked up Ben Shears (passenger side rear passenger). It was a pretty quiet ride and Vincent said that he was tired and just looking out the passengers side window for most of the ride. He believes that Elizabeth was listening to her Pod 8 that Pez had an Pod that was plugged into the stereo with a long cord and he was controlling the music they were listening to through the car stereo. He remembers someone song Chris! Look out! and he turned his head to see the SUV in front of them. He doesnt recall seeing the lights of the SUV being on. He said after the crash happened he remembered looking around the cat. He called to several of the others and got no response. He does not recall Chris being on the phone. While talking to him he said that he Doesnt know what distracted him. He stated that Chris was distracted but, since he was looking out the window, doesnt know by what. County Crash Team to complete diagram & other Investigative items. oo 1 Di COPY http: //www .dot6. state. pa. u s!crsapp/Printi mages/XmIFiles/2010102644201011180907427... 11/18/2010 ,too Patient Name: MCCLEEREY, ELIZABETH A Date of Birth: 5/20/1996 MRN: 7508540 FIN: 10508540 UndirAl RPA-nrd Niimhor / ?fS f1 -6,1 Rw kdw"xWbn PNNer ownw ww" j Request #: 1010-0855-A Svc Date: 10/22/201 Name: McCleary, Elizabeth 4j Type: Helicopter Air- On-scene (Traum Addy. 5845 Aspect Lane Priority: Emergent ` Dispo: Patient Transported Enoia, PA 17025 DOB: 0512011996 ?LO01?Q" Age: 14 yrs Sex: F Name: Cumberland County Comm SS: - - . Race: White / nor-Hispanic Carlisle, PA 17013 Next of Kin: a 0 Scene: Location: Silver Spring twp (Cumberl Loc County: Cumberland PA Lac CSZ: ENOLA, PA 17025 Erwot 1kmw Call Rcvd: 07:3923 on 10/22F MO i# RsvA*VAgw -y I Name: Perot We Hershey Mod Center Notify PIt:. 07:39:58 on 10/221201b ? Hershey, PA 17033 W x Confirm: 07:40:08 Unit: Emergency Department Respond: 07:43:42 Ar Bedside: 911 :02:00 Rec MD: Liftoff: 07:50:27 Dp Bedside: 08:16:35 Arrive 1: 07:59:00 711 Depart 1: *08:16:35 Crew 1: Carr, Joe JJC Arrive 2: *08:26:21 awpwd ? nwr/ y Crew 2: Cate, Elisabeth ERC Depart 2: 011:28:20 Dispatch: 0 Crew 3: Arrive 3: 08:29:49 Wx Check: 1 i f Crew 4: liftoff: 7 Response: 11 Pilot 1: Balda, Joseph Fry to Pt: 9 Dispatcher: Alessi, Charles Fly with Pt: 10 Other Fit: 1 Tot Leg Time: 20 On Scene: 17 Bedside: 14 Ident: NMSJ (Dauphin 365-N1) Total Crew: 76 /Breelr 7Arw Loaded Miles: 18 am (PtoP); Actual: 22 em In Service: 08:59:50 Total Miles: 30 am Max.-Alt- 0 Completed: 08:59:50 on 1012MIO i ca"DwyMwwep Ok Category: AduW Trauma Pt Weight: 50 kg Diagnosis: Multiple Trauma Mechanism: Accident- Motor Vehicle Allergim. unknown S McCleary, 'Elizabeth. r page. 1 of, 4 Facility: HMC Page 35 of 167 Patient Name: MCCLEEREY, ELIZABETH A Date of Birth: 5/20/1996 MRN: 7508540 FIN: 10508540 .. Fright Request PrMtout Request #:101 0-0955-A Chief Complaint: Motor Vehicle accident Date & Time of Injury / Onset: 102212010 07:35 mil". of Present Nlneae: Lifelion 3 requested for standby and then requested to respond on scene in silver spring township Cumberland county. AOS to find multiple EMS units, fire department and Police on the scene lof a 2 vehicle accident. Providers on scene convey that there are 5 patients who are critical. Life Lion 3 directed to this female teenager who is in ambulance with EMS personnel present. As per EMS this patient was a rear seat passenger of a mid sized sedan that was struck head on. This vehicle has extreme front end damage, pt has been fully immobilized on a LBB. It is unknown whether this patient was restrained. Pt is in rear of ambulance upon arrival and is unresponsive. Pt Is nasally intubated prior to LL arrival. Pt. ventilated via BVM and 1009/0 o2 ftysical lExam: 08:02:00: Skin Assessment: Normal, warm and dry Head/Face Assessment: No gross trauma noted. dried blood noted in nares " Neck Assessment: Normal " Chest/Lungs Assessment: Normal BS, no gross trauma noted Heart Assessment: Not Done Abdomen Left Upper Assessment: Normal Abdomen Left Lower Assessment: Normal " Abdomen Right Upper Assessment: Normal " Abdomen Right Lower Assessment: Normal GU Assessment: Not Done " Hack Cervical Assessment: Not Known Back Thoracic Assessment: Not Known Back Lumbar/Sacral Assessment: Not Known " Extremities-Right Upper Assessment: Normal Extremities-Right Lower Assessment: Normal " Extremities-Left Upper Assessment: Normal " Extremitles-Left Lower Assessment: Normal Eyes-Left Assessment: 4-mm, sluggish Eyes-Right Assessment: 4mm sluggish Mental Status Assessment: Unresponsive, withdraws to painful stimuli Neurological Assessment: decerebrate posturing Past Medical History: Tre?atrrtettt: , Assessed patient, Attached monitors, Medical Command contacted, Moved patient to litter, Patient covered, Patient secured to litter. Pt loaded into aircraft and monitored enroute to HMC. pt ventilated thru transport to HMC. Upon arrival at HMC pt unstable/critical ReportlWan to trauma team by Carr, Joe. lab VaNies: McCleary, Elizabeth Page 2 of 4 Facility: HMC Page 56 of 167 Patient Name: MCCLEEREY. ELIZABETH A Date of Birth: 5120/1996 MRN: 7508540 FIN: 10508540 Flight RsquM PrN*out - Request *-. IWO-MS-A Vital Signs Time NIBP P R Effort 02 Pain Sedation Notes 0ss12 112/58 6] 2D Patigesd 1OStl! ili/60 67 1] 1 0% Vital Asa "Merit Tine EKG TempCS Soore AVPU RTS Glu Notes Os=iS si. MWtba 1 2 !r ]r lis EVMGCS Airway Manbgemsnt Time Ma0sod Rate Conc ETr Tdas SIU Who Notes 08100 Ma- nasal iatvbation it ion 610 a Jic T Rempoaaer gscbaaged; rube secured at ]i eat iaitial Wacaant ocatir'sd by Auscultation of Bilateral Breiath Stands, Negative Auscultation of the !;pigmstriua, visualization of the CAUL Rising with ventilation, aavefosa C02 Coofisatiaal Delivery Placement otnfissad * Anacml.tat CK of Bilateral Br*th saunas, Digital C02 Confirmation, vieissalisation of the Meet Rising with ventilation, Waveform C02 Confirmation; Adiess ft inttiated prior to arrival of! Life Lion IV Fluids and Drip Msdlcations Time Access Method Site Rafe Dose Notes Who Fluid / Medication Infused Ga. Concentration Ot:12 Access- Peripheral Auto b to ra0 al/hr t IWp-. Vac-banged/ Consaiaatioass Mosel JJC Noteal saline 200 18.0 Aathocisaticas Protocol (standing order); Nvtees initiated prior arrival 06:12 Access- Pszipnerai b to TX0 al /hr ; Rosposse: Daeheegad/ Complications: None; JJC Normal saline 200 10.0 Autbarizations Protocol (a"andjns amur)f not": initiated prior arrival Total Intake (Pre-Transport) 400 (During Transport) 0 Total Output (Pre-Transport) 0 (During Transport) 0 L McCleary, Efizabeth Page 3 of 4 Facility: HMC Page 37 of 167 Patient Name: MCCLEEREY. ELIZABETH A Date of Birth: 5/20/1996 MRN: 7508540 FIN: 10508540 F ftht Request Pt irrtout - Request #- 1010.0 WA Place EKG Strip Here SIGNATURES Joseph Carr EMT-P Elisabeth Cate RN McCleary, lfiiabefh Page d of 4' Facility: HMC Page 38 of 167 PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 ..?...? .............m...........,........??..?.w.?......r.?...,.....?.............,.....?.........,....m..?. Consult ,.....,..?.....?...?..........?.m..?................?.?...?....?,.,....r..?..,r,.?...............?......? RESULT STATUS: Modified DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Popernack,Myra L (12/23/2010 19:05 EST); Popernack,Myra L (10/27/2010 23:20 EDT) Addendum by Popernack, Myra L on December 23,2010 19:05 Please note the patient's name was incorrectly documented as Caitlin. The patient information is accurately entered for Elizabeth McCleerey with MRN 7508540 and the correct medical records were reviewed for the consultation. Electronic Signature on File Electronically Reviewed/Signed by.' Myra L Popernadc, CRNP Author Signature Dt/Tm:23.12.2010 07:05 PM MLP DD: 12123110 CONSULT Pediatric Rehabilitation Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Service: 10/22/2010 REASON FOR CONSULT: TBI w/ mobility deficits HPI: Caitlin is a 14 year-old Caucasian female who was a restrained rear seat passenger in a vehicle driven by her older brother, Christopher who is an inpatient in SICU. There were 3 other passengers as well, one of which Was uninjured. No fatalities occured. The vehicle was in a head on crash on 10/22 as the group was driving to school. Caitlin was found unresponsive and restrained in the car per her mother and was intubated at the