HomeMy WebLinkAbout02-21-14 IN THE COURT OF COMMON PLEAS
CUIVIBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF . ORPHANS' COURT DIV��ON = �� �
-, � �
MARYLN HARTSOCK ' -�'I-OI C�O � ��
An Alleged Incapacitated Person : No.� `t � ���
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EMERGENCY PETITION FOR ADJUDICATION OF INCAPACI�' ` � �. ' '�
A N D A P P O I N T ME N T O F A G UARDIAN " �`•? `��'c'
-�,
AND NOW COMES Robert Hartsock, by and through his attorney and hereby petitions
for an adjudication of incapacity and appointment of guardianship under 20 P.S. §5511, 5512
and 5512.1, and, in support thereof, represents as follows:
1. The name of the alleged incapacitated person is Maryln Hartsock.
2. Maryln Hartsock is a 59 year old female, who lives with her husband, Robert
Hartsock, in Mechanicsburg, Pennsylvania.
3. Maryln suffered a massive stroke on December 18, 2013, and was taken to the
hospital after being found in her car along the side of the road.
4. Since the incident, Maryln has been receiving extensive medical treatment
through a variety of inedical practitioners, including LifeCare Hospitals of Mechanicsburg, and
Holy Spirit Hospital and remains hospitalized receiving treatment
5. Petitioner, Robert Hartsock is an adult individual and Maryln's husband of 36
years. Robert resided with his wife in Mechanicsburg, PA prior to the incident.
6. Robert Hartsock has acted as Maryln's caretaker and managed the financial and
medical affairs of he and his wife since Maryln's stroke and wishes to continue to act as a
guardian for his wife.
7. Maryln' s condition is more fully described in the medical reports attached hereto
as Exhibit "A" which show her cognitive impairments.
8. Maryln is unable to fully remember and make intelligent decisions regarding her
finances due to her condition.
9. Maryln is incapable due to her injuries to fully handle her personal and financial
affairs. She has been, and continues to be, incapable of caring for herself without assistance as
well as making financial decisions for herself.
10. Robert Hartsock desires to serve as guardian for his wife so that he can make
medical, financial and legal decisions for Maryln while she is incapacitated.
11. No other Court within this Commonwealth, of which Petitioners have knowledge,
has appointed a guardian for Maryln Hartsock.
12. The type of guardianship sought over Maryln Hartsock is plenary as she has been
unable to make financial decisions for herself since December 2013, and Robert has been
assisting her with her care and making decisions on her behalf.
13. Maryln and Robert have two adult children together Darren Hartsock and Kevin
Hartsock, and they do not desire at this time to serve as guardian of their mother and do not
oppose the appointment of Robert as plenary guardian of Maryln.
14. Robert is qualified to act as a guardian on Maryln's behalf by virtue of the fact
that he is her husband of 36 years and has already been caring for her and making decisions on
her behalf since her stroke in December 2013.
15. Robert Hartsock has no interests which are adverse to his wife, Maryln.
16. Petitioner seeks an expedited resolution to this matter as his wife is unable to
speak and he must make all financial and medical decisions on her behalf.
2
WHEREFORE, the Petitioners, pray that Maryln Hartsock, show cause, if there be any,
why she should not be declared an incapacitated person and Robert Hartsock be appointed as a
plenary guardian of her person and estate.
Respectfully submitted,
Stone, Duncan, & Linsenbach, P.C.
Dated: � ���/ � By. �y'���
ason B. Duncan, Esq.
Attorney No. 87946
8 N. Baltimore Street
Dillsburg, PA 17109
(717) 432-2089
Attorneys for Plaintiffs
3
IN THE COURT OF COMNION PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF . ORPHANS' COURT DIVISION
MARYLN HARTSOCK .
An Alleged Incapacitated Person . No.
CONSENT OF PROPOSED GUARDIAN
Robert Hartsock does hereby certify that he is willing to act as Guardian of Maryln
Hartsock, an alleged incapacitated person effective immediately, if the Court shall so appoint.
Further, Robert Hartsock does hereby certify that he is not a fiduciary of any estate in
which Maryln has an interest, nor does he have any interest currently adverse to the alleged
incapacitated person.
l � �U �Of Qc�� .�'� �
Dated: P� y _/` �'fG�
Robert D. Hartsock
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF . ORPHANS' COURT DIVISION
MARYLN HARTSOCK .
An Alleged Incapacitated Person . No.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that on this day I have served a true and correct copy of the
foregoing Petition for Appointment of a Guardian upon the following persons by first-class mail:
Marlyn Hartsock
Health South Rehabilitation Center
175 Lancaster Blvd.
Mechanicsburg, PA 17�.��
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. 2 /Z/ / �'�/ � �'��
Datad.
Jason B. Duncan, Esquire
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,PENNSYLVANIA
IN THE MATTER OF . ORPHANS' COURT DIVISION
MARYLN HARTSOCK .
An Alleged Incapacitated Person . No.
VERIFICATION
The undersigned hereby verifies that the statements of fact in the foregoing document are
true and correct to the best of my knowledge, information and belief. I understand that any false
statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to
unsworn falsification to authorities.
