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HomeMy WebLinkAbout05-3732 Kenneth A. Wise, Esq, Attorney I.D. No. 16142 Barbara G. Graybill Attorney I.D. No, 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108,1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: DS-37Jd {!tu'lt-r8UY/ v. Manor Care, Inc., Health Care And Retirement Corporation of America, HCR ManorCare, the Nightingale Nursing Home, Inc., D/B/A ManorCare Health Services Camp Hill HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM Defendants JURY TRIAL DEMANDED PRAECIPE FOR A WRIT OF SUMMONS TO THE PROTHONOTARY: Please issue a writ of summons on the above-named Defendants, to wit: 1. Manor Care, Inc., 1700 Market Street, Camp Hill, Pennsylvania 17011. 2. Health Care And Retirement Corporation of America, 1700 Market Street, Camp Hill, Pennsylvania 17011. 3. HCR ManorCare, 1700 Market Street, Camp Hill, Pennsylvania 17011, 4. The Nightingale Nursing Home, Inc., D/B/A Manor Care Health Services Camp Hill, 1700 Market Street, Camp Hill, Pennsylvania 17011, Respectfully submitted, Date: 12- JiJ/vJ 1(-' / !/ ~0 YjJt-h /";/..,f1-1 KENNETH A. WI E, ESQUIRE Attorney I.D. No. 16142 Graybill & Wise, P,C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs ~ -k!,. 19 fh, ~ ~ ~ ' ~ - ......... V f:: ;::; ~ w -.0 b ~ .;L- -L ..............- ~\ ~ ';-;::'~ "" N -:-; f''"'-> .' /' ~ u~ - Kenneth A. Wise, Esq. Attorney 1.0. No. 16142 Barbara G. Graybill Attorney 1.0. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: dK'- 3732 (!;u,'L 1<e:a."1 v. Manor Care, Inc., Health Care And Retirement Corporation of America, HCR ManorCare, the Nightingale Nursing Home, Inc., D/B/A ManorCare Health Services Camp Hill HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM Defendants JURY TRIAL DEMANDED WRIT OF SUMMONS TO THE FOLLOWING NAMED DEFENDANTS, TO WIT: 1. Manor Care, Inc., 1700 Market Street, Camp Hill, Pennsylvania 17011. 2. Health Care And Retirement Corporation of America, 1700 Market Street, Camp Hill, Pennsylvania 17011. 3. HCR ManorCare, 1700 Market Street, Camp Hill, Pennsylvania 17011, \ 4. The Nightingale ~ing Home, Inc., D/B/A Manor Care Health Services Camp Hill, 1700 Market Street, Camp Hill, Pennsylvania 17011. You are hereby notified that Elizabeth Carr and Terri Doutrich have commenced an action against you. 0JA:zS2k~ Protho ry Date: 7/::J .;l. / OS / I B~ ho~c P~;l/rc../ Deputy Prothonotary ORIGINAL IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ELIZABETH CARR, TERRI DOUTRICH, Plaintiffs CIVIL ACTION - LAW v. NO: 05-3732 MANOR CARE, INC., HEALTH CARE AND RETIREMENT CORPORATION OF AMERICA, HCR MANORCARE, THE NIGHTINGALE NURSING HOME, INC., d/b/a MANORCARE HEALTH SERVICE - CAMP HILL, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM Defendants JURY TRIAL DEMANDED ENTRY OF APPEARANCE Kindly enter our appearance on behalf of Defendants, Manor Care, Inc., Health Care And Retirement Corporation of America, HCR ManorCare, the Nightingale Nursing Home, Inc., d/b/a ManorCare Health Services - Camp Hill, in the above-captioned. Respectfully submitted, McKissock & Hoffman, P.C. By: /e? Edwin A.D, Sch Esquire 1.0. No.: 75902 William J. Mundy, Esquire 1.0. No,: 57679 Lauren G. Marshall, Esquire 1.0. No.: 92412 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Dated: ~2'7"""'( Attorneys for Defendants, Manor Care, Inc., Health Care And Retirement Corporation of America, HCR ManorCare, the Nightingale Nursing Home, Inc., d/b/a ManorCare Health Services - Camp Hill CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing Entry of Appearance upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Kenneth Wise, Esquire Graybill & Wise, P,C, 126 Locust Street P.Q, Box 11489 Harrisburg, PA 17108-1489 (Counsel for Plaintiffs) McKissock & Hoffman, P.C. By: Edwin A.D, Schwartz, /.D. No,: 75902 William J. Mundy, Esquire 1.0. No.: 57679 Lauren G. Marshall, Esquire 1.0. No.: 92412 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Dated: ~~",..{"s: Attorneys for Defendants, Manor Care, Inc., Health Care And Retirement Corporation of America, HCR ManorCare, the Nightingale Nursing Home, Inc., d/b/a ManorCare Health Services - Camp Hill 0 ..., = CJ c--: = "" en -::~ -t c: :r: ..,-, (,"") n1 p: y....) "TJiTi ,0 i{~ ~~~ ~ \--''''1 ....."... ,--) (') C',';"- ( .~ r'" = ,--, ..._1 a <<:....,. .A. -. -< SHERIFF'S RETURN - REGULAR CASE NO: 2005-03732 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CARR ELIZABETH ET AL VS MANOR CARE INC ET AL ROBERT BITNER Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon MANOR CARE INC the DEFENDANT , at 0014:00 HOURS, on the 12th day of August , 2005 at 1700 MARKET STREET CAMP HILL, PA 17011 by handing to HELEN MALONEY (ADMIN.) a true and attested copy of WRIT OF SUMMONS together with PREACIPE FOR WRIT OF SUMMONS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 12.00 .00 10.00 ,00 40.00 r~~? , R. Thomas Kline Sworn and Subscribed to before me this .13-fU> day of A~S/ ~A.D. (J';i!"JJ;'J 08/15/2005 GRAYBILL & WISE BY:~~~ eputy Sheriff SHERIFF'S RETURN - REGULAR CASE NO: 2005-03732 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CARR ELIZABETH ET AL VS MANOR CARE INC ET AL ROBERT BITNER , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon HEALTH CARE AND RETIREMENT CORPORATION OF AMERICA the DEFENDANT , at 0014:00 HOURS, on the 12th day of August 2005 at 1700 MARKET STREET CAMP HILL, PA 17011 by handing to HELEN MALONEY (ADMIN.) a true and attested copy of WRIT OF SUMMONS together with PREACIPE FOR WRIT OF SUMMONS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 .00 .00 10.00 .00 16.00 So Answers: ~~~e R. Thomas Kline 08/15/2005 GRAYBILL & Sworn and Subscribed to before me this ~3f(p day of iW'/J~r ~(.>t5 A.D, ~~9 By: WISE ~cJ~J-- h:;b De uty Sheriff SHERIFF'S RETURN - REGULAR CASE NO: 2005-03732 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CARR ELIZABETH ET AL VS MANOR CARE INC ET AL ROBERT BITNER Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon HCR MANOR CARE the DEFENDANT , at 0014:00 HOURS, on the 12th day of August , 2005 at 1700 MARKET STREET CAMP HILL, PA 17011 by handing to HELEN MALONEY (ADMIN.) a true and attested copy of WRIT OF SUMMONS together with PREACIPE FOR WRIT OF SUMMONS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 6.00 .00 .00 10.00 .00 16.00 .~~~~ R, Thomas Kline 08/15/2005 GRAYBILL & WISE Sworn and Subscribed to before me this ~c3~ day of A~~'Ig;#;D rotho ary BY~4-~ ~ " - C=::>\. {.fA Deputy sheri\'1 SHERIFF'S RETURN - REGULAR CASE NO: 2005-03732 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CARR ELIZABETH ET AL VS MANOR CARE INC ET AL ROBERT BITNER , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon NIGHTINGALE NURSING HOME INC THE DBA MANOR CARE HEALTH SVCS the DEFENDANT , at 0014:00 HOURS, on the 12th day of August 2005 at 1700 MARKET STREET CAMP HILL, PA 17011 by handing to HELEN MALONEY (ADMIN.) a true and attested copy of WRIT OF SUMMONS together with PREACIPE FOR WRIT OF SUMMONS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 .00 .00 10.00 .00 16.00 So Answers: -~~~ R. Thomas Kline 08/15/2005 GRAYBILL & WISE Sworn and Subscribed to before me this 43/U> day of By: ~ c' Deputy Sheriff A.D. MCKISSOCK & HOFFMAN, P.C, BY: William J. Mundy Identification No. 57679 BY: Maria R. Granaudo Identification No, 80609 1818 Market Street, 13th Floor Philadelphia, PA 19103 (2 I 5)246,2100 Attomey for Defendants ELIZABETH CARR, TERRI DOUTRICH, CNIL ACTION - LAW Plaintiffs NO: 05-3732 II. MANOR CARE, INC" HEALTH CARE AND RETIREMENT CORPORATION OF AMERICA, HCR MANORCARE, THE NIGHTINGALE NURSING HOME, INe., d/b/a MANORCARE HEALTH SERVICE- CAMP HilL, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants PRAECIPE TO FILE COMPLAINT TO THE PROTHONOTARY: Please enter a Rule upon plaintiff to file a Complaint within twenty (20) days hereof or suffer the entry of a Judgment of Non Pros. BY: William J, Mundy, Esquire Maria R. Granaudo, Esquire RULE TO FILE COMPLAINT AND NOW, this 17R day of Cx::t- ,2005, a Rule is hereby granted upon plaintiff to file a Complaint herein within twenty (20) days after service hereof of suffer the entry of a Judgment of Non Pros. CERTIFICATE OF SERVICE I, MARIA R. GRANAUDO, ESQUIRE, hereby certify that a true and correct copy of defendants' Praecipe to Pile Complaint with Rule, has been served upon the following parties by United States mail, first class, postage pre-paid, on this I:lK day of October, 2005: Kenneth Wise, Esquire 126 Locust Street P.O. Box 11489 Harrisburg, PA 17108-1489 By: Maria R. Granaudo, Esquire ~...! 1<) (,....) ,',.'-' ,;-'\ o , (n,) ,,':\-\ :::-J II: .._~ ;;-\ I'} (.)l Barbara G, Graybill Attorney J.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: 06- r.313;).. v. MANORCARE HEALTH SERVICES, INC" D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attomey and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that 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 other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you, YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. PENNSYLVANIA LAWYER REFERRAL SERVICE Pennsylvania Bar Association P.O, Box 186 Harrisburg, PA 17108 (800) 692-7375 Barbara G, Graybill Attorney I.D, No. 39859 Graybill & Wise, P.C, 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: {J$. 31J d" v. MANORCARE HEALTH SERVICES, INC" D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANOR CARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants COMPLAINT AND NOW COMES, Plaintiffs, by their undersigned attorney, and respectfully bring this Complaint at law, setting forth in support thereof as follows: 1. Plaintiff Elizabeth Carr is an adult woman domiciled in Camp Hill, Pennsylvania, and currently residing in the Masonic Home, Elizabethtown, Pennsylvania, 2. Plaintiff Terri Doutrich is the daughter of Plaintiff Elizabeth Carr and resides in Mechanicsburg, Pennsylvania, 3. Defendant Manor Care Camp Hill (hereinafter Defendant Facility) is a licensed health care provider for nursing services located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 4. Defendant ManorCare, Inc. also know as HCR ManorCare (hereinafter Corporate Defendant) owns, operates, manages andllor controls ManorCare Camp Hill. It has a corporate office at 333 North Summit Street, P. 0, Box 10086, Toledo, Ohio 43699. 0086, 5, Defendant Facility is engaged in the business of providing nursing home services as a health care provider licensed by the Commonwealth of Pennsylvania. 6, Defendants jointly maintain oversight and control for the operation and management of Defendant Facility, including but not limited to: A Ownership and management of the physical plant; B, Establishing policies and procedures for hiring, training, supervising and retaining staff; C. Controlling contractual obligations of Defendant Facility with regard to the hiring, oversight and retention of the Medical Director and other ancillary providers; D, Establishing and implementing care policies and procedures for residents; E. Appointment of a governing board and administrator for Defendant Facility; F, Financial management of the facility regarding funds, indebtedness, operating capital, and operating budget of Defendant Facility; and G. Compliance with applicable laws, regulations, and, where applicable, appropriate accreditation standards. 2 7, Defendant Facility is a licensed health care provider with offices in Cumberland County, Pennsylvania. Plaintiffs are asserting a professional liability claim against this Defendant. S, Because of their joint responsibility for the operations at Defendant Facility, Defendants are also liable for the negligent and/or reckless acts of staff at Defendant Facility. 9. Defendant Facility holds itself out to be a health care provider, which purports to possess skill and knowledge in the field of nursing home care and holds itself out to the public as so qualified, As such, Defendant, through its agents and employees, holds itself out as being capable of providing nursing services under the direction of a medical director, holds itself out to be properly staffed and able to meet the needs of Elizabeth Carr and others like her, and further holds itself out as complying on a continual basis with all the rules and regulations applicable to licensed nursing facilities. 10. On August 13, 2003, Elizabeth Carr was discharged from Holy Spirit Hospital, Camp Hill, to Defendant Facility, Her admitting diagnoses were: right gluteal hematoma, COPD, history of deep vein thrombosis, right leg pain, confusion and gastrointestinal bleed, 11, On August 13, 2003, at 2:30 p.m., Defendant Facility staff noted on Plaintiff Carr's admission assessment that she had allergies to Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics, 12, On Thursday, August 14, 2003, Defendant Facility therapy notes that Plaintiff Carr was unable to respond as she was very sleepy, 3 13. Plaintiff Carr was receiving two doses daily of Seroquel25 mg., a drug to treat hallucinations. 14. Plaintiff Carr exhibited no hallucinations during the time she was at Defendant Facility. 15. Plaintiff Carr was non-responsive during her entire stay at Defendant Facility, sleeping constantly, 16, Due to her non-responsive status, Plaintiff Carr was unable to eat or drink, 17. Defendant Facility records have no documentation regarding the admission or discharge weight of Plaintiff Carr, 18, Plaintiff Terri Doutrich visited Plaintiff Carr several times each day during Plaintiff Carr's stay at Defendant Facility, each time finding her mother asleep. 19. On many occasions while Plaintiff Doutrich visited, a meal tray was brought into Plaintiff Carr's room, placed on a table, then removed after approximately 30 minutes, The food was never served to Plaintiff Carr, nor did any staff question why Plaintiff Carr left the tray untouched. 20. Plaintiff Doutrich complained to Defendant Facility each time meal service was provided in this manner, and expressed concern over her mother's constant sleeping, 21. On or about August 18, 2003, Plaintiff Doutrich requested that the facility discontinue the Seroquel because she was concerned that the drug was the cause of her mother's non-responsiveness, 22. At the next visit following this request, Plaintiff Carr was still being given Seroquel. 23.At that time, Plaintiff Doutrich sought out the Defendant Facility's physician, who was present in the building, and asked why Seroquel was still being administered, The 4 physician responded that he had not been advised of the request to discontinue the Seroquel. He immediately wrote an order to discontinue the Seroquel. 24, On her subsequent visit to her mother, Plaintiff Doutrich found that her mother was still being given Seroquel despite the physician order to discontinue it. Plaintiff Doutrich advised Defendant Facility staff that the medication should have been discontinued via a written order by the physician, but in fact had not been discontinued to be administered by the staff, 25, Following this medication error, Thomas VonNeda, son of Plaintiff Carr, visited Plaintiff Carr and found the Defendant Facility Staff ready to administer the Seroquel. The medication administration record of Defendant Facility shows that the Seroquel was administered at 5 p.m. on August 19, 2003. 26, On Tuesday, August 19, 2003, Plaintiff Carr's temperature became elevated. The nursing notes indicate that Tylenol was given for general discomfort and that Plaintiff Carr's appetite was poor and she had poor fluid intake. 27. When Plaintiff Doutrich visited on Tuesday, August 19, 2003, Plaintiff Carr was still non-responsive, Defendant Facility obtained a telephone order at that time to discontinue the Seroquel, despite the physician having earlier discontinued the medication, 28. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then 5 complained to Defendant Facility staff. No explanation for the status of this nudity and violation of personal dignity was forthcoming from the Defendant Facility staff. 29, On Tuesday, August 19, 2003, Plaintiff Carr was transferred from Defendant Facility to Harrisburg Hospital. 30. Upon admission to Harrisburg Hospital, the Emergency Department immediately administered Narcan to Plaintiff Carr due to her unresponsiveness. 31. Narcan is an antidote for opiate drugs, none of which were prescribed for Plaintiff Carr. 32, Narcan is not an antidote for Seroquel. 33. Plaintiff Carr responded to the Narcan, 34. Plaintiffs believe, and therefore aver, that Plaintiff Carr was administered opiate drugs by Defendant Facility without physician authorization, 35. Based upon Plaintiff Carr's poor food and nutrition intake, Defendant Facility should have known that Plaintiff Carr was at risk for dehydration, malnutrition, weight loss, skin breakdown and decubitus ulcers. 36. Despite this, Defendant Facility did not implement appropriate measures to ensure Plaintiff Carr did not become dehydrated, malnourished, or suffer from decubitus ulcers, 37. Additionally, to the extent Defendant Facility did monitor Plaintiff Carr's fluid and meal intake, documentation reveals that her fluid and meal intake were often inadequate. 38. Defendant Facility failed to properly assess Plaintiff Carr, failed to notify the physician of changes in Plaintiff Carr's status, and failed to provide basic care including food and hydration to Plaintiff Carr. 6 39. Defendant Facility failed to protect Plaintiff Carr from the unlawful and dangerous administration of narcotic drugs, which drugs had not been ordered for Plaintiff Carr and which Plaintiff Carr could not tolerate, 40. Defendant Facility failed to protect rights of Plaintiff Carr to a dignified existence in a safe environment. 41. Defendant Facility allowed Plaintiff Carr to lie naked and exposed for long periods of time, in violation of her dignity, rights, and basic care needs, 42. The amount claimed herein is in excess of the amount for compulsory arbitration for Cumberland County, COUNT I - NEGLIGENCE PLAINTIFF v. DEFENDANTS 43. Paragraphs 1-42 above are incorporated by reference herein. 44. By granting admission to Plaintiff Carr, Defendants voluntarily undertook a duty, as a licensed nursing facility and operators/managers of that facility, to provide Plaintiff Carr with adequate nursing facility care that met the minimum standards for such licensed nursing facility care. As part of this duty, Defendant had the duty to provide nursing services; to arrange for and monitor medical care; to hire and retain sufficient numbers of nursing personnel staff or sufficiently trained staff; to properly supervise or oversee the activities of staff members, including the medical director and/or physician retained to be responsible as medical director of the facility; and to assist all residents, including Plaintiff Carr, to attain and maintain the highest level of physical, mental, and psychosocial well-being. 7 45, Defendants, through agents, servants, and employees, breached the standard of care due to Plaintiff Carr for reasons including but not limited to the following: A. Despite the knowledge that Plaintiff Carr was at risk for altered nutritional status and weight loss, and despite Plaintiff Carr's significant weight loss during the period she was confined at Defendant Facility, Defendant Facility did not implement adequate and appropriate interventions to prevent such altered nutritional status and weight loss, S. Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr, C. Defendant Facility failed to notify, document and follow physician orders to discontinue Seroquel. D, Defendant Facility failed to protect the dignity of Plaintiff Carr. E. Defendant Facility caused Plaintiff Doutrich emotional distress upon finding her mother naked and exposed without blankets or clothes to protect her. F. Defendant Facility permitted the unlawful administration of opiate medications to Plaintiff Carr that were contraindicated and were not ordered by a physician, G. Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery, 46, The above negligent acts were not merely isolated instances but were a continuous course of conduct throughout Plaintiff Carr's stay of repeated negligent acts and omissions, 8 47, The above negligent acts were not the result of anyone individual but were a result of operational policies, procedures and practices carried out with full knowledge of Defendants, 48. The Defendants' deliberate failure in the face of obvious signs and acceptable standards of care, resulted in a high risk of physical harm and actual harm to Plaintiff Carr, who was in a feeble and frail condition, and further showed reckless indifference to her needs, rights, and requirements that Defendants purported to be able to meet. 49. Defendants knew or should have known that such conduct would result in harm to Plaintiff Carr. 50. Defendants' negligent and/or reckless acts and omissions violated 28 Pa. Code 9201,1 et seq, , 42 C,F.R. 9483 et seq. and 42 U.S.C. 9 1396r, 51, As a direct result of Defendants' failure to provide care to Plaintiff Carr in accordance with acceptable standards of care during the period from August 13 through August 19, 2003, Plaintiff Carr experienced needless pain, suffering, emotional distress, humiliation, and loss of enjoyment of life. 52. As a direct result of Defendants' failure to act on Plaintiff Carr's behalf, Plaintiff Carr was deprived of timely access to appropriate care. 53, As a direct result of Defendants' failure to provide accurate information regarding the status of Plaintiff Carr to Plaintiffs, Plaintiffs were deprived of the opportunity to secure such necessary care from any other source, 54. As a direct result of Defendants' failure to meet the basic needs of Plaintiff Carr, failure to provide care in accordance with established protocols and physician's orders, Plaintiff Carr's life was diminished in both quality and time. 9 WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania, COUNT" - NEGLIGENCE CORPORATE LIABILITY Plaintiffs v. Defendants 55. Paragraphs 1-54 are incorporated herein by reference. 56, At all times pertinent hereto, Defendants were acting in a corporate capacity in undertaking to provide care for Plaintiff Carr, through its management, through its staff, and its employees, agents and servants. 57. Defendant Facility is under the direction and control of the other Defendants. 58. Defendant Facility, as a total health care facility, is responsible for controlling and providing its physical plant, the services of a medical director, the administrator, nursing services, social services, dietary services, and such other services, including laboratory and ancillary services, in accordance with its obligation as a licensed health care provider of nursing facility services in the Commonwealth of Pennsylvania, 59. Services by other health care providers to residents of the Defendants' facility can only be provided on the premises to residents at the direction of Defendants, or in accordance with written agreements between such providers and Defendants; to Defendants retain the ultimate responsibility for any and all nursing, residential, and ancillary services provided to any resident, including Plaintiff Carr. 60. At the time of admission, Defendants assigned Plaintiff Carr to the care of the medical director or attending physician of Defendant Facility. 61, The Medical Director of the Defendant Facility, while individually licensed as a physician by the Commonwealth of Pennsylvania, is nevertheless responsible, by virtue of a written agreement with Defendants and by virtue of the applicable facility licensing and certification regulations, as an agent of Defendants. 62. The Medical Director of the Defendants' Facility is responsible, by virtue of the written agreement with Defendants and by virtue of the applicable licensing and certification regulations, to oversee the development and implementation of medical policies and procedures to be observed in the facility and by all attending physicians in Defendants' Facility, 63. The ultimate responsibility for Plaintiff Carr's care was solely with the Defendants, their agents and employees, in the capacity as a total health care facility, 64. Defendants had a non-delegable duty to use reasonable care in the maintenance of safe, adequate facilities and equipment. 65. Defendants had a non-delegable duty to retain and select only competent physicians as medical director or attending physicians to oversee and implement appropriate medical policies and procedures. 66. Defendants had a non-delegable duty to retain and select competent nursing professionals and staff to implement nursing practices, policies and procedures in 11 accordance with the medical policies of the facility, in accordance with applicable rules and regulations, and in accordance with acceptable standards of nursing. 67, Defendants had a non-delegable duty to use reasonable care in hiring and retaining a nursing home administrator capable of managing the facility in accordance with all applicable rules and regulations, and in accordance with acceptable standards of nursing home administration. 68. Defendants had a non-delegable duty to retain and hire employees and sufficient staff to oversee all services required to be provided in the facility, 69. Defendants had a non-delegable duty to oversee all persons providing care at the facility, 70, Defendants had a non-delegable duty to exercise sole control over the provision of nursing, ancillary and all other services that were provided to the residents at Defendant Facility, including Plaintiff Carr. 71. Defendants had a non-delegable duty to formulate, adopt, and enforce adequate rules, regulations, policies, and procedures to ensure quality care, 72. Defendant Facility held itself out to the general public as being able to provide nursing facility services as defined by the Commonwealth of Pennsylvania. 73, Defendants, through the admission process, held itself out to Plaintiff as being able to provide nursing facility services to Plaintiff Carr, 74. During the applicable time frame, Defendant Facility was the only provider of health care services responsible for Plaintiff Carr's needs, as directed either by Defendants' medical director or Defendants' attending physician, who agreed to abide by Defendants' policies. t2 75. Defendant Facility acted as a total health facility in its relationship to the Plaintiff Carr. 76. At all times, Defendant Facility was under a duty to provide care and services of a licensed nursing facility in the Commonwealth of Pennsylvania. 77,At all times, Defendants were required to manage Defendant Facility staff, agents, employees and servants in a manner that would result in Defendants delivering the necessary care and services to meet Plaintiff Carr's needs. 78. At all times, Defendant Facility was required to have in place policies and procedures, and carry out and enforce such policies and procedures, to deliver the necessary care and services to meet Plaintiff Carr's needs. 79. Defendants, through total control over the care and services Plaintiff Carr received, and by inducing Plaintiffs to rely on Defendant Facility for total care to Plaintiff Carr, acted as a total health care facility. 80. Defendants, by corporate policies and practices which engendered and fostered inadequate care, knew, and could reasonably foresee, harm to Plaintiff Carr that could have been prevented by the exercise of reasonable care in accordance with standards of practice and applicable rules and regulations. 81, The errors and omissions in the care of Plaintiff Carr are attributable to Defendants. 82, The Defendants, through corporate practices and procedures, have engaged in a systematic pattern of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: 13 A. Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. B. Fostering an environment in which staff, agents, employees were indifferent to the basic needs of Plaintiff Carr. C, Failing to acquire sufficient staffing to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and profits. D. Establishing, or permitting to be carried out, practices for charting that resulted in information not being available for effective management of Plaintiff Carr's care, E. Failing to establish and/or enforce policies for assuring the timely and accurate charting of Plaintiff Carr's care. F. Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff, G. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the delivery of nutrition and hydration. H. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the sufficiency of all services that Defendant had a duty to provide to Plaintiff Carr. 83. As a result of Defendants' failure, in its corporate capacity, to provide Plaintiff Carr with the care and services she required and which Defendants purported to be able to provide, Defendants denied Plaintiff Carr routine minimally required care; increased her 14 fear, discomfort, and humiliation and deprived her from being treated by other health care providers who could accurately assess and treat her condition, WHEREFORE, because Defendants acted with bad motive, deliberate and reckless failure in the face of obvious signs that Plaintiff Carr was not receiving appropriate care, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 3908, as adopted by the law of the Commonwealth of Pennsylvania, COUNT III VICARIOUS LIABILITY Plaintiffs v. Defendants 84. Paragraphs 1 - 83 are incorporated herein by reference, 85. At all times material thereto, Defendants held out the staff members who provided care to Plaintiff Carr, including its Medical Director, nursing staff and assistants, social workers, admission personnel, therapists and chaplain as its servants, agents, and/or employees. 86. At all times material thereto, Defendants controlled or had the right to control the work of these individuals. 87, Defendants are vicariously liable for the actions of any or all if the staff members, agents, servants or employees who provided care to Plaintiff Carr or caused the lack of care to Plaintiff Carr during her stay at Defendant Facility. 15 88. As a direct and proximate result of the conduct of Defendants and its staff members, agents, servants or employees, the care provided to Plaintiff Carr did not meet the acceptable standard of care during Plaintiff Carr's stay at Defendant Facility, resulting in harm to Plaintiff Carr, and which harm caused pain, suffering, mental anxiety, disfigurement, and loss of enjoyment of life, WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, S908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT IV Negligence Per Se Plaintiff v. Defendants 89. Paragraphs 1-88 are incorporated herein by reference, 9Q,Although the statutes and regulations contained in the paragraphs below do not necessarily provide a private cause of action, Plaintiff Carr was a member of the class of nursing home residents that the statutes and regulations were designed to protect. These statutes and regulations do establish a minimal standard of care relevant to nursing facilities licensed by the Commonwealth of Pennsylvania, of which Defendant Facility is one. 16 91. The Facility failed to notify the resident's family of significant changes in the status of Plaintiff Carr as required by 42CFR 483.10(b)(11), which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa, Code, 201 et seq, 92. The Facility failed to implement policies and procedures to prevent neglect and abuse of Plaintiff Carr as required by 42 CFR 483,13(c) which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa, Code, 201 et seq, 93. The Facility failed to care for Plaintiff Carr in a manner and in an environment that promoted maintenance or enhancement of Plaintiff Carr's quality of life, or in a manner that maintained Plaintiff Carr's dignity with full respect for individuality as required by 42 CFR 483,15(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 94. The Facility failed to meet the resident's right to reside in and receive services from the facility with reasonable accommodation of individual needs as required by 42 CFR 483,15(e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 95. The Facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, including, promoting actions by staff that maintain or enhance each resident's dignity in full recognition of each resident's individuality as required by 42 CFR 483.15(g) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq, 17 96. The Facility failed to provide a safe, clean comfortable and homelike environment, including housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior as required by 42 CFR 483.15(h), 97, The Facility failed to conduct a comprehensive, accurate assessment of Plaintiff Carr's functional capacity and obtain appropriate physicians orders for the resident's immediate care since the facility must provide care appropriate to resident's needs from admission to discharge, as required by 42 CFR 483,20(b) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq, 98. The Facility failed to provide Plaintiff Carr such necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being in accordance with the comprehensive plan of care as required by 42 CFR 483,25 which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 99. The Facility failed to ensure that the resident's activities of daily living did not diminish and failed to demonstrate that the circumstances of Plaintiff Carr's clinical condition showed that diminution was unavoidable, particularly with regard to nutritional intake, as required by 42 CFR 483,25(a)(1)(iv) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 100. The Facility failed to provide the necessary services to Plaintiff Carr to maintain good nutrition, grooming, and personal and oral hygiene as required by 42 CFR 18 483.25(a)(3) which is applicable to all nursing facilities licensed in Pennsylvania rn accordance with 28 Pa. Code, 201 et seq. 101. The Facility failed to ensure that the Plaintiff Carr received an adequate therapeutic diet as required by 42 CFR 483,25(i) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 102. The Facility failed to provide Plaintiff Carr with sufficient fluid intake to maintain proper hydration and health as required by 42 CFR 483.250) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 103. The Facility failed to employ sufficient support personnel competent to carry out the functions of the dietary service as required by 42 CFR 483.35(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa, Code, 201 et seq, 104. The Facility failed to provide Plaintiff Carr with food that was palatable, attractive and at the proper temperature and in a form designed to meet individual needs as required by 42 CFR 483.35(c) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa, Code, 201 et seq, 105, The Facility failed to have a proper therapeutic diet for Plaintiff Carr prescribed by the attending physician as required by 42 CFR 483.35 (e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa, Code, 201 et seq 106, The Facility failed to maintain clinical records on Plaintiff Carr in accordance with accepted professional standards and practices that are complete, accurately 19 documented, readily accessible, and systematically organized in accordance with 42 CFR 483.75(1)(1) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 107. The failure of Defendant to meet the minimum standards established by these regulations deprived Plaintiff Carr of the basic nursing facility care purported during its admission process to be provided by Defendant; deprived Plaintiff Carr of care that Plaintiff Carr and Plaintiff Doutrich, along with Plaintiff's loved ones, had an expectation of being provided as a result of the license under which Defendant operated; caused her deterioration and discomfort, deprived her of basic dignity and safety, and diminished the quality and quantity of her life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, S908, as adopted by the law of the Commonwealth of Pennsylvania. jJff1 Date: AI -1 ~ lJ 5' R"jV""'lty, ~ Adrtu ,g; /;;# Barbara G. Graybill Attorney I.D. No. 39859 Graybill & Wise, P,C. 126 Locust Street p, O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs 20 VERIFICATION Upon my personal knowledge or information and belief, I hereby verify that the facts averred in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements or averments therein made will subject me to the criminal penalties of 18Pa,C.S. 94904 relating to unsworn falsification to authorities. Date: 7 -;}. () ~ () S Jd1l Terri Doutrich CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached Complaint on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo, Esq, McKissock & Hoffman, P,C, 1818 Market Street Philadelphia, PA 19103-3933 Date: 1~/1/o3 ~ ~~ \"~ ( ;arbara G. Graybill ld. No, 39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney For Plaintiffs 22 ~ .; -< , 5:~ (~) (.) c ("") '" c..-=? () "T1 :~C1 "'r_ -'C: c~ ~~,..- t -J ~'O - CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MA TI'ER OF: Court of Commou Pleas - Cumberland County, P A ELIZABETH CARR vs. ANCOR CARE, INC., ET AL. TERM: I I CASE No: 05-3732 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22. RecordTrak on behalf of MARIA R GRANAIJDO Defendant certifies that (]) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena whicb is attached to the notice of intent to serve the subpoena. Date: 11114/2005 ~ k'CUlb ~ " , " /. / -, (, , ,', 'JL'~ k C", f'" RecordTrak on behalf of ISI MARIA R GRANAUDO Attomey for Defendant RT# 138461 CASE NAME; ELIZABETH CARR ELIZABETH CARR vs. ANCOR CARE, INC., ET AL. COURT: Court Of Common Pleas, Cumberland Counly, Pa TERM: I I DOCKET: 05-3732 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS TO: KENNETH WISE GRAYBILL & WISE 126 LOCUST STREET PO, BOX 11489 HARRISBURG PA 17108 (717) 238-3816 Octobcr 25, 2005 Plcase take notice that on behalf of MARIA R. GRANA UDO, attorney for Defendant, RecordTrak intends to serve a subpoena identical to the one(s) attached to this notice. You have until November 14, 2005 to file of record and serve upon the undersigned an objection to the subpoena(s). If no objection is made, the subpoena(s) will be served. IF PLAINTIFF'S COUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDICATE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PURCHASE COPIES OF THE RECORDS, PLEASE CONTACT RECORDTRAK FOR PRICING AND FAX THIS CORRESPONDENCE BY November 14, 2005 TO (610) 992-1416 OR REPLY THROUGH OUR WEB SITE AT RecordTrak.com, All records will be provided (including no record statements) as prodnced by each record location, Lisa Kanb 610-354-8321 RECORDTRAK 651 Allendate Road p, O. Box 61591 King of Prussia, P A 19406 LIST OF RECORD CUSTODIANS AND SUBPOENAS TAG I ECORD CUSTODIAN DR HAL FINEBURG ATERIALS BEING OBTAINED I. ALL BILLING RECORDS IN YOUR POSSESSION, INCLUDING ALL STATEMENTS, ITEMIZED BILLING RECORDS, INSURANCE RECORDS AND ANY OTHER PATIENT ACCOUNT RECORDS IN YOUR POSSESSION. . ALL MEDICAL RECORDS IN YOUR POSSESSION, INCLUDE OFFICE AND AND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, QUESTIONNAIRESIHISTORY & RECORDS RECEIVED BY OTHER HYSICIANS. PLEASE ALSO INCLUDE THE PATIENTS INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCffiVED RECORDS AND ALL CORDS LOCATED IN STORAGE. .. ELIZABETH CARR COURT: Court Of Common Pleas - Cumberland County, Pa TERM: II DOCKET: 05-3732 vs, ANCOR CARE, INC., ET AL. 2 HOLY SPIRIT HOSPlT AL (MED) 1. ALL MEDICAL RECORDS IN YOUR POSSESSION. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL CORDS LOCATED IN STORAGE. 3 HOLY SPIRIT HOSPlT AL (BILL) 1. ALL BILLING RECORDS IN YOUR POSSESSION, INCLUDING ALL STATEMENTS, ITEMIZED BILLING RECORDS, INSURANCE RECORDS ND ANY OTHER PATIENT ACCOUNT RECORDS IN YOUR POSSESSION, _ Yes, I would like a copy of all of the records listed above _ Yes, I would like specific records I have indicated above. SIGNATURE: Date: FIRM: Nate: An order for records from plaintiff s counsel will signifY that plaintiff s counsel has agreed to waive the notice period effective as of the date of the record order. YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD Signature ofPIaintitI's Counsel: Date: FIRM: Page 2 RT.138461-1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERlAND Elizabeth Carr v File No. 05-37 2 Ancor Care, Inc., et aI., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR' ISCOVERY PURSUANT TO RULE 4009.22 TO: DR. HAL FINEBURG (Name of P....on or Entity) Within twenty (20) days after service of this subpoena. you are ordered by the c( It to produce the fonowing documents or things: al RecordTrak. 651 A1lendale Rd. PO Box 61591. Kina 01 Prussia. PA 19406. You may deliver or mail legible copies of the documents or produce things reque led by this subpoena, together with the certificate of compliance, to the party making lhis t'1lquest .' h. address listed above. You may have the right 10 seek In advance the reasonable cost of preparing copi ; or producing the things sought If you fall to produce the documents or things required by tills subpoena within t rnty (20) days after its service, the party serving lhi. subpoena may seek a court oreler compelling you 10 co ply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING P RSON: Name: RecordTrak. Address: 651 Allendale Rd. PO Box 61591 Kina of Prussia. PA 19406 Telephone: 800-220.1291 Supreme Court 10# Attorney for. DEFENDANT BY THE COURT: C/~~i ~ Prothonotary/Clerli DATE: o~ J3 .;;ce.