HomeMy WebLinkAbout06-13-14 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
ESTATE OF SHELLEY HARTLAUB,
an alleged incapacitated person
O.C. No.: a j —l
PETITION FOR ADJUDICATION OF INCAPACITY
AND APPOINTMENT OF GUARDIAN
TO THE HONORABLE, THE JUDGE OF SAID COURT:
Petitioner, Carlisle Regional Medical Center(hereinafter "Petitioner" or"CRMC"), by
and through its counsel, Burns White, LLC, respectfully states that:
1. Petitioner is CRMC, a Cumberland County, Pennsylvania community hospital
currently providing 24 hour acute care to Shelley Hartlaub ("Ms. Hartlaub" or the "alleged
incapacitated person").
2. CRMC is located at 361 Alexander Spring Road, Carlisle, Pennsylvania 17015..
3. Ms. Hartlaub was born on April 22, 1961, is 53 years of age, and is engaged to be
wed to Mr. Paul Jumper. Ms. Hartlaub's Social Security Number is
4. To the best of Petitioner's knowledge, information, and belief, prior to her
hospitalization, Ms. Hartlaub resided at 10 Westminster Court, Carlisle,Pennsylvania 17013.
5. To the best of Petitioner's knowledge, information, and belief, Ms. Hartlaub's
next of kin include her mother, Sylvia Hartlaub, as well as three (3) brothers and4wo (2) sirs. >> m
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Their addresses are as follows: v G `' °
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Sylvia Mae Hartlaub (Mother)
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Elmcroft Assisted Living ca o -� ..,j
153 Logan Drive, Suite 107 c - T
Dillsburg, PA 17019 = ca r m
(Currently at Golden Living Rehab Center following a diabetic ana and baE�falkn
in April 2014) s
Connie Lee Hartlaub (Sister)
76 Clemens Drive
Dillsburg, PA 17019
Wanda Kay (Hartlaub) Jacoby (Sister)
164D Slatersville Road
Biglerville, PA 17307
Anthony Joseph Hartlaub (Brother)
76 Clemens Drive
Dillsburg, PA 17019
Donald Eugene Hartlaub (Brother)
1944 Green Street
Harrisburg, PA 17102
Gerald Nelson Hartlaub (Brother)
3370 Cranmere Lane
York, PA 17402
Sylvia Hartlaub is not of sound mind or ability to serve as Ms. Hartlaub's guardian. Ms.
Hartlaub's siblings, as well as her fiance, Paul Jumper, are not willing to act as guardian of Ms.
Hartlaub and have consented to the assignment of a guardian on her behalf. ,Finally, Ms. Hartlaub
has consented to the assignment of a guardian on her own behalf.
6. Upon information and belief, Ms. Hartlaub suffers from severe depression and has
a past medical history of seizure disorder. While admitted at CRMC, Ms. Hartlaub has
consistently refused treatment, including food and drink. This has had a significant adverse effect
on her health. See, May 31, 2014 Transfer Summary of Michael F. Hilden, M.D., attached hereto
as Exhibit "A."
7. Because of her mental and physical condition, Ms. Hartlaub is not competent to
make informed decisions with respect to her health care decisions.
8. Because of her impaired mental condition, Ms. Hartlaub lacks the capacity to
make responsible decisions concerning her person or estate, and is unable to make complex
decisions due to her severe depression.
9. These impairments necessitate a guard ianship.of the person and estate to facilitate
the making of decisions regarding her continuing health care decisions.
10. Specifically, Ms. liartlaub is in need of transfer to an inpatient care facility that
can provide a supportive environment and treatment for her severe depression. Ms. Hartlaub has
consented to voluntary admission to such an inpatient care facility. Sec, June 5, 2014 Progress
Note of Ruchi Dach, M.D., attached hereto as Exhibit "B."
11. It is the opinion of Ms. Hartlaub's treating physicians, Christina E. Collins, M.D.
and Michael P. Hilden, M.D., that, due to Ms. Hartlaub's current depressed state, she is not
capable of making decisions and guardianship and placement should be pursued.
