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Home My WebLink About06-26-14 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF SHELLEY HARTLAUB, an alleged incapacitated person O.C. No.: 2014-576 PRAECIPE TO ATTACH EXHIBIT TO PETITION FOR ADJUDICATION OF INCAPACITY AND APPOINTMENT OF GUARDIAN TO THE HONORABLE, THE JUDGE OF SAID COURT: Petitioner, Carlisle Regional Medical Center (hereinafter"CRMC"), by and through its counsel, Burns White, LLC, respectfully requests that this Honorable Court accept the June 14, 2014 Psychiatric Evaluation and Capacity Assessment of Shelley Hartlaub as prepared by Mary Kathleen Kush, M.D., board certified psychiatrist, as Exhibit"C"to CRMC's Petition for Adjudication of Incapacity and Appointment of Guardian, filed with this Court on June 13, 2014. A true and correct copy of Dr. Kush's June 14, 2014 Psychiatric Evaluation and Capacity Assessment is attached hereto as Exhibit"A". Respectfully Submitted, B WHIT LLC uart T. O'Nea , , Esquire (89097) Daniel A. Cutler, Esquire (307640) 100 Four Falls, Suite 515 1001 Conshohocken State Road West Conshohocken, PA 19428 Attorneys for Petitioner a � � � Carlisle Regional Medical Center i— � � c� : ca °-:. .—+ �:-� c-� �.�._ �-� �... �-'– ~ � C:" ��, ..� ��,s_ l,r. [� ._. <: :: C':;:. t,f_) ' � CV C .. E .. � 3W�� ;= �-`= �:._ ,, C:.> g.: � (:.`= -�,� Ca i..: � �z � a W � CJ cU IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE OF SHELLEY HARTLAUB, an alleged incapacitated person O.C. No.: 2014-576 CERTIFICATE OF SERVICE I, Daniel A. Cutler, Esquire, hereby certify that on this 25th day of June 2014, I served a true and correct copy of the foregoing Praecipe to Attach Exhibit to Petition for Adjudication of Incapacity and Appointment of Guardian on behalf of Petitioner, Carlisle Regional Medical Center, upon the counsel listed below via electronic mail: Mark F. Bayley, Esquire Bayley & Mangan 17 West South Street Carlisle, PA 17013 Attorney for Shelley Hartlaub BURNS WH TE L C - `------� _ uart 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 � � 77 06-24-14;03;09PM; ;7179603518 # 2/ 5 � � � � CARl,1SL� P$YCH1ATRtC SERVICES Mary Kathleen Kush, tvt.D. Adult Psychiatry 25 State Avenue, Suite.A. ... _.... Garlisie. PA t7073 O�fiGe;(717)243-4257 F�:�i�za3-�z�s Psych�i�tric Evaluatxan and Capacitv �lssessment Hours by appointrnent RE: 5helley Harkt�ub ]�OB:4/22/I9b 1 Date of Ass�ssment: Iu�e 14,2d 14 Inforinants: The patient was un�ble to e�peradve with examination,Information was taken fram:Dr.Tina�ollins,hospitatist;R1V 3ennifer Choat�. Aide VVanda Allenr case manager Lisa Damica and Paul,the patient's live i� boy&iend of l years. Question:Z}oes the patient have the capacity to participate in her medic�I decisiori m�king? Chief Comnlaint:"I�eAVe me alOne" P'resent IlIness: '�'he patieat was fouzzd unresponsive in a matel ydom on May I$,2Q��by police who wexe cantacted by the motel when the patient failed to check ou� She had been z'esidin�i.n ttie motel for abbut a week after unexpectedly leavizzp;her live ir�boyfz�iend Paul. A packet af trazadone was found in the motel room with 4 tablets remaining.ShE was bxought by ambulance to the Cariisle RegionallV�edical Emergeraay Room. Sbe was found by the physiaian there#o be stnporous.Lab was orde�ted and she was found to be sevexely dehydrated with tt�ute renaE failure severe hypernatremia and mxld rhabdomyolys�s.Her toxieology screen was negative. She was felt to ha,ve altered mental status duc to a metabolic encephalopathy and was admitted.A suicide attempt was suspected but hard evidence was Iacking. CwrrentIy,she has been medically stabilized with regard to her�cidney failure and metabolic abnoz�malitics. Staff reports t.hat she lays in her bed day and ni�ht and b�s refused to eat or drink. She wii�not get out of 13ed,will not shower or use th�toilet�She urinates zn t�d and then will tell the nurse"Wet"when someor�e comes in ta check her. She does not call the nursed and refuses to leave her bed to use the toilet. She refuses shqwors and only acCasion�lly daes nat resist a sponge bath. She does not speak to the nwcses for the most part and whex�she does comrrxunicate, it is a or�e ward a.n.gwer. Sl�e keeps her eyes clased aad does not want to open them when spoken to.VVhea asked questions regarctiag her medi+cal care,she stares"I just wac�,t to sleep"or"leave me alone". She wiil not discuss her medical care with Dr.Collins.Nursing raports that after ber admission,her beh�vior vvas more passive in natuxe,but now she is becoming xesistive to care.S3z�refuses to ieave the bed ta be weighed but nursing reports she is visibly losing weight.