HomeMy WebLinkAbout11-21-13 �
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IN THE COURT OF COMMON PLEAS � � � � �
CUMBERLAND COUNTY,PENNSYLVANIA � � �,�,--' �? �
ORPHANS' COURT DIVISION � � c-� � ,,,,�'„� .��°,
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IN RE: GLADYS SHIJG�IART ��'., � � � ",�,,, �
AN ALLEGED INCAPACITATED PERSON - � ►--.� r�.,;. rn
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PETITION FOR ADJUDICATIUN OF,INCAPACITY AND APPOINTMENT OF
PLENARY GUARDIAN UF THE PE,RSON AND ESTATE
PURSUANT TO 20 PA.C.S.&5511
TO THE HONORABLE JUDGE OF SAID COURT:
The Petitioner, Church of God Home, Inc.,by and through its attorney Eric J. Bialas,
Esquire, and Hynum Law Office, presents the following Petition to this Honorable Court for the
appointment of a permanent guardian of the Person and Esta.te of GLADYS SHUGHART, an
alleged incapacitated person,and in support thereof avers as follows:
1. Church of God Home, Inc. (hereafter"Petitioner") is a long and short-term skilled
nursing facility located at 801 N. Hanover Street, Carlisle, PA 17013.
2. GLADYS SHUGHART(the"alleged incapacitated person"or"AIP")was born on
September 25, 1920, is 93 years of age, single, and has resided at Church of God Home since
February 20, 2012.
3. Petitioner is an interested party because GLADYS SHUGHART,the alleged
incapacitated person,resides at Petitioner's facility and has provided and currently provides
long-term care and nursing services to the alleged incapacitated person. Petitioner has a
statutory and contractual obligation to act in the best interest of the alleged incapacitated person.
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 Statutes. �
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5. The following persons,to the best of Petitioner's knowledge, information and belief,are
the living next-of-kin of the alleged incapacitated person: Family: none; Power of
Attorney/friend,Ruth Hoffman, whose mailing address is P.O. Box 10, Plainfield, PA 17681;
alternate Power of Attorney/friend Terry Nickey whose address is 720 N. West Street,Carlisle,
PA 17013. A true and accurate copy of Power of Attorney executed in 1984 is attached as
Exhibit"A"as well as a true and accurate copy of Power of Attorney for Health Care executed in
1991 is attached as Exhibit"B". Petitioner believes that the aforementioned are unwilling or
unable to serve as guardian for GLADYS SHUGHART. .
6. As Power of Attorney, Ms. Hoffman has handled the AIP's finances and submitted
payment to Petitioner in the past. However, of late Ms. Hoffman has experienced difficulties in
performing her duties as follows:
a. Ms. Hoffman is unable to complete a Medical Assistance Renewal form for the
AIP,which is required for the AIP to receive continued Medical Assistance
benefits.
b. Ms. Hoffman demonstrates confusion regarding payment to the facility for
services rendered.
c. Ms. Hoffman has confusion regarding whether or not to pay health insurance
premiums for the AIP.
7. Petitioner has discussed these issues with Ms. Hoffman,however it is Petitioner's belief
that Ms. Hoffman is advanc�ng in age, overwhelmed, and is no longer able to provide the
services required to handle the AIP's person or estate.
8. Petitioner has spoken with Ms. Hoffman regarding the possibility of guardianship and it
is Petitioner's belief that Ms. Hoffman does not oppose the appointment of a guardian.
9. Petitioner has also corresponded with Terry Nickey, alternate Power of Attorney,who is
"agreeable"to the appointment of a guazdian in the case at hand.
10. To the extent known by Petitioner,the alleged incapacitated person has no assets.
11. To the extent known by Petitioner,the alleged incapacitated person's income consists of
monthly social security payments in the amount of$576.63. The alleged incapacita.ted person is a
recipient of Medical Assistance.
12. To the best of Petitioner's information, knowledge, and belief,the alleged incapacitated
person was not a member of the armed services of the United States and is not receiving benefits
from the United States Veterans' Administration.
13. The alleged incapacitated person's treating physician is:
Dr. Darryl Guistwite
56 Ashton Street
Carlisle, PA 17013
14. The alleged incapacitated person suffers from: Dementia. Attached hereto as E�ibit"C"
please find a completed Physician's Affidavit for the AIP by Dr. Guistwite.
