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HomeMy WebLinkAbout02-0332In Re: : ESTATE OF CHRISTOPHER WEEMS,: a Minor : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION PETITION TO AUTHORIZE SETTLEMENT OF MINOR'S PERSONAL INJURY CLAIM Pursuant to 20 Pa.C.S.A. Section 3323(a), Petitioner State Farm Mutual Automobile Insurance Company respectfully petitions this Honorable Court to enter a decree authorizing and approving a compromise settlement for the personal injury claim of Christopher Weems, a minor, and in support thereof avers as follows: 1. Petitioner State Farm Insurance Company ("State Farm") is an insurance company duly licensed and registered to do business in the Commonwealth of Pennsylvania. 2. Christopher Weems is a seventeen-year-old minor child residing with his natural parents, Claude P. Weems and Jill Weems at 15 Burgundy Circle, Boiling Springs, PA 17007-9730. 3. At all times relevant hereto, there was in full force and effect certain motor vehicle insurance policies issued by State Farm in favor of Claude P. Weems and Jill Weems, which policies listed as insured vehicles a 1985 Chevrolet Van, a 1994 Plymouth Voyager, and a 1991 Dodge Caravan, each owned by Claude P. Weems and Jill Weems, the minor's parents. 4. On August 19, 1998, Christopher Weems was the front seat passenger in an automobile being operated by one Michael Richie, which was traveling south on Middlesex Road, Cumberland County, Pennsylvania, when the driver lost control, struck a tree with the right side of the car. The car flipped over and caught on fire. 6. As a result of this one-vehicle accident, the minor Christopher Weems, sustained personal injury, including a closed head injury that has resulted in permanent residual cognitive disorders, more fully detailed on the report of Paul J. Moberg, Ph.D., a copy of which is attached hereto, made a part hereof and identified as Exhibit A. 7. Previously, the minor's parents settled a claim with the tortfeasor's insurer, Erie Insurance, in an amount equal to the policy limits. 8. On behalf of their minor son, Claude P. Weems and Jill Weems, have now made a claim for underinsured motorist benefits under their State Farm policies with respect to the personal injuries he sustained in the accident. 9. Petitioner State Farm has proposed the following settlement of the Weems claim, the terms of which Claude P. Weems and Jill Weems have approved on behalf of their minor son: a Lump sum payment of One Hundred Fifty Thousand(SI 50,000.00) Dollars. The Weems' written consent to and approval of the proposed settlement is attached hereto, made part hereof, and identified as Exhibit B. 9. Neither the Weems nor their minor son, Christopher, are represented by counsel. 10. Neither the Department of Public Welfare, nor any other entity, has a lien or claim against the Weems or their minor son in connection with his accident-related injuries. 11. Petitioners fully intend to invest the proceeds of this settlement as provided by Chapter 73 of the Decedents, Estates and Fiduciaries Code, and to make such distribution of the income in accordance with 28 Pa.C.S.A. Section 5164 for the ongoing, necessary and reasonable expenses for the care, maintenance and education of Minor. Date: WHEREFORE, Petitioner respectfully requests that the parties be permitted to enter into the settlement recited above and that the Court enter an Order approving payment of the settlement amount to Claude P. Weems and Jill Weems, as parents ofCbxistopher Weems, a minor, as set forth in the proposed Order attached hereto. Respectfully submitted, Brig~d Q. ~lford, E~quire]~ Supreme Court ID No. Boswell, Tintner, Piccola & Wickersham 315 North Front Street, P.O. Box 7410 Harrisburg, PA 17108-0741 UNIVERSITY OF PENNSYLVANIA MEDICAl. CENTER Paul J. Moberg, Ph.D., ABPP/CN Associate Professor of Neumpsychology University of Pennsylvania School of Medicine Hospital of the University of Pennsylvania Clinical Director, Brain-Behavior Laboratory Department of Psychiatry CONFIDENTIAL NEUROPSYCHOLOGICAL EVALUATION Name: WEEMS, Chris Date of Birth: 04/24/84 Age: 17 years Education: 11 years Occupation: Student Lateral Dominance: Right hand Date of Evaluation: 08/22/01& 10/31/01 Referred By: State Farm. Insurance Company R~C~=IVED HISTORY AND BACKGROUND Chris Weems is a 17-year-old, right-hand dominant, Caucasian male who was referred for neuropsychological evaluation to assess his current level of cognitive functioning. The evaluation was requested due to his history of a traumatic brain injury that was sustained during a motor vehicle accident. His history has been well-documented in previous records and reports and will not be extensively recounted here. The following records were available for review: [1] Commonwealth of Pennsylvania Police Accident Report; [2] Newspaper article; [3] Carlisle Pediatric Associates; [4] Correspondence from Jill Weems (mother); [5] Penn State Geisinger; [6] Life Lion On-scene Transport Note; [7] SAT Student Score Report; [8] School records. Other background information was obtained through a clinical interview with Mr. Weems and his mother. A police report dated 08/19/98 revealed that Mr. Weems was involved in a single car accident on this date. According to the report, Mr. Weems was a passenger in a car traveling South on Middlesex Road. Based on a statement from the driver of the car, he was reportedly going too fast and the driver lost.. control, striking a tree with the right side of the car and causing the car to flip over. The vehicle then started on fire and Mr. Weems was pulled from the front passenger seat by a passerby. He was reportedly unrestrained at the time of the accident. According to a newspaper article about the accident, Mr. Weems' legs were noted to be "jammed underneath the collapsed dashboard". The three other passengers