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Duncan & Hartman, P.C.
Susan J. Hartman, Esquire
1 Irvine Row, Carlisle, Pennsylvania 17013
7l 7.249-7780
717.249-7800 FAX
Attorney ID 65184
IN RE: DANIEL SHAFFER
AN ALLEGED INCAPACITATED
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
PERSON :ORPHANS' COURT DIVISION
NO. 21-12-0626
MOTION TO ALLOW TESTIMONY
OF PHYSICIAN BY WRITTEN DEPOSITION
Petitioner Susan M. Shaffer and Steven E. Shaffer, by and through their attorney, Susan J.
Hartman, set forth the following:
1. Petitioner filed a Petition pursuant to Section 5511 of the Probate, Estates and
Fiduciary Code to adjudicate Daniel Shaffer to be incapacitated and to appoint a Guardian for his
Person and his Estate.
2. Testimony by Jody M. Ross, M.D. is required in order to establish the existence of the
criteria necessary to adjudicate DANIEL SHAFFER to be incapacitated.
3. A hearing upon the Petition has been set for August 2, 2012.
4. Dr. Ross will be unavailable to testify by telephone or video on August 2, 2(II2 due to
prior engagements.
5. Petitioner proposes to enter the testimony of Dr. Ross by way of a written deposition, a
copy of which is attached hereto and marked Exhibit "A".
6. Mark F. Bayley, Esquire, appointed counsel for DANIEL SHAFFER, has been
apprised of these circumstances and has consented to entering the testimony of Dr. Ross by way
of a written deposition.
WHEREFORE, Petitioner requests your Honorable Court grant permission to allow the
testimony of Dr. Jody M. Ross to be entered into the record by way of written deposition.
Dated: June 27, 2012
Respectfully submitted,
PHYSICIAN TESTIMONY BY AFFIDAVIT
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: DANIEL A. SHAFFER
An alleged incapacitated person
NO. 21-12-0626
On the Petition of Susan M. and Steven E. Shaffer
DEPOSITION OF INDIVIDUAL QUALIFIED TO RENDER OPINION AS TO
INCAPACITATION
This written deposition of
is taken on the
Hershey, Pennsylvania.
day of
Please state your name and your professional address.
at
2. Please describe your education, training and background with particular
emphasis on your expertise in evaluation of individuals with incapacities OR attach to
this written deposition your curriculum vitae.
EXHi~IT
„An
Jody M. Ross, M.D., a witness in this matter,
3. In your professional capacity, have you had the opportunity to meet with,
examine, speak with and otherwise become acquainted with Daniel Shaffer'
If yes, please state the following:
I first became acquainted with Daniel Shaffer on
when he was brought to my
attention by
I have since (visited spoken with, examined or treated) him on
(circle applicable contacts)
times per
other occasions with an average frequency of
(day/week/month/year)
4. Please evaluate the present condition of this patient with respect to incapacities
of the type alleged in the Petition for Adjudication of Incapacity:
fn particular, please comment on the nature and extent of the alleged
incapacities and disabilities and also, insofar as you are able, his mental, emotional and
physical condition, adaptive behavior and social skills.
Based upon my education, training and experience, as well as my acquaintance
with this patient, it is my opinion, to a reasonable degree of medical certainty that his
incapacities are as follows:
Mental condition
Emotional condition
Physical condition
Adaptive behavior
Social skills
5. Based upon your education, training and experience, and your contacts with this
patient, do you have an opinion, to a reasonable degree of medical certainty, whether
he is impaired in his ability to effectively receive and evaluate information and to make
and communicate decisions in any way?
If so, please explain your opinion.
6. If you are of the opinion that he is impaired in his ability to effectively receive
and evaluate information and to make and communicate decisions in any way, does
such impairment render him either partially or totally unable to manage his financial
resources?
If yes, check whether such impairment renders him:
Partially unable, to manage his own finances.
Totally unable to manage his own finances.
Please explain your opinion.
7. If you are of the opinion that he is impaired in his ability to effectively receive
and evaluate information and make and communicate decisions in any way, does such
impairment render him either partially or totally unable to meet the essential
requirements for isr physical health and safety?
If yes, check whether such impairment renders him:
Partially unable, to meet essential requirements for his physical
health and safety
Totally unable to meet essential requirements for his physical
health and safety
Please explain your opinion
8. Please provide an assessment of the severity of any impairments of this patient.
Impairment
(Circle One)
a) mild moderate severe
Impairment (Circle One)
b) mild moderate severe
c) mild moderate severe
d) mild moderate severe
e) mild moderate severe
f) mild moderate severe
g) mild moderate severe
h) mild moderate severe
9. Is the condition of this patient such that because of his condition he would be
susceptible to undue influence by unscrupulous or designing persons?
If so, what services or assistance would you recommend as necessary to appropriate
management of this patient's finances?
10. What services or assistance would you recommend as necessary to meeting the
health and safety needs of this patient?
11. Are the services or assistance recommended the least restrictive alternative?
Does the patient need the services of the guardian to make decisions regarcing the
patient's healthcare, safety and financial resources? In other words, could the patient
evaluate, communicate and make decisions regarding his health treatment, safety and
financial resources in important matters without the guardian?
If not, please explain why less restrictive alternatives are inappropriate.
12. Based upon your education, training, experience and familiarity with thus patient,
what is your opinion as to the likelihood that the degree of incapacitation will
significantly change?
13. Would the physical or mental condition of this patient be harmed by his
presence in open court? NOTE: Pennsylvania law, 20Pa.C.S. § 5511(a)(1), requires
that the alleged incapacitated person be present at the hearing unless a physician or
licensed psychologist provides by testimony or sworn statement, an opinion that her
physical or mental condition would be harmed by his presence in court. If yes, please
explain.
VERIFICATION
I, Jody M. Ross, M.D., verify that the
statements made in the foregoing deposition are true and correct to the best of my
knowledge, information and belief. I understand that the statements herein are
subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Signature of Deponent
Dated:
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ON THIS, day of , 20 ,
before me a Notary Public, personally appeared Jody M. Ross, M.D. ,
known to me to be the person whose name is subscribed to the within instrument and
acknowledged that she executed the same for the purposes therein contained'.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public