HomeMy WebLinkAbout05-1933SHIPPENSBURG/ IN THE COURT OF COMMON PLEAS (
SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNSYLV
Plaintiff,
V. NO. 2005- Jr'"'?' CIVIL ACTION
SHARON KIRBY, individually and
as attorney-in-fact of CIVIL ACTION-LAW
Lawrence Perry
Defendant.
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in
t e
following pages, you must take action within twenty (20) days after this complaint and no e are
served, by entering a written appearance personally or by an attorney and filing in writing ith
the court, your defenses or objections to the claims set forth against you. You are warned at if
you fail to do so, the case may proceed without you and a judgment may be entered against you
by the court without further notice for any money claimed in the complaint or for any othe claim
or relief requested by the plaintiff. You may lose money or property or other rights importa nt to
you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU ]
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMA
ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE Al
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER
LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 17013
(717) 249-3166
SHIPPENSBURG/ IN THE COURT OF COMMON PLEAS (
SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNSYLV
Plaintiff,
V. NO. 2005- 1133 CIVIL ACTION
SHARON KIRBY, individually and
as attorney-in-fact of CIVIL ACTION-LAW
Lawrence Perry
Defendant.
COMPLAINT
NOW, comes Plaintiff, Shippensburg/South Hampton Manor, L.P., ("Shippensburg
Health Care"), by and through its attorneys, O'BRIEN, BARIC & SCHERER, and files
within Complaint and, in support thereof, sets forth the following:
ShippensburglSouth Hampton Manor, L.P. is a Maryland limited partnership
authorized to conduct business in the Commonwealth of Pennsylvania.
2. ShippensburglSouth Hampton Manor, L.P., owns and operates a skilled
facility ("facility") located at 121 Walnut Bottom Road, Shippensburg, Cumberland County,
Pennsylvania 17257
3. Defendant, Sharon Kirby, is an adult individual with a residence address of
Lindsay Lot Road, Shippensburg, Franklin County, Pennsylvania 17257.
4. On or about June 13, 1996, Lawrence Perry executed a certain General Durable
Power of Attorney naming his daughter, Sharon Kirby, as his attorney-in-fact. A true and
copy of the General Durable Power of Attorney is attached hereto as Exhibit "A" and is
incorporated by reference.
Upon information and belief the General Durable Power of Attorney was not
rescinded by Lawrence Perry from the date of execution to the date of his death.
6. On or about December 21, 2004, Sharon Kirby sought to have Lawrence
admitted to the facility.
On or about December 21, 2004, Sharon Kirby, as the attorney-in-fact for
Lawrence Perry, executed an Admission Agreement for Lawrence Perry to enter the facility. A
true and correct copy of the Admission Agreement is attached hereto as Exhibit "B" and is
incorporated by reference. The Admission Agreement was executed by Sharon Kirby at
facility.
On or about December 21, 2004, Lawrence Perry became a resident of the
9. Lawrence Perry remained a resident of the facility from December 21, 2004
through February 11, 2005.
10. Lawrence Perry passed away on February 21, 2005.
11. As of February 11, 2005, there existed an outstanding balance of $5,139.00
for the costs of care provided to Lawrence Perry by Shippensburg Health Care.
12, A true and correct statement of the amount due and owing as of February 11,
is attached hereto as Exhibit "C" and is incorporated by reference.
13. On or about March 26, 2005, Sharon Kirby, made a partial payment against the
debt in the amount of $1,377.00 leaving a balance due of $3,762.00.
14. Demand has been made upon the Defendant to pay the amount due and owing.
15. The Admission Agreement provides, in relevant part, as follows:
"If you or your representative do not pay the money you owe us and we hire a
collection agency or attorney, you agree to be liable for their fees and court co
COUNT I-BREACH OF CONTRACT
SHIPPENSBURG HEALTH CARE v. SHARON KIRBY and
THE ESTATE OF LAWRENCE PERRY
16. Plaintiff incorporates by reference paragraphs one through fifteen as though set
forth at length.
17. All conditions precedent to recovery under the Admission Agreement have
fulfilled.
18. Sharon Kirby was obligated to pay the amount due and owing for the costs
Lawrence Perry's care at the facility from the assets and funds of Lawrence Perry.
19. Sharon Kirby has breached the Admission Agreement by failing to pay for
costs of care which accrued while Lawrence Perry was a resident of the facility.
20. The Admission Agreement provides for the imposition of late charges of five
(5%) of the amount due commencing thirty (30) days after the end of the applicable billing
period which was March 1, 2005. The per diem rate commencing April 1, 2005 is $.5 1.
21. Late charges to April 15, 2005 are $7.65.
22. Lawrence Perry was obligated to pay for the costs of his care as provided by
Shippensburg Health Care pursuant to the Admission Agreement.
23. Lawrence Perry breached the Admission Agreement by failing to pay for the
of his care.
WHEREFORE, Plaintiff requests judgment in its favor and against Defendants
follows:
a. the sum of $3,762.00;
b. late charges to the date of award;
C. attorney fees, costs and expenses and
d. such other relief as is deemed just and proper all in an amount not
excess of the limits requiring compulsory arbitration.
Respectfully submitted,
O'BRIEN, BARIC & SCHE I
Y [? ? 4
David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Attorney for Plaintiff
d a b.d i r/shcc/perry/com pla int. pld
GENERAL DURABLE POWER OF ATTORNEY
ARTICLE I. DECLARATIONS
I, LAWRENCE P. PERRY, residing at 1440 Mainsville Road, Shippensburg, S uthampton
Township, Cumberland County, Pennsylvania, 17257, appoint my daughter, S N KAY
KIRBY, to be my true and lawful attorney with full power to carry out those acts s ecified in
accordance with any limitations imposed herein. In the event that she be unwilling or ble to act
as my said attorney, I appoint MARJORIE MARIE WEAVER as my attorney-in-fact to e my true
and lawful attorneys with full power to carry out those acts specified in accordanc with any
limitations imposed herein.
In exercising the powers granted hereunder, my attorney-in-fact may act severally and
This power-of-attorney shall take effect upon its execution and shall remain in effect until y death
unless revoked by notice to my attorney-in-fact. This power of attorney shall remain in of ct in the
event of my subsequent disability or incapacity.
In the event I revoke this instrument, any third party acting on the authority of the instru ent, and
without knowledge of the revocation, shall not be held accountable for any loss to me, m estate,
heirs, successors or assigns.
In the event an action is brought by any party in a court of competent jurisdiction for appointment
of a guardian of my estate, and such action is not dismissed by the court due to my executio of this
instrument, I nominate my attorney-in-fact to serve as guardian of my estate, unless such act on was
brought as a result of allegation that my attorney-in-fact has acted contrary to the instructions herein,
or my best interests, and such allegation is found to be warranted by the court.
My attomey-in-fact shall serve without compensation.
In the event that my attorney-in-fact, or a successor, is unable or unwilling to continue ?n that
capacity, the attorney-in-fact shall be empowered to appoint a successor or successors. I
ARTICLE IL POWERS GRANTED RELATED TO FINANCIAL MATTERS
The following powers are granted to my attorney to be used for my benefit and on my beh?If in
accordance with the directions specified herein.
As to my assets, real or personal, standing in my name, held for my benefit or acquired for my
I confer the following powers upon my attorney-in-fact:
I. As to any commercial, checking, savings, savings and loan, money market, Treasury
mutual fund accounts, safe deposit boxes, in my name or opened for my benefit -- to open,
EXHIBIT "A"
withdraw, deposit into, close, and to negotiate, endorse or transfer any instrument affeting those
accounts.
2. As to any promissory note receivable, secured or unsecured, or any accounts recer able -- to
collect on, compromise, endorse, borrow against, hypothecate, release and reconvey th note and
any related deed of trust.