( Seal orthe Court . . , . RT.138461-2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-37 2 Ancor Care, Inc., et aI., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR I ISCOVERY PURSUANT TO RULE 41109.22 TO: 1I0LY SPIRIt HOSPITAL (MED) (Name of Petoon or EnUtyj Wtthin twenty (20) days after service of this .ubpoena, you ant ordered by the C< rt to produce the foUowlng documents or lhings: at RecordTrak. 6S1 AJiendale IJd. PO Box 61691. Kino of Prunla. PA 19406. You may deliver or mail legible copies of the documents or produce things requE led by this subpoena, together with the certlncale of comp/lance, to lhe patty making this requeS1 a ne address listed above. You may have the righl 10 seek in advance Ihe reasonable cost of preparing cop! lor producing the things soughL If you la/I to produce the documents or things required by this subpoena within I enly (20) days after Its service, th. party serving lhls subpoena may seek a court ol1l.r comp.mng you 10 Co 'ply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOllOWING" :RSON: Name: RecordTrak. Address: 651 ARendale Rd. PO Box 61591 Klna of Prussia. PA 19406 Telephone: 800-220-1291 Supreme Court 10# Attorney for: DEFENDANT BY THE COURT: Pro~~ DATE: () a;),,, . 1..3';; 00 f Seal of the Court .... . Rr.138461-3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No, 05-37: 2 Ancor Care, Inc., at aI" SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR I ISCOVERY PURSUANT TO RULE 4009.22 TO: HOLY SPIRIT HOSPITAL (BILL) (Name of Pmon 0' EntIIy) Within twenty (20) days afler saMco of lhis subpoena, you are ordared by the Cc rt 10 produce the following documents or things: al RecordTrak. 551 Allendale Rd. PO Ball 111591. Kino of Prussia. PA 19406. You may deliver or mall legible copies of the documants or produce things reque :ed by this subpoena, IOgether with the certificate of compliance, 10 the party mal<ing this request al he address listed above. You may have the right 10 seek in advance the reasonable cost of preparing cop;, ; or producing the things sought, If you lailto produce the documents or things required by !hill subpoena within 11 '"ty 120) days after its service, the party serving this subpoena may seek a court order compelling you 10 co ply with It. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING P RSON: Name: RecordTrak, Address: 651 Allendale Rd. PO Box 61591 Kina of Prussia, PA 19406 Telephone: S00-22Q..1291 Supreme Court 10# Attorney for: DEFENllANT BY THE COURT: C?~ Pr<Sfhon C rk DATE: (Jrr"L.. I:>' ...J,x>" Seal of/ha Court (') ,~, 'c_:'") C) '-, C_::.) <.Jl -q ::-:-1 r:l ,- ~'--.. r..-- .., ,-.;..... _.l r CJ _:~ t"3 , 1': -I " r,.) :< ... . . . MCKISSaCK & HOFFMAN, P,C. BY: William J. Mundy Identification No. 57679 BY: Maria R. Granaudo Identification No. 80609 BY: Kathryn C, Mason 1818 Market Street, 13th Floor Philadelphia, PA 19103 (215)246-2100 Attomeys for Defendants ELIZABETH CARR, TERRI DOUTRICH, CUMBERLAND COUNTY COURT OF COMMON PLEAS Plaintiffs CIVIL ACTION - LAW v. NO: 05,3732 MANOR CARE HEALTH SERVICES, INC. d/b/a MANORCARE HEALTH SERVICE - CAMP HILL, AND MANORCARE, INC. a/k/a HCR MANORCARE JURY TRIAL DEMANDED Defendants PRELIMINARY OBJECTIONS OF DEFENDANTS, MANOR CARE HEALTH SERVICES, INC. d/b/a MANORCARE HEALTH SERVICE - CAMP HILL, AND MANORCARE, INC. aIkIa HCR MANORCARE, TO PLAINTIFFS' COMPLAINT Defendants, ManorCare Health Services, Inc. d/b/a ManorCare Health Service - Camp Hill, and ManorCare, Inc, a/k/a HCR ManorCare, (hereinafter referred to as "Defendants"), by and through their counsel, McKissock and Hoffman, p,c., hereby file these Preliminary Objections to the Complaint of Plaintiffs, Elizabeth Carr and Terri Doutlich (hereinafter known as "Plaintiffs"), and aver as follows: 1. On November 7,2005, Plaintiffs filed a Complaint against Defendants with the Court of Common Pleas of Cumberland County. A true and correct copy of Plaintiffs' Complaint is hereto attached as Exhibit "A," .. 2, According to the Complaint, Ms. Carr was discharged from Holy Spirit Hospital and admitted to the Defendant Facility, ManorCare Health Service - Camp Hill on August 13, 2003. See Exhibit "A" at paragraph 10, 3. At the time of her admission, Plaintiffs allege that Ms. Carr had diagnoses of a right gluteal hematoma, COPD, a history of deep vein thrombosis, right leg pain, confusion, and a gastrointestinal bleed. See Exhibit "A" at paragraph 10. 4. Plaintiffs further allege that Ms. Carr had allergies to "Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics." See Exhibit "A" at paragraph I I. 5. Plaintiffs' Complaint avers that Defendants were negligent in administering Seroquel, a drug used to treat hallucinations, to Ms. Carr from August 14, 2003, to August 19, 2003. See Exhibit "A" at paragraphs 12-29, 6. Plaintiffs contend that Seroquel was administered despite the attending physician's order to discontinue the medication. See Exhibit "A" at paragraphs 23-29. 7, In addition to the Seroquel, Plaintiffs' Complaint asserts that an unknown narcotic drug was given to Ms, Carr without a prescription. See Exhibit "A" at paragraphs 30-34. The Complaint does not allege what type of narcotic drug was administered. 8. Finally, Plaintiffs' Complaint avers that on multiple occasions family members found Ms. Carr lying naked on her bed either on top of the bed covers or partially underneath them. See Exhibit "A" at paragraph 28. 9, The Complaint avers that as a result of Defendants' acts and/or omissions that Ms. Carr was non,responsive and/or asleep for the six (6) day period she resided at the facility and suffered dehydration, malnutrition, weight loss, skin breakdown, and decubitus ulcers, See Exhibit "A" at paragraph 35. 2 , , , , 10. Ms. Carr only resided at the facility for six days, 1], Defendants file these Preliminary Objections on the bases that: (1) Defendant ManorCare, Inc. a/kIa HCR ManorCare was improperly served original process; (2) Plaintiff Doutrich fails to state a cause of action for negligent or intentional infliction of emotional distress; (3) Plaintiffs' general allegations of negligence should be stricken for lacking the proper factual specificity; (4) all allegations of corporate liability and Count II of Plaintiffs' Complaint should be stricken with prejudice for failure to state a cause of action; (5) paragraphs 91 through \01 and \03 through \06 of Plaintiffs' Complaint relating to Plaintiffs' claim of negligence per se should be stricken for failing to state a cause of action; and (6) Plaintiffs' improper allegations of Defendants' conduct as intentional and reckless and Plaintiffs' requests for punitive damages should be stricken. I. PLAINTIFFS' SERVICE OF PROCESS ON MANORCARE, INC. alk!a HCR MANORCARE WAS IMPROPER 12. Defendants incorporate the averments in Paragraphs 1 through] 1 as though the same were set forth fully herein at length, 13. Plaintiffs improperly served original process on ManorCare, Inc, alk!a HCR ManorCare at 1700 Market Street, Camp Hill, Pennsylvania 17011 as opposed to an address where it has an office or usual place of business. ]4, Pennsylvania Rule of Civil Procedure \028(a)(I) permits the filing of a preliminary objection in the nature of a motion to strike for improper service of a complaint. 15. "Proper service is a prerequisite to the court's jurisdiction over the person of a defendant. . . In determining whether proper service has been effected, [the court] requires strict adherence to the rules." Anzalone v, Vormack, 718 A.2d 1246, 1248 (Pa. Super. 1998). 3 , . , 16. Pennsylvania Rule of Civil Procedure 402 provides that "original process may be served. . , by handing a copy, . . at any office or usual place of business of the defendant to his agent or to the person for the time being in charge thereof." Pa. R.C,P. 402(a)(2)(iii). 17. Furthermore, service of original process outside the Commonwealth may be made, inter alia, by any form of mail requiring a receipt signed by the defendant or his authorized agent. Pa. R.C.P. 403, 404(2). 18. In the instant case, on August 15, 2005, ManorCare, 1nc, a!kJa HCR ManorCare was served a writ of summons by the sheriff or sheriff's deputy at the address of ManorCare Health Services, Inc, d/b/a ManorCare Health Service - Camp Hill located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 19. Defendant "ManorCare, Inc, a!kJa HCR ManorCare" does not own the facility located in Camp Hill. Instead, the facility is owned by ManorCare Health Services, Inc. 20, Manor Care, Inc. a!kJa HCR ManorCare and Manor Care Health Services, Inc. d/b/a ManorCare Health Service - Camp Hill are distinct and separate corporate entities, 21. In addition, there is no agent present at the facility who is authorized to accept service on behalf of Manor Care, Inc, a!kJa HCR ManorCare, 22. ManorCare, Inc. a/kla HCR ManorCare is a Delaware corporation with a principal office is at 333 North Summit Street, Toledo, Ohio 43699,0086. 23. In fact, Plaintiffs acknowledge that ManorCare, Inc. has a corporate office in Ohio. 24, Plaintiffs do not aver and cannot establish that Manor Care, Inc. has a corporate office or usual place of business at the stated address in Camp Hill. 4 . , , . 25. According to Pa. R.C.P. 403 and 404(2), Plaintiffs could not have properly served ManorCare, Inc. aIkIa HCR ManorCare at 1700 Market Street, Camp Hill, Pennsylvania. 26, Therefore, pursuant to Pa. R.C.P. 402(a)(2)(iii), 403, and 404, service upon ManorCare, Inc, a/k/a HCR ManorCare was improper and should be stricken, WHEREFORE, Defendants respectfully request this Honorable Court to strike the service of the writ of summons upon ManorCare, Inc. a/k/a HCR ManorCare. II. PLAINTIFF DOUTRICH FAILS TO STATE A CAUSE OF ACTION FOR EMOTIONAL DISTRESS A. Demurrer 26. Defendants incorporate the averments in Paragraphs 1 through 25 as though the same were set forth fully herein at length. 27. Paragraph 45(E) alleges that "Defendant Facility caused Plaintiff Doutrich emotional distress upon finding her mother naked and exposed with blankets or clothes to protect her." See Exhibit "A." Regardless of whether paragraph 45(E) is attempting to plead a cause of action for intentional or negligent infliction of emotional distress, Plaintiff Doutrich has not set forth a prima facie case for either cause of action. 28, Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. 1. Negligent Infliction of Emotional Distress 29. The law of Pennsylvania restricts recovery for negligent infliction of emotional distress to an individual who demonstrates that he sustained physical injury as a result of the defendant's negligence and that he was a reasonably foreseeable plaintiff. Armstrong v. Paoli Memorial Hospital, 633 A2d 605,609 (Pa. Super. 1993). 5 , , . 30. The Pennsylvania Supreme Court employs three factors in determining whether a bystander's emotional distress was foreseeable: (I) Whether plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it; (2) whether the shock resulted from a direct emotional impact upon plaintiff from the sensory and contemporaneous observance of the accident from others after its occurrence; and (3) whether plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship, Tackett v. Encke, 509 A.2d 1310, 1312 (Pa. Super. 1986) (quoting Sinn v. Burd, 486 Pa, 146, 404 A.2d 672,685 (1979)); alloc. denied, 31. The plaintiff must allege that he or she observed a "discrete and identifiable traumatic event" as opposed to a number of events over a period of time. Id. (emphasis added). 32. Under Pennsylvania law, physical injury must be alleged in order to state a cause of action for negligent infliction of emotional distress. Armstrong v. Paoli Memorial Hosp., 430 Pa. Super. 36, 633 A.2d 605 (1993), 33, In order to establish a claim for negligent infliction of emotional distress, plaintiff must establish that there was a temporal convergence of the negligent act and the event precipitating the emotional distress. Mazzagatti v. Everingham, 516 A.2d 673 (Pa. 1986). 34. Pennsylvania has "consistently refused" to expand the tort of negligent infliction beyond situations where the injury and tortious conduct are actually witnessed. Armstrong, 633 A.2d at 611; see ~ Yandric v, Radic, 433 A.2d 459 (Pa. 1981)(holding that where a father arrived on the scene of accident after his son had been taken to the hospital he did not state a cause of action for negligent infliction of emotional distress); Mazzagatti, 516 A.2d 673 (holding 6 , that where a mother arrived at the scene minutes after an accident involving her child she did not state a cause of action for negligent infliction of emotional distress). 35, Plaintiff Doutrich has not alleged that she witnessed the alleged tortious conduct that resulted in Ms. Carr's alleged state of nudity. 36. In fact, plaintiff Doutrich does not allege that Defendants caused or were aware of Ms. Carr's alleged state of being unclothed. 37. No other specific facts are mentioned in support of this claim, aside from a general allegation that familv members found Ms. Carr lying naked or partially naked in her room at the facility on three occasions, See Exhibit "A" at paragraph 28, 38. Since plaintiff has failed to allege that Doutrich witnessed tortious conduct by Defendants that cause Ms. Carr to become naked and/or partially naked, she cannot establish a prima facie case of negligent infliction of emotional distress. 39. Further, Plaintiff does not aver that she sustained any physical injury as a result of witnessing her mother naked or partially naked, which is required by Armstrong in order for a plaintiff to recover. Armstrong, 633 A.2d at 609. 40. It is unnecessary at this time to analyze whether Plaintiff Doutrich was a foreseeable plaintiff, because based on the facts pled in the Complaint, Plaintiff Doutrich does not establish the other requisite elements for a claim for negligent infliction of emotional distress. 2. Intentional Infliction of Emotional Distress 41. The tort of intentional infliction of emotional distress is defined as follows: "One who by extreme and outrageous conduct intentionally or recklessly causes severe emotional distress to another is subject to liability for such emotional distress, and if bodily harm to the other results from it, for such bodily harm." 7 , " Hov v. Angelone, 720 A.2d 745,753 (Pa. 1998)(citing Restatement (Second) of Torts S 46)). 42. Plaintiff's Complaint fails to specify which act or acts of the Defendants constitute extreme, outrageous, intentional and/or reckless conduct. 43, Even accepting all allegations as pled in the Complaint as true, Plaintiff Doutrich has failed to establish that Defendants acted outrageously or that they intentionally harmed Plaintiff Doutrich or caused her emotional distress, 44, The allegations of Ms. Carr being naked and/or being seen partially clothed by family members are not extreme, outrageous, intentional and/or reckless, and cannot form the basis for a claim for intentional infliction of emotional distress. 45. Indeed, the Complaint is devoid of any intentional act attributable to Defendants which would establish a cause of action of intentional infliction of emotional distress. 46. Pennsylvania case law, Abadie v. Riddle Memorial Hospital, 589 A.2d 1143 (Pa. Super. 1991), requires that the defendant's conduct "go beyond all possible bounds of decency" or be "utterly intolerable in a civilized community" to set forth a valid theory of intentional infliction of emotional distress. 47. The allegations relating to Plaintiff Doutrich do not approach the level of "outrageousness" necessary to sustain this cause of action. WHEREFORE, Defendants respectfully request that this Honorable Court dismiss Plaintiff s claim for infliction of emotional distress and strike paragraph 45(E) and the reference to Plaintiff Doutrich in the ad damnum clause of Count I of Plaintiffs' Complaint. B. Failure to Comply with Pa. R.C-P. 1020 48. Defendants incorporate the averments in Paragraphs 1 through 47 as though the same were set forth fully herein at length, 8 , 49. In the alternative, paragraph 45(E) of Plaintiffs' Complaint should be stricken for failure to comply with Pa. R.C.P. 1020. 50, Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. 51. Pennsylvania Rule of Civil Procedure 1020(b) provides: If persons join as plaintiffs under Rules 2228, 2229(a) or (e), the complaint shall state the cause of action, any special damage, and the demand for relief of each plaintiff in a separate count, preceded by a heading naming the parties to the cause of action therein set forth. 52. Plaintiffs Carr and Doutrich are joined as plaintiffs under Pa. R.C.P. 2229(a), which discusses permissive joinder. Parties are allowed to join as plaintiffs when they assert claims arising out of the same transaction or occurrence and that have a common question of law or fact. Pa, R.C. P. 2229(a). 53. In the instant case, Plaintiffs Carr and Doutrich are both averring injuries sustained as a result of Defendants' alleged inadequate care of Plaintiff Carr. Plaintiff Carr's claim is based on injuries directly related to the alleged deficient care provided by Defendants during her stay at the facility. Plaintiff Doutrich is setting forth a third party claim for negligent or intentional infliction of emotional distress based on an event allegedly caused by Defendants' inadequate care, See Exhibit "A." 54. Plaintiffs, however, plead these separate claims together under Count I of Plaintiffs' Complaint in a negligence cause of action. See Exhibit "A." 55, Such a style of pleading is specifically prohibited by Pa, R.c.p, 1020. 9 56. Plaintiffs must set forth their claims in separate counts, stating any special damage, the demand for relief, and naming the parties to the cause of action, Pa. R,C.P. 1020(b), WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraph 45(E) and the reference to Plaintiff Doutrich in the ad damnum clause of Count I of Plaintiffs' Complaint. III. MOTION TO STRIKE FOR LACK OF SPECIFICTY 57. Defendants incorporate the averments in Paragraphs 1 through 56 as though the same were set forth fully herein at length. 58. Paragraphs 45(B), 45(D), 45(G), 50, and the phrase "but not limited to" in paragraph 45 of Plaintiffs' Complaint lack the degree of specificity required by Pennsylvania law, 59. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court, 60. Pennsylvania Rule of Civil Procedure 1019(a) requires that the material facts on which a cause of action is based be stated in a concise and summary form. 61. Pennsylvania is a fact pleading state. Miketic v. Baron, 675 A.2d 324,330 (Pa. Super. 1996). Under the Pennsylvania system of fact pleacling, the pleader must define the issues, and every act or performance essential to that end must be set forth in the complaint. Santiago v. Pennsylvania Nat. Mut. Cas. Ins. Co., 613 A.2d 1235,1238 (Pa. Super. 1992). 62. With regard to Pa. R.C.P. 1019(a), the Superior Court stated: The purpose of 1019(a) is to require the pleader to disclose material facts sufficient to enable the adverse party to prepare his case. A complaint therefore must do more than give the defendant fair notice of what the plaintiff's claim is, and the grounds upon 10 " which it rests . . . It should formulate the issues by fully summarizing the material facts. Material facts' are 'ultimate facts', i,e, those facts essential to support the claim. . , Evidence from which such facts may be inferred not only need not but should not be alleged . . , Allegations will withstand challenge under 1019(a) if (1) they contain averments of all the facts the plaintiff will eventually have to prove in order to recover. . . , and (2) they are sufficiently specific so as to enable defendant to prepare his defense. Baker v, Rangos, 324 A.2d 498,505-06 (Pa. Super. 1974), 63, In the underlying litigation, Plaintiffs have pled certain allegations containing insufficient facts which do not provide Defendants with notice of Plaintiffs' claims and which do not adequately apprise Defendants of the relevant issues that they must defend. These averments provide in relevant portion: 45. Defendants, through agents, servants, and employees, breached the standard of care due to Plaintiff Carr for reasons including but not limited to the following: * * * * (B) Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr, * * * * (D) Defendant Facility failed to protect the dignity of Plaintiff Carr. * * * * (G) Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery. * * * * 11 50, Defendants' negligent and/or reckless acts and omiSSIOns violated 28 Pa. Code S 201.1 et seq., 42 C.F.R. S 483 et seq. and 42 U.S.C. S 1396r. See Exhibit "A" (emphasis added), 64. Such vague allegations of negligence afford Plaintiffs with the opportunity to introduce new theories of recovery at any time prior to trial and after the expiration of any applicable statute of limitations, See Connor v. Alleghenv Hospital, 461 A,2d 600,602-03 (Pa. ]983), 65. In Connor, the Pennsylvania Supreme Court allowed the plaintiff to amend his complaint to allege an entirely new factual theory of liability on the day of trial, holding that the new theory merely "amplified" a general allegation of negligence contained in the complaint. Id. at 602, 66, Connor stated that "[i]f Appellee did not know how it 'otherwise fail[ed] to use due care under the circumstances', it could have filed a preliminary objection in the nature of a request for a more specific pleading or it could have moved to strike that portion of appellants' complaint." 1d. at 603, n. 3. 67. Defendants raise this preliminary objection on the same premise as contemplated by the Pennsylvania Supreme Court in Connor. 68, For example, paragraph 45(B) states that Defendants breached the standard of care for reasons "including but not limited to the following." See Exhibit "A" (emphasis added), Paragraph 45(G) notes that Defendants "committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery." See Exhibit "A" (emphasis added). These phrases are catch-all language that will provide Plaintiffs with the opportunity to add other allegations of 12 .. negligence at a later point in time, which is strictly prohibited by Connor, See Connor, 46 I A.2d at 602-03; Mitchell v. Remskv, 39 Pa, D. & CAth 112, 125 (l998), 69, Paragraphs 45(B) and 45(D) are so overbroad and general that Defendants could not possibly prepare a defense to every alleged act and/or omission that falls within these vague categories. See Exhibit "A." 70. In paragraph 50, Plaintiffs aver that Defendants' conduct violated certain federal and state statutes, but Plaintiffs do not attempt to plead specific facts to support this contention or cite the particular sections of 42 D.S.C. S 1396r to which they refer. See Exhibit "A." 71. Such boilerplate averments prejudice Defendants in their attempt to prepare a defense, because it is unknown what specific acts constitute the alleged negligence to which Plaintiffs' Complaint has alluded to in the broad language of the above-cited paragraphs. 72. Accordingly, all of the above-referenced averments are overly vague on their face and must be stricken. WHEREFORE, Defendants respectfully request this Honorable Court to strike paragraphs 45(B), 45(D), 45(G), 50, and the phrase "but not limited to" in paragraph 45 of Plaintiffs' Complaint for lack of specificity. IV. PRELIMINARY OBJECTIONS TO PLAINTIFFS' CORPORATE NEGLIGENCE ALLEGA TIONS A. Demurrer to Plaintiff's Claims of CorDorate Nel!lil!ence 73. Defendants incorporate the averments in paragraphs] through 72 as though the same were set forth fully herein at length. 74. Count II of Plaintiffs' Complaint should be stricken, because corporate liability, as a matter of law, does not apply to Defendants, a nursing home. 13 75. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of pleading. 76, The Pennsylvania Supreme Court, in establishing the doctrine of corporate liability as it relates to hospitals, defined the following duties that a hospital owes directly to its patients: (1) a duty to use reasonable care in the maintenance of safe and adequate facilities and equipment; (2) a duty to select and attain only competent physicians; (3) a duty to oversee all persons who practice medicine within its walls as to patient care; and (4) a duty to formulate, adopt, and enforce adequate rules and policies to ensure quality care for patients. Thompson v. Nason Hospital, 591 A.2d 703, 707 (Pa. 1991), 77. The theory of corporate liability as adopted by the Supreme Court of Pennsylvania in Thompson applies only to hospitals, See M. Remshifski v, Kraus, No. ]845 Civ. 1992, slip op, (CCP, Monroe, Sept. 8, 1995), 78. Since Thompson, only one appellate decision has extended such liability. In Shannon v. McNultv, 718 A.2d 828 (Pa, Super. 1998), the Superior Court applied corporate liability to an HMO. The Court reasoned that the defendant HMO acted like a total health care provider in its relation to the plaintiff. Id, 835-36, "Specifically, while [HMOs] do not practice medicine, they do involve themselves daily in decisions affecting their subscriber's medical care. . . [T]he true effect of [the HMO's] actions. . , [is to dictate and direct] the subscriber's medical care." Id. 79, Since Shannon, however, no appellate court opinions have expanded corporate liability to other health care organizations. In fact, the Superior Court of Pennsylvania declined to apply the theory of corporate liability to a physician's practice group. Sutherland v. Monongahela Vallev Hospital, 856 A.2d 55,62 (Pa, Super. 2004). 14 80. In addition, several trial court opinions in Pennsylvania have limited corporate negligence to hospitals and HMOs. See Lebish v. Whitehall Manor, Inc., 57 Pa. D&C 4th 247 (Lehigh Co, 2002); Brewer v. Geisinger Clinic. Inc., 45 Pa. D&C 4th 215 (Lackawanna Co. 2000); Dibble v. Penn State Geisinger Clinic, Inc., 42 Pa, D&C 4th 225 (Lackawanna Co. 1999); Dowhouer v. Judson, 45 Pa. D&C 4th 172 (Dauphin Co. 2000); Remshifski v. Kraus, No. 1845 Civ, ]992, slip opinion (C.P. Monroe Co, Sept. 8, ]995), 81. Moreover, in Milan v. American Vision Center, 34 F.Supp, 2d 279 (E.D. Pa, 1998), the Eastem District of Pennsylvania, applying Pennsylvania law, refused to extend the doctrine of corporate liability to an optometrist's offices. Id. at 282, 82, Milan specifically relied on Thompson's interpretation and held that "Thompson sets a standard of care for hospitals, not necessarily for all health care organizations. . . The use of the language throughout Thompson similarly suggests that the Supreme Court believed itself to be crafting a rule of hospital liability, not health care organization liability generally." Id. at 280. 83, As articulated in Shannon, the central factor at issue is whether the defendant is legally responsible for the total health care of the patient. Shannon, 718 A.2d at 835. 84, In the instant case, Count II of Plaintiffs' Complaint alleges that the Defendants owed the Thompson duties to Ms. Carr as a resident of their facility. 85. As Plaintiffs recognize, however, Defendants' facility is a nursing home, not a hospital. See Exhibit "A" at paragraph 5. 86. As such, Defendants' facility did not act as a total health care facility in its relationship to Ms. Carr, despite the allegations that Plaintiffs set forth in paragraphs 58, 63, 74, 75, and 79. See Exhibit "A." 15 '. 87. For example, Defendants were not responsible for and did not provide medical care to Ms. Carr, as would a hospital. 88. Defendants, unlike the HMO in Shannon, did not have a role in the daily decisions affecting Ms. Carr's medical care. They did not limit the length of her hospital stays, restrict her use of specialists, prohibit or limit her post hospital care, restrict her access to therapy, or prevent the rendering of emergency care. 89. In fact, nursing home residents are free to seek placement at other facilities and, accordingly, they are neither constrained, nor compromised to remain at any specific facility, 90. Furthermore, in the nursing home setting, the determination of whether long-term care services are required is typically rendered by the resident's attending physician and the medical benefits provider (e,g" Medicare covered therapist), 91. Ultimately, the care provided is ordered and/or overseen by the attending physician, 92, Thus, Defendants assert that corporate liability should not extend to nursing homes, specifically the facility known as ManorCare Health Service - Camp Hill. WHEREFORE, Defendants respectfully request that all claims of corporate liability against Defendants be dismissed with prejudice and that Count II of Plaintiffs' Complaint be stricken. B. Motion to Strike for Lack of Specificity 93. Defendants incorporate the averments in paragraphs 1 through as though 92 the same were set forth full y herein 94, In the altemative, paragraphs 82(A), 82(C), 82(F), and 82(H) of Plaintiffs' Complaint should be stricken for lack of specificity. 16 95. Assuming, arguendo, that the Thompson duties do apply to nursing homes, which legal proposition is denied, Plaintiffs' Complaint fails to set forth any specific acts of corporate negligence by Defendants. Plaintiffs' claims are blind accusations unsupported by specific facts. 96. The Complaint contains the following general allegations regarding corporate liability: 82. The Defendants, through corporate practices and procedures, have engaged in a systematic pattem of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: (A) Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. * * * * (C) Failing to acquire sufficient staffing to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and profits. * * * * (F) Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff. * * * * (H) Failure to implement appropriate policies and procedures to adequately provide and adequately assess the sufficiency of all services that Defendant had a duty to provide Plaintiff Carr. See Exhibit "A," 17 97. As discussed above in Section III, such allegations provide insufficient facts which do not provide Defendants with notice of Plaintiffs' claims and which do not adequately apprise Defendants of the relevant issues that they must defend, Baker, 324 A.2d at 505-06, 98. For example, paragraphs 82(A) and 82(C) fail to indicate how Defendants' staff was not adequate in number or appropriately trained and how that alleged deficiency relates to Plaintiffs' injuries. WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraphs 82(A), 82(C), 82(F), and 82(H) of Plaintiffs' Complaint for lack of specificity. V. DEMURRER TO PLAINTIFFS' NEGLIGENCE PER SE CLAIM - COUNT IV 99. Defendants incorporate the averments in paragraphs 1 through 98 as though the same were set forth fully herein. 100. Paragraphs 91 through 10] and 103 through 106 of Plaintiff's Complaint should be stricken because the various sub-sections of 42 C.F,R. ~ 483 et seq, and 28 Pa, Code ~ 201 et seq. cited by Plaintiffs in Count IV of the Complaint do not set forth a basis for negligence per se, 101. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. 102. In order for a statute or regulation to establish a cause of action for negligence per se, "the purpose of the statute must be to protect the interest of a group of individuals, as opposed to the general public, and the statute must clearly apply to the conduct of the defendant." Frantz v. HeR Manor Care. Inc., 64 Pa. D, & C,4th 457,462 (Schuylkill Cty. 2003)(citing Wagner v. Anzon, Inc., 684 A.2d 570, 574 (Pa. Super. 1996)). 18 103. In addition, the policy behind the legislation must be appropriately served by using the statute to impose civil liability. The absence of a private remedy in a statutory scheme is a factor showing that the legislators did not contemplate enforcement for individual harms. Goda v. White Cliff Nursing Home, 62 Pa. D. & C.4th 476, 481 (Mercer Cty. 2003). 104. Although there are no appellate decisions addressing this issue, several Courts of Common Pleas have held that the Omnibus Budget Reconciliation Act (OBRA) regulations, as set out in 42 c.F.R. S 483 et seq., do not establish a basis for negligence per se claims. Frantz, 64 Pa. D. & C.4th at 467-68;1 Goda, 62 Pa. D. & C.4th at 485. 105. Aside from 42 C.F.R. S483.25(j) regarding the maintenance of proper hydration, the OBRA regulations set forth goals to be attained by long-term care facilities, not a standard of care that can be used to allege a negligence per se cause of action. Frantz, 64 Pa. D. & C.4th at 468-69; Goda, 62 Pa. D. & C.4th at 483. 106. Further, the Courts have held that the Pennsylvania regulations set forth in 28 Pa. Code S 20 I et seq. do not set forth a basis for negligence per se. Frantz, 64 Pa. D. & C.4th at 468-69; Goda, 62 Pa. D. & C.4th at 487. 107. The state regulations were intended to "implement a system to enhance the delivery of health services to promote public health," not to protect a particular class of individuals. Id. 108. In Count IV of the Complaint, Plaintiffs allege that Defendants were negligent per se because they violated 42 C.F.R. SS 483.1O(b)(1l), 483.I3(c), 483.15(a), 483.15(e), 483.15(g), 483.15(h), 483.20(b), 483.25, 483.25(a)(1)(iv), 483.25(a)(3), 483.25(i), 483.35(a), 483.35(c), 483.35(e), 483.75(1)(1), and 28 Pa. Code S 201 et seq. I Notably, Plaintiffs' counsel, Graybill & Wise, represented the plaintiff in Frantz v. HeR ManorCare, Inc. and is actually aware of the Court's opinion. 19 109. As discussed above, these statutes and regulations do not set forth a claim for negligence per se. 110. Accordingly, Plaintiffs do not state a cause of action upon which relief can be granted with regard to the above cited paragraphs in Plaintiffs' Complaint. WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraphs 91 through 101 and 103 through 106 of Plaintiffs' Complaint for failure to state a cause of action. VI. MOTION TO STRIKE PLAINTIFFS' CLAIMS FOR PUNITIVE DAMAGES AND TO STRIKE ALL ALLEGATIONS OF INTENTIONAL CONDUCT, RECKLESSNESS AND OTHER SIMILAR LANGUAGE 11\. Defendants incorporate the averments of paragraphs I through 110 as though the same were set forth fully herein. 112. Plaintiffs have failed to assert acts and/or omissions sufficient to support allegations of "reckless" or "intentional" conduct on the part of Defendants in order to sustain a claim for punitive damages. 113. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. 114. Pennsylvania Rule of Civil Procedure 1019(a) requires a party to formulate a concise summary of the facts that serve as a basis for a cause of action. ]\.1iketic, 675 A.2d at 330-3\. 115. Pennsylvania law does not allow an award of punitive damages for mere inadvertence, mistake, error of judgment and the like, which constitute ordinary negligence. Field v. Phil. Electric Companv, 565 A.2d 1170, 1184 (Pa. Super 1989). 20 116. Plaintiffs must, as a matter of law, plead factual allegations supporting a claim of outrageous conduct, or conduct with evil motive or reckless indifference to the rights of others in order to sustain an action for punitive damages. Chambers v. Montgomery, 192 A.2d 355 (Pa. 1963); Feld v. Merriam, 485 A.2d 742 (Pa. 1984). 117. To determine whether a party exhibited "reckless and/or intentional indifference" as to provide a basis for an award of punitive damages, the court in the underlying litigation must analyze whether the defendant actually knew or had reason to know of the facts which allegedly created a high risk of physical harm to the plaintiff. Field, 565 A.2d at 1182. 118. In addition, pursuant to the Medical Care and Reduction of Error (MCARE) Act 40 P.S. S 1303.505, punitive damages may only be awarded against a healthcare provider as follows: (a) Award. Punitive damages may be awarded for conduct that is the result of the health care provider's willful or wanton conduct or reckless indifference to the rights of others. In assessing punitive damages, the trier of fact can properly consider the character of the health care provider's act, the nature and extent of the harm to the patient that the health care provider caused or intended to cause and the wealth of the health care provider. (b) Gross Negligence. A showing of gross negligence IS insufficient to support an award of puniti ve damages. (c) Vicarious Liability. Punitive damages shall not be awarded against a healthcare provider who is only vicariously liable for the actions of its agent that caused the injury unless it can be shown by a preponderance of the evidence that the party knew of and allowed the conduct of its agent that resulted in an award of punitive damages. 40 P.S. S 1303.505 (emphasis added). 119. In all four counts of their Complaint, Plaintiffs request punitive damages as a result of the alleged acts and/or omissions of Defendants in this instant matter. 21 120. In addition, the Complaint characterizes Defendants' conduct as reckless, utterly reckless, outrageous, deliberate, and with reckless and intentional indifference See Exhibit "A" at paragraphs 8, 45(G), 48 and 50, and the ad damnum clause of each count. 121. Plaintiffs' allegations vary between direct theories of liability, such as training and staffing, and vicarious theories of liability, such as failing to provide proper nutrition and medication to Ms. Carr. 122. Plaintiffs' Complaint, however, fails to enumerate any specific conduct on the part of any of the Defendants which constitutes "recklessness" or "reckless indifference" with respect to the care that was provided to Ms. Carr. 123. Further, Plaintiffs have not pled any facts which demonstrate by a preponderance of the evidence that Defendants knew of and allowed its agents to provide care to Ms. Carr which amounted to "recklessness" or "reckless indifference." 124. In an attempt to justify an award of punitive damages, Plaintiffs' Complaint merely contains general boilerplate allegations of recklessness. These allegations, however, provide absolutely no factual support and/or relationship to the injuries allegedly sustained by Ms. Carr. 125. Accordingly, Plaintiffs fail to plead specific allegations, which even if established could possibly rise to the level necessary to award punitive damages. WHEREFORE, Defendants respectfully request that this Honorable Court strike all requests for punitive damages in Plaintiffs' Complaint and strike all references to reckless, intentional, or similar conduct against Defendants in paragraphs 8, 45(G), 48, 50, and the ad damnum clause of each count of Plaintiffs' Complaint. 22 Respectfully submitted, McKISSOCK & HOFFMAN, P.c. ~~c~ anaudo, Esquire Kathryn Mason, Esquire Attorneys for Defendants 23 . , CERTIFICATE OF SERVICE I, Kathryn C. Mason, Esquire, hereby certify that a true and correct copy of the Preliminary Objections of Defendants, ManorCare Health Services, Inc. d/b/a ManorCare Health Service - Camp Hill and ManorCare, Inc. a/k/a HCR ManorCare, to Plaintiffs' Complaint, has been served upon the following persons by United States Mail, First Class, postage pre-paid, on this A day of ~D\fQ Y'IiVfj ,2005: Barbara G. Graybill Graybill & Wise, P.c. 126 Locust Street P.O. Box 11489 Harrisburg, PA 17108-1489 ,'0 R[('!C'cD t ^hl~tr A " . Barbara G. Graybill Attorney 1.0. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, P A 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA \ NO: 06-c313~-, ; ~~ 0 C:l 11 c.n _-\ . -.::c.-n 25 f-n.c:~ -:..: -n :\~1(? L_:-:i~;' ...'-, Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, (") <:.; ~:- - CIVIL ACTION -LAW r- ---:J' :"J ;-n v. 0) ...:.:, c.) HEALTH CARE PROVIDER 0 PROFESSIONAL LIABILITY CLAIM ::i MANORCARE HEALTH SERVICES, INC., D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that 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 other claim or relief requested by the Plaintiffs. You may lose money or property or other right~ important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. PENNSYLVANIA LAWYER REFERRAL SERVICE Pennsylvania Bar Association P.O. Box 186 Harrisburg, PA 17108 (800) 692-7375 . Barbara G. Graybill Attorney J.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: 0$- 313~ v. MANORCARE HEALTH SERVICES, INC., D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants COMPLAINT AND NOW COMES, Plaintiffs, by their undersigned attorney, and respectfully bring this Complaint at law, setting forth in support thereof as follows: 1. Plaintiff Elizabeth Carr is an adult woman domiciled in Camp Hill, Pennsylvania, and currently residing in the Masonic Home, Elizabethtown, Pennsylvania. 2. Plaintiff Terri Doutrich is the daughter of Plaintiff Elizabeth Carr and resides in Mechanicsburg, Pennsylvania. " 3. Defendant Manor Care Camp Hill (hereinafter Defendant Facility) is a licensed health care provider for nursing services located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 4. Defendant ManorCare, Inc. also know as HCR ManorCare (hereinafter Corporate Defendant) owns, operates, manages andl/or controls ManorCare Camp Hill. It has a corporate office at 333 North Summit Street, P. O. Box 10086, Toledo, Ohio 43699- 0086. ' 5. Defendant Facility is engaged in the business of providing nursing home services as a health care provider licensed by the Commonwealth of Pennsylvania. 6. Defendants jointly maintain oversight and control for the operation and management of Defendant Facility, including but not limited to: A. Ownership and management of the physical plant; B. Establishing policies and procedures for hiring, training, supervising and retaining staff; C. Controlling contractual obligations of Defendant Facility with regard to the hiring, oversight and retention of the Medical Director and other ancillary providers; D. Establishing and implementing care policies and procedures for residents; E. Appointment of a governing board and administrator for Defendant Facility; F. Financial management of the facility regarding funds, indebtedness, operating capital, and operating budget of Defendant Facility; and G. Compliance with applicable laws, regulations, and, where applicable, appropriate accreditation standards.O 2 7. Defendant Facility is a licensed health care provider with offices in Cumberland County, Pennsylvania. Plaintiffs are asserting a professional liability claim against this Defendant. 