HomeMy WebLinkAbout03-14-14 r-4a
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1N THE COURT OF COMMON PLEAS �`"`- � ' '" `��`
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OF CUMBERLAND COUNTY, PENNSYLVANIA c�ir, � ; <-�
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��� : Orphans' Court Division �" �;.,., �'''
ROI R. BAPTIST : No. �� - ,� ' �a'T(�
PETITION FOR DETERMINATION OF INCAPACITY
AND APPOINTMENT OF EMERGENCY GUARDIAN
AND NOW COMES, Petitioner, Richard A. Suinmers, by the undersigned counsel,
petitioning this Court for determination of incapacity and appointment of emergency guardian as
follows:
1. The alleged incapacitated person is Roi R. Baptist ("incapacitated person"),
approximately seventy-two (72) years old, believed to have been born on or about September 5,
1942, with a personal residence at 144 Hummel Avenue, Lemoyne, Cumberland County,
Pennsylvania17043.
2. The incapacitated person is currently hospitalized at the Holy Spirit Hospital,
Room 237, 503 N. 21St Street, Camp Hill, Pennsylvania 17011.
3. The incapacitated person, whose parents have presumptively predeceased him,
was believed to never have married, has no known children, and has no known relatives living
within the United States.
4. The incapacitated person is believed to have a relative living in Switzerland and a
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relative living in Belgium, but no names and/or addresses have been located.
5. The incapacitated person was admitted to Holy Spirit Hospital, Critical Care
Services on February 26, 2014, with a diagnosis of pneumonia.
6. Subsequent to hospital admission, the incapacitated person has suffered several
severe medical complications leaving him unable to make medical decisions, nor able to provide
consent for medically necessary procedures. See Attached Exhibit "A" for a copy of a letter
from Dr. Anthony J. Perella, Pulmonary/Critical Care Intensivist at Holy Spirit Hospital,
documenting the state of the incapacitated person as of March 12, 2014.
7. Your Petitioner is seeking to have himself appointed as emergency guardian of
the person and estate of the alleged incapacitated person and would accept such appointment.
8. Your Petitioner and proposed emergency guardian has no interest adverse to the
alleged incapacitated person.
9. Your Petitioner seeks emergency guardianship because the alleged incapacitated
person is physically and mentally unable to make decisions related to his personal or financial
care.
10. Your Petitioner seeks plenary emergency guardianship of the alleged
incapacitated person's estate and limited power over the person, to wit: Powers of general care,
maintenance and custody, power to handle routine financial matters, power to enter any safe
deposit box(es) for the limited purposes of locating and retrieving estate planning documents
such as Power of Attorney, Advanced Medical Directive, and/or Will, power to designate the
place for the incapacitated to reside, power to provide required consents or approvals on behalf
of the incapacitated person and the power to assure proper medical and psychological services.
11. Your Petitioner Richard A. Summers, as proposed emergency guardian, states as
his qualifications: provided assistance for several months with personal care, cooking, and
cleaning during the recent months; encouraged the alleged incapacitated person to seek
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assistance at the onset of this current medical emergency; has cursory knowledge of his affairs
and estate, and has been a long-time acquaintance and friend of the alleged incapacitated person.
12. The gross value of the alleged incapacitated estate is unknown at this time. The
estate is believed to have at least some interest in his primary residence and personal property.
Net income for the alleged incapacitated person is also unknown at this time. Furthermore, it is
believed that no person has been granted Power of Attorney over the alleged incapacitated
person's affairs.
WHEREFORE, Petitioner respectfully request that this Honorable Court determine that
Roi R. Baptist is incapacitated and appoint Richard A. Summers as emergency guardian pursuant
to 20 Pa.C.S.A §5513.
Respectfully submitted,
LAW OFFICES OF CRAIG A. DIEHL
Date: � 2D/ By. �
omas L. McGlaugh 'n, Esquire
Attorney I.D.No. 208313
3464 Trindle Road
Camp Hill, PA 17011
Tel: (717) 763-7613
Fax: (717) 763-8293
Attorney for Petitioner
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EXHIBIT "A"
CRITICAL CARE
SERVICES
[�.SERv�CE OF HOI.X SPIRIT HEALTH SXSTEM
Janette Foster, M.D. �
Medicll DiPector, Critical Care Services
March 12, 2014
Cumberland County Orphan Court
RE: Roi R Baptiste
To whom it may concem,
This [etter is in regards to Roi R. Baptiste, who is a patient here at Holy Spirit Hospital.
Ne was admitted on February 26th, 2014 with diagnosis of pneumonia. His hospital
course has been
complicated by sepfiic shock, acute respiratory distress syndrome, acute renal failure
requiring
hemo-dialysis and a collapsed right lung requiring a tube for re-expansion. He is
requiring full respir�tory support and medication to keep u� his blood pressure.
At this time, because of the severity of his illness, he is not conscious enough to make
medical decisions nor is he capable of providing consent for medically necessary �
procedures_
Pleas� do not hesitate to call with any questions.
Sincerely, - .
��
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Anthony J. Perella M.D.
Pulmonary/Critical Care (ntensivist
Holy Spirit Hospital
Your Partner For Good Hea/th
503�iorch 21"Street • Caznp Hill,�'.A.17011-2288
T�'hone (717) 972-7377 • janette.foscer�a hsh.org
VERIFICATION
I, Richard A. Summers, Petitioner above-named, being duly sworn according to law,
depose that the facts set forth in the foregoing Petition for Determination of Incapacity and
Appointment of Emergency Guardian are true and correct to the best of his knowledge,
information, and belief. The undersigned understands that the statements made therein are made
subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities.
Date: .5 �1� l�c..� �
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ichard A. ers