HomeMy WebLinkAbout07-21-15 IN THE COURT OF COMMON PLEAS OF
In re: CUMBERLAND COUNTY, PENNSYLVANIA
Diana Stanley ORPHAN'S COURT DIVISION
CIVIL ACTION—ADJUDICATION OF
INCOMPETENCY AND APPOINTMENT OF A
GUARDIAN OF THE PERSON AND A
GUARDIAN OF THE ESTATE
NO. 15
PETITION OF LOUANN SPEESE-STANLEY SUPPORTING ADJUDICATION OF
INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON AND A
GUARDIAN OF THE ESTATE OF DIANA STANLEY,AN ALLEGED
INCAPACITATED INDIVIDUAL, PURSUANT TO 20 PA.C.S. CH. 55
TO THE HONORABLE JUDGES OF SAID COURT:
The Petitioner, Louann Speese-Stanley of 102 Hemlock Court, Mechanicsburg, PA
17055 deposes and says:
1. Louann Speese-Stanley is the named petitioner in the above titled civil cause of action
and Diana Stanley is the alleged incapacitated person.
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2. This Petition is instituted to aid and benefit Diana. w ,
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3. Louann Speese-Stanley is the mother of Diana. C,
C4. Louann Speese-Stanley is fifty-six (56) years of age. w
5. This petition is to inform the Court as to the incapacity of Diana, to appoint::Loilanrr 2 ?`
Speese-Stanley as primary plenary guardian of the person and primary plenary guar an r 7 :4+
to the estate for Diana. ;
6. No other guardian of the person of Diana has been appointed by any other court.
7. There is no trust, special needs or otherwise. benefitting Diana.
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8. Diana Stanley, born August 3, 1997 is seventeen (17) years old, has never been married,
and resides at home with her mother, Louann Speese-Stanley, at 102 Hemlock Court,
Mechanicsburg, Pennsylvania 17055.
9. Diana does not have any children.
10. Diana lives with her mother, Louann Speese-Stanley and therefore does not currently
submit to any residential services or institutions.
11. The name and address of Diana's Pediatrician is:
Dr. Richard Blutstein
Pennsboro Pediatrics
125 North Enola Drive, Suite 101
Enola, PA 17025
12. Diana receives mental health and psychiatric treatment from:
Sleber Associates, P.C.
2626 North Third Street, Suite 3B
Harrisburg, Pennsylvania 17110
13. Diana receives Neurological treatment from:
WellSpan Neurology
40 V-Twin Drive
Gettysburg, PA 17325
14. Diana's pediatrician, Dr. Blutstein, is in agreement with this petition. Dr. Blutstein has
treated Diana for the last 17 years and is familiar with her condition. Dr. Blutstein's
anticipated testimony will show that Diana has been diagnosed with a profound
intellectual disability and has the mental capacity of a two year old. Dr. Blutsetin's
testimony will also show that because of the aforementioned diagnoses Diana is unable to
make decisions concerning her person, property, finances,health, welfare, and safety; and
that Louann Speese-Stanley is the best person to serve as Diana's guardian.
15. Diana's next of kin is her father, Henry Stanley who resides at Lot 35, Salem Church
Road, Mechanicsburg, PA 17050. He is divorced from Louann Speese-Stanley. Henry
Stanley verbally expressed his agreement with this petition to determine Diana
incapacitated, to appoint Louann Speese-Stanley as Diana's primary guardian of the
person and the estate. However, Henry Stanley has not yet signed a consent to
appointment of a guardian. Henry Stanley has been served with a copy of this petition as
an interested party, should he wish to intervene or challenge.
16. Guardianship of the person and of the estate is being sought because Diana suffers from
Persistent Developmental Delay due to an abnormality of the I Q4 chromosome.
Developmentally, Diana is a 2-4 year old and lacks the ability to communicate or perform
basic tasks of caring for herself.
17. Diana's condition completely impairs her ability to make decisions. Because of Diana's
intellectual disability, she is unable to make responsible decisions concerning her person,
property, finances, health, welfare, and safety. She is unable to communicate her needs,
tend to her personal hygiene, medicate herself, and provide for her personal safety.
Diana is not able to make medical decisions that affect her general health and well-being.