15. Because of her mental and physical condition,the alleged incapacitated person is totally
unable to manage her financial affairs,property,and business and to make and communicate
responsible decisions relating thereto, including the ability to communicate her need for
assistance in these areas.
16. 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 and finances.
17. Petitioner has analyzed viable alternatives to the appointment of a Guardian for the AIP,
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 and Estate.
18. The severity of the alleged incapacitated person's mental and physical condition and the
lack of viable, less restrictive alternatives necessita.te that a plenary guardian of her Estate be
appointed to manage and handle all aspects of the alleged incapacitated person's estate,
specifically,but not limited to: a11 issues relating to cash, ehecks,bank savings, stocks,bonds,
personal property,real property, insurance policies, government entitlements,taxes,execution of
documents,entry in contracts and the payment of reasonable compensation for services provided
to the person.
19. The severity of the alleged incapacita.ted 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 inedication, employment and discharge of physicians, and other medical decisions as may be
required.
20. To the best of Petitioner's information,knowledge, and belief the alleged incapacitated
person has executed a living will on or about June 18, 1991. A true and accurate copy of said
living will is attached hereto as E�ibit"D".
21. Petitioner is unaware of any testamentary will.
22.The proposed plenary guardian of the person and estate is Neighborhood Services. The
consent of the proposed plenary guardian is atta.ched hereto as Exhibit"E".
23. The proposed plenary guardian has no interest adverse to the alleged incapacitated
person.
24. To the best of Petitioner's knowledge,no other guardian has been appointed for the
estate or person of the alleged incapacitated person.
25. 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.
26.Neighborhood Services 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.
WHEREFORE,Petitioner respectfully requests that this Honorable Court issue a Cita.tion,
directed ta the alleged incapacitated person, with notice thereof to be given to her next of kin,
Power of Attorney, and to such other persons as this Court may direct,to show cause why
GLADYS SHLJGHART should not be adjudged fully incapacita.ted and NEIGHBORHOOD
SERVICES should not be appointed plenary guardian of her person and estate.
Respectfully sub 'tted,
HYN
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En . Bialas, Esquire
Pa. Supreme Court I.D. No. 312326
Hynum Law
2608 North 3rd Street
Harrisburg,PA 17110
(717) 774-13 57 office
(717) 774-0788 fax
Ebialas(c�h�um�c.com
Attorneys for Petitioner
VERIFICATIUN
I, r r�� ..�'.r�*«!ar ,�n an authorized representative of Church of God House,inc.,
Petitioner,in tl�is matter,and do l�ereby verify►that the facts contained in the foregoing Petitiou
are true and co�rect to be best of m��knowledge, info��n�ation anc�betief. I uncierstand tt�at false
statements herein are made subject to tlie penalties of 18 Pa.C.S.A. §490� relatuig to unsworn
falsification to authorities.
Dated:
I��f Q�� �
GLADYS SHUGHART
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PO : OF ATTORNEY
GLAUYS A. S�N(�iART
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ItiTIH S. HOFF1�iAN
KNQW ALL N�i BY Tr1SSB PRBSFsKi'S that Z, Cladys A. Shughart � �
. vf 273 Sauth Pitt Street, Carlisle, Cumt�erl�nd Caxnty, Pezuisylvar�a 170X3,
have made, constituted and appointed, and by these presents do make, constitute
an�d appo�nt, �Ruth S. Hoffin�n, �
of Plainfield, West Pennsboro To�mship, (�umberland Ca�nty, Pennsylvania 1708�., �.
my true and lawful attorney, for me and in my name., place •and. stead:
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1. '
To draw checks against my accounts in any bank or trust company, for all �
or any part now or hereafter deposited, of t]ze money standing to my credit on t�e.
books tl�ereof. �
2. {
To endorse notes, checks, certificates, drafts ar�d bills of exchange '
which may require my endorsement for cleposits as cash or for collection, .
3. ';.
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To ask, demand, sue for and recexve all sums of money and securities now �
due or wIiich may become clu�e and payable to n� in any manner wha�soever, anc� unon ` �
receipt of the same to sig�, seal, execute and deliver a11 necessary acquittances:
and discha.rges therefor. �
4.