8. Because of their joint responsibility for the operations at Defendant Facility, Defendants are also liable for the negligent and/or reckless acts of staff at Defendant Facility. 9, Defendant Facility holds itself out to be a health care provider, which purports to possess skill and knowledge in the field of nursing home care and holds itself out to the public as so qualified. As such, Defendant, through its agents and employees, holds itself out as being capable of providing nursing services under the direction of a medical director, holds itself out to be properly staffed and able to meet the needs of Elizabeth Carr and others like her, and further holds itself out as complying on a continual basis with all the rules and regulations applicable to licensed nursing facilities. 10. On August 13, 2003, Elizabeth Carr was discharged from Holy Spirit Hospital, Camp Hill, to Defendant Facility. Her admitting diagnoses were: right gluteal hematoma, COPD, history of deep vein thrombosis, right leg pain, confusion and gastrointestinal bleed. 11, On August 13, 2003, at 2:30 p.m., Defendant Facility staff noted on Plaintiff Carr's admission assessment that she had allergies to Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics. 12. On Thursday, August 14, 2003, Defendant Facility therapy notes that Plaintiff Carr was unable to respond as she was very sleepy. 3 13. Plaintiff Carr was receiving two doses daily of Seroquel 25 mg., a drug to treat hallucinations. 14. Plaintiff Carr exhibited no hallucinations during the time she was at Defendant Facility. 15. Plaintiff Carr was non-responsive during her entire stay at Defendant Facility, sleeping constantly. 16. Due to her non-responsive status, Plaintiff Carr was unable to eat or drink. 17. Defendant Facility records have no documentation regarding the admission or discharge weight of Plaintiff Carr. 18. Plaintiff Terri Doutrich visited Plaintiff Carr several times each day during Plaintiff Carr's stay at Defendant Facility, each time finding her mother asleep. 19. On many occasions while Plaintiff Doutrich visited, a meal tray was brought into Plaintiff Carr's room, placed on a table, then removed after approximately 30 minutes. The food was never served to Plaintiff Carr, nor did any staff question why Plaintiff Carr left the tray untouched. 20. Plaintiff Doutrich complained to Defendant Facility each time meal service was provided in this manner, and expressed concern over her mother's constant sleeping. 21. On or about August 18, 2003, Plaintiff Doutrich requested that the facility discontinue the Seroquel because she was concerned that the drug was the cause of her mother's non-responsiveness. 22. At the next visit following this request, Plaintiff Carr was still being given Seroquel. 23. At that time, Plaintiff Doutrich sought out the Defendant Facility's physician, who was present in the building, and asked why Seroquel was still being administered. The 4 , . physician responded that he had not been advised of the request to discontinue the Seroquel. He immediately wrote an order to discontinue the Seroquel. 24. On her subsequent visit to her mother, Plaintiff Doutrich found that her mother was still being given Seroquel despite the physician order to discontinue it. Plaintiff Doutrich advised Defendant Facility staff that the medication should have been discontinued via a written order by the physician, but in fact had not been discontinued to be administered by the staff. 25. Following this medication error, Thomas VonNeda, son of Plaintiff Carr, visited Plaintiff Carr and found the Defendant Facility Staff ready to administer the Seroquel. The medication administration record of Defendant Facility shows that the Seroquel was administered at 5 p.m. on August 19, 2003. 26. On Tuesday, August 19, 2003, Plaintiff Carr's temperature became elevated. The nursing notes indicate that Tylenol was given for general discomfort and that Plaintiff Carr's appetite was poor and she had poor fluid intake. 27. When Plaintiff Doutrich visited on Tuesday, August 19, 2003, Plaintiff Carr was still non-responsive. Defendant Facility obtained a telephone order at that time to discontinue the Seroquel, despite the physician having earlier discontinued the medication. 28. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then 5 complained to Defendant Facility staff. No explanation for the status of this nudity and violation of personal dignity was forthcoming from the Defendant Facility staff. 29. On Tuesday, August 19, 2003, Plaintiff Carr was transferred from Defendant Facility to Harrisburg Hospital. 30. Upon admission to Harrisburg Hospital, the Emergency Department immediately administered Narcan to Plaintiff Carr due to her unresponsiveness. 31. Narcan is an antidote for opiate drugs, none of which were prescribed for Plaintiff Carr. 32. Narcan is not an antidote for Seroquel. 33. Plaintiff Carr responded to the Narcan. 34. Plaintiffs believe, and therefore aver, that Plaintiff Carr was administered opiate drugs by Defendant Facility without physician authorization. 35. Based upon Plaintiff Carr's poor food and nutrition intake, Defendant Facility should have known that Plaintiff Carr was at risk for dehydration, malnutrition, weight loss, skin breakdown and decubitus ulcers. 36. Despite this, Defendant Facility did not implement appropriate measures to ensure Plaintiff Carr did not become dehydrated, malnourished, or suffer from decubitus ulcers. 37. Additionally, to the extent Defendant Facility did monitor Plaintiff Carr's fluid and meal intake, documentation reveals that her fluid and meal intake were often inadequate. 38. Defendant Facility failed to properly assess Plaintiff Carr, failed to notify the physician of changes in Plaintiff Carr's status, and failed to provide basic care including food and hydration to Plaintiff Carr. 6 39. Defendant Facility failed to protect Plaintiff Carr from the unlawful and dangerous administration of narcotic drugs, which drugs had not been ordered for Plaintiff Carr and which Plaintiff Carr could not tolerate. 40. Defendant Facility failed to protect rights of Plaintiff Carr to a dignified existence in a safe environment. 41. Defendant Facility allowed Plaintiff Carr to lie naked and exposed for long periods of time, in violation of her dignity, rights, and basic care needs. 42. The amount claimed herein is in excess of the amount for compulsory arbitration for Cumberland County. COUNT I - NEGLIGENCE PLAINTIFF v. DEFENDANTS 43. Paragraphs 1-42 above are incorporated by reference herein. 44. By granting admission to Plaintiff Carr, Defendants voluntarily undertook a duty, as a licensed nursing facility and operators/managers of that facility, to provide Plaintiff Carr with adequate nursing facility care that met the minimum standards for such licensed nursing facility care. As part of this duty, Defendant had the duty to provide nursing services; to arrange for and monitor medical care; to hire and retain sufficient numbers of nursing personnel staff or sufficiently trained staff; to properly supervise or oversee the activities of staff members, including the medical director and/or physician retained to be responsible as medical director of the facility; and to assist all residents, including Plaintiff Carr, to attain and maintain the highest level of physical, mental, and psychosocial well-being. 7 45. Defendants, through agents, servants, and employees, breached the standard of care due to Plaintiff Carr for reasons including but not limited to the following: A. Despite the knowledge that Plaintiff Carr was at risk for altered nutritional status and weight loss, and despite Plaintiff Carr's significant weight toss during the period she was confined at Defendant Facility, Defendant Facility did not implement adequate and appropriate interventions to prevent such altered nutritional status and weight loss. B. Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr. C. Defendant Facility failed to notify, document and follow physician orders to discontinue Seroquel. D. Defendant Facility failed to protect the dignity of Plaintiff Carr. E. Defendant Facility caused Plaintiff Doutrich emotional distress upon finding her mother naked and exposed without blankets or clothes to protect her. F. Defendant Facility permitted the unlawful administration of opiate medications to Plaintiff Carr that were contraindicated and were not ordered by a physician. G. Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery. 46. The above negligent acts were not merely isolated instances but were a continuous course of conduct throughout Plaintiff Carr's stay of repeated negligent acts and omissions. 8 47. The above negligent acts were not the result of anyone individual but were a result of operational policies, procedures and practices carried out with full knowledge of Defendants. 48. The Defendants' deliberate failure in the face of obvious signs and acceptable standards of care, resulted in a high risk of physical harm and actual harm to Plaintiff Carr, who was in a feeble and frail condition, and further showed reckless indifference to her needs, rights, and requirements that Defendants purported to be able to meet. 49. Defendants knew or should have known that such conduct would result in harm to Plaintiff Carr. 50. Defendants' negligent and/or reckless acts and omissions violated 28 Pa. Code 9201.1 et seq., 42 C.F.R. 9483 et seq. and 42 U.S.C. 91396r. 51. As a direct result of Defendants' failure to provide care to Plaintiff Carr in accordance with acceptable standards of care during the period from August 13 through August 19, 2003, Plaintiff Carr experienced needless pain, suffering, emotional distress, humiliation, and loss of enjoyment of life. 52. As a direct result of Defendants' failure to act on Plaintiff Carr's behalf, Plaintiff Carr was deprived of timely access to appropriate care. 53. As a direct result of Defendants' failure to provide accurate information regarding the status of Plaintiff Carr to Plaintiffs, Plaintiffs were deprived of the opportunity to secure such necessary care from any other source. 54. As a direct result of Defendants' failure to meet the basic needs of Plaintiff Carr, failure to provide care in accordance with established protocols and physician's orders, Plaintiff Carr's life was diminished in both quality and time. 9 WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT II - NEGLIGENCE CORPORATE LIABILITY Plaintiffs v. Defendants 55. Paragraphs 1-54 are incorporated herein by reference. 56. At all times pertinent hereto, Defendants were acting in a corporate capacity in undertaking to provide care for Plaintiff Carr, through its management, through its staff, and its employees, agents and servants. 57. Defendant Facility is under the direction and control of the other Defendants. 58. Defendant Facility, as a total health care facility, is responsible for controlling and providing its physical plant, the services of a medical director, the administrator, nursing services, social services, dietary services, and such other services, including laboratory and ancillary services, in accordance with its obligation as a licensed health care provider of nursing facility services in the Commonwealth of Pennsylvania. 59. Services by other health care providers to residents of the Defendants' facility can only be provided on the premises to residents at the direction of Defendants, or in accordance with written agreements between such providers and Defendants;y 10 Defendants retain the ultimate responsibility for any and all nursing, residential, and ancillary services provided to any resident, including Plaintiff Carr. 60. At the time of admission, Defendants assigned Plaintiff Carr to the care of the medical director or attending physician of Defendant Facility. 61. The Medical Director of the Defendant Facility, while individually licensed as a physician by the Commonwealth of Pennsylvania, is nevertheless responsible, by virtue of a written agreement with Defendants and by virtue of the applicable facility licensing and certification regulations, as an agent of Defendants. 62. The Medical Director of the Defendants' Facility is responsible, by virtue of the written agreement with Defendants and by virtue of the applicable licensing and certification regulations, to oversee the development and implementation of medical policies and procedures to be observed in the facility and by all attending physicians in Defendants' Facility. 63. The ultimate responsibility for Plaintiff Carr's care was solely with the Defendants, their agents and employees, in the capacity as a total health care facility. 64. Defendants had a non-delegable duty to use reasonable care in the maintenance of safe, adequate facilities and equipment. 65. Defendants had a non-delegable duty to retain and select only competent physicians as medical director or attending physicians to oversee and implement appropriate medical policies and procedures. 66. Defendants had a non-delegable duty to retain and select competent nursing professionals and staff to implement nursing practices, policies and procedures in It accordance with the medical policies of the facility, in accordance with applicable rules and regulations, and in accordance with acceptable standards of nursing. 67. Defendants had a non-delegable duty to use reasonable care in hiring and retaining a nursing home administrator capable of managing the facility in accordance with all applicable rules and regulations, and in accordance with acceptable standards of nursing home administration. 68. Defendants had a non-delegable duty to retain and hire employees and sufficient staff to oversee all services required to be provided in the facility. 69. Defendants had a non-delegable duty to oversee all persons providing care at the facility. 70. Defendants had a non-delegable duty to exercise sole control over the provision of nursing, ancillary and all other services that were provided to the residents at Defendant Facility, including Plaintiff Carr. 71. Defendants had a non-delegable duty to formulate, adopt, and enforce adequate rules, regulations, policies, and procedures to ensure quality care. 72. Defendant Facility held itself out to the general public as being able to provide nursing facility services as ,defined by the Commonwealth of Pennsylvania. 73. Defendants, through the admission process, held itself out to Plaintiff as being able to provide nursing facility services to Plaintiff Carr. 74. During the applicable time frame, Defendant Facility was the only provider of health care services responsible for Plaintiff Carr's needs, as directed either by Defendants' medical director or Defendants' attending physician, who agreed to abide by Defendants' policies. 12 75. Defendant Facility acted as a total health facility in its relationship to the Plaintiff Carr. 76. At all times, Defendant Facility was under a duty to provide care and services of a licensed nursing facility in the Commonwealth of Pennsylvania. n. At all times, Defendants were required to manage Defendant Facility staff, agents, employees and servants in a manner that would result in Defendants delivering the necessary care and services to meet Plaintiff Carr's needs. 78. At all times, Defendant Facility was required to have in place policies and procedures, and carry out and enforce such policies and procedures, to deliver the necessary care and services to meet Plaintiff Carr's needs. 79. Defendants, through total control over the care and services Plaintiff Carr received, and by inducing Plaintiffs to rely on Defendant Facility for total care to Plaintiff Carr, acted as a total health care facility. 80. Defendants, by corporate policies and practices which engendered and fostered inadequate care, knew, and could reasonably foresee, harm to Plaintiff Carr that could have been prevented by the exercise of reasonable care in accordance with standards of practice and applicable rules and regulations. 81. The errors and omissions in the care of Plaintiff Carr are attributable to Defendants. 82. The Defendants, through corporate practices and procedures, have engaged in a systematic pattern of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: 13 , . . A. Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. B. Fostering an environment in which staff, agents, employees were indifferent to the basic needs of Plaintiff Carr. C. Failing to acquire sufficient staffing to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and profits. D. Establishing, or permitting to be carried out, practices for charting that resulted in information not being available for effective management of Plaintiff Carr's care. E. Failing to establish and/or enforce policies for assuring the timely and accurate charting of Plaintiff Carr's care. F. Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff. G. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the delivery of nutrition and hydration. H. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the sufficiency of all services that Defendant had a duty to provide to Plaintiff Carr. 83. As a result of Defendants' failure, in its corporate capacity, to provide Plaintiff Carr with the care and services she required and which Defendants purported to be able to provide, Defendants denied Plaintiff Carr routine minimally required care; increased her 14 fear, discomfort, and humiliation and deprived her from being treated by other health care providers who could accurately assess and treat her condition. WHEREFORE, because Defendants acted with bad motive, deliberate and reckless failure in the face of obvious signs that Plaintiff Carr was not receiving appropriate care, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT III VICARIOUS LIABILITY Plaintiffs v. Defendants 84. Paragraphs 1 - 83 are incorporated herein by reference. 85. At all times material thereto, Defendants held out the staff members who provided care to Plaintiff Carr, including its Medical Director, nursing staff and assistants, social workers, admission personnel, therapists and chaplain as its servants, agents, and/or employees. 86. At all times material thereto, Defendants controlled or had the right to control the work of these individuals. 87. Defendants are vicariously liable for the actions of any or all if the staff members, agents, servants or employees who provided care to Plaintiff Carr or caused the lack of care to Plaintiff Carr during her stay at Defendant Facility. 15 88. As a direct and proximate result of the conduct of Defendants and its staff members, agents, servants or employees, the care provided to Plaintiff Carr did not meet the acceptable standard of care during Plaintiff Carr's stay at Defendant Facility, resulting in hann to Plaintiff Carr, and which hann caused pain, suffering, mental anxiety, disfigurement, and loss of enjoyment of life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of$50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT IV Negligence Per Se Plaintiff v. Defendants 89. Paragraphs 1-88 are incorporated herein by reference. 90.Although the statutes and regulations contained in the paragraphs below do not necessarily provide a private cause of action, Plaintiff Carr was a member of the class of nursing home residents that the statutes and regulations were designed to protect. These statutes and regulations do establish a minimal standard of care relevant to nursing facilities licensed by the Commonwealth of Pennsylvania, of which Defendant Facility is one. 16 , . 91. The Facility failed to notify the resident's family of significant changes in the status of Plaintiff Carr as required by 42CFR 483.10(b)(11), which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 92. The Facility failed to implement policies and procedures to prevent neglect and abuse of Plaintiff Carr as required by 42 CFR 483.13(c) which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 93. The Facility failed to care for Plaintiff Carr in a manner and in an environment that promoted maintenance or enhancement of Plaintiff Carr's quality of life, or in a manner that maintained Plaintiff Carr's dignity with full respect for individuality as required by 42 CFR 483.15(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 94. The Facility failed to meet the resident's right to reside in and receive services from the facility with reasonable accommodation of individual needs as required by 42 CFR 483.15(e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 95. The Facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, including, promoting actions by staff that maintain or enhance each resident's dignity in full recognition of each resident's individuality as required by 42 CFR 483. 15(g) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 17 " . 96. The Facility failed to provide a safe, clean comfortable and homelike environment, including housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior as required by 42 CFR 483.15(h). 97. The Facility failed to conduct a comprehensive, accurate assessment of Plaintiff Carr's functional capacity and obtain appropriate physicians orders for the resident's immediate care since the facility must provide care appropriate to resident's needs from admission to discharge, as required by 42 CFR 483.20(b) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 98. The Facility failed to provide Plaintiff Carr such necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being in accordance with the comprehensive plan of care as required by 42 CFR 483.25 which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 99. The Facility failed to ensure that the resident's activities of daily living did not diminish and failed to demonstrate that the circumstances of Plaintiff Carr's clinical condition showed that diminution was unavoidable, particularly with regard to nutritional intake, as required by 42 CFR 483.25(a)(1 )(iv) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 100. The Facility failed to provide the necessary services to Plaintiff Carr to maintain good nutrition, grooming, and personal and oral hygiene as required by 42 CFR L8 " . 483.25(a)(3) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 101. The Facility failed to ensure that the Plaintiff Carr received an adequate therapeutic diet as required by 42 CFR 483.25(i) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 102. The Facility failed to provide Plaintiff Carr with sufficient fluid intake to maintain proper hydration and health as required by 42 CFR 483.25(j) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 103. The Facility failed to employ sufficient support personnel competent to carry out the functions of the dietary service as required by 42 CFR 483,35(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 104. The Facility failed to provide Plaintiff Carr with food that was palatable, attractive and at the proper temperature and in a form designed to meet individual needs as required by 42 CFR 483.35(c) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 105. The Facility failed to have a proper therapeutic diet for Plaintiff Carr prescribed by the attending physician as required by 42 CFR 483.35 (e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq 106. The Facility failed to maintain clinical records on Plaintiff Carr in accordance with accepted professional standards and practices that are complete, accurately 19 " . documented, readily accessible, and systematically organized in accordance with 42 CFR 483.75(1)(1) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 107. The failure of Defendant to meet the minimum standards established by these regulations deprived Plaintiff Carr of the basic nursing facility care purported during its admission process to be provided by Defendant; deprived Plaintiff Carr of care that Plaintiff Carr and Plaintiff Doutrich, along with Plaintiff's loved ones, had an expectation of being provided as a result of the license under which Defendant operated; caused her deterioration and discomfort, deprived her of basic dignity and safety, and diminished the quality and quantity of her life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. /Jff1 Date: ~; -1~/) ') ;r"y' ~ 'A~ ,JA ~ . Barbara G. Graybill Attomey 1.0. No. 39859 Graybill & Wise, P.C. 126 locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attomey for Plaintiffs 20 , " VERIFICATION Upon my personal knowledge or information and belief, I hereby verify that the facts averred in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that false statements or averments therein made will subject me to the criminal penalties of 18Pa.C.S. ~ 4904 relating to unsworn falsification to authorities. Date: 7 - ~ () ~ C> S Jd(CL Terri Doutrich .. . , 22 CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached Complaint on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo, Esq. McKissock & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Date: ~4b \f~&~! Id. No. 39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney For Plaintiffs ,-' -, ,', .~~\ ----<\ ','.' , -' ~- ',~ .) , c 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 (elltire captioll must be stated ill full) Elizabeth Carr, Terri Doutrich (Plaintift) vs. Manor Care Health Servi.ces, Inc. d/b/a Manorcare Health Services- Camp Hill, and Manorcare, Inc. a/k/a HCR Manorcare (Defendant) No. 05-3732 Term I. State matter to be argued (i.e., plaintiffs motion for new trial, defendant's demulTer to complaint, etc.): Defendants' Preliminary Objections to Plaintiff's r.ompl~inr 2. Identify counsel who will argue cases: (a) for plaintiff: Barbara Graybill, Graybill & Wise. 126 LOCllst St"rppt- . (Name and Address) P.O. Box 11489, Harrisburg, PA 17108 (b) for defendant: Maria R. Granaudo, McKissock & Hoffman. P.C. (Name and Address) 1818 Market Street, 13th Floor, Philadelphia, FA 19103 I will notify all parties in writing within two days that this case has been listed for argument. 3. February 15, 2006 4, Argument eourt Date: Maria R. Granaudo, Esquire Print your name Date, December 5, 2005 Manor Care Health Services, Inc. Attorney for f~-J c -1 r-,':: CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN TIIE MATIER OF: ELIZABETH eARR, ET AL vs. MANOR CARE, ET AL. Court of eommon Pleas - Cumberland eounty, P A TERM: I I CASE No: 05-3732 As a prerequisite to service ofa subpoena for documents and things pursuant to Rule 4009.22. RecordT rak on behalf of MARIA R GRANA1JDO Defendant certifies that (I) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: 12/12/2005 ~..c. k'a..u6 \ } " ~;,H:0 i< o.,-,,-_A_}-. RecordT rak on behalf of ISI MARIA R GRANAUDO Attorney for Defendant . RT#: 139087 CASE NAME: BETTY CARR ELIZABETH CARR, ET AL vs. MANOR CARE, ET AL. eOURT: eourt Of Common Pleas - eumberland County, Pa TERM: II DOeKET: 05-3732 NoneE OF INTENT TO SERVE A SUBPOENA TO PRODUeE DOeUMENTS TO: KENNETH WISE GRAYBILL & WISE 126 LOCUST STREET P.O, BOX 11489 HARRISBURG PA 17108 (717) 238-3816 November 21, 2005 Please take notice that on behalf of MARlA R. GRANA UDO, attorney for Defendant. RecordTrak intends 10 serve a subpoena idenlical to the one(s) attached 10 this notice. You have until December 12,2005 to file of record and serve upon the undersigned an objection to the subpoena(s), If no objeclion is made, the subpoena(s) will be served, IF PLAINTIFF'S COUNSEL AGREES TO W AWE THE 20 DAY NOTICE PERIOD, PLEASE lNDIeA TE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PURCHASE eOPIES OF THE REeORDS, PLEASE CONT AeT REeORDTRAK FOR PRICING AND FAX THIS CORRESPONDENCE BY December 12, 2005 TO (610) 992-1416 OR REPLY THROUGH OUR WEB SITE AT RecordTrak.com. All records will be provided (including no record statements) as produced by each record localion. Lisa Kaub 610-354-8321 RECORDTRAK 651 Allendale Road P O. Box 61591 King of Prussia, PA 19406 LIST OF RECORD CUSTODIANS AND SUBPOENAS TAG REeORD CUSTODIAN MATERIALS BEING OBTAINED I _ HOLY SPIRIT HOSPITAL I, ALL MEDIeAL REeORDS IN YOUR POSSESSION. (MED) PLEASE BE SURE TO INCLUDE Al"L ARCHIVED RECORDS AND ALL meORDS LOeATED IN STORAGE. 2 _ HOLY SPIRIT HOSPITAL I. ALL BILLING REeORDS IN YOUR POSSESSION, INCLUDING ALL BILL) STATEMENTS, ITEMIZED BILLING REeORDS, INSURANeE RECORDS AND ANY OTHER PATIENT ACCOUNT RECORDS IN YOUR POSSESSION, vs. MANOR eARE, ET AL. eOURT: eourt Of Common Pleas - Cumberland County, Pa TERM: II DOeKET: 05-3732 . EI':IZABETH eARR, ET AL 3 HARRISBURG HOSPITAL (MED) I. ALL MEDIeAL REeORDS IN YOUR POSSESSION. PLEASE BE SURE TO INCLUDE ALL ARCHIVED REeORDS AND ALL CORDS LOCATED IN STORAGE. 4 PINNACLE HEALTH SYSTEM BILLING I. ALL BILLING RECORDS IN YOUR POSSESSION, INCLUDING ALL STATEMENTS, ITEMIZED BILLING REeORDS, INSURANCE REeORDS NDANY OTHER PATIENT ACeOUNT REeORDS IN YOUR POSSESSION. ""PLEASE PROVIDE ALL BILLING RECORDS FROM HARRISBUGH OSPIT AL ... _ Yes, I would like a copy of all of the records listed above. _ Yes, I would like specific records I have indicated above SIGNATURE: Date: FIRM: Note: An order for records from plaintiWs counsel will signify that plaintiff's counsel has agreed to waive the notice period effective as of the date of the record order. ------------------------------------------------------------------------------------------------------------------------------------ YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD Signature of Plaintiff's eounsel: Date: FIRM: Page 2 . '. RT. 138461-1 , COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-37 2 Ancor Care, Inc., et aI., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR I rSCOVERY PURSUANT TO RULE 4009,22 - TO: DR. HAL FINEBDRG (Name of Pelson or Entity) Within twenty (20) days after service of this subpoena. you are orderecl by th.. c, rt to produce the following documents or things: at RecordTrak, 651 Allendale Rd. PO BOll &1691, Kina otPrussia, PI< 194D&, You may deliver or maillegibla copies of the dOcuments or produce things reque led by this subpoena, together with the certificate of compllence, to the party making this ",que-.t a' he eddress lisled above. You may have the right to seek in advance the reasonable cost of preparing c:opi ; or producing the thing. $ought, If you fall to produce the documents or Ihings required by this subpoena within t .nly (2D) day. after its $ervice, the party serving this subpoena may seek a caurt order compelling you f(, co ply with II. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWlN(~ P RSON: Name: RecordTrak. Address: 651 A"endale Rd. PO Box 81591 Kina of Pru$sia. PA 19406 Telephone: 8DO-22D-1291 Supreme Court 1011 Altomey for: DEFENDANT BY THE COUR:T: CrJ,,-'i ProthonotarylClertl DATE: (JI~ 13 ';;MJ'( Seal of Ihe Court . . . . RT.13B.61-2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-~17 2 Ancor Care, Inc" et aI., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOf;~ I fSCOVERY PURSUANT TO RULE 4009.22 TO: HOLY SPIRIT HOSPITAL (MED) (Name of Penon or Enffty) Within twenty (20) days after service of this subpoena, you are ordered by the ,Cr rt to produce the following documents or things: at RecordTrak. 651 Allendale Rd. PO Sox 61591. Kina of Prussia. PA 19406, You may deliver ar mall legible copies of the dacuments or produce things requi ted by this subpoena, together with the certificate of compliance, to the pany making this request a ne address listed ebove, You mey have the right to seek in advance the reasonable cost of preparing cop; . or producing the things sought. If you fail to produce the documents ar things requlred by this subpoena withl<l t enly (20) days after its service, the party serving this subpOena may seek a court ortler compelling you to "c 'ply with It. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING I' :RSON: Name: RecordTrak Address' 651 ARendale Rd. PO Box 61591 Kina of Prussia. PA 19406 Telephane: 800-220-1291 Supreme Court ID# Attorney for: DEFENDANT BY THE COURT: ~~~ Pro 1:lnotary ii DATE: (}u;;,L 1..3 oJ 00 f Seal cflhe Court " , RT.138461-J ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-3'7: 2 Ancor Care, Inc., et al., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FORj ISCOVERY PURSUANT TO RULE 4009.22 TO: HOLY SPIRIT HOSPITAL (BILL) (Name of P"""'n or En6ly) Within twenty (20) days after service oflhis subpoena, you ere ordered bylhel:c rll0 produce tile fo/lowing documents or lhings: at ReconlTrak. 651 AII.ndale Rd. PO Box 61591. Kina of Prussia. PA 19406. You may deliver or maillegibJe copies of the docwnents or produce things req"e :ed by tills subpoena, together with tile certificate of compliance, to the party making this request al he address listed above. You may have the right to seek in advance the IllllSonable cost of preparing copi, J or producing the things sought. If you fail to produce the documenlll or things required by this subpoena within h ,nty (20) days after ils service, the party serving this subpoena may seek a court order compelling you to 1:0 ply with It. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING P RSON: Name: RecordTrak. Address: 651 Allendale Rd. PO Box 61591 Kino 01 Prussia. PA 19406 Telephone: 800-220.1291 Supreme Court 10# Attorney for: DEFENDANT BY THE COURT: pro(Q~ DATE: afT,,).... I >, ~ IX> " Seal orthe Court " ' -1, -, , , . CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: ELIZABETH eARR vs. ANCOR eARE, INe., ET AL, eourt of Common Pleas - eumberland County, P A TERM:/ / eASE No: 05-3732 As a prerequisite to service ofa subpoena for documents and things pursuant to Rule 4009.22. RecordTrak on behalf of MARTA R GRANATJDO Defendant certifies that (I) A notice of intent to serve the subpoena with a copy of th,~ subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Date: 12/12/2005 ~-.L k'{.U{b " '-6L,~;0 k Ctc__j:y RecordT rak on behalf of /S/ MARIA R. GRANAUDO Attorney for Defendant . RT#: 138461 eASE NAME: ELIZABETH eARR ELIZABETH CARR vs. ANeOR CARE, INC" ET AL. eOURT: eourt Of Common Pleas - Cumberland eounty, Pa TERM: II DOeKET: 05-3732 NOTleE OF INTENT TO SERVE A SUBPOENA TO PRODUeE DOCUMENTS TO: KENNETH WISE GRAYBILL & WISE 126 LOeUST STREET P.o. BOX 11489 HARRISBURG PA 17108 (717) 238-3816 November 22, 2005 Please take notice that on behalf of MARIA R, GRANA UDO. attorney for Defendant. RecordTrak intends to serve a subpoena identical 10 the one(s) alJached to this notice. You have until December 12, 2005 to file of record and servc upon the undersigned an objection 10 the subpoena(s), If no objection is made, the subpoena(s) will be served, IF PLAINTIFF'S COUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDICATE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST Ol'PORTUNITY. IF YOU WISH TO PURCHASE COPIES OF THE RECORDS, PLEASE eONTACT REeORDTRAK FOR PRIeING AND FAX THIS eORRESPONDENCE BY December 12, 2005 TO (610) 992-1416 OR REPLY THROUGH OUR WEB SITE AT RecordTrak.com. All records will be provided (including no record stalements) as produced by each record location, Lisa Kaub 610-354-8321 RECORDTRAK 651 Allendale Road p, O. Box 61591 King of Prussia, P A 19406 LIST OF REeORD eUSTODIANS AND SUBPOENAS TAG 4 CORD CUSTODIAN INTERNISTS OF eE A (DR. DEMICHELE) ATERIALS BEING OBTAINED 1. ALL MEDICAL RECORDS IN YOLR POSSESSION. INeLUDE OFFICE AND AND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, QUESTIONNAlRESIHISTORY & REeORDS REeElVED BY OTHER HYSICIANS. PLEASE ALSO INeLUDE THE PATIENTS INFORMATION SHEET: **INeLUDE THE RECORDS FROM DR. MICHAEL DEMleHELE. ** PLEASE BE SURE TO INeLUDE ALL ARCHIVED RECORDS AND ALL eORDS LOeA TED IN STORAGE _ Yes, I would like a copy of all ofthe records listed above _ Yes, I would like specific records I have indicated above, .. .. ELIZABETH CARR eOURT: eourt Of Common Pleas - Cumberland County, Pa TERM: II DOeKET: 05-3732 vs. ANeOR eARE, INC., ET AL. SIGNATURE: Date: FIRM: Note: An order for records from plaintiffs counsel will signify that plaintiffs counsel has agreed to waive the notice period effective as of the date ofthe record order. ~-------------------------------------------------------------------------------------...-------------------.------------------------ YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD Signature of Plaintiff's Counsel: Date: FIRM: Page 2 ." .. RT.138451-4 .. . .~.. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. O!;-3732 Ancor Care, Inc., et a!., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: INTERNISTS OF CENTRAL PA. (DR. DEMICHELE) (Name of Person or Entity) Within twenty (201 days after servi,;e of this subpoena, you are ordered by the Court to produce the following documents or things: at RecordTrak. 651 Allendale Rd. PO Box 111591. Kina of Prussia. PA 19406. You may deliver or maillegibJe COf.ies ofthe documents ar produce things ,requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You may have the right to seek in advance the reasonable cost of preparing' copies or producing the things sought. If you fail to produce the documents or things required by this subpoena wrthin twenty (20) days after its service, the party serving this subpoerlll may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: Name: RecordTrak, Address: 651 Allendale Rd, PO Bolt 61!i91 Kino of Prussia. PA 19406 Telephone: 8()(l..220-1291 Supreme Court 10# Attorney for: DEFENDANT BY THE COURT; ivlsion p DATE: @n-.J~. J I>, ...)00" Seal ofthe Court CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 [N THE MATTER OF: ELIZABETH eARR vs. MANOR eARE. INC. ET AL. Court ofeommon Pleas - Cumberland eounty, PA TERM: I I eASE No: 05-3732 As a prcrcquisitc to scrvicc ofa subpoena for documents and things pursuant to Rule 4009,22. RecordTrak on behalf of MARIA R GRANA1JDO Defendant certifies that ( I) A notice of intent to serve the subpocna with a copy of the subpoena attached thcrcto was mailed or delivered to each party at least twenty days prior to the date on which thc subpoena is sought to be served, (2) No objcction to the subpoena has been rcccivcd or it has been waived. and (3) The subpoena which will be served is identical to thc subpoena which is attachcd to the notice of intcnt to scrve the subpoena, Date: 12/20/2005 ~---c. j(CUi 6 ,j " , (::<\.l4'tl..v KG.-u.-h- RecordTrak on bchalf of ISI MARIA R. GRANAUDO Attomey for Dcfcndant RT# 138461 eASE NAME ELIZABETH eARR ELIZABETH eARR VS. eOURT: eourt Of eommon Pleas - Cumberland eounty, Pa TERM: II DOeKET: 05-3732 MANOR eARE, INC., ET AL. NOTleE OF INTENT TO SERVE A SUBPOENA TO PRODUeE DOeUMENTS TO: KENNETH WISE GRAYBILL & WISE 126 LOeUST STREET PO BOX 11489 HARRISBURG PA 17108 (717) 238-3816 Novcmbcr 30, 2005 Please takc noticc that on behalf of MARIA R. GRANA UDO. attorney for Defendant. RccordTrak intends 10 servc a subpoena idcntical to Ihe one(s) altachcd to this notice, You havc until December 20, 2005 to file of record and scrvc upon the undersigncd an objection to thc subpoena(s), If no objection is made, the subpoena(s) will be served. IF PLAINTIFF'S eOUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDIeA TE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PUReHASE eOPIES OF THE REeORDS, PLEASE eONT AeT IlEeORDTRAK FOR PRlelNG AND FAX THIS CORRESPONDENeE BY December 20, 2005 TO (610) 992-141" OR REPLY THROUGH OUR WEB SITE AT RecordTrak.com. All records will be provided (including no record statements) as produced by each record localion, Lisa Kaub 610-354-8321 RECORDTRAK 651 Allcndale Road PO, Box61591 King of Prussia, P A 19406 LIST OF REeORD eUSTODlANS AND SUBPOENAS TAG 5 eORD eUSTODlAN MASONle NURSING OME ATERIALS BEING OBTAINED 1. ALL MEDleAL REeORDS IN YOUR POSSESSION, INeLUDE OFFleE AND AND WRITTEN NOTES, TEST RESULTS, eORRESPONDENeE. QUESTIONNAIRESIHISTORY & REeORDS REeElVED BY OTIIER HYSleIANS. PLEASE ALSO INeLUDE THE PATIENTS INFORMATION SHEET PLEASE BE SURE TO lNeLUDE ALL AReHlVED REeORDS AND ALL eORDS LOeATED IN STORAGE. ELIZABETH eARR eOURT: eourt Of eommon Pleas - eumbcrland eounty, Pa TERM: / / DOCKET: 05-3732 vs, MANOR CARE, INC" ET AL. G RENOV A eENTER 1. ALL MEDleAL REeORDS IN YOUR POSSESSION, INeLUDE OFFleE AND AND WRITTEN NOTES, TEST RESULTS, eORRESPONDENeE, QUESTlONNAlRESIHTSTORY & REeORDS REeElVED BY OTHER HYSleIANS. PLEASE ALSO INeLUDE THE PATIENTS INFORMATION SHEET PLEASE BE SURE TO INeLUDE ALL ARCHIVED REeORDS AND ALL ECORDS LOeA TED IN STORAGE, _ Yes, I would like a copy of all of the records listed above _ Yes, I would like specific records 1 have indicated above SIGNATURE: Dalc: FIRM: Note: An order for records from plaintiffs counsel will signiJY that plaintiffs counsel has agreed to waive the notice period effective as of the date of the record order. YES, I AGREE TO WAIVE THE 20 DAY NOTICE PERIOD, Signature ofPlaintiJrs eounscl: Daw: FIRM: Page 2 RT. 138461-5 COMMOI~WEAL TH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-3732 Ancor Care, Inc., et aI., SUBPOENA TO PRODUCE POCUMENTS OR THINGS FOR DISCOVERY PURliuANT TO RULE 4009.22 TO: MASONIC NURSING HOME (Name of Person or Entity) Within twenty (20) days after service (If this subpoena, you are ordered by the Court to produce the following documents or things: at RecordTrak, 651 Allendale Rd, PO Box 61591, KinCl of Prussia, PA 19406. You may deliver or mail legible copies of the documents or produce thin!Js requested by this subpoena, together with the certificate of compliance, to the party making this re,quest at the address listed above. You may have the right to seek in advance the reasonable cost of preparing copies or producing the things sought. If you fail to produce the docurnents 3r things required by this subpoena within twenty (20) days after its service, the party serving this subpoena na~ seek a court order compelling you to corn ply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: Name: RecordTrak, Address: 651 Allendale Rd. PO Box 61591 Kinq of Prussia. PA 19406 Telephone: 800-220-1291 Supreme Court ID# o..ttorney for: DEFENDANT BY THE COURT: iJ.'