scene for LOG and posturing. She was transported via Life Lion to the PICU. She had a cough and was moving spontaneously but nonpurpose'fully upon admission. She is receiving prophylactic Keppra and Lovenox. Her injuries include: DAI with subtentorial ischemic brain injury R > L and contusion of corpus callosum,w/ hemorrhagic and ischemic manifestation per MRI on 10/25/10; multiple orthopedic injuries (L distal clavicle fx, bill acetabular fx, b/I inferior/superior pubic rami fx, sacral fx, and pelvic hematoma), b/I pulmonary contusions w/ L small pn6umothorax, and Grade 1 splenic laceration w/ small perisplenic hematoma. On 10125, she underwent surgical stabilization of her pelvic fx with L percutaneous ileo-sacral screw placement and an anterior pelvic ex-fixator. Her cervical and TL Spines were cleared and she was successfully extubated on 10/26. She had an elevation of LFTs 10/26 indicating pancreatitis. She has received multiple doses of Vitamin K for'elevated INR. An NJ was placed and feedings were begun) today. She had an acute oxygen desaturation this morning and was placed on NC oxygen at 2 L. A CXR was negative. Allergies: NKA Medications: Date/Time Printed: 3/25/2011 11:19 EDT Page 14 of 167 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 Consult Senna 5 ml NJ BID Colace 50 mg NJ BID Lovenox 30 mg sq q12 hr lasix 20 mg NJ g12hr Keppra 500 mg IV q12 hr Pantoprazole 40 mg IV g24hr acetaminophen 650 mg PR g4hr prn Pertinent lab results: 10/26 lipase 1067; amylase 184 10/27 lipase 932; amylase 179 HCT stable at 30.7 INR 1.21 PE: Caitlin was being repositioned after a PT treatment sifting at edge of bed with her mother assisting. In NiAD, lying with her eyes closed. She had been reported to have an inconsistent visual fix and following of commands per PT and was able to support herself at the edge of the bed by extending her L arm and fair truncal tone. She reportedly picked up a stuffed animal and threw it at the nurse in response to a venipuncture earlier. Immediately after her PT treatment, I was unable to elicit any response or movement with a sternal rub or shoulder pinch but after I had stopped stimulating her, she used her R hand to pick off the sat probe from her L hand. She has spontaneous but inconsistent purposeful movements of all extremities. Her pupils are equal and react briskly with out abnormal gaze or movements. She has a strong cough and gag. A/P: Caitlin is a 14 year-old female multiple trauma with TBI, splenic lac medically managed, orthopedic injuries with ex-fix stabilization, pulmonary contusions, and pancreatitis. 1. Impaired cognition at Rancho level III with improving responsiveness to stimuli and normal tone 2. Mobility deficits--she has been evaluated by OT and PT with Speech pending. Ortho was to be cleared for BLE WB status today and the ex-fix may remain for as long as 6 weeks per trauma coordinator, Bev Shirk. 3. Lipase is decreasing slightly and feeds are tolerated. She is cardiovascularly stable. I have reviewed the medical record, discussed the case with the trauma coordinator, and discussed my assessment with Dr. Ramer. I have spoken with Caitlin's mother (who is a RN) and encouraged her to tour the Pediatric Rehab. Caitfin would benefit from inpatient intensive multidisciplinary rehab services and may be discharged to rehab when deemed medically stable. Dr. Harry Bramley will be the on-service physician as of 10/28/10. Thank you for the consult and we look forward to providing rehabilitative care to Caitlin and her family. Date/Time Printed: 3/25/2011 11:19 EDT Page 15 of 167 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 75085#0 Consult Electronic Signature on File CC: Harry P Bramley, DO Department of Pediatrics Penn State Milton S. Hershey Medical Center PO Box 850 Hershey PA 17033 Electronically Reviewed/Signed by. Myra L Popernack, CRNP Author Signature Dt/Tm:2710.2010 11:20 PM MLP DD: 10127110 Date/Time Printed: 3/2512011 11:19 EDT Page 16 of 167 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey IV Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 :..? _.? .. ?.~ , w.... ?. w ED Summary _ .? RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Trauma - major Final Trauma - major ONeill,Rory M (11/3/201018:02 EDT) Patient: MCCLEEREY, ELIZABETH A MRN: 7508540 OOS: FIN: 10508540 Age: 14 years Sex: Female DOB: 5/2011996 Associated Diagnoses: None Author: ONeill, Rory M History of Present Illness The patient presents with major trauma. The onset was just prior to arrival. The course of symptoms is constant. Type of injury: motor vehicle collision. unknown mechanism, unknown details of car accident at this time. Review of Systems Additional review of systems information: Unable to obtain due to: Clinical condition. Health Status Allergies: . No allergies have been recorded. Medications: . Medication Orders pantoprazole (Protonix), 40 mg, IV, Daily, PRN: Agitation fentanyl, 70 mcg, IV, q1 h, PRN: Agitation midazolam (Versed), 2 mg, IV, q1 h, PRN: Agitation vecuronium, 5 mg, IV, q1 h, PRN: Agitation Continuous Infusion Orders NaCl 0.9% 1000 mL, 100 mUHR, IV, Stop: 11/21/10 8:56:00 Past Medical/ Family/ Social History Medical history Unknown. Surgical history: unknown. Family history: Unknown. Social history: Unknown. Physigal Examination Vital Signs Vital Signs. 10/22/2010 09:15 10/22/2010 09:10 Date/Time Printed: 3/25/2011 11:19 EDT ETC02 Sp02 Heart Rate Respiratory Rate 32 mmHg 100 % 70 bpm 12 br/min Page 64 of 167 Printed By: Tice,Cindy L PENN STATE HERSHEY Milton S. Hershey q7 Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 ?. ?.? .,..? ?...? .H ..? ?? ED Summary 10/22/2010 09:00 Systolic Blood Pressure Diastolic Blood Pressure BP Location # 1 Mean Blood Pressure Cuff Pulse Pressure Oxygen Therapy Fi02 ETC02 Sp02 Temperature Central Monitor Rhythm Head: Normocephalic. Cardiovascular: tachycardia. Gastrointestinal: Soft, Non distended. Genitourinary: Normal genitalia for age. 110 mmHg 59 mmHg Right Arm 85 mmHg 51 mmHg Ventilator 50 % 32 mmHg 100 Cool Normal sinus rhythm Medical Decision Making Trauma team: Trauma criteria met. Differential Diagnosis: Contusion, fracture, sprain, abrasions, head injury, neck injury, spinal cord injury. Notes: Patient CT's perform - patient taken directly to the PICU afterwards, pelvic fracture and splenic fracture. Impression and Plan MVA, Pelvic Fracture, Splenic laceration Plan Condition: Critical. Disposition: Admit: to Inpatient Unit. Addendum Signatures: Electr±onicatty Reviewed/Slaned (03-NOV 2010 18:02:001 by; Rory M. ONeill, DO Date/Time Printed: 3/25/2011 11:19 EDT Page 65 of 167 Printed By: Tice,Cindy L Patient Name: MCCLEEREY, ELIZABETH A Date of Birth: 5/20/1996 PENNSTATE 10 Milton S. Hershey Medical Center College of Medicine PROGRESS REPORT MRN: 7508540 FIN: 10508540 ti ; Maggio IIpYE: EpEYr ELIZAK 1060WO '0 Woo IRA: T aRETi No:: UDi: V191?dOdO QA . 10/2212010 : 061 4t y98 LOC: 7 1 121s N ._ SEX: STANDW . -- . .... I- - PICU Attending Date/Time: lu:tlln lit 0 `- SIP WA wn.ss ?orlet•12 a {?lhr spine >? twFX b? lc? ?Zctso? h? 0 'Friar P=el m List: $?l Vaj"s FX r'SQCrk t c(cw. r ?r I SP(pjtlc; LAC '5- Trmrvcxe P- ca.14 tsr- L D' 64A& ,- Svn. hunwpe,?i{ay?w?, Interval Hx: Patient examined and all organ systems discussed with pediatric CNS Sedation Level CS -7 ? Fentanyllmc ® mcg pm x ? Midazolam mg/kg/hr mg Pm x ? Morphine,_mg q___hr mg pm x ? Pentobarbital me/ke/h ? mg prn x ? Vecuronium ® mg prn x- ? Other o?hpi? 60-D A/ UP RESP O, Sat:ARR:?jYr. ABG /VBG: CXR: Respiratory Suppott:VeV • ' X 10 ',T- Is. Therapy: Albuterol Atrovent Chest PT Other l2 BP: 24hr: /117-5WCVP:_ CV HR: 241142-q Lines: ICU housestaff on rounds CNS Exam; Goals: 64-k rtlaeo ?Iae --4SL3 RESPIRATORY Exam• ' T/I l- Goals . '?' D lrtlr Exam nl xt d7 Goals: l? --?a-lr?e r u FEN/GI Exam: t?d1 , ND manxt rt u Goals; U a- - > 1_ Ne. I , i? a rro>r c L b ehed: -WW1 17l Q2 //? Q4h, C, w Q6h N q . CQ?jw Q8 h Q12h Q24 QMMh QWk Vasoactive Infusions: Medications: FEN/ G1 W I/0 14in, 320 out UO_ml/kg/hr Drain( s) Stool IVF/TPN/IL/NPO: 1JS 7S?C @3AMQAf Diuretics/Meds: Prophylaxis/Mods: ac. 4ht?7'? - - Supplements: NA-lr C 3 x T ? Insulin: u/kg/hr U? _ 14 'b ?13`-1 1 t.old 2 is 5D 0 02 3c? ?b r46cs. 3.1 1 Y . . Theophylline Level Alb: PreAlbumin: Trigs: Bili: AP:_ALT/AST:Of / GGT:^ Amylase?2 Lipase:9_NH3:_ uvof k6w HEMS Blood Products / 24 hrs: c. i, t) LovenoxMepl?'n HWHct: It -? (o Pits 2 ,2 PT/INR 1-1--b I PTT 3_ Fibrinogen Medications: V't;U.M IC HEMATOLOGIC Goals: 4- it eeec?rit . 