Dated: fi°h �d :�D�� /`�"�,'l � ��
� Robert Hartsock
MASLAND ASSOCIATES INC.
INTERNAL MEDICINE
MEDICAL ARTS BUILDING Z2,O WILSON STREET, CARLISLE,PA 17013
(717) 249-1929 Fax (717) 249-9332
DEa�D.Tnn,ox,M.D. LES�R L.Huvrn�r.xEicx,M.D. TE�zY A.Rosisorr,D.O.
PHII.IP A.NEIDERER,D.O. DOUGLAS J.BOWER,M.D. WILLIAM R.VONAH,M.D.
MICHAEL A.DEMICHELE,M.D. C�sTOr�z J.BExo,M.D.,PHARM.D. MICHELLE M.HALE,CRNP
January 9, 2014
Jason Duncan, Esq.
8 N Baltimore St.
Dillsburg, PA 17019
RE: Maryin Hartsock(DOB 1/18/55) Tel: 697-2661
476 Ariel Court, Mechanicsburg, PA 17055
Dear Mr. Duncan:
Maryln Hartsock presently is unable to make anydecisions regarding her health orfinancial
status. She has had a massive stroke r�sulting in right sid�d weakness(actuaily paralysis)
and an inability to speak. She also is difficuft to arouse much af the time.
Therefore, I recomm�nd the appointmen� of a �urrogate t� make her decisions for her.
Thank you v�ry much.
Sincerely,
�'
Debra D. Taylor, Ni.D.
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T: 1/9/14
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�an, IU. 1U14 Z: 3�NM IllhjlU398 - No. 9495 P, 1
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PENNSTATE H�RSHEY
�Milton S. Hershey
Med�cal Cent�r �
January 10,2014
Attn:Mr. rason Uuncan '
Mrs. Hartsock rxras under the medical management of Dr. Scott Simon from 12/1/13 to 1/6/2014
at Penn State Hershey Medical Center in the Neuroscience Critical Caa�e Unit. Mrs. Hartsock
remains in rehab at this time due to physical, occupational and severe cogr�itiive deficits.At tlus
titne, Mrs.Hartsock is unable to make medical or financaal decisions fox herself and,will require
tlae assistance o�her husband, Robeit Hartsock,to make these decisions for her.
Feel free to call�crith any fiuzhex questions or concerns.
Thank you,
Emily Kraus,MSW, T,SW
Penn Sta�e Hershc�Medical Center
Netuoscience Critical Care Unit
717-531-8521 pager 0819
HISTORY AND PHYSICAZ
REASON FOR ADMISSION TO THE ACUTE (LTCH) �EVE:: OF CARE: IV
antibiota.cs for p�►,eumonia, continued medica). .lev�l of caxe after
a x'ecent lax�e l�f�l', :i.ntrapar_enchymal hemorrha��e with
intr_aventricuJ.ar exten,sion wi�l:h densc ri.ght h.�,ma.plegi� and
expxessive aphasia.
H�STORY OF PRESENT ILLNESS: Paticrit �.s a ve,r_ � pleaSant 58-year-
old marr�ed whi'l:e femalc, a pata.ent of D,r. . De:�ra Taylor, with
known his�oxy of hypextension, diabetes, hypo�hyroid�.sm, and
dyslipidemia who was �ound road�?_de in her car unzespon.sivE wi�th,
vom?.t all over. She was intu.bat�d in thc fietd and lot of vpmit
was �ou,nd in the airway. Shc was then �.nitial].,y taken. to Holy
Spi_rit Hospa.tal . She was .f,aund to havc a l.ar�c le�t
inL'xapar�nchymal hemorrhage with inL'.r,aven�l;ricular extension. on
12/J.8/2013, so she was takcn. Hershcy Medical �entcr. Shc r.3d an
extens�_ve hospita.liza�tion a� Hershey. She bas�.cally was treated
tor pr�eumonia. She had an F, coli UTZ that was tr.eated. S�.e
had a P�G placed on O1/02/2019 . She had multi.pa.e cx�l,ensivc
scans done o� her b,rain �ro see i� sh.e r�qua.red an,y evacu.a.tion o.r
cr.aniotomy if the bl��d got worse. They did tzeat Yaer
m�di_ca11y. She d�.d. not; r_equire any surgery. She �s stated �a.a.d
� PFG placed and txansFcr.xed to HealthSouth Acute Rch�b. She
was f.ound to hav� this dense righ�l:. hemiparesis w�th aph�sia. tt
was fEJ-t that she was not �ppxopriate for �t;hzt lcvel of ca.r_e.
ShF also had marked. lcukocytosis and fevers Gn admissa.on.
Becav.se of concerns o,f pncv.m�onia and the .f_act �that she wa.s no�:
appxopria�l,e for that lcve)_ of c�?:e� that she would benefi�t mo.r.e
f.rom an LTAC l,evel of �:arc fo� closer monitozing o.f hcr �edic�]_
issues, �he is now b�ing t.ransfe,r,r_ed �L'o .LifeCa,.r_e LT�C. ns
sta�,ed, FCP i.s Dr. DPbra Tay.l.or.
ALLERGIES: SHE HAS NO IQ�iOWN DRUG ALT�ERGZES.