/4''-- ~C1 rk, Civi ivision lATE: (5'rt;,)". ~ /:>, dCX-'~ Seal of the Court RT.13MO!-U , . COMMONWEALTH OF PI:NNSYLVANfA COJNTY OF CUMBERLAND Elizabeth Carr v File No, 05-3732 Ancor Care, Inc., et a/., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: RENOVA CENTER (N .me of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the Court to produce the following documents or things: at RecordTrak, 651 Allendale Rd, PO Box 61:1.91, KinQ of Prussia. PA 19406. You may deliver or mail legible copie!, of the documents or produce things requested by this subpoena, together with the certificate of cO'11pfiance, to the party making this n~quest at the address listed above. You may have the right to seek in advance the reasonable cost of preparing copies or producing the things sought. If you fail to produce the documents :,r things required by this subpoena within twenty (20) days after its service, the party serving this subpoena nay seek a court order compelling you to comply with it. Name: RecordTrak, Address: 651 Allendale Rd, PO Box 61591 Kino of Prussia. PA 19406 Telephone: 800-220-1291 Supreme Court 10# Attorney for: DEFENDANT BY THE COURT: ~f-.... Ia PI' hOnGta1V1C rk, Civi iv/sion THIS SUBPOENA WAS fSSUED AT HIE REQUEST OF THE FOLLOWING PERSON: DATE: ai'!hJv. ~ 12> ='2O"b,,/ Seal of ttie Court o c_ C-" c:) ~ CJ P1 n ('0.) -..J o ., -I ::r:: .." In?"", i'; I,:; -" :'''': r.,) r~.) ~ Barbara G. Graybill Attorney 1.0, No, 39859 Graybill & Wise. P.C, 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION -LAW NO: 05-3732 v. MANORCARE HEALTH SERVICES, INC., D/B/A MANOR CARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that 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 other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. PENNSYLVANIA LAWYER REFERRAL SERVICE Pennsylvania Bar Association P.O. Box 186 Harrisburg, PA 17108 (800) 692-7375 27 Barbara G. Graybill Attorney I.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: 05-3732 v. MANORCARE HEALTH SERVICES, INC., D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants FIRST AMENDED COMPLAINT AND NOW COMES, Plaintiffs, by their undersigned attorney, and respectfully bring this Complaint at law, setting forth in support thereof as follows: 1. Plaintiff Elizabeth Carr is an adult woman domiciled in Camp Hill, Pennsylvania, and currently residing in the Masonic Home, Elizabethtown, Pennsylvania. 2. Plaintiff Terri Doutrich is the daughter of Plaintiff Elizabeth Carr and resides in Mechanicsburg, Pennsylvania. 3. Defendant Manor Care Camp Hill (hereinafter Defendant Facility) is a licensed health care provider for nursing services located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 4. Defendant ManorCare, Inc. also known as HCR ManorCare (hereinafter Corporate Defendant) owns, operates, manages and/or controls ManorCare Camp Hill as a nursing facility as a Pennsylvania licensed health care provider. While it has a corporate office at 333 North Summit Street, P. O. Box 10086, Toledo, Ohio 43699- 0086, it maintains a principal place of business at 1700 Market Street, Camp Hill, Pennsylvania. Furthermore, it holds itself out to the residents of the facility as being the owner, operator, manager or controller of said facility by use of HCR ManorCare documents, forms, policies and procedures such as those in Plaintiff Carr's records (See Attachment A) which were made in the course of Plaintiff Carr's stay at Defendant Facility. 5. Defendant Facility is engaged in the business of providing nursing home services as a health care provider licensed by the Commonwealth of Pennsylvania. 6. Defendants jointly maintain oversight and control for the operation and management of Defendant Facility, including but not limited to: A. Ownership and management of the physical plant; B. Establishing policies and procedures for hiring, training, supervising and retaining staff; C. Controlling contractual obligations of Defendant Facility with regard to the hiring, oversight and retention of the Medical Director and other ancillary providers; D. Establishing and implementing care policies and procedures for residents; 2 E. Appointment of a governing board and administrator for Defendant Facility; F. Financial management of the facility regarding funds, indebtedness, operating capital, and operating budget of Defendant Facility; and G. Compliance with applicable laws, regulations, and, where applicable, appropriate accreditation standards. 7. Defendant Facility is a licensed health care provider with offices in Cumberland County, Pennsylvania. Plaintiffs are asserting a professional liability claim against this Defendant. 8. Because of their joint responsibility for the operations at Defendant Facility, Defendants are also liable for the negligent and/or reckless acts of staff at Defendant Facility. 9. Defendant Facility holds itself out to be a health care provider, which purports to possess skill and knowledge in the field of nursing home care and holds itself out to the public as so qualified. As such, Defendant, through its agents and employees, holds itself out as being capable of providing nursing services under the direction of a medical director, holds itself out to be properly staffed and able to meet the needs of Elizabeth Carr and others like her, and further holds itself out as complying on a continual basis with all the rules and regulations applicable to licensed nursing facilities. 10. On August 13, 2003, Elizabeth Carr was discharged from Holy Spirit Hospital, Camp Hill, to Defendant Facility. Her admitting diagnoses were: right gluteal hematoma, COPD, history of deep vein thrombosis, right leg pain, confusion and gastrointestinal bleed. 3 11. On August 13, 2003, at 2:30 p.m., Defendant Facility staff noted on Plaintiff Carr's admission assessment that she had allergies to Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics. 12. On Thursday, August 14, 2003, Defendant Facility therapy notes that Plaintiff Carr was unable to respond, as she was very sleepy. 13. Plaintiff Carr was receiving two doses daily of Seroquel 25 mg., a drug to treat hallucinations. 14. Plaintiff Carr exhibited no hallucinations during the time she was at Defendant Facility. 15. Plaintiff Carr was non-responsive during her entire stay at Defendant Facility, sleeping constantly. 16. Due to her non-responsive status, Plaintiff Carr was unable to eat or drink. 17. Defendant Facility records have no documentation regarding the admission or discharge weight of Plaintiff Carr, which information is basic and critical to the provision of nursing home care. 18. Plaintiff Terri Doutrich visited Plaintiff Carr several times each day during Plaintiff Carr's stay at Defendant Facility, each time finding her mother asleep and unable to be aroused. 19. On many occasions while Plaintiff Doutrich visited, a meal tray was brought into Plaintiff Carr's room, placed on a table, then removed after approximately 30 minutes. The food was never served to Plaintiff Carr, nor did any staff question why Plaintiff Carr left the tray untouched. It is the responsibility of the facility to assure that each resident receives adequate services to meet the needs of the resident; the failure to feed a non- responsive patient adequate nutrition is a deviation from the standard of care required 4 by a nursing facility. It is believed, and therefore averred, that such failure constitutes neglect by Defendant Facility's own policies and procedures. 20. Plaintiff Doutrich complained to Defendant Facility each time meal service was provided in this manner, and expressed concern over her mother's constant sleeping. 21. On or about August 18, 2003, Plaintiff Doutrich requested that the facility discontinue the Seroquel because she was concerned that the drug was the cause of her mother's non-responsiveness. 22. At the next visit following this request, Plaintiff Carr was still being given Seroquel. 23. At that time, Plaintiff Doutrich sought out the Defendant Facility's physician, who was present in the building, and asked why Seroquel was still being administered. The physician responded that he had not been advised of the request to discontinue the Seroquel. He immediately wrote an order to discontinue the Seroquel. 24. On her subsequent visit to her mother, Plaintiff Doutrich found that her mother was still being given Seroquel despite the physician order to discontinue it. Plaintiff Doutrich advised Defendant Facility staff that the medication should have been discontinued via a written order by the physician, but in fact had not been discontinued to be administered by the staff. 25. Following this medication error, Thomas VonNeda, son of Plaintiff Carr, visited Plaintiff Carr and found the Defendant Facility Staff ready to administer the Seroquel. The medication administration record of Defendant Facility shows that the Seroquel was administered at 5 p.m. on August 19, 2003. 5 L___ 26. On Tuesday, August 19, 2003, Plaintiff Carr's temperature became elevated. The nursing notes indicate that Tylenol was given for general discomfort and that Plaintiff Carr's appetite was poor and she had poor fluid intake. 27. When Plaintiff Doutrich visited on Tuesday, August 19, 2003, Plaintiff Carr was still non-responsive. Defendant Facility obtained a telephone order at that time to discontinue the Seroquel, despite the physician having earlier discontinued the medication. 28. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then complained to Defendant Facility staff. Plaintiff Doutrich was traumatized and visibly upset when she reported this violation of her mother's privacy and personal dignity. It was reasonably foreseeable that the family members would suffer emotional distress at repeatedly finding their mother without clothing or care despite the facility being continually advised of this condition. No explanation for the status of this nudity and violation of personal dignity was forthcoming from the Defendant Facility staff, nor was the Defendant Facility able to correct the situation and maintain the clothed state of a non-responsive sleeping Plaintiff. Defendant was totally responsible for the care of Plaintiff Carr, and the failure to provide such care is directly attributable to Defendant. The failure of Defendant to provide such care is a tortious act of omission. Such omission to provide basic care to Plaintiff Carr, who 6 was totally unable to care for herself at the time, constitutes extreme, outrageous, intentional ad/or reckless conduct. 29. On Tuesday, August 19, 2003, Plaintiff Carr was transferred from Defendant Facility to Harrisburg Hospital. 30. Upon admission to Harrisburg Hospital, the Emergency Department immediately administered Narcan to Plaintiff Carr due to her unresponsiveness. 31. Narcan is an antidote for opiate drugs, none of which were prescribed for Plaintiff Carr. 32. Narcan is not an antidote for Seroquel. 33. Plaintiff Carr responded to the Narcan. 34. Plaintiffs believe, and therefore aver, that Plaintiff Carr was administered opiate drugs by Defendant Facility without physician authorization. 35. Based upon Plaintiff Carr's poor food and nutrition intake, Defendant Facility should have known that Plaintiff Carr was at risk for dehydration, malnutrition, weight loss, skin breakdown and decubitus ulcers. 36. Despite this, Defendant Facility did not implement appropriate measures to ensure Plaintiff Carr did not become dehydrated, malnourished, or suffer from decubitus ulcers. 37. Additionally, to the extent Defendant Facility did monitor Plaintiff Carr's fluid and meal intake, documentation reveals that her fluid and meal intake were often inadequate. 38. Defendant Facility failed to properly assess Plaintiff Carr, failed to notify the physician of changes in Plaintiff Carr's status, and failed to provide basic care including food and hydration to Plaintiff Carr. 7 39. Defendant Facility failed to protect Plaintiff Carr from the unlawful and dangerous administration of narcotic drugs, which drugs had not been ordered for Plaintiff Carr and which Plaintiff Carr could not tolerate. 40. Defendant Facility failed to protect rights of Plaintiff Carr to a dignified existence in a safe environment. 41. Defendant Facility allowed Plaintiff Carr to lie naked and exposed for long periods of time, in violation of her dignity, rights, and basic care needs. 42. The amount claimed herein is in excess of the amount for compulsory arbitration for Cumberland County. COUNT I - NEGLIGENCE PLAINTIFF CARR v. DEFENDANTS 43. Paragraphs 1-42 above are incorporated by reference herein. 44. By granting admission to Plaintiff Carr, Defendants voluntarily undertook a duty, as a licensed nursing facility and operators/managers of that facility, to provide Plaintiff Carr with adequate nursing facility care that met the minimum standards for such licensed nursing facility care. As part of this duty, Defendant had the duty to provide nursing services; to arrange for and monitor medical care; to hire and retain sufficient numbers of nursing personnel staff or sufficiently trained staff; to properly supervise or oversee the activities of staff members, including the medical director and/or physician retained to be responsible as medical director of the facility; and to assist all residents, including Plaintiff Carr, to attain and maintain the highest level of physical, mental, and psychosocial well-being. 45. Defendants, through agents, servants, and employees, breached the standard of care due to Plaintiff Carr for the following reasons: 8 A. Despite the knowledge that Plaintiff Carr was at risk for altered nutritional status and weight loss, and despite Plaintiff Carr's significant weight loss during the period she was confined at Defendant Facility, Defendant Facility did not implement adequate and appropriate interventions to prevent such altered nutritional status and weight loss. B. Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr as evidenced by the inability of Defendant Facility to provide basic care, including nutrition, hydration, clothing, dignity and safety to Plaintiff Carr. C. Defendant Facility failed to notify, document and follow physician orders to discontinue Seroquel. D. Defendant Facility failed to protect the dignity, safety and well-being of Plaintiff Carr as evidenced by the continual failure of Defendant facility to monitor the state of nakedness or clothing and covers of a non-responsive sleeping Plaintiff Carr. E. Defendant Facility caused Plaintiff Doutrich trauma and emotional distress by causing her mother to be repeatedly naked and exposed without blankets or clothes to protect her and without sufficient staff to provide such basic care to her mother. F. Defendant Facility permitted the unlawful administration of opiate medications to Plaintiff Carr that were contraindicated and were not ordered by a physician. G. Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery. 9 46. The above negligent acts were not merely isolated instances but were a continuous course of conduct throughout Plaintiff Carr's stay of repeated negligent acts and omissions. 47. The above negligent acts were not the result of anyone individual but were a result of operational policies, procedures and practices carried out with full knowledge of Defendants. 48. The Defendants' deliberate failure in the face of obvious signs and acceptable standards of care, resulted in a high risk of physical harm and actual harm to Plaintiff Carr, who was in a feeble and frail condition, and further showed reckless indifference to her needs, rights, and requirements that Defendants purported to be able to meet. 49. Defendants knew or should have known that such conduct would result in harm to Plaintiff Carr. 50. Defendants' negligent and/or reckless acts and omissions, as set forth herein, violated 28 Pa. Code S 201.1 et seq., 42 C.F.R. S 483 et seq. and 42 U.S.C. S 1396r. 51. As a direct result of Defendants' failure to provide care to Plaintiff Carr in accordance with acceptable standards of care during the period from August 13 through August 19, 2003, Plaintiffs experienced needless pain, suffering, emotional distress, humiliation, and loss of enjoyment of life. 52. As a direct result of Defendants' failure to act on Plaintiff Carr's behalf, Plaintiff Carr was deprived of timely access to appropriate care and Plaintiff Doutrich was deprived of an opportunity to secure appropriate care for her mother. 10 53. As a direct result of Defendants' failure to provide accurate information regarding the status of Plaintiff Carr to Plaintiffs, Plaintiffs were deprived of the opportunity to secure such necessary care from any other source. 54. As a direct result of Defendants' failure to meet the basic needs of Plaintiff Carr, failure to provide care in accordance with established protocols and physician's orders, Plaintiff Carr's life was diminished in both quality and time, and Plaintiff Doutrich suffered emotional distress. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT II - NEGLIGENCE CORPORATE LIABILITY Plaintiffs v. Defendants 55. Paragraphs 1-54 are incorporated herein by reference. 56. At all times pertinent hereto, Defendants were acting in a corporate capacity in undertaking to provide care for Plaintiff Carr, through its management, through its staff, and its employees, agents and servants. 57. Defendant Facility is under the direction and control of the other Defendants. 58. Defendant Facility, as a total health care facility, is responsible for controlling and providing its physical plant, the services of a medical director, the administrator, 11 nursing services, social services, dietary services, and such other services, including laboratory and ancillary services, in accordance with its obligation as a licensed health care provider of nursing facility services in the Commonwealth of Pennsylvania. 59. Services by other health care providers to residents of the Defendants' facility can only be provided on the premises to residents at the direction of Defendants, or in accordance with written agreements between such providers and Defendants; Defendants retain the ultimate responsibility for any and all nursing, residential, and ancillary services provided to any resident, including Plaintiff Carr. 60. At the time of admission, Defendants assigned Plaintiff Carr to the care of the medical director or attending physician of Defendant Facility. 61. The Medical Director of the Defendant Facility, while individually licensed as a physician by the Commonwealth of Pennsylvania, is nevertheless responsible, by virtue of a written agreement with Defendants and by virtue of the applicable facility licensing and certification regulations, as an agent of Defendants. 62. The Medical Director of the Defendants' Facility is responsible, by virtue of the written agreement with Defendants and by virtue of the applicable licensing and certification regulations, to oversee the development and implementation of medical policies and procedures to be observed in the facility and by all attending physicians in Defendants' Facility. 63. The ultimate responsibility for Plaintiff Carr's care was solely with the Defendants, their agents and employees, in the capacity as a total health care facility. 64. Defendants had a non-delegable duty to use reasonable care in the maintenance of safe, adequate facilities and equipment. 12 65. Defendants had a non-delegable duty to retain and select only competent physicians as medical director or attending physicians to oversee and implement appropriate medical policies and procedures. 66. Defendants had a non-delegable duty to retain and select competent nursing professionals and staff to implement nursing practices, policies and procedures in accordance with the medical policies of the facility, in accordance with applicable rules and regulations, and in accordance with acceptable standards of nursing. 67. Defendants had a non-delegable duty to use reasonable care in hiring and retaining a nursing home administrator capable of managing the facility in accordance with all applicable rules and regulations, and in accordance with acceptable standards of nursing home administration. 68. Defendants had a non-delegable duty to retain and hire employees and sufficient staff to oversee all services required to be provided in the facility. 69. Defendants had a non-delegable duty to oversee all persons providing care at the facility. 70. Defendants had a non-delegable duty to exercise sole control over the provision of nursing, ancillary and all other services that were provided to the residents at Defendant Facility, including Plaintiff Carr. 71. Defendants had a non-delegable duty to formulate, adopt, and enforce adequate rules, regulations, policies, and procedures to ensure quality care. 72. Defendant Facility held itself out to the general public as being able to provide nursing facility services as defined by the Commonwealth of Pennsylvania. 13 73. Defendants, through the admission process, held itself out to Plaintiff as being able to provide nursing facility services to Plaintiff Carr. 74. During the applicable time frame, Defendant Facility was the only provider of health care services responsible for Plaintiff Carr's needs, as directed either by Defendants' medical director or Defendants' attending physician, who agreed to abide by Defendants' policies. 75. Defendant Facility acted as a total health facility in its relationship to the Plaintiff Carr. 76. At all times, Defendant Facility was under a duty to provide care and services of a licensed nursing facility in the Commonwealth of Pennsylvania. n.At all times, Defendants were required to manage Defendant Facility staff, agents, employees and servants in a manner that would result in Defendants delivering the necessary care and services to meet Plaintiff Carr's needs. 78. At all times, Defendant Facility was required to have in place policies and procedures, and carry out and enforce such policies and procedures, to deliver the necessary care and services to meet Plaintiff Carr's needs. 79. Defendants, through total control over the care and services Plaintiff Carr received, and by inducing Plaintiffs to rely on Defendant Facility for total care to Plaintiff Carr, acted as a total health care facility. 80. Defendants, by corporate policies and practices which engendered and fostered inadequate care, knew, and could reasonably foresee, harm to Plaintiff Carr that could have been prevented by the exercise of reasonable care in accordance with standards of practice and applicable rules and regulations. 81. The errors and omissions in the care of Plaintiff Carr are attributable to Defendants. 14 82. The Defendants, through corporate practices and procedures, have engaged in a systematic pattern of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: A. Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. B. Fostering an environment in which staff, agents, employees were indifferent to the basic needs of Plaintiff Carr, as evidenced by the continuing stripping of Plaintiff Carr's clothes and bedclothes, leaving her naked and cold in an unresponsive state; and as further evidenced by the failure of the facility to provide adequate nutrition and hydration in a form and manner that could be processed by Plaintiff Carr in her non-responsive state. C. Failing to acquire sufficient staffing, as shown by the lack of care for Plaintiff Carr, to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and profits. In the alternative, the lack of care provided to Plaintiff Carr was a result of reckless indifference to the needs of Plaintiff Carr, or outrageous conduct and intentional neglect of a frail, elderly woman who was incapable of caring for herself. D. Establishing, or permitting to be carried out, practices for charting that resulted in information not being available for effective management of Plaintiff Carr's care. 15 E. Failing to establish and/or enforce policies for assuring the timely and accurate charting of Plaintiff Carr's care. F. Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff. G. Failures to implement appropriate policies and procedures to adequately provide and adequately assess the delivery of nutrition and hydration. H. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the sufficiency of all services that Defendant had a duty to provide to Plaintiff Carr, as evidenced by the resulting nakedness, non- responsiveness, lack of nutrition and hydration which Plaintiff Carr experienced. 83. As a result of Defendants' failure, in its corporate capacity, to provide Plaintiff Carr with the care and services she required and which Defendants purported to be able to provide, Defendants denied Plaintiff Carr routine minimally required care; increased her fear, discomfort, and humiliation and deprived her from being treated by other health care providers who could accurately assess and treat her condition. WHEREFORE, because Defendants acted with bad motive, deliberate and reckless failure in the face of obvious signs that Plaintiff Carr was not receiving appropriate care, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. 16 COUNT III VICARIOUS LIABILITY Plaintiffs v. Defendants 84. Paragraphs 1 - 83 are incorporated herein by reference. 85. At all times material thereto, Defendants held out the staff members who provided care to Plaintiff Carr, including its Medical Director, nursing staff and assistants, social workers, admission personnel, therapists and chaplain as its servants, agents, and/or employees. 86. At all times material thereto, Defendants controlled or had the right to control the work of these individuals. 87. Defendants are vicariously liable for the actions of any or all if the staff members, agents, servants or employees who provided care to Plaintiff Carr or caused the lack of care to Plaintiff Carr during her stay at Defendant Facility. 88. As a direct and proximate result of the conduct of Defendants and its staff members, agents, servants or employees, the care provided to Plaintiff Carr did not meet the acceptable standard of care during Plaintiff Carr's stay at Defendant Facility, resulting in harm to Plaintiff Carr, and which harm caused pain, suffering, mental anxiety, disfigurement, and loss of enjoyment of life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 3908, as adopted by the law of the Commonwealth of Pennsylvania. 17 COUNT IV Negligence Per Se Plaintiff v. Defendants 89. Paragraphs 1-88 are incorporated herein by reference. 90.Although the statutes and regulations contained in the paragraphs below do not necessarily provide a private cause of action, Plaintiff Carr was a member of the class of nursing home residents that the statutes and regulations were designed to protect. These statutes and regulations do establish a minimal standard of care relevant to nursing facilities licensed by the Commonwealth of Pennsylvania, of which Defendant Facility is one. 91. The Facility failed to notify the resident's family of significant changes in the status of Plaintiff Carr as required by 42CFR 483.10(b)(11), which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 92. The Facility failed to implement policies and procedures to prevent neglect and abuse of Plaintiff Carr as required by 42 CFR 483.13(c) which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 93. The Facility failed to care for Plaintiff Carr in a manner and in an environment that promoted maintenance or enhancement of Plaintiff Carr's quality of life, or in a manner that maintained Plaintiff Carr's dignity with full respect for individuality as required by 42 CFR 483.15(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 94. The Facility failed to meet the resident's right to reside in and receive services from the facility with reasonable accommodation of individual needs as required by 42 18 CFR 483.15(e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 95. The Facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, including, promoting actions by staff that maintain or enhance each resident's dignity in full recognition of each resident's individuality as required by 42 CFR 483.15(g) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 96. The Facility failed to provide a safe, clean comfortable and homelike environment, including housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior as required by 42 CFR 483.15(h). 97. The Facility failed to conduct a comprehensive, accurate assessment of Plaintiff Carr's functional capacity and obtain appropriate physicians orders for the resident's immediate care since the facility must provide care appropriate to resident's needs from admission to discharge, as required by 42 CFR 483.20(b) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 98. The Facility failed to provide Plaintiff Carr such necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being in accordance with the comprehensive plan of care as required by 42 CFR 483.25 which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 19 99. The Facility failed to ensure that the resident's activities of daily living did not diminish and failed to demonstrate that the circumstances of Plaintiff Carr's clinical condition showed that diminution was unavoidable, particularly with regard to nutritional intake, as required by 42 CFR 483.25(a) (1)(iv) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 100. The Facility failed to provide the necessary services to Plaintiff Carr to maintain good nutrition, grooming, and personal and oral hygiene as required by 42 CFR 483.25(a)(3) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 101. The Facility failed to ensure that the Plaintiff Carr received an adequate therapeutic diet as required by 42 CFR 483.25(i) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 102. The Facility failed to provide Plaintiff Carr with sufficient fluid intake to maintain proper hydration and health as required by 42 CFR 483.250) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 103. The Facility failed to employ sufficient support personnel competent to carry out the functions of the dietary service as required by 42 CFR 483.35(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 104. The Facility failed to provide Plaintiff Carr with food that was palatable, attractive and at the proper temperature and in a form designed to meet individual needs as 20 required by 42 CFR 483.35(c) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 105. The Facility failed to have a proper therapeutic diet for Plaintiff Carr prescribed by the attending physician as required by 42 CFR 483.35 (e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq 106. The Facility failed to maintain clinical records on Plaintiff Carr in accordance with accepted professional standards and practices that are complete, accurately documented, readily accessible, and systematically organized in accordance with 42 CFR 483.75(1)(1) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 107. The failure of Defendant to meet the minimum standards established by these regulations deprived Plaintiff Carr of the basic nursing facility care purported during its admission process to be provided by Defendant; deprived Plaintiff Carr of care that Plaintiff Carr and Plaintiff Doutrich, along with Plaintiff's loved ones, had an expectation of being provided as a result of the license under which Defendant operated; caused her deterioration and discomfort, deprived her of basic dignity and safety, and diminished the quality and quantity of her life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct 21 towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT V NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS 108. Paragraphs 1 - 107 are incorporated herein by reference. 109. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then complained to Defendant Facility. Plaintiff Carr was traumatized and crying when she reported this violation of her mother's privacy and personal dignity, since it was indicative of abuse and neglect. 110. It was reasonably foreseeable that the family members would suffer emotional distress at repeatedly finding their mother without clothing or care despite the facility being continually advised of this condition. No explanation for the status of this nudity and violation of personal dignity was forthcoming from the Defendant Facility staff, nor was the Defendant Facility able to correct the situation and maintain the clothed state of a non-responsive sleeping Plaintiff. 111. Defendant was totally responsible for the care of Plaintiff Carr, and the failure to provide such care is directly attributable to Defendant. The failure of Defendant to provide such care is a tortious act of omission. Such omission to provide basic care to Plaintiff Carr, who was totally unable to care for herself at the time, constitutes extreme, outrageous, intentional ad/or reckless conduct. 22 112. Defendants knew that it was reasonably foreseeable that such dereliction of duty by Defendants to Plaintiff Carr as set forth in the paragraphs above would cause emotional distress to family members, including Plaintiff Doutrich, who was personally confronted with the outrageous, extreme, intentional and reckless conduct of omission in the care of her mother. 113. Plaintiff Doutrich suffered trauma and emotional distress by Defendants causing her mother to be repeatedly naked and exposed without blankets or clothes to protect her and without sufficient staff to provide such basic care to her mother. Plaintiff Doutrich was traumatized and crying as she reported such facts. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, !';908, as adopted by the law of the Commonwealth of Pennsylvania. Date: If~k ~~, ''jJ . - Barbara G. Graybill ~ Attorney 1.0. No. 39859 Graybill & Wise, P.C. 126 Locust Street p, O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs 23 ATTACHMENT A EVIDENCE OF CONTROL BY HCR MANORCARE 24 HCR-ManorCare Patient ~ ~/?l~ih"/(!\h'l!?jl;~!; I ~11 ~I ~(ij II ~{I ~, '1?l0ct- '6 Room No. ~ L ZS' A c. (\ ~J DESCRIPTION: Bathrobe Bed Jackels Bells Blouses Bras Coat Dresses Girdles Hat Hose Ni ht owns Pajamas Panties Shirts Shoes Skirts Slips Slippers Sweaters Ties Trousers Undershirts Undershorts Wallet I certify that the above is a correct list of my personal belongings. I take full responsibility for retaining in my possession the articles listed above and any others brought to me while a patient in this facility. Cane Comb Brush Crutches Dentures-Full U er Partial U Lower Lower Rimless ) Safety ( Q I ALL ITEMS BROUGHT FOR THE PERSONAL USE OF THE PATIEr!T MUST BE PROPERLY MARKED AND LISTED AS ARE THE ABOVE. Please bring additional items to the Nurse's Station for proper handling. Patient's washable clothing to be: taken home, for laundering laundered here at the center. I understand the Management will not be responsible for any valuables, money, or clothing left in the possession of the patient. Disposition on DIS. Charge A 11, / "iW- ~ r;Kffi1 . 'irr ~ Signaturr Nurse " , M" Date Z 7~ ~. Signature of Patient (or Relative) Signature of Nurse Date r; -14- f/if.'3 Date r-/r f17 J 'Upon Discharge, all Personal items are sent with patient or picked up by responsible party. Upon transfer, all Personal items are to be boxed and placed in designated storage area for safe keeping. OOOO:J:1_ Signature of patient/relative Date Inwmtorv of Pp.r!=;on::ll EffActs HCR'ManorCare DATE 1D:m;ti8~ ~ ~ /:;.--03 STAG~~IZE' 2, em Wide }J ,,PESCRIPTION: 0 G"nul,tion Z' y o Tunneling o Exudate (Description): PRESSURE ULCER REPORT Amount: D Necrotic Tissue (Description): SURROUNDING SKIN (Characteristics), TREATMENT PLAN, SIGNATURE/DATE, STAGE, DESCRIPTION, em Deep o 'Epithelialization o Undermining o Serosanguineous o Scont o Slough o Normal Appearance o Induration o Revised to: Cleanse with (solution) SIZE, em Wide o Granulation o Tunneling o Exudate: (Description): Amount: o Necrotic Tissue (Description): SURROUNDING SKIN (Characteristics), TREATMENT PLAN: -."" J SIGNATURE, o Continue "'] -. "j,"'"'" em Deep o Epithelialization o Undermining o Serosanguineous o Scant o Slough o Normal Appearance o Induration Location '>,D oL. em Long o Pain o Odor o Serous 0 Purulent o Moderate 0 Heavy o Eschar 0 Debrided Date: o Erythema 0 Maceration OEdema 0 Cyanosis Apply (product) Frequency em Long o P,in o Odor o Serous 0 Purulent o Mod",,, 0 Hesvy o Eschar 0 Debrided Date: o Erythema 0 Maceration OEdema 0 Cyanosis ASSESSMENT DATE: STAGE: DESCRIPTION, em Deep o Epithelialization o Undermining o Serosanguineous o Scont o Slough o Normal Appea1rance o Induration o Revised to: SIZE: em Wide o Granulation o Tunneling o Exudate (Description): Amount: o Necrotic TIssue (Description): SURROUNDING SKIN (Characteristics), TREATMENT PLAN, SIGNATURE, o Continue em Long o Pain o Odor o Serous 0 Purulent o Moderate 0 Heavy o Eschar 0 Debrided Date: o Erythema 0 Maceration OEdema 0 Cyanosis em Deep o Epithelialization o Undermining o Serosanguineous o Scant o Slough o Normal Appearance o Induration o Revised to: FHC.3083 (Rev. 6/99) BRIGGS. 0.. Moo"u, lA 503015 1800) 2.1.2343 ~om!O NI,lSA SIZE: em Wide o Granulation o Tunneling o Exudate (Description): Amount: o Necrotic Tissue (Description): ) SURROUNDING SKIN (Characteristics): o Continue ASSESSMENT DATE, em Long o Pain o Odor STAGE, DESCRIPTION, TREATMENT PLAN: SIGNATURE, Resident Name: o Serous 0 Purulent o Moderate 0 Heavy o Eschar 0 Debrided Date: o Erythema 0 Maceration OEdema D Cyanosis ASSESSMENT DATE, MR Number: . ~ o' ~ "" Q .~ o '" ~bS ~~ ot ~ ~, s: '" 0. ~. ~I 0. z !'! ;::)0 '" '" V> " c: '" a z '" 3 ~ z o < o ((J Q. .g -~ p c: co <- Eo <- c: '" s: P D.l "0 '< ~ s: '" ~ " '" 0' I c... '" :> ii'. ~" !!. [i"~ i" ii ;; ;,1<" ~ ;" to ;; -.0 ~ ; ;; ~l"!, !- .. ;: Q , S' ".0 i~ ... U!~ rg~~~ ~ " ~~ v>z 15"2. !:l. _. Ul .''1- ~ U Q /II 0 y , ~ 0. _. tn ~::I::Ii! ~ :g Q , - 0. -. 0 . ' 'I- ~ 0; 0 O' ;: o ~ '" ~ , . , tiS" ~ ~ ~ ,"' ~ , . , ..0 "! . ~ "'. ~ , . " ~"! ~ '" ~ , . , if! ~ iii' V> o '" " z o o~ D.l -. -" "'E!. o' :> 'i ~, '" o' ;;:: '1 ~ ell o' :! ~ '" '" "" .:;:: ~ C1l o' J>.-, ::J' 51 (jj ~ ell o' :! "5 ~ C1l o. :! s: o :> - ::J' .:;:: ~ '" o' ;:r Vi ill o' S: o' D.l a ~ C1l o' :! (') ::J' D.l '" co ell o~:r:o ~ CD ~. ~ :;" cO' <g. ~ "'::T_ O" -.. " ~ ell o' =: ::u '" '" co ~ ~enc:Ol(,)~ :::r-g=2t~1ll ctl ('):E =:T _.:::1 co-'--o...,o. oE.5:J" 5' :::T- C) lC tIJ '< en -. - -. cr::::"" r: ""ctlc5~ "Q c. - -' co :! -; 3 '" 2- 0. '" ;:E ;:E'< '" '" ~ rtl CD ~ ~~a: '<'<", :< :< a ~. ~.~ tg.<g. ~. V;-Ui~ e-:o~ (II C".. 8 '" " 0. :=:'0 " " ; !'D P- o '" !iT }> 3 o c: a '" " 0. -< '" '" 2- n 0' 5' 3' !P '" '" "2- iii' " n '" .'" '" p is: 3 (ii' II> 0' :> :>; :> :> c: 2!. C '0 0. D.l '" ~ r ~ ~ '" 0' ~ 3 E!. o' ? en " D.l " 0' c: II> C1l 0' ~ 5' (ii' ~ C1l lI> c: C1l ~ ~ m G) :r: -i ::JJ m (') o ::JJ o (f) '0 C1l Q. Il> 3' !!l. ~ c: U o' '" '" o '" ::; C1l o' ::J' 3' co -< CD OJ :0 ~ C1l lI> c: C1l '" ~ OOO!'l13 '" _L _,~ ,~Initial 0 Discharge ^ ,~- 0 Reassessment ,--' SPEECH/LANGUAGE EVALUATION HCR.'ManorCare ) MI Rehab Payor '!'--lccl IT Patient DOB & Age \-31 -2L{. CSt) 1)~CI.. ~ 'S.~~~ ,v; ye~ Prior Uving Arrangements D~ G sy\ Other Related Medical. Rehab, Social Hx. Precautions Q\- ~~ Auditory/Visual/Speaking/ Augmentative Devices Prior Communication Status source of infonnation: 0 Patient 0 Relative/Caregiver 0 Facility Staff 0 Medical Chart 0 Other: When: If not English. needs: 0 Bilingual Therapist o Modified Materials. if so describe: O!nterpreter p n ..;;i~~r.ma.t;: <6,::7~}~~ified;lri~p1:#t!!i~~~~~Ji.~,~!EeYi~~; .: 5 .-" ~~~rviSio~/~'t.rip/C,~~:~~4*":; 4~'MirlI. ..1 )~~i~"e?~~~f#iM. ~i;;:';:~~i~~~:!~-5~~~.~~~~~~f'r~~~~~~it~~~g7~~gi~~i';~~f~}j!#~l~~o~~~~~~0,~~(.l"~l~~. ~.~~~~t:.~/{~i~~~!~~t~:~. . Speech Intelligibility: Use key for rating as indicated ,# 0 Not functional. complete below section Ql.J11fiCtional - Slip this section Rate: Intelligibility of: single words _ sentences _ conversation _ Comments: Oral Motor Function for Speech/Swallowing: Use key for rating as indicated 0 Nor functional. complete below section Rate: Lingual: ROM _ Coord _ Strength _ Labial, ROM _ Coord _ Strength _ Palatal; ROM _ Coord _ Strength _ unctional . Skip this section Comments: _J Swallowing: Use key for rating as indicated NST, Current 0 NPO 0 Oral Type/Level, Hx of Swallowing Probs: Pre-Swallowing Assmt: Swallowing Assmt: Volitional or Reflexive cough (Circle) Throat clearing _ List Symptoms of Dysphagia: Self Feeding Skills, Comments; o Not functional . complele below section Prior Level ~tiona1- Skip this section o NPO 0 Oral Type/Level, Voice Assessment: Use key for rating as indicated 0 Not functional. complete below section ~nal . Skip this section Quality: 0 WFL or if impaired, rate: _ Nasality: hyper/hypo,_ Harshness _ Hoarseness _ Breathiness_ Strained _ Aphonia _ Pitch: 0 Normal 0 Low 0 High Intensity: 0 Normal 0 Low 0 High Resp control: 0 Adequate, If not, rate: _ Comments: Language Comprehension Assessment: Use key for rating as indicated 01 functional. complete below section 0 Functional - Skip this section Status: Prior: Overall _ Aud _ Reading._ ViS _ CUrrent: Overall _ Aud _ Reading _ Vis_ Aud Comprehension: Resp to: sound _ speech _ name _ ID by: name _ func_ Commands: Step{s) I _ 2 _ Mult _ Aud Resp to: Y/N quest _ Paragraphs._ Conversation_ Reading Comprehension: Single words _ Simple or complex phrases/sent _ Paragraphs _ Functional Reading _ VISual Comprehension: Matches objects _ Pictures _ Pictures to objects _ Detect: Difference in pictures _ Compensates for VF Deficits _ Comments: 000045 Therapist's Signature/Credentials M.J CJ:M../Jt.P Date 0/IS/63 FMc.1501.SLP (Rev. 9/991 I o Physical Therapy o Occupational Therapy · HCR.ManorCare ~Ch Language Pathology Medical Record # -\0 S\ .. ,. 