78}Wrl-Vi f K. ID Tmax: 35.-3 WBC's: ! S' INFECTIOUS Antibiotics: t6 Day# / Goals: - Davl1 / p? e) 1k ruwidiW -W r"01 Cultures: ?6f SaAn?na?y; l4 z. Sf r A4V;4 E at?eltz( My 71; CarnPt(,IC vii 4rncfare . ' SA hAs sh°-vo ;,,h ? Ck" Total Time Spent with Pt Today:. _ LNI,,,,h, Facility: HMC Page 187 of 237 PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 ?....? .?. ?a. ... ?.? ?? ?. Interdisciplinary Narrative Form .. :.....?. .. „_ DOCUMENT TYPE: Interdisciplinary Narrative Form RESULT STATUS: Final PERFORM INFORMATION: Shirk,Beverly J (10/22/2010 12:55 EDT) SERVICE DATE/TIME: 10/22/2010 12:55 EDT Interdisciplinary Narrative Form 10/22/10 12:55 pm Performed by Shirk, Beverly J Entered on 10/22/10 01:02 pm Interdisciplinary Narrative Interdisciplinary Narrative Discipline Trauma Coordinator Interdisciplinary Narrative Text Patient arrived this AM as a level 1 pediatric trauma activation - Elizabeth Mccleary, a 14 yr old. She was a passenger in head-on MVC, brother driver, mulitple teens in car, this AM en route to school. Details remain unclear. +LOC. She was the first of 4 to arrive, intubated on scene, transported by Life Lion. Injuries known to this time: +LOC, posturing on scene - CHI L clavicle fracture, L elbow lacerations L pneumothorax, small on CT, bilateral base pulmonary contusions Grade I splenic laceration with small perisplenic hematoma L buttocks/flank contusion bilateral acetabular fractures, bilateral inferior/superior pubic rami fractures, sacaral fractures, pelvic hematoma Orthopedics, Neurosurgery, GI consulted - she remains intubated in PICU at this time, +cough with suctioning, turning head to the left slightly, no eye opening with care. Pupils equal bilaterally, briskly responsive. Solid organ injury care, non-operative protocol planned. NPO with OG tube maintained. HCT 31, monitoring. INR 1.4 - Vit K x3 doses planned. Started on protonix, Keppra. Continues on full spinal Date/Time Printed: 3/25/2011 11:23 EDT Page 35 of 47 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey I ;; Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 a .~. ?~ .? ... N ,... Interdisciplinary Narrative Form.. ?. ,m ... a. precautions, in MJ cervical collar, small, with good fit noted. Small abrasion/laceration to left hip. Parents arrived, updated by teams. Her brother currently in surgery (Fox, adult trauma). Family supportive services engaged and "crowd control" planned. Will continue to follow with teams during stay. DOCUMENT TYPE: RESULT STATUS: PERFORM INFORMATION: SERVICE DATE/TIME: Interdisciplinary Narrative Form Final Horton,Amy L (10/22/2010 19:30 EDT) 10/22/201019:30 EDT Interdisciplinary Narrative Form 10/22/10 07:30 pm Performed by Horton, Amy L Entered on 10/23/10 01:11 am Interdisciplinary Narrative --------------------------- Interdisciplinary Narrative Discipline Nursing Interdisciplinary Narrative Text . report received. Emergency equip at BS. Mom at BS = reflective listening utilized. Encouraged mom and dad to get some time together and to eat and get some rest. Multiple family members around for support. Continue to monitor. DOCUMENT TYPE: RESULT STATUS: PERFORM INFORMATION: SERVICE DATEITIME: Interdisciplinary Narrative Form Final Horton,Amy L (1 0/22/201 0 20:00 EDT) 1 0/22/201 0 20:00 EDT Interdisciplinary Narrative Form 10/22/10 08:00 pm Performed by Horton, Amy L Entered on 10/23/10 01:12 am Interdiscipli nary Narrative Interdisciplinary Narrative Discipline Nursing Interdisciplinary Narrative Text Rectal temp 39.4. MD notified. Date/Time Printed: 3/25/2011 11:23 EDT Page 36 of 47 Printed By: Tice,Cindy L PENNSTATE HERSHEY R Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 w ., ? ...... .... ....?.,....?,...,.?.,?,.. ??, .,, .,,,?..,? ..,,. ,. Operative Report RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY. OPERATIVE REPORT Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Service: 10/25/2010 SURGEON: Carol E. Copeland, MD ASSISTANT(s): Michelle Bramer, MD Darin Jurgensmeier, MD Final .Operative Report Copeland,Carol E (10/28/2010 11:01 EDT) PREOPERATIVE DIAGNOSIS: Lateral compression type 2 pelvic ring disruption on the left, lateral compression type 1 pelvic ring disruption on the right with transforaminal left sacral fracture and extra foraminal sacral fracture. POSTOPERATIVE DIAGNOSIS: 1. Closed treatment of posterior pelvis with iliosacral screw placement. 2. Closed treatment with manipulation and application of anterior external fixator. 3. Intraoperative interpretation of fluoroscopy including AP inlet, lateral, SI, and stress views of the pelvis. ANESTHESIA: General with endotracheal. INDICATIONS: The patient is a 14-year-old female who is status post head-on collision on 10/22/10. She has been nasotracheally intubated in the field and has been followed for splenic injury, closed head injury, and pelf is ring disruption. Informed consent has been obtained from the patient's parents regarding surgical stabilization of her complete sacral fracture on the left and incomplete sacral fracture on the right. PROCEDURE: The patient was taken to the operating room and after induction of general anesthesia with endotracheal intubation the pelvis was prepped and draped in the usual fashion after first ascertaining with the imaging intensifier that we could easily visualize in AP and outlet and lateral views the sacrum safely. After an appropriate time*out was performed administration of IV Ancef and placement of SCDs the pelvis was prepped and draped in the usual fashion. We used the lateral view to create our starting hole centered over the body of Si. The guidewire was then passed safely through the body of S1` and into the iliac wing on the contralateral side to maximize purchase on the pelvis. The image intensifier was used in AP, inlet, outlet, and lateral views to verity safe placement of the guidewire before a fully threaded 7.3 Synthes cannulated screw was placed without difficulty. We then performed stress views of the pelt'%s to assess the need for anterior stabilization. The pelvis was felt to be stable on the left but did internally rotated on the, right with lateral stress on the lateral stress views. We therefore placed an anterior external fixator with a single pin on each iliac wing after predrilling. The image intensifier was used to verity the placement of the pins on obturator oblique views and we then Date/Time Printed: 3/25/2011 11:19 EDT Page 21 of 167 Printed By: Tice,Cindy L PENN STATE HERSHEY Milton S. Hershey 1W Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 Operative Report interconnected the two pins with an anterior construct. The patient tolerated the procedure well. Estimated blood loss was less than 50 mL and the plan will be for the patient to be weightbearing as tolerated on the right lower extremity, foot flat and nonweightbearing on the left lower extremity, no restrictions to sitting or range of motion of the lower extremities and pin care will be begun in approximately 24 hours. She will receive 24 hours of Ancef. I was personally present for, performed, and supervised the case from start to finish. J#344447 Electronic Signature on File Electronically Reviewed/Signed by. Carol E Copeland, MD Author Signature Dt/Tm:28.10.2010 11:01 AM CEC /JGM DD: 10125110 DT: 10125110 12:20 Date/Time Printed: 3/25/2011 11:19 EDT Page 22 of 167 Printed By: Tice,Cindy L "I-,) PENN STATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN: 7508540 Date of Birth: 5/20/1996 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 10508540 Visit Type: Inpatient Patient Location: 7SAI; 7121; 11 ..?...............................................................,...............?.w......................, ....... ..................................................?.....u........................................ Discharge `Summary RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final .D/C Summary Updegrove,Gary (11/2/2010 02:33 EDT); Engbrecht,Brett W (11/1 /2010 07:25 EDT) DISCHARGE SUMMARY Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Admission: 10/22/2010 Date of Discharge: 10/29/2010 Reason for Discharge: Transfer to PSHMC Rehabilitati Physician: Engbrecht, Brett W Service: Peds Surgery Destination: Penn State Hershey Rehab Hospital (717) 832-2600 Discharge Diagnosis: Small left anterior pneumothorax, Bilateral pulmonary contusions, Grade 1 splenic laceration with associated small perisplenic hemoperitoneum/hematoma, Contusion within the soft tissues of the left buttock/flank, Left clavicular fracture Multiple pelvic and sacral fractures. Other Diagnoses: Ischemia and/or hemorrhage in the supratentorial brain. Significant contusion of the corpus callosum with hemorrhagic and ischemic manifestation. Surgical Procedures: 10/25/10: Closed treatment of posterior pelvis with iliosacral screw placement and closed treatment with manipulation and application of anterior external fixator. - Dr. Copland Vaccinations Received This Hospital Stay: No vaccinations were given this hospital stay. Date/Time Printed: 3/25/2011 11:19 EDT Page 1 of 167 Printed By: Tice,Cindy L PENN STATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 Discharge Summary Discharge Medications: 1. Acetaminophen (Tylenol) 650 mg by NJ-tube every 4 hours, as needed for Fever/Pain. 2. Docusate (Colace) 50 mg by NJ-tube 2 times daily. 3. Enoxaparin (Lovenox) 30 mg subcutaneously every 12 hours. 4. Furosemide (Lasix) 20 mg by NJ-tube every 24 hours. 5. Levetiracetam (Keppra) 500 mg by NJ-tube every 12 hours. 6. Ocular lubricant (Refresh PM ophthalmic ointment) 1 appl in both eyes As indicated, as needed for Dryness. 7. Pantoprazole (Protonix) 40 mg by NJ-tube every 24 hours. 8. Senna 8.8 mg by NJ-tube 2 times daily. Brief History of Present Illness: Patient is a 14 year old female who was in a head on motor vehicle collison on 10/22/10. She was in a bar with 4 other teenagers on their way to school in the morning. The patient was found in the car with a GCS of 3. It is not documented if she was restrained but according to EMS others in the car were restrained. She was nasaly intubated at the scene and life-flighted to HMC. Hospital Course: A Level 1 trauma was activated. Standard ATLS protocol was followed. She had normal vitals in the trauma bay. Once examined and IVF running she was taken for a CT scan which showed small left anterior pneumothorax, bilateral pulmonary contusions, Grade 1 splenic laceration with associated small perisplenic hemoperitoneum/hematoma, contusion within the soft tissues of the left buttock/flank, left clavicular fracture and multiple pelvic and social fractures. No spine or brain pathology was seen. She was then transfered to the PICU for continuous monitoring and ventilator care. She continued very close monitoring. Neurologically she was not responding to commands although she had minimal sedation. Pt underwent pelvic fixation PID 3, tolerated the procedure well. She also had an MRI same day which revealed ischemia and a significant contusion to the sorpus collosum. She is receiveing no sedation, and has inconcsistent examination - slight eye opening and eye movements ? tracking visually, no purposeful grasping - does withdraw extremities to painful stimulation X4. +strong cough/gag. Currently on CPAP trial, plan to extybate. PT OT engaged for bedside ROM. Her weight-bearing restrictions per orthopedic team: Weight bearing as tolerated RLE, flat foot touch 30 lb limit left lower extremity. External fixator intact to pelvis - pin care to start 3 days post-op - gauze with dry blood. CTL spines "cleared" today - will have hip flexion restrictions (limited by fixator). Attempting NJ placement today. Lovenox therapy was begun. SCDs remain on currently. To remain on Keppra therapy. PID 4: Ellizabeth is now extubated. She has some oxygen desaturations with deep sleep but responds to nasal oxygen. Rehabilitation Services were in to evaluate. Therapies have begun. She does show minimal response to sitting at the side of the bed. PID # 6. PT OT ST continue - assisted OOB this AM with transfer - she continues with inconsistent responses - some eye opening, very little tracking visually, occasional moan. Some grasping with bilateral hands at times, better head control today. Pin care started, pelvic pin sites open but not red. Tolerating NJ feeds - stooled this AM. Continues on Lovenox therapy. HCT 32, lipase down to 395. We are awaiting insurance approval for transfer to Penn State/Select Rehab facility. PID#7 - Pt cleared for d/c to PS/select Rehab. Exam on Discharge: Vitals Temp Pulse BP RR Sp02 F102 Date Wt(kg) Wt(lb) 10/29 09:00 ---- 99 ----- 16 98 -- 10/26 55.0 121 10/29 08:41 ---- 98 ----- 15 --- --- 10/26 55.0 121 10/29 08:37 ---- 98 ----- 16 99 --- 10/26 55.0 121 10/29 08:00 36.6 99 118/70 17 98 --- 10/26 55.0 121 Date/Time Printed: 3/25/2011 11:19 EDT Page 2 of 167 Printed By: Tice,Cindy L PENNSTATE HERSHEY 10 Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 r Discharge Summary 10/29 07:00 ---- 100 106/64 16 98 --- 10/26 55.0 121 24 Hr Tmax: 38.6 at 10/28 16:00 36 Hr Tmax: 38.6 at 10/28 16:00 Vital Signs are the last 5 in the past 48 hours. Weights display the last 5 within 7 days. Initial Wt: 10/22 55.0 kg 121 lb NAD NJT in place RRR CTAB S ND NT NABS Care Instructions: 1. supervision at all times to maintain safety. 2. NJ with routine care/flushes. 3. Elimination - diapered, dependent. Last stool: 10/28 4. wash all abrasions/lacerations wtih soap/water, dry and apply a thin layer of bacitracin twice/day. 5. Pin Care: bid -'/2 Saline mixed with r/2 Peroxide solution - Use sterile Q-Tip and the solution to clean around the pin and also clean the pin itself - Push the skin downward, making sure the skin is mobile on the pin. - If the pin site is draining, wrap the pin with gauze and use the clip to apply gentle pressure - Do not remove the clips 6. L arm - sling to comfort prn. 7. CPT every 4 hours, oral suctioning as needed. routine oral care. 8. anticontracture boots - on/off every 4 hours. ROM. Diet Guidelines: Enteral Feeds - Ntren 1.0 @ goal of 75 mi/hour/24 hours. NPO, continue with speech therapy (Alternative means of feeding is recommendation from speech therapy on 10/27) Activity Guidelines: Weight bearing instructions: FILE WBAT LLE flat foot touch down weight bearing - start with stand pivots and advance gait with above recommendations as tolerated L arm - weight bearing as tolerated, sling to comfort. May be OOB as tolerated with therapy team. No contact or impact activities Qumping, etc). Return to school - to be determined as per rehab progression/recommendations. Call your doctor if: For questions to Pediatric Surgery/trauma, please call 717 531-8342 For questions to Dr Dias and the Neurosurgery team 717 531-4191 Date/Time Printed: 3/25/2011 11:19 EDT Page 3 of 167 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 ?..?..? ..............r............??..r .. ?..?....? ...,w Discharge Summary ...,?.? ..,.,.? ...r ,, ..., ,. .,.,....... ??.,..., ....? ., . .?,? Call your doctor with questions regarding your Orthopaedic Surgery (Dr. Copeland) - Call with any questions concerning fevers > 101 OF, chills, redness, swelling, drainage, pus or any questions you feel necessary - Monday - Friday 8am-4:30pm Call (717) 531-5638 - Ask to speak to Carol Forsyth CRNP - Evenings or Weekends call the hospital operator (717) 531-8521 and ask for the Orthopaedic resident on call to be paged Other Instructions: Orthopaedic Surgery Follow up Please call (717)531-5638 to confirm your follow up appointment f/u 3 weeks post op with Dr. Copeland 30 Hope Drive; Building B, second floor Suite 2400 Hershey, Pa 17033 Pediatric surgery follow-up: please call 717-531-8342 to schedule follow-up following rehab stay. When children are seriously ill or injured, they and their families may feel upset/worried. These feelings are common, normal and can continue after returning home. Visit aftertheinjury.com for interactive tools and quick tips to help recovery. Penn State Children's Hospital Injury Prevention Tips - Teen Driver Safety 1. ALWAYS travel with your lap and shoulder seat belt, snugly fastened. 2. Never ride or drive under the influence of alcohol or drugs. 3. Obey posted speed limits. 