HomeMy WebLinkAbout10-04-13 IN THE COURT OF COMMON PLEAS
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CUMBERLAND COUNTY,PENNSYLVANIA M
ORPHANS' COURT DIVISION m = C, -� c
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O.C. No. o / c
IN RE: ANNE DYKES DAVIS o == ca
AN ALLEGED INCAPACITATED PERSON r- T
TO THE HONORABLE JUDGES OF SAID COURT:
The Petitioner, Dawn Ferguson, by and through her attorneys, Brian K. Zenner, Esquire,
and Hynum Law presents this Petition to this Honorable Court for the appointment of a
permanent guardian of the person and the estate of ANNE DYKES DAVIS and respectfully
represents that:
1. Dawn Ferguson (hereinafter"Petitioners") is the daughter of the alleged
incapacitated person. Dawn Ferguson resides at 6217 Charring Cross, Mechanicsburg, PA
17050.
2. ANNE DYKES DAVIS, the alleged incapacitated person, is a single individual
who was born on August 14, 1931. She currently is 82 years old and resides at Emeritus at
Creekview, 1100 Grandon Way, Mechanicsburg, PA 17050.
3. Petitioner is an interested party because ANNE DYKES DAVIS, the alleged
incapacitated person, is her mother.
4. Because the alleged incapacitated person resides in Cumberland County,this
Court has jurisdiction pursuant to §711(10) of Title 20,the Probate Estates and Fiduciary Code,
of the Pennsylvania Consolidated Statues.
5. To the best of the Petitioner's knowledge, information and belief, ANNE DYKES
DAVIS, the alleged incapacitated person has the following additional family members: Frederick
Davis, Son,who resides at 626 Shadow Tree Drive, Oceanside, California 92058; Dawn
R ��
Ferguson, Daughter, whose address is listed in Paragraph 1; Falon Davis, Son, whose current
whereabouts are unknown and last known address is Rikers Island Prison,New York. Frederick
Davis and Falon Davis are either unwilling or unable to serve as guardian of the alleged
incapacitated person. The proposed Guardian is Dawn Ferguson.
6. To the best of Petitioner's knowledge, information, and belief, the alleged
incapacitated person's estate has the following assets: a two-family home rental property located
at 218-11 1401h Ave., Laurelton, NY 11413; an account with Intervest Bank containing
approximately$36,000.00
7. To the best of Petitioner's knowledge, information, and belief,the alleged
incapacitated person's estate has the following income: Monthly income from the rental
properties in the amount of$2,63250(minus any repairs or additional maintenance); social
security in the monthly amount of$1,018.00; and a pension in the monthly amount of$1,441.75.
8. The alleged incapacitated person has not served in the United States Armed
Forces,therefore is not receiving VA benefits.
9. The alleged incapacitated person's treating physician is:
Dr. Namrata V. Haldipur
Hampden Physician Associates
3456 Trindle Road
Camp Hill, PA 17011
10. ANNE DYKES DAVIS, the alleged incapacitated person, has been diagnosed as
suffering from severe dementia,diagnosed by Dr. Haldipur. Said mental condition causes her
incapacity and requires that she receive 24-hour-a-day care. Dr. Haldipur's written deposition
regarding said incapacity, along with her Curriculum Vitae is attached hereto as Exhibit"A"and
is incorporated herein by reference.
2
11. Because of her impaired mental and physical condition,the alleged incapacitated
person lacks the capacity to make or communicate responsible decisions concerning her person
and is unable to take care of herself in all aspects of her Activities of Daily Living. She is also
unable to make decisions regarding her healthcare.
11 Petitioner has analyzed viable alternatives to the appointment of a Guardian for
the alleged incapacitated person, and has not pursued any other courses of action as it is the
belief that no other options exist other than to appoint a Guardian of the person of ANNE
DYKES DAVIS.