041; ~Initiai 0 Discharge o Reassessment PlIYSK AL TlIERr\PY r\'r\LlJATIO\ HCR.ManorCare , Prior Living Arrangements ch... Rehab, Social Hx r ...... Back. Extension '- Hip Flexion ELBOW / FOREARC...:> 'I-<@ L~ Hip Extension Hip Abduction WRlS'f / FINGERS t.JSI" l(0 Hip Adduction Hip lal Rot.. ROM: Cervical &: Trunk us F( ,~ Hip E:tt. Rot Knee Flexion Tone: 0 'WNL Comments: ~bnonnal Endurance: Good / / PoOr Tolerance: Sitting Unsupported Standing Unsupported { L~ Knee Extension Ankle Dorsiflexion Inversion Balance: Sit:Static~ Dynamic ~ Standing: Static. Nr:- DynamIc Ankle Plantar Flexion Skin Condition: Proprioception: Edema: 0 Absent 0 Present GAil ,\SSESSMP, r Gait Analysis Key: 1. Completely independent: 6 - Modified Independence, extra time I device; S. Supervision / Set Up; 4 - Minimal Assistance 25%: J - Moderate Assistance 50%; 2 - Maximal Assistance 75%; I. Total Dependency; NT. Not Tested _ Other: level Surface Uneven Surface Stairs Ramp 000048 COMMENTS Thmp'" Sign'~"de~"I' Date JJ ('I( d3 "uf'T PHYSICAL THERAPY SUMMARY HCR.ManorCare Change In payer (payer/date): o Weekly o 14 Day Report , ". ,,~~sl';;'~~,;:~:;~;*~Di~,oli~,~ Pa!erNu,~~_""~>_ w', ~1t FaciI,ftyName&:Num . .;6{\}~~{!~ :l~~i;,",i:::~t~ ~_~w~i~~~iL~'~t't;, "( Treatment Approac,hesi'. )f~#~;~~1\~~it~};~~~~~.~:~~~j!1~:.: :s 4. t;~ ~~~~{\I .. extra time '/ device; 5 - Supervision I Set up; NT - Not Tested; NTx - Not Treated SKILL _. <.... c..... .. ;.,.',.., ..".\,.::...._..:;. COMMENTS / DESCRI~;IOi'! c,:! _,'... '-', ,", ,-_,_"_,,__,,'__,l,~,, Neuromuscular & Orthopedic Status: C/o ~ ([J ~ ~~ BED MOBILITY Supine..... Sit Roll 'Turn Scoot I Bridge TRANS- FERS Sit ....Stand To Bed To Chair I Whel!lchair To Toilet Gait I Balance I Coordination: To Car ~ -c.... ~ &t~~ ToFtoor GAIT Levc:ISurfaee Uneven Surface Stain Ramp W/C MOBILITY Safety & Other Related Issues: Comments on Progress / Summary I Assessment: -;)"' ~ :0 -t;.z ~ I ~ ~ u-Hfo ~. Treatment Plan and Goals: o Refer to abon Chart for ole Goals a Refer to above Chart for STGs Frequency: Days per week Per Day: 0 Q.D. 0 B.LD. Duration: o Patient I Family I Caregiver education, teaching and training to prepare for discharge from therapy. -t, (,.>JJl- ~~ ~~~t~~:- ~-~ e-... ~'1j~~~ o Patient 1 Caregiver instructed in Home Program C ~ ...' \ S)(<- ~ .\" db , ~ , 30 Day Summary Only - Physician Recertification o ( ha~'e reviewed this. pta.n ;l.nd recertif'f a con~inuing need fur 3G more days' of ser\'ices. o Discontinue o Recertification not necessary Physician Signature and Date ~ FMC.HI03-PT (Rev. 8/02) o Initial 0 Discharge o Reassessment OCCLJPATIONAL THERAPY E\AllJATlON HCR.ManorCare Date of Onset 7-5u'0..] -'<I-D Other Pcrtinent Dx '_',,"'" -fr:, !M.<<.. \1], ';'",3"S~~'ll"'~~l:~",f'''''' Patient's Last Name First Name Mt Other Related Medical, Rehab, Social Hx Co fOb GI6/" <;.-4.- ~ Precautions Adaptive Equipmen hl\'(.b-- i~~Yi'/.'J>i>(iCEPTUAi,'.Mci,tOR:!'~~~N.T.i'I!'ri<frcii!e~;:~fjvrt;JMp;~!rij':NlM~l~@rtr~~#n'i\PI;it~1~h Sensory: sharp / dull. touch. pressure. temperature 1bu E t'^ i'z\ a- Vision: acuity (glasses) / ocular pursuits / visual field Ulrr..- Stereognosis I Proprioception: N-l Visual Perception: visual organization I diSl:riminalion / spatial relations I neglect rt; Auditory I Communication: 1M. i lJ{ \'\OK' Comments: ..<~'l4j(jrn' '..." ",,_.,..,.. "'~"""',.,. "~.," "","",,"'N' >",,"' . ,,,,.,,,..,, ''''~'''r'''''~l!.It~,,:;;';;-=_.~, :~g~h~\t:f9N'f^_~E~~~C(@~~~~~k~"~-~~~"~t~~"iJ,l!}l~~tSi~:~i~~ii~tf~;~:1~~~l~ff~~~~~~~~~"'J~i(>Afft, Alertness W FL. Attention Wf't- Orientation .J._ A.. >>..., ~_____ ^ V/ Memory: LTM I"" V SfM / I+. /) Follo'Wing Directions W ;:: t- I"""" 11 Problem Solving 1~.;1 Sequencing tV ~V f ~ Judgment Comments: tre.t{~~~TY~1' ~UR9M:U.sq~"$fA'fi[S'0~~~f1~~:{J~,ff._'lJJl:~l{fj:%;~:"1:';i~~'::)~~~.;j~.~:~t:;~i.~\~-~~f~~':~~~~~~'~~~~:!~E~":F LEFT MMT ROM PIA ,,,,~",I1IC't. A ri~~ RIGHT FUNCTIONAL ASSESSMENT MMT ROM P / A Indicate: WNL. WFL. IMP. NT. NA Shoulder Exeen. ,1,1" I.,(/...- A ~<r 1..l' Function L R Function L R Shoulder flexion Shoulder Abduct Re~ch Over He<ld I Touch lop &. bad:: of head 1)1 fl.- wft- ern" L,gs V J., . Hand to Mouth ,,11 JJ\ Rlach Fo,,",'" i tvj:t }.J W Reach Behind Bacle or Buttocks \ v-f I"'f Open & CIow Hand Comments: 1J.J1'" )/f 1<1'(;1_ WfI', Shoulder Addu<.:.t. Rotate Trunk Shoulder IItt Rot. JOlJch Knees Shoulder Ext ROI. Touch Feet I, (V Elbow Flexion Tone, i:/!l WNL !>Vii o Abnonnal Elbow Exeention \ \'.I -j; Wrist Extension 'i -0 COMMENTS: Functional Endurance Good / Fair / Poor 'pvc- y-- Pain J location f{.l.J;:. (0/10 none - 10/10 high level) Skin IntegritJ: r~ Ed,m.. II)!' funclional Tolerance include position &. duration >l/~ 1r.7( Supination Pronation Wrist flexion Coordinalion: Hand & Fingers, ROM. Strength & Function {$xmq.;p jy~~ opotf? (j) ~I ~ -+t"-O~ h//C Fine MOlor 6 vB" Gross Motor lJ.l Ft--- '1 00005,- Th\':rapisl Signature I Credentials ~A:t--- ondv 0", '1)-1'-1-03 FMC~1501.OT (9l~9) n ~ ~ OC( UPATIONAl THERAPY SliM MARY HCR.'.M'anorCare 7 - Completely independent; 6 - Modified Independence, extra time / device: 5 - Supervision / Set up; 3 - Moderate Assistance 50%; 2 - Maximal Assistance 7S%; 1 - Total Dependency; NT. Not Tested; NTx ~ Not Treated "'~il~wr:')~ ""''''"'.....,.'.~ '-S-~'k"tt,?); ~:t;.,~, ~f:~;:>~0~,CO - ",' Neuromuscular Status: Indicating ~k1~tj,~~1 '~-- ~,4:""" iff physical changes and UE status Grooming " LU0L- Eating & Feeding Oral Hygiene Balhing Upper Body Bathing Lower Body Dressing Uppel' Body Dressing Lower Body Cognitive.Perceptual Status: ToUet Hygiene Bed Mobility ~+ax J {~l fIu.n "c. ~ ..ftA 0Jld. ~ ADL Transrcrs Wheelchair Mobility Wheelchair Set-up Foot Rests / Prakes Home Management Safety & Other Related Issues: Comments on Progress / Summary / Assessme : (L(L , a..t:n..~, c:L...fym '1 n.v-.d-.fd rtb f ~ ~ScL ~'I~ q- '6' 'CJ. o..urun~ ~e. ~S}O') ciu1 ~. ~ ~ C/o r cx:b;(' P ~ClC.L pzr (n, ,:) o?J.u, d..Jc..sL..U.ui 61 . ~_Tr~4~~~:g~~4i(~f:",:~~~-;.!,.":.~~i~;{f,:::e,;~;~.\~\~;'1~{S:~}~.;;':~::S ,.'.~.~;;-~~ 7I Refer to above ADL Chart for DIC Goals ~ Refer to above ADL Chart for STGs Frequency: Days per week Per Day: 0 Q.D. 0 B.I.D. Duration: o Patient / Family / Caregiver education. teaching and training to prepare for discharge from therapy. I ~rYtA TOTt-l ~ · Cilc..- 0\ d-~ l\D~ 00005:3 o Patient I Caregiver instructed in Horne Program Therapist's Signature I Credentials I Date ifJ03 30 Day Summary Only - Physician Recertification o I h3ye reviewed this plan and recertify a continuing need for 30 more days of services. .4-0nz..! o Discontinue o Recertification not necessary Physician Signature and Date RElI^BIUT^TION PROGRESS NOTES o Physical Therapy o Occupational Therapy HCR'ManorCare ~Ch Language Pathology. ' Medical Record II S\ (! . ~~ FMC.;~02.PH t9/991 :PI~I nill'lll~\I'~'tl;prllnl I nil ~1.~Care Date Department P b 411I Progress Note Time (Nursing, ::'0.' ~ . P.T., eel.) i ~ SlgnatureITrtJe \ i.- /.): 017,-" ;VSc ,'\.J ~ / ~ .------ <g(J0 :5? f ' Iv'$-t - 03'1) ''':O~_'' , '.,... &-( 'U..<../ a If3 . 01 \ 01)/0 prJ ~/~ Patient's Name (Last, First. MI) Room Numer Patient Number !I/2,rZ A f3 TERDISCIPLlNAR PROGRESS NOTES FMC-11148 Rev.112/98} 000057 . /" {, ' ~(.y' ... '~~ f _~'1'~ HCR.ManorCare Date Department P b ~ Progres~"'Note Time (Nursing, ~o. ,,,....' P.T., ect.) o. I ~ SignaturefTitte I ? ( '--/ ------ C-M.L . ~JO ~ 7 -'6'''' \.JSGo >....5"'-'"' '" 11 +- ~ Q t c::; \,f+. , .,. \ \ 6 w~\.l (, 9 IJO 9r tlnL) leer"" h , -(7 ~~ "'- ~ NSeo QL./"/IJ (h (24 r:rlvnJ 111M df-!a cr ch j, /Y-.h.-\ JILI.N fu-, _ ~ ,.,f'tcu /I-b_ ,'.N.~ ftl.v J '6V tot j, ~ : Patient's Name (Last. First, MI) ,;)ntl l/LJ) INTERDISCIPLI ARY PROGRESS NOTES HCR.ManorCare Date Department Prob ~ Progress Nota Time (NursIng, N' P.T., eet.) o. 1 ~ SlgnaturelTitle ( ~r/.J II!!_ ,['c Patient's Name (Last, First. MJ) '-'- , ,- 7r ... c Attending Physician r- Room Numer Patient Number u~ ooonS9 " ., U-<...:....... c. ()I 'ffN I YY -" PROGRESS NOTES INTERDISCIPLlNAR \(.;1t. 'lY1ailU.1'li..Al'c . DO NOT THIN Resident'sN.ame: 13 (0/ (6'i"5u6dl,) C-rl'r Date of Birth:, /, J' /- 011 Physician: Admitledfrom: j,./()~ Sp,~;rJ..1. Via: Qh7f" Date 01 Admission: 0- - ) 3 - 0."3 02.) Y rLj E.IYI r::s ~ Time: ~ Room No.: Accompanied by: Primary language: EngrlSh o Other. Reason for admission; include current diagnoses ~ medicaJ/surgicaJ history: 1. it' CAiro"! hrY>->IJ'f',j/n{<./ COP.D3. C~nf'<-0,m &-t: hJ(',,~z:f 4. Allergies G (f'f/;" ,c> ~ n c, Ii" vvr If 1:;3., to tA /1"1 I /. C/Y1/)n t/,'/"J ;nlU/~'~YJr '1''''' Co.J-r; (".5 /!I>I7~1 BP: Temp.: 1:'1-11. ~i>-> yoe/,.., Weight: cy-;,y- .' 7~ Apical Pulse: '7.y Rad'13l ;"'Ise: ~ <-.5r I fj// Resp.: 0/0 Height MENTAL STATUS QUESTIONNAIRE: Ask the resident the following questions and record the SCORING resident's exact response to each item. Assign the' resident 0 point for each correct answee', 1 point .tor each incorrect response. TotaJ the score. and it indicated adjost as follows (check if applicable): Total Points: ...f'" =:. o AI~w 000 more error ~ resident has less l1ian..a high school education . . .' .' .. o ^!Iow one less error if resident has had education beyond high school: Points Menta~ Status lndtcatOC' . . , ... . RESIDENT'S RESPONSE POINT .0-2 Intact mentaJ functioning" What is leday's date (day of the mo'nth)? . 3~4 Mild 'cognitive Impairment ., --- .....f.anu4' / When is your birthday (month and datel? -tiJ? 3/ ~ o I / Who is the president of the United States? I no / f;2 '1 Who was president before him? o Resists care o Withdrawn o Self:rmage issue o Sociable/talkative o Physically abusive DOlher. o Socialty inappropriate behavior . -. - - ,- ~,r_);_~'!~"'f"";' -..:: _ _ _ _h . Responds to: o Toueh o Voice o Painful stimuli o Other. MEOICAL RECORD NO.: Rt;SIOENrs NAME: I FHC.JOO:l: lAlIlv.5/991 ELRICCS.OuUoorooo...lA5O.JOO 1&0012.1.2343 oooos~. HCR.ManorCare SKIN RISK ASSESSMENT Instructions: Assess the resident upon admission and quarterly for Skin Risk, Enter the score in the appropriate columns ant then total. Proceed to care plan with interventions/approaches based upon the lotal points and needs of the resident. Indicators Risk Factors to Skin Management Quarterl scores Assess each indicator and assign a point value. Total these points. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter See below for score. ~J/.; Date Date Date f,1.1~5, 0= Excellent (Eats all 0; most) / 1 = Adequate (Eats> II Q! TF/TPN meets needs) . Nutritionai Intake 2 = Probably Inadequate (Generally eats < ;\) 3= Very Poor (Rarely eats more than 1/3) 0= Alert l 0 I Level of 1 = Lethargic I Consciousness 2 = Semi.conscious s= Comatose I i I 0= Ambulant , 1 = Walks/help d--- I Activity , 2- Chair bound , . I 3= Bedfast 0= Full I 1 = Slightly limited Bed Mobility 2 = Very limited " Immobile ,- 0- Not incontinenl 3 Incontinent 1 = Occasionally incontinenl 2- Frequently incontinent , 3 = Incontinent TOTAL POINTS 7 , INTERPRETATION: A score of 0-3 indicates no skin risk (no interventions are indicated) and 4 or greater indicates that the resident is at risk of developing skin problems requiring preventative interventions. Signature: =j;!f.Lv?7 'J) ~ /L_____...e/ 1 sl Quarter 7 6 2nd Quarter 3rd Quarter 4th Quarter Resident Name ;L C' Cl /1'/ L:/5 ci-~.!.., Medical Record Number < 'HC-:1t2. tRev.3/991 ~OU~"lA~JOO 18001247.2:J~J _'n..,u~ 00006~ -.-'D'--"~f ~l"nl,.:\-""" ." :': ", ',- . '. ' ~." Care . 'ill "t. ' '1' O'~ , " . ii" ' '\' 1 u , ,'" '1l1..L~ ..tJ, ,1~t'~~J?,.t.~.L\..L..J ~~ 0' , . . b.,ad ~"" ......,. ~ ''" r M ~~ ~ ;_~ C:~b~~~i~,==~r re. r plan of calli and the Go&I as stated on care plan, :1 RESIDENT IS CAPABLE 0; INCAPABLE OF UNDERSTANDING RESIDENT RIGHTS. IF INCAPABLE, STATE REASON C '" h .F <-0 , in RESIDENT IS AWARE OF CURRENT CONDITION., AND PROGNOSIS: YES 0; Nq.6' IF NO, STATE REASON C t> n r ULJ,"" ANCillARY ORDERS LEVEL OF CARE: 0 SKILLED 0 NON-SKILLED 0 OTHER REHAB POTENTIAL.: 0 GOOD 0 FAIR 0 POOR 0 MAINTENANCE DISCHARGE PLAN: 0 RETURN HOME 0 OTHER FACIlITY ~ONG TERM PLACEMENT 0 OTHER MAY SEE: PODIATRIST 0 YES 0 NO OPTH/OPT 0 YES DNO DENTIST, ,xl'YES 0 NO LAB o YEARLY LAB IF REDUIRED BY FACIUTY IS DUE EVERY o OTHER THERAPY EVALUATION AND TR~TMENT AS INDICATED . ~~ISSION OCCUPATlONAL THERAPY rlYES 0 NO SPEECH THERAPy/E( YES 0 NO PHYSICAL THERAPY ~ES 0 NO THERAPEUTIC RECREATlON 0 YES 0 NO RESPIRATORY THERAPY 0 YES 0 NO , SEE THERAPY ORDERS & REPORT FOR FURTHER ORDERS RECREATIONAL ACTIVITY PROGRAM MAY PARTICIPATE IN RECREATlONAL ACTIVITIES: CHOOSE 1 OF 4: 0 WITH NO RESTRICTlONS 0 LIMITATIONS: o ONLY NON-EXERTIVE PROGRAMS 0 BEDSIDE ONLY: CHOOSE 1 OF 2: 0 MAY HAVE OCCASIONAL ALCOHOL 0 NO ALCOHOL CHOOSE 1 OF 4: o MAY GO LOA/PASS UNATTENDED WITH MEDICATIONS o MAY GO LOA/PASS ATTENDED WITH MEDICATIONS o THERAPEUTIC PASS ONLY 0 MAY NOT GO LOA/PASS DIET ORAL.:~ SUPPLEME /N URISHMENT: AMOUNT: ~ rc- "f)vtK'tfl. !J~~~8~ ~ . ' FREDUENCY: ENTERAL NUTRITION PRODUCT_ STRENGTH_ CAL/24hr_ ROUTE_ CYCLES/FRED FLOW RATE SIZE REASON FOR TUBE TUBE CHANGE FRED REASON FOR PUMP, IF USED , FLUSH TYPE AMOUNT ' HYDRArlON TYPE AMOUNT FRED FRED <,) tlvflU 4" '; Diagnosis t::: / '"V~ CO/1rot..c.Il~ tf7" 1< MAY ADMINISTER 2 STEP MANTOUX SKIN TEST ON ADMISSION AND ONE STEP ANNUALl.Y IF NO, STATE REASON: IDE NT FREE FROM ACTIVE T.B. AND COMMUNICABLE DISEASE 0 YES 0 NC MAY HAVE ANNUAL FLU VACCINE PER CENTER POLICY 0 YES 0 NO AY HAVE PNEUMOCOCCAL VACCINE PER CENTER POLICY 0 YES 0 NO CATH~TER DOES RESIDENT CATHETER:)( YES 0 NO L <;v. ~ / IF YES. JUSTIFIC Fa / elf' ~ Oc. ':/e--- .r TYPE .-<---- "e CHANGE Date'?;/.] , .:>-' ed this resident's medication program and: o No irregularities were noted. o See separate report for statement or irregularities and/or observations. R.Ph. SIGNATURE & DATE AtlendingPhysician '.. .~'. . . .~.. ~. .'. ""... .~III"'. 1~1;l.. . , 11'1.' Name ~. '-' 1<f:77?j- AlchoholfTobacco Use % {/6 Birthdate / / ~/ /IY.81 Birthplace ,/7~~-)l( Date of admission 103 = living arrangements prior to admission: .&.- Marital status: OM o D 'i ~ S If married, spouse's name: Veteran? DYes oNo eo //' ,.--< rl language spoken M Speech: Clear o Unclear, explain Former occupation /0'e-...&~c~ Education (able to read and write?): ~ ~ Clubs/Organizations Voting Interests: Registered voter? ~ Yes D No . ,Interested in voting? dYes :J No If yes :J Absentee :zKGo to polls Spiritual Involvement: Faith identity je1#-"P7~ Active partIcipation Church "z,/$- Town .#~ Phone # Should facility contact? :J Yes ANo :J No spiritual contact desired Is more support desired? 0 Yes .erNo If Yf!Js ,s}visits 0 Prayer o Special Counseling :J Other Has life condition affected faith? ;If yes oNo Finds strength in faith? .l!J Yes :J No Referral DYes o No Date of referral To whom? '1"1\ . '~!I~~~ p!CII'J. ACTIVITY pic N ACTIVITY PC N ACTIVITY PC N ACTIVITY P clt<I ACTIVITY tV Animals v I Current Events V Parties V lNalking/VVheeling IV Shopping ...--r: Arts/Crahs . Newspaper Coffee Weight Training Museums ,/, Needlework . Children rea Aerobics Zoo ! Ceramics Church Smoking Swimming Special Events i Cooking '" Bible Study Sports .... Games VolunteerinCl IV Music .. Reading Bowling ,I.- Singo Other: V Eptertainment p Books Galt Dominoes Other: I Iv' Singing V Magazines Volleyball "" Cards Other: , V Radio Tapes Fishing I" Soard Gar:es Other: iV r'Television Writing Hunting II- Trips Other: I~ Movies IV Gardening EJ'ercise I Sehor Cer,ter Other: When would you prefer to participate in scheduled activities? "..r Morning ;l Afternoon ;a Evening o None' of these, explain , Preferred activity setting: ~ Own room ~ Day/activities rpom ytlnside facility/off unit . )rOutside facility o None of these, explain Y4f Resident preferred wake up in the morning? 7~' Resident preferred time to retire?;?' - /,., Resident naps? 0 Yes '1( No It yes. what time of day and how long? Would you like to have a facility volunteer jOb position? ':J Yes -~ No If yes, type . . ,.- Do you feel that leisure time is important? ~Yes :J No 0 Not Sure 0 N/A Are you satisfied with your current leisure lifestyle? res :J No :J Not Sure o N/A Do you like to participate in activities on a regular basis? Yes :J No o Not Sure Cl N/A 00 you consider yourself a social person? Yes .:J No o Not Sure o N/A Do you consider yourself a person who prefers being alone? DYes J1 No o Not Sure oN/A Do you enjoy new chailenges? 1 Yes '0 No o Not Sure o N/A SummaiY 00007"" . Residen! Name: ReCord No.: IAO~";'1 ?f MOl7i3103 (! 4 d.-JI ME77?/- 170/-3 m, HCR.ManorCare :J Initial 0 Re-admit. 0 Change o/condltlon" '0 Annual _.....~". _...- FHC.I009 (11,021 El'''jll,C'''pIl'l>'oQn. 0.... """',....I...~)OoO 1ItOO,2J!.:!:)43 ~"""!I),""~A ACTIVITY/RECREATION , ASSESSMENT z ~ 0 ~ '!\ 3 '" .. e P" 'Y % r- p " !/'. ." :ll ~ .,,0 S~ ~; "," -% ~ ~w. g? t:.. %~ Cl:ll "'''' 5 .' :ll% %e. :t ,.. '" GJ -< ." ; '" ~ ~ IT' !/'. \: ~ t b \'I' ~ ~ l g tr ~ t ~. I e. '0 ~ - !!. .... 0; ,!\" ",,,, '" ~ ill c: ~ '" - % ~ ..c. ;1. .J:: z \> '-..s-< "" , ~ , ~. ?;j L .. '" 0 l- f, ~ ~ " \;. f' - ~ t '" h ~ g~ . \-..) 'I\!lJ ,"0. eX ~~ \ \ \ \ \ ",!!; 10 .- . -.; Z -I ~ o Ui (') ::0 I Z ']> ~ (') 'f t1 -U I ']> Z ~( ~ ~ () ~ '" ;::> n n ;::> tug.. "", ..'" <0 .. 0. ( 000' L r- z i. ~ 3 \ ~ .. ') .... ~ , ~ !2 ll:" , . ,- ~ S' .- " ; , / i P '\ , , i cor ~=o -~=-,-' , - . ~' , , .. " ,-" \\ ~ I[ "- ~. '- I 2: -i m JJ o en n =ti r- 2: ):> :n -< ~ i ~ ;- a-. , .. '" , . 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I " ->-.'" , )000'1'1 HCR.ManorCare NO ,.. o. PROBLEM. NE~D: STRENGTH 0" ;".~lOIOR POT'ENTIALCONCERN DATE " .' - '.DATE IDENTIFIED _ .RESOLVEO ~..Il a y; ';-/,,,.r:;,Y'.I5Jaj;... T;l:fk:3 ? d,;2;" j ~,. ;t:'S;"tfjt;~ldJ;';11 '5.:'} .,' --:J<1 ~t- P'7vi lIf'-n"!""" .. / /./ 4.~ Sla,Lf1 v :z:t; ;(7 /'f ~- ~d.. hGJ AD) '6- 1'-/ ,..!,...,:J,II'.-Q.. -_.-- -.-------- .< -.",. 1----_0 ------- -.-----.-----.-- f-"--o -- -----.-" ".--.----..-,-.--.---".---...-.- -- . , .. ,'i. ." _____ _._____ ______0___" , . , ,,' ..,.. , .. ," ':' ''',..''" , '. '.' ..... - '.< ~ -. r.'.! \::,.,...;.....>;~..;~:;{.. ,":: -,.,.:: -~ _ _...:~:::.:.~;,.,~ '~..~-...y.,~~;;~\,{~i.t~~#-:;:::;:.'.-; . , ..'. " '. .....~" ~ ~,--: '...~-_....~~::.:.'...:. ...:-, .-':::':~..:--.:'.-: .,+ ,:".,.,... .... '0'" ..,.;' "..... ". '" ...."...'.... ...,'.. '...""'.. i ._ ..,.....: .~._~.~:~. .::'~'~.-.....,...,.-..~.-. "". ._...~..~._....., ", . .~ame Las! .' First '. . ,::~ Initial .. . ", ~ ..' ...' " ::,',.. >~. ',- .." .. . .. \ .. .. ..";,,,;..',..r- ,op,.... t ',.....y.,._., .......... "_.,,,, ,~,; ':q::J:J~~:Of..'."--- - .. '.. ", '{'''.. "/Z') . '" ,. . .,...~" n,/J, ~.~, 'n .;.;1:17(;1<:.... FHC~OIl9 (Rev.1/99) BntG01,C.."'~..I,l.$O::lO<t '!Iooj2.j'.2J~J -,'''"""", ',t.-:.:.." S ,_..' -~ _~.. __.. n_.""" Resident No. .. ,'..;:cz...'..@....:..". ...,,). .'..".", ." DArE MANAGED ,.' .- DATE REACTIVATED , " , - i . I --", ____..J j I -- _____n -1 -- . ... ". ... ", ........; ';", '.. ;;-;_.:-:~~;~.;: 'i;.,.. .":":' ""-''-: !:.-:c.<t.;!..~' .,.;.r.'-!_ ", " .',"'. ........,.,,'. ,., ',.'. " ". ".,..'.,"F.. ,..,' " ..;.,..."". OO<1o.'?~__". " '.....,.. RESIDENT CARE PLANNING' AND/OR POTENTIAL CONCERN US,T ENGl'H 066 \ '0 .qnr'll,lIWW ~Q?;'~61 ~ =- "g .2:. "'\ n ~ ',:l. g ~ ..... to r;JJ,.... c.. ~~. 6' 0 ~ ~ ..., g,!? '" ~ < I , ~ ,. .. ~ ~ ~ ~ :. i-:- <: %. ~. .. ! o' -f")-g t \5::' ~ 0:: )- {;V Ii - :;:'. t"l"" o ~ S o' s " " 0 a 0 ., " ~ :t: ~ ~ "i? 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"-""":.,,"'- ' "-"-:>:!;rIf~,- /30 ;"," rJu /J C Q Cfi o Problems/Approach/Slatus o Emergency Situation 721<" poJ'J_ -0 J cr" (VI" U C/,yI 'r Stale Ombudsman Address Phone o Skin Intact 1/ Not Delail Above Items Accompanying Patient "EqwpmeotAequired, .; Nurse's Sig~ature X" Date ~__ /. , J~ /" X"~<:- /..) :/.,"-;. J ,-"Jt,,/ / /.J X For Emergef\Oj Tr~s!ers. 'COmplete Unshaded Sections Only Receiving Party's Signature o.'e ... A".. ...." . .",.............. A. ....... a ...."""'_...... """'. .......... ,-. HCRiHanorCare i ( RESIDENT INFORMED CONSENT: INFLUENZA VACCINATION ~~r::~ ~""G\I , ~fR ==..-l y y.~ I ac',.now\~dg~ &.~t I ha\'e received and undersc:lnd rh~ ir:corr:ucior_ reprciing rhe influenza ,-accir.arion. I h~'-e had me opportuniry ro ask quesrions, and b,'e ~ud my c,uescom answered saasc.;lccorJy. ;.'1 I acknowledge thar I have been informed and undersrar:d me ..:sks of nor receiving rhe ,-accination, I Curther undersrand rhar b~- nor recei,-ing rhe ,-accinarior., I m:lY be ar an increased risk of concncring rhe t1u. I understand mar the opportUnity to recep.-e rhe vaccination is being offerea to me in an effort to reduce the risk of becoming infected wirh the flu. I undersracd th~r the \-accination will reduce c,,"te risk of my becoming infected \hirh the flu, bur does nor guaranree me rhar I will nor become infected wlth the flu. I am aw:u:e that there may be risks and side effects associated "ith me vaccinJ.cion. ( I acknowledge rhar I am nor pregnane. I undersund dlar if! were pregna'lr I would need aurhorization from my physician to tecei\'e me vaccinanon. receive the vaccinarion freei~', and of my ow/,'ill, knO\~ and understanding the possible cis~s and consequences of the vaccination. ~ ~ ~ "6!f3!03 Rc:~idet1t 0(' RC:'Jpoojible p~. 0'1': 000088 ,~ " ,: lnfCCtlon Cannot M:1f1u;d Di~:uc Sp:cilic Guidelines or>HCR Manor C.Jl'e Date: 04/O81O:! P:.se 60 . - -~ ..-.. HCR.AJanorCare .. RESIDENT INFORMED CONSENT:. PNEUMONIA VACCINATION :\"~m~: t:>-e~ C~ ~rR# I 1Cknowledge enJ.e I r.J.'-e eecei,"ed J.nd und~rse~nd c..'te inrorm~oon re!2'3.rding c..'t~ on~umoni~ '- ..... ... ~ \"J.ccirt.lcion. I h.l\'~ had the O?porrurucy co ask questions~ and have had ";'y quescions J.ns\\"e:ed sJ.ostJ.ccorily. I :lck:1o\\"I~dge ehJ.c I b'"e been informed and und~rst~nd m~ nsks of not recei,"ing t.~~ nccinJ.oon. I turm~r undersond chat by noc recei'-ing me vaccinaoon, I ma~' b~ ac an incre~sed risk of concr~ccing pn~umonia. I underscaC'.d mat th~ opporrunicy to receive ch~ nccinacion is b~ing offered co me in an effort co reduce the risk of b~coming infected wich pneumonia. I understand chJ.t the vaccination will reduce ehe risk ot my becoming int-~cted "ich pneumonia, but does nOt gu:u:~neee me chac I "ill nOt become infected wich pneumoniJ._ \ I ~m ~w~re mat chere may be risks and side effects associated "ich ch~ \":lccination, and I accepr am' and aU resDonsibili,," tor an\' advetse conditions and side effects ch~t ma" occw: due co che . ~ . . . vaccination. I acknowledge th~t I am noe pregnane. I understand chat if I were pregnane I would need auchorinoon from my physician co receive che. vaccinaoon. . I . , I acknowledge chat I a~to receive che ;accination freely. and of my own will, Xa:=Possible risks and copsequences ofche~c/c~:~o:CS R~~id~m ot' R,:spOO$ibl.: Put;' D:lt~ 000089 ~ lnfeetion Concrol M.:mual Di~~ Specific Guidelines ':'HCR M:lnO( C:ue O;ste: 04/081OZ Pal:;e ,g~ CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached First Amended Complaint on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo, Esq. McKissack & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 And Kathryn C. Mason, Esq. McKissack & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Date: k.J!9/.JI1&.5 /~ /Bartara G. Graybill Id. No. 39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attomey for Plaintiffs 26 C) ~., ~; ~.;) r:7> o -n :-:1 >i~ L.,"; C:J t71 C) f',' CD ,.,~ , I '-"., -n : ~~'~ ) -;-~ ~....., :,~< -~~:' r'_' (....J o Barbara G. Graybill Attorney I.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL i\CTION - LAW NO: 0~i-3732 v. MANORCARE HEALTH SERVICES, INC., D/B/A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants MOTION OF PLAINTIFFS FOR ENLARGEMENT OF TIME TO FILE CERTIFICATE OF MERIT AND NOW, come Plaintiffs, by their undersigned counsel and, pursuant to Pa.R.C.P. Rule 1042.3(d) respectfully move this Court for Enlargement ofTime to File a Certificate of Merit and set forth in support thereof as follows: 1. Movants herein are Plaintiffs. 2. This is a professional liability action governed in part by Pa.R.C.P. Rule 1042.1 etseq. 3. In this case Plaintiffs are alleging wrongful death and survivor actions based on professional negligence on the part of Defendants. 4. Defendant Manor Care is believed to be a Iicensl~d professional health care provider within the meaning of Pa.R.C.P. Rule 1042.1, in accordance with the Department of Health web site. 5. In this action Plaintiffs are alleging negligence on the part of Manor Care in failing to take proper interventions to keep Plaintiff Carr from dElteriorating, becoming malnourished, being neglected and possibly abused, and failin9 to provide appropriate assessment, monitoring and care which lead to the suffering and decline of Plaintiff Carr. 6. Plaintiffs' counsel is in receipt of an expert report sufficient to establish that the care provided fell outside professional standards. 7. Plaintiffs' counsel is uncertain whether or not they have been supplied with a qualified written statement that would establish causation. 8. Plaintiffs have engaged a qualified expert to revie~w the records and give an opinion on causation. Arrangements have been made for that I~xpert to review records and render a report. Plaintiffs are unable to obtain that report within the time allowed, which runs out on January 6, 2006. 9. Defendants will not suffer any material harm. 10. Plaintiffs make this Motion within the time allowed under Pa.R.C.P. Rule 1042.3(a). 11. Counsel has forwarded this motion by fax or by email to Defendants on January 6, 2005, and Defendants _do do not concur. 12. No hearing is necessary for this Motion. 2 WHEREFORE, Plaintiffs respectfully request that an additional sixty (60) days in which to file Certificates of Merit with respect to the licensed Defendant. Date: / - C? -c) 0 Resp,ctfully,. Y~/~y~~v Barbara G. Graybill Attorney I.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-38:18 Attorney for Plaintiffs 3 J. CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and Gorrect copy of the attached Motion for Enlargement of Time to File Certificate of Merit on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo, Esq. McKissack & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 And Kathryn C. Mason, Esq. McKissack & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Date: /- &{J{; ~ dc' ~ " -"/ Bam'~ G G~yb;n ~.. Id. No. 39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs 5 () ( (-'. -":1 ::-:i f ;~ I C" :--; ,;-- -':--1 f',.) !Jl C:) :.! .< ///- .~/------- --- ~ PRAECIIi'E FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in duplicate) TO TIlE PROTHONOTARY OF CUMBERLAND COUNTY: Please list the within matter for the next Argument Court. ~~------------------------------------------------------------------------------------------------------------------- CAPTION OF CASE (entire caption must be stated injUll) Elizabeth Carr, Terri Doutt;icb (plaintiff) vs. Manor Care Health Services, Inc. d/b/a Manorcare Health Services- Camp Hill, and Manorcare, Inc. a/k/a HCR Manorcare ODefendan~ No. 05-3732 Term I. State matter to be argued (i.e., plaintiff's motion for new trial, defendant's demurrer to complaint, etc.): Defendants I Preliminary Objections to Plaintiff..' Jl'.i r"t nlllenG.ed Complaint 2. Identify counsel who will argue cases: (a) for plaintiff: Barbara Graybill, Graybill & Wise. 126 LocuM ~rrppr, (Name and Address) P.O. Box 11489, Harrisburg, PA 17108 (b) for defendant: Maria R. Granaudo, McKissack & HOffman. P.C. (Name and Address) 1818 Market Street, 13th Floor, Philadelphia, PA 19103 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: ~~. ~~~/U . Mason Es uire Date: Jd;,,!uary 5, 2006 Manor Care Health Services, Inc. Attorney for ",., <;..;...J ;; 'c;r> ~~ :? '- ::~. 0'" ",:c:..- ,,-0 -...--; e,? r....,J <.."::) MCKISSOCK & HOFFMAN, P.c. BY: William J. Mundy Identification No. 57679 BY: Maria R. Granaudo Gesty Identification No. 80609 BY: Kathryn C. Mason Identification No. 201168 1818 Market Street, 13th Floor Philadelphia, PA 19103 (215)246-2100 Attorneys for Defendants ELIZABETH CARR, TERRI DOUTRICH, CUMBERLAND COUNTY COURT OF COMMON PLEAS Plaintiffs CIVIL ACTION - LAW v. NO: 05-3732 MANOR CARE HEALTH SERVICES, INC. d/b/a MANORCARE HEALTH SERVICES - CAMP HILL, AND MANORCARE, INC. alk!a HCR MANORCARE JUR Y TRIAL DEMANDED Defendants PRELIMINARY OBJECTIONS OF DEFENDANTS, MANORCARE HEALTH SERVICES, INC. d/b/a MANORCARE HEALTH SERVICES - CAMP HILL, AND MANORCARE, INC. a/kJa HCR MANOR CARE, TO PLAINTIFFS' FIRST AMENDED COMPLAINT Defendants, ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill, and ManorCare, Inc. alk!a HCR ManorCare, (hereinafter referred to as "Defendants"), by and through their counsel, McKissock and Hoffman, P.c., hereby file these Preliminary Objections to the First Amended Complaint of Plaintiffs, Elizabeth Carr and Terri Doutrich (hereinafter known as "Plaintiffs"), and aver as follows: 1. On November 7,2005, Plaintiffs filed a Complaint against Defendants in the Court of Common Pleas of Cumberland County. 2. Defendants filed their Preliminary Objections to Plaintiffs' Complaint on November 28,2005. 3. Subsequently, on December 28,2005, Plaintiffs filed this First Amended Complaint. A true and correct copy of Plaintiffs' First Amended Complaint is hereto attached as Exhibit "A." 4. According to the First Amended Complaint, Plaintiff Carr was discharged from Holy Spirit Hospital and admitted to the Defendant Facility, ManorCare Health Services - Camp Hill on August 13,2003. See Exhibit "A" at paragraph 10. 5. The physician orders on the transfer sheet from Holy Spirit Hospital include an order for Seroquel 25 mg, twice a dav. 6. At the time of her admission, Plaintiffs allege that Plaintiff Carr had diagnoses of a right gluteal hematoma, COPD, a history of deep vein thrombosis, right leg pain, confusion, and a gastrointestinal bleed. See Exhibit "A" at paragraph 10. 7. Plaintiffs further allege that Plaintiff Carr had allergies to "Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics." See Exhibit "A" at paragraph 11. 8. Plaintiffs' First Amended Complaint avers that Defendants were negligent in administering Seroquel, a drug used to treat hallucinations, to Plaintiff Carr from August 14, 2003, to August 19,2003. See Exhibit "A" at paragraphs 12-29. 9. Plaintiffs contend that Seroquel was administered until and including August 19, 2005 at 5:00p.m. despite the attending physician's order to discontinue the medication. See Exhibit "A" at paragraphs 23-29. 10. Plaintiff attempts to disguise the fact that plaintiff's attending physician, an independent contractor, did not discontinue the medication until August 19,2003 at 5:00 p.m. 11. In addition, Plaintiffs' First Amended Complaint asserts that an unknown narcotic drug must have been given to Ms. Carr without a prescription because she responded to Narcan, a medication used as an anti-opiate. See Exhibit "A". 2 , 12. Finally, Plaintiffs' First Amended Complaint avers that on three separate occasions family members found Plaintiff Carr lying naked on her bed with either no blanket covering her or with only partial covering by a blanket. See Exhibit "A" at paragraph 28. 13. The First Amended Complaint avers that as a result of Defendants' acts and/or omissions Plaintiff Carr was non-responsive and/or asleep for the six (6) day period she resided at the facility. Further, plaintiff alleges defendants failed to implement measures to prevent dehydration, malnutrition, weight loss, skin breakdown, and decubitus ulcers. See Exhibit "A" at paragraph 35-36. 14. Plaintiff Carr only resided at the facility for six days. 15. Defendants file these Preliminary Objections on the bases that: (1) Defendant ManorCare, Inc. a/k1a HCR ManorCare was improperly served original process; (2) Plaintiff Doutrich fails to state a cause of action for negligent infliction of emotional distress; (3) Plaintiffs' general allegations of negligence should be stricken for lacking the proper factual specificity; (4) all allegations of corporate liability and Count II of Plaintiffs' First Amended Complaint should be stricken with prejudice for failure to state a cause of action; (5) paragraphs 91 through 101 and 103 through 106 of Plaintiffs' First Amended Complaint relating to Plaintiffs' claim of negligence per se should be stricken for failing to state a cause of action; (6) allegations relating to Plaintiff Doutrich should be stricken from Count I; and (7) Plaintiffs' improper allegations of Defendants' conduct as intentional and reckless and Plaintiffs' requests for puniti ve damages should be stricken. I. PLAINTIFFS' SERVICE OF PROCESS ON MANORCARE, INC. aJkfa HCR MANORCARE WAS IMPROPER 16. Defendants incorporate the averments in Paragraphs I through 15 as though the same were set forth fully herein at length. 3 , 17. Plaintiffs improperly served original process on ManorCare, Inc. a/kla HCR ManorCare at 1700 Market Street, Camp Hill, Pennsylvania 17011 as opposed to an address where it has an office or usual place of business. 18. Pennsylvania Rule of Civil Procedure 1028(a)(1) permits the filing of a preliminary objection in the nature of a motion to strike for improper service of a complaint. 19. "Proper service is a prerequisite to the court's jurisdiction over the person of a defendant. . . In determining whether proper service has been effected, [the court] requires strict adherence to the rules." Anzalone v. Vormack, 718 A.2d 1246, 1248 (Pa. Super. 1998). 20. Pennsylvania Rule of Civil Procedure 402 provides that "original process may be served. . . by handing a copy. . . at any office or usual place of business of the defendant to his agent or to the person for the time being in charge thereof." Pa. R.C.P. 402(a)(2)(iii). 21. Furthermore, service of original process outside the Commonwealth may be made, inter alia, by any form of mail requiring a receipt signed by the defendant or his authorized agent. Pa. R.C.P. 403, 404(2). 22. The "office or usual place of business" requirement applies equally to the situation where a parent corporation is served at the location of its subsidiary or vice versa. See Delaware Vallev Surgical SUP1;llv Co. v. Geriatric & Medical Centers, Inc., 299 A.2d 237 (Pa. 1973); Botwinick v. Credit Exchange, Inc., 213 A.2d 349 (Pa. 1965)(striking service on parent corporation at location of subsidiary where facts showed that the parent and subsidiary had separate and distinct corporate existences and therefore the office or usual place of business requirement was not met). 23. In the instant case, on August 15,2005, ManorCare, Inc. a/k/a HCR ManorCare was served a writ of summons by the sheriff or sheriff's deputy at the address of ManorCare 4 , Health Services, Inc. d/b/a ManorCare Health Service - Camp Hill located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 24. Defendant "ManorCare, Inc. alkla HCR ManorCare" does not own the facility located in Camp Hill. Instead, the facility is owned by ManorCare Health Services, Inc. 25. ManorCare, Inc. alkla HCR ManorCare and ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill are distinct and separate corporate entities. 26. In addition, there is no agent present at the facility who is authorized to accept service on behalf of ManorCare, Inc. aIkIa HCR ManorCare. 27. ManorCare, Inc. alkla HCR ManorCare is a Delaware corporation with a principal office at 333 North Summit Street, Toledo, Ohio 43699-0086. 28. In fact, Plaintiffs acknowledge that ManorCare, Inc. has its corporate office in Ohio. 29. Plaintiffs contend that Defendant ManorCare, Inc. maintains a principal place of business at the Defendant Facility because the Defendant Facility uses "HCR ManorCare documents, forms, policies and procedures such as those in Plaintiff Carr's records (See Attachment A)." See Exhibit "A" at paragraph 4. 30. Plaintiffs fail to recognize, however, that the corporate relationship between ManorCare, Inc. and ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill in itself is not enough to validate service. See Botwinick, 213 A.2d at 353-54. 31. The fact that the forms used in Plaintiff Carr's facility chart bear the name "HeR ManorCare" does not change the fact that Defendants are separate and distinct corporate entities. Use of the forms certainly does not justify an allegation that ManorCare, Inc. maintains a principal place of business at the Defendant Facility. 5 > 32. Thus, Plaintiffs cannot establish that ManorCare, Inc. has a corporate office or usual place of business at the stated address in Camp Hill. 33. According to Pa. R.C.P. 403 and 404(2), Plaintiffs could not have properly served ManorCare, Inc. a/k/a HCR ManorCare at 1700 Market Street, Camp Hill, Pennsylvania. 34. Therefore, pursuant to Pa. R.C.P. 402(a)(2)(iii), 403, and 404, service upon ManorCare, Inc. a/k/a HCR ManorCare was improper and should be stricken. WHEREFORE, Defendants respectfully request that this Honorable Court strike the service of the writ of summons upon ManorCare, Inc. a/k/a HCR ManorCare. II. PLAINTIFF DOUTRICH FAILS TO STATE A CAUSE OF ACTION FOR NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS 34. Defendants incorporate the avennents in Paragraphs 1 through 33 as though the same were set forth fully herein at length. 35. Plaintiff Doutrich fails to set forth a prima facie case for negligent infliction of emotional distress in Count V of the First Amended Complaint. 36. Pennsylvania Rule of Civil Procedure 1028(a)(4) pennits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. 37. The law of Pennsylvania restricts recovery for negligent infliction of emotional distress to an individual who demonstrates that he sustained physical injury as a result of the defendant's negligence and that he was a reasonably foreseeable plaintiff. Annstrong v. Paoli Memorial Hospital, 633 A2d 605,609 (Pa. Super. 1993). 38. The Pennsylvania Supreme Court employs three factors in detennining whether a bystander's emotional distress was foreseeable: (1) Whether plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it; 6 (2) whether the shock resulted from a direct emotional impact upon plaintiff from the sensory and contemporaneous observance of the accident from others after its occurrence; and (3) whether plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship. Tackett v. Encke, 509 A.2d 1310, 1312 (Pa. Super. 1986) (quoting Sinn v. Burd, 486 Pa. 146, 404 A.2d 672,685 (1979)); alloc. denied. 39. The plaintiff must allege that he or she observed a "discrete and identifiable traumatic event" as opposed to a number of events over a period of time. rd. (emphasis added). 40. Furthermore, a plaintiff must establish that there was a temporal convergence of the negligent act and the event precipitating the emotional distress. Mazzagatti v. Everingham, 516 A.2d 673 (Pa. 1986). 41. Finally, physical injury must be alleged in order to state a cause of action for negligent infliction of emotional distress. Armstrong v. Paoli Memorial Hosp., 430 Pa. Super. 36, 633 A.2d 605 (1993). 42. Pennsylvania has "consistently refused" to expand the tort of negligent infliction of emotional distress beyond situations where the injury and tortious conduct are actually witnessed. Armstrong, 633 A.2d at 611; see ~ Yandric v. Radic, 433 A.2d 459 (Pa. 1981)(holding that where a father arrived on the scene of accident after his son had been taken to the hospital he did not state a cause of action for negligent infliction of emotional distress); Mazzagatti, 516 A.2d 673 (holding that where a mother arrived at the scene minutes after an accident involving her child she did not state a cause of action for negligent infliction of emotional distress). 7 43. The requirement of observing the defendant traumatically inflict injury on a close relative applies equally to cases in which the alleged tortious conduct of the defendant was an omission. Bloom v. Dubois Regional Medical Center, 597 A.2d 671, 682-83 (Pa. Super. 1991). 44. Count V of Plaintiff's First Amended Complaint alleges that the Defendant Facility caused Plaintiff Doutrich emotional distress upon finding her mother naked and exposed with no blankets covering her or with only partial covering of blankets. See Exhibit "A" (emphasis added). 45. Plaintiff Doutrich asserts that her mother's nudity was a result of Defendants' failure to provide adequate care, thus constituting a tortious omission. See Exhibit "A" at paragraph 111. 46. However, Plaintiff Doutrich has not alleged that she witnessed the alleged tortious conduct that resulted in Plaintiff Carr's alleged state of nudity. Such is required whether she labels Defendants' alleged conduct as misfeasance or nonfeasance. See Bloom, 597 A.2d at 682- 83. 47. In addition to failing to allege an observance of the alleged negligent conduct, no other specific facts are mentioned in support of this claim, aside from a general allegation that familv members found Plaintiff Carr lying naked or partially naked in her room at the facility on three occasions. See Exhibit "A" at paragraph 109. 