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To manage, let and ctemise any real estate nolv belonging, or which may €
hereafter belong, to me; to sell at public or private sale �y personal praperty �
or ha�sehold good.s now belanging, or which hereafter may belong, to me. �.
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To grant, bargain, sell and canvey in fee simple, lYy deed of general or �
�,,,�o�„�„ special warranty, fo�r such price or prices, upon such terms and conditions, as to
�.a►�o�s a sucx such person or persons as th�ey may see fit, all or any part of the real estate i
which 1 now awn or may own at any futtire time wherever situate. • �
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To receivo ar.3 to sell, assign and trans�er any srocks Uonds mor��a�o
bands, loa�2s �r other securities now stand3.n�; or tliat may hereaf�er sYand in my
�ia�uo on tlio books o� any and alz coz�,orations, eitlier national, stato, x�nicxpal �
or pri�ate., tio �,nvest and re�,nvest such portions of my monies from taune to tinu� �
in suc.�i securities as may be deemed safo and judicious by my said attornay-in-
fact; to re�resent nte and in my bei�al.f to vote and act for me at all meetin,�s
cannected with any company in yv}uc,}� Y ma,y own stocks or bonds, or be interested
in any way zvhatsoever.
7.
Ta receive the pxincipal a��+d intor�st duo on any judgments, boncis, mort-
gages or other obligations gi.ven 'to ma by any person or persons, natural or arti-
ficial, tivlia havrs heretofore or shall herea�ter secure the payment ot the samc3 hy
any jcx�gnment, bond, mortgage or other obligatians, and said judgment, bond, mort-
gage or other obiigation shall heretofore or may heroafter be entered of record
in tl�a 4��ice of the Prothonotary or of the Recorder of Deeds and r.iortgages, or
of tl�e Clerk of Courts in and far any county in tIie Com�mornrn,�eealth of Pennsylv�nia,�
as we11 as in and for any other co�ty o� any state in the United States of �ner-�
ica; and on tlie receip� ol said pri.ncipal, interest and costs clue on said judg- � ;
ment, bond, mortgage or ather obligation, appoar for me and in my na� a�ciozow- f
ledge ancl �iter satisfaction in whole or in part by iristrwnent in writing or on 1 '
tha mergin of tl� recoxrl of s^id judgncnt or mortga ge, or to assi g n the sa� b y
instn�ctit in writing or.on the margin t�hereof to any persan or persons paying to� �
my said attorney-in-fact.the interest or principal due thereof and thereon; and
also by instxument 3�n writ�.ng or an-t�ie margin of the recoxd thereof or oti�Yenvise� �
to release from the Iien of any judgm�t,. mortgage or other lien standin,g in nry s ;
nama as above described, with. o r w i t�l o u t c o n si de ra t ion, any por t ion o f t l i e pre- � '
mi.ses d�escribed or bound by said mort ga ge, jud g m e nt or other ]ie�i; to extend due � �
dates on jt�d.gments and m�rtgages and vther liens of record, arid to postpone la.e�s� _
thereof to others, on the record thereof or by instnuu�reent an writing. �
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To do and perfornn generally a11 matters and things, transact all businessi �
n�ke, execute and acknowledge and delivor all contracts, deeds, writin,gs, assur- � �.