were transported via ambulance to the Carlisle Emergency Room. Mr. Weems was taken via Life Lion helicopter to Hershey Medical Center (HMC) for treatment. Records from Life Lion on 08/19/98 noted that Mr. Weems was found in an altered level of consciousness with t~o obvious deformities or trauma. Periods of lethargy were observed. He was noted to be following commands and was oriented to his name only. A laceration was noted on the back of his head. Swelling around his eyes was also observed. In flight, Mr. Weems was noted to have two episodes of dark emesis and vomiting. He was subsequently transferred to the trauma team at HMC. Admit note to HMC dated 08/19/98 noted details of the accident and listed loss of consciousness and amnesia as "?". X-rays on 08/19/98 of his left leg did not reveal any fractures or other acute.bony injury. CT of the abdomen, pelvis and thorax revealed a "small dependent atelectasis in the left lung". No other acute injury to the chest, abdomen of pelvis was reported. Echocardiography study on this same date was reported to be generally within normal limits. Another consultation report on the same date t0th Floor, Gates Building - 34.00 Spruce Street · Philadelphia, PA 19104-4283 · 215-662-6094 ' FAX: 215-662-~ Internet: moberg@bblmail.psycha.upe nn.edu U.','[', t.:Jq.s'l I'r' (~t: Pl.i.¥,~sYI, [:-~,¥L~ ['[~':Al. Fll S¥'STI..'.~t C~)NFIDENTIAL WEEMS, Chris Page 2 raised questions of facial and orbital fractures and a CT was recommended. R~CEtVED A CT scan on 08/19/01 revealed "two definite small hemorrhagic shear injuries. One involves the splenium of the corpus callosum and a second involves the gray-white matter junction in the left frontal lobe". Several other small less well-defined areas of increased attenuation were felt to reflect small shear injuries. Soft tissue swelling and a soft tissue laceration was noted over the orbits. Bilateral lamina papyracea fractures were also reported as was a mildly comminuted fracture at the roof of the left orbit at the apex. Ethmoid, sphenoid and frontal sinuses were reported to be subtotally opacified with air fluid levels demonstrated. A follow-up CT scan on 08/20/98 revealed: 1) Bilateral lamina papyracea fractures. 2) Left orbital roof apex fracture. 3) Bilateral nasal bone fractures. 4) Right orbital inferior blowout fracture. A consult note dated 08/20/98 noted a GCS of 14 upon admission to the ER. A CT scan was reported to reveal "bifrontal petechial hemorrhage/petechiae of the corpus callosum". He was noted to be answering questions with short responses but was a "wise guy" and somewhat angry in tone. Assessment was Rancho Level VI and he was felt to be "moving quickly in recovery". A number of inconsistent responses, episodes of mood lability and combativeness were noted, however. Follow-up for issues of attention, mood lability and fatigue secondary to his brain injury was recommended. A Rehabilitation consult on 08/20/98 listed a diagnosis of: 1) CHI with shear injury, 2) ICH. 3) Ethmoid fracture. 4) Left orbital roof fracture. The possibility of a short rehabilitation admission was raised. Ophthalmology consult on 08/21/98 for diplopia noted some difficulties and the use of a prism was suggested if the problem persisted after his swelling went down. Records from Penn State Geisinger noted that Mr. Weems was evaluated in the Brain Injury Clinic on 09/11/98 for follow-up of a moderate brain trauma. He was noted to have been acutely hospitalized on the Pediatric Unit and was discharged on 08/23/98. His discharge summary noted the following discharge diagnoses: 1) Status post motor vehicle collision. 2) Closed head injury, shear injury. 3) Multiple facial fractures including bilateral orbital fracture (left orbital roof fracture, right orbital floor fracture), nasal fractures, bilateral (word omitted) fractures right greater than left. Follow-up assessment was requested due to significant frontal lobe symptoms including belligerence, short attention span, poor short term memory and irritability. These symptoms were, however, noted to have "gone away" and that he had "regained his usual personality". No problems in school or with attention span were noted. Additionally, he denied any fatigue, headache, balance problems or other difficulties which were referable to his brain injury. Some slow alternating movements were observed, but there was concern that Mr. Weems was not putting forth full effort. The remainder of the note was not available for review. A CT scan of the brain dated 08/28/98 revealed: "The hemorrhages seen on the prior scan are not apparent on today's scan. The brain is normal". A letter from Paul Kanev, M.D. to Dr. Hoffman dated 08/31/98 stated that Mr. Weems' scans revealed a "thin degree of traumatic subarachnoid hemorrhage, layered along the falx and the corpus callosum". Several tiny contusions along the midline were noted to have resolved. Post-concussion agitation and belligerent behavior were noted to have "completely resolved". No headache, double vision or changes in energy or activity were noted. Dr. Kanev stated that Mr. Weems could resume non-contact sports at this time. He was discharged from Dr. ranev's care. A note from the otolaryngology clinic at HMC dated 08/31/98 noted decreased swelling around his orbits, although some upper eyelid ecchymosis was noted to remain. His nose was felt to be back at its pre-injury state. Diplopia was reported to be resolved and extraocular motion was felt to be normal. A follow-up note from Mae Millicent Peterseim, M.D. dated 09/16/98 stated Mr. Weems came in for follow-up of his double vision. Impression of this exam was: 1) S/P orbital fracture following car accident. 