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COURT OF COMMON PLEAS OF :,� � `- C'
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CUMBERLAND COUNTY,PENNSYLVANIA ` -+ � � o
ORPHANS' COURT DIVISION y" � �
IN THE INTEREST OF: . NO. � r. �"- - ��j, �I
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MARILYN L. MEEKS, :
An Alleged Incapacitated Person :
EMERGENCY PETITION FOR ADNDICATION OF INCAPACITY AND
FOR THE APPOINTMENT OF A PLENARY GUARDIAN
OF THE PERSON AND ESTATE
TO THE HONORABLE, THE JUDGES OF SAID COURT:
AND NOW,this �n d day of � �,�► , 2015, comes the Petitioner,
Gregory T. Meeks,by and through his counsel, David D.Nesbit of Keystone Elder Law P.C.,
and files the following in support of this Petition for Adjudication of Incapacity and for the
Appointment of a Plenary Guardian of the Person and Estate.
1. Petitioner, Gregory T. Meeks, is the son of Marilyn L. Meeks, the alleged
incapacitated person, currently residing at 6427 Ryan Avenue, Hanover, Maryland 21076.
2. The alleged incapacitated person, Marilyn L. Meeks, is an adult individual
Eighty-seven(87) years of age, having been born on August 10, 1927.
3. The alleged incapacitated person is a widow and a resident of Cumberland
County, Pennsylvania. She has been living at Country Meadows Retirement
Communities, 4905 East Trindle Road, Mechanicsburg, Pennsylvania, 17050, for
2.5 months. She is not a patient of a mental hospital.
4. The following individuals are the alleged incapacitated person's next of kin:
Gregory T. Meeks (son) Yvonne M. August(daughter)
6427 Ryan Avenue 12311 Kensington Lakes Drive
Hanover, Maryland 21076 # 1003, Jacksonville, Florida 32246
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Michelle D. Meeks (daughter)
508 Skylark Lane
Dresher, Pennsylvania 19025
5. To the best knowledge, information and belief of Petitioner, the Gross Estate of the
alleged incapacitated person consists of
a. Real Estate in Cumberland County with a County Assessed value of
$175,600.00.
b. Citizens Bank savings account approximately $30,000.
6. The total of the foregoing non-real estate assets are Thirty Thousand ($30,000)
Dollars.
7. To the best knowledge, information and belief of Petitioner,the income from all
sources of the alleged incapacitated person is:
a. Retirement Pension survivors benefit $1,800.00 per month
8. Her total monthly income,not including unknown interest income, is believed to be
approximately One Thousand Eight Hundred ($1,800.00) Dollars.
9. The alleged incapacitated person was never a member of the Armed Services of the
United States and is not currently receiving benefits from the United States Veterans � "
Administration.
10. The name and address of the individual or entity providing residential services to the
alleged incapacitated person is as follows: Country Meadows Retirement
Communities, 4905 East Trindle Road, Mechanicsburg, Pennsylvania 17050.
11. The following entities or individuals are also presently providing services to the
alleged incapacitated person: none.
12. The appointment of a guardian is sought because the alleged incapacitated person's
ability to receive and evaluate information effectively and communicate decisions is
impaired to such a significant extent that she is totally unable to manage her financial
resources or to meet essential requirements for her physical health and safety.
13. The name and address of the proposed emergency guardian of the person and estate
and relationship to the alleged incapacitated person is as follows: Gregory T. Meeks,
6427 Ryan Avenue, Hanover, Maryland 21076, son of Marilyn L. Meeks. However,
Gregory T. Meeks would prefer not to be the permanent guardian of the person and
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the estate because he believes a non-family member would be best suited to serve as
guardian.
14. The proposed guardian has no interest adverse to that of the alleged incapacitated
person.
15.No court has ever assumed jurisdiction in any proceeding to determine the
competency of the alleged incapacitated person.
16. The alleged incapacitated person has executed a durable financial and health care
power of attorney which named two of her children, Gregory T. Meeks and Yvonne
M. August. No guardian has previously been appointed. "I'hese documents are still
valid and may still be used, but the two Agents are appointed to act at the same time
and are unable to agree about the Alleged Incapacitated Person's person and estate.