ances and instxum�nts which may bo requisa.te or praper to effectuate any matter } ;:
or fi,�u.�g appertainix�g or Uelo�ging to me; ta enter ar�d have access to m y safe � �
deposit box in any bank or ot�ierwise; and ta arrange for nursing hame care. 1 r
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9. � # �
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Tlla.s Pow�r of Attorn shall not be af fec�ed b R
suc.h event, shall rejnain in full force and ef�ect. y �' �sability, but, in ' �
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�.��o�.t�QV j�iith tho same powers, and to all inta��s and purposes with the san�a '
_Ai'rDiti Gt GLACK va�idity as I could if �rsanally pres�nt; hereUy ratifying and'c�onfi�mi,ng what- + �
.��w�.s,rQ![MOYa.VAkfA S�VC�Y� IJ� SS�,d tZttO��iy SJiCill � �y �, by vir�tue hereof. � �
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y IN 1�RTT�IBSS Wf�REOF, I have herevnto set my �d and seal, and hereby
� si 8 ify my intention to 'be legali� baund, this j'(�, day o� .J'''GtGy
19 4
WITNF,SS:
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co�cn�rrY oF ccn►�s��a�n ) �
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Chi this, the �li � �aq of L� ' , 1.9 a�, before me� a i
Nota Public in and �or the aforesai �w�salth and County, persanally ap- �
peared the above-named, GI,AI�YS A. S'�Nc�tART , lato�m to me (or s ;
s a t a,s f a c t o r i l y p�ro v e n) t o b e t h e p e r s o n w h o s e n a m e i s s u b s c r i b e d t o t h e f o r e g o i n g.� ,
Power of Attorney, end acknawledged that he executed t11e same of h own voli- 4 ;
tiun an d f r ee will, a n d for the purnoses t��erein contairied. � �
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WITNESS my hand and official seal the day and. year aforesaid. � F
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� otary i� : �
� f,UI�;Y GOi+.N►.AN.Mut:�ry t`ub1tC ( 5
�� L'o�lislr.,C�rmbar�ead to.,Pa. '
My l'omrnis-tan Expires S�pt.19,i 981 � �
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r / POiA'ER OF �TTORNEY FOR HEALTH CARE
OF ,.
� QLADYB !�. BBUQIi1�iRT ;
1. D$SIGN7ITION OF H$ALTB.CAAE. I�iGENT. I, C3LADY8 A.
BxIIQH�RT, og carlisle,. Cumberland County, Pennsylvania, hereby
appoint ROTH 8. 80BFM�Id, of Plainfield, Cumberland County,
Pe»nsylva»ia, as my Attorney in-Fact (or "Agent") to make health
and personal care decis�ons for me as authorized in this �
document. .
2. EFFECTZVE DaTE AND DuRAHILITY. By this document I
ir.ter.d t� �_��t� w �L::��1�.�p�t;•a;- r,F �tte�^��� f3�forti�,•e ���nn; ���+�
only during, any period� of incapac.ity in which, i� the opinion of
. my aqent and attending phys�ician, I am unable to make or '
communicate a choice regarding a particular health care decisfon. �
3. AaENT�B POWERB. I qrant to my Aqent full suthority to
make decfsfons for me regardinq my health care. In exercising
this authority, my Agent shall follow mydesires as stated in
this document or otherwise khown to my Agent. In making any
decision, my Agent shall attempt to discuss the pfoposed decisfon
wit�i me to determine my desires if I am able to communicate in
any way. If my Agent cannot• determine the choice I would want '
rct�de, then my Agent shall make a choice for me based upon what my
Aqent believes to be in my best interests. My Agent�s authvrity
to interpret my d�sires is intended to be as k�rcad as possible,
except for any limitations I may state below. Accordingly,
unless specifically �limited by Section 4, below, my Agent is
authorized as foll'ows:
A. To consent, refuse, or withdraw consent to any and
all �ypes of taedical care, treatment, surgical procedures,
diagnostic procedures', mectication, and the use of iR��;tl$rlit;Bl.
or other procedures that affect any bodily function,
including (but not limited toj artificial respiratior�,
nutritianal support and hydration, and'cardiopulmonary
resuscitationj �
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8. To have access to medfcal records and information
to th'e same ext�nt ttiat I am entitled to, including the
rfght to dfsclose the co»tents to others;
' C. To authorize my adm•ission to or di•scharge (even
aqafnst medical advicey from any hospital, nur.sing home,
. residential care� assisted living or siiailar facility or
service; ��
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• � D. To aontract on my behalP for any health care �
• related service or facility on abilitalfor suchucontractst '
inaurrinq personal tinancial li Y , Y
�.
� E. To hire and fire medica�=.�S°care;$e�ice, and other f
support personnel respon�ible f Y
F. To authorize, or refuse to authori�e, any :
medication or procsdure intended to relieve pain, even =
thou h such use may lead to physical damage, addiction., or .
g deatht
hasten the moment of {b�t not intentior►ally cause) my `
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G. To make aiaatomiCal qifts o� part or all of my body .