2) Resolved diploplia. No further follow-up outside of reg'ular eye exams was recommended. A note from Lynn Hoffman, M.D. dated 04/30/01 addressed Mr. Weems' frequent tardiness at school. According to Dr. Hoffman, Mr. Weems suffered from Attention Deficit disorder-inattentive type CONFIDENTIAL ': ":7 '7"~ ~ WEEMS. Chris due to a brain injury sustained in the 08/98 accident. In addition, Dr. Hoffman reported that Mr. Weems' sleep cycle had been altered, with a significant delayed sleep-onset syndrome being present. A formal sleep study was recommended as was phototherapy to readjust his sleep cycle. A letter to Jeanette Ramer, M.D. dated 05/28/00 from Mrs. Jill Weems detailed her son's sleep problems. She reported that Mr. Weems has to be up for school at 6:45 am so he can get to school by 7:35. She noted that she will shake and attempt to rouse her son to no avail. Due to his problems getting up, she stated that he has been late to school over 40 times this year. Mrs. Weems reported that it usually takes him until 8:00 or 8:30 before he is fully awake and functioning. She also reported that even if he gets to school on time, he will often sleep through his first period class. Mrs. Weems stated that his behavior is like "a drunk who mumbles nonsense and is overall uncooperative and then sobers up and becomes apologetic and normal again". She stated that "After 9:00 o'clock in the morning he does fairly well". As a result of these difficulties, he failed English in the Fall and has received negative feedback from his teachers regarding his functioning in class. Mr. Weems reportedly saw a psychiatrist who prescribed Wellbutrin, bu-he apparently refused to take this medication. Mrs. Weems also reported that her son was slow in carrying out his work, writes slowly, is fatigued, does not pay attention, has a lack of attention to details, was "scatter brained", and had problems with test-taking. She also indicated that her son's personality was "different" in that he is more passive and laid back. Overall, her main concern was getting him to wake up in the morning. Another letter on the same date to Mr. Gallagher, the Assistant Principal at Boiling Springs High School, reiterated the comments mentioned above and asked for consideration for his problems. Other notes indicate that before the accident, Mr. Weems' best subjects were English and history-related classes. Now, he was reported to do best in math and science/computer related subjects. School records were also available for review. In the first grade, Mr. Weems' grades ranged from a low of 87 (Science/Health) to a high of 95 (Reading). Similar grades were noted in the 2~ and 3a grades as well. In the 1st grade, Mr. Weems' score on the California Achievement Tests (CAT) were in the average range for total reading and at the 99°~ percentile for mathematics. In the 2~ grade, Mr. Weems' scores on the CAT were generally in the average range with the exception of science, math computation and math concepts/applications which were in the above average range. In the 1995 Pennsylvania System of School Assessment exams (5t~ grade), Mr. Weems attained a score of 1304 (49t~ %ile) in Reading and a 1349 in Mathematics (69~h %ile). In the 7~ grade (1996-97), Mr. Weems' grades ranged from a low of 81 (Computer Sci) to a high of 96 (Tech Ed). In the 8th grade, his scores ranged from a low of 72 (Computer Sci) to a high of 96 (Business Ed). Records from Boiling Springs High School revealed that in the 9~ grade (1998-99), Mr. Weems' QPA was 79.8 with a low grade of 71 in Algebra I and a high of 95 in Basic Foods. He was noted to exhibit some behavioral problems such as not staying in his seat, talking constantly, not paying attention, not turning in homework, etc. In the 10t~ grade, Mr. Weems was noted to have failed Computer II and English 1I, with grades of 58 and 68 respectively. His QPA for this academic year was 77.8. Notes also revealed some inappropriate conduct and late/incomplete homework. Some lack of participation in class was also reported. Records from the first nine weeks of the 11~ grade revealed most grades in the 'B' range with a 'C' in Co-Ed PE 111. Notes on this report indicated that .... Absenteeism affecting work" and "Inattentive/uses time unwisely". A number of other letters and notes detailed detention and administrative actions for excessive absences and tardies. Results of a career aptitude survey on 02/23/00 revealed the following scores: Verbal Comprehension (14, below average), Numerical ability (35, average to above average), Visual speed and accuracy (78, below average), Speed visualization (28, highest), Numerical reasoning (14, > highest). C6NFIDENTIAL WEEMS, Chris Page 4 R~CE~,V~D Mr. Weems recently took the SATs (03/01) and received a verbal score of 400 and a Math score of 420. These scores fall in at the 16~ and 19~h percentiles, respectively (relative to college bound seniors, national). In a letter from Mrs. Weems to the examiner dated 07/31/01, she detailed a number of residual problems from his accident. She reported that his reasoning abilities are poor, "cause and effect reasoning" was impaired, personality change (i.e., aggressive to passive), slow writing/printing, being "scatter-brained", cannot be rushed or hurried, takes a long time to perform simple tasks, and great difficulties in waking up in the morning. The latter issue was noted to be his greatest problem at this time. She noted that it can often take one to 1V2 hours of "constant work" to get him up and awake. She noted that once he is awake, things are much better. Mrs. Weems also noted that he takes Adderal to keep his concentration up during the school day. BEHAVIORAL OBSERVATIONS AND CLINICAL INTERVIEW Mr. Weems was alert and oriented to person, place, and date. He was well groomed and appropriately dressed for the evaluation. No gait abnormalities were evident upon observation and gross motor movements in the upper extremities appeared intact. Spontaneous speech