SOCIAL HTSTORY: Mar_ri�d, living �t horne wi�:}�� her husband. ShE
w�s a.n ac��ive hospi.ce nurse a�L Cel.tic Health Ca�re. No repoxted
h�..story o,f, cigaxettES, alcohot, or i.1_1_ici�t d.��ugs but ca.nnot bc
.. . .. -. k)ZSTORY AND PHYST.:.,�. •-
�,ifeClre L�os�it2t1S of MeC�anicabuz'g P1�TTENT PtAME,; H,A�RTSOCK, bJARYLN
8950 Wi�son Lane ACCOUNT N�fi�ER: 802209 '
Mechanicsburg, PA, 17055 MEDICAL RECORD: 261921
717-679-7706 ROOM Nt31+IDER- 4�P^^�03-W
�EIYSTCIAN= P,RATHEESH VTSWANATkJ�IN, IyID
ADMYT DATE: O1/09/2014
PAGE 1 �'£ 5
confirmEd from th.e patient .
EP�SZY HISTORY: Cann.ot be confirm�d lrom the patien�.
MEDZCAL ANn stTRGZCAL H2STORY: Inc_lv.des :
1. Hyper_t�nsa�on.
2. Hypothyroidism.
3. I��abetes .
4 . Recent MSSA aspir�ti_pn pneurnoni�..
5. Hyperka�-emia.
6. RccenL E. col_i U2'I, trcaLed..
7 . Dyslipidcmia.
Pr�sent 1_y, she is on Kcpp.ra ,f,o.r seizurE proph;,�.laxis and vT
prophyl�xis w�_L-h, T�ovenox p�r Hexsh.ey, but sh� aJ.so had ch�ngeG
done to her meds a'� �cute rehab wii:h th.e antil�io'tiCS which will
bC dictated below.
REV�Ew oF sySTEMS: 1� 12-�oa.n.t revicw of syst��rns is ava�.l.abJ_e
from the pat��ent. P1�ase note, that pa�ient ��a.d show
�.mp,rovement in her i_nteraction compared to wh��n I saw her ai� �:he
acu�� rehab as a consulL. She was able to no�� and shake her
he1d, secros to be znor� appr_op,r.i,ate than what .ahe was a�: �CVte
r_ehab. ShE did m�ke eye con�L�.ct, was �blc to t,ransfen c�r_ head
.le,ft �nd right; when, she movEd around the b�d From. one side 'l.o
9:he othe.r_ . She inda.cates th�t she feel,s my ���uch, on her righ.�G
a,xm and thc leg, but had no movement �xccp� s'ze did �linch when
I did a Rabinski tcst on hP.r, moved her. 1.eg s�?on�l:aneau.sly, just
puJ.l,ed up h�r leg. She was ab.le to move hcr l.eft leg withou.r,
any problem., but please n.ote tha�l: she J.i.fted Zer l.eft arm up
f,r.om. the elbow, r.efused to l.i_�'�; it up frorn her shouldcr. Wk►en :l
asked. a.f she was �ti..r.ed., she said yes, but I w�s able to do �.t
passivcly, though she r�ft�sed to do it actively, �l:h.ough. I did
notice he.r having a ti.ssue in he.r ha,nd and movi.nq up to he.r_
mouth at �times . She did havE ?_ aunts preserat at thc bed.s�-de and
they havE some qu�s�;ions that werc answexed �o �l.h.ea.,r,
sati5�action. RESt o.f the 12-po�.nt revicw o.f syst�ms is real..ly
IJSSTORY AND PHYSZCAL ...
LifeCare Hospxt�,ls of Mech�r►�.csburg PATx��f2 NAME: I�i�SOCK, MARYLN
4950 WiJ.son �sne ACCOC7NT NOI�IDER: 902209
Mechaniesbu�g, PA 170SS MEDIC�0.L RECORD: 261921
717-679-7706 kt001d NL1bIDER: 4Q0""G03-W
PHYSTCTAN: PRATHEEBH VISWXiNATHAN, 1�ID
ADMIT DA�'�- 01/09/203�4
PAGE 2 Ur 5
not �vaa.lab?.e rrom �:h� pa.ti�nt .
MEDICATIONS FROM ACUTE REHAB: Jn.clud.e:
1 . N�rvasc 10 mg daily.
2 . I,a.pitor. �10 mg at bedtim�.
3. Pe,ridcx ora.�. car.� t. �..d.
� . Clona.dine 0 . 4 mq q• 8 h•
5. l,ovenox 40 mg subru g. 12.
6. Colace 100 mg q. 12.
7 . HydxochJ.orothiaza.d� 50 mg dai�]_y.
g . P,ro�ox�ix 40 mg daily.
9. Keppra 500 zng vj.s �ube a. 12 -
10. Lcvothyroxine 25 mcc� dai�.�. �
11. Li�i,nopri._l 90 mg dailY.
12. Lop.r,esso.r, 125 mg v�a tube q. 6 with hold �►arame�cx� . No1:
sure why she a.s on. 125. This needs to be adc�.ressed.