3. As to any shares of stock, bonds, or any documents or instruments defined as sec ies under
law -- to open accounts with stock brokers (on cash or margin), buy, sell, endorse transfer,
hypothecate and borrow against.
4. As to any real property, now or hereafter owned by me, specifically including, but n t limited
to, my real estate know as 1440 Mainsville Road, Sbippensburg, Southampton Township, Franklin
County, Pennsylvania -- to collect rents, disburse funds, keep in repairs, hire professional property
managers, lease to tenants, negotiate and renegotiate leases, borrow against, renew any loan, sign any
documents required for any such transaction, and to buy or sell, without need for pr or court
approval.
5. To hire and pay from my funds for counsel and services of professional advisors,
dentists, accountants, attorneys and investment counselors.
6. As to my income taxes and other taxes -- to sign my name, hire preparers and advilors and
pay for their services from my funds, and to do whatever is necessary to protect my ass s from
assessments as though I did those acts myself,
7. To apply for public benefits or benefits from any pension or insurance plan or policy public
or private, to which I might be entitled, and in connection with any such plan or policy, to xecute
options under, borrow against, cancel, surrender for cash value, or change beneficiaries.
8. To prosecute and defend legal actions.
9. To arrange for transportation and travel.
10. To partition property to create separate property for me.
11. To disclaim or release any powers or interests which I may have in any property.
12. To manage tangible personal property, including but not limited to, moving, storing,
donating, or otherwise disposing of said property.
13. To borrow money for me if that appears to be prudent, and in connection with any such
transaction, to pledge any personal property for security as may be necessary.
14. To create one or more trusts for my benefit and to contribute to such trusts and
income and/or principal from such trusts in accordance with their terms.
IS. To represent me in any and all matters requiring my approval and consent in conn ction with
or arising out of my interest in any trust of which I am the settlor or beneficiary, and to xercise at
any time and from time to time any power which I now or may hereafter have with res ect to any
such trust, including any power to make withdrawals therefrom and any power to alter amend or
revoke, in whole or in part, the same.
16. To renounce or resign any fiduciary position to which I have been appointed or in hich I am
serving, including, both without limitation, any position as an executor, administrato , trustee,
guardian, attorney-in-fact or officer or director of a corporation, and in connection ith such
resignation, to file an accounting with a court of competent jurisdiction or agree to settleme t by way
of receipt and release or such other informal method as my attorney shall deem advisabl .
17. To make limited gifts, in accordance with the provisions of Pennsylvania law (20 Pa.C.S.
5603), except that the class of permissible donees may include religious or charitable org izations
where I have established a pattern of giving.
ARTICLE 111. POWERS GRANTED RELATED TO HEALTH CARE
As to decisions related to my health care, I hereby grant the following powers to my attorn e within
the limitations specified.
I . To have full access to all of my medical records and to authorize or withhold authc
for medical and surgical procedures which my attorney judges to be in my best interest, after
consultation.
2. To authorize my admission to a medical, nursing, residential or similar facility and t enter
into agreements for my care, whether at home or in such facility, with appropriate medical pro iders.
3. To arrange for my discharge, transfer from, or change in type of care provided.
4. To arrange and pay for consultation, diagnosis or assessment as may be required r my
proper care and treatment.
IN WITNESS WHEREOF, I hereby sign my name to this Power-of-Attorney
this `S "day of?x 1996.
Witnesses:
Z?IJ_441, CV
LAWRENCE P. PERRY
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
On this, the /'P day of , 1996 before me,
Public in and for said County and State, the on ersigned officer, personally appeared Lai
Perry, known to me (or satisfactorily proven) to be the person whose name is subscribed to t
Power-of-Attorney, and acknowledged that he executed the same for the purposes therein c
SS.
IN WITNESS WHEREOF, I hereunto set my hand and official seat..
44?iL(ilc
Notary Public
Notarial Seal
Rhonda R. Wollord, Notary Public
Shlppensbu g Bo o, Cumbe a xi County
iviy Commisslon gre s,lan. 2Q 1 g
Notary
-nee P.
within
HEALTH CARE CENTER
121 Walnut Bottom Road
Shippensburg, Pennsylvania
17257-9005
(717)
FAX (717)
TTY 1-800
ADMISSION AGREEMENT
This Agreement is between Shippensburg Health Care Center (the "Facility" or "we" and)
L,b?Etat& Q pd (the "Resident" or "you") and, if you or the court ave
designated an individual to act on your behalf, or there is another individual to act on our
behalf, or operation of law, Wu U J (? R8 ( ("your representative"). A
checklist of the rights and responsibilities applicable to your representative is listed in Exhi t I
and is incorporated into this Agreement.
Paying for Your Care
if you are applying to this facility as a private-pay resident, you must provide all
information requested by us. If we later find that the information you or your repri
provided was incomplete or inaccurate; we-will consider that as a breach of this A
which gives us the right to pursue all legal remedies against you or your representative.
Who Can Be Required to Pay for Your Care
Only you and your insurer can be required to pay for your care. No other person, (i.e. a fan
member, friend, neighbor, legal representative or guardian) can be required to pay from tl
own funds for your care, although he or she may knowingly and voluntarily agree to guaran
payment for the cost of your care. We require the person responsible for making payments
your behalf to pay for your care under the terms of this contract in a timely manner.
If you are a beneficiary of Medicare, Medicaid or any other third-party payment plan,
representative agrees to make all necessary payments from your funds. Your represent;
could face a civil penalty for intentionally failing to pay required amounts from your funds
could face a criminal penalty for abusing your funds.
Private Pay Residents
The items and services included in our daily rate is basic room, board and general nursing care
required by your medical condition. Payment for items and services that are included in
daily rate and is payable one month in advance and due on the first of each month. Items z
services included in your daily rate are listed in Exhibit 2.A.
You will be charged separately for additional items and services not included in our daily rate
such as special nursing care, special equipment, pharmacy charges, laboratory charges, medical
transportation and additional services such as telephone expense, dry cleaning, beauty and barber
services and newspapers. Items and services for which you will be charged are listed in Exhibit
2.13. Payment for these additional items and services are due after you have requested them, and,
you have received and have been billed for them. Within 30 days of receiving an item or service,
EXHIBIT "B"
If you or your representative do not pay the money you owe us and we hire a collection
or attorney, you agree to be liable for their fees and court costs.
Private Duty Nurses Geriatric Aides
If you want a private duty nurse or a private duty geriatric aide, you are responsible for Selo
a person licensed and/or certified according to Pennsylvania laws and regulations. You are
responsible for paying him or her and for letting us know that you have hired one. The pt
you hire is not an employee or agent of the facility, but he or she must meet our standards
follow our policies and procedures. Employees of the Facility may not serve as private
nurses or private duty geriatric aides.
Ifloldine Your Bed if You Leave the Facility
If you are hospitalized or on leave from the Facility, we will hold your bed for you as follows:
A. If you are private-pay resident, or are receiving inpatient care reimbursed under Medic
Program (and you are,not covered under Medicaid), unless you notify us otherwise,
will hold your hed for as long as you pay for it at the daily rate you are currently be
charged.
1 4;
B. If Medicaid pays for part or all of your nursing home care and you need to i
hospitalized, we will hold your bed for up to the maximum number of days required t
this state, currently 15 days. If you leave for any other reason, we will hold your bed fc
up to the maximum number of days required by this state, currently 18 days. You have
right to be readmitted to the facility to the first available appropriate bed. While we a
holding your bed, you are still required to pay the Facility any amount for which you ai
liable as determined by the Medicaid Program.