She is unable to make life-altering decisions, such as consenting to necessary surgeries or
other emergency,procedures, because she cannot comprehend the effects of her medical
decisions.
18. Diana receives a small amount of income in the form of Supplemental Security Income
(SSI), but she is unable to manage her personal finances or make financial decisions.
19. Diana receives SSI in the amount of$755.50 per month, this is her only income.
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20. For the reasons listed above, Petitioner alleges that Diana Stanley is a legally
incapacitated person under 20 Pa.C.S.A. § 5501 as she is "an adult whose ability to
receive and evaluate information effectively and communicate decisions in any way," and
"impaired to such a significant extent that [s]he is partially or totally unable to manage
[her] financial resources or to meet essential requirements for [her] physical health and
safety."
21. The Petitioner has made efforts to allow Diana to retain as much autonomy as possible.
However, she continues to be dependent upon others to assist her in her personal care.
22. The nature of Louann Speese-Stanley's relationship with Diana is that of a mother and
caretaker. Louann Speese-Stanley has been the sole provider of care for Diana since her
birth and has primary custody of her.
23. Ms. Speese-Stanley has extensive knowledge of Diana's idiosyncrasies and behaviors.
She intimately understands Diana's needs and wants through years of caring for her.
24. Allowing Diana to stay in her own home with her mother as her guardian is the least
restrictive means by which she can maintain some independence. Because Diana
requires intensive care and supervision, either Ms. Speese-Stanley or a full'-time care
service would be best suited to provide for Diana's needs. Ms. Speese-Stanley is
immediately ready, willing, and able to act as Diana Stanley's guardian.
25. All less restrictive alternatives to the appointment of a guardian of the person and
guardian of the estate have been considered. The Petitioner believes that such alternatives
will be ineffective
26. Louann Speese-Stanley is qualified to be Diana's guardian because she is interested in
Diana's welfare and has no interest adverse to Diana's. Ms. Speese-Stanley's consent to
become guardian is attached to this petition.
WHEREFORE, Petitioner respectfully requests that this Court adjudicate Diana Stanley
an incapacitated person, and assign to Petitioner, Louann Speese-Stanley, guardianship of the
persona and estate.
Date.
Connor Line
Certified Legal Intern
A-� &'���
Megan Wesmey, er
Supervising Attorney
COMMUNITY LAW CLINIC
45 North Pitt Street
Carlisle, PA 17013
(717) 243-2968
Fax (717) 241-3596
,:
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VERIFICATION
I verify that the statements made in the foregoing PETITION SUPPORTING
ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE
PERSON AND A GUARDIAN OF THE ESTATE are true and correct, to the best of my
knowledge, information and belief. I understand making a false statement would subject me to
the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsifications to authorities.
D ate:a
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ULduann Speese-Aaanley
Petitioner
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IN THE COURT OF COMMON PLEAS OF
In re: CUMBERLAND COUNTY, PENNSYLVANIA
Diana Stanley ORPHAN'S COURT DIVISION
CIVIL ACTION—ADJUDICATION OF
INCOMPETENCY AND APPOINTMENT OF A
GUARDIAN OF THE PERSON AND A
GUARDIAN OF THE ESTATE
NO.
CONSENT OF INDIVIDUAL TO APPOINTMENT AS GUARDIAN
1, Louann Speese-Stanley, hereby consent to my appointment as primary plenary
guardian of the person and primary plenary guardian of the estate of Diana Stanley, an alleged
incapacitated person, and certify that:
1. I am 18 years of age or older.
2. 1 reside at 102 Hemlock Court, Mechanicsburg, Pennsylvania, 17055.
3. 1 do not work outside of the home.
4. 1 speak, read, and write the English language.
5. 1 am a citizen of the United States.
6. 1 do not have any interest adverse to the alleged incapacitated person.
7. 1 am not a fiduciary, or an officer or employee of a corporate fiduciary, of an estate in
which the alleged incapacitated person has an interest, or a surety, or an officer or
employee of a corporate surety, of such a fiduciary.
8. 1 am the biological mother of the alleged incapacitated person.
Date i�
/Louann Speese-Stanley
Petitioner
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NOTARIZED
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND Ss.
On this, the day of- T(,k 1 2015, before me,TK1sh0S_VQZ(a
Notary Public of the Commonwealth of P&hnsylvania,the undersigned officer, personally
appeared LouanD Speese-Stanley, known to me (or satisfactorily-proven)to be the person whose
name is subscribed to the within.Verification, and acknowledge that she executed the same for
the purpose therein contained.