17. The physical condition and limitations of the alleged incapacitated person are as
follows: suffers from Dementia caused by Microvascular Disease that was the result
of a series of tiny strokes. See attached statement from her Care provider.
18. The alleged incapacitated person suffers from the following cognitive/psychological
infirmities: suffers from Dementia caused by Microvascul�r Disease that was the
result of a series of tiny strokes. See attached statement from her Care provider.
19. The following steps have been taken to find a less restrictive alternative than the
appointment of a guardian: She does have a durable financial and health care power
of attorney, and living will that were executed June 3, 2013. However, her Co-Agents
are unable to agree about the proper care of her estate and person. She is unable to
grant a new power of attorney and a representative payee could not manage her care
or medical decisions. Mediation was proposed and rejected by one of the Power of
Attorney Agents. One of the Power of Attorney Agents has indicated an intention to
remove the alleged incapacitated person from Country 1Vleadows where she is
currently safe and receiving care in her best interest. This same Power of Attorney
Agent has indicated an intention to move the alleged incapacitated person to Florida
immediately.
20. A Guardian is sought over the following specific areas of incapacity: Plenary
Guardian of the Person and Estate.
21. The alleged incapacitated person does not have a relationship with an attorney at law
who is expected to represent her in this matter, and given her placement in a Personal
.°�,i i .,ir ir�rn �
Care Home Memory Care Unit and confusion, is unlikely to be able to engage an
attorney on her own.
WHEREFORE, Petitioner prays this Honorable Court to issue a Citation direction to the
alleged incapacitated person,with notice to her next of kin and to such other persons as the court
may direct,to show cause why she should not be adjudged an incapacitated person and an
Emergency Plenary Guardian for her Person and Estate appointed. Petitioner prays this
Honorable Court to issue an order granting Emergency Guardianship of Marilyn L. Meeks to
Gregory T. Meeks in order to keep Marilyn L. Meeks in her current safe environment and not
allow her to be moved to another state at this time,which would in turn be detrimental to the
alleged incapacitated person's health and well-being.
Respectfully submitted,
L;�y'l._.�.
David D. Nesbit, Esquire
Pennsylvania Supreme Court ID No. 77411
Keystone Elder Law P.C.
555 Gettysburg Pike, Suite C-100
Mechanicsburg, PA 17055
(717)697-3223
Dave(c�keystonee lderlaw.com
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COUNTRY MEAD��''�����'�
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To Whom It May Concern:
It is the opinion of Country Meadows,that based on Marilyn's cu�rei7� condition,and diagnosis
of dementia with delusions and hallucinations,that she is appropriat.��ly placed in our secure
dementia unit. It is also our opinion that she would not be able to re��.ide at home alone and
that she does require 24 hour supervision due to her cognitive impairment.
This opinion is supported by the recommendation of her previous dc�ctor, Dr. Kathleen Semples,
who performed and completed a documentation of inedical ev�luaticm,completed on 4j14/15,
and recammended and signed for her to be in a secure dementi� uni�:. It is also supported by
her 6/17/15 visit to the Penn State Milton S. Hershey Medical Ceriter where she was diagnosed
• with Vascular Dementia with delusions,among several other me�licaN conditions that are
monitored and treated by Country Meadows. Her current physi�cian, Dr. Ghosh has a{so
supported her placement in the secure dementia unit.
