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Home My WebLink About06-18-14 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF SHELLEY HARTLAUB, � � ..,� �, an alleged incapacitated person �� ° ��7 � O.C. No.: 2014-576 �`'' �� _ `�'- �' � i :-_ c� � -� ;� . - T--- � : +`� W �..f EMERGENCY PETITION FOR ADJUDICATION OF INCAP�CI'�'Y-v ' AND APPOINTMENT OF GUARDIAN y _ � � -'' . �:,, �, _ �; _ , _y r�. �'� TO THE HONORABLE, THE JUDGE OF SAID COURT: .�- f-� ��> � cr� �� 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 Apri122, 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 and two (2) sisters. Their addresses are as follows: Sylvia Mae Hartlaub (Mother) Elmcroft Assisted Living 153 Logan Drive, Suite 107 Dillsburg, PA 17019 (Currently at Golden Living Rehab Center following a diabetic coma and bad fall in April 2014) 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 and constitutes a medical emergency. 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 guardianship of the person and estate to facilitate the making of decisions regarding her continuing health care decisions. 10. Specifically, Ms. Hartlaub 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. See, June 5, 2014 Progress Note of Ruchi Dach, M.D., attached hereto as Exhibit "B." I 1. It is the opinion of Ms. Hartlaub's treating physicians, Christina E. Collins, M.D. and Michael F. 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 on an emergent basis to manage and handle all aspects of Ms. Hartlaub's health care decisions. 16. The proposed guardian of the person and estate is Keystone Guardianship Services, 115 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 $11,000.00, 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 l, 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. 2l. 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. WHEREFORE, Petitioner, Carlisle Regional Medical Center, respectfully requests that this Court issue a Citation on an emergent basis, directed to the alleged incapacitated person, Shelley Hartlaub, and to such other persons as this Honorable Court may direct, to show cause why sh� should not be adjudged fully incapacitated and why Keystone Guardianship Services should not be appointed guardian of her person and estate. Respectfully Submitted, BURNS W TE L art T. O'Neal, III, 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 I,Michael F. Hilden,M.D., verify that I am authorized to sign on behalf of tlie Petidoner in the within petition,and that the facts contained in the foregoing Peritian true and comect to the best of my know(edge, information and belief; and that this verification is subject to the penalties of 18 Pa C.S.A. Section 4904, relating to unsworn falsification to authorities. --r�JJ/ Date: June 10,2014 Michael F. Hilden, .D. CONSENT TO SERVE AS GUARDIAN Keystone Guardianship Services, a non-profit corporation (ocated at 115 W. Broad Street, Elizabethville,PA 17023, having been apprised of the matter of an alleged incapacitated person, dces hereby consent to serve as(limited/plenary)guardian of the estate/person of Shetley Hartlaub, should the Court determine that the appointment of a guardian is appropriate. � onstance E.Stoneroad � President and Secretary, Keystone Guardianship Services EXHIBIT "A" 960352 1 02:07:19 p.m. 06-06-2014 43/66 PATIENI!