IN WITNESS WHEREOF, I have set my hand and notarial seal.
(seal) JAJ-(a '4
Notary Public
My Commission Expires:
Date
OMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Trisha S.Prosser,Notary Public
Carlisle Boro,Cumberland County
My Commission Expires May 13,2018
MEMBER,PENNSYLVANIA ASSOCIATION Of NOTARIE
.lAX, IkUTWI
Exhibit A
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CONFIDENTIAL
SLEBER ASSOCIATES, P. C.
LICENSED PSYCHOLOGISTS
2626 NORTH THIRD STREET,SUITE 36
HARRISBURG,PENNSYLVANIA 171 10 THOMAS L.HANSHAw,MED.
M
TELEPHONE(717)236885 ARK A.ZENGERLE,M.S.
FAX(717)236-6633
RICHARD L.SLEBER,M.A.
ALICELYN WATSON SLEBER,MPSSC
PSYCHOLOGICAL EVALUATION
Name: Diana Stanley
Evaluation Date: October 28, 2013
IDENTIFYING INFORMATION
Birth Date: August 3, 1997 Age: 16
Gender: Female Race: Caucasian
Address: 102 Hemlock Court Phone: 802-0728
Mechanicsburg, PA 17055
Mother: Louann Stanley Birth Date: 5/27/59
Father: Henry Stanley Birth Date: 11/9/54
Custody: Parents
Siblings: Breanna McCloskey, Half Sister Birth Date: 1/26/93
Hannah Stanley, Sister Birth Date: 6/19/00
Grace Stanley, Sister Birth Date: 8/5/00
School: Cumberland Valley High School Grade/Setting:
Community Systems Involved: Case Management Unit
Sources of Information: Interview with Louann Stanley
Observation of Diana Stanley
AUDIT
DAST-10
a �TIAL.
Diana Stanley Page 2
REASON FOR REFERRAL
Diana was referred for the evaluation by her mother to obtain an updated assessment.
RELEVANT INFORMATION
Client& Family Strengths:
Diana is a generally compliant youngster. Mother presents as interested and concerned.
Concerns:
Diana has a severe autistic disorder and also epilepsy. She is nonverbal and has difficulty
effectively communicating her wants and needs. She shows limited interest in interacting with
others. Seizures have resulted in her falling and hitting her head requiring stitches and knocking
her teeth out.
Family History:
The mother, Louann Stanley, has not experienced any mental health, drug, or alcohol-related
problems. The father, Henry Stanley, has had substance abuse issues for which he has received
treatment.
School/Vocational:
Diana attends Cumberland Valley High School where she is in a MDS classroom. She receives
speech, occupational, and physical therapy.
Community/Leisure:
Diana is not involved in any community-based social or recreational activities.
Peer Relationships:
Diana does not have any involvement with peers. She is nonverbal and shows little interest in
interacting with others.
Drugs&Alcohol:
Diana has not had any involvement with drugs or alcohol. The AUDIT and DAST-10 did not
indicate any difficulties with drugs or alcohol.
Medical:
Diana has been physically healthy. She has a seizure disorder. There are no significant
difficulties with eating or appetite. There are no disturbances of sleep. She is not yet fully toilet
trained.
Developmental:
Mother did not have difficulties during pregnancy although she was considered high risk because
she was over 35 years old. Diana was delivered 9 days over term via induced vaginal delivery.
Mother did not smoke cigarettes, drink alcohol, or take illicit drugs during pregnancy. She had
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Diana Stanley Page 3
an extra digit on her left hand that was surgically removed at birth. She had a poor sucking
reflex which resulted in dehydration causing her to be hospitalized at 8 or 9 days after birth. She
cried incessantly until the hospitalization and during that time seizure activity was first noted.
Her activity level as a toddler was extremely low resulting in Early Interventions Services
beginning at 6 months old. She was hospitalized approximately 6 times related to her seizures.
She walked on her own at approximately 36 months. At 18 months, she was using words such as
"ma-ma,""da-da," "my daddy," and "good girl." Her first spontaneous use of sounds
approximately words began at 5 to 6 months of age. All speech communication stopped when
she began to ambulate. She has a number of medical and physical problems which include
seizure disorders, asthma, chronic otitis, hypertonia and hypertonia of the trunks and legs.