4. Avoid distracted driving - using cell phone or texting, eating, adjusting the climate or music controls. Follow-Up Appointments: Scheduled Penn State - Hershey Appointments Within the Next 90 Days. 1. Follow-Up with Radiology EC at Orthopaedics East Campus on 11/18/2010 at 01:45 pm 2. Follow-Up with Copeland, Carol Eat Orthopaedics East Campus on 11/18/2010 at 02:15 pm 3. Follow-Up with Dias, Mark at Pediatric Bone & Joint and Neuroscience East Campus on 12/06/2010 at 09:00 am Follow-Un Imaging Studies ortho - x-rays Pelvis; Left clavicle AP and angled view 355577 Date/Time Printed: 3/25/2011 11:19 EDT Page 4 of 167 Printed By: Tice,Cindy L DOCUMENT TYPE: Physician Discharge Instructions Form RESULT STATUS: Final PERFORM INFORMATION: Stapinski,Brian C (10/29/2010 09:0&EDT) SERVICE DATE/TIME: 10/29/2010 09:08 EDT Physician Discharge Instructions Form 10/29/10 09:08 am Performed by Stapinski, Brian C Entered on 10/29/10 09:18 am Patient Discharge Instructions - HMC --------------------------------- Discharge Diagnosis Principle Small left anterior pneumothorax, Bilateral pulmonary contusions, Grade 1 splenic laceration with associated small perisplenic he moperiton eu m/hematoma, Contusion within the soft tissues of the left buttocklfiank, Left clavicular fracture Multiple pelvic and sacral fractures. Other Discharge Diagnoses Ischemia and/or hemorrhage in the supratentorial brain. Significant contusion of the corpus callosum with hemorrhagic and ischemic manifestation. Procedures 10/25/10: Closed treatment of posterior pelvis with iliosacral screw placement and closed treatment with manipulation and application of anterior external fixator. Medication Review Complete Discharge Medication Reconciliation Completed Historical Medication atomoxetine multivitamin zinc acetate Date/Time Printed: 3/2512011 11:27 EDT Printed By: Tice,Cindy L Page 59 of 72 ?X?;? ?? PENNSTATE HERSHEY Milton S. Hershey W Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN: 7508540 Date of Birth: 5/20/1996 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 15380618 Visit Type: Clinic Patient Location: RH00 Outpatient Letter RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final Ramer,Jeanette C (1/11/2011 20:58 EST) January 10, 2011 Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Service: 01 /10/2011 Mary P. Consevage, M.D. 3705 Vartan Way Harrisburg, PA 17110 Dear Dr. Consevage: Your patient, Elizabeth McCleerey, was evaluated in followup of a closed head injury and multiple fractures as a result of a motor vehicle crash on 10/22/2010. She had been hospitalized acutely at Hershey Medical Center and then in Penn State Hershey Pediatric Rehabilitation Unit. This is her first followup visit since discharge. In the Rehabilitation Unit, Elizabeth made very consistent progress, moving from Rancho level 3 on admission to Rancho level 6 to 7 at discharge. Since discharge, Elizabeth has been taking Strattera 40 mg in the morning to help with attention focus. She has not had side effects from this medication. She has just begun to receive homebound instruction from her school program. They will be completing assessments this week and then begin to work actively with her next week. Elizabeth is much more interactive. Her mother describes that her personality is returning, although she is still somewhat restricted in self expression. There are times when she smiles appropriately and understands humor. She answers questions clearly and appropriately,providing more detail but there are memory deficits that both Elizabeth and her mother acknowledge. Elizabeth said she could not recall what she did the day before, but recalls friend's names and things that she lik%-W do. Her attention focus has been good. She is able to work on activities for a good amount of time. Both Elizabeth and her mother acknowledge that she is tired and although she is no longer taking naps in the afternoon, she still goes.to bed early. Date/Time Printed: 3/28/2011 07:35 EDT Page 1 of 11 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 ;........w.,..?...?? .?....?....?..?.....?,..?.?....?..,?....?.?....?.?..?.......V...?.. Outpatient Letcer?.?..?...?....??.w...?,....V.?..a_...?....?...?....?..? Elizabeth is receiving speech, occupational and physical threrapy 3 times a week. Her left arm continues to strengthen and is near strength of the right arm. She is walking with some weakness evident in the right hip and balance difficulties. Elizabeth has not had any significant post head injury symptoms including headache, difficulty sleeping, nightmares, or significant dizziness. She does have some mild dizziness when she stands up quickly. Examination showed that Elizabeth was interactive and mildly flat in affect, but much more animated than when I saw her on discharge from the Rehabilitation Unit. She responded to questions appropriately, with good information. There were short pauses before she answered suggesting that she is still struggling somewhat to retrieve information. As noted, she reports fatigue, but she is enthusiastic about doing things. She has been shopping and has been able to walk unassisted for some distances. Her family still takes her wheelchair along for anything beyond of short distances. Elizabeth's cranial nerves appear to function normally. She had mild nystagmus in all gaze fields. She did not apparently have eye muscle imbalance or double vision to my examination. Oral motor skills were normal. She was able to walk with some difficulty with right hip weakness both in the hamstrings and also the hip musculature itself. This lead to outturning of the right foot. She had normal strength in the left leg. Her left arm was slightly less strong, especially in grip and wrist movement than right, but there is not a great deal of difference. Elizabeth is making excellent improvement. She continues to have some difficulty with memory, retrieval of words and mild left arm and right leg weakness. She will have an assessment by her school program over the next week. I asked to see her again in about 1 to 2 months to evaluate how she is doing and work toward school re-entry. Whether Strattera will continue to be needed is unclear. She does not seem to have significant focus problems. I mentioned the possibility of using Aricept if memory skills continue to be impaired, but she has at least 3 to 4 months during which there will be improvement in memory function and personality. I did provide permission for her to visit school perhaps at lunchtime or during art class so that she can see her friends and they can see her and see how well she is doing. 492178 CC: Mrs. Jamie McCleerey 5845 Aspen Lane Enola PA, 17025 Date/Time Printed: 3/28/2011 07:35 EDT Page 2 of 11 Printed By: Tice,Cindy L PENNSTATE HERSHEY Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN: 7508540 Date of Birth: 5/20/1996 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 15259065 Visit Type: Clinic Patient Location: HD11 .................................. ..........................,..........w................... .................Outpatient Note ....W.............w.................w.....W.w.................................................,,..v......... f RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Service: 01 /13/2011 Final Copeland,Carol E (1/18/2011 11:02 EST) OUTPATIENT NOTE Ms. McCleerey is status post a pelvic ring disruption sustained on 10/22/10. She was treated with anterior distraction external fixator, as well as a percutaneous iliosacral °homerun" screw from the left to the right. She also sustained a severe closed head injury and was in rehab until December 22nd. She had her external fixator removed on 11/30/10. She is here today with no complaints. She is not taking any medication. Her mother states she still has some balance issues. On physical examination, her pin sites are clear. There is still a residual scab on the right hand side with no erythema or drainage. She has full range of motion in hips, knees, and ankles. She has 3 beats of clonus on the left, 1 beat on the right. She has 4+/5 hip flexors, ab and adductors, quadriceps, and hamstrings. Her pelvis is nontender to compression. Her gait is significant for some spasticity broad based and weak push off, as well as a slight left Trendelenburg component. There is no antalgic component. The following radiographs were independently reviewed by me, AP, inlet, and outlet views of the pelvis reveal an intact iliosacral screw, as well as well-healed ramus fractures bilaterally. The pelvis is symmetric. IMPRESSION: 1. Status post closed head injury and multiple trauma. 