HomeMy WebLinkAbout11-24-14 IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN THE MATTER OF : c � � .� �
SARAH QUIMBY, : � ; �� : ���r �-'"'',
An Alleged Incapacitated Person : No. 21-14-0927 � ' � �? �= . � `�;
_ r. r1, �
. --.� I
AFFIDAVIT OF ATTENDING PHYSICIAN -�'
;
REGARDING ATTENDANCE AT HEARING ; ,`. �
`� ' _ .�,
�::, � :" . �.,..
_., v _ >
The undersigned hereby verifies the following: � � +:';, o
.;-�
1. I am Michael Sams, D.O., the medical director at Messiah Lifeways' skilled
nursing unit, located at 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania, 17055.
2. I am the attending physician of Sarah Quimby, the alleged incapacitated person in
the above-captioned matter.
3. Sarah Quimby's physical or mental condition would be at risk of harm by her
transportation to and presence at the hearing scheduled in this matter on November 26, 2014. I
have come to this conclusion within a reasonable degree of inedical certainty for the following
reasons: Sarah Quimby suffers from severe progressive end stage dementia with significant
memory impairment. She cannot remember events from one minute to the next. She suffers
significant mobility challenges and is at high risk for falls. She also suffers from dysphagia and
respiratory issues. In light of these conditions, forcing her to leave her familiar surroundings and
placing her in a courtroom would make her anxious and upset and unnecessarily heighten the
risk of an adverse health event.
The above statements are made subject to the penalties of 18 Pa.C.S. § 4904 relating to
unsworn falsifications to authorities. „� ,, � L
CO(�-��`'�O,nw�e.�..\`� C-� `"�u��n.S:��v�-.� CO"`'.�� `",� �""`^r`�f
n�,��,��- C��' �
Dated: �e�aber�, 2014 By: �
Michae Sams, D.O.
SWORN TO AND SUBSCRIBED
BEFORE ME THIS 1�I DAY OF
Y 'dIJ�U�2'r , 2O 14. COMMONWEALTH OF PENNSYLVANU
� � NotaMal Seai
Betsy A. Barnhart, Notary Public
West Comwall Twp., Lebanon tounty
My Commisslon Expires)an. 27, 2018
Notar Public MENBER�Y[NNSYLYAt11A ASSOCIA�tON Oi NOTI,p1E5
493298v1
r ��
�
iJ