was fluent with no evidence of dysprosody or formal thought disorder; however, Mr. Weems appeared to have mild word- finding difficulties as well as subtle articulation problems. Mr. Weems engaged appropriately in conversation with the examiner. Comprehension of language appeared intact. He easily understood complex test instructions. Mr. Weems was able to attend and stay on task throughout the day long evaluation. He rarely required redirection to task. Mr. Weems was friendly and cooperative during the evaluation. He appeared motivated to perform to the best of his ability and appeared reasonably confident in his ability to complete challenging tasks. His test taking manner was rather slow and deliberate. His affect was situation-appropriate and his mood appeared neutral. The obtained test results are thought to reflect Mr. Weems' current level of cognitive functioning accurately. Mr. Weems stated that on 08/19/98 he was driving with some friends to get something to eat at McDonalds. He stated that he recalls being at the restaurant and subsequently leaving to go home. He reported that there were four people in the car and he was in the front passenger seat. He was not wearing a seatbelt. He stated that they were "driving pretty fast". Approximately 2V2 miles down the road the car they were traveling in apparently went out of control, skidding off of the road and striking a tree. The car then reportedly flipped over and skidded further subsequently catching on fire. Thus, the duration of his retrograde amnesia is estimated to be approximately 5 minutes. His next clear memory was waking up at Hershey Medical Center (HMC) approximately three days later. While in the hospital, Mr. Weems stated that he felt "pretty bad" and was in a "daze". He reported feeling light headed, his eyes were swollen shut and his legs were banged up, Mr. Weems stated that while he could hear everything going on around him, he had a hard time r.esponding. He reported that he was at HMC for 4-5 days. He also stated that others told him that while in the hospital he was "flipping out" and would not often respond to others. Upon his return home, he reported that he suffered from a headache and felt "cloudy" for approximately two more weeks. Mr. Weems noted that he would sleep "very deeply" and would have great difficulty in getting up and awake. He stated that his brain felt "shook up" and that on some days he was able to get up at a reasonable time while on other days he got up quite late. Mr. Weems said that he attended the first day of the 1998 school year and he remembers feeling very sleepy and that he wasn't thinking straight. Mr. Weems reported that persistent sleepiness has been the most troubling residual effect of his injury. He reported that this interferes with his attendance, particularly at early morning classes. He said that he even if he is able to wake up in time to get to class, he often is very drowsy during his first period and may fall asleep in the classroom. He reported trouble concentrating on his school work when he is tired. CONFIDENTIAL WEEMS, Chris 5~'"~ 3 1 2~.1 Page 5 R.z_.C, EIVI~D He stated that approximately 1 V2 years ago he saw a psychologist for a single session reg~ding his problems in w~ing up, but did not return as he did not see it as helpful. He also indicated that he went to Carlisle Hospital for a sleep study 4-5 months ago. They reportedly felt he went to bed too late and were unclear as if this was due to his head trauma. Mr. Weems stated that they asked him to come back for funher evaluation ~d treatment but he had not done so. He also reported that he saw a psychiatrist who had prescribed Wellbuthn because they thought he was depressed. Mr. Weems reposed that he was switched to Adderal later ~ they thought it would help him stay alert in school. When asked about his mood or any personality changes, Mr. Weems stated that he felt that his basic personality had not changed much. He did, however, feel that right after the accident he felt"different" and that he would have some "weird" thoughts. He stated these feelings resolved however, and that he was "pretty much over it now". He stated that he will be a senior this year, and that so far the year has been good. He reported that his thinking is much clearer and that he "get more out of things in class". He also stated that he is not "constantly tired" as he was in the past. He reported that he took a chemistry class this summer with the help of a tutor. He stated that he had to get up early for this (- 9:00 am) and was able to do this without any significant problems. Mr. Weems stated that he feels that he does much better if he gets enough rest and sleep. When asked about last year in school, Mr. Weems stated that he had 74 tardies and missed 20 days of school. He also reported that he had failed chemistry. As noted above, he felt that he was off to a much better start due to a change in his attitude and approach. When asked about his change in attitude toward school, Mr. Weems stated that he was "sick of getting poor grades". He reported that he changed his study habits, going to a local college to study work on his homework. He stated that'he works and studies better at night as he feels more awake. Mr. Weems stated that he currently stays up until 2 or 3 o'clock in the morning and gets up at 6:00 am. The night prior to the current examination, he reported going to bed at 2:00 am and getting up at 6:00 am. He stated that if he did not have to get up for the exam, he would have slept in until 11:00 or 12:00. During school he stated that he was in bed by 1:00 am. Mr. Weems stated that he plans on going to college in West Virginia or community college in Myrtle Beach.. He indicated that he feels ready for this year and anticipates it will be "a better year". He reported that he feels that he has