48. Since Plaintiff Doutrich has failed to allege that she witnessed tortious conduct by Defendants that caused Plaintiff Carr to become naked and/or partially naked, she cannot establish a prima facie case of negligent infliction of emotional distress. See Bloom, 597 A.2d at 682-83. 8 49. Further, Plaintiff does not aver that she sustained any physical injury as a result of witnessing her mother naked or partially naked, which is required by Armstrong in order for a plaintiff to recover for negligent infliction of emotional distress. Armstrong, 633 A.2d at 609. 50. Plaintiff Doutrich merely asserts that she was "traumatized," suffered "emotional distress," and was crying at the time she reported the facts to Defendant Facility. See Exhibit "A." These are mere temporary psychic injuries, and thus do not meet the requisite standard of physical injury set out by Armstrong. Id. 51. It is unnecessary at this time to analyze whether Plaintiff Doutrich was a foreseeable plaintiff, because based on the facts pled in the First Amended Complaint, Plaintiff Doutrich does not establish the other requisite elements for a claim for negligent infliction of emotional distress. WHEREFORE, Defendants respectfully request that this Honorable Court dismiss with prejudice Count V of Plaintiffs' First Amended Complaint titled Negligent Infliction of Emotional Distress for failure to state a claim upon which relief can be granted. III, MOTION TO STRIKE FOR LACK OF SPECIFICTY 52. Defendants incorporate the averments in Paragraphs 1 through 51 as though the same were set forth fully herein at length. 53. Paragraphs 45(B), 45(0), and 50 of Plaintiffs' First Amended Complaint lack the degree of specificity required by Pennsylvania law. 54. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. 55. Pennsylvania Rule of Civil Procedure 1019(a) requires that the material facts on which a cause of action is based be stated in a concise and summary form. 9 56. Pennsylvania is a fact pleading state. Miketic v. Baron, 675 A.2d 324, 330 (Pa. Super. 1996). Under the Pennsylvania system of fact pleading, the pleader must define the issues, and every act or performance essential to that end must be set forth in the complaint. Santiago v. Pennsvlvania Nat. Mut. Cas. Ins. Co., 613 A.2d 1235, 1238 (Pa. Super. 1992). 57. With regard to Pa. R.C.P. 1019(a), the Superior Court stated: The purpose of 1019(a) is to require the pleader to disclose material facts sufficient to enable the adverse party to prepare his case. A complaint therefore must do more than give the defendant fair notice of what the plaintiff's claim is, and the grounds upon which it rests . . . It should formulate the issues by fully summarizing the material facts. Material facts' are 'ultimate facts', i.e. those facts essential to support the claim. . . Evidence from which such facts may be inferred not only need not but should not be alleged . . . Allegations will withstand challenge under 1019(a) if (I) they contain averments of all the facts the plaintiff will eventually have to prove in order to recover. . . , and (2) they are sufficiently specific so as to enable defendant to prepare his defense. Baker v. Rangos, 324 A.2d 498,505-06 (Pa. Super. 1974). 58. In the underlying litigation, Plaintiffs have pled certain allegations containing insufficient facts which do not provide Defendants with notice of Plaintiffs' claims and which do not adequately apprise Defendants of the relevant issues that they must defend. These averments provide in relevant portion: 45. Defendants, through agents, servants, and employees, breached the standard of care due to Plainti ff Carr for the following reasons: * * * * (B) Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr as evidenced by the inability of Defendant Facility to provide basic care, including nutrition, hydration, clothing, dignity and safety to Plaintiff Carr. * * * * 10 (0) Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or ami tted the performance of necessary care and treatment that will be revealed through discovery. * * * * 50. Defendants' negligent and/or reckless acts and omissions, as set forth herein, violated 28 Pa. Code S 20Ll et seq., 42 C.P.R. S 483 et seq. and 42 U.S.c. S 1396r. See Exhibit "A" (emphasis added). 59. Such vague allegations of negligence afford Plaintiffs with the opportunity to introduce new theories of recovery at any time prior to trial and after the expiration of any applicable statute of limitations. See Connor v. Alleghenv Hospital, 461 A.2d 600, 602-03 (Pa. 1983). 60. In Connor, the Pennsylvania Supreme Court allowed the plaintiff to amend his complaint to allege an entirely new factual theory of liability on the day of trial, holding that the new theory merely "amplified" a general allegation of negligence contained in the complaint. Id. at 602. 61. Connor stated that "[i]f Appellee did not know how it 'otherwise fail[ed] to use due care under the circumstances', it could have filed a preliminary objection in the nature of a request for a more specific pleading or it could have moved to strike that portion of appellants' complaint." Id. at 603, n. 3. 62. Defendants raise this preliminary objection on the same premise as contemplated by the Pennsylvania Supreme Court in Connor. 63. For example, paragraph 45(0) notes that Defendants "committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery." See Exhibit "A" (emphasis added). 11 This paragraph is so overbroad and vague that it could include any cause of action in tort law. This is catch-all language that will provide Plaintiffs with the opportunity to add other allegations of negligence at a later point in time, which is strictly prohibited by Connor. See Connor, 461 A.2d at 602-03; Mitchell v. Remskv, 39 Pa. D. & C.4th 112, 125 (1998). 64. In fact, paragraph 45(0) appears to be written to purposefullv leave the door open for future amendments. 65. With respect to paragraph 45(B), Plaintiffs fails to provide any information as to how Defendant Facility failed to adequately assess Plaintiff Carr upon her admission. See Exhibit "A." 66. In paragraph 50, Plaintiffs aver that Defendants' conduct violated certain federal and state statutes, but Plaintiffs do not attempt to plead specific facts to support this contention or cite the particular sections of 42 D.S.C. S 1396r to which they refer. See Exhibit "A." 67. Such boilerplate averments prejudice Defendants in their attempt to prepare a defense, because it is unknown what specific acts constitute the alleged negligence to which Plaintiffs' First Amended Complaint has alluded to in the broad language of the above-cited paragraphs. 68. Accordingly, all of the above-referenced averments are overly vague on their face and must be stricken. WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraphs 45(B), 45(0), and 50 of Plaintiffs' First Amended Complaint for lack of specificity. IV. PRELIMINARY OBJECTIONS TO PLAINTIFFS' CORPORATE NEGLIGENCE ALLEGATIONS A. Demurrer to Plaintiffs' Claims of Corporate Nel!.lh!ence 69. Defendants incorporate the averments in paragraphs 1 through 68as though the same were set forth fully herein at length. 12 70. Count II of Plaintiffs' First Amended Complaint should be stricken, because corporate liability, as a matter of law, does not apply to Defendants, a nursing home. 71. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of pleading. 72. The Pennsylvania Supreme Court, in establishing the doctrine of corporate liability as it relates to hospitals, defined the following duties that a hospital owes directly to its patients: (1) a duty to use reasonable care in the maintenance of safe and adequate facilities and equipment; (2) a duty to select and attain only competent physicians; (3) a duty to oversee all persons who practice medicine within its walls as to patient care; and (4) a duty to formulate, adopt, and enforce adequate rules and policies to ensure quality care for patients. Thompson v. Nason Hospital, 591 A.2d 703,707 (Pa. 1991). 73. The theory of corporate liability as adopted by the Supreme Court of Pennsylvania in Thompson applies only to hospitals. See M. Remshifski v. Kraus, No. 1845 Civ. 1992, slip op. (CCP, Monroe, Sept. 8, 1995). 74. Since Thompson, only one appellate decision has extended such liability. In Shannon v. McNulty, 718 A.2d 828 (Pa. Super. 1998), the Superior Court applied corporate liability to an HMO. The Court reasoned that the defendant HMO acted like a total health care provider in its relation to the plaintiff. Id. 835-36. "Specifically, while [HMOs] do not practice medicine, they do involve themselves daily in decisions affecting their subscriber's medical care. . . [T]he true effect of [the HMO's] actions. . . [is to dictate and direct] the subscriber's medical care." rd. 75. Since Shannon, however, no appellate court opinions have expanded corporate liability to other health care organizations. In fact, the Superior Court of Pennsylvania declined 13 to apply the theory of corporate liability to a physician's practice group. Sutherland v. Monongahela Vallev Hospital, 856 A.2d 55,62 (Pa. Super. 2004). 76. In addition, several trial court opinions in Pennsylvania have limited corporate negligence to hospitals and HMOs. See Lebish v. Whitehall Manor. Inc., 57 Pa. D&C 4th 247 (Lehigh Co. 2002); Brewer v. Geisinger Clinic, Inc., 45 Pa. D&C 4th 215 (Lackawanna Co. 2000); Dibble v. Penn State Geisinger Clinic, Inc., 42 Pa. D&C 4th 225 (Lackawanna Co. 1999); Dowhouer v. Judson, 45 Pa. D&C 4th 172 (Dauphin Co. 2000); Remshifski v. Kraus, No. 1845 Civ. 1992, slip opinion (C.P. Monroe Co. Sept. 8, 1995). 77. Moreover, in Milan v. American Vision Center, 34 F.Supp. 2d 279 (E.D. Pa. 1998), the Eastern District of Pennsylvania, applying Pennsylvania law, refused to extend the doctrine of corporate liability to an optometrist's offices. Id. at 282. 78. Milan specifically relied on Thompson's interpretation and held that "Thompson sets a standard of care for hospitals, not necessarily for all health care organizations. . . The use of the language throughout Thompson similarly suggests that the Supreme Court believed itself to be crafting a rule of hospital liability, not health care organization liability generally." Id. at 280. 79. As articulated in Shannon, the central factor at issue is whether the defendant is legally responsible for the total health care of the patient. Shannon, 718 A.2d at 835. 80. In the instant case, Count II of Plaintiffs' First Amended Complaint alleges that the Defendants owed the Thompson duties to Plaintiff Carr as a resident of their facility. 81. As Plaintiffs recognize, however, the Defendant Facility is a nursing home, not a hospital. See Exhibit "A" at paragraph 5. 14 82. As such, the Defendant Facility did not act as a total health care facility in its relationship to Plaintiff Carr, despite the allegations that Plaintiffs set forth in paragraphs 58, 63, 74,75, and 79. See Exhibit "A." 83. For example, Defendants were not responsible for and did not provide medical care to Plaintiff Carr, as would a hospital. 84. Defendants, unlike the HMO in Shannon, did not have a role in the daily decisions affecting Plaintiff Carr's medical care. They did not limit the length of her hospital stays, restrict her use of specialists, prohibit or limit her post hospital care, restrict her access to therapy, or prevent the rendering of emergency care. 85. In fact, nursing home residents are free to seek placement at other facilities and, accordingly, they are neither constrained, nor compromised to remain at any specific facility. 86. Furthermore, in the nursing home setting, the determination of whether long-term care services are required is typically rendered by the resident's attending physician and the medical benefits provider (e.g., Medicare covered therapist). 87. Ultimately, the care provided is ordered and/or overseen by the attending physician. 88. Thus, Defendants assert that corporate liability should not extend to nursing homes, specifically the facility known as ManorCare Health Services - Camp Hill. WHEREFORE, Defendants respectfully request that all claims of corporate liability against Defendants be dismissed with prejudice and that Count II of Plaintiffs' First Amended Complaint be stricken. B. Motion to Strike for Lack of Specificity 89. Defendants incorporate the averments in paragraphs 1 through as though 88 the same were set forth fully herein 15 90. In the alternative, paragraphs 82(A), 82(C), and 82(F) of Plaintiffs' First Amended Complaint should be stricken for lack of specificity. 91. Assuming, arguendo, that the Thompson duties do apply to nursing homes, which legal proposition is denied, Plaintiffs' First Amended Complaint fails to set forth any specific acts of corporate negligence by Defendants. Plaintiffs' claims are blind accusations unsupported by specific facts. 92. The First Amended Complaint contains the following general allegations regarding corporate liability: 82. The Defendants, through corporate practices and procedures, have engaged in a systematic pattern of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: (A) Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. * * * * (C) Failing to acquire sufficient staffing, as shown by the lack of care for Plaintiff Carr, to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and profits. In the alternative, the lack of care provided to Plaintiff Carr was a result of reckless indifference to the needs of Plaintiff Carr, or outrageous conduct and intentional neglect of a frail, elderly woman who was incapable of caring for herself. * * * * (F) Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff. See Exhibit "A." 16 93. As discussed above in Section III, such allegations provide insufficient facts which do not provide Defendants with notice of Plaintiffs' claims and which do not adequately apprise Defendants of the relevant issues that they must defend. Baker, 324 A.2d at 505-06. 94. For example, paragraph 82(A) fails to indicate how Defendants' staff was not adequate in number or appropriately trained and how that alleged deficiency relates to Plaintiffs' InJunes. 95. With respect to paragraph 82(C), Plaintiffs allege that Defendants "failed to acquire sufficient staffing. . . in order to maximize profits." See Exhibit "A." They further contend that Defendants exercised "reckless indifference" toward Plaintiff Carr and exhibited "outrageous conduct and intentional neglect." rd. However, these allegations lack any factual support and do not create a link between Defendants and Plaintiff Carr's alleged injuries. Paragraph 82(C) asserts generalized, unsubstantiated accusations, which can only be considered mere name calling. 96. Finally, paragraph 82(F) is so vague and overbroad that it could encompass numerous theories of recovery and could be applied to any nursing home professional liability action. 97. Accordingly, all of the above-referenced averments are overly vague on their face and must be stricken. WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraphs 82(A), 82(C), and 82(F) of Plaintiffs' First Amended Complaint for lack of specificity. V. DEMURRER TO PLAINTIFFS' NEGLIGENCE PER SE CLAIM 98. Defendants incorporate the averments in paragraphs 1 through 97 as though the same were set forth fully herein. 17 99. Paragraphs 91 through 101 and 103 through 106 of Plaintiff's First Amended Complaint should be stricken because the various sub-sections of 42 C.F.R. S 483 et seq. and 28 Pa. Code S 201 et seq. cited by Plaintiffs in Count IV of the First Amended Complaint do not set forth a basis for negligence per se. 100. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. 10 1. In order for a statute or regulation to establish a cause of action for negligence per se, "the purpose of the statute must be to protect the interest of a group of individuals, as opposed to the general public, and the statute must clearly apply to the conduct of the defendant." Frantz v. HCR ManorCare, Inc., 64 Pa. D. & C.4th 457, 462 (Schuylkill Cty. 2003)(citing Wagner v. Anzon, Inc., 684 A.2d 570, 574 (Pa. Super. 1996)). 102. In addition, the policy behind the legislation must be appropriately served by using the statute to impose civil liability. The absence of a private remedy in a statutory scheme is a factor showing that the legislators did not contemplate enforcement for individual harms. Goda v. White Cliff Nursing Home, 62 Pa. D. & C.4th 476, 481 (Mercer Cty. 2003). 103. Although there are no appellate decisions addressing this issue, several Courts of Common Pleas have held that the Omnibus Budget Reconciliation Act (OBRA) regulations, as set out in 42 C.F.R. S 483 et seq., do not establish a basis for negligence per se claims. Frantz, 64 Pa. D. & C.4th at 467-68; Goda, 62 Pa. D. & C.4th at 485. 104. Aside from 42 C.F.R. S483.25(j) regarding the maintenance of proper hydration, the OBRA regulations set forth goals to be attained by long-term care facilities, not a standard of care that can be used to allege a negligence per se cause of action. Frantz, 64 Pa. D. & C.4th at 468-69; Goda, 62 Pa. D. & C.4th at 483.l 18 105. Further, the Courts have held that the Pennsylvania regulations set forth in 28 Pa. Code ~ 201 et seq. do not set forth a basis for negligence per se. Frantz, 64 Pa. D. & C.4th at 468-69; Goda, 62 Pa. D. & C.4th at 487. 106. The state regulations were intended to "implement a system to enhance the delivery of health services to promote public health," not to protect a particular class of individuals. Id. 107. In Count IV of the First Amended Complaint, Plaintiffs allege that Defendants were negligent per se because they violated 42 C.F.R. ~~ 483.1O(b)(II), 483.13(c), 483.15(a), 483.15(e), 483.15(g), 483.15(h), 483.20(b), 483.25, 483.25(a)(l)(iv), 483.25(a)(3), 483.25(i), 483.35(a), 483.35(c), 483.35(e), 483.75(1)(1), and 28 Pa. Code ~ 201 et seq. 108. As discussed above, these statutes and regulations do not set forth a claim for negligence per se. 109. Accordingly, with regard to the above cited paragraphs in Plaintiffs' First Amended Complaint, Plaintiffs do not state a cause of action upon which relief can be granted. 110. Note that Plaintiffs' counsel, Graybill & Wise, has actual knowledge of the case law cited above, as counsel represented the plaintiff in Frantz v. HCR ManorCare. Inc.. III. Furthermore, Plaintiffs' counsel also represented the plaintiffs in Stare v. ManorCare Health Services, Inc. (CCP York County No. 2003-SU-005492-Y39). On January 13, 2005, the Honorable Penny L. Blackwell granted the defendants' preliminary objections, striking the plaintiffs' claim for negligence per se, except for those allegations concerning hydration/dehydration and nutrition. 112. Despite the Court's opinion in Frantz and Plaintiffs' counsel's past failures in successfully pleading negligence per se claims, Plaintiffs' counsel continues to include negligence per se as a cause of action in the complaints they file, such as in the instant action. 19 WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraphs 91 through 101 and 103 through 106 of Plaintiffs' First Amended Complaint for failure to state a cause of action. VI. MOTION TO STRIKE REFERENCES TO PLAINTIFF DOUTRICH IN COUNT I OF THE FIRST AMENDED COMPLAINT 113. Defendants incorporate the averments in Paragraphs I through 112 as though the same were set forth fully herein at length. 114. All references to Plaintiff Doutrich in Count I of the First Amended Complaint must be stricken for failure to comply with Pa. R.C.P. 1020. 115. Pennsylvania Rule of Civil Procedure 102S(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. 116. Pennsylvania Rule of Civil Procedure 1020(b) provides: If persons join as plaintiffs under Rules 222S, 2229(a) or (e), the complaint shall state the cause of action, any special damage, and the demand for relief of each plaintiff in a separate count, preceded by a heading naming the parties to the cause of action therein set forth. 117. Plaintiffs Carr and Doutrich are joined as plaintiffs under Pa. R.c.P. 2229(a). Parties are allowed to join as plaintiffs when they assert claims arising out of the same transaction or occurrence and that have a common question of law or fact. Pa. R.C. P. 2229(a). lIS. In the instant case, Plaintiffs Carr and Doutrich are both averring injuries sustained as a result of Defendants' alleged inadequate care of Plaintiff Carr. Plaintiff Carr's claim is based on injuries directly related to the alleged deficient care provided by Defendants during her stay at the facility. Plaintiff Doutrich is setting forth a third party claim for negligent infliction of emotional distress based on an event allegedly caused by Defendants' inadequate care. See Exhibit "A." 20 119. Count I of the First Amended Complaint is titled "Count I - Negligence, Plaintiff Carr v. Defendants." 120. However, Count I includes allegations that are specific to Plaintiff Doutrich. See Exhibit "A" at paragraphs 45(E), 51, 52, 53, and 54. 121. Plaintiff Doutrich is even referenced in the ad damnum clause of Count 1. See Exhibit "A." 122. Such a style of pleading is specifically prohibited by Pa. R.C.P. 1020. 123. Plaintiffs must set forth their claims in separate counts, stating any special damage, the demand for relief, and naming the parties to the cause of action. Pa. R.C.P. 1020(b). 124. Notably, based upon this same preliminary objection to Plaintiffs' Complaint, Plaintiffs filed this amended complaint which purports to separate Plaintiff Doutrich' s negligent infliction of emotional distress cause of action by adding Count V in the First Amended Complaint. 125. However, despite the clear mandates of Pa. R.C.P. 1020(b), not only did Plaintiffs fail to remove allegations pertaining to Plaintiff Doutrich from Plaintiff Carr's negligence claim (i.e., paragraph 45(E) of Plaintiffs' Complaint), they intentionally added more allegations to Count I, which pertain only to Plaintiff Doutrich. See Exhibit "A" at paragraphs 45(E), 51, 52, and 54. 126. Accordingly, the above cited references to Plaintiff Doutrich in Count I of the First Amended Complaint are violative of Pa. R.C.P. 1020(b). WHEREFORE, Defendants respectfully request that this Honorable Court strike paragraph 45(E) and the references to Plaintiff Doutrich in paragraphs 51, 52, 53, and 54 and the ad damnum clause of Count I of Plaintiffs' First Amended Complaint. 21 VII. MOTION TO STRIKE PLAINTIFFS' CLAIMS FOR PUNITIVE DAMAGES AND TO STRIKE ALL ALLEGATIONS OF INTENTIONAL CONDUCT, RECKLESSNESS AND OTHER SIMILAR LANGUAGE 127. Defendants incorporate the averments of paragraphs 1 through 126 as though the same were set forth fully herein. 128. Plaintiffs have failed to assert acts and/or omissions sufficient to support allegations of "reckless" or "intentional" conduct on the part of Defendants in order to sustain a claim for puniti ve damages. 129. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. 130. Pennsylvania Rule of Civil Procedure 1019(a) requires a party to formulate a concise summary of the facts that serve as a basis for a cause of action. Miketic, 675 A.2d at 330-31. 131. Pennsylvania law does not allow an award of punitive damages for mere inadvertence, mistake, error of judgment and the like, which constitute ordinary negligence. Field v. Phil. Electric Companv, 565 A.2d 1170, 1184 (Pa. Super 1989). 132. Plaintiffs must, as a matter of law, plead factual allegations supporting a claim of outrageous conduct, or conduct with evil motive or reckless indifference to the rights of others in order to sustain an action for punitive damages. Chambers v. Montgomerv, 192 A.2d 355 (Pa. 1963); Feld v. Merriam, 485 A.2d 742 (Pa. 1984). 133. To determine whether a party exhibited "reckless and/or intentional indifference" as to provide a basis for an award of punitive damages, the court in the underlying litigation must analyze whether the defendant actually knew or had reason to know of the facts which allegedly created a high risk of physical harm to the plaintiff. Field, 565 A.2d at 1182. 22 134. In addition, pursuant to the Medical Care and Reduction of ElTor (MCARE) Act 40 P.S. S 1303.505, punitive damages may only be awarded against a healthcare provider as follows: (a) Award. Punitive damages may be awarded for conduct that is the result of the health care provider's willful or wanton conduct or reckless indifference to the rights of others. In assessing punitive damages, the trier of fact can properly consider the character of the health care provider's act, the nature and extent of the harm to the patient that the health care provider caused or intended to cause and the wealth of the health care provider. (b) Gross Negligence. A showing of gross negligence IS insufficient to support an award of punitive damages. (c) Vicarious Liability. Punitive damages shall not be awarded against a healthcare provider who is only vicariously liable for the actions of its agent that caused the injury unless it can be shown by a preponderance of the evidence that the party knew of and allowed the conduct of its agent that resulted in an award of punitive damages. 40 P.S. S 1303.505 (emphasis added). 135. In all five counts of their First Amended Complaint, Plaintiffs request punitive damages as a result of the alleged acts and/or omissions of Defendants in this instant matter. 136. In addition, the First Amended Complaint characterizes Defendants' conduct as reckless, utterly reckless, outrageous, deliberate, and with reckless and intentional indifference See Exhibit "A" at paragraphs 8, 28, 45(0), 48,50, 82(C), 111, and 112 and the ad damnum clause of each count. 137. It is well established that "blind suspicions and unsupported accusations simply do not state a cause of action pursuant to any theory of tort recovery. Even our present liberalized system of pleading requires that the material facts upon which a cause of action is premised be pled with sufficient specificity so as to set forth the prima facie elements of the tort or torts alleged." Feingold v. Hill, 360 Pa.Super. 539, 549, 521 A.2d 33, 38 (Pa. Super. 1986). 23 138. It appears that the basis of Plaintiffs' claim for punitive damages is the allegation the Seroquel was negligently administered and administered after it was discontinued. 139. It is undisputed that Plaintiff Carr's physician's orders from Holy Spirit Hospital included an order for Seroquel. A copy of the transferring physician's orders upon admission to Manor Care is attached as Exhibit "B." 140. Plaintiff acknowledges that Seroquel was last given on August 19,2003 at 5:00 p.m. See Exhibit "A" at page 25. 141. Further, although Plaintiffs' First Amended Complaint attempts to disguise this fact, it is clear that Ms. Carr's physician, an independent contractor, did not discontinue Seroquel until August 19,2003 at 5:00 p.m. See a copy of the physician's order attached as Exhibit "C." 142. Plaintiffs' allegations regarding the use of Seroquel are nothing more than blind suspicions and completely unsupported by the record. In fact, these accusations are contradicted by the record. 143. As such, any such allegations cannot be used to support Plaintiffs' request for punitive damages. 144. Plaintiffs' First Amended Complaint, fails to enumerate any specific conduct on the part of any of the Defendants which constitutes "recklessness" or "reckless indifference" with respect to the care that was provided to Plaintiff Carr. 145. Further, Plaintiffs have not pled any facts which demonstrate by a preponderance of the evidence that Defendants knew of and allowed its agents to provide care to Plaintiff Carr which amounted to "recklessness" or "reckless indifference." 146. In an attempt to justify an award of punitive damages, Plaintiffs' First Amended Complaint merely contains general boilerplate allegations of recklessness. These allegations, 24 however, provide absolutely no factual support and/or relationship to the injuries allegedly sustained by Plaintiff Carr. 147. In addition, despite the fact that Plaintiff Doutrich asserts a claim for negligent infliction of emotional distress, Count V alleges that Defendants' conduct was outrageous, extreme, intentional, and reckless. See Exhibit "A" at paragraphs 111 and 112 and the ad damnum clause of Count V. This is clearly at odds with Plaintiff Doutrich's theory ofrecovery, and further shows that Plaintiffs' punitive damages claims are merely boilerplate allegations with no factual support. 148. Accordingly, Plaintiffs fail to plead specific allegations, which even if established could possibly rise to the level necessary to award punitive damages. WHEREFORE, Defendants respectfully request that this Honorable Court strike all requests for punitive damages in Plaintiffs' First Amended Complaint and strike all references to reckless, intentional, or similar conduct against Defendants in paragraphs 8, 28, 45(G), 48, 50, 82(C), Ill, and 112 and the ad damnum clause of each count of Plaintiffs' First Amended Complaint. Respectfully submitted, McKISSOCK & HOFFMAN, P.C. ~lL Dated: (1LVWJL~J 5rXO 0' ndy, Esquire Maria R. Gr audo Gesty, Esquire Kathryn C. Mason, Esquire Attorneys for Defendants 25 MCKISSOCK & HOFFMAN, P.c. BY: William J. Mundy Identification No. 57679 BY: Maria R. Granaudo Gesty Identification No. 80609 BY: Kathryn C. Mason Identification No. 201168 1818 Market Street, 13th Floor Philadelphia, PA 19103 (215)246-2100 Attorneys for Defendants ELIZABETH CARR, TERRI DOUTRICH, CUMBERLAND COUNTY COURT OF COMMON PLEAS Plaintiffs CIVIL ACTION - LAW v. NO: 05-3732 MANORCARE, INC., HEALTH CARE AND RETIREMENT CORPORATION OF AMERICA, HCR MANORCARE, THE NIGHTINGALE NURSING HOME, INC., d/b/a MANORCARE HEALTH SERVICES - CAMP HILL, JURY TRIAL DEMANDED Defendants BRIEF IN SUPPORT OF THE PRELIMINARY OBJECTIONS OF DEFENDANTS, MANORCARE HEALTH SERVICES, INC. d/b/a MANORCARE HEALTH SFPVrCFS - CAMP HILL, AND MANORCARE, INC. aIkIa HCR MANORCARE. TO PLAINTIFFS' FIRST AMENDED COMPLAINT I. FACTS AND PROCEDURAL HISTORY On November 7,2005, Plaintiffs filed a Complaint against Defendants with the Court of Common Pleas of Cumberland County. Defendants filed their Preliminary Objections to Plaintiffs' Complaint on November 28,2005. Subsequently, on December 28, 2005, Plaintiffs filed this First Amended Complaint. A true and correct copy of Plaintiffs' First Amended Complaint is hereto attached as Exhibit "A." According to the First Amended Complaint, Plaintiff Carr was discharged from Holy Spirit Hospital and admitted to the Defendant Facility, ManorCare Health Services - Camp Hill on August 13,2003. See Exhibit "A" at paragraph 10. The physician order on the transfer sheet from Holy Spirit Hospital include an order for Seroquel 25mg, twice dailv. At the time of her admission, Plaintiffs allege that Plaintiff Carr had diagnoses of a right gluteal hematoma, COPD, a history of deep vein thrombosis, right leg pain, confusion, and a gastrointestinal bleed. See Exhibit "A" at paragraph 10. Plaintiffs further allege that Plaintiff Carr had allergies to "Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics." See Exhibit "A" at paragraph 11. Plaintiffs' First Amended Complaint avers that Defendants were negligent in administering Seroquel, a drug used to treat hallucinations, to Plaintiff Carr from August 14, 2003, to August 19, 2003. See Exhibit "A" at paragraphs 12-29. Plaintiffs contend that Seroquel was administered until and including August 19, 2003, at 5:00 p.m. despite the attending physician's order to discontinue the medication. See Exhibit "A" at paragraphs 23-29. Plaintiffs attempt to disguise the fact that Plaintiff Carr's attending physician, an independent contractor, did not discontinue the medication until August 19,2003, at 5:00 p.m. In addition to the Seroquel, Plaintiffs' First Amended Complaint asserts that an unknown narcotic drug must have been given to Plaintiff Carr without a prescription because she responded to Narcan, a medication used as an anti-opiate. See Exhibit "A" at paragraphs 30-34. The First Amended Complaint does not allege what type of narcotic drug was administered. Finally, Plaintiffs' First Amended Complaint avers that on three (3) occasions family members found Plaintiff Carr lying naked on her bed either on top of the bed covers or partially underneath them. See Exhibit "A" at paragraph 28. The First Amended Complaint avers that as a result of Defendants' acts and/or omissions that Plaintiff Carr was non-responsive and/or asleep for the six (6) day period she resided at the facility. Further, Plaintiffs allege that Defendants failed to implement measure to prevent dehydration, malnutrition, weight loss, skin breakdown, and decubitus ulcers. See 2 Exhibit "A" at paragraph 35-36. The First Amended Complaint does not specify when Plaintiff Carr was discharged from the Defendant Facility. Defendants file these Preliminary Objections on the bases that: (1) Defendant ManoR:are, Inc. a1k/a HCR ManoR:are was improperly served original process; (2) Plaintiff Doutrich fails to state a cause of action for negligent infliction of emotional distress; (3) Plaintiffs' general allegations of negligence should be stricken for lacking the proper factual specificity; (4) all allegations of corporate liability and Count II of Plaintiffs' First Amended Complaint should be stricken with prejudice for failure to state a cause of action; (5) paragraphs 91 through 101 and 103 through 106 of Plaintiffs' First Amended Complaint relating to Plaintiffs' claim of negligence per se should be stricken for failing to state a cause of action, (6) allegations relating to Plaintiff Doutrich should be stricken from Count I; and (7) Plaintiffs' improper allegations of Defendants' conduct as intentional and reckless and Plaintiffs' requests for punitive damages should be stricken. II. LA W AND ARGUMENT A. Motion to Strike Plaintiffs' Improper Service of Process on ManorCare, Inc. a/k/a HCR ManorCare Plaintiff improperly served process on ManoR:are, Inc. a1k/a HCR ManorCare by serving the corporation at the address of the Defendant Facility. The facility is not an office or usual place of business of ManoR:are, Inc. a1k/a HCR ManoR:are. Pennsylvania Rule of Civil Procedure 1028(a)(l) permits the filing of a preliminary objection in the nature of a motion to strike for improper service. "Proper service is a prerequisite to the court's jurisdiction over the person of a defendant. . . In detennining whether proper service has been effected, [the court] requires strict adherence to the rules." Anzalone v. Vormack, 718 A.2d 1246, 1248 (Pa. Super. 1998). Pennsylvania Rule of Civil Procedure 402 3 provides that "original process may be served. . . by handing a copy. . . at any office or usual place of business of the defendant to his agent or to the person for the time being in charge thereof." Pa. R.C.P. 402(a)(2)(iii). Furthermore, service of original process outside the Commonwealth may be made, inter alia, by any form of mail requiring a receipt signed by the defendant or his authorized agent. Pa. R.C.P. 403, 404(2). The "office or usual place of business" requirement is applicable to the situation where a parent corporation is served at the location of its subsidiary or vice versa. See Delaware Vallev Surgical Su~>ply Co. v. Geriatric & Medical Centers, rnc., 299 A.2d 237 (Pa. 1973); Botwinick v. Credit Exchange, Inc., 213 A.2d 349 (Pa. 1965)(striking service on parent corporation at location of subsidiary where facts showed that the parent and subsidiary had separate and distinct corporate existences and therefore the office or usual place of business requirement was not met). The corporate relationship between a parent corporation and subsidiary in itself is not enough to validate service. See rd. Where the parent and subsidiary maintain separate and distinct corporate existences, and business is not conducted at the location of service, service on a parent corporation at the subsidiary's office, or vice versa, is improper. rd. In Delaware Valley, a parent corporation and its three subsidiaries, all defendants to the suit, were served at the Philadelphia office of the chairman of the board of the parent corporation. Delaware Valley, 299 A.2d at 238. The Supreme Court held that service as to the parent corporation was proper, but struck service on the three subsidiaries as improper. rd. at 239. While the Philadelphia office was not the corporate office of the parent corporation, the Court held that it satisfied the "office or usual place of business" requirement, because the chairman of the board maintained the office "in his capacity as chairman of the parent corporation" and received mail there. rd. at 239. However, while the chairman of the parent 4 corporation was also an officer for the subsidiary corporations, he did not conduct the business of the subsidiaries at his Philadelphia office. Id. In addition, the parent and subsidiaries existed as separate and distinct corporate entities and not as alter egos; and therefore, service on the subsidiaries was improper. Id. In the instant case, ManorCare, Inc. alkJa HCR ManorCare was served a writ of summons by the sheriff or sheriff's deputy at the address of the Defendant Facility, ManorCare Health Services - Camp Hill, at 1700 Market Street, Camp Hill, Pennsylvania 17011. The facility, however, is not ManorCare, Inc. alkJa HCR ManorCare's office or usual place of business. The facility is owned by ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill. ManorCare, Inc. alkJa HCR ManorCare is a distinct and separate corporate entity from ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill, and all corporate formalities are respected. ManorCare, Inc. aIkIa HCR ManorCare is a Delaware corporation with a principal office at 333 North Summit Street, Toledo, Ohio 43699-0086. Plaintiffs' counsel is well aware of the location of ManorCare, Inc. aIkIa HCR ManorCare's corporate office. The First Amended Complaint lists the Ohio address in paragraph 4. See Exhibit "A." In addition, ManorCare, Inc. alkJa HCR ManorCare does not have an agent present at the facility with the authority to accept service. Nor does any agent of the facility have the authority to act at all on behalf of ManorCare, Inc. alkJa HCR ManorCare. Plaintiffs contend, however, that the facility is the principle place of business of ManorCare, Inc. alkJa HCR ManorCare because the Defendant Facility uses "HCR ManorCare documents, forms, policies and procedures such as those in Plaintiff Carr's records (See Attachment A)." See Exhibit "A" at paragraph 4. Plaintiffs fail to recognize, however, that the corporate relationship between ManorCare, Inc. and ManorCare Health Services, Inc. d/b/a 5 ManorCare Health Services - Camp Hill in itself is not enough to validate service. See Botwinick, 213 A.2d at 353-54. The fact that the forms used in Plaintiff Carr's facility chart bear the name "HCR ManorCare" does not change the fact that Defendants are separate and distinct corporate entities. It certainly does not justify an allegation that ManorCare, Inc. maintains a principal place of business at the Defendant Facility. Nor is Plaintiffs' contention relevant that ManorCare, Inc. "holds itself out to the residents of the facility as being the owner, operator, manager or controller of said facility." See Exhibit "A" at paragraph 4. What is material is that ManorCare, Inc. alkla HCR ManorCare and ManorCare Health Services, Inc. d/b/a ManorCare Health Services - Camp Hill are legally independent corporate entities. A simple search of Department of State records would have revealed that fact. Therefore, according to Pa. R.C.P. 403 and 404(2), Plaintiffs should have served the writ of summons via certified mail at ManorCare, Inc. a!k/a HCR ManorCare's corporate office in Ohio. Because Plaintiffs violated the Pennsylvania Rules of Civil Procedure regarding service of original process, service upon ManorCare, Inc. alkla HCR ManorCare was improper and should be stricken. B. Demurrer to Plaintiff Doutrich 's Nel!:lil!:ent Infliction of Emotional Distress Claim Plaintiff Doutrich fails to aver facts sufficient to support a claim for negligent infliction of emotional distress. Plaintiff Doutrich does not establish that she witnessed Defendants' alleged tortious conduct that caused Plaintiff Carr to be naked or partially naked or that she sustained physical injury as a result of seeing Plaintiff Carr naked or partially naked. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. In order to state a cause of action for negligent infliction of emotional distress, a plaintiff must demonstrate that shc 6 suffered physical injury as a result of the defendant's negligence and that she was a foreseeable plaintiff. Armstrong v. Paoli Memorial Hosp., 633 A.2d 605,609 (Pa. Super. 1993). The Pennsylvania Supreme Court employs three factors in detennining whether an injury to a plaintiff was reasonably foreseeable: (I) Whether plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it; (2) whether the shock resulted from a direct emotional impact upon plaintiff from the sensory and contemporaneous observance of the accident from others after its occurrence; and (3) whether plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship. Tackett v. Encke, 509 A.2d 1310, 1312 (Pa. Super. 