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Home My WebLink About08-09-12 C~ ~ . ~;LL -~ ti r G-! ~+ J l-- IN THE COURT OF COMMON PLEAS OF c~~`_, CUMBERLAND COUNTY, PENNSYLVANIA `~'` _;~ ~ ---~ In Re: Russell Lee Zimmerman ORPHANS' COURT DIVISION An Alleged Incapacitated Person O.C. No.: ~ l / ~ ~~ ~` ~., f1 EMERGENCY PETITION FOR ADJUDICATION OF INCAPACITY AND THE APPOINTMENT OF A GUARDIAN OF THE PERSON OF RUSSELL LEE ZIMMERMAN r:.._.. ~~., ~_~ u7 1 -~: ~'`.,? AND NOW, comes Petitioner, Select Specialty Hospital -Central Pennsylvania, L.P. ("Petitioner"), by and through its attorneys, THOMAS, THOMAS & HAFER, LLP, and hereby respectfully petitions this Honorable Court pursuant to 20 Pa. C.S. §5513 for adjudication of incapacity and appointment of an Emergency Guardian of the Person of Russell Lee Zimmerman and, in support thereof, avers as follows: 1. The alleged incapacitated person is Russell Lee Zimmerman who is a 62 year old individual currently residing at Petitioner's Specialty Hospital located at 503 North 21St Street, 5t" Floor, Camp Hill, Pennsylvania 17011. 2. Petitioner is a foreign limited liability partnership licensed under the laws of the State of Delaware with its principal place of business located at 503 North 21St ~7 ~ ~-, C ; ~ _~.> ` `~. •`! . _; . ~,--- 1.~3 ~^~ T~ Street, 5t" Floor, Camp Hill, Pennsylvania 17011. 3. Pursuant to 20 Pa. C.S. §5512(a), this Honorable Court has jurisdiction over this matter as the alleged incapacitated person resides in Cumberland County. 4. Upon investigation, information, and belief, Mr. Zimmerman has no next of kin, living heirs, or friends who are sui juris. 5. To the extent of Petitioner's knowledge, Mr. Zimmerman does not own any real property and the value of an estate, if any, is unknown. 6. Mr. Zimmerman is on Medical Assistance benefits and receives a monthly income from Social Security. The amount of such benefits is not known to Petitioner. 7. Mr. Zimmerman's treating physician is: Dr. Howard Roy Cohen 4713 East Trindle Road Mechanicsburg, PA 17050-3616 Phone: (717) 737-8686 Fax: (717) 737-8692 8. Upon admission to Select Medical in March 2012, Mr. Zimmerman had undergone a coronary bypass grafting and aortic valve replacement. His recovery was complicated by diabetes mellitus, hypertension, hyperlipidemia and alcohol abuse. During the recovery he was treated with a balloon pump, cardiogenic shock, and suffered from severe cardiomyopathy with a final ejection fraction of 20%. Mr. Zimmerman was in atrial fibrillation and was ventilated with at least two (2) shocks to bring him to normal sinus rhythm. He underwent a tracheostomy, was ventilated, and underwent percutaneous endoscopic gastrostomy (PEG) tube placement for feeding. Mr. Zimmerman also developed acute renal failure requiring a course of continuous 2 1127388.1 dialysis and ultracentrifugation. At the time of admission to Select Specialty Hospital, his status was seriously ill with a guarded prognosis. His condition has continually deteriorated during his four and one-half (4-1 /2) months of treatment at Select Medical. 9. Due to the diagnoses listed in paragraph 8, Mr. Zimmerman does not have the ability to make or communicate decisions related to healthcare or his financial affairs and the probability of improvement by Mr. Zimmerman is not medically reasonable or foreseeable. 10. Due to the urgent need for Mr. Zimmerman to have a Guardian of the Person appointed, locating a suitable Guardian is not feasible. 11. We respectfully request that this Honorable Court appoint an appropriate individual to consult with Petitioner's Ethics Commission to determine the necessary medical treatments and the need for approving withdrawal of treatment and palliative care, if any, for Mr. Zimmerman. 