Trauma History:
Diana has not experienced any emotional,physical, or sexual abuse. She has not witnessed any
domestic violence.
Legal:
Diana has not had any involvement with the legal system or Children& Youth Services.
Service History:
Diana began receiving Early Intervention Services when she was 6 months old. She originally
received wraparound services through New Hope which were later transferred to Cornell
Abraxas in April, 2003. Services were then transferred to Gateway Community Services on
August 1, 2005 after Cornell discontinued their BHRS Program. Services were discontinued by
mother in October, 2005 as the agency could not provide a TSS. She began receiving services
through the Youth Advocate Program in August, 2006 but later discontinued due to lack of
progress. She has also received occupational, physical or speech therapy through the
Intermediate Unit.
Service Update:
Diana is not currently receiving any mental health treatments or interventions. She receives PT,
OT and speech through the school. She is prescribed Banzel 1,000 mg. bid, Onf. 20 mg. hs, and
Lamictal 250 mg. ER am. Medication is followed by Dr. Barron.
Interviews:
An interview with the mother, Louann Stanley, indicated she is concerned Diana is regressing
and there has also been an increase in her seizures. Her seizures have caused her to fall and hit
her head requiring stitches and she has also knocked out several of her teeth. Mother has been
attempting to have medical marijuana legalized in Pennsylvania as it has been demonstrated in
studies conducted in other states to help control seizures. She has been interviewed several times
on TV and also talked to members of the legislature. There remains, however, resistance to
having it approved and she has not been able to find individuals in the medical community
willing to advocate for its use. She is strongly considering taking Diana to a state where it is
legal, but her doing so is complicated by her two others daughters being at the Milton Hershey
School. She feels that the seizures Diana is having and/or the medication she takes for them are
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Diana Stanleyr �., YI Page 4
impacting on her cognitively which is leading to the regression being seen. She expressed
considerable frustration about the situation and is concerned that if medical marijuana is ever
legalized in Pennsylvania it will be too late to help Diana. Additionally, as Diana has gotten
bigger, it is getting more and more difficult to care for her as she still needs assistance with
eating, bathing, dressing, and toileting. Diana continues to engage in considerable stimming
behaviors and still likes to hold her breath to the point that she falls down.
Diana was observed in the presence of her mother. Due to her being nonverbal, a formal mental
status could not be conducted. For most of the evaluation, she sat in a chair moving her head
from side to side. On several occasions, she began to hold her breath which necessitated mother
doing something such as blowing in her face to try to get her to stop. On one occasion, she
walked over to where the evaluator was sitting and leaned against him for a brief period of time
before returning to her chair.
DISCUSSION
Diana is a young lady with a severe autistic disorder which is further complicated by the
presence of a seizure disorder. Her seizures are not being well controlled by medication and
there have been several incidents where she has fallen and injured herself. Mother has been
advocating for the passage of a medical marijuana law in Pennsylvania as in states where it is
legal, it has been found to help with seizure control. She has met with individuals from the
legislature but has not found much support nor has she been able to find individuals in the
medical community that would support its usage. She is considering taking Diana to a state
where it is legal, but that would then affect the status of her other two daughters who are at the
Milton Hershey School. It has been several years since Diana was last seen by the evaluator, and
she does appear to be moving more and more into her own world and showing less interest in
what is going on around her. She engages in primarily stimming behaviors with her favorite
being to hold her breath which at times leads to her having a brief loss of consciousness and
falling down. While that behavior has been noted at previous evaluations in the past, she did
show somewhat more interest in what was going on around her. She is essentially totally
dependent on her mother as she cannot feed, bathe, dress, or toilet herself on her own. Mother
was not looking for any type of BHR services nor would they be warranted.
DIAGNOSIS
Axis I Autistic Disorder—299.0
Axis 11 No diagnosis
Axis III Seizure disorder
Axis IV Stressors—Inability to effectively communicate wants and needs, inability
to care for herself
Axis V GAF—40
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WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17325
(717) 339-2790
07/01/2015 1:20PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more, visit
http://mywelispan.org . Please contact our office if you have questions or concerns
about your health, or if you have not received the results of any tests within the
timeframe you were given. Thank you for allowing us to partner in your care.