13. Frovigil, 200 mg v;�a L'ub� daily.
14 . Senna �0 mL b.i,•d•
15. Ccfepime 1 q IV q. 12 ,f,or 1,0 day; .
16. V�ncomyc].z� 1 g TV q. 12 st�rtPd 01./09/�01A . Th.i.s was �v.st
started yest�rday because of the jump u.p in ler whitP cE.11
count .
�.'] . �ryleno.l p. r. n.
1,8 . �].butcx'ol p. ,r, . n.
Sh� has ��_r�ady b�en sePn by Dr. Tnners ar�d <<pp.ropr.�ate orde,r,s
ha.v� been writ�l•en by him.
PHYSICA� EXAMIN�iTION:
VIT�1T� SIGNS: Reco.r_ded and r_evicwed in th� b:Luc book incJ.uding
t�he blood sug�rs .
GENERAL: Pa'�ien.t was awake, a.l�rt, inte.ract �vc, cooperati.ve Lo
thc bes�t of he,r. ab?_1_ii.y, much. bett�r than sh.��� was when .r, did her
�dma.ssion..
HE�ENT: IIcad atxaumatic, normocEphalic. Pupi_ls were reactive to
light . Shc was able to move hEr eyes right �o le!'t but did no�L
do extraocular. movemenl:s specifically for me.
- ' . Y1zSTORY. AND PHXS:CCAL �.-.
Lif9CarA Hospita7.s of M�chasiiCSburg ACCOUNT PTI7MBER: �20g�x, M�R7CI�N
9950 Wilson Lane
Mect�+�niCSburg, PA 17055 MEDIG�I. RECORD: 26192:1
�17-679-7706 ROOM �1[JiyIDER: 9W^^403-W
p,HYSiCIAN: FRA'.Cf1EESH VI3WANATHAN, NID
ADM7'� DATF: 01/0912014
FAGE 3 OF 5
kI��RT: Rate was around 92, r_egula,r rhyt�m.
LUNGS : Decr�ased bxea�h sounds bo�h tung .f,i_e1.ds . Nonlabo.r.ed
breathing .
ABDOMEN: Saf.t, nondis�:ended, non�tender. Pos�.tivc bowc.l soun.ds .
GU: Deferred.
FXTREM:C'�'2ES: 'Lowe.r ex�:remii�ies wi'th no edema. No calf pain.
Positive peda]. pulses. Sh,e moved hcx� lef�: arrt, �lease sce above
regar.da.ng the interact:�on, a.nd hEr lEft leg mlxch better,, bui: no
movemcnt in the right sa.de nol:ed �hough she d:_d ind.ic�t•e shE
fel�t my 'touch.
I7�T�II:GED NFUROLOG�C: I�efErr.ed a� this poin��.
MUSCULOSKELFTAL: Def�r_x'ed a�t this poin��. Shfi secros to have
equal muscle bulk �11 �;hroughout.
SK.7N : w�.th age-appropriate cha.nges. we wa.:l.l hyd,:ra�es .
LA80ZiATORY DATA: I do no�t hav� �ny labs on h�,=..r �l:oday. T.�bs
� from yes�terday showEd whi�� cell count of 32. �, H&H af 17. a.nd
39 . 8, plat�lets ofi 500 . Blood cultur.es pre].i:nina,r.ily dzawn on
O:1.108/20:19 w�re negative. Her last BUN and creatini.ne was 35
an.d 1, sodium, 1.35, potassiu.m � . n, �hlor?.de a.nd CO2 of 92 and
26, xandoxn blood sugar 173, c�,lcium of 9. 2, this was yesterd�,y.
Clrine cul�L'ure was nega�L�.vE.
P1easE note tha.t I have con�a.r_med her mctoprolo]. is de.fini�:�1_y
a,25 mg via PFG q. 6 h.
ASSESSMENT AND PZAN:
1, . Patient �_� sta'I:us post l.arge left :in,trap�.xenchyrnal
h.emorrh,age spontancov.s with� intraventricu.lar extension tha�l;
haPpened on 12/�.B/2013, did �ot requi.re an.,y surger.y fo,r
evacu.ation, just f.ollowed closel.� whiJ.e she was at H�rsh.ey. Sh.e
has righ�� hemipar_esis, expressa,v� aphasia. :hc wa.11 be SE�n by
PT, OT he,r..P. wi�_1 fo].l.ow he.r, closel,y. Sk�e is an Keppra
.f.or sei.zur� pxophylaxis .
2 . Dysphagi.a, h.�s a PEG.
3. nspira�:i_on pneumonia. She was in�.ti.ally tr�a�;ed a�l; He.rsh�y.
She was �ound to have increased white cel_1 c��v.nt whil�e she was
aL �.cut� rehab al,ong wi_1:h tcver. . Sh.P had m.ei.hic�-1_.lin-sensiti.ve
—_ ... . .. iazsTO�y �Nn �xYSr,�
LifeCare Hospita�.s of MeChaniCSbvr4 FATIEIJ'�' NAME: FiARTSOCK, MARYLN
G 950 v�i,7.son I,�n� ACCOCINT NUMB£R: 902209
Mechar►icsbux'g, PA 17055 MEpiCAL RECORD: 267.921
717-679-7706 ROOM NCTNIDER: 4�0^^903-W
BHYS7CY21N: PRATHE�SH VISWRNATHA[3, MD
AnMIT DAT�:: 01j09/20J�4
pAGE 4 �E' 5
Staphytococcus a,ureus pnEUmonia while she was at Hezshey.