\ � � .*-�' �
MargareQ t Anders� RNY�W
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Amanda Bobb, Connections Executive Director
Country Meadows of West Shore �'-i�: ''dE: '17.975.3434 FAX: '17.975.2i18
4837 East Trindle Road Mechanicsburg, PA 17050 www•countrymeadows.com
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Penn State Milton S. Hershey Ct�edic�l �en�er
C�u�pa�ient llisit Surnmar�y
Name: MEEKS, MARILYN L Gender: Female Date of Birth: Of31101192T
Race: White (Caucasian} Ethnicity: Not Hispanic or Latina Languac�e: English
Attending : fngraharn, MD, Jorn Michael PCP: SempeEes, MD, Kathleen L
Visit Inforr�ation
Reason(s)for Visit: Neoplasm, uncertain whether benign or mafignant
AK(actinic keratosis}
Visit Date. Q6/17i�5 09:00 am
Location: PSHMG Camp Mill A
Provider: (ngraham, MD; John Michael Phone; 717 531-8952
Smoking Status: �ormer Smoker, quit> 1 yr
Vita9 Signsl�easureenents
Temperature:
Hsart Rate: 74 bpm
Blood Pressure: 150 mmHg /75 mmHg
Neight:
Weight:
BM[:
Health IssueslProbier�s
Anemia
Breast cancer
Cerebrovascular disease
Cnronic disease of genitourinary system
COPD, rni3d
Degeneration of(umbosacral intervertebra! disc
Diastalic dysfunction
Hearkburn
Herpes zoster
History af breast cancer
History af CVA{cerebrovascular accident}
Nistary af pneurnonia
HYPERTENSION
hiypokaEemia
Iron deficiency
Lymphedema
Post herpetic neuralgia
Rheumatic fever
Subclinica! hyperthyroidism
Thyroid nod�le
Vascular dementia
Vascular dementia with delusions
Vitamin 812 deficiency
Medicatians and Immunizations Given During Yc�ur Uffice Visit
Medications/Immunizations Date/Time C�iv�r� Dose �
i
Name� MEEKS,MARILYN l i of 8 06t17/2015 1d:30:3fi
Date af Birth�811 011 92 7 MRN:00346Q6
FIN:22750729
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Physician's Qrders
MARILYN MEEKS [ID: , f2oom 209, COUNTRY MEADOWS WEST SHORE]
Date Of Birth: 90-Aug-1927 Arrival Date: 16-Apr-2015 Physician: GHOSH, SUPRIYO
CURRENT ORDERS (as of 2-Ju1-2015 1q:33 AM}
ROUT(NE MEDICATfONS
AMLODIPINE TAB 5MG 5�11G TABS Orig Date:4-May-2015
TAKE 181/2 TABLETS(7.5 MG)ORALLY DAILY(HYPERTENSION) [EquivTo:NORVASCj RX:845963
Schedule:DAiIY AT 08:30 DX:HTN
ANASTROZOLE TAB 1MG 1MG TABS Orig Date:i6-Apr-2Q15
TAKE 1 TABLET ORALLY DAIIY{BREAST CANCER HISTdftYJ jEq�iv To:ARIMIDEXj RX:832110
Schedule:DAILY AT�8:30 DX:BREAST CANCER
H15TORY
' ASPIRIN{ASA)CHW 8'IMG 81MG CHEW Orig Date:16-Apr-2015
CHEW 1 TABLET AND SWALLOW ORALLY DAIIY(STROKE PREVENTION} [EquivTo:BAYER RX:8321fl0
CHILORENS ASPIRIN] DX:S7RdKE
� Scheciule:DAI�Y AT 0$:30 PREVENTlON
CAlCAf2B fiO4MG+D400 UNITS TAB TABS Orig Date:16-Apr-2015