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Jun 16 2015 11:15AM
Message
Jun 16,2015
Dear Dr.Richard Blutstein MD:
I had the pleasure of seeing DIANA STANLEY for a pediatric neurology follow-up on Jun 16,2015. DIANA is a
17 year-old with a nonprogressive encephalopathy associated with severe intellectual disabilities,and intractable
epilepsy.Her mother and I discussed treatment strategies and we will optimize rufenamide. She elected to replace
the vagal nerve stimulator as it now has a form of seizure detection.We also spent a good amount of time discussing
transition planning.We'll repeat an ambulatory EEG. I will see her back in 3 months.Mother was in agreement with
this plan.
Please see the details of her visit below.
Thank you for allowing me to share in DIANA's care.
Sincerely yours
Todd Barron.
Assessment
•Peripheral neurostimulator
Mental retardation(319)(F79).
Seizure disorder(345.90)(G40.909).
Orders
Renew Banzel 400 MG Oral Tablet;TAKE 4 TABLET Every twelve hours;Qty240;R5;Rx.
Renew ClonazePAM 0.5 MG Oral Tablet;TAKE 1 TABLET AS NEEDED for cluster of seizures;Qtyl5;R5;Rx.
Renew Diazepam 20 MG Rectal GeI;DIALED(a7 15MG;USED RECTALLY PRN FOR PROLONGED
SEIZURES;Qty/;R5;Rx.
Discontinue C1oNIDine HCl_0.2 MG Oral Tablet(Catapres).
We have streamlined her medication such that she is currently only on rufenamide.You stopped the alternative
medication that you're providing.I would hold off on starting anything else that his alternative or complementary.
Let's optimize the rufenamide as follows:
6/16-20:3 tablets the morning, 4 tablets at bedtime
Please go to www.mywellspan.org to enroll in our portal and gain access to your lab results,X-Ray reports,and medical records.
r
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717) 339-2790
07/01/2015 1 :20PM
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Jun 16.2015 11:15AM
6/21 and after:4 tablets twice daily
If that is ineffective,we can consider lacosamide.This is a well-tolerated medication.Main side effects can be
drowsiness,fatigue and rarely behavioral changes.Also,you expressed interest in now replacing the vagal nerve
stimulator with the newer model that has a form of seizure detection.I will make referral to neurosurgery.
Let's plan on speaking 3-4 weeks from now.Contact me in the interim if she has side effects or symptoms worsen.
I would apply to the scabs on her face some topical antibiotic.
REFERRAL NEUROSURGERY;Requested for: 16 Jun 2015.
Coun/Edu
The current visit lasted approximately 45 minutes of which 30 minutes of the visit was spent on counseling,
coordination of care and/or education.Review management for managing her seizures as well as transition planning.
Mother reports that she will be obtaining guardianship.
Chief Complaint
-DIANA is a 17 year old female here for a follow up
Team Notes
The medication list was verified/clarified with the caregiver
This process revealed the following med changes/discrepancies: None
She reports the following as potential medication side effects: None.
Other visits/testing since last appointment:None
Patient does have a PCP
Patient does have an appointment with their PCP.
Above recorded by Jaimie Brown,MA.
HPI
The patient is a 17-year-old ambidextrous girl with a history of the following problems:
1. Intellectual disabilities with recent genetic testing revealing a deletion on 1 q. Previous workup had been
negative including MR imaging and as I recall,metabolic studies and karyotype.
2. Growth hormone-deficiency currently receiving replacement therapy
3. Aerophagia
4. Intractable epilepsy with previous treatments including phenobarbital,phenytoin,oxcarbazepine,carbamazepine,
valproic acid,lamotrigine,clobazam and vagal nerve stimulation,clobazam and levitiracetam. Currently,she is on a
combination on rufenamide monotherapy
Since her last evaluation,her mother discontinued the cannabadiol formulation that she was providing. She felt that
this increased the patient's seizures.We successfully tapered her other meds her seizure medications and she
remains on rufenamide alone.Mother tried to decrease the rufenamide and there was a marked increase in her a
tonic episodes.In fact,she knocked out a number of teeth.Her mother wanted to discuss other treatment strategies
today.In addition,mother and I elected to.discuss som a transition planning concepts.