12. Petitioner is not aware that the alleged incapacitated person signed any powers of
attorney or advance health directives or in any way designated anyone to serve as her agent over
any of her personal or financial affairs, or as her surrogate over her medical care.
13. Alternatives to the appointment of a guardian of the person and estate are not
available.
14. Petitioner has attempted to arrange for Ms. Hartlaub's placement at a psychiatric
or medical/psychiatric facility at approximately 50-75 healthcare facilities but has had no
success.
15. The severity of Ms. Hartlaub's mental condition, and the lack of a viable, less
restrictive, or alternative means to address these issues, necessitates that a guardian of her person
and estate be appointed to manage and handle all aspects of Ms. I-lartlaub's health care decisions.
i
16. The proposed guardian of the person and estate is Keystone Guardianship
Services, 1 15 W. Broad Street, Elizabethville, PA 17023, (717) 674-5757.
17. The proposed guardian has no interest adverse to the alleged incapacitated person.
18. The proposed guardian has no prior relationship to Ms. Hartlaub.
19. Upon information and belief, and after reasonable investigation, Ms. Hartlaub's
estate is worth approximately $1 1,000.00, not inclusive of approximately $1,500.00 owed to the
Internal Revenue Service. Ms. Hartlaub is not currently employed. After reasonable
investigation, Petitioner is unaware of any additional income received by Ms. Hartlaub.
Accordingly, upon information and belief, the gross value of Ms. Hartlaub's estate as of June 1,
2014 is approximately $9,500.00.
20. Upon information and belief, Ms. Hartlaub has never been a member of the
Armed Services of the United States and is not receiving any benefits from the United States
Veterans Administration.
21. Legal counsel has not been retained by or for the alleged incapacitated person.
22. No other court has assumed jurisdiction in any proceeding to determine the
capacity of the alleged incapacitated person.
23. No other guardian has been appointed for the estate or person of the alleged
incapacitated person.
***Intentionally left blank***
WHEREFORE, Petitioner, Carlisle 'Regional Medical Center, respectfully requests that
this Court issue a Citation, directed to the alleged incapacitated person, Shelley Hartlaub, and to
such other persons as this Honorable Court may direct, to show cause why she should not be
adjudged fully incapacitated and why Keystone Guardianship Services should not be appointed
guardian of her person and estate.
Respectfully Submitted,
BURNS ' I 6 C
art T. O'Neal, 111, Esquire (89097)
Daniel A. Cutler, Esquire (307640)
100 Four Falls, Suite 515
1001 Conshohocken State Road
West Conshohocken, PA 19428
Attorneys for Petitioner
Carlisle Regional Medical Center
VERIFICATION
1, Michael F. Hilden, M.D., verify that I am authorized to sign on behalf of the Petitioner
in the within petition, and that the facts contained in the foregoing Petition true and correct to the
best of my knowledge, information and belief, and that this verification is subject to the penalties
of 18 Pa. C.S.A. Section 4904, relating to unswom falsification to authorities.
Date: June 10, 2014 Michael F. Hilden, D.
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CONSENT TO SERVE AS GUARDIANy
i
Keystone Guardianship Services, a non-profit corporation located at 115 W. Broad Street,
Elizabethville, PA 17023, having been apprised of the matter of an alleged incapacitated person,
does hereby consent to serve as (limited/plenary) guardian of the estate/person of Shelley f
Hartlaub, should the Court determine that the appointment of a guardian is appropriate.
r
onstance E. Stoneroad
President and Secretary,
Keystone Guardianship Services ?
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9603521 01:51:44 p.m. 06-06-2014 4166
PROGRESS NOTE
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PATIENT ID
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9603521 ( 02:07:19 p.m. 06-06-2014 43156
PATIEN ARTLAUB, SHEL MED ICE: 001000845 +ADMIT DATE: 05014
DATE OF ADMISSION: 0511812014
DATE OF DISCHARGE:
DISCHARGE DIAGNOSES:
Major depression.