12. There are no less restrictive alternatives to the appointment of an Emergency Guardian of Mr. Zimmerman's Person and Estate. 13. The Petitioner does not have any knowledge of any court within the Commonwealth that has appointed a Guardian for Mr. Zimmerman. 14. Upon information and belief, Mr. Zimmerman was not a member of the Armed Services of the United States and does not receives any benefits from the United States Veterans' Administration. WHEREFORE, Petitioner prays this Honorable Court to declare Russell Lee Zimmerman to be an incapacitated person and to appoint an individual of the court's 3 1127388.1 choosing to be the Emergency Guardian of Mr. Zimmerman's Person, for the period of 72 hours and thereafter for an additional twenty (20) days until such time as the Petitioner can file a Petition for Permanent Plenary Guardianship of Mr. Zimmerman's Person and Estate. Respectfully Submitted, THOMAS, THOMAS & HAFER, LLP ~; B Date: ~' - ~~ - /2~ By: `f ~ '~ ~~ Barbara G. Graybill PA Attorney I.D. No.: 39895 Anthony T. Lucido PA Attorney I . D. No.: 76583 305 N. Front Street, 6t" Floor P.O. Box 999 Harrisburg, PA 17108 4 1127388.1 VERIFICATION The unde~=5igned hereby-verifies--that the statements--of fact in t e foregoing - - -- - -- -- -- -- -, Emergency Petition for Adjudication of Incapacity and the Appointment of an Emergency Guardian of the Person of Russell Lee Zimmerman are true and correct to ~~ the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. ~ ~ ~~~ ~_ B : .~.___ ~ ~ Date. y Thomas Mullin, CEO Select Specialty Hospital - Central Pennsylvania 1127388.1 - ~ _ . -- - - lN.THE COURT OF COMMON PLEAS OF .~ ~ CUMBERLAND: COUNTY, PENNSYLVANIA ~ - ~ ~ : - . ~. ~ In Re: Russell Lee Zimmerman ~ ORPHANS' COURT DIVISION - - ~ - An ~Alfeged incapaci#ated-Person : ~. ~ ~ - - - O.C. Na.: ~ ~ . - - ~ ~ ~ .. - -- ANSWERS TO WRITTEN INTERROGATORIES UNDER TITLE 20 PA.C.S.A. . 5518 REGARDING INCAPACITY AIy~D NEED FOR GUARDIANSHIP SERVICES ~[ ~ _ l.) My name is 1 ~ " ~ ~ ~ ~ (~ and my office address is r ~ ~ - ~ ~' /~% < ~ ~ _ 2.) 'Z'he colleges and graduate/professional schools I attended, the degrees I received and the years in which such degrees were conferred are: 3.) I am currently licensed to practice (check as appropriate) Medicine ^ Psychology - ^ Other (Specify) in the states of ~/'r - 4.} -L am,currently Board certified in the f/ell(s)-of . - ~~ _/ A r 5.) The name of the alleged incapacitated person is ../~ and his/her date of birth is 6.) I first met the alleged incapacitated person in my professional capacity on ~- a ~ ~ - and last saw him/her on - ~ ° 1 ~ ~ -~. ~~- 7.) (Complete part (a) or (b) as appropriate) (a} I have been treating the alleged incapacitated person since and have since visited, spoken with, examined or treated him/her on approximately ~,! ~ . , other occasions with an average frequency of - ~ °~t ~~ . t' per (day, week, month, year) _ - - .,~,~.~ The date and the reason for my most recent treatment were: ~~ _ ~. ~~ ~-~_ (b) I evaluated, but have not treated, the alleged incapacitated person following dates: _ -- _ j $.) (Complete part (a) or (b) as appropriate): (a} I dial NOT administer a mini mental status exam to the alleged incapacitated person because: ~ $`~ , ' ~ ~ ' ^ ~ (b) I administered a mini mental status exam to the alleged incapacitated person on and the score was out of - 9.) I- ^ have not have_ reviewed the alleged incapacitated person's medical __ ~. ~. T records, most recently on ~~ ~{.~ ~ `s"~ ~' i _~ 14.) In my opinion, the alleged incapacitated person currently suffers from the following condition(s)/diagnosis(es): Ph sical: ~ ~E~ cy ~.