�iARTLAU6,SHEI� MED I�: 001000645 ; �ADMIT DATE: 0�014 DA7E OF ADMISSION: 05N812014 DATE OF DISCHARGE: DISCHARGE DIAONOSES: Majw�depression. Hypematremia secondary to no orai intake. Polycythemia secandary to severe dehydration. Miid rhabdomyolysis. History of seizure disorder. Metabofic encephalopaihy. Acute renal failure,preronal in origin. Questionable trazodone overdose. Urinary tract iMectlon secondary to Escherichia coli. Hypokalemia Severe malnutrition. DISCHAROE DISPOSITION: Mrs.Hartlaub is being fransferred to an acute inpatieM psychiaVic hospital for further psychiatric care.Her condition was stabte.She was discharged on a regular diet and was to resume activities as tolerated. DISCHARGE MEOICATiON3: 1. Keppra 500 mg b.i.d. 2. Multivitamin 1 daiiy. 3. Celexa 20 mg daHy. 4. Subcutaneous hepa�in 5000 units q.8 hours while immobile. 5. D5 haN normal saltne 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 iemale who was brought to the emergency depa►tment on O�h 8/2014 by EM3 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 chedc out as scheduled on Sunday aftemoon,the stafl at the hotel called the police.The poiice entered the�oom and found he� unresponsive on her bed.According to her boyfiiend,she haa been very withdrawn and depressed since she got fired from her job. Her boyMend lhinks that she checked into the motei because she was embarrassed to tell him that she had tost her job.He apparently found some trazodone in her room in blister packs but does not think she has been presaibed that medication from any of her physiaans. It is unknown how much she had taken, but he stated that she has been taking a lot of Unisom and Vazodone because she just wants to sleep. Upon arrnral to the emergency depa�tment.she was minimaly responsive and only gave one woni answera to some simple questions. She was unable to provide any meaningful history. On laboratory evaluation, she was noled ta have signiflcant abnormalities which included a BUN oi 138,crestinine of 7.1 and a sodium oi 180. Her CPK waa also minimally elevated at 1765. She was subsequently admitted to the hospital for further treatment and evaluation. PATIENT: HARTLAUB, SHELLEY DOB: 04/22/1981 MED REC: 001000645 ACCOUNT�: 9577981 ADMIT DATE: 05/18/2014 Di3CHARGE DATE: ATTENDING: Michael F Hilden, MD DICTATING: Michael F Hilden, MD ROOM: 03Z8 FAMILY OOCTOR: CARLI9LE REGIONAL MEDICAL CENTER TRANSFER SUMMARY Page t of 3 9603521 02:07:52 p.m. 06-06-2014 44 J66 PATIEN�ARTLAUB,SHE� MED � 001000845 �DMR DATE: O�Ot4 � HOSPITAL COURSE: t. Majcr depression:As the patlenYs metabolic derangements were coRected.she became more awake and aler�however,she was not very interactive with the stafL She repeatedly stafied that she just wanted to be IeR ato�e.She was reiusing to eat or drink.A cansultaUon was placed to Psychology�and the paatient was evaluated by Dr.Klein; he recommended antMepresaant medicatb�and psychotherapy.She was started o� Celexa 20 mg daily.Unio�tunately,this faciliiy doea not have a psychiatrist on staA.Multiple attempb have been made to have her transfemed to a faalily where she can receive the necessary psychiattic care. A 302 condiHon was completed on 05/31/2014 with the hopes that it might expedite her placement. 2. Hypematremia:As mentioned above.the patient's svdium on admission was 180. Her iree water deficit was calculated at approximately 7 l.She was started on{V fluids,not to correct her sodium faster than 0.5 mEq peir hour.Ove�the course of several days,her sodium was oo�rected to normal.UnfoRunately,she continuea to refuse to d�ink so shs needs to be mafntained on D5 half-nortnal saGne at 40 mL per hour. 3. Polycythemia:The patlenrs hemoglobin cn admission was quite elevated at 19.5.This was secondary to he� severe dehydraHon.Once her dehydration was corrected,her hemoglobin corrected ta 11.9. 