Hypematremia secondary to no oral intake.
Polycythemia secondary to severe dehydration.
Mild rhabdomyoiysis.
History of seizure disorder,
Metabolic encephalopathy.
Acute renal failure,prerenal in origin.
Questionable trazodone overdose.
Urinary tract infection secondary to Escherichia coli,
Hypokalemia.
Severe malnutrition.
DISCHARGE DISPOSITION: Mrs. Hartlaub is being transferred to an acute inpatient psychiatric hospital for
further psychiatric care.Her condition was stable.She was discharged on a regular diet and was to resume
activities as tolerated.
DISCHARGE MEDICATIONS:
1. Keppra 500 mg b.i.d.
2. Multivitamin i daily.
3. Celexa 20 mg daily.
4. Subcutaneous heparin 5000 units q.8 hours while immobile.
5. 05 half-normal saline with 20 mEq of potassium at 40 mL per hour.
CONSULTATIONS:
1. Albin Harris, MD, Nephrology.
2. Dr. Klein,Psychology.
HISTORY OF PRESENT ILLNESS:Mrs. Hartlaub is a 53-year-old Caucasian female who was brought to the
emergency department on 05/1812014 by EMS after being found unresponsive in a hotel by the Middlesex Police.
According to the police,she had checked into the motel on a Friday and when she did not check out as scheduled
on Sunday afternoon, the staff at the hotel called the police.The police entered the room and found her
unresponsive on her bed.According to her boyfriend,she has been very withdrawn and depressed since she got
fired from her jab. Her boyfriend thinks that she checked into the motel because she was embarrassed to tell him
that she had lost her job.He apparently found some trazodone in her room in blister packs but does not think she
has been prescribed that medication from any of her physicians. It is unknown how much she had taken, but he
stated that she has been taking a tot of Unisom and trazodons because she just wants to sleep.
Upon arrival to the emergency department, she was minimally responsive and only gave one word answers to
some simple questions, She was unable to provide any meaningful history. On laboratory evaluation, she was
noted to have significant abnormalities which included a BUN of 138,creatinine of 7.1 and a sodium of 180.Her
CPK was also minimally elevated at 1785. She was subsequently admitted to the hospital for further treatment
and evaluation.
PATIENT: HARTLAUS,SHELLEY D013: 04/22/1981
MED REC: 001000845 ACCOUNT#, 9577981
ADMIT DATE: 05/18/2014 DISCHARGE DATE:
ATTENDING: Michael F Hilden,MD DICTATING: Michael F Hilden,MD
ROOM: 0328 FAMILY DOCTOR:
CARLISLE REGIONAL MEDICAL CENTER
TRANSFER SUMMARY
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9603521 02:07:52 p.m. 06-06-2014 44/66
PATIEN ARTLAUS, SHELS MED I. 001000645 %DMIT DATE: 05,6014
HOSPITAL COURSE:
1. Major depression:As the patient's metabolic derangements were corrected,she became more awake and
alert; however,she was not very Interactive with the staff. She repeatedly stated that she just wanted to be
left alone.She was refusing to eat or drink.A consultation was placed to Psychology,and the patient was
evaluated by Dr. Klein;he recommended antidepressant medication and psychotherapy. She was started on
Celexa 20 mg daily. Unfortunately,this facility does not have a psychiatrist on staff. Multiple attempts have
been made to have her transferred to a facility where she can receive the necessary psychiatric care. A 302
condition was completed on 05/31/2014 with the hopes that it might expedite her placement.
2. Hypematremia:As mentioned above,the patient's sodium on admission was 180. Her free water deficit was
calculated at approximately 7 L. She was started on IV fluids, not to correct her sodium faster than 0.5 mEq
per hour. Over the course of several days, her sodium was corrected to normal. Unfortunately, she continues
to refuse to drink so she needs to be maintained on D5 half-normal saline at 40 ml-per hour.