. 4 . Esch.ericha.a coli uri.x►ary tr_ac�t infection. Cultures of the
urine are neg�Li,ve so far. She had blood cult.ur�s drawn in
acute which were nega1:ive. Con'tinu� the cefeF�i.,me a�d vancomycin
whil� she i.s b�ing foJ.lowed close).y. Labs arG: pendi.ng �'o.r.
today. This will be monitor.ed as .far as whitE: c�ll a.s coa�cern.ed
�nd ,fol).ow h�r temperatux� .
5. DiabeLes, �:rend will be moni.tored.
6. Hypertensi.on. Sh� was fou.nd to bc exten,s:�vel.y hypertensive
whilE she was at Hershey. :Ct wa,s fe),t that hc�x hyper�l:ension was
the cav.se of her b1ECd. She wi1,J. con�tinue on h,er multip�e BP
medica�:�.ons.
7 . �lypothyroidism. . ContinuP tr�atm�nt. L�ov��nox fo.r, VT
pro�hylax�.s �o be continued.
B . Resuscitation s��;atus was d�_scus�ed with h��z s�o«s� M.,r.
Robert H.artsock on thc phonF. Hc wishes for zcr to be fu1J.
codc. Pat?.ent ev�dcntly does not have a la.ving wi1l. n�i�tk�er
doss she have a power �.f. at�Lo;�n�y, but h,er husband is the next
of kin.
PR111'EIEESH ISWANATHAN, MD
�
PV/mt�na. Q �
� ���,�1 t�I
Di,ctatCd� by: VIN�IYSHEZ�E KUM�1R, L'�1-C ` �.� ,:
D: O1/10/2019 11: 41 : S:1
T : 01/10/7_014 19: 32 : �2
Job #205609 �
, . ., �- HISTORY �AND QHYSICAI. �
LifeC�s'e Hospitals of M�chaniC:�burg PA'CIENT NAME: HARTSOCK, MAIZYLN
0950 rR�lson La�na ACCOIINT t�7tJl�ER: 802209
Mechas�a.csburg, PA 1�055 N�DIC1�. RECORD: 261921
717-679-7706 ROOM NCTD�ER: 4'P7""403-v�
Pii]fSiCIAN: P.RATHEESN VISWANZ�THAN, �!D
ADMIT DATE: 0]./09/2014
EAGE 5 O� 5
PROGRESS NOTE .
DATE OF PROGRES$ NOTE: Oi../16/7019
PUI,�'lONARY PROGRESS NOTE
CHiEF COMPLAINT: Respiratory failurelrecent �:neumonia./rECen�
sepsis syn.drome.
The pat�.ent ' s medica.l r�cord w�s xeviewed. Hc r case wa,s
discussed wi.th th.e nuxsing and respiratory st�.�'f. . Her
medic�tion prof.�le was .r,eviewed.
:r.his 56-year-o�.d woman .r,ema].ns ve.ry seriou,sly and complexly 17.1 .
Sh.e h�s underly�ng hyp�r.tensi,on, hypo�tk�yroidi�;m, obesity,
dj_abc�es, and d.yslipa.demia. She was found un��esponsive al.ong
L'he si_c�e of the r_oad, covered with emcsis on '.2/1812013. She
was in�tuba��d in the :Eield. She was takcn to H.ershe,y Med,ical
CEnter wher� she remained intuba�ted. A CT sc.�;n showed a l�rg�
l.e.ft fron�:a7. int,rapaxenchymal h.emorrhage with extcnsion a_nto th�
ven�.r.icles . She had, accelerated hypertension and did ,r.squlre Iv
l.abeta]_ol a.s we].1 �s a. Caxdenc drip. The pat.�ent was shown �l:o
have cerebr_al �dema and did have brai.n stem c��mpressa.on. Sh�
had sigan.ificant d,ysphagia a.nd did h�ve a PEG �tube placed on
01102/2l�J.4 • She has ha.d. right-sid.ed hemipl�gia a�d appears to
havc a maxked aphasia . She developed a UTT a.n.d receivcd �
couxsc �.f antibiotics . She had an aspirati.on pn.eumon�a. She
a].so had mu�.tiple mE�tabolic �bnormal:i,tics inc:luding low
po�:assium and an �leva•L•ed sod.a_um. Shc was able 1:o bE extub�ted.
She was transfcrr_ed �l;o H�aJ.th South a,s of 07./06/2019; howev�r,
shc did n.ot do w�1�. at �ezlth South, having clevc].opEd .f.�v�.r, as
ha.gh a.s 103. Sh.e also developed a new 1ef_t �.ower lobe
in.f,i_ltr_a.te and was though� to h�.ve yet znotrer aspira.tion
pnc:umonia.. Becaus� of th� medica]. compl.exi�Cy of h.er si.tu�'t.ion,
the pat�.ent was txansferr�d to L�i..f_eCar_e as o.f:: O1/09/2014 .