C. If you have applied for Medicaid, your bed will be reserved in accordance with Parag
B. However, if you are found to be ineligible for Medicaid, thckYou are required to
for the bed as ayrivate pay resident as described in Paragraph A.
D. Other third-party payers may or may not have a bed hold policy. We will discuss this
applies to you.
Your RithtAoMake CQ_=laints and Sneeest_Chanees in Policies and Services
As a nursing home resident, you have many rights according to State and Federal law. These
described in detail in Exhibit 6, which is attached and is part of this Contract.
You may make complaints about your care in the Facility and you may also suggest changes in
the policies and services of the Facility. You will not be harassed or discriminated against for
making a complaint or suggesting a change in a policy or service. You may present your
complaints to facility, management company or to one of the following State agencies:
If you or your representative do not pay the money you owe us and we hire a collection
or attorney, you agree to be liable for their fees and court costs.
Private Duty Nurses Geriatric Aides
If you want a private duty nurse or a private duty geriatric aide, you are responsible for sele
a person licensed and/or certified according to Pennsylvania laws and regulations. You are
responsible for paying him or her and for letting us know that you have hired one. The pe
you hire is not an employee or agent of the facility, but he or she must meet our standard,,
follow our policies and procedures. Employees of the Facility may not serve as private
nurses or private duty geriatric aides.
Holding Your Bed if You Leave the Facility
If you are hospitalized or on leave from the Facility, we will hold your bed for you as follows:
A.
also
and
If you are private-pay resident, or are receiving inpatient care reimbursed under Medi are
Program (and you are not covered under Medicaid), unless you notify us otherwise, we
will hold your bed for as long as you pay for it at the daily rate you are currently b ing
charged.
B. If Medicaid pays for part or all of your nursing home care and you need to be
hospitalized, we will hold your bed for up to the maximum number of days required by
this state, currently 15 days. If you leave for any other reason, we will hold your bed or
up to the maximum number of days required by this state, currently 18 days. You hay a
right to be readmitted to the facility to the first available appropriate bed. While we re
holding your bed, you are still required to pay the Facility any amount for which you re
liable as determined by the Medicaid Program.
C. If you have applied for Medicaid, your bed will be reserved in accordance with Parag:
B. However, if you are found to be ineligible for Medicaid, then you are required to
for the bed as a private pay resident as described in Paragraph A.
D. Other third-party payers may or may not have a bed hold policy. We will discuss this It
applies to you.
Your Right to Make Complaints and Suggest Changes in Policies and Services
As a nursing home resident, you have many rights according to State and Federal law. These
described in detail in Exhibit 6, which is attached and is part of this Contract.
You may make complaints about your care in the Facility and you may also suggest changes
the policies and services of the Facility. You will not be harassed or discriminated against 1
making a complaint or suggesting a change in a policy or service. You may present yc
complaints to facility, management company or to one of the following State agencies:
Larry D. Cottle, LNHA
Administrator
Shippensburg Health Care Center
121 Walnut Bottom Road
Shippensburg, PA 17257
717-530-8300
Ombudsman
Office of Aging
16 West High Street
Carlisle, PA 17013
717-240-6110
717-532-7286 Ext. 6110
Peter E. Perini, Sr.
President
Magnolia Management, Inc.
1710 Underpass Way
Hagerstown, MD 21740
301-745-8700
Department of Health
100 North Cameron Street
2nd Floor
Harrisburg, PA 17101
717-783-3790
Your Right to Make Decisions
You have the right to make your own medical decisions and to manage your personal affairs.
you become disabled, it may be necessary for someone else to make decisions for you. For
reason, we recommend that you have a living will and/or advance directive for medical decisi
and a financial Power of Attorney but you are not required to do so. See Exhibit 7 fc
description of your legal rights to decide about your future medical treatment.
Transfer, Relocation and Discharge
You have the right to remain here, and you may not be transferred, relocated or disch
against your will, except for the following reasons: (1) A medical reason (i.e. the facility c
provide the kind of care that you need, your condition has improved so that you no longer
the care we provide, or a medical emergency arises; (2) Your welfare or the welfare of
residents or staff, (3) Nonpayment for a stay, or (4) the Facility ceases to operate.
If we decide that you should be transferred or discharged, we will notify you, and an imm
family member or legal representative, by letter 30 days in advance. If you are trans
because of an emergency situation, we will provide the required notice as soon as practi
The letter will contain the reasons for the transfer or discharge and its effective date. The
will also tell you how you can appeal our decision to transfer or discharge you.
If you are discharged involuntarily, we will attempt to make other appropriate arrangements
your care. However, if other arrangements are not available, your representative agrees to ac(
you into his or her custody if it is medically appropriate.
Your Right to End This Contract
If you decide to end this Contract and leave the Facility, you must pay your bill before you le
You must give us five (5) days written notice to terminate this contract. If you leave before
end of that time, you must still pay for each day of the required notice.
If
a
In the event you die while a resident of the facility, your representative is responsible for king
the funeral arrangements. We will notify your representative immediately. If we are una le to
reach your representative, we will contact the funeral home of your choice to fac litate
arrangements.
Additional Documents
It is not possible to cover everything that is important to your stay in our Facility in the r
this Contract. Therefore, we have included additional important documents as Exhibits.
Exhibits are part of this Contract. Please verify that you received the Exhibits and t
contents of the Exhibits were explained to you by placing your initials on the line next
description of each Exhibit.
Exhibit I. Rights and Obligations of Representatives.
Exhibit 2. For Private Pay Residents:
(a) Items and services covered by daily rate.
(b) Items and services not covered by daily rate.
X Exhibit 3. How to Apply For and Use Medicare and Medicaid Benefits.
Exhibit 4. (a) Items and Services Covered by Medicaid.
(c) Items and Services Not Covered by Medicaid.
Exhibit 5. Physicians Who Practice at the Facility.
Exhibit 6. Legal Rights of Pennsylvania to Decide Future Medical Treatment.
?X Exhibit 7. Policies and Procedures Concerning Your Personal Funds and Your
Personal Property.
Exhibit 8. Services Provided by Outside Health Care Providers.
Chanees in Law
Any provision of this Contract that is found to be invalid or unenforceable as a result of a cha
in State or Federal law will not invalidate the remaining provisions of this Contract. If there
services we have agreed to provide that are later found to be impossible to render as a result c
change in State or Federal law, it is agreed that to the extent possible, the Resident and
Facility will continue to fulfill our respective obligations under this Contract consistent with
law.
of
the
the
IN WITNESS WHEREOF, the parties have executed this Contract on this day of
1) t-A IR 2X O
Witness
By:
D. Cotter Administrator
Witness
Shippensburg Health Care Center
Resident
If the Resident has been adjudicated disabled or the Resident's doctor determines that he
Resident is incapable of understanding or exercising his or her rights and responsibilities, he
Facility may require the signature of another person on this contract. The other person may Je;
(1) An appointed healthcare agent under an advance directive for medical care; (2) A guardia or
?,P?%o of Attorne f the person; (3) A surrogate or family member.
Witn s
Responsible Party (Name)
'Z
Title: Indicate whether you are (1), (2) or ( )
STATEMENT
SHIPPENSBURG HEALTH CARE CTR
121 WALNUT BOTTOM RD
SHIPPENSBURG, PA 17257
Facility Phone: 717-530-8300
Resident: LAWRENCE PERRY
Statement Date: 03/21/05
Sharon Kirby
1424 LINDSAY LOT RD
Shippensburg, PA 17257
Date Service Through Qty Description I Amount
Charges
03/01105 01110/05 01/31/05 22 Co-Insurance 2,508.00
02/20/05 02112105 02/20105 9 Bed Hold-Room Charges 1,377.00
03/01105 02/01105 02/11/05 11 Co-Insurance 1,254.00
Sub Total 5,139.00
Balance 5,139.00
Total Amount Due 1 5,139.00
1317. ob
?" 3 zslos
EXHIBIT "C"
P o
04/12/2005 12:59 7172495755 OBS
VF _ i,FJC 'fJ0
The statements in the foregoing Complaint are based upon information which has
assembled by my attorney in this litigation. The language of the statements is not my
have read the statements; and to the extent that they are based upon information. which I
given to my counsel, they are true and correct to the best of my knowledge, information
belief. I understand that false statements herein are made subject to the penalties of 18
4904 relating to unworn falsifications to authorities.