--s y Mental: Emotional: Adaptive Behavior: Social Skills: Other: 1 l.) In my opinion, the alleged incapacitated person is impaired in the following ways and to the following extent (check as appropriate): Receive and evaluate information ^ N.A. ^ Mild ^ Moderate Severe Communicate decisions ^ N.A. ^ Mild ^ Moderate ~evere Short-term memory ^ N.A. ^ Mild ^ Moderate ~evere g ry Lon -term memo ^ N.A. ^ Mild ^ Moderate severe Oriented x 3 ^ N.A. ^ Miid ^ Moderate evere If the alleged incapacitated person is NOT generally oriented x 3, describe his/her general level of orientation: Understand his/her medical condition .A. ~~ ^ Mild ^ Moderate ^ Severe Understand his/her medical needs ~~~.A. ^ Mild ^ Moderate ^ Severe Is compliant with medical treatment/medication .A. ^ Mild ^ Moderate ^ Severe . ~'' 3- -- --- - - - --~ - - Provide-for. his/her:physical-safety N.A. ' ^ Mild ^-Moder--ate _ ^ -Severe- Able to give informed consent ,~ N.A. ^ Mild ^ Moderate ^ Severe Prepare own meals ~'N.A. ^ Mild ^ Moderate ^ Severe - ---- -- -- Perform personal/hygiene care - - -- -- I.A. ^ Mild ^ Moderate ^ Severe Drive a motor vehicle safely ~'N.A. ^ Mild ^ Moderate ^ Severe Enter into a contract, e.g. marriage ~'N.A. ^ Mild ^ Moderate ^ Severe Pay own bills ~'~I.A. ^ Mild ^ Moderate ^ Severe Manage own checking account N.A. ^ Mild ~ ^ Moderate ^ Severe Be susceptible to persons of designing .A. ^ Mild ^ Moderate ^ Severe influences Describe the extent to which the alleged incapacitate person old be taken advantage of by unscrupulous or "designing" persons: _ ,n 12.) In my opinion, the prognosis for the alleged incapacitated person is: ~ a .a ~ . ~~ ~ ~ 13.) In my opinion, the most appropriate, least restrictive living situation for the alleged incapacitated person is (check one): ^ Home ^ Independent living facility ^ Assisted living facility ^ Skilled care facility ^ Secure facility ~~ ~. ~- ~wqV~ dUi W L ~e ~~'a~t~- - - - -- 14:) In.my opinion,.the:.following. other.service(s) or. assistance is/are necessary to meet the health or safet~~ needs of the alleged incapacitated person: 15.) (a) Has any family or friends accompanied the alleged incapacitated person to your treatments or evaluation of the alleged incapacitated person? ^ Yes o If "yes', identify such individuals by name and relationship to the alleged incapacitated person: ~~ oti~ (b) Are you otherwise acquainted with any of the alleged incapacitated person's family or friends? ^ Yes ~,~o. If "yes", identify such individuals by name and relationship to the alleged incapacitated person: (c) In your opinion, which persons, if any, you identified in part (a) or (b) above have the best interests of the alleged incapacitated person at heart AND should be considered by the Court for appointment to make decisions for the incapacitated person: ~. -- ---5 -- - ----- ---- ----- ------------- ------- 16:)- The law requires the. alleged-incapacitated-.person be present at-the hearing unless. a physician or licensed psychologist testifies the physical or mental condition of the alleged incapacitated person would be harmed by his/her presence in court. Would the physical or mental condition of the alleged incapacitated person be harmed by his/her presence in court? If so, specify the basis for such opinion: ~ ~ I certify that all of my opinions are based upon my education, training, experience and contact with the alleged incapacitated person as described, and are stated to a reasonable degree of professional certainty. Further, I verify that the foregoing answers 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}. ~--~ Dated: '~ ~ ~ Signature: ~3 ~~ ~ ~~ ~~ --------- --~-- --6-