a better "mind set" as well as "clear goals". He reported that his biggest difficulty this upcoming academic year will be "getting up". According to Mr. Weems, his past medical history is unremarkable for any prior illnesses or injuries involving the central nervous system. Weems did report that he had to get stitches on his scalp following an incident when he and another player struck heads during a basketball game. He reported that he gets headaches easier now, and still will get dizzy when he stands up suddenly. These problems were not reported to be constant, however. He denied any prior history of seizure, diabetes, loss of consciousness or any alcohol or drug abuse. He said that his family physician prescribed him Adderal to help him stay awake and he takes it a few times a week. Mr. Weems acknowledged that for the first two years following his injury he tended to dwell on the accident and it had a negative impact on his mood. However, he reported that recently his mood has been fairly good and he no longer thinks about the accident very much. Mr. Weems currently lives with his parents, his older brother, and his older sister. He reported that in his free time he enjoys spending time with friends. His parents both graduated from college. His mother manages a senior citizens' facility and his father is an engineer. His sister has completed approximately 2 years of college and his brother has completed 1 year of community college. Mr. CONFIDENTIAL WEEMS, Chris Page 6 Weems said that he would like to attend college after he graduates from high school. R:F. CEtVE:D Mrs. Weems was also interviewed. As for his current symptoms, Mrs. Weems stated that her son has done better this summer as there was "no pressure". She reported that he took a chemistry class with a tutor and had passed. She also reported that he had played summer league basketball. She reported that her son does not tolerate stress well, but this summer was a "slower pace" and that he seemed to have adjusted well to his. She reported that the last academic year "was rough". Mrs. Weems stated that she could not get him to wake up in the morning for school. Mrs. Weems stated that her son's difficulty in awakening in the morning was the biggest problem. She stated that this difficulty seems to have worsened since the accident, with her son becoming progressively harder to awaken. She stated that she will try and sit him up, but he will often fall back asleep in a chair or the bathroom. She also stated that he will become aggressive and verbally abusive as she tries to wake him up (i.e., "get the hell out of here"). As a result of his problems in waking up, Mrs. Weems stated that her son was tardy 65 times last year. Mrs. Weems reported that she took her son to a sleep center in Carlisle in May of this year and they reportedly recommended phototherapy. She stated that the staff at the sleep center thought his sleep cycle was off by about 4 hours and that phototherapy would help readjust it to a more appropriate schedule. She reported, however, that they had not followed up on this recommendation, though she thought they might do so this Fall. Mrs. Weems also reported that it takes him longer to study and that his writing is very slow. In contrast, his typing speed was felt to be quite good. She noted that last year, teachers would often have him return to class so he could complete exams. She reported that her son "tends not to move fast" and that he "cannot be pushed". She described him as "scatter-brained" and that he is frequently forgetful. Mrs. Weems stated that she also worries about his slowness of writing and poor response to stress as having a negative impact on his ability to do well in college. She indicated that by the time other students are finishing up a report, her son is just getting started. She stated that he does better in a one-on-one situation as opposed to a large classroom. Overall, she expressed concern that he could do well on his own. Mrs. Weems felt that the Adderal had helped with her son's concentration. As for his emotional state, Mrs. Weems stated that before his accident he was "always the kid who talked too much". Now she stated he is quite quiet. She reported that he threatened suicide four times last year, and while she has not felt he would actually follow through on these comments, she does feel somewhat uncomfortable when he makes them. Outside of these threats, however, she felt he did not have any other symptoms of depression. In general, she stated that he does not seem to "have the fire" he once had. She felt he was now more "average" or "passive". Mrs. Weems stated that there is a history of depression in her husband's family, his mother committing suicide. Mrs. Weems did not know about her family as she was adopted. As for medical history, Mrs. Weems noted that she was Rh negative during her pregnancy and that the shot she had received to counter this had "failed". As a result, she noted that her son required a transfusion shortly after his delivery. He was reported to be a full-term baby, and that she was induced. Duration of labor was - 12 hours and he was a vertex delivery. With the exception of some jaundice, Mrs. Weems denied any peri- or post-natal complications. Developmental milestones were reported to have been achieved on time. She denied any prior history of seizures, loss of consciousness, or other medical illness. She reported that he broke a bone in his hand while playing baseball in 1997 and. also got stitches in his knees and arms at one point. She also indicated that he had a mild case of asthma as a child, but seems to have grown out of it. She feels he may have experimented with alcohol, but feels that he has not tried any other type of illicit substances. CONFIDENTIAL WEEMS, Chris Page 7 Mrs. Weems stated that her son attended Rice