DATE: dd-
Larry Cottle,
PAGE 07
Hampton Manor, L.P.
t? C% ?''-' t??-it
,v j n
C"?. t? ?y?, ,. I _S
?J.+ ?+- Lit K_T
_ '?.
"" ')
?l
`f ?-_??
r
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY - PENNSYLVANIA
Shippensburg / : No. 2005-1933 Civil Action
South Hampton Manor, L.P.
Plaintiff
Civil Action - Law
VS.
Sharon Kirby, individually and
As attorney-in-fact of
Lawrence Perry
Defendant
TO: Shippensburg/ South Hampton Manor, LP and its counsel O'Brien, Baric &
Shearer,
You are notified to file a written response to the enclosed Preliminary
Objections within twenty (20) days from service hereof or a judgment may be
entered against you.
H. Anthony Adams
Attorney for Defendant
49 West Orange Street, Suite 3
Shippensburg, Pa. 17257
Supreme Court ID # 25502
PRELIMINARY OBJECTIONS
The Defendant, Sharon Kirby, by and through her attorney, H. Anthony
Adams, raises the following:
INSUFFICIENT SPECIFICITY IN PLEADING
1.
The complaint fails to state any fact that would make Sharon Kirby liable
for the debts of her father either as an individual or as attorney in fact.
NONJOINDER OF A NECESSARY PARTY
2.
The complaint appears to allege that Lawrence Perry obtained services for
which he did not make payment but neither Lawrence Perry nor his estate are
named as a party to the action.
FAILURE TO EXERCISE OR EXHAUST A STATUTORY REMEDY
3.
The Plaintiff has a full and adequate remedy established by statute,
Probate Estate and Fiduciary Code 20 Pa. C.S.A. § 3155(b) and 20 Pa. C.S.A.
3384
DEMURRER
4.
The complaint fails to state a cause of action against Sharon Kirby.
Wherefore Defendant, Sharon L. Kirby, request that the court dismiss the
complaint filed by Shippensburg/ South Hampton Manor, L.P.
Respectfully,
H. Anthony Adams
Attorney for Defendant
49 West Orange Street, Suite 3
Shippensburg, Pa. 17257
Supreme Court ID # 25502
J
SHIPPENSBURG/
SOUTH HAMPTON MANOR, LP
Plaintiff
V.
SHARON KIRBY, individually
and as attorney-in-fact for
Lawrence Perry,
Defendants
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2005-1933 CIVIL TERM
CIVIL ACTION-LAW
ANSWER TO PRELIMINARY OBJECTIONS
NOW, comes Plaintiff, Shippensburg/South Hampton Manor, L.P., by and through its
attorneys, O'BRIEN, BARIC & SCHERER, and files the within Answer to Preliminary
Objections and, in support thereof, sets forth the following:
Denied. To the contrary, the complaint and exhibits thereto establish liability on
the part of Sharon Kirby for the debt incurred by Lawrence Perry at the skilled care facility
operated by Plaintiff.
2. Denied. To the contrary, Lawrence Perry, who is deceased, is not a necessary
party. Moreover, to the date of the filing of the complaint, no estate has been filed of record in
either Franklin or Cumberland Counties.
3. Denied. To the contrary, to the date of filing of the complaint, no estate has been
filed of record in either Franklin or Cumberland Counties.
4. Denied. To the contrary, the complaint and exhibits thereto establish liability on
the part of Sharon Kirby for the debt incurred and states a cause of action against her.
Respectfully submitted,
O'BRIEN, BARIC & SCHERER
David A. Baric, Esquire
I D # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
dab.d it/shcc/perry/preliminaryobj ection.ans
CERTIFICATE OF SERVICE
I hereby certify that on May 18, 2005, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Answer To Preliminary Objections, by first class U.S. mail, postage
prepaid, to the party listed below, as follows:
H. Anthony Adams, Esquire
49 West Orange Street, Suite 3
Shippensburg, Pennsylvania 17257
David A. Baric, Esquire
,?_
_,
',
?_
"?
:?,-,
,?, ?.
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2005-01933 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SHIPPENSBURG SOUTH HAMPTON
VS
KIRBY SHARON
R. Thomas Kline , Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and inquiry for the within named DEFENDANT , to wit:
KIRBY_SHARON IND & AS ATTY IN FACT FOR LAWRENCE PERRY
but was unable to locate Her in his bailiwick. He therefore
deputized the sheriff of FRANKLIN County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On May 16th 2005 , this office was in receipt of the
attached return from FRANKLIN
Sheriff's Costs: So answe,511->. r?
Docketing 18.00 -
Out of County 9.00
Surcharge 10.00 R. Thomas Kline
Dep Franklin Cc 38.40 Sheriff of Cumberland County
Psotage .74
76.14
05/16/2005
OBRIEN BARIC SCHERER
Sworn and subscribed to before me
this fi-!? day of
Ga. A. D. l
Prothonotary'
-
County to execute this Writ, this
-?I
Sheriff of Cumberland County, PA
Affidavit of.Service
Now, 14 20_2:Z, at 3`6 o'clock 09 M. served the
h The Court of Common Fleas of Cumberland County, Pennsylvania
Sharon Kirby
Shippensburg South Hampton Manor
VS.
NOW, April-,19, 2005
hereby deputize the Sheriff of
No. 05-1933 civil
I, SHERIFF OF CUMBERLAND COUNTY, PA, do
Franklin
deputation being made at the request and risk of the Plaintiff.
within
upon
at I cLa ( L : ri
by handing to G- Peg"C d K
a
copy of the original n n,.U lc
and made known to G-epf?e t h the contents thereof.
So answers,
C a
Sheriff of GY car t 1 County, PA
COSTS
Sworn and ubscribed before SERVICE $
me is ?S -aay of 20 a s MILEAGE
AFFIDAVIT
Notarial dal
Richard D. McCarty, Notary Public S .
Chambersbwg Dom Franklin Cwnty
My Commissiw Expires Jan. 29, 2001
SHIPPENSBURG/
SOUTH HAMPTON MANOR, L.P.
Plaintiff,
V.
SHARON KIRBY, individually and
as attorney-in-fact of
Lawrence Perry
Defendant.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2005-1933 CIVIL ACTION
CIVIL ACTION-LAW
PRAECIPE TO ATTACH EXHIBITS
TO THE PROTHONOTARY:
Please attach the following exhibits to the Complaint filed in the above-captioned matter
on April 15, 2005.
Respectfully submitted,
O' N, BARIC & S 7AHERER
0?' - '/' David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
dab.dir/shcc/perry/exhibit.pra
EMITS
TABLE OF CONTENTS
Exhibit 1 - Rights and Obligations of Representatives.
Exhibit 2 - For Private Pay Residents:
A. Items and Services Covered by Daily Rate
B. Items and Services Not Covered by Daily Rate.
Exhibit 3 - How to Apply For and Use Medicare and Medicaid Benefits.
Exhibit 4 - A- Items and Services Covered by Medicaid.
C. Items and Services Not Covered by Medicaid.
Exhibit 5 - Physicians Who Practice at the Facility.