.T.h� pa.tiEn,t present�y is breathing easi?..y on .room air with a
satura��ion of 94�5 . She has no spon•taneous cc�ugh and wh�n �sked
to do so, could not coope.ra�te . Sh.e appears e�xtremely
' �� � � PROGRE3S NO'rE -
�,ifeCare HO�pitalS of MeahaniCSbnrg P11�TIENT �)�t�: HARTSCCK� 1�6ARYLN
4950 Wi�.�on LanA ACCOUNT 'i�L7DffiER. 802209
MechaniCSburg, PA 17055 MEDrCAL REGORD: 261921
717�679-7706 ROOM NUtYIDER: 4DP^^903-97
PAYS�CIAN: Ck�tI+ES TNNERS, NID
PACyE 1 OF 5
� frust,rat�d. She is wa.de awake and alext; howE:ver, has extr�mely
limited abili't,y, to compxPhend a.rad commu.na,cat�_ She did open hex
mouth fo,r. me when ask�d to do so. She has a dense r.igh��
�emiplcgia. Shc also has the �xpressivE apha�,ia, i.f not, a morc
gl,obal a�hasia. She is on tube fceds. I am L�naware of any
signs or symptozns o� asp�.ra�io�,. She a.s havi.r�g no nausea,
vomiting, or abdomi.nal pain�. II�r a.ntak� and c>utput for
yesterday were measuxed at 3Qg0 and 7_975 mL .r.e:spectively. H.er
weight �..� ��r 96 kg. The ��tient do�s raot appcaa.x ed�rnatous . She
da.d hav� .low-grade tempezatur� �:ha.s morniz�g oi: 99. 5, ol:herwis�,
sh.e has been afeb,r.ile. He,r blood pressure is �xc�7..lent a't
J.38/67 . The p��ient cont?.n,u.es as mentioned. ta have the d�nse
righ.t hemipl.egia and aphasia. �
She continucs on a ru11. array of supp�xtivc c<ixe, which incJ.udes
an TVC �iJ.ter that we placed on 01./:l1/207.4 . :�he d,a.d have OVT
documen,ted upon arrivaJ. here. She alsv is on. suppl�mental 02, as
indica'red. Shc ,r,emains on �mloda.pinE, chlorh��X�.d�.ne ox'a.l c�re,
Ca,tapres, Colace, low-dose 7�ovenox, Difluca,n, gua�.£enesi�.,
h_ydrala2ine, hydroChloro��Y?.i.azidc, i.nsulin wi�tl� cove,r.age, nuoNeb,
Kepp,ra, Synl:hzoid, Pxi.nivil, metopro�.o�., moda Ci.nil, Protonix,
pravasta,tin, Floxastor, ;enokot,. She a.s on I'J ce,fepimc� LV
mEtr_o�idazoJ.e, and IV vancom.yr,i_n.
PHYSICI�L EXAMTNATION:
GENFRI.�L: She is an a,l_1-appEar_ing wom.an .
VIT,�T, SIGNS : Blood p,r.essure i_s 138/67, temp�r.2.tur� 99. 5, pul.ss
66, respi_ratory .r.ate 20. Weigh.t is 96 kg.
HEAf�, EYES, EARS, NOSE, 11NA THR011T: Normocephalic/atraumari_c.
�upils equ�l, round, and. reac�.tvs to light . No nasal discharge
or con.ges�tion not�d. Slightly dry o.ra1. mucov.s m�mbran.es with, no
dcfi.n�t� mu.cosi�,is . Parot�.ds norma]..
CHEST: Mildly k,yphotic� obcse, sorncwhat stiff. with da.minishccl
cxcursion. Brea�l,Y?, sounds �n�.ldly decrEased, bilaLe,r.a.11y.
Slightly proJ_onged expa_ra�tory �has� of respir.ation. very
ma.nimal J.ower lu,n.q zonc raJ_es wa,th r�rc ,r,honchi. N� wh�ezes,
consolidative changes, or rub� .
C1IRATAC: Regular r.hythm. Norma.l S]./S2. A ]./6 to 2/6 systola.c
murmur. �osi�tive S4 . N� S3 or ,r,ubs .
ABDOM�N: Obese, sof�t, non�l.cn.der. l3owel souz�ds present . N�
� PROCRES3 NOTE �
LifeCa�A E�OSpital5 Of: MechaniCSburg PATIENT N.�b�: HART30CK, MARYLN
4950 Wilson LanE ACCO(7NT NLINIDERo 602209
Mrchanicsburg, PA 17055 t�DICAL RECORD: 26].927,
717-679-7706 ROOM NUTABRR: 96G^^n03-W
PHYSICIAN: CH,ARLES INNE�tS, NID
PAGE 7, •�F 5
masses or organo�egaly. PFG tube in p.lac�.
�XTRE�7TIES: Some doughy �textur� at •�he pro�ima]. lowe,.r,
� extr�mities. No patting edcma. No �igns of PVT. spECi.,f_ica�ly,
no palp�ble co,rds, exyth�ma, wa.rmth, or �endEa:ness over any of.
the maj or venous sys�:em flow pa�tterns . Pe,r,i_pk:.eral puJ_ses
diminished be�.ow the f�morals bilateralJ.y.
