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HomeMy WebLinkAbout02-11-05 (2) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION &., \ - OS - 0 \ \.\ l PETITION TO THE HONORABLE, THE JUDGES OF SAID COURT The Petition ofBEVERL Y HEALTH CARE CAMP HILL, CAMP HILL, PA, by it's Attorneys CAPOZZI & ASSOCIATES, P.C., respectfully represents as follows: I. The Petitioner, Beverly HealthCare - Camp Hill, by Toni Blair- Jones, Administrator, is located at 46 Erford Road, Camp Hill, Cumberland County, Pennsylvania 17011. \"",,,'" 2. WILLIAM JUMPER is a man age 86, having been born March 9; 1918, and his principal residence being at Beverly HealthCare:-'camJ:lc Hill, Camp Hill, Cumberland County, Pennsylvania 170 II. Hl~ Social:' :'~ Security Number is 199-07-2770. C) N 3. That after reasonable investigation, your Petitioner avers that the only known heirs or next of kin of WILLIAM JUMPER is his long time estranged wife Thelma Jumper, an adult whose last known address is 2109 Cedar Run Drive, Camp Hill, PA 17011-7483; his daughter Andrea Beayen, address unknown, and an Interested Party, Helen Kocher, an adult who resides at 1051A Allendale Road, Mechanicsburg, PA 17055. 4 4. WILLIAM JUMPER was admitted to Beverly HealthCare - Camp Hill on October 12, 2004 because of a Fracture of the pelvis, Diabetes Mellitus, Essential Hypertension and Dementia. 5. That to the best of your Petitioner's knowledge WILLIAM JUMPER was a member of the Armed Services of the United States of America and he is/not receiving any benefits from the United States Veterans Administration or its successors. 6. An Emergency Guardian is being sought for WILLIAM JUMPER because he is currently hospitalized at Holy Spirit Hospital, in immediate need for surgery on an obstructed kidney and insertion of a feeding tube, without which he could prematurely expire. 7. William Jumper's ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that he is partially or totally unable to manage his financial resources or to meet essential requirements for him physical health and safety. 8. That attached hereto as Exhibit "A" and incorporated as iffuUy set forth herein, is an Affidavit completed by Dr. Greg Ehgartner, who has examined WILLIAM JUMPER and confirms the need for surgery to be performed as quickly as possible. 9. Your Petitioner believes and is advised by competent medical authority that WILLIAM JUMPER is suffering from among other things, Kidney Obstruction, Sepsis, Senile Dementia, diabetes mellitus, and 5 16. Faith, Hope and Love Guardianship Services, Inc., by and through Alfred D. Sloan, MAR, having no interest adverse to the Alleged Incapacitated Person, has agreed to act as Guardian of his Person and Estate if this Honorable Court shall so appoint. Neither Petitioner, nor Proposed Guardian, is related to the Alleged Incapacitated Person nor does either have an interest in the estate of same. 17. If appointed by this Honorable Court, the Guardian will act in compliance with regulations promulgated under Court Order in Pennsylvania Bulletin 931, et seq., April 19, 1975. WHEREFORE, your Petitioner prays that an Emergency Guardian be appointed and a Citation be issued to the alleged incapacitated person as to why WILLIAM JUMPER should not be adjudged an incapacitated person and an Emergency Guardian of his Person be appointed. Respectfully submitted, Michael B. V olk, Esquire Attorneys for Petitioner 7 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION IN RE: PETITION FOR THE APPOINTMENT OF AN EMERGENCY ~O. GUARDIAN OF THE PERSON OF WILLIAM JUMPER, AN ALLEGED INCAPACITATED PERSON AND PERMANENT GUARDIAN OF THE PERSON AND ESTATE Affidavit of Dr. Greg Ehgartner in support of Petition to Adjudicate WILLIAM JUMPER an Incapacitated Person 1. My name is Dr. Greg Ehgartner. 2. My occupation is as a physician. 3. My business address is Susquehanna Internal Medicine 890 Poplar Road, Camp Hill, P A 4. My educational background is as follows: a. Medical/ Graduate School - Philadelphia College of Osteopathic Medicine b. State Undergraduate - Pennsylvania State University 5. I am licensed by the State of Pennsylvania as a Physician 6. I specialize in Internal Medicine 7. I am affiliated with Beverly Healthcare Camp Hill. 8. I first met WILLIAM JUMPER approximately four (4) months ago. 9. I last met with WILLIAM JUMPER on January 17,2005 10. I last reviewed WILLIAM JUMPER'S chart on February 4,2005 8 II. WILLIAM JUMPER is in need of emergency surgery due to an Obstructed Kidney Sepsis, the need to insert a feeding tube, Senile Dementia and Advanced Age. 12. WILLIAM JUMPER currently takes the medications on the list attached to this Affidavit. 13. WILLIAM JUMPER' prognosis is poor. 14. The extent of WILLIAM JUMPER'S ability to communicate is as follows: a. V erball y poor. b. In Writing poor. c. Other Means poor. 15. The extent of WILLIAM JUMPER'S ability to receive information is as follows: a. Reading: poor. b. Hearing: poor. 16. WILLIAM JUMPER is capable of independently performing NONE of the following activities of daily living. a. Ambulating b. Eating c. Grooming d. Toileting e. Transferring 17. WILLIAM JUMPER has emotional limitations in the form of poor understanding. 