Exhibit 6 - Legal Rights of Pennsylvanian's to Decide About Future Medical
Treatment.
Exhibit 7 - Policies and Procedures Concerning Your Personal Funds and
Your Personal Property.
Exhibit 8 - Services Provided by Outside Health Care Providers.
EDIT 1
RIGHTS AND OBLIGATIONS OF REPRESENTATIVE
The -Representative shall have the right to be notified by the Facility of.any event or occurrence
involving the Resident;: -which directly affects'any obligation- of theaRepresentative.under this
Agreement. Representative agrees to, assume--independently, under this, Agreement; the
following.. obligations and°is entitled to the following. rights;?.as indicated= by-Representative's
initials accompanying any of the following provisions:
• ' Representative agrees to be responsible for ensuring. that: any,payment?fronrthe-vesident to.
which. the Facility is entitled- pursuant: to this Agreement §hall-•.be•:paid: to -the: +I aeility . is a
timely manner. In the event the Resident is a beneficiary of Medicare, Medicaid or any other
third-party payment plan, Representative agrees to ensure that all co-payments, co-insurance
or charges and fees for non-covered items and services, together with any late fees as
described, under this Agreement, shall be paid from the Resident's funds... Representative is
subject to, a - civil -penalty for willfitl violation-of the°agreement-ta?distribute•'the•Rcsident's
funds to the facility.
• (Unless the Representative voluntarily agrees to act as guarantor), Representative shall be
responsible for any payments required under this Agreement only to thee extent, of the
Resident's funds:
•. , Resident is applying. for admission on private pay. basis, and Representative agrees to. assist
the Resident in providing all financial, information required by the Facility to determine the
extent. of the Resident's. resources. If it is ever determined the Representative participated in
the disclosure of incomplete or inaccurate information, the incomplete or inaccurate
disclosure shall be deemed a material breach of this Agreement and the Facility reserves the
right to pursue all available legal remedies against the Representative, including but not
limited to an action for breach of contract.
Representative is signing this Agreement as a duly authorized agent such as an appointed
healthcare agent under an advance directive or guardian appointed by a court. A copy of all
supporting documentation for this representation is attached to this Agreement.
Representative is signing this Agreement on Resident's behalf, based upon a physician's
certificate, a copy of which is attached to this Agreement, certifying that Resident does not
possess the capability to understand his or her rights and responsibilities.
Representative agrees that in the event of the Resident's death, Representative shall take
responsibility of all burial arrangements for the Resident and for removal of all personal
property from the Facility.
(Exhibit 1, Continued)
• If it is the desire of the Resident or Representative to obtain the supplemental services of
private duty nurses in accordance with the requirements described under this Agreement,
Representative agrees to be responsible for, arranging independently for those services,
including ensuring any payment.
• . Representative agrees that in. the event the Resident's private funds are .exhausted during the
Resident'•s-stay and:theResident is:eligible to applyforbenefits.under:theMedicaid'Program, ,
the ' Representative shall- assist the Resident and - the- -Facility .:with -any application for
Medicaid benefits. Representative. fiuther .agrees to, act,. eoii:behalfi oftthe',Resident,, to _
facilitate any Medicare, Veterans Administration, or other third party benefits. which, maybe
available to cover the cost of Resident's care at the Facility.
• In the event the resident seeks to terminate this Agreement, the Representative agrees to
ensure that all notices required under this Agreement are provided to Facility.
• In the event of an involuntary . termination of this Agreement.. if .. other .,arTangements
acceptable to the Resident cannot be made, the Representative agrees to accept the.Resident
into the Representative's custody, if medically appropriate.
• Representative has.the right to copies of the following documents and any amendment to
them Representative fiuther acknowledges receipt of the following documents, which may
be amended from time-to-time.
1. A copy of this Admission Agreement.
2. A list of the Facility's rates, subject to amendment on thirty-(30) days notice, and a
description of charges for services not included.
3. A list of health care providers offering services at the facility.
• Representative acknowledges the Facility's right to any legal remedies available under law
for Representative's breach of this Agreement.
EX>C(Brr 2.A
Private Pay Residents
A. Items and Services Included in the Daily Rate
The items and services included in the daily rate, and their related charges, are listed below:
Description of Items and Services Included in the Daily Rate
1. Room
2. Board
3. Social Services
4. Nursing Care, including:
a. The administration of prescribed medications, treatments and diets.
b. The provision of care to prevent skin breakdown, bedsores and deformities.
C. The provision of care necessary to encourage the resident from accident, injury and
infection.
d. The provision of care necessary to encourage, assist and train theresident in self-care and
group activities.
5. Other. Activities
Total Daily Room Rates (effective July 1, 2003)
Special Care
Program
Private Rooms
Semi-Private Rooms
Triple/Quad Rooms
$179.00 $189.00
$164.00 $184.00
$152.00 $174.00
Medicare co-pay: $105.00
EXEI[B T 2.B
ITEMS AND SERVICES NOT COVERED BY THE DAILY RATE
The following items and services are not covered by the Facility's basic daily rate:
Item or Service
Physician Services
Medications
Prescribed Dietary Supplements
Personal Dry Cleaning, Personal Linens
Telephone
Television Service
Beauty/Barber Shop Services
Clothing
Sundry Pharmaceutical
Ambulance Service, Medical Transportation
IV Therapy
X-Ray Services
Medical-Nursing Supplies
Dental, Podiatrist and Opthamology Services
Physical, Speech and Occupational Therapy Services
Oxygen
Newspaper, Periodicals
Lab Services
Specialized and/or specially ordered medical services/equipment
Guest meals
(Exhibit 2.B, Continued)
ITEMS AND SERVICES NOT COVERED BY THE DAILY RATE
(refer to the Ancillary Charge List for additional costs)
Item
Telephone
Television/Cable per month
Beauty/Barber Shop Services:
Permanent
Haircuts and Blow-dry
Hair Sets
Cut Only
Color'
Personal Laundry
Personal Dry Cleaning
Physical Therapy Service
Occupational/Speech Therapy
IV Therapy
Aerosol Therapy
Charge
Direct bill from telephone company
$7.00 per month
$35.00
$10.25
$8.25
$8.25
$30.00
$45.00 per month
Same as billed by cleaner
Determined by level of care required
Determined by level of care required
Charge list will be provided by contract
pharmacy prior to delivery of services
Determined by level of care required
******************************************************************************
Shippensburg Health Care Center cordially invites family members, guests and friends to join
our Resident's at meal times.
The prices for guest trays, effective July 1, 2001 are as follows:
Breakfast A $4.00 Will be served at 7:00 AM
Breakfast B $4.00 ($3.77 +.23 state tax) served at 7:30 AM
Lunch A $4.00 Will be served at 12:00 PM
Lunch B $4.00 ($3.77 +.23 state tax) served at 12:30 PM
Dinner A $4.00 Will be served at 5:00 PM
Dinner B $4.00 ($3.77 +.23 state tax) served at 5:30 PM
*The Resident's will be assigned their meal times upon admission.
e
Meals can be paid for at the Receptionists' desk. In order to prepare sufficient quantities we
require a 2-hour notice to prepare guest tray.
EDIT 3
The following summarizes the Medicare and Medicaid programs. It also tells you who to call for
more detailed information. If you have questions, our staffwill also help you.
What's Covered - Medicare
1. Care in a hospital
2. 100 days of skilled care in a nursing home. Medicare provides full coverage for the first
20 days. You must make a co-payment after that. The following services are. examples
of skilled care:
a. Injections & feedings given through an IV
b. Tube feedings
c. Application of a dressing that involved prescription medication
d. Treatment of stage 3 or 4 bedsores
3. Medically necessary doctor's services.
What's Covered - Medicaid
Medicaid is a comprehensive program that will cover most of the costs-of a nursing home stay.