NEUROI�OGIC: Th� patiex�t is awake, alErt, a.tte:mpts to ini:e,r_ac�:
aa,thou.gk� v�,r,y lima,ted because of her aphasia,. ShP moves her
le,ft side ac•tively. Do�s have a dens� r.ight r�emiplegia. She
has an expr�ssj_ve a.phasia..
02 saturation is 99� on room air_ today.
Ch�st x-ra.y from O1/19/2014 shows no �ctive d:.seasc.
CT Scan of. the brain, from 01/15l7_Ol� shows 6 ;nm shift of the
mid:line to th� ra.ght. She d,oes h3ve �n acu�e,�subacut� l,eft
frontal hem,atoma measu.r.ing 4 . 8 x 3 . ?_ �m. Th�::e is surrounding
vasogenic eclem� . '�here was some ma.ss �FTect ��n th� ],eft
cerEbral hcmi,sphEre wii:h sffacement o.f the su.lci.
I�ABORATORY DATA: I'rom O1/�.512019 , WBC 6. 3, h��ma�oc.rit 33 . � ,
pl�tel�t � coun�: �51, 000 . Sod.ium 1.3Q, potassiv;� � . 1, chlo,r.a.d� 99,
CO2 26, c�eatinine 0. 6 with F3UN of 14 , gJ.ucos� 112, cal.cium 9.3,
a..lbumin 3 . 2 . LFTs no.rma).. Magnesium 1. 8, ph�spharus 4 . 1 . Her
vancomycin �rough level Lrom today is elevate� �t 22. 6. Bloocl
cul,tures havE been negativ� from 01/14/201� . Likcwise, u.r.inc
cultu,r� is growing no o,r,ganisms . Stool negative for C. dit,f, as
o.f O1/13/z014 .
AS SES SMENT:
1 . Acute/chron;.c respiratozy laa,l�ur� - 1?a�l:i_�nt p,r,escntl,y has an
acceptable work o� breathing and 02. sai.u,r,�tic:n on room aix at
rest. We wj.tl con,tinuc to doCU.m�n�: her 02 s7tuxation. at rest
w�.th act�vity and a'l z�igh'�, and 5upply supplcmen��.l, 02 �:o
main�ta.in hex in th.e low to mid 90s .
2 . R�curzeni: aspirati.on pn�umon?..a . The pa�ta ent ha� impaircd
ai.r,way def�nses as a resu.l.t oL r.er stzok�. ��h� i_s on
vancomycin, cefcpime, and F1agy1 . T,atest chr:st x-ray from�
O1/:1.9I20a.4 n�ga,tivc_ Sh� h�a.� a norma). A-a g;�adient . Continues
PROGIik�SS NOTF
LifeCaxe Hosp9.t�is of klu�chanicsburg PATZENT NAI�: I�ART30CK, MAR3tI.N
4950 P1i].sors Lane A,CCOIJNT tdt�ER: 802209
Mechai�icsburg, PF1 17055 MEDICZ�►t. RECOk�D: 261921
717�679-7706 ROOM �1LT[�ER: 9W"^403-W
PHYSIC�AN: CE1,�IRLES �NN�RS, tt�
PAGE 3 OF 5
on a.spirataon precauti.on, ch7_or.hexidine oral <:ar_e. She has bcen
on guai.fencsi_n. and anta.biotics as w�ll. She cloes not to�.erate
the DuoNeb; hence, I am going to discon�inue �.t.
3. RECent fevEr to 103 with a white count of 22, 000 . Again,
thc patient in sss�nce has been afebrile ap�rka fr.om toda�r' s
vatue o� 99. 5 . He.r, whi�:� count yesterday nor.r.lal at 6. 3 . Sne is
on a�n.tibio�l:�cs as above. Overa.11, I �ee� ShE ha.s improved from
this standpoint. All cu,J.tures have be�n negai;ive includ�.ng
stool �or Clos�;x�.dium di.�ficilE. The fcv�:r at�d wh.a,te coun.t
elevation werE th.ought likely s�con�dary i.o a.n aspiration
pneumonia .
9 . Recen�L left ironta]. inLra,parEnchyr�a.l hcmo:�xk�age. Zt was a.n
extens�.ve hcmorrhage with intraventricu.lar ex�:�ns�.on. I�
occur,r.ed on 12/18/2013 . We d�.d an updated CT scan o� the bra?.n.
,yest�rda,y, �1 we�ks aft�r th.e acute ev�n�C. Th��rc was no comment
regarding hyd.roc�pha.].us . Sk�e con�in.u.es to ha��e large
intraparenchyma,l hemorr.hage with the ongo9_ng inass e.f_f�c�� and
vasogenic ecicma.
5 . Incxeased ra.sk of sei.zures - .r.emains on K��ppra.
6. RECent ��rinary txact inf.ection � t.r_eatEd. opda��d ur_inc
cul�ure negative .
7 . Hyp�rtension - b:lood pressure t,oday is ex.�el_len�e at 138/67 .
Renal a.rtery Doppler showed no evidenc� of r_enal .artery
stenosis .
8 . Hypo'l'.h.,yroidism - on Syntr„r,oid rCp.letion. TSH is no.r„mal a't
0. 75.