18. WILLIAM JUMPER is UNABLE to interact socially on any meaningful level. 19. WILLIAM JUMPER does not generally comprehend his surroundings to such an extent that she requires consistent supervision in his activities of daily living. As a result of his condition, she requires specific one- on- one assistance with grooming, transferring, ambulation, toileting and bathing. She absolutely could not manage any of his own activities of daily living without supervision or assistance. 20. WILLIAM JUMPER IS NOT capable of handling his financial and personal affairs, however minor. She requires total assistance in these areas. 21. WILLIAM JUMPER, if called upon to grant informed consent to any medical procedure, however minor or straightforward, would be unable grant it because of his inability to comprehend the nature of the procedure. 9 22. WILLIAM JUMPER absolutely cannot actively and effectively participate in monitoring and managing his own medical care and medication. He requires supervision in this area. 23. WILLIAM JUMPER'S limitations relevant to this guardianship proceeding are not likely to improve neither in the immediate future nor over time. To the extent relevant change is likely, it will be, in my opinion, expressed with reasonable medical certainty, for the worse. 24. I have been made aware of the statutory defiilltion of "incapacitated person" under Pennsylvania law. 25. My opinion, based on my examinations of WILLIAM JUMPER and my review of his medical records, expressed with reasonable medical certainty, is that WILLIAM JUMPER is totally incapacitated as to matters affecting his person. 26. My opinion, based on examinations of\V1LLIAM JUMPER and my review of medical records, expressed with reasonable medical certainty, is that he is totally incapacitated as to matters affecting his financial affairs. 27. Based on the opinions that I have expressed, my opinion, expressed with reasonable medical certainty, is that WILLIAM JUMPER requires the appointment of a guardian of his person and estate. 28. My opinion is that WILLIAM JUMPER could possibly be harmed ifhe were required to attend his guardianship hearing, however, I feel this point is moot because WILLIAM JUMPER would not be able to contribute in any way to the hearing. 29. My opinion is that WILLIAM JUMPER would not understand nor benefit from participation in a court hearing regarding a determination of his capacity to handle his own personal and financial affairs. IO FEB-04-Z005 04:17PM FRtlIKAPOZZI AltD ASSOCIATES +717-233-4103 7-314 P.007/00B F-5S6 I. Dr. Greg Ehgartner, being duly sworn according to law deposes and says thllt I make this Affidavit on behalf of WILLIAM JUMPER and that the facts set forth in the foregoing Affidavit are true and correct to the best of my knowledge. information, and belief. I verify that the statements In this Affidavit are true and correct. I understand th.lt false statements herein are made subject to the penalties of 18 Pa.C.S.A. ~ 4904 relating to unsworn falsification to authorities. Date:#- ~~~ DR. GREG EH RTNER Sworn to and subscribed before me this ~~ 11.. day of ::;u,rlla:,'_;t.... ,^-ooS--., iOO4. NOTARIAL SEAL JULIE ANN KRAMER. Notary Public Camo Hill Cumberland County My Commission Expires February 18, 2007 ~Lt~/ ILui j;~ NotarY Public My Commission Expires II IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: PETITION FOR THE APPOINTMENT OF AN EMERGENCY NO. GUARDIAN OF THE PERSON OF WILLIAM JUMPER, AN ALLEGED INCAPACITATED PERSON AND PERMANENT GUARDIAN OF THE PERSON AND ESTATE Medication list pursuant to paragraph 12 of the foregoing affidavit of Dr. Greg Ehgartner supporting the Petition to Adjudicate William Jumper, an Incapacitated Person. 1. CIPRO 2. NPH Insulin 3. Lisinopril 4. Neutrophos 5. KCL 6. Solucortef 7. Xalaton 12 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: PETITION FOR THE APPOINTMENT OF AN EMERGENCY ~O. GUARDIAN OF THE PERSON OF WILLIAM JUMPER, AN ALLEGED INCAPACITATED PERSON AND PERMANENT GUARDIAN OF THE PERSON AND ESTATE CONSENT TO SERVE AS EMERGENCY AND PERMANENT GUARDIAN I, Alfred D. Sloan, MAR, am an authorized representative of Faith, Hope and Love Guardianship Services, Inc., and do hereby certifY that we are willing to act as the Emergency and/or Permanent Guardian of the Person and Estate of WILLIAM JUMPER if the Court shall so appoint us. Further, I do hereby certifY that I am not a fiduciary of any estate in which the alleged incapacitated person has an interest, nor have I any interest adverse to the alleged incapacitated person. The facts and opinions contained herein are true and correct to the best of my knowledge, information and belief. /1 Date: .J< ~ () ~rrNv- ALFRED D. SLOAN 13 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION IN RE: PETITION FOR THE APPOINTMENT OF AN EMERGENCY NO. GUARDIAN OF THE PERSON OF WILLIAM JUMPER, AN ALLEGED INCAPACITATED PERSON AND PERMANENT GUARDIAN OF THE PERSON AND ESTATE VERIFICATION I, verifY that the statements made in the foregoing Petition are true and correct. I understand that false statements made herein are subject to the penalties of 18 Pa. C.S.A., Section 4094, relating to unsworn falsification to authorities. Date: .~ ) C{ I O~ v!i!J 14