Elementary school from kindergarten through 4' grade. He subsequently attended Iron Forge Middle School for the 54 and 6* grades. He has been at Boiling Springs High School from the 7* grade to the present. Mrs. Weems stated that her son was "never a straight A student" but that he was generally a good student. He was also noted to have gotten detention a number of times before the accident, but she indicated that "it was not for anything bad". She stated that last year, he primarily got detention for being tardy. She reported that her son does not seem to comprehend what is said to him as well as others and that he is "forgetful, doesn't look ahead to possible danger, doesn't consider circumstances". She rated his intelligence as average to below average depending on the subject. She noted that he was never in special classes, never repeated a grade and is currently in a regular classroom. She noted that he failed three classes since the accident, primarily due to his problems staying awake. She also stated, however, that he had problems understanding a computer programming class and that he had problems with the reading in chemistry. She noted that he seldom seeks help from his teachers. Mrs. Weems also endorsed the following behaviors for her son: Poor attention span, low activity level, easily frustrated, poor memory, somewhat heedless to danger and having an excessive number of accidents. PROCEDURES ADMINISTERED Ps¥chosocial: Clinical Interview with Drs. Moberg and Gunning-Dixon, Gardner Developmental History Questionnaire. General Intellectual Function: Wechsler Adult Intelligence Scale Third Edition (WAIS- m). Academic Achievement: Wide Range Achievement Test, Third Edition (WRAT-3). Attention, Executive Function and Motor: Trail Making Test, Vigilance subtest from the Gordon Diagnostic System Continuous Performance Test (CPT), Auditory Consonant Trigrams (ACT), Stroop Color-Word Test, Wisconsin Card Sorting Test (WCST), Finger Tapping Test, Contrasting Motor Programs-Go No-Go Test. Memory and Learning: California Verbal Learning Test (CVLT); Visual Reproduction and Logical Memory subtests from the Wechsler Memory Scale, Third Edition (WMS-III). Language and Related Functions: Vocabulary and Similarities from the WAIS-III; Controlled Oral Word Association Test (COWA); Animal Naming (AN); Sentence Repetition Test. Visuoperceptual/Visuomotor Function: Block Design, Matrix Reasoning and Picture Completion from the WAIS-III. Affective and Personali~_ Function: Beck Depression Inventory (BDI); State Trait Anxiety Inventory (STAI); Wender Utah Rating Scale (WURS), Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2). Effort and Motivation: Test of Memory Malingering (TOMM). TEST RESULTS General Intellectual Function: Mr. Weems' current level of intellectual functioning, as assessed by the WAIS-m, is estimated to fall within the Average Range (FSIQ = 98, 454 percentile). His verbal skills (VIQ = 102, 554 percentile, Average range) and performance abilities (PIQ = 92, 30~ percentile, Average Range) were equally well developed. Analysis of performance on more specific cognitive domains revealed Average perceptual organizational skills (SS = 99, 47* percentile), Average verbal comprehension abilities (SS = 101, 53a percentile), and borderline processing speed (SS = 79, 84 percentile). Academic Achievement: Results of academic assessment with the WRAT-3 revealed average single word reading ability (SS = 104, 61st percentile), average spelling skills (SS = 108, 70* percentile), and average ability to perform mathematical operations using a paper and pencil (SS = 97, 42~ percentile). Overall, his academic skills were generally consistent with obtained Average IQ. Attention~ Executive Function and Motor: Mr. Weems' immediate auditory attention span was average (digits forward = 7). His auditory working memory was generally within the normal range. For CONFIDENTIAL WEEMS. Chris Page 8 example, his ability to hold three letters in mind while counting backward by threes (ACT) was variable but generally within normal limits. His speed of processing on the Vigilance subtest of the CPT was average, although his performance was characterized by a significant number of false positives. Response times were intact On a task of visual scanning and concentration that involved tracking letters in sequential order (Trails A), Mr. Weems' performance was average. Similarly, on a more complex task of sequencing involving response set shifting (i.e., tracking numbers and letters in alternation, Trails B) his performance was also average. Regarding executive functions, Mr. Weems' performance on a complex task of problem-solving abilities and cognitive flexibility (WCST) was variable. Although Mr. Weems attained an average number of categories and demonstrated the ability to modify his performance in response to verbal feedback (e.g., perseverative errors, T score = 45), attentional difficulties appeared to interfere with his performance on this task (failure to maintain set, < 5%). His ability to inhibit prepotent responses (Stroop) was within normal limits when interpreted within the context of his reduced speed of processing. Fine motor soeed, as measured on a finger-tapping task, was average for his dominant right hand and high average when he tapped with his nondominant left. His ability to learn and execute a motor sequence was generally intact. Memory and Learning: Mr. Weems' ability to learn a list of shopping items (CVLT) was mildly impaired. Both the total number of words he recalled and his learning curve were mildly below expectations. Similarly, his recall of the words after approximately a 3-minute delay and again after a 20- minute delay was moderately impaired. Mr. Weems' pattern of performance suggested the use of a rather haphazard approach to the task rather than the