2. Healed pelvic ring disruption. 3. Residual gait abnormality related primarily to closed head injury. The plan is to continue with physical therapy. She has no specific orthopedic restrictions at this time. We will see her back for a clinical exam and follow up without x-rays in 2 to 3 months' time. I personally saw,-examined, and counseled the patient and her mother. 498265 Date/Time Printed: 3/28/2011 07:35 EDT Page 1 of 8 Printed By: Tice,Cindy L 1?? PENNSTATE HERSHEY PM. Milton S. Hershey IV Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN: 7508540 Date of Birth: 5/20/1996 Patient Gender: Female Penn State Hershey Tel: (717) 531-8055 Milton S. Hershey Medical Center Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 Visit Number: 15487838 Visit Type: Clinic Patient Location: RH00 ... _......_?._.._..._.... .............. u..........._._ _..._.... _.........._... Outpatient Letter... _ ._._.. . _... ........_ . _.. __.?.. .w..._..._.......... _? _....I RESULT STATUS: DOCUMENT SUBJECT: ELECTRONICALLY SIGNED BY: Final'' ' - Ramer,Jeanette C (2/16/2011 20:13 EST) February 14, 2011 Name: MCCLEEREY, ELIZABETH A HMC Number: 7508540 DOB: 05/20/1996 Date of Service: 02/14/2011 Mary P. Consevage, M.D. 3705 Vartan Way Harrisburg, PA 17110 Dear Dr. Consevage: Your patient, Elizabeth McCleerey, was evaluated in followup of a quite significant closed head injury and multiple fractures as the result of a motor vehicle crash on 10/22/2010. She is currently receiving zinc supplementation and Strattera at a dose of 40 mg once a day in the morning. Strattera had been initiated in the Rehabilitation Unit to treat impaired attention focus. Elizabeth has made good progress since her last visit in January, but her mother is concerned about poor appetite and weight loss. Elizabeth often turns down foods that she used to enjoy saying that she is simply not hungry. She does not seem sick in any other way. There are no headaches and no persistence of other medical complaints. Elizabeth is working successfully with a tutor from her school district. She still has significant memory deficits that do impact on her performance, but has caught up with what she has been asked to do in her major subjects. She would like to return to school for at least one class at this point. Elizabeth is receiving physical and occupational therapy 3 times a week and is making good progress in the right hemiparesis that is most evident in the hip and leg. Date/Time Printed: 3/28/2011 07:34 EDT Page 1 of 9 Printed By: Tice,Cindy L PENN STATE HERSHEY 0 Milton S. Hershey Medical Center Patient Name: MCCLEEREY, ELIZABETH A MRN 7508540 Outpatient Letter i Evaluation showed that her weight was 47.9 kg, a decrease since November of 7 kg. She appears slender, but not undernourished. Her affect was not as flat and she was more interactive with me at this visit, but memory deficits remain evident as her conversation still does not "flow" as it would for most adolescents. She relates that she is not having discomfort anywhere and that things are going reasonably well with her tutor. She was more descriptive when talking about what she was working on with her tutor than previously. One complaint is that she has blurred vision, and that her glasses do not help. She has a visit with her optometrist next week to address this. She would like to be able to stop Strattera and zinc. Neuromuscular exam showed that cranial nerves function normally. Her right arm has minimal weakness compared to the left, most evident in her hand. When she reaches out with both hands, her grip strength appears to be equal. There was spooning of the right hand when both arms were extended. One can see some weakness in the right hip and upper leg while walking with a mild degree of circumduction on that side. Her balance was reasonable, but she still struggled with tandem stand or one foot stand on the right leg. It was my impression that Elizabeth continues to make excellent gains. She still has residual right hemiparesis especially evident in her leg and hip. There are also memory deficits of which she is aware of and that her mother describes as well. I was concerned about her weight loss and decreased appetite. Ultimately, I suggested stopping both zinc and Strattera. It is not clear if Strattera is needed and it can be a medicine that decreases appetite. I did give permission for Elizabeth to return to school for one class per day. This may be very motivating to her because she strongly wants to work toward going back to school. I do not think she is quite ready for a half day at this point, but perhaps going back for one class to see her friends and to interact in school would be helpful. Even with taking just one class, she may require some modification of the amount of work and certainly needs continuing education in the home to address the other subjects. We also briefly re-discussed the possibility of use of Aricept for the memory problems if they remain significant and do impact on school. I asked for an update in about 2 weeks regarding the transition into school for one class. 59203 CC: Ms. Jamie McCleerey 5845 Aspen Lane Enola, PA 17025 Date/Time Printed: 3/28/2011 07:34 EDT Page 2 of 9 Printed By: Tice,Cindy L c Encompass- Creating protection wound you P.O. Box 16203, Reading, PA 19612 ;2/./2012 SOLLENBERGER & JANUZZI, LLP 2225 MILLENNIUM WAY ENOLA'PA 17025 Our Claim Number.• Z0168134 HE Your Client. Elizabeth McCleerey Your Reference Number.• Our Insured. Earl W Mccleerey Jr Date of Loss. 10122/2010 Policy Number. US 280943453 Insuring Company. Encompass Indemnity Company To All it may concern: encompessinsurance.com Patricia E. DeFrank Staff Chn sera Adi Telephone (610) 401-2254 (800) 936-4203 x12254 Facsimile (866) 298-7867 Intemet patride.defrank@encompossins,com This will confirm that we have extended offers to all parties whom have presented bodily injury claims to Encompass as a result of this accident and to advise that all offers have been accepted. We therefore move forward to resolving all claims. All minor's claims will be court approved in Pennsylvania, therefore we will forward the respective releases to all parties and once the court approvals are all finalized and provided to me, along with signed and notarized releases, I may then issue settlement drafts to all parties. In the meantime if anyone has any questions, do not hesitate to contact me. I cannot thank all of you enough for your cooperation and understanding to aid in moving this claim as promptly as could be expected towards resolution. Sincerely, Patricia E. DeFrank CC: Gina Harris-Franke Dolores Sponsler Mr. & Mrs, Termin for Vincent Termin Vincent Cimini Esq. for Anthony Pesavento Kathryn Simpson, Esq. for Benjamin Shears xFraudWamingn FES 0 6 loll n("rpass ` encompassinsurance.com ?Eom Creating protection around you P.O. Box 16203, Reading, PA 19612 Patricia E. DeFrank Staff Glm Serv Adj Telephone (610) 401-2254 (600) 936.4203 x12254 February 2, 2012 Facsimile (666) 296-7967 tntemet paNde.defrank@encompassins.ogm SHOLLENBERGER & JANUZZI, LLP Attn: Karl Januzzi, Esq. 2225 MILLENNIUM WAY ENOLA PA 17025 Our Claim Number. Z0168134 HE Your Client. Elizabeth McCleerey Your Reference Number Our Insured: Earl W Mccleerey Jr Date of Loss: 10/2212010 Insuring Company. Encompass Indemnity Company Dear Karl: This will confirm our agreement to settle your client's claim for $90,000. Please forward the minor's joint tortfeasor=s release for our review.. Once approved we will advise and please have your clients sign the appropriate release and return to our office. We are asking that their signature be witnessed and notarized. We are able to issue payment after we receive the properly executed release and all of the respective minor's agreements. If you have any questions do not hesitate to contact me. Thank you for your cooperation in bringing this to a successful resolution. Sincerely, Patricia E. DeFrank CC: Enc: Release Any person who knowingly and with intent to Injure or defraud any insurer files an application or j claim containing any false, incomplete or misleading Information shall, upon conviction, be subject to imprisonment for up to seven years and the payment of a fine of