PSH
Install Percutaneous Neurostimulator For Vagal Nerve.
Allergies .
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717) 339-2790
07/01/2015 1 :20 P M
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Jun 16 2015 11:15AM
No Known Drug Allergies.
Current Meds
Loratadine 10 MG Oral Tablet;TAKE 1 TABLET DAILY AS NEEDED.;RPT
Nasonex 50 MCG/ACT Nasal Suspension,-USE 2 SPRAYS IN EACH NOSTRIL ONCE DAILY AS NEEDED;
RPT
CVS Gas Relief 125 MG Oral Capsule;;RPT
CVS Ranitidine 75 MG Oral Tablet;TAKE ONE TABLET TWICE DAILY;RPT
CVS Glycerin Adult 2 GM Rectal Suppository;;RPT
Diazepam 20 MG Rectal Gel;DIALED P,, 15MG;USED RECTALLY PRN FOR PROLONGED SEIZURES;Rx
Banzel 400 MG Oral Tablet;TAKE 2&1/2 TABLETS TWICE DAILY;Rx
ClonazePAM 0.5 MG Oral Tablet;TAKE 1 TABLET AS NEEDED for cluster of seizures;Rx
C1oNIDine HCl-0.2 MG Oral Tablet(Catapres);TAKE 1 TABLET DAILY AT BEDTIME.;Rx
Pravastatin Sodium 20 MG Oral Tablet;;RPT.
Personal Hz
Never smoked.
Family Hz
Type 2 Diabetes Mellitus.
ROS
BEYOND WHAT MAY BE MENTIONED IN HPI:
GENERAL: Denies any problems within category.
EYES: Denies any problems within category.
EARS/NOSE/THROAT: Denies any problems within category.
RESPIRATORY: Denies any problems within category.
CARDIAC: Denies any problems within category.
MUSCULOSKELETAL: Denies any problems within category.
GASTROINTESTINAL: Denies any problems within category.
PSYCHOLOGICAL: Denies any problems within category.
NEUROLOGICAL:
drop seizures
ENDOCRINE: Denies any problems within category.
GENITOURINARY: Denies any problems within category.
HEMATOLOGIC/LYMPHATIC: Denies any problems within category.
Vital Signs
Adult Vitals Recorded by Brown,Jaimie on June 16,2015 11:08 AM
Height: 155.40 cm,Weight:43.14 kg,BMI: 17.87,BSA: 1.38 ;BMI Percentile 8%;2-20 Weight Percentile 1
%;2-20 Stature Percentile 12%
Physical Exam
On examination,she was alert. She tendency to arch her back. She continues to have aerophagia. Vital signs are
noted above.
HEENT examination was remarkable for loss of her medial and lateral incisors. She had an area of scabbing
involving the upper lip and frenulum.Neck was supple without thyromegaly.Lungs examination revealed clear
breath sounds.Cardiac rhythm is regular without murmurs,gallops or rubs. Abdomen was soft,nontender mildly
4
WeIlSpan Neurology- Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717) 339-2790
07/01/2015 1 :20PM
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Jun 16 2015 11:15AM
distended from the aerophagia.There was no vertebral tenderness. She tends to have a lordosis.Extremity
examination revealed no clubbing,cyanosis or edema. She was well perfused.
On neurological examination,she is an event intellectual disabilities.Eye contact was minimal. She does not follow
directions. She is nonverbal.
Crown her cereal pupils are equal and reactive.I could not assess visual fields I could not visualize fundi.Ductions
are.It tasted. Grimace was symmetric.Tongue was midline.
On motor examination, she diffuse hypotonia. She moved all 4 extremities symmetrically against gravity.There
were no abnormal motor movements. She would not reach for objects.There was no titubation.Reflexes were
difficult to elicit as she was not cooperative.Gait was minimally wide-based and she walked with a lordotic posture.
Postural stability was diminished.
During the visit,she may of had 2 or 3 drops have seizures which she simply falls back for a second or 2.
Active Problems
High cholesterol(272.0)(E78.0).
Signature
Electronically signed by: Todd F Barron NO;06/16/2015 12:05 PM EST.
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17325
(717) 339-2790
07/01/2015 1:21 PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more, visit
http://mywellspan.org . Please contact our office if you have questions or concerns
about-.your health, or if you have not received the results of any tests within the
timeframe you were given. Thank you for allowing us to partner in your care.