�1n NG tube was fu3ally placed for life4sustaiaing nourisl�ment as s��is unable or unwilling to care fox tter most basic needs. Her boyfriend Paul was interviewed by phone.The�+have lived together for 7 years and work for the same com�any.�e states her farnily is aot involved in her life, I�e regarts�he hss r�o history of dept�ession and has never been treated for mental health issues to his knowledge.�e reports that she has a seizure disorder from a xemote head injury and is on an arati-seizure msdicatian.He ._.. ......-�--�-----��-------� ___._-_--�-.----.. ... .. ..,...... .._... 06-24-14;03:09PM; ;7179603518 # 3/ 5 � � � desCribes h�r premorbid fianctionkng as "shyyy SI2�"gullible". She tends to believe everything anyone t�ils her and is too trusting. �e reports she was able to hald a ste�d.y job for 29 years until she was fired-in�u1y 101�3 for"stealing time".Appare�tly she did not clack'out in.'a#i.mely manner becaus�she was talking to the supervisor.�Ter boyfriend said the�'irzng was unfair and they had decided to"make�esample"of hex. The company refused her unemployment compensation until it went to a hearing.The patient won as no-one fronn tbe company showed up.An addit�onal stressor£or her�t the rime was takin�care af her mvther who was admitted to a nursing home iri November. In March 2014,the patient was f red fxom another job a#ter 5 days as she was not productive erzough.She was fired again af�er few days at a yet another job. She became withdrawn,was minirnally verbal even with Ixer boyfrieud. She wo;ild szt in a dark room att day. H�r memory and coz�centration deteriox�ated,she stopped wearing makeup azxd stapged her gooming. She be�aa to do things that her boyfriend said did m�ke sensc. �Ier sleep becarine very disturbed and she started taking sleeping pills behind his back because she could nat sleep. Finally she stopped eating and drinking completely. About a week ar so p�ior to her admission, she tpld her boyfriend she was Ieaving hizn because she needed to sleep,wluch was not log�cal to him left her hoyfriead saying she needed to sleep. Paul doss not think the patient had a thought old plan for�eaving his as she then tried to stay with 2 friends who refused her.She then checked herself into the hotel.She apparently got another jvb during this time but was firea y�t again. Paul did not hear from her again until s�ie was found un�`esponsive by the polxce.Paul statas that the patient never expressed that she was depressed and never expressed a wish to commit suicide. She did express to him multiple times that she wanted ta sieep. She coz�tinues to be�hospitAlized at this tzme and r�fuses or is unable to participate in her medical care which is a great eoncer�to her nospitalist, Past Ps�chiatric Historv; none per boy�iriend of seven years.He reparts that she has not ex�erienced maod swings,anger outburst,sp�nding issues or zisk taking in the•time they have been together.There appears to be no history of an eating disorder. Substance Abuse�Iistor�s►: Records shaw that the patient wa5 druiking 5 or 6 beers per day.Her boy&i.end did not cansider her to h�ve a drinking problem althpugh Lhere were a few episades of heavy drinking over the iast months.�'aul said this was nvt typical of her FamiFv HistorY; Unknovvn Madical�Iistorv: Has a.history of head trauma and has a seizure disorder for wtzich she takes Kep�ra. Was admittsd for observation a#Carlisle Rcg"i.onal Medicat Center in February 2014, apparentty for altered mental status.I�er curre�t RN also cared fox�er�t#hat tim�and reports sh�was able to hold a cor►versation,was eaiing and w�s able to care#'ox her needs.Current medical status is described above i�Fresent Illness, Current Medi ions:.Citalopram 20 mg daily started S/2912014,Keppra�00 mg twice a day for seizures,omegrazol�4Q rxtg daily,metro�id�zole cream started an 6II?.l"L014 fvr facial Iash and Heparin SQ00 mg SQ q$h for prevention of tt�rombosis. 