13. The severity of her condition requires that a guardian be appointed to manage the
estate of ANNE DYKES DAVIS, an alleged incapacitated person. Said guardian should be
appointed to manage and handle all aspects of her estate, specifically including,but not limited
to: all issues relating to her cash, checks in any bank or savings account held in her name, her
stocks and bonds, her personal property, her real estate, her life and other insurance of which she
is a beneficiary, her entitlement to any government or non-government benefit plans, federal,
state, Iocal taxes, trust accounts of which she is the beneficiary, claims made or to be made on
her behalf or against her, the execution of documents, the entry into contracts affecting her and
the payment of reasonable compensation or casts to provide services for her.
14. The severity of the alleged incapacitated person's mental and physical condition
and the lack of viable, less restrictive alternatives necessitate that a plenary guardian of her
person be appointed to handle all issues relating to the person of the alleged incapacitated person,
specifically, but not limited to living arrangements, medical and psychiatric care, administration
of medication, employment and discharge of physicians, and other medical decisions as may be
required.
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15. Petitioner is not aware that the alleged incapacitated person signed any powers of
attorney or advance health directives or in any other way designated anyone to serve as her agent
over any of her personal affairs or as her surrogate over her medical care, that she designated in
writing her wishes with regard to health care, including the use or refusal of life sustaining
treatment.
16. The proposed plenary guardian of the person is Dawn Ferguson, whose residence
is described in paragraph 1. The proposed plenary guardian has no interest adverse to the alleged
incapacitated person. A signed Acceptance of Proposed Guardianship is attached hereto as
Exhibit "B".
17. To the best of Petitioner's knowledge, information and belief, no other Court has
ever assumed jurisdiction in any proceeding to determine the capacity of the alleged
incapacitated person not has a guardian.
18. Pursuant to Section 5122 (d), Title 20, of the Pennsylvania Consolidated Statutes,
the Court may dispense with the requirement of a bond when for cause shown the Court finds
that no 'bond is necessary,
19. Dawn Ferguson does not have any adverse interest to the alleged incapacitated
person and thus does not present a situation that generally would require imposition of a bond.
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WHEREFORE, Petitioner respectfully requests that this Honorable Court issue a
Citation, directed to the alleged incapacitated person, with notice thereof to be given to her next
of kin and to such other persons as this Court may direct, to show cause why ANNE DYKES
DAVIS should not be adjudged fully incapacitated and Dawn Ferguson should not be appointed
plenary guardian of her person and estate.
Respectfully submitted,
HYNUM LAW
Brian K. Zellner, Esquire
Pa. Supreme Court I.D. No. 59262
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357 office
(717) 774-0788fax
bzellnern hynumyc com
Attorneys for Petitioner
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VERIFICATION
I,Dawn Ferguson,Petitioner in this matter,hereby verify that the facts contained in the
foregoing Petition are true and correct to be best of my knowledge, information and belief I
understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §4904
relating to unworn falsification to authorities.
Dated: to
Dawn Ferguson
6
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IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
O.C. NO.
IN RE: ANNE DYKES DAVIS
AN ALLEGED INCAPACITATED PERSON
DEPOSITION BY INDIVIDUAL QUALIFIED IN
EVALUATION OF ALLEGED INCAPACITATED PERSON
The deposition of Dr. Namrata Haldipur, a witness in this matter, made on the
day of A7,,k,, 1— , 2013, at Pennsylvania.
1. What is your name and your professional address?
A. My name is
My professional address is
Him n oc.
W6 Trindle Road
Camp Hill,PA 17011-4468
2. Please describe your education, training and background with particular
emphasis on your expertise in evaluating individuals with incapacities. If you
prefer to do so, please attach curriculum vitae to these interrogatories that details
this information.
A. (Cross out the answer that does NOT apply.)
(a) ✓ My curriculum vitae detailing this information is attached.
(b) I received my college degree at r
and my post graduate training at
and I have practiced _
(e.g. medicine, psychiatry, psychology, gerontological social
work, etc.) since My special qualifications and
EXHIBIT
training with respect to evaluating persons with incapacities
consists of
3. In what states are you licensed to practice medicine?
A. I am licensed to practice medicine in the following states:
4. In your capacity as (e.g. physician, psychologist, social worker, etc.) have
you had the opportunity to meet with, examine, speak with and otherwise
become acquainted with ANNE DYKES DAVIS and if so, upon what occasions
and in what fashion have you been able to do so?