9 . GastroesophagEal ,r,eflux da.sease - on proton•-p�,�mp inhibi.tor.
10. DysJ_i�pidemia - on s�eata.n thcrapy.
11. Obesity - does not �.pp��r to havc �rhe ob�sity-
hypoven�l:ilat�.on synd.r.ame.
7.2. Posslble sleep-disor.derEd breathing - �3edside s�eep study
shows no cvid,PncE oL same. ni.d have aGCeptak�J.e results on room
aar.
1,3. Diabetes - on a.nsulin plus Covezage . Ba.��od sugar from
yes�Ler.day 112 .
14 . M�L•abol.a_c/nutr.a.tional abnorma]_a.ties - 1�s of yesterd�y, h.ez
sodium, potasGiu.m, chlora.de, serum CO2, ca,a_ca.um, phosphorus, and
m�gnesium are normal.
15. Deep venous 'L'h,r,ombosls a.n thc J�eft p�rone;al vcin. P���ien.t
not a candida�l:e f.or fv.1,1 an�ticoagulant thera�:�y given he,r, .reccni.
�V N PROGI�.CS3 NOTE �
�,i.fPCare t3ospitals o£ I��:chaniesbuz�g P+tlTTENT NAME: HARTSOCK, MARYLN
Q950 Wit!:on Lane ,q,CCOLTNT NU1�ER: 802209
Mechanicsburg, P� 17055 MEDICA� RECORD: ?.61921
717-679-7?06 ROOM NCT�ER: d.�v^"403-W
PAYSxCZAN: CFfARLES INP3'�:125, 1�ID
A.11GE 4 �F 5
in�t.racranial b�eed. She had an �VC filfier, pl�ccd on Ol/ll./?_O1� .
ShC ,r,emains on T,pvenox a'I� ,low-do�e but high r�sk stxatification
dosing.
16. TT�feriOr vena cava �ilter.
17 . Coaguto�athy - xesolved. �ler 1_atest p1at�1��
count/PT/INR/�.�TT arc a�.l norm.aJ. .
18 . Encephalopa�;hy - on P�^ovigil. `z'h� Br�in Tnjur.y t�am
consul�:ecl.
19 . Dysphagi� - PFG tubc �.n pla�;c.
20 . necondi.tioning/generalized failure to th,r,ive. ,
DISPOSITZON: 1�l�ase see comme�ts n�xr. to abo��e diagn.oses . �'hi_s
pat�.ent r�m.aa.ns vcry se.riousl,y and com.plexly ,i 11 .
BLAN: As �bovc/per orders.
CH.ARLES ,T.NNFRS, Mb
Cl/mL.r.i_c
Dictated by: C.HARLES tNN�RS, MD
D: 0�./16/2014 11 : �7 : J.0
T: O1/�.6/2014 1.6: 02 : 33
Job #2100H6
PROGRESS NOTE
I.ifeCare Hospi�ls of Mechani,caburg PA�'xENT NF,ME: AARTSOCK, MARYJ�N
�1950 Wilson Lan? ACCOtfi1T NC1bIDER: 802209 .
Mochanicaburg, PA 17055 �9EOICA2, EtECORD: 261921
73.7-679-7706 ROOM NUMA�R: 4U1^^403-W
PHYSICIAN: CF1AFtLES ZN��RS, IyID
PAGE S ��r 5
oate(s):
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Au mentative Comm. Oevice Eval 1 st Hr 92507GN
Each addl.30 minutes 92S08GN
s ha ia Evaluation 92610GN
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MG- MechaniC��Ground P � Pureed = HT=Honey ThiCk PT=Pudding Thick TH =Thin NS =No SCraws
� ❑See Precautions Posted in Patient's Room and Chart
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(�i�.��C�.L. ��4v �o ,
�nACi �anna�S.SOORAPW
HAaTSOCK, I�ARYIN F 58Y 0111811965
SPEECH-LANGUAGE PATHO�OGY RMk':403—ty MR�;261921 AOM�': 802209
TREATMENT / PROGRESS REPORT DR; MIRARCiI, DOM�NIC 0110911A LIFECAR�
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�! •'�:nt demonstrates progres9 thls week as followsc []ExCellent ❑Good p Fe�lr_Q PoOr d None. Patient met�of set goats_
.� :�. .:on(s)goals nat mel:
;• • �
� •..'a: I]Continue with CurreM ST plan of tre�tment and progres6 to patie�t's toleranCe. _
�...
! Q Revise ST plan af trestment to indlcate highsr/lower I�vel goa�s secondary to chEnge in pa,llent's st�►tu&.
' ❑Recommend discharge from ST secondary to plateau in progress,rto prog�ess,or p�tient demonstrating co�°naive,commumcation and swallowing skins WFI.
. ❑Palient remelns on hold irom ST untll turther notice. �
....., ,.n�nr_eennono�.i
. HARTSOCR, MARYLM F 56Y 0111811995
. :��:ECH-LANGUAGE PATHOLOGY RMa;403-W MR;V:261921 ADM�; 802209
� -:�.�A T M E N T / P R O G R E S S R E P O RT oR: MIRARCNI, nom�Nic Oi109/14 IIFFCARF
Hosl MR�: Hosl ADMN:
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