_
for medical purp
oses, authorize an autopsy, and direct th.e :
disposition of my remains, to the extent pertaitted by' law; :
H. To take any other action necessary to do what I . _
� ,. s �. � Y�r.t;r.. �r_;� _
aui:hori�e i�are, �nc:la..ing (�ut r�o� l..xti4c3 ta, q_ 7
� waiver or re�ease from •liability required by any hospital,. ,
phyBician, or other health ca�re provider; signing atny � i
documents relating to refusals of treatment or the leaving :
of d facility against medf.cal advice, and pursuing any legal `
action in my name, and at the expense of my estate to �orce
compliance with. my,wishes as dete�mined by my Agent, or to
seek actual or punitive damages for the failure to comply. �
;
4. STl�TEMENT OB DE8ZRE8, BPECIAL PROVISIONB AND -
LIMITATIONB. . , .
A. With respect to any life-sustaining treatment, I
direct the following:
I do not want my life to be prolonged noro o I
want li fe-sus t a i n i n g t r e a t m e n t t.o b e p=o v i d e d
continue d i f m y A gent .benefits.thl wantemy Agenteto ent ,
outwe�iqh the expected be the expense involved,
consider the relfef ot auffering.� �
� and the ouality as well as the possible extension of Yay
life, in making decisions concerning life-sustaining
treatment. � .
Within this framework� life-sustainingYtreatmentbe. ;
prolonged and I .do not wan ,
a. if I have a conditfon that is incurable ,`
or irreversible and, without the administration of ,
. life-sustaining treatment, expected to. result in ;
death within a relatively short time; or j
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b. if I am in a coma or persistent ;
vegetat.ive state which is reasonably concluded to :
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be irreversible. ;
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' B. With respect to nuzr.����,� M..M ..� ---
� ans of a nasoqastric tube ar t�@siclearhthat Iaintend to
� me or veins, Z wish to n►ak
intestines, thg ��life-sustaininq •r
include thege procedures amonq
� cedures" that may be withheld or withdrawn under�.the
pro
co.nditions qiven above. .
880R6. If anY Agent named by me shall die, become
5, eIICCB regube to act� be unavailable, o= (if
leqally disabled, resiqn, separated or divorced f�rom me,
s ouse) be legally in the
�ny Agent is mY p ach to act alone and successively,
I na�e the follosucces�ors to mY Aqent:
order named) as
First Alternate Aqent: ,TERRY L• NICREY .
• of Carlisle, Pennsylvania ,
Second Alternate Agent: NONE , �
No
6. pgOTBCTION OF THIRD PATtTIEB �O �LresentationsTby �Y
person who relies i» good faith upon any P m Bgtate, my
A ent ox Succegsor Agent shall�ne �hebAg�,°t,seaut ority.
g s for recognlz g
heirs or assiqn ,
If a quardian og my person �
�� WpMIDT7ITZON OF a���• A ent (.or his
shauld f�r any resson be appointed, I nominate my �3
or h�r suceesser) named above. . • .
g� ]1DMIDiIB'1'R�►TIV'E PROVIBIONS.
A. I revoke any prior power of attorney for health
aare. '
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. This power of attorney is intended to be valid in
any 3urisdiction in which it is presented.
A ent shall not be entitled to cbmpensation for 4
C. My g but he or , ,
serviaes Perf°r��d under this pol�er of attorney,
be entitled to reimbursement for allaneas�ovision .
she shall in out y P
expenses incurred as a result of carry g ,
of this power of attorney. •
' � ower of attorney
D, The powers delegatedValidity of one or more powera
� are separable, Bo that the in
shall not aff��� any others. r
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' By aigning here I indieate that I unaerszann �.��� ���.��•.•.a �•.
g document and the effect of this qrant of powers to my Agent. �
` .�ave hereunto set my hand and seal and ��eby siqnify m r ;
rtention to be legally bound on this day ot ^ r �
991.�
lady A. Shuqhart
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1fITNE86 BTATEI�ENT �
I declare that the person who siqned or acknowledged this ; �r
document is personally known to me, that she signed or : ;
a c k n o w l e d q e d t h i s d u r a b l e power of attorne y fn my pres.ence, and• , ;
�hat shs appears to be of sound mind and under no duress, fraud, ; 4
o r u n d u e i n f l u e n c e. I a m n o t t h e p e r s o n a p pofnted as a qent b y ' �
thia docuiaent, nor am I the patient's health care provider, or an tl
employe� ot the patient•s healtn care provider. I further .
declare �that I am not related to the principal by blood,
marriaqe, or adoption, and to the best of my knowledge, I am not
a areditor o� the principal nor entitled to any part of his -
estate under a will now existing or by operation,ot law.