most efficient strategy of using semantic categories to encode and retrieve the word lists. His recognition memory for the word list was severely impaired and characterized by a very conservative response bias. By comparison, Mr. Weems' immediate recall of short stories from the WMS-ffI (LM) was borderline (11~ percentile) and his recall of the stories following a 30-minute delay was low average (16~ percentile). Regarding visual memory, Mr. Weems' reproduction of geometric figures from the WMS-III (VR) was high average immediately following exposure (84~ percentile) and average following a 30- minute delay (50th percentile). His recognition memory for the geometric figures was within normal limits (75~' percentile). Overall, Mr. Weems' memory performance was variable with average to high average memory skills for geometric designs, mild deficits in learning and recalling a word list, and borderline to low average memory for short stories. Language and Related Functions: Mr. Weems' spontaneous speech was fluent with no evidence of paraphasias, dysprosody or formal thought disorder. However, he did demonstrate mild word-finding difficulties. Langna.ge comprehension appeared grossly intact. Formal testing revealed average performance on tasks of word knowledge (Vocabulary, 50~ percentile) and verbal abstract reasoning skills (Similarities, 63~ percentile). Word-list generation in response to phonemic cues (COWA) was average, whereas word-list generation in response to semantic cues (AN) was moderately impaired. Mr. Weems' auditory-verbal attention as measured by a task that tapped the ability to repeat back sentences that were read aloud to him was within normal limits (25~ percentile). Visuoperceptual/Visuomotor Functions: Mr. Weems' visuoperceptual skills were average. When completing a task that required him to identify the most essential missing feature from each picture, his performance was average (Picture Completion, 37th percentile). In addition, Mr. Weems performed within the average range on a task for which he was required to construct block designs to CONFIDENTIAL WEEMS. Chris Page 9 match pictured templates (Block Design, 75~' percentile). Further, his performance on an untimed task of abstract reasoning using pictorial stimuli was average (Matrix Reasoning, 50m percentile). Mr. Weems demonstrated relative weaknesses on select tasks of visuoperceptual tasks that were reliant on psychomotor processing speed (Digit Symbol = 5~ percentile; Symbol Search = 16~ percentile). Affective and Personality Function: Mr. Weems' responses on the BDI were not suggestive of depression. Further, his responses on the STAI indicated that he did not endorse feeling significant symptoms of anxiety either at the time of the evaluation or in his daily life. In addition, Mr. Weems' responses to the WURS are not suggestive of the presence of ADD symptomatology during childhood. Mr. Weems' responses to the MMPI-2 did not reveal any bias in responding with the resulting profile of clinical scales considered valid. Patients with this profile often have poor stress tolerance may be described by others as depressed and anxious. Mr. Weems appears to feel somewhat insecure and inadequate in his interactions with others and may have concerns about his abilities in school. He may feel socially isolated at times and may feel conflicted in his interpersonal and social relationships. Some obsessive feelings, depreasion, cynicism and unusual thoughts were also evident in his profile. While both Mr. Weems and his mother denied any social or interpersonal concerns, these data do suggest some emotional distress. Effort and Motivation: Mr. Weems' performance on the TOMM, a test assessing effort and motivation, suggested that he appeared to be putting forth adequate effort during the evaluation. SUMMARY AND CONCLUSIONS Mr. Weems is a 17-year-old, right-hand dominant, Caucasian male with a history of a traumatic brain injury who was evaluated to determine his cognitive strengths and weaknesses. Intellectual assessment revealed overall abilities in the Average range with equally well developed verbal and performance abilities. Against this background, results of achievement testing revealed that basic academic skills were also in the average range. Results of neuropsychological testing revealed attention, language skills, and visual spatial skills that were generally within the normal range. However, Mr. Weems did exhibit mild deficits on measures of attention and processing speed, semantic word-list generation, and memory for auditory/verbal information. His memory deficits were consistent with a failure to use efficient strategies to encode and retrieve information. Results of self-report behavioral and mood inventories were not indicative either of the presence of major depression or ADD symptomatology in childhood. In contrast, his responses to the MMPI-2 did suggest some emotional concerns characterized by poor stress tolerance, depression, anxiety and concerns about his thought processes. Although Mr. Weems exhibited some of the cognitive weaknesses that are often observed in individuals with ADD, a typical ADD profile would be characterized by more notable deficits on measures of attenti6n. Nor was his academic history or his pattern of performance on neuropsychological testing suggestive of a long-standing learning or attentional disorder. Instead, it appears that the observed weaknesses in attention, processing speed, and memory are the residual effects from the traumatic brain injury he sustained on 08/19/98. These findings are also supported by his past radiologic studies as well as his subsequent clinical course and presentation. Given that he is approximately three years post injury, it is unlikely that any further spontaneous recovery will occur. While he appears to have made a