A. I first became acquainted with ANNE DYKES DAVIS
the month of a!j 19_ or 20_L?,_, when she was
brought to my attention by means of_114V
I have since that time (visited ! spoken with!
examined !treated) her on ';Z- other occasions with
an average frequency of 1 --Z- times perms Ph, (day!
week!month /year).
5. To a reasonable degree of medical certainty,do you have an opinion as to
whether the ability of ANNE DYKES DAVIS to receive and evaluate information
effectively and to communicate decisions is in any way impaired to such
significant extent that she is:
(a). partially unable to manager her financial resources; or,
(b) totally unable to manage her financial resources.
Answer: tv
6. To a reasonable degree of medical certainty, do you have an opinion as to
whether the ability of ANNE DYKES DAVIS to receive and evaluate information
effectively and to communicate decisions is in any way impaired to such
significant extent that she is:
(a) partially unable to meet essential requirements for her physical health
and safety; or,
(b) totally unable to meet essential requirements for her physical health
and safety.
Answer: _k-1D[-,I
7. Please describe the type and severity of any irrVairments of the
alleged incapacitated person using the chart below.
A. The impairments of ANNE DYKES DAVIS are as follows:
'F-----------------(check one)--------------------3
List Impairment None Mild Moderate Severe
(a) Mme " [ ] [ 1 [ 1 [
(c)
(d) [ ] [ ] [ ] [ ]
(e) [ ] [ ] [ ] [ ]
(g) [ 1 [ ] [ 1 [ l
8. To a reasonable degree of medical certainty, can you express an opinion
as to whether ANNE DYKES DAVIS is partially or totally unable to manage her
financial resources?
A. The ability of ANNE DYKES DAVIS to manage her financial
resources is impaired (not at all, partially, totally) as follows:
9. To a reasonable degree of medical certainty, can you express an opinion
as to whether ANNE DYKES DAVIS is able to meet essential requirements for
her physical safety and health?
A. The ability of ANNE DYKES DAVIS to meet essential requirements
for her physical health and safety is impaired
{not at all, partially, totally}as follows:
10. Can you please evaluate the present condition of ANNE DYKES DAVIS
with respect to incapacities of the type alleged in the Petition. In particular, could
you comment on the nature and extent of the alleged incapacities and disabilities
and also, insofar as you are able, the mental, emotional and physical condition of
ANNE DYKES DAVIS, her adaptive behavior, and her social skills?
A. Based upon my education, training and experience, as well as my
acquaintance with ANNE DYKES DAVIS as stated above, it is
my opinion that her incapacities and disabilities are as follows:
Her mental condition is: �o ('Yn r7
Her emotional and physical conditions are
11. Is the condition of ANNE DYKES DAVIS such as would make her
susceptible to be taken advantage of by unscrupulous or designing persons?
A. Her adaptive behavior is w-r -
Her social skills are 12 0111,
J
12. What recommendations would you make concerning services necessary
to meet the essential requirements for the physical health and safety of
ANNE DYKES DAVIS.
A. I would recommend that her physical health and safety be
protected by kRy-p 1K� + (A 01 9ec A-r-L
w�a-wi i-tic-� .4u.e.+ln.l�n
13. What recommendations would you make concerning management of the
financial resources of ANNE DYKES DAVIS?
A. I would recommend S
14. What recommendations would you make concerning the development or
regaining of physical or mental abilities of ANNE DYKES DAVIS?
A. I would recommend the following:
15. What types of assistance do you think are required by ANNE DYKES
DAVIS?
A. I believe she needs assistance with a A0 L;s
16. Why is it that no less restrictive alternatives would be appropriate?
A. Less restrictive alternatives would NOT be appropriate because
In�c0✓ (� 0 2✓✓\ �O \�
17. What is the probability that the extent of incapacities of ANNE DYKES
DAVIS may significantly lessen or change:
A. In my judgment, and based upon my training, experience and
acquaintance with ANNE DYKES DAVIS, I believe the
probability that her incapacities may significantly lessen or
change is: (A" t Ice t")
18. Would the physical or mental condition of ANNE DYKES DAVIS
be harmed by her presence in open court?