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: .Dec 16 2014 10:45AM
Message
Dec 16,2014
Dear Dr.Richard Blutstein MD:
I had the pleasure of seeing DIANA STANLEY for a pediatric neurology follow-up on Dec 16,2014. DIANA is a
17 year-old with a nonprogressive encephalopathy secondary to a chromosomal anomaly associated with intellectual
disabilities and refractory epilepsy.Mother has taper number of her medications as she is getting any CBD
preparation until she is doing better.I cannot disagree.We discussed some long-term planning issues during the
visit.I will see her back in 6 months
Please see the details of her visit below.
Thank you for allowing me to share in DIANA's care.
Sincerely yours
Todd Barron.
Assessment
Mental retardation(319)(F79).
Aerophagia(306.4)(F45.8).
Seizure disorder(345.90)(G40.909).
Orders
Renew ClonazePAM 0.5 MG Oral Tablet;I-tablets po,pm cluster of seizures;Qty15;R2;Rx.
Renew LamoTRIgine 100 MG Oral Tablet;TAKE 1/2 TABLET DAILY;Qty60;R0;Rx.
Renew CloNIDine HCl-0.1 MG Oral Tablet;TAKE 1 TABLET BEDTIME or as directed-,Qty30;R5;Rx.
Examination today was unchanged.We discussed the aerophagia and unfortunately,Cypher behavioral management
techniques and using simethicone to diminish bowel gas,there are no effect of therapies.I am pleased that her
seizures are under better control with the CBD preparation you're using.Unfortunately,neither of us can speculate
on the concentration.You will be changing preparations in January.Please let us know what exactly you will be
giving her at that time. Since she is doing well,I would agree with the discontinuation of lamotrigine at the end of
the month Please continue the rufenamide. Please contact the Hershey Medical Center and have her previous EEGs
sent to me for our records.I will see her back in 6 months or sooner should problems arise.
Please continue to follow good seizure safety guidelines. She should not sit in a bathtub by herself,go swimming
unobserved or alone. Care should be taken in the bathroom and in the kitchen.
Please go to www.mywellspan.org to enroll in our portal and gain access to your lab results,X-Ray reports,and medical records.
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717).339-2790
07/01/2015 1:21 PM
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Dec 16 2014 10:45AM
Coun/Edu
The current visit lasted approximately 30 minutes of which 20 minutes of the visit was spent on counseling,
coordination of care and/or education.
Chief Complaint
•DIANA is a 17 year old female here for a follow up
Team Notes
The medication list was verified/clarified with the caregiver based on provided med list.
This process revealed the following med changes/discrepancies: None
She reports the following as potential medication side effects: None.
Other visits/testing since last appointment:None
—Above recorded by Jaimie Brown,MA.
HPI
The patient is a 17-year-old ambidextrous girl with a history of the following problems:
1. Intellectual disabilities with recent genetic testing revealing a deletion on Iq. Previous workup had been
negative including MR imaging and as I recall,metabolic studies and karyotype.
2. Growth hormone deficiency currently receiving replacement therapy
3. Aerophagia
4. Intractable epilepsy with previous treatments including phenobarbital,phenytoin,oxcarbazepine,carbamazepine,
valproic acid,lamotrigine,clobazam and vagal nerve stimulation and levitiracetam. Currently,she is on a
combination of rufenamide,lamotrigine and CBD
Since her last evaluation,mother and I will have been on the phone a number of times. She tapered and discontinued
the clobazam. She is currently tapering the lamotrigine and is only on 50 mg daily.Mother is using a different
CBD/THC preparation. She is unsure of the ratio with concentration. She will be switching preparations in January
and she is getting up from a different supplier and she will no better the content.Despite this,mother feels her
seizures have decreased substantially.Previously,she had to 3 seizures weekly.Mother reports seizures now only
once monthly around the "full moon." She can have up to 3 seizures a each lasting less than 3 minutes.These are
generalized events with eye deviation to the left.Her most recent EEG showed generalized slowing.Mother reports
no obvious side effects from the current combination of medications and supplements.Mother feels with the
introduction of this particular preparation of CBD,the patient is more alert and makes better eye contact.