7AKE 1 TABLET ORALIYTWtCE DAtLY(BONE STRENGTH) {EquivTo:CALTRATE WNIT Q] RX:832104
Schedule:DA(LY AT 08:3q, OAILY AT 16:30 DX:SUPPLEMENT
FLORASTdR 250MG CAPSULE 250MG CAPS �rig Date�22-Jun-2015
TAKE 1 CAPSULE QRALLY TW ICE DAILY X14 DAYS(PROBIOTIC) RX:888819
Schedule:DAiLY AT Q8:30, DAILY AT 20:30 DX:PROBIOTIC
FOLIC AClD TAB 1MG 1MG 7ABS Orig Pate:7-May-2015
TRKE 1 TABLET ORALLY dAILY{SUPPLEMENT) RX:848834
Schedule:DAILY AT 08:30 DX:SUPPLEMENT
METHIMAZOlE TAB 5MG 5MG TABS Orig Date:18-Jun-20'i5
TAKE 1 TABLET ORALLY DAtLY(HYPERTHYROIDISM) [Equiv To:TAPAZOLE] RX:885175
Schedule:DAILY AT 06:40 DX:HYPERTHYROIDISM
METOPROLOL ER 25MG TAB 25MG T624 drig Date:29-Apr-2415
TAKE 1 TABLET ORALLY TW ICE DAILY(HYPERTENSIQN) [Equiv To:TOPROL XL} RX:842481
Schedule:DAILY AT 08:30, DAILY AT 1830 DX:HTN
POTAS5IUM CHLORIDE CRIOMEQ* 14MEQ TBCR Orig Date;16-Apr-2015
TAKE 1 TABLET ORALIY TW ICE OAILY(LOW POTASSiUM)"'DO NOT CRUSH" [Equiv To:K-7AB] RX:832099
Schedule:QAIIY AT 08:30, DAII.Y A7 16:30 OX:LOVV POTASSIUM
GIUETiapine 25MG TASS 25MG TABS Orig Date:15-Jun-2015
TAKE 1 7ABLET ORALLY AT BEDTIME{MQQD) [Equiv To:SEROQUEI.J RX:882037
Schedule:DAILY AT 20:30 DX:maod
SLQW RELEASE IRON 45MG 45MG TBCR Orig Rate:16-Apr-2Q15
TAKE 3 TABLET OftAILY DAILY{ANEMIA) RX:832103
Schedule:QAILY AT 08:30 DX:ANEMIA
VITAMIN B12 1000MCG TAB 1004MCG TABS �rig Date:18-Apr-2015
TAKE 1 TABLET OF2AL�Y DAILY(VITAMIN 812 DEFtCIENCY} RX:832102
Schedule:DAILY AT 08:30 DX:VITAMiN B12
DEFICIENCY
PRN MEDtCATIONS
ACETAMINOPHEN(MAPRPj 325MGTAB 325MG TABS Orig Date:29-Apr-2015
TAKE 2 TA$LETS{850 MG)ORALLY EVERY 4 HOURS AS NEEDED FOR PAIN'NOT TO EXCEED 4c3MS RX:8A207fi
APAP/24HR5*'RE-QRDER* (EquivTo:TYIENQI]
ACETAMINOPHEN{MAPAP}325MGTA8 325MG TABS drig Date:29-Apr-2015 ,
TAKE 2 TABI.ETS(65�MG)ORALLY EVERY 4 HOURS AS NEEdED FOR FEVER'NOT TO EXGEEI�4GMS RX:$42076
APAP(24HRS''RE-ORDER' [Equiv To:TYLENOL]
ONDANSETRON TAB AMG AMG TABS Orig Date:29-May-2015
TAKE 1 TABLET ORALLY EVERY 6 HOURS AS NEEDED FOR NAUSEA'RE-ORDER* [Equiv To:Z{3FRANj RX:867552
DX:NA 5�A
Physician Signature: Nurse's Signature:
Datelf ime: DateRime:
�� _ . P8g0 1 of 2 Pnnt Date:2-Ju1-2015
�m-�
� '�if ill'1�f11' °
Physician's Orders
MARI�YN MEEKS [ID: , Room 2Q9, C�UNTRY MEADOWS WE�T SHORE]
Date Of Birth: 10-Aug-1827 Arrival Date: 16-Apr-2U15 Ph fsician: GHQSH, SUPRlYO
CURRENT ORDERS (as of 2-Ju1-2015 10:33 AM}
VENTOLIN HFA AER 108MCGlACT RERS Orig Date:16-Apr-2015
1NHALE Z PUPFS ORAILY EVERY A HOUftS AS NEEDED FQR W FiEEZiNG`RE-ORDER` RX:832106
DX:W HEEZING
ViTALS
� MdN?HLY WEIGHT Coliect:W EIGHT Orig Oate:23-Apr-2015
WElGhi EVERY MONTH AND REPORT THE DIFFERENCE OF 5LB Td THE NURSE.