�itn�ss No. •
signat
ure: . • .�� ��-- Date: � �
Address: � South Co house Avenue Phone: 71?-243-0123` , ��
,Carlisle, 17�13 • .
�;.�.ne�o. 2: =
. C,.� ...�--- Date: 6�/��9�
Signatu=e. ___r,i�_____,�____.� ----- �
Address: 10 South Courthouse Avenue Phone: 717-243-0123
Carlisle; PA 17013
• �O'_P.F.I�?�TIOM '
CO1�II�+IONWEALTH OF PENNSYLVANIA� , .
: SS.
COUNTY OF CUMBERLAND � ' • '.
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On th i s, the j� day o f K ____�,, 19 91, the . �
said GLADYS A. SHUGHART, known to (�or satisfactorily proven�) .;
to be the person 'named in the foreqoi�g instrument, personaily •
appeared before me, a Notary Public, within and for the State and
County 8fvresaid, and acknowledged �hat she freely and
voluntarily executed tbe� same for the purposes stated tharein.
��.. • `,y:.��'� (SEA�) � �.
� Notary P�ublic :
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. ;erwxl.L er�hn�t�lct�y Ri6pa . • ;
� Cat�ds 9ono.G'Wnb�W�d �
t�dffii�i�s�ot� ��M.�
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iN THE CGURT OF CUMMON PLEAS
CUMBERLAND COUNT'Y,PENNSYLVAiVIA
ORPHANS' COURT DIVISION
O.C.NO,
IN RE: GLAD�S SHUGHART
AN ALLEGED INCAPACITATED PERSON
DEPC�SlTION BYlNDI_VIDUAL QUALIFIED iN,
EVALUATION OF ALLEGED INCAPACITA;ED PERSON
The deposition of Dr. Darryl Guistwite, a witness in #his matter, made on the
day af , 2013, at , Pennsylvania.
1. What is your name and your professional address?
_ ` . -� ,�
A. My name is :.��:��, � � �; � � . (.: ,.� : ,S� �,F,., .
� My professiona! address is
5 � � S � ��C„=. „� S'"� •
-- ��_
C C+ , ! �. S 1 SZ ��',��% 4 � G�r C`' ..
2. Prease 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#he answer that does NOT appiy.)
(a} My curriculum vitae detaiiing this infoRnation is attached.
(b} I received my college degree at r"� �' S S �� c� �t
and my past graduate training at �C� �►/�'� ,
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and ! have practiced �c:t w. ���,, �.�.� � ���° � c ct.,
(e.g. medicine, psychiatry, psychology, gerantological social
work, etc.) since �Z� My special qual�c�tions and
training with respect to evaluating persons with incapacities
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consists of G'�r`�� .`� ,, �'�C�. •°v���t4� �c.�i ��r'1C.s���C.��/'
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3. In what states are you licensed to practice medicine?
A. I am licensed to practice medicine in the following states:
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4. !n your capacity as �e.g. physician, psychotogist, social worker, etc.) have
you had the opportunity to meet with, examine, speak with and otherwise
become acquainted with GIADYS SHUGHART and if so, upon what occasions
and in what fashion have you been able to do so?
A. I first became acquainted with GLADYS SHUGHART
the month of , 20 , when she was
brought to my attention by means of n p �..� _� �,cz.
� �C��� . ! have since that time �visited/spoken with/
examined/treafed} her on v�_• �� o#her occasions with
_ an average frequency of t — �. times per (day/
week/ on year).
_.p
5. To a reasonable degree af inedical certainty, do you have an opinion as to �
whether the ability of GLADYS SHUGHART 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 resouroes; or,
�b j totally unable to manage her f nancial tesources.
Answer: :
6. To a reasanable degree of inedica! certainty, do you have an opinion as to
whether the ability of GLADYS SHUGHART'ta receive and evaluate infvrmafion
effe�tively and to communicate decisions is in any way�mpaired to such
sign�cant extent that she is:
(a) partially unabie to meet essentia! requirements for her physical health
and safety; or,
�b totaily unable to meet essential requ�rements for her physical health
and safety.