Mother had some questions about transitioning we spent a good part of the visit discussing the transition planning.
PSH
Install Percutaneous Neurostimulator For Vagal Nerve.
Allergies
No Known Drug Allergies.
Current Meds
Loratadine 10 MG Oral Tablet;TAKE 1 TABLET DAILY AS NEEDED.;RPT
Melatonin 3 MG Oral Capsule;take 1-3 mg as needed;RPT
Nasonex 50 MCG/ACT Nasal Suspension;USE 2 SPRAYS IN EACH NOSTRIL ONCE DAILY AS NEEDED;
RPT
CVS Gas Relief 125 MG Oral Capsule,;RPT
CVS Ranitidine 75 MG Oral Tablet;TAKE ONE TABLET TWICE DAILY;RPT
CVS Glycerin Adult 2 GM Rectal Suppository;;RPT
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717) 339-2790
07/01/2015 1:21 PM
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Dec 16 2014 10:45AM
ClonazePAM 0.5 MG Oral Tablet;/-tablets po,prn cluster of seizures.;Rx
Alternative Med NOS";Medical marijuana-high CBD content- l0mg/mllml tid;RPT
Banzel 400 MG Oral Tablet;TAKE 2&1/2 TABLETS TWICE DAILY;Rx
CloNIDine HCl-0.1 MG Oral Tablet;TAKE 1 TABLET BEDTIME or as directed;Rx
Diazepam 20 MG Rectal Ge1;DIALED(cry, 15MG;USED RECTALLY PRN FOR PROLONGED SEIZURES;Rx
LamoTRIgine 100 MG Oral Tablet;TAKE 1/2 TABLET DAILY.;RPT.
Personal Hx
No changes reported.
Family Hx
Type 2 Diabetes Mellitus.
ROS
BEYOND WHAT MAY BE MENTIONED IN HPI:
GENERAL: Denies any problems within category.
EYES: Denies any problems within category.
EARS/NOSE/THROAT: Denies any problems within category.
RESPIRATORY: Denies any problems within category.
CARDIAC: Denies any problems within category.
MUSCULOSKELETAL: Denies any problems within category.
GASTROINTESTINAL: Denies any problems within category.
PSYCHOLOGICAL: Denies any problems within category.
NEUROLOGICAL:
minimal seizure activity.
ENDOCRINE: Denies any problems within category.
GENITOURINARY: Denies any problems within category.
HEMATOLOGIC/LYMPHATIC: Denies any problems within category.
Vital Signs
Adult Vitals Recorded by Brown,7aimie on December 16,2014 10:49 AM
Height: 154.89 cm,Weight:40.88 kg,BMI: 17.04,BSA: 1.35 ;2-20 Stature Percentile 11 %;2-20 Weight
Percentile 1 %;BMI Percentile 3%
BP: 102/68 mmHg LUE Sitting
Physical Exam
On examination,she was alert. She demonstrated significant aerophagia.Vital signs are noted above.
HEENT examination is remarkable for fractured medial incisors.Neck was supple.Lungs are clear to auscultation.
Cardiac rhythm is regular without murmurs,gallops or rubs.Abdomen was soft,nontender.It was quite protuberant
secondary to all the air swallowing.There was no vertebral tenderness.Extremity examination revealed full range of
motion there was no clubbing,cyanosis or edema. She was well perfused.
On neurological examination,she was alert. She is profound intellectual disabilities.Cranial nerves 2 through 12
were intact. Is unable to visualize fundi.I was unable to assess visual fields due to her lack of cooperation.
On motor examination,she normal truncal tone.Appendicular tone was appropriate. She is'not cooperative for
formal strength testing but moved all 4 extremities symmetrically against gravity. There were no abnormal motor
f
WeIlSpan Neurology - Gettysburg
WeIlSpan Adams Health Center 40 V Twin Drive, Ste 205
Gettysburg, PA 17403
(717) 339-2790
07/01/2015 1:21 PM
Patient DIANA STANLEY
MRN 000932682
Birth Date 08/03/1997
Encounter: Dec 16 2014 10:45AM
movements. I could not could reach for objects. There was no titubation Gait was narrow based. She maintains a
somewhat lordotic posture.Postural stability was appropriate.
Signature
Electronically signed by :Todd F Barron NO; 12/16/2014 11:53 AM EST.
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