See Exhibit 4 for information about covered and non-covered items.
1 VUR I DULL LVVLLVLL-ITAVURMV
Medicare does not nay 100% of the cost of covered services. ,,You will be required to pay part of
the charges. Your payment may be called a "co-payment", "deductible" or "premium",
depending on the type of care provided. If you receive Medicaid, Medicaid will pay for any
payment that you are responsible for under Medicare.
Your Contribution - Medicaid
Depending on your income and assets, you may be required to make a contribution toward the
cost of your care. The amount of any contribution will be decided by the local Board of
Assistance.
Who's Eligible - Medicare
People 65-years old or.older•who are eligible to collect old-age benefits under Social Security are
eligible. Persons. who receive. Social Security disability benefits for at least 24 months, or have
been found eligible for Medicare by the Social Security Administration because they have end
stage renal disease requiring regular dialysis or kidney transplant are also eligible.
Who's Eligible -- Medicaid
Eligibility depends on whether your income and assets are below certain levels:
1. Income: You should consult the local Board of Assistance to find out whether your
income makes you eligible. That phone number is listed on the next page. If you qualify,
$30 per month of your income is protected for your personal use while in the Facility.
(Exhibit 3, Continued)
2. Assets: The Cumberland County Board of Assistance will also be able to evaluate your
assets and tell you whether you qualify. The following are examples of things MZ
counted as assets.
a. Your house if your spouse lives there.
b. Household goods.
C. A certain amount of cash.
d. Personal Property in your possession in the Nursing home.
e. A certain amount of money for burial arrangements.
How to Apply - Medicare
Contact the local Social Security Office at the following address:
Social Security Office
401 E. Louther Street
Carlisle, PA 17013
(800) 772-1213
(717) 243-0085
How to Aonly - Medicaid
Contact the local County Board of Assistance at the following address:
Board of Assistance
33 Westminister Drive
Carlisle, PA 17013
(800) 269-0173
(717) 249-2929
TV MUM IA I UMMR U V VU U4VC A V VCJUVU Vi rCV VICM - 1ViCUMGi[C
If Medicare denies a claim, you have the right to appeal the denial. You may appeal by writing
to: Aetna Medicare Claim Administration
501 Office Center Building
Fort Washington, PA 19034
(215) 643-7200
Whom to. Contact if you have a Ouestion or Problem - Medicaid
If your application for Medicaid is denied, your coverage is terminated, or a service is not
covered, you may appeal in writing to:
County Board of Assistance Office
33 Westminister Drive
P.O. Box 599
Carlisle, PA 17013
(717) 249-2929
(800) 269-0173
(Exhibit 3, Continued)
- Not
'ttWhom to Contact. if vowhave Incurred Medical Expenses prior to.vourMA• Effectiv&Date .....
- Medicaid
Medical bills that you received in the 3 months prior to'receiving.Medicai&may-be-covered by
Medicaid. Contact:
County Board of Assistance Office
33 Westminster Drive
P.O. Box 599
Carlisle, PA 17013
(717) 249-2929
(800) 269-0173
FI=IT 4.A
A. Items and Services Covered by the Medicaid Per Diem Rate
•.: Regular room; dietary•service-% social services and othecservices :required-to, meet
certification standards, medical and surgical supplies and the use of equipment
and facilities.
•.:;. General nursing -services; including but not-UmitecL ta,?iadministration: oE;oxygen
:and- related:: medications; hand feeding, incontinency care-,-v tray-:.service; and
enemas.
-
• ...Basic BeautyBarber Services: The facility. must provide shampooing and hair
care which is considered necessary for hygiene. The facility must inforin the
resident of the types and frequency of the services provided.
• Items furnished routinely and relatively uniformly,to alFresidents, such as water
pitchers, basins, and bedpans.
• Items furnished, distributed, or used individually in _ small quantities such as
alcohol, applicators, cotton balls, band aids; antacids;- aspirin (and other
nonlegend drugs ordinarily kept on hand), suppositories; and tongue depressors.
• Items used by individual residents but which are reusable and expected to be
available such as ice bags, bed rails, canes, crutches, walkers, wheelchairs,
traction equipment, and other durable medical equipment.
• Special dietary supplements used for tube feeding or oral feeding, such as
elemental high nitrogen diets, even if written as a prescription item by a
physician.
• Laundry services for other than personal clothing.
• Non-emergency-medical transportation services.
• Other special medical services of a rehabilitative, restorative, or maintenance
nature, designed to restore or sustain the resident's physical and social capacities.
• Personal care items including a patient gown, shampoo, skin lotion, comb, brush,
toothpaste, toothbrush, and denture cream.
EXMBIT 4$
B. Items and Services Not Covered by the Medicaid Per Diem Rate
• Medical expenses such as, but not limited to:
• Health insurance premiums.
A. :Visits by a non-participating, physician. other.. than: approved bf.:the, nursing care
facility.
• • Emergency. ambulance services; if the ambulance company doessnot acceptUA.
• Over-the-counter medications, which are a particular brand not supplied by the
nursing facility. For example, the nursing facility must provide aspirin, but the
patientcmay request and buy a specific brand of pain relieves; such as?Excedrin
PK or Tylenol.
.0 Hearing aids and batteries.
• Specialized Beauty/Barber Shop services.
• -Diapers, i£ the resident wants a style or brand..whieh:is:•not: providedv by the
nursing care facility.
• Personal care items of the resident's choice if he prefers them instead of the items
provided by the nursing care facility. This includes items such as brushes, combs,
toothbrushes, cosmetics, etc.
EDIT 5
PHYSICIANS WHO PRACTICE AT THE FACILITY
Dr. Yogindra S. Balhara, MD.
Dr. William Kramer, M.D.
Dr. Paul Orange, M.D.
Dr:: Baxter Drew Wellmon, K D.O.; P.C.
Dr.. Hong S. Park, M.D.
761 Fifth Avenue
Chambersburg, PA 17201
(717) 261-2583
144 South Eighth Street
Chambersburg,-PA 17201
(717) 2646511
4225 Lincoln Way Fast
Fayetteville, PA 17222
(717) 352-3616
127, Walnut Bottom.Road
Shippensburg, PA 17257
(717) 532-3211
120 North Seventh Street
Chambersburg, PA 17201
(717) 267-7735
EJCff[BIT 6
LEGAL RIGHTS OF PENNSYLVANIANS TO DECIDE ABOUT HEALTH CARE
x ou nave the tuQnt to Lecrae noout x our ittemm tare
Adultsrgenerally -.have the- right to decide if, tthey want-medical. treatment,runless-they. are not.:,
competent This right includes decisions about treatments that. extend life,=life-.support machines,.
or feeding tubes.
Sometimes; -an-accident or• illness.takes away- a•person's ability:.tcrmake:health care choices ? But
-:.the decisions-still- must be made.-. If you are unable:to:make them othens:will °:The?r will decide
based on your. wishes; or your best interests if your wishes areunknown.
Pennsylvania law gives -you the right to make many healthcare decisions, in advance. One way
to do this is by using a written advance directive to name an agent to make your health care
decisions if you cannot. A written advance directive can also state your treatment preferences,
especially about life sustaining procedures.
Naming a Health Care Agent
You : can. name.,anyone to • be your health care agent. The-only.-exception: is that; ! in general,
someone who works where you are receiving your care cannot be your agent. • Your agent- can be
a family member or a friend.