up to $15,000. e "10,51 Power of Attorney and Contingent Fee Agreement I, Elizabeth McCleerey, a minor, by and through her parent and natural guardian, Earl McCleerey, do hereby retain Shollenberger & Januzzi, LLP of Enola, Pennsylvania, as my attorneys to negotiate for me a settlement or to institute for me in my name any legal actions that in their judgment are necessary in connection with my bodily injury claim, including my claim for uninsured or underinsured motorist benefits against C.A. and any other person, firm, corporation, insurer or entity who may be liable arising from a collision that occurred on October 22, 2010. I hereby give to my attorneys a Power of Attorney to execute all documents connected with the claim, including pleadings, contracts, commercial papers, settlement agreements, compromises and releases, verifications, discontinuances, orders and settlement checks. I agree not to settle or adjust this claim or any legal action arising from it. I agree to fully cooperate with my attorneys in the handling of the claim. This includes, but is not limited to, attending depositions, legal proceedings and conferences; keeping my attorneys informed as to my current mailing address, phone number and medical condition. I warrant that the information which I have supplied and will supply during the course of the representation has and will be true and accurate, and has not been and will not be obtained through fraud or illegal activities. I agree to pay attorneys' fees from the total amount recovered from any source, except first party benefits which are paid or payable pursuant to the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law, on account of my bodily injury claim, including my claim for uninsured or underinsured motorist benefits, on the following basis: Shollenberger & Januzzi, LLP 2225 Millennium Way, Enola, Pennsylvania 17025 Tel. (717) 728-3200 Fax (717) 728-3400 www.sholl'anlaw.com Settlement of third party tort claim prior to filing of legal action Settlement of third party tort claim on or after filing of legal action Settlement of uninsured or underinsured motorist claims prior to selection of my arbitrator or prior to filing of legal action versus UM/UIM carrier Settlement of uninsured or underinsured motorist claims after selection of my arbitrator or after filing of legal action versus UM/UIM carrier 25% of total sum recovered 33 and 1/3rd % of total sum recovered 25% of total sum recovered a;?S76 33 d 1/3rd % of total sum recovered In the event that no recovery is obtained on my claim, I will not be responsible to pay anything to my attorneys for their time or services. Pre and post litigation costs and expenses will be advanced by my attorneys but are to be repaid to them from my share of the recovery. Pre and post litigation costs and expenses include, but are not limited to: photocopies; fax charges; postage; notary fees; long distance telephone charges; mileage for attorneys and staff; investigation charges; photographs; court costs; WEST LAW research charges; medical records costs; fee for police report; deposition costs; expert witness fees; stenographer costs; and video deposition fees. I will repay any pre or post litigation costs or expenses advanced by my attorneys from my share of the recovery. In the event that no recovery is obtained on my claim, I am only responsible for repayment of pre and post litigation costs and expenses if I fail or refuse to follow my attorneys advice regarding settlement of the claim. In the event that the amount of the recovery is less than the amount of the pre and post litigation costs and expenses advanced by my attorneys, my attorneys will make no charge for their time or services and the amount of the recovery will be accepted by my attorneys as a full and final repayment of all such costs and expenses, but only if I follow their advice regarding settlement of the claim. If I do not follow their advice regarding settlement, I remain responsible for payment of the fees set forth above as well as all pre and post litigation costs and expenses advanced on my behalf. Shollenberger & Januzzi, LLP 2225 Millennium Way, Enola, Pennsylvania 17025 Tel. (717) 728-3200 Fax (717) 728-3400 www.shollianlow.com My attorneys shall have a security interest in any amounts recovered on my behalf that are subject to a fee under the terms and conditions of this agreement. As one possible settlement option, I authorize my attorneys to explore the possibility of a structured settlement through the use of deferred periodic payments. I agree that if my claim is settled through such structure, the attorneys' fees on the part that is structured shall ble calculated in the percentages as set forth above based upon the cost of the structured settlement. I authorize my attorneys to repay my medical caregivers for all outstanding medical bills and expenses incurred as a result of my collision related injuries from my share of the recovery, unless paid or payable by another source. This Power of Attorney and, Contingent Fee Agreement applies to all proceedings up to and including verdict or decision at trial or arbitration. If, in the discretion of my attorneys, post-trial proceedings, including appeals, are warranted, they will not be covered by this Contingent Fee Agreement and a new fee agreement will be required. This Power of Attorney and Contingent Fee Agreement shall not apply to any right, claim or cause of action that I may have for collection of first party benefits paid or payable pursuant to the provisions of the Pennsylvania Motor Vehicle Financial Responsibility Law or property damage. further authorize my attorneys to destroy my file three (3) years after the file is closed. In Witnes reof, I have hereunto set my hand and seal this o? ( day of V- 2010. (Seal) (Seal) (Seal) (Seal) And Now, this ;q day of U&- , 2010, the above Contingent Fee Agreement and Power of Attorney has been read, approved, and understood by me and the receipt of a copy thereof acknowledged: The terms set forth (Seal) ?/A / Seal (Seal) (Seal) SHOLLENBERGER & JANU7.ZI, LLP 2225 MILLENNIUM WAY ! ENOLA, PA 17025 (717) 728-3200 ! M(7i7)728-3400 ?C?'?'?r'?' Apr 12/2012 Shollenberger & Januzzi, LLP Page: 1 Client Ledger ALL DATES Data Received From/Paid To Chq# I----- General -----I Bld I----------- Trust Activity -----------I Entry N Explanation Re c# Rcpts Diabs Fees Invi Ace Repts Diabs Balance 2377 McCLBERES (!MOOR) , ELIZABETH 1025 17 FEE: 258, 33 1/38 DOI: 10/22/10 SOL: 10/22/ Reap Lawyer: KJJ Nov 15/2010 Silver Spring Township Police Dep 158898 Police Report ELIZABETH 15876 15.00 MCCLEFPFY Dec 2212010 !fast Payment Center 159931 )Re"Preh Zrl"formation Ckgzyes 10514 84.66 'N4 WBER 2010 McCLMEY MI?C04Z ) Dec 28/2010 Expense Recovery 160266 Postage NOVEMBER, 2010 01462 13.96 ELIZABETH McCLEEREY Jan 31/2011 Expense Recovery 162361 igCslmi7ielf';JAttUARY, 2C,11 01484 4.50 McCUERFY (MINOR) Mar 31/2011 ii-th Port 164226 Medical Records - MCCLEERY 454.29 FLTZABETH Apr 1/2011 Expense Recovery 164364 Postage .10ARC1, 2011-E. MCCLEEREY 01497 0.44 Apr 6/2011 Expense Recovery 164798 - 01503 292.25 0- -- 1_-_4 05/11- MCLEE-Ei Apr 6/2011 txpepse Recovery 164799 Faceimili-" -` 01503 2.00 03!25/11-09105/11- MCCLEEREY Apr 1112011 Milton S. Hershey Medical Center 165173 Ma 7i_= r--:Eels - -LEER_EY 20.00 Apr 21/2011 Expense Recovery 165659 Photocopies - 01511 2.25 ?4/5/li-9/20/11-MCCLEEREY May 5/2011 E;:_-nsc ?-_ :cr- 166226 P_-ac- 1.72 May 19/2011 expense Recovery 166870 Photocopies - APRIL 20- HAY, 19 01519 6.50 -MCCLEERE7. May 19/2011 Expense Recovery 166871 Photocopies - APRIL 20- MAY 19 01519 14.00 -rrnLOR- Mr_r_•LEEREY Jun 112611 Fedea 16-343 Postage - Overnight Shipping 24,60 Charges- Mccleery Jul 6/-?= - ,--.--- 16'>, 34.63 Oct 14/2,011 Expense Recovery 172241 Photece_ries as of Sept 30 2011 01544 0.25 Oct -- 2011 E;:r -ns- ' 3465 _ P-s_ e. -;1- 01555 0.44 Feb 27/2012 Expense Recovery 179794 Photoccpie3 JANUARY 201.2 01596 5.00 Mar 20/2012 - - . - 180412 -??- - °e1- - ._- 01598 0.45 Mar 21/2012 Expense Recovery 180513 Photocopies - Feb. 2012 01600 1.50 Apr 1/2012 E:i e-i s- Recovery 181267 F--t?>?