3. Polycythemia: The patient's hemoglobin on admission was quite elevated at 19.5.This was secondary to her
severe dehydration.Once her dehydration was corrected, her hemoglobin corrected to 11.9.
4. Mild rhabdomyolysis: It is unknown how long the patient was unresponsive. Her initial CPK was elevated;
however,with IV hydration it did normalize.A myoglobin was checked and found to be less than 27.
S. History of seizure disorder. The patient had an old traumatic brain injury and had been prescribed Keppra 500
mg b.i.d.; although, it is unlikely that she has been compliant with taking that medication. She was monitored
for seizure activity and there was none noted during her admission. She was, however, restarted on Keppra
500 mg b.i.d. On admission,she also had a CT scan of her brain which showed some encephalomalacia in
the right frontal lobe;this was unchanged from a prior CAT scan.There were no acute abnormalities noted.
6. Acute renal failure:As mentioned above, her BUN and creatinine on admission were 138 and 9.7
respectively. She had a renal ultrasound which showed medical renal disease. There was no evidence of
obstruction. Her uric acid level was quite elevated at 21.6 and her phosphorus level was also elevated at 7.
Fortunately, her potassium was within normal range. A consultation was placed to Dr. Harris, and he
recommended conservative treatment. Over the course of her hospitalization, her BUN and creatinine
returned to normal.At the time of this dictation,they were 20 and 1.0 respectively.
7. Urinary tract infection secondary to Escherichia call: Her initial white blood cell count was elevated in the
20,000 range; it did peak to 31,000. She was pancultured, and her urine ultimately grew Escherichia coli. She
was treated with a 3-day course of antibiotics. By the time of discharge, her white count did come down to
9.6.
8. Hypokalemia: Her potassium on admission was normal despite her acute renal failure. Once her renal failure
was corrected,her potassium did trend down; it was as low at 2.7. She received some IV replacement.
Unfortunately, since she was not eating, her potassium remained low despite replacement. Prtor to discharge,
potassium was added to her maintenance IV fluids; this will need to be monitored closely as an outpatient.
PATIENT: HARTLAUS,SHELLEY BOB: 04/22/1961
MED REC: 001000645 ACCOUNT# 9577981
ADMIT DATE: 05/18/2014 DISCHARGE DATE:
ATTENDING: Michael F Hilden,MD DICTATING: Michael F Hilden, MD
ROOM: 0326 FAMILY DOCTOR:
CARLISLE REGIONAL MEDICAL CENTER
TRANSFER SUMMARY
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9603521 02:08:35 p.m. 06-06-2074
® (� 45/66
PATIEN ARTLAUS, SHELL�P MED : 001000645 `ADMIT DATE: 050014
9. Increased liver function tests: The patienrs LFTs were mildly elevated on admission. It was initially thought
that they were probably related to excessive amounts of trazodone. Unfortunately, her LFTs have not trended
down to within normal range. A hepatitis panel was drawn; however, the results are still pending at discharge.
These abnormal labs should not preclude her from her much needed psychiatric care. These can safely be
worked up as an outpatient.
TIME SPENT: I spent over 35 minutes coordinating this discharge.
Michael F Hilden, MD
DD: Sat May 31 18:25:212014
DT: Sat May 3120:25:10 2014
70195511 /41151
CC:
THIS DOCUMENT IS NOT A LEGAL COPY UNLESS SIGNED
PATIENT: HARTLAUB, SHELLEY DOB: 04/22/1961
IVIED REC: 001000645 ACCOUNT#: 9577981
ADMIT DATE: 05/18/2014 DISCHARGE DATE:
ATTENDING: Michael F Hilden, MD DICTATING: Michael F Hilden,MD
ROOM: 0326 FAMILY DOCTOR:
CARLISLE REGIONAL MEDICAL CENTER
TRANSFER SUMMARY
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