1986) (quoting Sinn, 404 A.2d at 685). The plaintiff must allege that he or she observed a "discrete and identifiable traumatic event" as opposed to a number of events over a period of time. Id. (emphasis added). In order to establish a claim for negligent infliction of emotional distress, plaintiff must establish that there was a temporal convergence of the negligent act and the event precipitating the emotional di3trc's. Mazzagatti v. Everingham, 516 A.2d 673 (Pa. 1986). Pennsylvania has "consistently refused" to expand the tort of negligent infliction beyond situations where the injury and tortious conduct are actually witnessed. Armstrong, 633 A.2d at 611; see ~ Yandric v. Radic, 433 A.2d 459 (Pa. 1981). The requirement of observing the defendant traumatically inflict injury on a close relative applies equally to cases in which the alleged tortious conduct of the defendant was an omission. Bloom v. Dubois Regional Medical Center, 597 A.2d 671,682-83 (Pa. Super. 1991). In Bloom, the plaintiff's wife was voluntarily admitted to the psychiatric unit of the defendant-hospital. Id. at 673. When the plaintiff went to visit his wife the next day, he found her hanging by the neck 7 from shoestrings behind a bathroom door. Id. The plaintiff asserted a claim for negligent infliction of emotional distress against the defendant-hospital for alleged inadequate care and supervision of the plaintiff's wife and for alleged insufficiently trained and unsupervised staff. Id. at 673-74. The Court held that the plaintiff failed to state a cause of action because he did not observe any traumatic infliction of injury on his wife by the defendants, because none occurred. Id. at 683. He merely witnessed the aftermath. Id. The Court, however, noted that an "omission might be construed as a traumatic infliction of injury on the plaintiff's relative and, if the plaintiff observed that occurrence, recovery could be had." Id. Bloom proffered an example of such a claim: Take, for example, the situation where a husband plaintiff seeks to admit his wife to an emergency room for medical care. Because of inaction by the emergency room personnel, the wife is left to languish in the outer office and expires there. Husband has viewed the entire event. The omission by the emergency room personnel in this scenario might create a sufficiently traumatic situation to be the basis for recovery for negligent infliction. Id. (emphasis added). Such an example is consistent with the Court's holding that to successfully recover for negligent infliction of emotional distress, the plaintiff must observe the defendant traumatically inflicting harm on the plaintiff's close relative "with no buffer of time or space to soften the blow." Id. at 682. Furthermore, several courts have declined to recognize a cause of action for negligent infliction of emotional distress absent physical injuries sustained by the plaintiff. Covello v. Weis Markets, Inc., 610 A.2d 50 (Pa. Super. 1992)(holding that a policeman who was unable to save a boy's life did not state a cause of action for negligent infliction of emotional distress, because he did not allege physical harm to himself); Abadie v. Riddle Memorial Hospital, 589 A.2d 1143 (Pa. Super. 1991)(sustaining a demurrer to the plaintiff's claim for negligent infliction 8 of emotional distress where no physical injuries were alleged to be a result of the defendant's negligent conduct); Wall by Lalli y. Fisher, 565 A.2d 1236 (Pa. Super. 1989)(holding that a mother who witnessed a dog bite her child could not recover on the basis of negligent infliction of emotional distress absent averments of physical injury). In the instant case, in Count V of the First Amended Complaint, it is alleged that the Defendant Facility caused Plaintiff Doutrich emotional distress upon finding her mother naked and exposed without blankets or clothes to protect her. See Exhibit "A" at paragraph 109. Specifically, she alleges that she came into Plaintiff Carr's room to find Plaintiff Carr naked or partially naked. See Exhibit "A" at paragraph 109. She does not aver that she witnessed the Defendants causing Plaintiff Carr's nudity. Rather, Plaintiff Doutrich contends that it was the Defendants' alleged tortious omission of providing adequate care that caused such result. Like the plaintiff in Bloom, Plaintiff Doutrich cannot establish that she directly observed Defendants traumatically inflicting harm on Plaintiff Carr. Unlike Bloom's example of a potentially successful claim based upon an omission, Plaintiff Doutrich does not establish that she was present during the alleged omission of care and does not aver that she viewed the entire event. Furthermore, Plaintiff does not allege that she sustained any physical injury as a result of witnessing her mother naked or partially naked, which is required by Armstrong in order for a plaintiff to recover. Armstrong, 633 A.2d at 609. Plaintiff Doutrich merely asserts that she was "traumatized," suffered "emotional distress," and was crying at the time she reported the facts to Defendant Facility. See Exhibit "A." These are mere temporary psychic injuries, and thus do not meet the requisite standard of physical injury set out by Armstrong. Id. It is unnecessary at this time to analyze whether Plaintiff Doutrich was a foreseeable plaintiff, because based on the facts pleaded in the First Amended Complaint, Plaintiff Doutrich 9 does not establish the other requisite elements of the prima facie case. Without alleging the requirement of physical injury or witnessing tortious conduct by Defendants, Plaintiff is not entitled to recover on a claim of negligent infliction of emotional distress. C. Motion to Strike for Lack of Specificitv The general allegations of negligence contained in paragraphs 45(B), 45(G), and 50 of Plaintiffs' First Amended Complaint should be stricken for lack of specificity. Such allegations are vague and unspecific, providing Defendants with no opportunity to prepare their defense. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. Pennsylvania Rule of Civil Procedure 1019(a) requires that the material facts on which a cause of action is based be stated in a concise and summary form. Pennsylvania is a fact pleading state. Miketic v. Baron, 675 A.2d 324, 330 (Pa. Super. 1996). The Rules require that a pleading define the issues and that every act or performance essential to that act be set forth in the complaint. Getsie v. Borough of Braddock, 560 A.2d 875, 877 (Pa. Commw. Ct. 1988). The complaint must therefore not only give the defendant notice of what the plaintiffs claim is and the grounds upon which it rests, but it must also formulate the issues by summarizing those facts essential to support the claim. Sevin v. Kelshaw, 611 A.2d 1232, 1235 (Pa. Super. 1992); Alpha Tau Omega Fraternitv v. Universitv of Pennsvlvania, 464 A.2d 1349, 1352 (Pa. Super. 1983). If a plaintiff does not adhere to this specificity requirement, great prejudice can result to the defendant. This was well illustrated in Connor v. Alleghenv General Hosp., 461 A.2d 600 (Pa. 1983). In Connor, the Pennsylvania Supreme Court allowed the plaintiff to amend his complaint on the day of trial to allege an entirely new factual theory of liability. The Supreme 10 Court held that the new factual theory of liability merely "amplified" a general allegation of negligence contained in the complaint. Id. at 602. In footnote three of the Opinion, Justice Larsen stated: If Appellee did not know how it "otherwise failed to use due care and caution under the circumstances," it could have filed a preliminary objection in the nature of a request for a more specific pleading or could have moved to strike that portion of appellant's complaint. Id. at 602, n.3. The Court has thus indicated that, upon the appropriate preliminary objection, either in the nature of a motion to strike or for a more specific pleading, vague allegations should be stricken or pled with greater specificity. Pa. R.C.P. 1028(a)(2), (a)(3); Connor, 461 A.2d at 603, n.3.; AlTIer v. Sokol, 96 A.2d 854, 856 (1953). Thus, lower courts have relied on Connor to grant preliminary objections to general conclusory allegations of negligence by either striking the language and/or requiring a more specific pleading. Latniak v. Yon Koch, 70 Pa. D. & C.4th 489 (2004); Bovd v. Somerset Hosoital; 24 Pa. D. & C.4th 564 (1993). In the medical malpractice case of Latniak, the plaintiffs' complaint alleged that the defendants "otherwise failed to use due care under the circumstances." Latniak, 70 Pa. D. & C.4th at 493. Citing Connor, Latniak held that the above- cited allegation violated the requirements of Rule 1019(a) forfailure to apprise the defendants of the nature and extent of the plaintiffs' claim. Id. at 495-96. As pled, the defendants did not have notice of what the plaintiffs intended to prove at trial and could not prepare to meet such proof with their own evidence. Id. Ultimately, the court struck the catch-all allegation, stating that it gave the plaintiffs too much latitude to make surprise amendments to their complaint. Id. at 496- 97. Similarly, the court determined the sufficiency of the following averments in Bovd, another medical malpractice case: 11 42. [Defendants] were careless and negligent in their aforesaid care and treatment of [the plaintiff] in that they: . . . (t) failed to exercise the proper skill, diligence and due care under the specific circumstances aforesaid; (u) failed to adhere to the standards of medical care in the community under the specific circumstances noted aforesaid; (v) failed to otherwise adhere to pertinent and applicable medical standards, and/or otherwise furnish medical care, treatment, evaluation and diagnostic procedures as one would reasonably and ordinarily expect from physicians in the specialty and profession of the defendant-doctor under the specific circumstances set forth aforesaid; and (w) failed to exercise that degree of skill, care and treatment and/or possess that degree of knowledge ordinarily possessed and exercised by other members of their profession and business under the specific circumstances noted aforesaid. Bovd, 24 Pa. D. & C.4th at 566. Again, the court granted the defendant's motion to strike these allegations, reasoning that the allegations were so general that they failed to provide the defendants with sufficient factual information to prepare their defense. Id. at 568. In the instant case, it would be highly prejudicial to Defendants to require them to prepare a defense against every possible cause of action that might fall within the overly bro~d, vague, boilerplate allegations of negligence found in the First Amended Complaint. Similar to the plaintiffs in Latniak and Bovd, Plaintiffs have pled allegations in the First Amended Complaint which contain insufficient facts that do not adequately inform Defendants of the relevant issues that they must defend. For example, paragraph 45(0) notes that Defendants "committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery." See Exhibit "A" (emphasis added). This paragraph is so overbroad and vague that it could include any cause of action in tort law. This is catch-all language that will provide Plaintiffs with the opportunity to add other allegations of negligence at a later point in time, which is strictly prohibited by 12 Connor. See Connor, 461 A.2d at 602-03; Mitchell v. Remskv, 39 Pa. D. & C.4th 112, 125 (1998). In fact, paragraph 45(0) appears to be written to purposefully leave the door open for future amendments. With respect to paragraph 45(B), Plaintiffs fail to provide any information as to how Defendant Facility failed to adequately assess Plaintiff Carr upon her admission. In paragraph 50, Plaintiffs aver that Defendants' conduct violated certain federal and state statutes, but Plaintiffs do not attempt to plead specific facts to support this contention or cite the particular sections of 42 V.S.C. S 1396r to which they refer. See Exhibit "A." Obviously, these sub- paragraphs could encompass endless additional causes of actions not previously alleged. These allegations are so general and boilerplate that they could be applied to numerous other nursing home lawsuits. Accordingly, Defendants respectfully request that this Honorable Court strike paragraphs 45(B), 45(0), and 50 of Plaintiffs' First Amended Complaint for lack of specificity. D. Preliminarv Objections to Plaintiffs' Corporate Liabilitv Claim 1. Demurrer Count II of Plaintiffs' First Amended Complaint should be dismissed with prejudice because corporate liability, as a matter of law, does not apply to Defendants, a nursing home. The appellate courts of Pennsylvania have not extended corporate liability to healthcare organizations other than hospitals and certain HMOs. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of pleading. In Thompson v. Nason Hospital, 591 A.2d 703 (Pa. 1991), the Supreme Court of Pennsylvania adopted the doctrine of corporate liability with respect to hospitals. Vnder such theory, a hospital is directly liable if it fails to uphold the proper standard of care owed to its patient. Thompson, 591 A.2d at 707; 13 Edwards v. Brandvwine Hosp., 652 A.2d 1382, 1386 (1995). The Thompson court classified a hospital's general corporate duties into four discrete areas: (1) A duty to use reasonable care in the maintenance of safe and adequate facilities and equipment; (2) A duty to select and retain only competent physicians; (3) A duty to oversee all persons who practice medicine within its walls as to patient care; and (4) A duty to formulate, adopt and enforce adequate rules and policies to ensure quality care for the patients. Thompson, 591 A.2d at 707 (citations omitted). The Thompson court held that "the corporate hospital's role in the total health care of its patients" required that hospitals be held to a standard of care separate and apart from the duties of a physician. rd. at 708. The court further stated that in order to prove corporate negligence, a plaintiff must show that the hospital "had actual or constructive knowledge of the defect or procedures which created the harm" and that the hospital's negligence was "a substantial factor in bringing about the harm." rd. Thompson limited the applicability of corporate liahility to hospitals. More recently, however, our Superior Court enlarged the doctrine of corporate liability to encompass a Health Maintenance Organization (hereinafter "HMO"). Shannon v. McNultv, 718 A.2d 828 (Pa. Super. 1998). Shannon's extension of the corporate liability doctrine centered on the HMO's role in the plaintiff's total health care. The Court stated: [W]e recognize the central role played by HMOs in the total health care of its subscribers. . . [HMO] subscribers [are] given little or no say so in the stewardship of their care. Specifically, while these providers do not practice medicine, they do involve themselves daily in decisions affecting their subscriber's medical car~ . . . [T]he true effect of the provider's actions . . . [is to dictate and direct] the subscriber's medical care. . . We see no reason why the duties applicable to hospitals should not be equally applied to an 14 HMO when that HMO is performing the same or sirrtilar function as a hospital. Id. at 835-836 (citations omitted). In Shannon, the plaintiff's HMO gave her the option of choosing one of six physicians when she advised them that she was pregnant. Id. at 831. In addition, the HMO provided in- house triage services by telephone. Id. at 832. The plaintiff sought assistance from both her doctor and the HMO triage service on several occasions when she experienced difficulties with her pregnancy. Id. Consequently, the triage service failed to immediately refer the plaintiff to a hospital concerning her medical issues, resulting in the loss of the plaintiff's newborn. Id. Outside the context of Thompson and Shannon, our appellate courts have not issued any other authoritative determination that corporate liability applies to any other health care organizations. In fact, the Superior Court of Pennsylvania declined to apply the theory of corporate liability to a physician's practice group in Sutherland v. Monongahela Valle v Hospital, 856 A.2d 55, 62 (Pa. Super. 2004). Pennsylvania trial courts have interpreted these two holdings to limit corporate lia"iljty to hospitals and HMOs as well.. See Lebish v. Whitehall Manor, Inc., 57 Pa. D&C 4th 247 (Lehigh Co. 2002); Brewer v. Geisinger Clinic, Inc., 45 Pa. D&C 4th 215 (Lackawanna Co. 2000); Dibble v. Penn State Geisinger Clinic, Inc., 42 Pa. D&C 4th 225 (Lackawanna Co. 1999); Dowhouer v. Judson, 45 Pa. D&C 4th 172 (Dauphin Co. 2000); Remshifski v. Kraus, No. 1845 Civ. 1992, slip opinion (C.P. Monroe Co. Sept. 8, 1995). Notably, in Dowhouer v. Judson, the court granted defendant physician practice group's prelirrtinary objections to plaintiff's corporate negligence claims. Id. at 178. Dowhouer held that corporate liability did not apply to a physician's practice group because the Supreme Court did not intend to extend such liability beyond hospitals and health maintenance organizations. Id. Central to its decision was the fact 15 that the plaintiff was not required to commit to a single health care provider for treatment and was free at any time to choose another physician. Id. at 181. Similarly, the Eastern District of Pennsylvania, applying Pennsylvania law, has refused to extend the doctrine of corporate liability beyond hospitals and HMOs. Milan v. American Vision Center, 34 F.Supp. 2d 279 (E.D. Pa. 1998). Milan specifically relied on Thompson's interpretation and held that "Thompson sets a standard of care for hospitals, not necessarily for all health care organizations. . . The use of the language throughout Thompson similarly suggests that the Supreme Court believed itself to be crafting a rule of hospital liability, not health care organization liability generally." Id. at 280. Milan also concluded that unlike the hospital in Thompson a visit to an optometrist's office generally does not require a paticnt to commit to a single corporate health care provider as a matter of medical necessity. Id. at 282. For the same reasons, corporate liability does not apply to Defendants, a nursing home. Nursing homes do not fit into either context considered by the Thompson or Shannon courts. Defendants are by definition neither a hospital nor an HMO. Additionally, as a nursing home, the role Defendants play in the care of its residents is not analogous to the role of a hospital or certain HMOs in the total health care of its patients or subscribers. For example, Defendants were not responsible for and did not provide medical care to Plaintiff Carr, as would a hospital. Defendants, unlike the HMO in Shannon, did not have a role in the daily decisions affecting Plaintiff Carr's medical care. They did not limit the length of her hospital stays, restrict her use of specialists, prohibit or limit her post hospital care, restrict her access to therapy, or prevent the rendering of emergency care. In fact, residents at nursing homes are free to seek placement at other facilities and, accordingly, they are neither constrained, nor compromised to remain at any specific facility. Furthermore, in the nursing home setting, the determination of whether long- 16 term care services are required is typically rendered by the resident's attending physician and the medical benefits provider (e.g., Medicare covered therapist). Ultimately, the care provided is ordered and/or overseen by the attending physician. Therefore, the theory of corporate liability as adopted in Thompson does not apply to nursing homes, specifically the facility known as ManorCare Health Services - Camp Hill. 2. Motion to Strike for Lack of Specificity In the altemati ve, if corporate liability is applicable in the nursing home setting, which legal proposition is specifically denied, Plaintiffs' First Amended Complaint fails to set forth any specific acts of corporate negligence by Defendants. As discussed above in Section II.C., such allegations provide insufficient facts which do not provide Defendants with notice of Plaintiffs' claims and which do not adequatel y apprise Defendants of the relevant issues that they must defend. Baker, 324 A.2d at 505-06. Plaintiffs' claims are merely blind accusations unsupported by specific facts. For example, paragraph 82(A) fails to indicate how Defendants' staff was not adequate in number or appropriately trained and how that alleged deficiency relates to Plaintiffs' injuries. With respect to paragraph 82(C), Plaintiffs allege that Defendants "failed to acquire sufficient staffing. . . in order to maximize profits." See Exhibit "A." They further contend that Defendants exercised "reckless indifference" toward Plaintiff Carr and exhibited "outrageous conduct and intentional neglect." Id. However, these allegations lack any factual support and do not create a link between Defendants and Plaintiff Carr's alleged injuries. Paragraph 82(C) asserts generalized, unsubstantiated accusations, which can only be considered mere name calling. Finally, paragraph 82(F) is so vague and overbroad that it could encompass numerous theories of recovery and could be applied to any nursing home professional liability action. 17 Based on the foregoing, Count II of Plaintiffs' First Amended Complaint should be dismissed with prejudice for failure to state a cause of action. In the alternative, paragraphs 82(A), 82(C), and 82(F) should be stricken for lack of specificity. E. Demurrer to Plaintiffs' Nel!lil!ence Per Se Claims Paragraphs 91 through 10 1 and 103 through 106 of Plaintiff's First Amended Complaint should be stricken because the various sub-sections of 42 C.F.R. S 483 et seq. and 28 Pa. Code S 201 et seq. cited by Plaintiffs in Count IV of the First Amended Complaint do not set forth a basis for negligence per se. These statutes and regulations were not intended to protect a particular class of people. Pennsylvania Rule of Civil Procedure 1028(a)(4) permits the filing of a preliminary objection in the nature of a demurrer for legal insufficiency of a pleading. In order for a statute or regulation to establish a cause of action for negligence per se, "the purpose of the statute must be to protect the interest of a group of individuals, as opposed to the general public, and the statute must clearly apply to the conduct of the defendant." Frantz v. HCR ManorCare, Inc., 64 Pa. D. & CAth 457, 462 (Schuylkill Cty. 2003)(citing Wagner v. Anzon, Inc., 684 A.2d 570,574 (Pa. Super. 1996)). In addition, the policy behind the legislation must be appropriately served by using the statute to impose civil liability. Id. at 465. The absence of a private remedy in a statutory scheme is a factor showing that the legislators did not contemplate enforcement for individual harms. Goda v. White Cliff Nursing Home, 62 Pa. D. & CAth 476, 481 (Mercer Cty. 2003). Although there are no appellate decisions addressing this issue, several Courts of Common Pleas have held that the Omnibus Budget Reconciliation Act (OBRA) regulations, as set out in 42 c.F.R. S 483 et seq., do not establish a basis for negligence per se claims,. Frantz, 18 64 Pa. D.&CAth at 467-68; Goda, 62 Pa. D. & CAth at 485. The OBRA regulations set forth goals to be attained by long-term care facilities, not a standard of care that can be used to allege a negligence per se cause of action. Frantz, 64 Pa. D. & CAth at 468-69; Goda, 62 Pa. D. & CAth at 483. Furthermore, the Courts have held that the Pennsylvania regulations set forth in 28 Pa. Code S 201 et seq. do not set forth a basis for negligence per se. Frantz, 64 Pa. D. & CAth at 468-69; Goda, 62 Pa. D. & CAth at 487. These state regulations were intended to "implement a system to enhance the delivery of health services to promote public health," not to protect a particular class of individuals. Id. In Frantz, relying on Goda, the trial court sustained the defendants' preliminary objection to the plaintiff's negligence per se claim for failure to state a cause of action upon which relief can be granted. Frantz, 64 Pa. D. & CAth at 468-69. Frantz involved a survival and wrongful death action by a decedent's wife against HCR ManorCare, Inc. t1a ManorCare of Pottsville for alleged inadequate care which resulted in the decedent's death. Id. at 458. The plaintiff averred that the defendant nursing home was negligent per se for violating various sub-sections of 42 C.F.R. S 483 et seq. and Pa. Code S 201 et seq. The court, however, stated that "OBRA was enacted 'to improve the quality of care for Medicaid-eligible nursing home residents, and either to bring substandard facilities into compliance with Medicaid quality care requirements or to exclude them from the program. '" Id. at 467. The court held that only 42 C.F.R. S 483.25(j), regarding the maintenance of proper hydration satisfied the elements of Wagner and could be used as a basis for negligence per se. Id. In Count IV of the First Amended Complaint, Plaintiffs allege that Defendants were negligent per se because they violated 42 c.F.R. SS 483.LO(b)(1l), 483.13(c), 483.l5(a), 483. 15(e), 483.15(g), 483.l5(h), 483.20(b), 483.25, 483.25(a)(1)(iv), 483.25(a)(3), 483.25(i), 19 483.35(a), 483.35(c), 483.35(e), 483.75(1)(1), and 28 Pa. Code S 201 et seq. Plaintiffs' list of statutes which were allegedly violated by Defendants is almost identical to the statutes alleged to be violated in Frantz. This is not surprising, however, since Plaintiffs' counsel, Graybill & Wise, was also the plaintiff's counsel in Frantz. As such, counsel should be well aware that these statutes and regulations do not set forth a claim for negligence per se. In fact, Plaintiffs' counsel was also unsuccessful in pleading a cause of action for negligence per se in Stare v. ManorCare Health Services, Inc. (CCP York County No. 2003-SU-005492- Y39). Yet, Plaintiffs' counsel continues to include negligence per se as a count in complaints that they file, as in the instant case. Accordingly, Plaintiffs do not state a cause of action upon which relief can be granted with regard to the above cited paragraphs in Plaintiffs' First Amended Complaint. Paragraphs 91 through 101 and 103 through 106 of Plaintiffs' First Amended Complaint should be stricken for failure to state a cause of action. F. Motion to Strike References to Plaintiff Doutrich in Count I of the First Amended Complaint All references to Plaintiff Doutrich in Count I of Plaintiffs' First Amended Complaint should be stricken for failure to comply with Pa. R.C.P. 1020. Plaintiffs must plead their causes of action in separate counts within the First Amended Complaint. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. Pennsylvania Rule of Civil Procedure 1020(b) provides: If persons join as plaintiffs under Rules 2228, 2229(a) or (e), the complaint shall state the cause of action, any special damage, and the demand for relief of each plaintiff in a separate count, preceded by a heading naming the parties to the cause of action therein set forth. 20 Plaintiffs are joined in the instant matter under Pa. RC.P. 2229(a), because they assert claims arising out of the same transaction or occurrence and that have a common question of law or fact. Pa. R.C.P. 2229(a). They are both averring injuries sustained as a result of Defendants' alleged inadequate care of Plaintiff Carr. Plaintiff Carr's claim is based on injuries directly related to the alleged deficient care provided by Defendants during her stay at the facility. Plaintiff Doutrich is setting forth a third party claim for negligent infliction of emotional distress based on an event allegedly caused by Defendants' inadequate care. Count I of the First Amended Complaint is titled "Count I - Negligence, Plaintiff Carr v. Defendants." However, Count I includes allegations that are specific to Plaintiff Doutrich. See Exhibit "A" at paragraphs 45(E), 51, 52, 53, and 54. Plaintiff Doutrich is even referenced in the ad damnum clause of Count 1. See Exhibit "A." Such a style of pleading is specifically prohibited by Pa. RC.P. 1020. Plaintiffs must set forth their claims in separate counts, stating any special damage, the demand for relief, and naming the parties to the cause of action. Pa. RC.P. 1020(b). Notably, based upon this same preliminary objection to Plaintiffs' Complaint, Plaintiffs purported to separate Plaintiff Doutrich's negligent infliction of emotional distress cause of action by adding Count V in the First Amended Complaint. However, despite the clear mandates of Pa. R.C.P. 1020(b), not only did Plaintiffs fail to remove allegations pertaining to Plaintiff Doutrich from Plaintiff Carr's negligence claim (i.e., paragraph 45(E) of Plaintiffs' Complaint), they intentionally added more allegations to Count I on Plaintiff Doutrich's behalf. See Exhibit "A" at paragraphs 45(E), 51, 52, and 54. Accordingly, the above cited references to Plaintiff Doutrich in Count I of the First Amended Complaint are violative of Pa. R.C.P. 1020(b). Paragraph 45 (E) and the references to 21 Plaintiff Doutrich in paragraphs 51, 52, 53, and 54 and the ad damnum clause of Count I of Plaintiffs' First Amended Complaint must be stricken. G. Motion to Strike Plaintiffs' Claims for Punitive Damal!es and to Strike All Allel!ations of Intentional Conduct. Recklessness and Similar Lanl!Ual!e Plaintiffs' averments in paragraphs 8, 28, 45(G), 48,50, 82(C), Ill, 112 and the ad damnum clause of each count of the First Amended Complaint, which allege that Defendants acted intentionally and recklessly, and Plaintiffs' prayers for punitive damages should be stricken. Plaintiffs fail to plead specific facts that establish conduct by Defendants which would warrant a punitive damages award. Pennsylvania Rule of Civil Procedure 1028(a)(2) permits the filing of a preliminary objection in the nature of a motion to strike for failing to conform to law or rule of court. Rule 1019(a) of the Pennsylvania Rules of Civil Procedure requires a party to formulate a concise summary of the facts that serve as the basis for the cause of action. See Miketic, 675 A.2d at 330. Pennsylvania law does not allow an award of punitive damages for mere inadvertence, mistake, error of judgment and the like, which constitute ordinary negligence. Field v. Phil. Electric Companv, 565 A.2d 1170, 1184 (Pa. Super 1989). Plaintiff must, as a matter of law, plead factual allegations supporting a claim of outrageous conduct, or conduct with evil motive or reckless indifference to the rights of others in order to sustain an action for punitive damages. In any other circumstance, a demand for punitive damages must be dismissed. Chambers v. Montgomerv, 192 A.2d 355 (Pa. 1963); Feld v. Merriam, 485 A.2d 742 (Pa. 1984). In order to determine whether Defendants exhibited such conduct as to provide a basis for an award of punitive damages, the court must analyze whether defendants actually knew, or had reason to know of the facts which allegedly created a high risk of physical harm to the plaintiff. Field,565 A.2d at 1182. In Field, the Superior Court found that the requisite mental state required for the 22 imposition of punitive damages was alleged in the plaintiff's complaint, since the plaintiff claimed that defendants had actual knowledge that they were exposing the plaintiff to grave danger. Id. at li83. In addition, pursuant to the Medical Care and Reduction of Error (MCARE) Act, 40 Pa. C.S.A. ~ 1303.505, punitive damages may only be awarded against a healthcare provider as follows: (a) Award. Punitive damages may be awarded for conduct that is the result of the health care provider's willful or wanton conduct or reckless indifference to the rights of others. In assessing punitive damages, the trier of fact can consider the character of the health care provider's act, the nature and extent of the hann to the patient that the heath care provider caused or intended to cause and the wealth of the health care provider. (b) Gross Negligence. A showing of gross negligence is insufficient to support an award of punitive damages. (c) Vicarious liability. Punitive damages shall not be awarded against a healthcare provider who is only vicariously liable for the actions of its agent that caused the injury unless it can be shown by a preponderance of the evidence that the party knew of and allowed the conduct of its agent that resulted in an award of punitive damages. 40 Pa. C.S.A. ~ 1303.505 (emphasis added). Here, Plaintiffs' First Amended Complaint fails to enumerate any specific facts demonstrating that Defendants' conduct was reckless, intentional, or rose to the level necessary to justify an award for punitive damages. In fact, the general, non-specific allegations which Plaintiffs do make do not amount to egregious acts and/or omissions which show recklessness on the part of Defendants or any of their staff members. For example, Plaintiffs' primary allegations regarding Plaintiff Carr revolve around her physical condition while at the Defendants' facility, primarily her alleged non-responsive state due to the administration of 23 Seroquel and her state of nudity which allegedly caused Plaintiff Doutrich emotional distress. Even assuming that Defendants could have prevented these alleged injuries, these acts or failures do not justify an award of punitive damages. Furthermore, while Plaintiffs' First Amended Complaint includes several pages with respect to the conduct of Defendants and Plaintiff Carr's injuries, Plaintiff does not plead facts sufficient to meet the requisite mental state required to impose punitive damages. They do not demonstrate by a preponderance of the evidence that Defendants knew of and allowed its agents to provide care to Plaintiff Carr which amounted to recklessness. 40 Pa. C.S.A. S 1303.505(c); see Field, 565 A.2d at 1183. In an attempt to justify an award of punitive damages, Plaintiffs' First Amended Complaint contains only bare assertions that Defendants' conduct was reckless, utterly reckless, outrageous, deliberate, and with reckless and intentional indifference. See Exhibit "A" at paragraphs 8, 28, 45(0), 48, 50, 82(C), Ill, and 112 and the ad damnum clause of each count. These allegations provide absolutely no support and/or relationship to the injuries allegedly sustained by Plaintiff Carr. It is well established that "blind suspicions and unsupported accusations simply do not state a cause of action pursuant to any theory of tort recovery. Even our present liberalized system of pleading requires that the material facts upon which a cause of action is premised be pled with sufficient specificity so as to set forth the prima facie elements of the tort or torts alleged." Feingold v. Hill, 360 Pa. Super. 539, 549, 521 A.2d 33,38 (Pa. Super. 1986). It appears that the basis of plaintiff's claim for punitive damages is the allegation the Seroquel was negligently administered and administered after it was discontinued. It is undisputed that Plaintiff Carr's physician's orders from Holy Spirit Hospital included an order for Seroquel. A copy of the transferring physician's orders upon admission to Manor Care is attached as Exhibit 24 "B". Plaintiffs acknowledge that Seroquel was last given on August 19,2003 at 5:00 p.m. See p. 25 of Exhibit "A". Further, although Plaintiffs' First Amended Complaint attempts to disguise this fact, it is clear that Plaintiff Carr's physician, an independent contractor, did not discontinue Seroquel until August 19,2003 at 5:00 p.m. See a copy of the physician's order attached as Exhibit "C". Plaintiffs' allegations regarding the use of Seroquel are nothing more than blind suspicions and completely unsupported by the record. In fact, these accusations are contradicted by the record. As such, any such allegations cannot be used to support Plaintiffs' request for punitive damages. Furthermore, despite the fact that Plaintiff Doutrich asserts a claim for negligent infliction of emotional distress, Count V alleges that Defendants' conduct was outrageous, extreme, intentional, and reckless. See Exhibit "A" at paragraphs III and 112 and the ad damnum clause of Count V. This is clearly at odds with Plaintiff Doutrich's theory of recovery, and further shows that Plaintiffs' punitive damages claims are merely boilerplate allegations with no factual support. Not every death or personal injury gives rise to a cause of action in negligence. Moreover, not every death or personal injury gives rise to an award for punitive damages. The facts in the instant case DO NOT justify an award of punitive damages. Accordingly, Defendants respectfully request that the various allegations of reckless, utterly reckless, outrageous, and deliberate conduct contained in the First Amended Complaint including such allegations contained in paragraphs 8, 28, 45(G), 48, 50, 82(C), Ill, and 112 and the ad damnum clause of each count of the Plaintiffs' First Amended Complaint and Plaintiffs' request for punitive damages be stricken. 25 III. CONCLUSION Based upon the foregoing reasons, Defendants respectfully request that this Honorable Court grant these Preliminary Objections to Plaintiffs' First Amended Complaint and enter the attached proposed Order. Respectfully submitted, McKISSaCK & HOFFMAN, P.C. William J. M' dy, Esquire Maria R. Or udo Oesty, Esquire Kathryn C. ason, Esquire Attorneys for Defendants Dated: ~l\4 ~ :;Woit? 26 CERTIFICATE OF SERVICE I, Kathryn C. Mason, Esquire, hereby certify that a true and correct copy of the Preliminary Objections of Defendants, ManorCare Health Services, Inc. d/b/a ManorCare Health Service - Camp Hill and ManorCare, Inc. aJk/a HCR ManorCare, to Plaintiffs' First Amended Complaint, has been served upon the following persons by United States Mail, First Class, postage pre-paid, on this5-\- h day of /'f n\\lJJ\ ~ ,2006: Barbara G. Graybill Graybill & Wise, P.c. 126 Locust Street P.O. Box 11489 Harrisburg, PA 17108-1489 ~ 0' ~ J;> t:-)(h: l:t A - Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW Barbara G. Graybill Attorney J.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO: 05-3732 v. MANORCARE HEALTH SERVICES, INC., O/P!A MANORCARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE HEALTH CARE PROVIDER PROFESSIONAL L1ABILl1Y CLAIM JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your qefenses or objections to the claims set forth against you. You are warned that if you fail Ita 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 other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. PENNSYLVANIA LAWYER REFERRAL SERVICE Pennsylvania Bar Association P.O. Box 186 Harrisburg, PA 17108 (800) 692-7375 27 NO: 05-3732 Barbara G. Graybill Attomey 1.0. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for the Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW v. MANORCARE HEALTH SERVICES, INC., D/B/A MANOR CARE CAMP HILL And MANORCARE, INC., also known as HCR MANORCARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED Defendants FIRST AMENDED COMPLAINT ,I AND NOW COMES, Plaintiffs, by their u'ndersigned attorney, and respectfully bring this Complaint at law, setting forth in support thereof as follows: 1. Plaintiff Elizabeth Carr is an adult woman domiciled in Camp Hill, Pennsylvania, and currently residing in the Masonic Home, Elizabethtown, Pennsylvania. 2. Plaintiff Terri Doutrich is the daughter of Plaintiff Elizabeth Carr and resides in Mechanicsburg, Pennsylvania. 2 3. Defendant Manor Care Camp Hill (hereinafter Defendant Facility) is a licensed health care provider for nursing services located at 1700 Market Street, Camp Hill, Pennsylvania 17011. 4. Defendant ManorCare, Inc. also known as HCR ManorCare (hereinafter Corporate Defendant) owns, operates, manages and/or controls ManorCare Camp Hill as a nursing facility as a Pennsylvania licensed health care provider. While it has a corporate office at 333 North Summit Street, P. O. Box 10086, Toledo, Ohio 43699- 0086, it maintains a principal place of business at 1700 Market Street, Camp Hill, Pennsylvania. Furthermore, it holds itself out to the residents of the facility as being the owner, operator, manager or controller of said facility by use of HCR ManorCare documents, forms, policies and procedures such as those in Plaintiff Carr's records (See Attachment A) which were made in the course of Plaintiff Carr's stay at Defendant Facility . 5. Defendant Facility is engaged in the business of providing nursing home services as a health care provider licensed by the Commonwealth of Pennsylvania. 6. Defendants jointly maintain oversight and control for the operation and management of " " Defendant Facility, including but not limited to: A. Ownership and management of the phy~ical plant; B. Establishing policies and procedures for hiring, training, supervising and retaining staff; C. Controlling contractual obligations of Defendant Facility with regard to the hiring, oversight and retention of the Medical Director and other ancillary providers; D. Establishing and implementing care policies and procedures for residents; 3 E. Appointment of a goveming board and administrator for Defendant Facility; F. Financial management of the facility regarding funds, indebtedness, operating capital, and operating budget of Defendant Facility; and G. Compliance with applicable laws, regulations, and, where applicable, appropriate accreditation standards. 7. Defendant Facility is a licensed health care provider with offices in Cumberland County, Pennsylvania. Plaintiffs are asserting a profess/anal liability claim against this Defendant. 8. Because of their joint responsibility for the operations at Defendant Facility, Defendants are also liable for the negligent and/or reckless acts of staff at Defendant Facility. 9. Defendant Facility holds itself out to be a health care provider, which purports to possess skill and knowledge in the field of nursing home care and holds itself out to the public as so qualified. As such, Defendant, through its agents and employees, holds itself out as being capable of providing nursing services under the direction of a medical director, holds itself out to be properly staffed and able to meet the needs of Elizabeth Carr and others like her, and further.!holds itself out as complying on a \' continual basis with all the rules and regulations applicable to licensed nursing facilities. 