!You .choose::when.your agent. can decide for you - right away;. if.you want; or; only- after two
doctorsagree-that you are notableto:decidefor. yourself. Youalsachoose.theldnds:oftlecisions
your agent can-make for-you.- For example,. if you.want, you can.give your. agent very broad-
power to decide about life-sustaining treatment. Pick your health care agent very carefully.
Make sure your agent knows what you want. Your agent will then follow your wishes, even if
your friends or family disagree.
Using Advance Directives
There are many ways to use an advance directive. A living will is a type of written advance
directive that states your wishes on life-sustaining treatments. It usually comes into affect when
a person will die very soon from an incurable condition. It can also be used when a person is
permanently unconscious (in a vegetative state).
You can make a broader written advance directive for other health care issues too. For example,
you can decide whether you want life-sustaining treatment if you are in an end-stage condition:
An end-stage condition is an advanced, progressive, and incurable condition resulting in
complete dependency.
What Happens If You Do Not Make an Advance Directive?
No one can deny you health care because you do not have an advance directive. But you should
know what happens legally if you do not.
(Exhibit 6, Continued)
Pennsylvania law allows a surrogate to make medical decisions for you if you have not named a
health care agent and are no longer able to decide treatment issues yourself. Then, your closest
relative: would be asked. to, make health: care- decisions for- you...:Your:.spouse; -adult children,-.t:,.,
parents; or adult brothers and sisters; in that order, are considered•your, closest relatives. r Nthese
reMves.:are not available, another, relative or close friend:can:make,decisions for:you.• A
surrogate,. though,, might :have :less•authority. to-decide against:fife-snsfaining:procedures•:xhan a•,
health care agent.
JEthere•is no one.to be.,a:surrogate,;w court, might have :t(rappoiava-guardian: twixn ke your
medical decisions:, The guardianmight,be somebody who doesmoE.ltnovwyori;personallyr •,•:,
How.Do:You Get More Information?
This summary. does not cover every issue. If you have legal questions about your rights, please
Speak to a lawyer.. Also.talk to your. healthcare provider about. the.medical.issues involved. in
?yout_care::- Telb those:caring for you about your decisions and °give :there a, copy,ofwT. advance . r
directive.
For a free copy of a Living Will or Advance Directive form contact:
State Representative Jeff Coy
39 West King Street
Shippensbur& PA 17257
(717) 532-1707
or
Cumberland County Office of Aging
Human Service Building
16 West High Street
Carlisle, PA 17013
(717) 532-7286 Ext. 6110
(717) 240-6110
EDIT 7
POLICIES AND PROCEDURES CONCERNING YOUR PERSONAL FUNDS
AND YOUR PERSONAL PROPERTY
A Your Rights:
1. You have. the right to, keep and use your••personaL-,property,::including some
furnishings and clothing, so long as there is enough spaceeandsother.residents are
not. inconvenienced. You also have the right- to security : for. your, personal
possessions.
2; You have•the right:to.manage your financiaLvffaiss unless=a' aGarkdeteftniiaw. that
you. are,., incapacitated:. or the Social .-SavOtyi:. strat
A44drkird bm a
representative to receive Social Security fimds for.your use and benefit.
We cannot require you to deposit your personal funds with us. You may,
however, choose any person to manage your funds, including the Facility.
4. If you. decide to have us manage your personal, funds,:you,may.withdraw -your
I money: that :we keep in the Facility-. during.. the4acility'. , business.:hours . 7.If we
have deposited .any of your funds in a bank, yowmay obtain•those.-fimds within
three banking. days; provided the funds have cleared.
5. If you .need < help to.! perform your, banldngw transactionsjr you •v may,: give . the
administrator. of:our-.Facility legal .authority. to'. access, your account, This
authority is called "representative payee." To give : the administrator this
authority, you will need to complete a special form.
6. You and your personal representative have the right, during normal business
hours, to inspect our, written records that concern your personal funds.
7. You and your personal representative have a right to file a complaint if either of
you believes that your funds, valuables or other assets have been stolen or
damaged. The agencies to contact in order to make a complaint are listed below:
a. The Cumberland County Office of Aging
Attn: Ombudsman
Human Services Building
16 West High Street
Carlisle, PA 17013
(717) 532-7286 Ext. 6110
(717) 240-6110
(Exlubit 7, Continued)
b. Cumberland County Board of Assistance
33 Westminster Drive
P.O. Box 599
Carlisle, PA 17013
(717) 249-2929
(800) 269-0173
C. The Department of Health -
. Division of Nursing Care Facilities
100 North Cameron Street
2°d Floor
Harrisburg, PA 17101
(717) 783-3790
B. Our Responsibilities:
1; = We will provide a reasonable •amount of•%secure:spzcesfoc)ryou.- tcr.3keep., your
•clothing and other personal property.: We mush investigate any damage fa or loss
of your personal property.
2. ^?Ifyow-want us to. manage $50.,Oo.?or,,,Iess;ofty.ourATwsdhat*.,fandsi--we.will;deposit
this moneyin a non-interest. beating account or--a petty caslLfund.-
3_ If:you,want,us.to•manage more than-$50;00 of.yourc.persanal,: u ds,.-,we,wM.:;
deposit this money.inan interest bearing.. account. that•.is :insured .by.the.Iederal...
government. This account will be separate from the accounts we use to operate
the facility. In addition, we will credit you with all interest earned on your .
money.
4. We will maintain a full, complete and separate accounting of your personal funds.
We will also provide you with a quarterly statement of the activity of your
account.
5. If, you receive Medicaid benefits, we will notify you if your account balance
becomes too high. If you are to remain eligible for Medicaid, your account
balance must be under a certain dollar limit that is established by the Federal
government and changes periodically.
6. We may not use your personal funds to pay for an item or service that Medicare
or Medicaid covers.
7. We will maintain adequate fire and theft coverage to protect your funds and
personal property that are kept at the Facility. We shall also obtain a surety bond
or otherwise assure the security of your personal funds that are deposited with the
Facility.
(Exhibit 7, Continued)
8. If you are discharged, there are several things we must do:
a. We will ensure the return of your personal funds in our:possession..If we
.. have deposited. your.personal funds in a bank account;. we:will•ensure.that
this: money is made available to you, or your. authorized !representative
within 30 days.
b, Ifcwe.are. your- representative payee for:Social<^Smuit3r:benefits,,,we.will
..Promptly- ask • the Social Security: Administration•,: to::•name a t new
representative payee and!we will transfer youf•inoney:to:that persona -
9. In the event of your death, there are several things we must do:
a. We will convey your personal funds and a final accounting of those funds
to the: person in charge of administering•:your:est4tewithin.30 days.. We
will, immediately notify. any government.agency,that<paid:Tor. all:'oupart• of
your care. in our Facility. That agency, shallhave the right to assist us in
determining what to do with your property.
b.. - If a- government: agency did not pay for your care,- we -..will. firunediately
notify your. representative or next of kintordetetidoe.what.todo:with your
property.
C. If we. have your funds, valuables or other. assets, in our possession, we will
hold them until • the appointed personal representative of your estate
presents a copy of the certified Letters of Administration to us. All
conveyance of personal funds will be by check made payable "To the
Estate of..".
d. We will make reasonable attempts to locate your personal representative
and your heirs. If no claim is made on your funds, valuables or other
assets in our possession within six weeks of your death, we will write the
State Office of the Comptroller for direction.
10. If we are in possession of your funds, valuables or other assets for more than one
year from the date of your transfer or discharge, we will transfer your funds, any
interest on your funds, and your valuables or other assets to the State Office of the
Comptroller's Office of any account(s) in your name of which we have
knowledge.