very nice recovery from these injuries, the biggest barrier to Mr. Weems' functioning at this juncture appears to be is difficulty waking in the morning and feelings of fatigue. Both the patient and his mother stated that when rested, he seems to perform at pre-injury cognitive levels. While the Adderal seems to be aiding his alertness level during the day, his sleep hygiene and pattern still appears to be significantly disrupted. CONFIDENTIAL WEEMS, Chris Page 10 Once his sleep difficulties are appropriately addressed, his prognosis looks quite good. That is, the cognitive deficits noted here are mild and would not be expected, in and of itself, to significantly interfere with his academic and daily functioning. These deficits are, however, significant when exacerbated by his sleep disturbance. Lastly, while Mr. Weems' responses to self report mood inventories and self report during the clinical interview were somewhat conflicting, there does appear to be some evidence of emotional disruption characterized by depression, anxiety and concerns over his thought processes. RECOMMENDATIONS 1. Mr. Weems' residual cognitive weaknesses are likely to be significantly exacerbated by his persistent fatigue and sleep disturbance. While phototherapy was reportedly recommended back in May of this year, Mrs. Weems stated that they had not been back to follow-up on this recommendation. Thus, Mr. Weems and his family should follow-up on the treatment recommendations made from his previous sleep evaluation. Interventions aimed at restoring his sleep cycle and helping improve his sleep hygiene will likely prove most benefioial. Once his difficulties with sleep and fatigue are addressed, his cognitive and classroom functioning should improve significantly. 2. In light of the mild deficits in cognitive functioning observed on testing, Mr. Weems may benefit from a time-limited intervention from a cognitive remediation specialist to teach him the use of compensatory strategies to cope with his cognitive weaknesses. Such treatment could further assess and explore any potential emotional concerns that Mr. Weems may have. Thank you for the opportunity to participate in Mr. Weems' care. Please feel free to contact me at (215) 662-2826 if you have any questions about this evaluation and report. Paul J. Moberg, Ph.D., ABPP/CN Associate Professor of Neuropsychology Departments of Psychiatry and Otorhinolaryngology: Head and Neck Surgery Axis 1: Axis II: Axis Ill: Axis IV: Axis V: 294.9 Cognitive Disorder NOS, Mild, secondary to closed head injury 307.45 Circadian Rhythm Sleep Disorder, D~layed Sleep Phase Type (by history) R/O Adjustment disorder with mixed anxiety and depressed mood V71.09 No d!agnosis Closed Head injury with shearing Academic and sleep hygiene problems GAF = 76 (current) CERTIFICATE OF SERVICE I do hereby certify that I have served a tree and correct copy of the foregoing Petition to Authorize Settlement of Minor's Personal Injury Claim by placing the same in the United States Mail, first class, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Claude P. Weems Jill Weems 15 Burgundy Circle Boiling Springs, PA 17007-9730 Date: By: Brigid 0J Alford, Esquire] CONSENT AND APPROVAL BY MINOR'S PARENTS We, Claude P. Weems. and Jill Weems, do hereby state that we are the natural parents and guardians of Christopher Weems, a minor, that we have reviewed the terms and conditions of the foregoing Petition presented by State Farm Mutual Automobile Insurance Company, and that we agree to the same. Claude P. Weems Jill ~eems Sworn to and subscribed before me this ~ day of t.~~ ,2002. N-~ary eul/iic Notarial Seal Rosemary Giancoli, Notary Public South Mlaaleton Twp,, Cumberland Counly My Commission Expires Mar, 15, 2006 EXHIBIT B In Re: : : ESTATE OF CHRISTOPHER WEEMS,: a Minor : : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ORDER NOW, this ~f~. day of ]~( ~ , 2002, it is HEREBY ORDERED AND DECREED that a hearing on the Petition of Claude P. Weems and Jill Weems, parents and natural guardians of Christopher Weems, a Minor, is hereby scheduled for 7'~t)o'clock on )~ ~/~u- ~ , 2002, in Courtroom No. ~__ of the Cumberland County Courthouse, Carlisle, Pennsylvania, at which time, all interested parties shall appear and be heard. ¢? m:home/BQA/litigaffStatefrm/Weems/Praecipe to Withdraw Petition.wpd April 26, 2002 In Re: : ESTATE OF CHRISTOPHER WEEMS, : a Minor : IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-332 PRAECIPE TO WITHDRAW PETITION TO AUTHORIZE SETTLEMENT OF MINOR'S PERSONAL INJURY CLAIM To the Clerk of Orphans' Court: Kindly withdraw the Petition to Authorize Settlement of Minor' s Personal Injury Claim, filed April 1, 2002 in the above-captioned matter, inasmuch as the claimant, Christopher Weems, born April 24, 1984, has now reached the age of eighteen (18) years and is legally competent to consent to the settlement of the claim by himself, without thc approval of the Court. Date: Respectfully submitted, By: Brigid Q?Alford, l~quire/~ Supreme Court ID #38590 Boswell, Tintner, Piccola & Wickersham 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 (717) 236-9377 Attorneys for State Farm Insurance Company CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DONALD J. DAVIS Date of Death: April 1, 2002 Will No. 2001-00332 No. 21-01-0332 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 2, 2002. Name Address Gloria J. Ferron 141 Winston Drive Mechanicsburg, PA 17055 Claire E. Marsh 2441 Bradford Drive York, PA 17402 Byrle K. Stevens 38 Buttonwood Avenue / /" Wilkes-Barre, PA 18702 // Notice has now been given to all persons entitled tahe~y~ nd/~//~e 5.~exfcept:: None//~ Date: May 2, 2002 Murrel R. ~ ~lters, III, Esquire 54 East Main Street Mechanicsburg, PA 17055 (717) 697-4650 Capacity: __ Personal Representative X Counsel for personal representative I