-ries - March 2012 01603 2.25 Apr 1/2012 Expense Recovery 181499 Postage - March 2012 01604 1.35 Apr 12/2012 Cumberland County Prothonotary 181398 Filing Fees - Prothonotary - E 103.75 McCleerey UNBILLED I I BILLED I BALANCES I TOTALS CHE + RECOV + FEES = TOTAL DISBS + FEES + TAX - RECEIPTS = A/R TRUST PERIOD 736.93 348.86 0.00 1085.79 0.00 0.00 0.00 0.00 0.00 0.00 END DATE 736.93 348.86 0.00 1085.79 0.00 0.00 0.00 0.00 0.00 0.00 UNBILLED I I BILLED 1 1 BALANCES I FIRM TOTAL CHE + RECOV + FEES = TOTAL DISBS + FEES + TAX - RECEIPTS = A/R TRUST PERIOD 736.93 348.86 0.00 1085.79 0.00 0.00 0.00 0.00 0.00 0.00 END DATE 736.93 348.86 0.00 1085.79 0.00 0.00 0.00 0.00 0.00 0.00 REPORT SELECTIONS - Client Ledger Layout Template Default Advanced Search Filter None Requested by csholley Finished Thursday Ver 9.31d Matters 102517 Clients All Major Clients All Client Intro Lawyer All Responsible Lawyer All Assigned Lawyer All Type of Law All Select From Active, Matters Sort by Default New Page for Each Lawyer No New Page for Each Matter No April 12, 2012 at 11:29:09 AM Inactive, Archived Matters • VERIFICATION i 1, Ear I W. WCI eerey, J r. , hereby acknowledge that I am a Plaintiff in this action and that I have read the Pet i t i on for Mi nor' s Comnromi se and that the facts stated herein are true and correct to the best of my knowledge, information and belief. I understand that any false statements herein are made subject to penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. ?e?` Si nature Date: 4/13/12 G:\GLOBAL\WPDATA\DOCSUNITIAL CONSULT DOCS (SETUPS)\Verification.wpd SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way, Ends, PA 17025 (717) 728-3200 ! FAX (717) 728-3200 IN RE: IN THE COURT OF COMMON PLEAS OF ELIZABETH McCLEEREY, CUMBERLAND COUNTY, PENNSYLVANIA A Minor CIVIL ACTION - LAW NO. 12-2391CIVIL TERM IN RE: PETITION TO APPROVE COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS ORDER OF COURT AND NOW, this 25 h day of April, 2012, upon consideration of the Petition To Approve Compromise Settlement and Distribution of Proceeds, it is hereby ordered that the Petitioner is authorized to enter into a settlement on behalf of Elizabeth McCleerey in the gross amount of $90,000.00. Petitioner is further authorized to sign a Release and to mark the matter settled, discontinued and ended as to the Respondent. IT IS FURTHER ORDERED and DECREED that the settlements funds of $90,000.00 shall be allocated as follows: TO: Shollenberger & Januzzi, LLP, $22,500.00 for counsel fees; TO: Shollenberger & Januzzi, LLP, $1,085.79 for reimbursement of costs; The balance, the sum of $66,414.21 TO THE MINOR. COUNSEL (and not the parents and/or guardians to the Minor) is hereby AUTHORIZED and specifically DIRECTED to execute all documentation necessary to deposit the funds belonging to the Minor in an interest-bearing savings certificate in a federally insured bank or savings institution having an office in Cumberland County IN THE NAME OF THE MINOR ONLY. The certificate shall be marked as hereinafter directed. The Certificate shall be titled and restricted as follows: Elizabeth McCleerey, a Minor, not to be redeemed except for renewal in its entirety, nor to be withdrawn, assigned, negotiated, or otherwise alienated before the Minor attains majority, except upon prior Order of Court. If no withdrawals are made from the investments authorized by this Decree, the depository may pay over the balance on deposit when the Minor attains majority, upon the order of the late Minor, without further Order of this court. Within ten days from the date of this Decree, counsel for Petitioner shall file an Affidavit with the Court of Common Pleas certifying compliance with this Decree. Counsel shall attach to the Affidavit a copy of the savings certificate reflecting the required restrictions and shall pay such fee as may be required by the Court. The Affidavit shall further contain a specific averment by counsel that counsel, and. not the parent(s) and/or guardian(s) of the Minor, established the account(s) and deposited the funds therein as directed above. BY THE COURT, ? Karl J. Januzzi, Esq. 2225 Millennium Way Enola, PA 17025 Attorney for Petitioner n :rc Cory 1Yt a'Je-ty 'Vas-/ a AW n c o _? =rn (??lL r" -V CA r- Christylee L. eck, J. pa Cn M < C-- r..0 a SHOLLENBERGER & JANUZZI, LLP 2225 Millennium Way Enola, Pennsylvania 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 Attorneys for Plaintiff IN RE: ELIZABETH McCLEEREY, a minor. E? THE 'RO7NQNIJ Ak 2012 MAY 14 AM 10: 53 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 2012-2391 CIVIL CIVIL ACTION - LAW AMENDED DECREE AND NOW this //--4!f4 day of 20/, upon consideration of the Petition to Amend Decree, it is hereby ordered that the Petitioner shall have until June 11, 2012, in which to submit his Affidavit evidencing compliance with the deposit provisions of Court's Decree of April 25, 2012. All remaining provisions the Decree shall remain in full force and effect. BY THE COURT: ? J. DISTRI TION LEGEND: Karl J. Januzzi, Esq., 2225 Millennium Way, Enola, PA 17025 717-728-3200; 717-728-3400; kii(Msholljanlaw. com 4 2225 Millennium Way Enola, Pennsylvania 17025 Telephone Number: (717) 728-3200 Fax Number: (717) 728-3400 AttnrnAUc fnr Plaintiff fiLED-OFFICE. & ' THE PROTONOTARY 2012 JUL 12 PM 1: 46 . UM;ERLAND COUNTY PENNSYLVANIA IN RE: ELIZABETH McCLEEREY, a minor. IN THE COURT OF COMMON PLE4S CUMBERLAND COUNTY, PENNSY VANIA NO. 12-2391 CIVIL TERM CIVIL ACTION - LAW AFFIDAVIT OF DEPOSIT OF MINOR'S FUNDS The undersigned, as counsel for the minor, Elizabeth McCleerey, hereb certifies that the net settlement amount of $66,414.21 as set forth in this Court's Order 4ted April 25, 2012, was deposited by the undersigned into a restricted certificate of deposit with Integrity Bank that provides for no withdrawals prior to the minor's 18th birthday. Account No. 1052989 is entitled: Elizabeth A. McCleerey, and the proof of deposit is hereto as Exhibit "A." Pi, Esquire Karl JIr AttorEliz abeth A. McCleerey, a minoDated: 7/1"111- INTEGRITY BANK HILL BRANCH, 3345 Market Street, Camp Hill, PA 1 TIME CERTIFICATE OF DEPOSIT NONTRANSFERABLE AND NONNEGOTIABLE Account Title ELIZABETH A MCCLEEREY Account Type 24 - 35 MONTH CD Taxpayer ID Nu 196-76-2110 er Account Number Amount Date of Issue Maturity Date Term 0000000001052989 $ 66 414.21 Jul 10, 2012 Jul 10, 2014 24 Months / Automatic Renewal Interest Rate Per Annum Interest Payment Frei uency 0.648 % with an annual percentage yield of 0,65%. Monthly Elizabeth McCleerey is unable to withdraw until 18`" Birthday Per Court Order. Interest Payment Dls ositlon Interest will be capitalized o this certificate. TIME CERTIFICATE OF DEPOSIT Agreement, This Time Certificate of Deposit is a part of, and governed by, our Time Deposit Agreement. Among other things, thi means that all terms defined in that agreement have the same meanings here. You have received a copy of that agreement, the Truth in Savings disclosures (if applicable), and the fee schedule. You have read them and agree to them. Early Withdrawal Penalty. We do not have to permit early withdrawals from the account. On each one we do permit, we can harge a penalty calculated as follows: If the term is under 30 days interest will be waived if the account is closed before maturity. If the term is between 30 days and under one year a penalty of one month interest will be assessed, If the term is one year and over, a penalty of three months interest will be assessed. If there is enough accrued interest to cover the penalty, we deduct the penalty from it. If not, wed duct the remainder of the penalty from principal. If the account is a variable rate account, we will calculate the penalty using the interest rate being applied at the time of withdrawal. If the account is an Individual Retirement Account, the early withdrawal penalty will be in additio to any penalty imposed under the Individual Retirement Account (IRA) Disclosure Statement. The minimum early withdrawal penalty is sev n days' simple interest on any amount withdrawn (a) within the first six days after the account is opened, or (b) within six days after a previ us early withdrawal. This Time Certificate of Deposit is nonnegotiable and nontransferable. All purported holders or assignees of it 11 have priority over any grtheir claims, Date TIME CERTIFICATE OF DEPOSIT NONTRANSFERABLE AND NONNEGOTIABLE KARL J JANUZZI / 0000000001052989 02008 ree that