4. Mild rhabdomyolysis:!t fs unknown how fong the patieM waa unresponsive.Her in�iai CPK waa elevated; hrnnre�rer,with iV hydratlon it did nonnalize.A myoglobi�was chedced and found to be less than 2T. 5. Histcry of seizure disorder:Tfie patient had an old trsumatic brain injury and had been prescribed Keppra 500 mg b.i.d.;although,it is unlikely that she has been c�mpliant with taking that medication.She was monitored fof seizure activiiy and there was none noted du�ing her admission.She was. however, restaRed on Keppra 500 mg b.i.d.On admission.she also had a CT scan of he�brain which showed some encephalomalacia in the right frontal tobe;this was unchanged from a prior CAT scan.There were no acute abnoRnalitles noted. 6. Acute renal isilure:Aa mentioned above.her BUN and creat�nine on admission were 138 and 9.7 respecdvely. She had a renaf ultrasound which sho�wed medical renal disease.There was no evidence of obstructton. Her uric acid level was quite elevated at 21.8 and her phosphorus level was also elevated at T. Fortunately,her potassium was within nortnal range.A consultaUon was placed to Dr.Harris, and he rec:ommended conservative treatment.Over the course of her hospitalization�he�BUN and cresUnine retumed to noRnal.At the time of this dictation,they were 20 and 1.0 respecWely. 7. U�inary tract infection secondary to Esche�ichia coli: Her initial white blood cell count was elevated in the 20,000 range; it did peak to 31,000. She waa pancuttured,and her urine ulUmately g�ew Escherichia coli. She was treated with a 3-day course of antibioHcs. By the time of discharge.her white count did come dow�to 9.6. 8. Hypokalemia: Her potassium on admissicn was nortnal despite her acute renal iailu�s.Once her rena!failure was corrected,her potessium did trend down; it was as low at 2.7.She received some IV replacement Unfortunately,since she was not eating�he�potassium remained 1ow despite�eplacement. Prfor to discharge, potasslum was added to her maintenance iV fluids;this wiil need to be mo�ito�ed closely as an outpatient. PATIENT: HARTLAUB, SHELLEY DOB: 04/22h 961 MED REC: 001000645 ACCOUNT#: 9577981 ADMIT DATE: 05/18/2014 DISCHAR�3E DATE: ATTENOlNG: Michasl F Hilden,MD DICTATINO: Michaei F Hilden, MD ROOM: 0326 FAMILY DOCTOR: CARLI3LE REGIONAL MEDICAL CENTER TRANSFER SUMMARY Page 2 of 3 9603521 02:08:35 p.m. 06-06-2014 45/66 PATIEN�ARTLAUB.SHEL� MED t�C: 001000845 ''�ADMIT OATE: 0�014 9. Increased liver iunction tests:The paUenrs LFTs were mifdly elevated on admissbn. It was ini�ally thought that they were probably�elated to excessive amounts of trazodone. Unfortunately, het LFTs have not trended down to within nortnal rangs.A hepatitis panel was drawn;however,the results are still pe�ding at discharge. These abnoRnal la6s should not predude her from her much needed psychiatric care.These can safely be worked up as an outpatient TlME SPENT: I spent over 35 minutes coordinating this discharge. Michael F Hilden, MO D0: Sat May 31 18:25:21 2014 DT: Sat May 31 20:25:10 2014 70195511 /41151 CC: THIS DOCUMENT IS NOT A LEGAL COPY UNLESS SiGNED PATfENT: HARTLAUB� SHELLEY DOB: 04/22/1961 MED REC: 001000645 ACCOUNT�: 9577981 ADMI'F DATE: 05/18/2014 DISCHARGE DATE: A'RENDING: Michael F Hilden, MD DICTATiNO: Michael F Hiiden,MO ROOM: 0326 �AMILY DOCTOR: CARLI3LE REGIONAL N�D{CAL CENTER TRANSFER SUMMARY Page 3 of 3 EXHIBIT "B" 9603521 01:51:44 p.m. 06-06-�014 4/66 � � � � � PROGRFSS NOTE: Date/Time �f�1'�( . �i��. �,� �t� '�� _ ^ L�;l( 1 b `E a 1ti�. `,��v�,�.� � -to��a�S •`I�lt� e, , . . ¢ f IM y �i tl�s G► '�S� •`�W(ir.N�'N't��w�,� �0 3 � e 3eZ. � , 1'�- t � , �Vlc N, �K tt. � -t'o ?-o I USS c.�- !t-+r'. , �w..9�.Q r.,�.��---t,-1 �'�, � � �t 't ^^wb .� -e��.�,.�. 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