Schedule:ON DAY(s)23 AT 08:OQ
02 SAT% Co!lect:02 SAT°1fl Orig bake:21-May-2015
NURSE TCJ CHECK PULSE QXIMET�2Y W EEKLY AL.ONG W ITH C�PD MONITORING;NdTIFY tv1D OF ANY
CNANGES
Schedule:W ED AT�t 1:00
TREATMENTS
ACE BANDAGE Orig Date:20-Jun-2015
ACE WRAP ON RIGHT ARM DAfIEY WRAP FRdM HAND TO ELBOW.CHEGK EVERY HS Ft3R
PLACEMENT AND REWRAP IT IF NEEDED.SHOULD BE C}N ALL THE iIME UNTILI.7!1l2415. DX:SWOLLEN HAND
Scheriule:OAILY AT 08:a0, DAILY AT 2Q:Qd
COPD MONITQRING � Orig Date:21-May-2015
NURSE TO MON{70R W EEKLY FOR RESPIRATORY CHANGES;SJS OF INFECTION AND PUt.SE
OXIMETRY.NOTIFY MD OF ANY CHANGES DX:COPD
Schedule:WED AT 11:06
TRIAMCINOLQN OIN 0.1°to Orig Date:16-Apr-2015
APPLY TOPICALLY TO AFFECTED AREA(S)TWICE DAILY AS NEEDED�OR DRY,1TCHY�G�:F_MAj'RE-
ORDER" DX:ITCHY EGZEMA
WEIGM REVfEW Orig Date:29-Jun-2415
Nurse ta review monthiy weights;NOTIFY MD OF A DIFFERENCE OF 5�B
Schedule:ON DAY{s)23 AT OS:00
INFORMATlt7NA�ORDERS
d1ET ��— Orig Date:15-Jun-2015
SELF MONITOR:Regular diet textures,Heart Healthy,thin liquids.
INSTRUGTIONS:
Resident: MARILYN MEEKS DOB: 14-Aug-1927 ` Physician: GHOSH,SUPRiYO
Diagnoses: Allergies: `
Anemia,Hyperthyroidism,Iron Deficiency,Cyanocobalamin Deficiency, Suifia Antibiotics,Penicillin,3actrim,Pravachol,Tramadol,Levaquin,
Chronic Obstructive Puimonary Disease,HypeKension,F{aliucination, Avelax �
Delusions,Dementia,History of Malignant Neopiasm of Breast,History
of Cerebrovascular Accident,Chronic Rerial Disease,Mastectomy.
Lumpectomy of Breast,Diastolic Dysfunction
Physician Signature: Nurse's Signature:
Date(fime: DatelTime:
! �
Page 2 of 2 Pnnt Da�e:2Jui-2o�5
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VERIFICATION
The undersigned hereby certifies, subject to the penalties of 18 Pa. C. S. § 4904, relating
to unsworn falsification to authorities, that I am the son of the alleged incapacitated person, and
that the facts set forth in the foregoing Petition are true and correct to the best of my knowledge,
information and belief.
��� ,�,
Date: a J��y ad�S� BY: �r �'�(.�'�%�
Grego . M eks
--��.i�r iu��rr�r ,
CONSENT OF PROPOSED GUARDIAN
The undersigned hereby consents to his appointment as Guardian for the alleged
incapacitated person, Marilyn L. Meeks.
The address of the undersigned is: 6427 Ryan Avenue, Hanover, Maryland 21076
The occupation of the undersigned is: ��I °l �y 57
The undersigned speaks, reads and writes the English language.
The undersigned does not have any interest adverse to the alle�ed incapacitated person.
The undersigned is not a fiduciary, or an officer or employee of a corporate fiduciary, of
an estate in which the alleged incapacitated person has an interest; and is not the surety, or an
officer or employee of a corporate surety of such a fiduciary.
DATE: � ���y ��(S� BY: � �.. , ,,_z �-
Gregory; . M ks
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