A. I believe that the presence of ANNE DYKES DAVIS in open Court
would be harmful to her because:
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NOTE: Pennsylvania law (20 Pa.C.S. §5511(a)(1) requires that the alleged
incapacitated person must be present at the hearing unless a physician or
licgnsed psychologist provides by testimony or statement, an opinion that
her physical or mental condition would be harmed by her presence.
VERIFICATION
I, Dr. Namrata Haldipur, verify that the statements made in the foregoing
deposition are true and correct to the best of my knowledge, information and belief. 1
understand that the statements herein are subject to the penalties of 18 Pa.C.S. §4904
relating to unsworn falsification to authorities.
Date:
Signature of Deponent
ANNE DYKES DAVIS
Namrata V. Haldipur, MD
5 Truffle Glen Road
Mechanicsburg Pa-17050
Cell 717-433-5569
Email psLaj,s�sl�i2,@.,�ah�Q,cgrt�
Pr9fessional Exoeriencei
Medical Director, Bathany Village Sept 2006-pRSent
Medical Director, Genti✓a Hoapicr
Feb 2010-present
Medical Director, Woods at Cedar Run Sept 3011-present
Internist, Hampden Phys Assoc Sept 2006-pre5ent
Internist, G/ah Medical Croup Mar2003-present
Hospitalist, Wellspan Jul 2004-Sep2006
ER Physician, Pinnacle Heath Mar 2004-Sep2006
Internist, Mountain Hlth Services,NH Dec 1999-Sept2o03
Board CQriification and Traini_g:
Board Certified in Internal Medicine Nov 1999
Recertified In Internal Medicine Oct 2012
Chief Resident IM Residency
Bronx Lebanon Hospital Center, NY
Sep 199$-)un 1999
Residency Training in IM
Aug 1995-Sept 1998
Medical Education, Bangalore,India Aug $
g 9 5-Mar 1991
ZO/T0 39t7d AHd N3CcJWVH 6LOZ5E9LTL 6E :01 ETOZ/60/60
Member hi s pw rds and Llcensure:
Member of American College of physicians
Member of Pennsylvania Medical Society
Member of PAMDA
Licensed to practice in pA
Medical StaFF'at Holy Spirit Hospital and Pinnacle Health System
Poster presentation at ACP conference 1998 "Needle stick injuries among residents".
Past Positions and S ecial Interests:
Medical Director, St-Vincent Depaul Nursing Home Berlin, NH.
Medical Director, Home Health and Hospice at Androscoggin Valley Hospital, Berlin, NH,
Geriatric, Long Term Care Medicine and Obesity Management.
Z0/Z0 39Vd AHd N3QdWVH bL0Z5E91TL 6E:01 ETBZ/60/60
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
ORPHANS' COURT DIVISION
O.C.NO.
IN RE: ANNE DYKES DAVIS
AN ALLEGED INCAPACITATED PERSON
ACCEPTANCE OF PROPOSED PLENARY GUARDIAN OF THE ESTATE
I, Dawn Ferguson, proposed plenary guardian of the Estate of Anne Dykes Davis, the
alleged incapacitated person, agree to accept the appointment as permanent plenary guardian of
the Estate and aver that:
I. I am the daughter of the alleged incapacitated person.
2. I reside at 6217 Charring Cross, Mechanicsburg, PA 17050.
1 My occupation is a supply systems analyst for the Department of Defense.
4. As proposed guardian, I aver that I speak,read,and write the English language.
5. As proposed guardian, I do not have any interest adverse to the alleged
incompetent person.
6. As proposed guardian, I am not a fiduciary, or an officer or employee of a
corporate fiduciary, of an estate in which the alleged incompetent has an interest; not a surety, of
an officer or employee of a corporate surety of such a fiduciary.
DATED: S �a
DAWN FFRGU9bN
EXHIBIT