Answer:
7. Please describe the type and severity of any impairments of the
aileged incapacitated person using the chart below.
A. The impairments of GLADYS SHUGHART are as follows: ,
F -------------(check one) ------�----�
L�st Impairment None Mild Moderate Severe
(a� ��,s:�G� � [ l [ ] [ k] [ 1
(b) n�.��;�� [ ] [ l [ � [ k l �
(�� [ ] [ ] I ] [ ]
{d) [ ] t ] [ l [ 1
(e) C � [ ] [ a [ ]
tfl t J [ ] t ] [ l
(9) i ] I I I ] [ 1
8. To a reasonable degr� of inedicai certainty, can you express an opinion
as to whether GLADYS SHUGHART is partially or totai(y unable to manage her
financial resources?
A. The ability of GLADYS SHUGHART to manage her�nancial
resources is impaired {not at all, partially, totaffy) as follows:
Y � ,. � �
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9. To a reasonable degree of inedicai certainty, can you express an opinion
as to whether GLADYS SHUGHART is able to meet essential requirements for
her physical safety and health?
A. The ability of GLADYS SHUGHART to meet essentiai requirements
for her physical health �nd safety is impaired
(not at all, partially, totally} as follows:
v���� S �k'�, i l��,� cc t J �
14. Can you please evaluate the present candition of GLADYS SHUGHART
with respect to incapacities of the�ype aEleged in the Petition. In particular, could
you comment on the nature and extent of the alleged incapacities and disabilities
and a{so, insafar as you are able, the mental, emotional and physical condition of
GIADYS SHUGHART, her adaptive behavior, and her social skills?
A. Based upon my educa#ion, training and experience, as weli as my
acquaintance w'rth GLADYS SHUGHART as stated above, it is
my opinion that her incapacities and disabilities are as fallows:
'`-��.. -- �' Ct ���(� �t` � S S �.;��1.
f.rc r C�.��C�C.. t. S �c�,S�
Her mental condition is:
Her emotionai and physical conditions are
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1'!. !s the condition of GLADYS SHUGHART such as would make her
susceptible to be taken advantage of by unscrupulous or designing persons?c.� ��
A. Her adaptive behavior is ��� .�. �-� ��
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Her sociaf skiNs are_ � �� �„ �� ��'
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12. What recommendations would you make concerning services necessary
to meet the essential requirements for the physicaJ heaith and safety af
GLADYS SHUGHART.
A. I would recommend that her physical heaith and safety be
protec#ed by_ C"� c� �;�►(-� ;�c� �-- '.,�.�c��.`� C3 �
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trc�.,r I�� ��L( `�r .
—.�.
13. Wha#recommendations would you make conceming management of the
fnanciai resources of GLADYS SHUGHART?
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A. I would recommend ��}���x� � n��� � G� �
—�-�--
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14. What recommendations would you rnake concerning the de�elopment or
regaining of physical or mental abilities of GLADYS SHUGHART?
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A. I would recommend the foll�wing: i�c� < < :�
.—�-
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15. What types of assistance do you think are required by GLADYS
SHUGHART?
A, i believe she needs assistance with c'� C( ��c �ts�,�v�.�s��
�_�"�'�-. 1�' • ,
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16. Why is it that no less restrictive alternatives wou(d be appropriate?
A. Less restrictive altematives would NOT be appropriate because
i�'C�S �'.� f ,t �.,��=.~�-,��.�t,"-' .
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�7. What�s the probability that the exfent of incapacities of GLADYS
SHUGHART may significantly lessen or change:
A. In my judgment, and based upon my training, experience and
acquaintance with GLADYS SHUGHART. I believe the
probability that her incapacities may significantly lessen or
change is: �'��'.,`�` �.�� �}���•, - �
18. Would the physical or mental condition of GLADYS SHUGHART
be harmed by her presence in open court?