EIiIII(BIT 8
SERVICES PROVIDED BY OUTSIDE HEALTH CARE PROVIDERS
, . Some. o€thaservices available.in the Facility, such, as pharmaeyLservices; are. proxided, by. outside
-healtlrcare•providers:-tThese services and information abouttherprovidersj7 appear below. -You
are free toF pick your own provider or to use one of those listed below:
Whether we have
Provider's Name, aTinaneial
Address and Interest in
Type•of.Service Telephone Number the Provider
Physician Dr. Yogindra Balhara
761 Fifth Avenue No
Chambersburg, PA 17201
(717) 264-6185
X-Ray Services Mobil X-Ray Services
The Chambersburg.Hospital No
112 N. Seventh Street
Chambersburg, PA 17201
(717) 267-6356
Lab Services The Chambersburg Hospital
112 N. Seventh Street No
Chambersburg, PA 17201
(717) 267-7153
Pharmaceutical Pharmacare
Route 3, Box 3-A No
Cumberland, MD 21502
(301) 777-1773
Podiatrist Dr. Peter Holdaway
1936 Scotland Avenue No
Chambersburg, PA 17201
(717) 264-5211
Podiatrist Dr. Kirk Davis, D.P.M.
601 Wayne Avenue No
Chambersburg, PA 17201
(717) 267-2255
(Exhibit 8, Continued)
Type of Service
Provider's Name,
Address and
Telephone Number
Whether we have
a financial
Interest in
the Provider
Dentist Health Drive
928 Jaymor Road No
Suite C-190
Southampton, PA 18966
(215) 942-9950 FAX (215) 942-9954
Hospital
Inpatient or Carlisle Hospital No
Emergency Chambersburg Hospital No
Room Fulton Co. Medical Center No
Hershey Medical Center No
Waynesboro Hospital No
CERTIFICATE OF SERVICE
I hereby certify that on June 20, 2005, 1, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Praecipe To Attach Exhibits, by first class U.S. mail, postage
prepaid, to the party listed below, as follows:
H. Anthony Adams, Esquire
49 West Orange Street, Suite 3
Shippensburg, Pennsylvania 17257
David A. Baric, Esquire
n r_o
?' n
4? 'Y1
- .J
??
-? f?if::
(?) t
?..) ?
'l 7
?i?
!?.) `:1
! +.)
('v -?.7
PRAECIPE FOR LISTING CASE FOR ARGUMENT
(Must be typewritten and submitted in duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
Please list the within matter for the next Argument Court.
CAPTION OF CASE
(entire caption must be stated in full)
SHIPPENSBURG/
SOUTH HAMPTON MANOR, L.P.
(Plaintiff)
VS.
SHARON KIRBY, INDIVIDUALLY AND AS
ATTORNEY-IN-FACT OF LAWRENCE PERRY
(Defendant)
No, 1933
Civil Term
t7
c
a
+ T
M1' ?
0
-X
`jrn
N -<
4ij 2005
1. State matter to be argued (i.e., plaintiff's motion for new trial, defendant's
demurrer to complaint, etc.):
DEFENDANT'S PRELIMINARY OBJECTIONS
2. Identify counsel who will argue case:
(a) for plaintiff: DAVID A. BARIC, ESQUIRE
Address: O'BRIEN, BARIC & SCHERER
19 WEST SOUTH STREET
CARLISLE, PENNSYLVANIA 17013
(b) for defendant: H. ANTHONY ADAMS, ESQUIRE
Address. 49 WEST ORANGE STREET, SUITE 3
SHIPPENSBURG, PENNSYLVANIA 17257
3. I will notify all parties in writing within two days that this case bas
been listed for argument.
4. Argument Court Date: AUGUST 24, 2005
dAi? /-e
Dated: JULY 7 2005 Attorney for PLAINTIFF
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY - PENNSYLVANIA
Shippensburg / No. 2005-1933 Civil Action
South Hampton Manor, L.P.
Plaintiff
Civil Action - Law
VS.
Sharon Kirby, individually and
As attorney-in-fact of
Lawrence Perry
Defendant
-?)P vc' f??
To The Prothonotary:
Counsel for the Defendant hereby withdraws the preliminary objections
previously filed.
s
s
Attorney for Defendant
49 West Orange Street, Suite 3
Shippensburg, Pa. 17257
Supreme Court ID # 25502
9n
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY - PENNSYLVANIA
Shippensburg / : No. 2005-1933 Civil Action
South Hampton Manor, L.P.
Plaintiff
: Civil Action - Law
vs.
Sharon Kirby, individually and
As attorney-in-fact of
Lawrence Perry
Defendant
ANSWER
NOW comes the Defendant, Sharon Kirby, and sets forth the following.
1.
Admitted
2.
Admitted
3.
Admitted
4.
Admitted
5.
Admitted
6.
Denied, Lawrence Perry required admission to the facility and Sharon
Kirby as his daughter assisted her father.
7.
Admitted
8.
Admitted
9.
Admitted
10.
Admitted
11.
Denied Defendant is without sufficient knowledge or information to form a
belief as to the truth of the matter averred.
12.
Admitted that a statement is attached.
13.
Admitted, although the payment should not have been made.
14.
Admitted
15.
Admitted
16.
Admitted and Denied as set forth in the answers to the specific
paragraphs.
17.
Admitted
18.
Admitted and by way of further answer Lawrence Perry's assets and funds
including payment from Veteran's organizations amounted to $6,295.69, from
which the Defendant as Executrix must pay funeral and administrative cost in
excess of that amount. There are no funds of Lawrence Perry available to be
paid to priority creditors.
19.
Denied, Sharon Kirby not only paid to the facility the amount available to
her but has also paid an amount that should not have been paid of $1,377.00.
Defendant further answers that she was not a party to the admission agreement
and could not therefore breach the same.
20.
Admitted
21.
Admitted
22.
Admitted
23.
Admitted
NEW MATTER
24.
Defendant has made payment in full (actually in excess) from the funds
available from Lawrence Perry.
25.
The Defendant, Sharon Kirby, has performed all and every act required of
her as an individual and as a "responsible party".
Wherefore, Defendant prays your Honorable Court enter judgment in her
favor.
Respectfully,
= ALL
H. Anthony Adams
Attorney for Defendant
49 West Orange Street
Shippensburg, Pa. 17257
Supreme Court ID # 25502
VERIFICATION
I verify that the statements made in this answer are true and correct. I
understand that false statements herein are made subject to the penalties of 18
Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Date: A-[ff as
%?UAA 992V A &- Cf.
SHARON KIRBY 61
? o n
<_e ?,.,
??
J -r? f"
-r; :7
W
i ,'t ??
_ _
l.> <7
„- ? ,-?
?? N
' -?
^ tL7
SHIPPENSBURG/
SOUTH HAMPTON MANOR, L.P.
Plaintiff,
V.
SHARON KIRBY, individually and
as attorney-in-fact of
Lawrence Perry
Defendant.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 2005-1933 CIVIL ACTION
CIVIL ACTION-LAW
PRAECIPE TO DISCONTINUE
TO THE PROTHONOTARY:
Kindly mark the above-captioned action as having been settled and discontinued without
prejudice.
Respectfully submitted,
O' EN, BARI SCHE
Date: September 30, 2008
David A. Baric, Esquire
I.D. # 44853
19 West South Street
Carlisle, PA 17013
(717) 249-6873
Attorney for Plaintiff
1W +•
CERTIFICATE OF SERVICE
I hereby certify that on September 30, 2008, I, David A. Baric, Esquire of O'Brien, Baric &
Scherer, did serve a copy of the Praecipe To Discontinue, by first class U.S. mail, postage prepaid,
to the party listed below, as follows:
H. Anthony Adams, Esquire
49 West Oran a eet, Suite 3
Shippensburg, P sy ia11725
David A. Baric, Esquire
CIO
L.J ?i7