06-24-14;03:49PM; ;7179603518 # 4/ 5 � � � � � Sacial History: �Ias lived with hoyfriend Pau1 for seven ye.�rs in a jointly awned trailer.Het family does not seem to be involved.She does�ot smok� Mental status Exam: ?he patient was lying motionless in her hospital bed with a blanket over h�r f�ce. She did not cooperate with the exain,saying"Leave rne alone"w1n�n a question was asked.�pulled the blanket from her face�.nd observed th�t she appeared to be about her stated age.Her hair was oily and unbrushed and there was a red rash on her face.Her eyes remaiaed ciosed, Wzth rninimum morion, she pnlied the blanlcet back over her face and sait3.lauder"Leave me alone," . � whi�h she repeated several times in a perseverative way.Nursing repozts that she tends to be imrnobile and mute aithough thexe may b�a day when is wilt respond wi�th tt short sentence lackin�content.Nursing reports she resists attempts to move parts vf her body althou�h she wil� roll a�er to ailow changing of her diaper.Today she was t'esistive to a sponge bath and has refused food or arir►k. She did not appeaz to be responding to unseen stimuli.Insight into her issues appeared to be completely absent.Judgment is severely impaired to the point she is unable to care for hex basic needs. Assessment:Pat�ent is in a severe major depressive episode following a series of significant stressors.�t is un3ikely that her boyfrie�td.reeognized the onset of her depression but by history, she did demonstrate that she me#the criteria�fQr A severe ma}ax d�ressive egisode with anhedonia,insomnia,decreased�ppetit�,decreased memvry,decreased attention and focus an:d possib�y demonstrated some evidence of psychosis in her history of peculiax beh�.vior. She is demonstrating catatonia with marked m�otor disturbance,negativism,and mutism. She lacks the cmgacity to make medical decisions invalving her care and like�y will die of malnutrition wxthout intexvention. She is nnable to express a ehoice ixt her care,and does not iisten to or understand presented information involving hex care. She is unabie to appreciate the gravity of her situation �nd tbe Iikelihood that her behaviors wi1�leac3 to her in,�wr�y or death. Sh�lacks the capacity td participate in medical decision making in hex own behatf. �ychietric�piasmosis: ,A�cis I:Majox Dcpressive Disorder, First Episode, Severe,with Cc�tato�ic and psychotia�eatures Alcohal Abuse Axis II: defened A,xis IY.T: Seazure T�isordex,Malautritiari, S/P severm dehydration with metabolic encephstlopathy Axxs N: Severe stressors AXIS V; G��.F=S • Recommendatians:I reco�runend that Carlisle Regional Medical Center pursue a com,petency hearin�. Tf she is jud�ed incompetent.wo�Id need to have the coeuts appaiat a guardian£or rnediCal decisioz�makiug. Her needs wottld be be5t met by transferring her to anotIzer medical faeility, At this po�nt,she is unable to care for hex basic needs and an inpa�ient psychiatry unit wauld not have the xesources ta provi�de for her basic care.I woutd suggest that she be transferreti to tl�e medicat unit of a hqspita�which has a psychiatiic consultation li�ison service to follow her psychiatricatly. When she improves, she could be transferred in house to the xztpaticnt psychiatric�i.t. Catatoaia is fiequently treated by ECT although�do not knflw if this is an optian since she is on Keppra. Benzodiapines can also successfully treat catatonia�nd I would 06-24-14;03;09PM; ;7179603518 # 5/ 5 . • � � su��est a trial of Benzodiapines immediately.The protocol is 2 mg IoraxCpazn every 3 hours far 3 doses to see if hex cataton�a will respand. GYta�opram should be aontinued. I recammend that both atypiaal and typical antipsychotics be avoided as they have the pot�ntial to worsen catatonia. I also recommend thttt the Access card be pursued a�gressiveiy so�s to facilitate transfer fio another haspital.I ttave discussed my recommenc�ations with hospitalist Dr.Tina Collins. Mary Kathleen Kush,MD r-yf� �''��.-�,�-A'h-' ��,� � � �� BoArd aertified psychiatrist Juz�e I4,2bI4