A. ! believe that the presence of GLADYS SHUGHART irt apen Court
would be harmful to her because:
-- � ��'� �t � �?���►-'� ,r��c. �u�s �Aa.. c�
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�,.,�. v-�� �. c a�h s�
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N_OTE: Pennsylvan�a law(20 Pa.C.S. §5511(a)(1) requires that the alleged
incapacitated person must be present at the hearing unless a physician or
licensed psychalogist provides by testimony or statement, an opinion that
her physical ar mental condition would be harmed by her presenoe.
�,oU� t�� 1� �- •�--��
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VERIFICATION
I, Dr. Darry� Guistwite, verify that the statements made in the foregoing
deposition ar�true and correct to the best of my knowledge, informatian and belief. I
unders#and that the statements herein are subject to the penalties of 18 Pa.C.S. §4904
relating to unsworn faisification to authorities.
Date: <<< �`� t� 3
Signatu Depanent
GI..ADYS SHUGHART °
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• � MY LZVINa 11ILL
� .M
To Ky Family, pbysioi�tn, l�iy La�ry�r ~
21nd l►11 Otb�rs 11hom Zt May Concern
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Death is as much a reality as birth, growth, maturity and
old age --it ia the one certainty of life. If the time comes.
when I can no longer take part in decisions for my own future,
let this �statement stand as an expression of my wishes and
directions, while I arn still of sound mind.
If at such a time the situation should arise in which there,
fa no reasonable expectation of my recovery from extreme physical
or mental disability, I direci: that I be allowed to die and not
be kept alive by medications, artificial means or "heroic
- met�sures." " I do, h�owever, ask that medication be. mercifully
a�dministered to me to allaviate suffering even though�this may �
shorten my remaining life. � �
This statement is made after aareful. consideration and is fn
accordance with my strong convictions and �beliefs. I want the �
wishes and direQtions herein expressed carried out to the extent
permitted by law. Insofar as they are not leqally en.fo=ceable, I
hope that those to whorn this Will fs addressed will regard .
themselves as morally bound� by these provisions.
Measures of artificial life-support in the face of impending
death that I specifically refuse are:
aj Electrical or mechanf�al resuscitation of �my heart when it .
has stopped beating.
• b) TTasogastric tube feeding when I am paraiyz�ed or utiable� 4�+
take �otxrishment by mouth. . . . . �
c) Mechanical respiration when I am no lonqer able to sustain
my own breathing. � .
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I would lfke to live out my last days at home� rather than in
a hospital if it does not jeopardize the chance of my recovery tc�
a meaningful and sentient life or does not impose an undue bu�cden � ,
on my family. _ �
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DVR718LE BORL�R ti? llit'TORNEY �
I hereby deeiqnate ZtIITB 8. BoF�t�lN to sarve as my Attorney- �
in--Fact for tha purpoee o! makinq madical tre.atmenti� deaisions.
This Power of Attorney shall rsmain e�ttective in the event that I .
become incompetent or otherwise unable to n�ake auch decisions� for `
rnyself. . ,
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Gladys A. shughart
Date: �' �� �
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Witnse a .�-�i�____,
Addrese s 1 s. Caurth e Avenue �
arlisle, PA 1�0.13
Witness ��� i� �
Address; 10 S. courthouse Avenue
Carlisle, PA 17013
BpORN and s�ubs�aribed to before me this � �` day of
_ ..� , 1991.
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. .�Y� �����•�� (SEAL1 .
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conn„y.la, ,,an.a,oMt �
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Cop ies of this request have b.een given to: • p
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVA1vIA
ORPHANS' COURT DIVISION
IN RE: ESTATE OF GLADYS SHUGHART: NO.
Alleged Incapacitated Person -
ACCEPTANCE OF PROPOSED PLENARY GUARDIAN
OF THE PERSON AND ESTATE
Neighborhood Servi�es,proposed plcnary guardian of the Person ana Estate of GLADYS
SHUGHART,the alleged incapacitated person, agrees to accept the appointment as permanent
plenary guardian of the Person and Estate and avers that:
1. Neighborhood Services provides guardianship services and is not related in any
way to the alleged incapacita.ted person.
2. Neighborhood Services has no interest in nor is fiduciary of any estate in which
the alleged incapacitated person has an interest; and,
3. Neighborhood Services has no interest adverse to that of GLADYS SHUGHA.ItT,
the alleged incapacitated person.
DATED: (/ I �`- K
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