10. On August 13, 2003, Elizabeth Carr was discharged from Holy Spirit Hospital, Camp Hill, to Defendant Facility. Her admitting diagnoses were: right gluteal hematoma, COPD, history of deep vein thrombosis, right leg pain, confusion and gastrointestinal bleed. 4 11. On August 13, 2003, at 2:30 p.m., Defendant Facility staff noted on Plaintiff Carr's admission assessment that she had allergies to Ceftin, Oxycodone, Augment, Emycin and that she was intolerant to narcotics. 12. On Thursday, August 14, 2003, Defendant Facility therapy notes that Plaintiff Carr was unable to respond, as she was very sleepy. 13. Plaintiff Carr was receiving two doses daily of Seroquel25 mg., a drug to treat hallucinations. 14. Plaintiff Carr exhibited no hallucinations during the time she was at Defendant Facility. 15. Plaintiff Carr was non-responsive during her entire stay at Defendant Facility, sleeping constantly. 16. Due to her non-responsive status, Plaintiff Carr was unable to eat or drink. 17. Defendant Facility records have no documentation regarding the admission or discharge weight of Plaintiff Carr, which information is basic and critical to the provision of nursing home care. 18. Plaintiff Terri Doutrich visited Plaintiff Carr several times each day during Plaintiff Carr's stay at Defendant Facility, each time finding ,her mother asleep and unable to be I' aroused. 19. On many occasions while Plaintiff Doutric~ visited, a meal tray was brought into Plaintiff Carr's room, placed on a table, then removed after approximately 30 minutes. The food was never served to Plaintiff Carr, nor did any staff question why Plaintiff Carr left the tray untouched. It is the responsibility of the facility to assure that each resident receives adequate services to meet the needs of the resident; the failure to feed a non- responsive patient adequate nutrition is a deviation from the standard of care required 5 by a nursing facility. It is believed, and therefore averred, that such failure constitutes neglect by Defendant Facility's own policies and procedures. 20. Plaintiff Doutrich complained to Defendant Facility each time meal service was provided in this manner, and expressed concern over her mother's constant sleeping. 21. On or about August 18, 2003, Plaintiff Doutrich requested that the facility discontinue the Seroquel because she was concerned that the drug was the cause of her mother's non-responsiveness. 22. At the next visit following this request, Plaintiff Carr was still being given Seroquel. 23. At that time, Plaintiff Doutrich sought out the Defendant Facility's physician, who was present in the building, and asked why Seroquel was still being administered. The physician responded that he had not been advised of the request to discontinue the Seroquel. He immediately wrote an order to discontinue the Seroquel. 24. On her subsequent visit to her mother, Plaintiff Doutrich found that her mother was still being given Seroquel despite the physician order to discontinue it. Plaintiff Doutrich advised Defendant Facility staff that the medication should have been discontinued via a written order by the physician, but in fact !),ad not been discontinued to be I' 1 administered by the staff. 25. Following this medication error, Thomas V.onNeda, son of Plaintiff Carr, visited Plaintiff Carr and found the Defendant Facility Staff ready to administer the Seroquel. The medication administration record of Defendant Facility shows that the Seroquel was administered at 5 p.m. on August 19, 2003. 6 26. On Tuesday, August 19, 2003, Plaintiff Carr's temperature became elevated. The nursing notes indicate that Tylenol was given for general discomfort and that Plaintiff Carr's appetite was poor and she had poor fluid intake. 27. When Plaintiff Doutrich visited on Tuesday, August 19, 2003, Plaintiff Carr was still non-responsive. Defendant Facility obtained a telephone order at that time to discontinue the Seroquel, despite the physician having earlier discontinued the medication. 28. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then complained to Defendant Facility staff. Plaintiff Doutrich was traumatized and visibly upset when she reported this violation of her mother's privacy and personal dignity. It was reasonably foreseeable that the family members would suffer emotional distress at repeatedly finding their mother without clothing or care despite the facility being continually advised of this condition. No explanation for the status of this " \' nudity and violation of personal dignity was forthcoming from the Defendant Facility staff, nor was the Defendant Facility able',to correct the situation and maintain the clothed state of a non-responsive sleeping Plaintiff. Defendant was totally responsible for the care of Plaintiff Carr, and the failure to provide such care is directly attributable to Defendant. The failure of Defendant to provide such care is a tortious act of omission. Such omission to provide basIc care to Plaintiff Carr, who 7 was totally unable to care for herself at the time, constitutes extreme, outrageous, intentional ad/or reckless conduct. 29. On Tuesday, August 19, 2003, Plaintiff Carr was transferred from Defendant Facility to Harrisburg Hospital. 30. Upon admission to Harrisburg Hospital, the Emergency Department immediately administered Na'rcan to Plaintiff Carr due to her unresponsiveness. 31. Narcan is an antidote for opiate drugs, none of which were prescribed for Plaintiff Carr. 32. Narcan is not an antidote for Seroquel. 33. Plaintiff Carr responded to the Narcan. 34. Plaintiffs believe, and therefore aver, that Plaintiff Carr was administered opiate drugs by Defendant Facility without physician authorization. 35. Based upon Plaintiff Carr's poor food and nutrition intake, Defendant Facility should have known that Plaintiff Carr was at risk for dehydration, malnutrition, weight loss, skin breakdown and decubitus ulcers. 36. Despite this, Defendant Facility did not implement appropriate measures to ensure ,I I' Plaintiff Carr did not become dehydrated, malnourished, or suffer from decubitus ulcers. 37.Additionally, to the extent Defendant Facility did monitor Plaintiff Carr's fluid and meal intake, documentation reveals that her fluid and meal intake were often inadequate. 38. Defendant Facility failed to properly assess Plaintiff Carr, failed to notify the physician of changes in Plaintiff Carr's status, and failed to provide basic care including food and hydration to Plaintiff Carr. 8 39. Defendant Facility failed to protect Plaintiff Carr from the unlawful and dangerous administration of narcotic drugs, which drugs had not been ordered for Plaintiff Carr and which Plaintiff Carr could not tolerate. 40. Defendant Facility failed to protect rights of Plaintiff Carr to a dignified existence in a safe environment. 41. Defendant Facility allowed Plaintiff Carr to lie naked and exposed for long periods of time, in violation of her dignity, rights, and basic care needs. 42. The amount claimed herein is in excess of the amount for compulsory arbitration for Cumberland County. COUNT I - NEGLIGENCE PLAINTIFF CARR v. DEFENDANTS 43. Paragraphs 1-42 above are incorporated by reference herein. 44. By granting admission to Plaintiff Carr, Defendants voluntarily undertook a duty, as a licensed nursing facility and operators/managers of that facility, to provide Plaintiff Carr with adequate nursing facility care that met the minimum standards for such licensed nursing facility care. As part of this duty, Defendant had the duty to provide nursing i services; to arrange for and monitor medical,lcare; to hire and retain sufficient numbers of nursing personnel staff or sufficiently trained staff; to properly supervise or oversee the activities of staff members, including the medical director and/or physician retained to be responsible as medical director of the facility; and to assist all residents, including Plaintiff Carr, to attain and maintain the highest level of physical, mental, and psychosocial well-being. 45. Defendants, through agents, servants, and employees, breached the standard of care due to Plaintiff Carr for the following reasons: 9 A. Despite the knowledge that Plaintiff Carr was at risk for altered nutritional status and weight loss, and despite Plaintiff Carr's significant weight loss during the period she was confined at Defendant Facility, Defendant Facility did not implement adequate and appropriate interventions to prevent such altered nutritional status and weight loss. B. Defendant Facility failed to conduct an adequate assessment of Plaintiff Carr upon her admission to Defendant Facility and failed to implement appropriate care for Plaintiff Carr as evidenced by the inability of Defendant Facility to provide basic care, including nutrition, hydration, clothing, dignity and safety to Plaintiff Carr. C. Defendant Facility failed to notify, document and follow physician orders to discontinue Seroquel. D. Defendant Facility failed to protect the dignity, safety and well-being of Plaintiff Carr as evidenced by the continual failure of Defendant facility to monitor the state of nakedness or clothing and covers of a non-responsive sleeping Plaintiff Carr. E. Defendant Facility caused Plaintiff Doutrich trauma and emotional distress by causing her mother to be repeatedly nak~d and exposed without blankets or I I clothes to protect her and without sufficient staff to provide such basic care to her mother. F. Defendant Facility permitted the unlawful administration of opiate medications to Plaintiff Carr that were contraindicated and were not ordered by a physician. G. Upon information and belief, Defendant committed or permitted to be committed other negligent and/or reckless acts, or omitted the performance of necessary care and treatment that will be revealed through discovery. 10 46. The above negligent acts were not merely isolated instances but were a continuous course of conduct throughout Plaintiff Carr's stay of repeated negligent acts and omissions. 47. The above negligent acts were not the result of anyone individual but were a result of operational policies, procedures and practices carried out with full knowledge of Defendants. 48. The Defendants' deliberate failure in the face of obvious signs and acceptable standards of care, resulted in a high risk of physical harm and actual harm to Plaintiff Carr, who was in a feeble and frail condition, and further showed reckless indifference to her needs, rights, and requirements that Defendants purported to be able to meet. 49. Defendants knew or should have known that such conduct would result in harm to Plaintiff Carr. 50. Defendants' negligent and/or reckless acts and omissions, as set forth herein, violated , 28 Pa. Code 9 201.1 etseq., 42 C.F.R. 9483 etseq. and 42 U.S.C. 9 1396r. 51. As a direct result of Defendants' failure to provide care to Plaintiff Carr in accordance with acceptable standards of care during thE!, period from August 13 through August 19, " I 2003, Plaintiffs experienced needless pain, suffering, emotional distress, humiliation, and loss of enjoyment of life. 52. As a direct result of Defendants' failure to act on Plaintiff Carr's behalf, Plaintiff Carr was deprived of timely access to appropriate care and Plaintiff Doutrich was deprived of an opportunity to secure appropriate care for her mother. 11 53.As a direct result of Defendants' failure to provide accurate information regarding the status of Plaintiff Carr to Plaintiffs, Plaintiffs were deprived of the opportunity to secure such necessary care from any other source. 54. As a direct result of Defendants' failure to meet the basic needs of Plaintiff Carr, failure to provide care in accordance with established protocols and physician's orders, Plaintiff Carr's life was diminished in both quality and time, and Plaintiff Doutrich suffered emotional distress. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 3908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT II - NEGLIGENCE CORPORATE LIABILITY Plaintiffs v. Defendants / I I 55. Paragraphs 1-54 are incorporated herein by reference. 56. At all times pertinent hereto, Defendants w~re acting in a corporate capacity in undertaking to provide care for Plaintiff Carr, through its management, through its staff, and its employees, agents and servants. 57. Defendant Facility is under the direction and control of the other Defendants. 58. Defendant Facility, as a total health care facility, is responsible for controlling and providing its physical plant, the services of a medical director, the administrator, 12 nursing services, social services, dietary services, and such other services, including laboratory and ancillary services, in accordance with its obligation as a licensed health care provider of nursing facility services in the Commonwealth of Pennsylvania. 59. Services by other health care providers to residents of the Defendants' facility can only be provided on the premises to residents at the direction of Defendants, or in accordance with written agreements between such providers and Defendants; Defendants retain the ultimate responsibility for any and all nursing, residential, and ancillary services provided to any resident, including Plaintiff Carr. 60. At the time of admission, Defendants assigned Plaintiff Carr to the care of the medical director or attending physician of Defendant Facility. 61. The Medical Director of the Defendant Facility, while individually licensed as a physician by the Commonwealth of Pennsylvania, is nevertheless responsible, by virtue of a written agreement with Defendants and by virtue of the applicable facility licensing and certification regulations, as an agent of Defendants. 62. The Medical Director of the Defendants' Facility is responsible, by virtue of the written agreement with Defendants and by virtue oUhe applicable licensing and certification I' I regulations, to oversee the development and implementation of medical policies and procedures to be observed in the facility al')d by all attending physicians in Defendants' Facility. 63. The ultimate responsibility for Plaintiff Carr's care was solely with the Defendants, their agents and employees, in the capacity as a total health care facility. 64. Defendants had a non-delegable duty to use reasonable care in the maintenance of safe, adequate facilities and equipment. 13 65. Defendants had a non-delegable duty to retain and select only competent physicians as medical director or attending physicians to oversee and implement appropriate medical policies and procedures. 66. Defendants had a non-delegable duty to retain and select competent nursing professionals and staff to implement nursing practices, policies and procedures in accordance with the medical policies of the facility, in accordance with applicable rules and regulations, and in accordance with acceptable standards of nursing. 67. Defendants had a non-delegable duty to use reasonable care in hiring and retaining a nursing home administrator capable of managing the facility in accordance with all applicable rules and regulations, and in accordance with acceptable standards of nursing home administration. 68. Defendants had a non-delegable duty to retain and hire employees and sufficient staff to oversee all services required to be provided in the facility. 69. Defendants had a non-delegable duty to oversee all persons providing care at the facility. 70. Defendants had a non-delegable duty to exe[cise sole control over the provision of t I I nursing, ancillary and all other services that were provided to the residents at Defendant Facility, including Plaintiff Carr. . 71. Defendants had a non-delegable duty to formulate, adopt, and enforce adequate rules, regulations, policies, and procedures to ensure quality care. 72. Defendant Facility held itself out to the general public as being able to provide nursing facility services as defined by the Commonwealth of Pennsylvania. 14 73. Defendants, through the admission process, held itself out to Plaintiff as being able to provide nursing facility services to Plaintiff Carr. 74. During the applicable time frame, Defendant Facility was the only provider of health care services responsible for Plaintiff Carr's needs, as directed either by Defendants' medical director or Defendants' attending physician, who agreed to abide by Defendants' policies. 75. Defendant Facility acted as a total health facility in its relationship to the Plaintiff Carr. 76. At all times, Defendant Facility was under a duty to provide care and services of a licensed nursing facility in the Commonwealth of Pennsylvania. 77. At all times, Defendants were required to manage Defendant Facility staff, agents, employees and servants in a manner that would result in Defendants delivering the necessary care and services to meet Plaintiff Carr's needs. 78. At aI/times, Defendant Facility was required to have in place policies and procedures, and carry out and enforce such policies and procedures, to deliver the necessary care and services to meet Plaintiff Carr's needs. 79. Defendants, through total control over the ca~e and services Plaintiff Carr received, and I' I by inducing Plaintiffs to rely on Defendant Facility for total care to Plaintiff Carr, acted as a total health care facility. 80. Defendants, by corporate policies and practices which engendered and fostered inadequate care, knew, and could reasonably foresee, harm to Plaintiff Carr that could have been prevented by the exercise of reasonable care in accordance with standards of practice and applicable rules and regulations. 81. The errors and omissions in the care of Plaintiff Carr are attributable to Defendants. 15 82. The Defendants, through corporate practices and procedures, have engaged in a systematic pattern of failing to comply with its duty to its residents, including Plaintiff Carr, as established by applicable statutes and regulations relative to provision of adequate care and other applicable standards of care as set forth above, such actions or omissions including: A. Failure to retain adequate numbers of properly trained staff to provide the basic nursing services Defendant Facility holds itself out as being able to deliver, and which services were provided inadequately or not at all to Plaintiff Carr. B. Fostering an environment in which staff, agents, employees were indifferent to the baSIC needs of Plaintiff Carr, as evidenced by the continuing stripping of Plaintiff Carr's clothes and bedclothes, leaving her naked and cold in an unresponsive state; and as further evidenced by the failure of the facility to provide adequate nutrition and hydration in a form and manner that could be processed by Plaintiff Carr in her non-responsive state. C. Failing to acquire sufficient staffing, as shown by the lack of care for Plaintiff Carr, to meet Plaintiff Carr's needs in order to maximize profits, resulting in an affirmative \ I , decision to decrease Defendant's ability to provide the basic required services, with the goal of maximizing occupancy and p'rofits. In the alternative, the lack of care provided to Plaintiff Carr was a result of reckless indifference to the needs of Plaintiff Carr, or outrageous conduct and intentional neglect of a frail, elderly woman who was incapable of caring for herself. D. Establishing, or permitting to be carried out, practices for charting that resulted in information not being available for effective management of Plaintiff Carr's care. 16 E. Failing to establish and/or enforce policies for assuring the timely and accurate charting of Plaintiff Carr's care. F. Failing to adequately establish and implement policies, procedures, and practices to prevent abuse or neglect by staff. G. Failures to implement appropriate policies and procedures to adequately provide and adequately assess the delivery of nutrition and hydration. H. Failure to implement appropriate policies and procedures to adequately provide and adequately assess the sufficiency of all services that Defendant had a duty to provide to Plaintiff Carr, as evidenced by the resulting nakedness, non- responsiveness, lack of nutrition and hydration which Plaintiff Carr experienced. 83. As a result of Defendants' failure, in its corporate capacity, to provide Plaintiff Carr with the care and services she required and which Defendants purported to be able to provide, Defendants denied Plaintiff Carr routine minimally required care; increased her fear, discomfort, and humiliation and deprived her from being treated by other health care providers who could accurately assess and treat her condition. WHEREFORE, because Defendants acted with bad motive, deliberate and I I reckless failure in the face of obvious signs that Plaintiff Carr was not receiving appropriate care, Plaintiffs request judgment against Defe.ndants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) ofTorts, S908, as adopted by the law of the Commonwealth of Pennsylvania. 17 COUNT III VICARIOUS LIABILITY Plaintiffs v. Defendants 84. Paragraphs 1 - 83 are incorporated herein by reference. 85. At all times material thereto, Defendants held out the staff members who provided care to Plaintiff Carr, including its Medical Director, nursing staff and assistants, social workers, admission personnel, therapists and chaplain as its servants, agents, and/or employees. 86. At all times material thereto, Defendants controlled or had the right to control the work of these individuals. 87. Defendants are vicariously liable for the actions of any or all if the staff members, agents, servants or employees who provided care to Plaintiff Carr or caused the lack of care to Plaintiff Carr during her stay at Defendant Facility. 88. As a direct and proximate result of the conduct of Defendants and its staff members, agents, servants or employees. the care provided to Plaintiff Carr did not meet the acceptable standard of care during Plaintiff Carr's stay at Defendant Facility, resulting J in harm to Plaintiff Carr, and which harm caused pain, suffering, mental anxiety, disfigurement, and loss of enjoyment of life. WHEREFORE, Plaintiffs request judg'ment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. 18 COUNT IV Negligence Per Se Plaintiff v. Defendants 89. Paragraphs 1-88 are incorporated herein by reference. 90.Although the statutes and regulations contained in the paragraphs below do not necessarily provide a private cause of action, Plaintiff Carr was a member of the class of nursing home residents that the statutes and regulations were designed to protect. These statutes and regulations do establish a minimal standard of care relevant to nursing facilities licensed by the Commonwealth of Pennsylvania, of which Defendant Facility is one. 91. The Facility failed to notify the resident's family of significant changes in the status of Plaintiff Carr as required by 42CFR 483.10(b)(11), which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 92. The Facility failed to implement policies and procedures to prevent neglect and abuse of Plaintiff Carr as required by 42 CFR 483.13( c) which is applicable to all nursing facilities in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. " 93. The Facility failed to care for Plaintiff Carr in a manner and in an environment that promoted maintenance or enhancement of Plaintiff Carr's quality of life, or in a manner that maintained Plaintiff Carr's dignity with full respect for individuality as required by 42 CFR 483.15(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 94. The Facility failed to meet the resident's right to reside in and receive services from the facility with reasonable accommodation of individual needs as required by 42 19 CFR 483.15(e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 95. The Facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, including, promoting actions by staff that maintain or enhance each resident's dignity in full recognition of each resident's individuality as required by 42 CFR 483.15(g) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 96. The Facility failed to provide a safe, clean comfortable and homelike environment. including housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior as required by 42 CFR 483.15(h). 97. The Facility failed to conduct a comprehensive, accurate assessment of Plaintiff Carr's functional capacity and obtain appropriate physicians orders for the resident's immediate care since the facility must provide care appropriate to resident's needs from admission to discharge, as required by 42 CFR 483.20(b) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et " \ I seq. 98. The Facility failed to provide Plaintiff Carr ,such necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being in accordance with the comprehensive plan of care as required by 42 CFR 483.25 which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 20 99. The Facility failed to ensure that the resident's activities of daily living did not diminish and failed to demonstrate that the circumstances of Plaintiff Carr's clinical condition showed that diminution was unavoidable, particularly with regard to nutritional intake, as required by 42 CFR 483.25(a) (1)(iv) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 100. The Facility failed to provide the necessary services to Plaintiff Carr to maintain good nutrition, grooming, and personal and oral hygiene as required by 42 CFR 483.25(a)(3) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 101. The Facility failed to ensure that the Plaintiff Carr received an adequate therapeutic diet as required by 42 CFR 483.25(i) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 102. The Facility failed to provide Plaintiff Carr with sufficient fluid intake to maintain proper hydration and health as required by 42 CFR 483.250) which is applicable to all nursing facilities licensed in Pennsylvani~ in accordance with 28 Pa. Code, 201 et I I seq. 103. The Facility failed to employ sufficient !,upport personnel competent to carry out the functions of the dietary service as required by 42 CFR 483.35(a) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 104. The Facility failed to provide Plaintiff Carr with food that was palatable, attractive and at the proper temperature and in a form designed to meet individual needs as 21 required by 42 CFR 483.35(c) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 105. The Facility failed to have a proper therapeutic diet for Plaintiff Carr prescribed by the attending physician as required by 42 CFR 483.35 (e) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq 106. The Facility failed to maintain clinical records on Plaintiff Carr in accordance with accepted professional standards and practices that are complete, accurately documented, readily accessible, and systematically organized in accordance with 42 CFR 483.75(1)(1) which is applicable to all nursing facilities licensed in Pennsylvania in accordance with 28 Pa. Code, 201 et seq. 107. The failure of Defendant to meet the minimum standards established by these regulations deprived Plaintiff Carr of the basic nursing facility care purported during its admission process to be provided by Defendant; deprived Plaintiff Carr of care that Plaintiff Carr and Plaintiff Doutrich, along with Plaintiffs loved ones, had an expectation of being provided as a result of ~he license under which Defendant I I operated; caused her deterioration and discomfort, deprived her of basic dignity and safety, and diminished the quality and quantity of her life. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous conduct 22 towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. COUNT V NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS 108. Paragraphs 1 - 107 are incorporated herein by reference. 109. On three separate occasions during Plaintiff Carr's stay at Defendant Facility, family members came into the room to find Plaintiff Carr lying naked on the bed with no blanket covering her, or lying naked with only a partial covering of blanket. Each time this occurred, family members covered Plaintiff Carr or redressed her and then complained to Defendant Facility. Plaintiff Carr was traumatized and crying when she reported this violation of her mother's privacy and personal dignity, since it was indicative of abuse and neglect. 110. It was reasonably foreseeable that the family members would suffer emotional distress at repeatedly finding their mother without clothing or care despite the facility being continually advised of this condition. No explanation for the status of this nudity and violation of personal dignity was forthcoming from the Defendant " , Facility staff, nor was the Defendant Facility able to correct the situation and maintain the clothed state of a non-respo,:!sive sleeping Plaintiff. 111. Defendant was totally responsible for the care of Plaintiff Carr, and the failure to provide such care is directly attributable to Defendant. The failure of Defendant to provide such care is a tortious act of omission. Such omission to provide basic care to Plaintiff Carr, who was totally unable to care for herself at the time, constitutes extreme, outrageous, intentional ad/or reckless conduct. 112. Defendants knew that it was reasonably foreseeable that such dereliction of duty by Defendants to Plaintiff Carr as set forth in the paragraphs above would cause emotional distress to family members, including Plaintiff Doutrich, who was personally confronted with the outrageous, extreme, intentional and reckless conduct of omission in the care of her mother. 113. Plaintiff Doutrich suffered trauma and emotional distress by Defendants causing her mother to be repeatedly naked and exposed without blankets or clothes to protect her and without sufficient staff to provide such basic care to her mother. Plaintiff Doutrich was traumatized and crying as she reported such facts. WHEREFORE, Plaintiffs request judgment against Defendants in an amount in excess of $50,000.00 together with interest and costs of suit. At all pertinent times, the above described conduct of Defendants amounted to an utterly reckless and/or intentional indifference to the rights of others, and Defendants' outrageous ,conduct towards Plaintiff Carr justifies an award of punitive damages pursuant to a Restatement (Second) of Torts, 9908, as adopted by the law of the Commonwealth of Pennsylvania. Date: Ifo//)f) I . I ~~ . 'Barbara G. Graybill Attorney I.D. No. 39859 Graybill & Wise, P.C. 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs 23 I I , , ATTACHMENT A EVIDENCE OF CONTROL BY HCR MANOR CARE 24 lCR.ManorCare Patient ~ ~/?1 ~~h'l U! IIl'/!?i \; ~!' '~i(e(h(~IIH!"' , ~d C (\ )-t)'"\..J Room No. ~ L <6A DESCRIPTION: Bathrobe Bed Jackets Belts Blouses Bras Coat Dresses Girdtes Hat Hose NI ht owns Palamas Panties Shirts Shoes Skirts Slips Slippers Sweaters Ties Trousers Undershirts Undershorts Wallet I certify that the above Is a correct list of my personal belongings. I take full responsibility for retaining in my possession the articles listed above and any others brought to me while a patient in this facility. Cane Comb Brush Crutches Dentures-Full U er Partial U er .' Furniture Glasses Rimmed Rimless Lu ae Other Prosthesis Purse Radio Razors-Electric ( ) Safely ( Rings Toothbrush Walker Watch 1 Wheelchair ~ /./r;.-' !,MR>- l!/ 1/ ALL tTEMS BROUGHT FOR THE PERSONAL USE OF THE PATIEth- MUST BE PROPERLY MARKED AND LISTED AS ARE THE ABOVE. Ptease bring additional items 10 Ihe Nurse's Stallon for proper handling. Patient's washable clothing 10 be: taken home:for laundering laundered here at the center. I understand the Management will not be responsible for any va/uables, money, or clothing left in the possession of the patient. Disposition on Dlschal'!le A Il. / ..ffIr/ ./) m-t1 . V ' ,,~.w",~wv Dale l~ . Signalure of Patient (or Relative) Signature of Nurse Date tj' -1'-/- fJ'..3 Date ~/r 'r'7 y 'Upon Discharge, all Persona/items are senl with patient or picked up by responsible p.arty. Upon transfer, all Personal items are to be boxed and placed In designated storage area for safe keeping. ooon:tt Signalure of patient/refative Dale 1......___.............. .....:: n______1 r-~1._......J.,.. HCR'ManorCare DATE I~~~ f ~ /:;:03 STAG~~IZE: 2, em Wide )~}lESCR?PTI N: D Granul.tion D TunneUng o Exudate (Description): PRESSURE ULCER REPORT em Deep o "Epithelialization o Undermining o Set'osanguineous o Scant D Slough P Normal Appearance o Induration o Revised to: Amount: o Necrotic TIssue (Description): SURROUNDING SKIN (Characteristics): TREATMENT PLAN: Cleanse with (solution) SIGNATURE/DATE: STAGE: DESCRIPTION: SIZE: o Granulation o Tunneling o Exudate (Description): em Wide Amount: o Necrotic TIssue (Description): SURROUN~ING SKIN (Characteristics): TREATMENT PLAN: ,1 SIGNATURE: .',0' o Continue STAGE: DESCRIPTION: SIZE: em Wide o Granulation o Tunneling o Exudate (Description); AmOUnt: o Necrotic TIssue (Description): SURROUNDING SKIN (Characlen..;cs): TREATMENT PLAN: o Continue SIGNATURE: o Re...ised to: .('}.:j;..c'~' .J::'~~"''''''"",-'<-' ~!.~;~,....~ em: Deep .... o EpicheliaIiuuon o Undermining o Serosanguineous D Scan. D Slough o Normal Appearance o Induration em Deep o Epithelialization o Undermining o Serosanguineous o Scant o Slough .: /1 o Normal Appedrance o IndUC'ation Location 'I,D oL- em long D p.in DOdo, o Serous 0 Purulent D Modeme D Hcsvy o Eschar 0 Debrided Date: o Erythema 0 Maceration D Edem. D Cyanosis Apply (product) Frequency em Long D p.in D Odor o &rous 0 Purulent D Modeme D Hcsvy o Eschar 0 Debrided Date: o Erythema 0 Maceration D Edem. D Cy.nosis ASSESSMENT DATE: cm Long D p.in D Odor o Serous 0 Purulent o Moderate 0 Heavy o Eschar 0 Debrided Date: o Erythema 0 M2ceration OEdema 0 Cyanosis ASSESSMENT DATE: cm Deep o Epithelialization o Undermining o Serosanguineous o Scant D Slough o Normal Appearance o Induration o Revised to: STAGE: DESCRIPTION: SIZE: cm \"Vide o Granulation o Tunneling o Exudate (Description): Amount: o Necrotic Tissue (Description): SURROUNDING SKIN (Characteristics): ) TREATMENT PLAN: o Continue SIGNATURE: cm Long o Pain DOdor o Serous 0 Purulent o Moderate 0 Heavy o Eschar 0 Debrided Date: o Erythema 0 Macerarion OEdema 0 Cyanosis ASSESSMENT DATE: Rcsidenc Name; ........., IrA1 MR Number: ~ - :;:() 0 z 0 Ul S <- <- s: > s: -n <- i .. g 0 !l. '" S. CO ll> "0 ll> '" ll> .. < '0 ::0 -< ~ ~ fS ::0 " a '" ~ .. ;!. ~ ;: :; z ~\? 0 .. - EO :> r. 3 Z. ~ ... . -< '" 0 \ ~ :: lH~ ~ '" "" iE, . $~~i: ~ ;:r 0 v; 13 ~ i" 0 ).: ~~ ~ , \ "'z Ul 0'2- ;;:" ~ \ \ E: ~S'~ . o' '" ~ ,",0 ;:!. \II 0'; ~ \ ,,.. ~ ~S'U' ;;:" ~ ~ ;:r 'Be ~ (l \ ;:r , ~ '" f1 g-3"0 :> -< ...tft. co . ~o co 0- \ s: :z: 0 [ 0 0;' o~ Vi' '" -' _0 ..- is co~ ~'" .. o' . .. .. :> \ a.to ~ ~ i "'i \ :E ~ . ~ '", i'i \ , ;r . , .. . ;!' :;'~O ;: ;. ;- " "'0 \ \ I , :E ~ . . , ;r co .0' ~ \ \ \ \ , ;;! '" . " '" . ~ ~ ?< .:z s: \ \ \ \ \ -.0 ~ '" ~ ~ '" ,4 .0' :>9 ::r ~' \ ~ v; "'. ~ ;! '" "- .0' z . \ ;;! , " -" . . ;!. \ fi";' ~ <i "'., :E ~ :3 ;! '" .. ... i'i :c , . '" '" . ;r . -- o~:I:O ~ amS!'~ _ --to (l) 3 a'g.a:" v. ~ 0" -" '" (i o' ~ :> ;; ~ ::> '" ::> ;;: co l ~ :;tl c . '" ~ :> "0 '" a. 9'. '" ~ \ co ;; - 0 ~ ~ 3 ~ o' ~ ? ~UlC:lll(lcn :J"~:=~~S CD C'l:E. ":::T......::> ~Ci.:=:o-. 9:. g.;::::J"g ~ fl,)"< UI -' - _" Cf:=:"" c .., (t):J::': ~ 0.(0 - .., - <3" ;;! \\tl\ .. ~ ~-< '" '" - CD ro ~ ~c:o: -<-<", ~ ~ ;!. ~.!.~ ~'g.~. - -<!J '" .. ::r e.:o~ (II Cf'" g .. :J 0. C. 0 ~ ~ .. . p.. o .. ~ \ c (f) <> ~ '" o c: '" (l) a ~ :i- v' ~ '" '" 0: co ~ (fl '0 '" n ~ ~ 5" 0. ~ 2 s:l. o' ::> '" o :> :: <I> ;;:" ::r :;' co ~ co '" 0: '" '" P :J ~ 1n13\ -0 .. g, " 0' :3' :;' 'P .. '0 "2- ii' " " .. yo ~ ~ GJ :r: ~ :0 rn () o :0 o -< (i) III :'1 ,0 atInitial' 0 Discharge , . - 0 Reassessment .... SPEECH/LANGUAGE EVALUATION HCR.ManorCare ) \ "" Ml R.ehab Payor 'I'JCO- A Patient DOB & Ale \-3\ -2L{. CJti 1)~o-. ~ S\u-..~~ Prior living Amngcmcnts l>~ Q.,.'8Y'\ Ocher Related Mcdic3.J. Rehab, Soci3.1 Hx Precautions Q--\- ~~ "(e~ AuditorY/VlSual/Sptal.:ing/ Augmenutive Devices Primary unguaae t;;N '\\~n If not EniJish. needs; 0 Bilingual Therapist 0 Interp~ter a Modified Materials. if so descri~: Prior Communication Status saucc.: of inrormacion: 0 Patient 0 Rdative/Caregiver 0 facility Staff 0 Medical Chart 0 Other: When: . .~:"A..~., '.- ~r,1~.,"'~~~f~.,_~a.1i::~~:~.~~..._~.i!i.~;lii.,"~. "p~~Ci~.~~~.:;~i?if~e~.:r.~$...-~ ~..~~._rYW_O.'Y. ~t_..lip.i~~:~d;;~~~.;~' 4 -:.':~iml..._.l)~. ~._"~c~:~~!! ~~~~ti~~~~~~~~~~'~~l~~;~~~r~r:;~~;:;~f~~i-;:~~~~~~~~~r~~mn~1~~,~~,~:~~~~W;3i.~~~~.;:. Speech Intelligibility: Use key for ratiog as indicated ;t 0 Not functional. complete: below section ~tional . Skip this section. Rate: Intelligibility of: single words _ sentences _ conversation _ Comments: Oral Motor Function for Speech/Swallowing: Use key for rating as indicated 0 Not functional. complete below section Rate: Lingual: ROM _ Cooed _: Strength_ Labia!: ROM _ Cooed _' Strength_ Palata!: ROM _ Cooed _ Strength _ CommenLS: ) unctjonal . Skip this section o Not functional. complete below section Prior Level ~tionaJ. Skip this section o NPO 0 Oral Type/Level: Swallowing: Use key for rating as indicated NSf: Currenl 0 NPO 0 Oral Type/Level: Hx of Swallowing Probs: Pre-Swallowing Assmt: Swallowing Assmt: Volitional or Renexive cough (Circle) Throat clearing _ List Symptoms of Dysphagia: Self Feeding Skills: Comments: 'I I' , , " Voice Assessment: Use key for rating as indicated 0 Not functiona.!". complete below section ~naJ # Skip this section Quality: 0 WFL or if impaired. rate: _ Nasality: hyper/hypo._ Harshness ~ Hoarseness _ Breathiness_ Strained _ Aphonia _ pjtch: 0 Nonnal 0 Low 0 High Intensity: 0 Nonnal 0 Low 0 High Re.sp control: 0 Adequate, If not, rate: _ Comments: Language Comprehension Assessment: Use ley for rating as indicated ot functional. complete below seciion 0 Functional. Skip this secllon Status: Prior: Overall _ Aud _ Reading._ VlS _ Current: Overnll _ Aud _ Reading _ Vis_ Aud Comprehension: Resp to: sound _ SIXe:ch _ name _ 1D by: name: _ func_ Commands.: Step{s) 1 _ 2 _ Mult _ Aud Resp to: Y IN quest _ Paragraphs _ Convenation_ Reading Compreheasion: Single words _ Simple or complex phrases/sent _ Paragraphs _ Functional Reading _ VlSuaJ Comprehension: Matches objects _ Pictures _ Pictures to objects _ DeleCl: Difference in pictures _ Compensates for VF Deficits _ Comments: Therapist's Signature/Credentials V. /lA,( ,'n/J /S" h D." X'/IC /If< 000045 o Physical Therapy o Occupational Therapy . HCR.ManorCare ~Ch Language Pathology Medical Record It ;r I i ,; 'I I I 041; ~[nitial' 0 Discharge o Reassessment PIIYSICAl THERAPY EVAlUATlO~ HCR.ManorCare Prior Lirinc AmngG'ffleou c~ kehab.SociaI Hx r Bact. Extension Hip Flexion ELBOW / FO~ rc@ Hip Extension Hip Abduction WRISf / FINGERS ~1(0 Hip Adduc:tion Hip Int. ROl ROM, Cervical'" Trunk VS F (. .~ Hip En. ROl Tone: 0 oWNL Gomments: ~bQormal L..t: Knee Flexion Knee Extensioll EndUl'3lIce: Good / Fair / PoOr Totel1U1ee: Sitting Unsupported c.. A~ Standing Unsupported (....---'-l...- Ankle Dor1iOexion Ankle Plantar Flction Balance: :Sit:Static~ i Dynamie ~ Standing: Static 0 Nt Oynarntc l'n.ti, Inversion Sensory: Skin Condition: Proprioception: Edema: 0 Absent 0 rresenl GAIT ,\SSESSMEil:T Gaic Analysis Key: 7. Comp/.::!dy independellf; 6. ModWed Independence, extra lime / device: S. Supervision / Set up; 4 - Minimal Assiscance 2S%: 3 - Moderatt.: Assistance 50%: 2 - Maximal Assistance 75%: I - Total Dependency: NT. Not Tesled Level Surface Uneven Surface Stairs Ramp COMMENTS 000048 "'L___'_, e-.___.o.._ , ""~a"an.:..l~ n..,.. ...... '- PHYSICAL THERAPY SUi\Ii\lARY Change In payer (payer/date): o w..k1y o 14 Day Report 030 p;,. S~f~~7;":. HCR'ManorCare ~-.\:;i:;~"~.~~_~(~~:~1::~i;t;~~~~1fi~~~~;%t~lti~~ TCQ~o,tt~?:.~~:~~r~~ ~~~~~~~_?J~~~~)\D}9~iJ~~i&!f~~;Zi:~r~,. .. -s <{ ~~ ~~~='","",{\I Mobility Assessment Key: 7 - Completely independent; 6. Modified Independence. extra time"' device; S - Supervision J Set up; 4. Minimal Assisunce 25%; 3. Moderate Assistance SO~; 2. Maximal Assistance 15%; 1. Total Dependency; NT ~ Not Tested; NTx - Not Treated GGalSf Coal_.,. ,-. :. '~'.'- ":i.:"-, ':~~""""";",,":-:i':t1 Neuromuscular& D.,,17' D~ CO~~/D~C~~~.;;;i~} Orthopedic Status: C(D~([J ~~; ~~ SKllL BED MOBILITY Supine - Sit o RoD IThm &oot/Brldge TRANS- FERS Sit-Sland To Bed To Chalr I Wheelchair To Toilet To Dr To Floor GAIT Lcve1Surfaee UncvcnSllrface SUI" lUmp \V/C MOBILITY Safety & Other Related Issues: Comments on Progress I Summary I Assessment: Q <.:> ~ ::j ~ ~ I u->-6-o ~. Gait I Balance I Coordination: ~ -t:.... ~ ~~~ I /1r-'O ~ Treatment Plan and Goals: o Rtfcr to abovt Chart for ole Goals 0 Rtfer to above Chart for STGs Fn:qutncy: Days ptr wttk Per Day: 0 Q.D. 0 B.1.D. Duration: o P3lltnll Family I Cartgiver tducation, ttachlng and training to prtpare for discharge from lhtrapy. ~~ t~~ ~.-C ~.~.: ~ /U-~ C-' ~'1/~~~ o P3tient I Careglnr instructed in Home Prognm 't;; ~ ,.... \ S){L- ~ .l db , ~ , ) 30 Day Summary Only - Physician Recertification o I h3Vt revi.:wed this plan and rKertify It continuing need {or JO more d3YS of services. (f\ o Discontinue o Recertification not necessary o Initial' 0 Discharge o Reassessment OCCUPATIO;\lAllHERAPY E\ALVATION HCR.ManorCare Date of Onset -/0 u<"-. Prior Li'iing Arrangements Ill/isZ to,,", Other Related Medi~d Rehab. Sodal Hx Co/Pi:> GI 6/~ PccClutions AdaPli.'#c Equipmen /V~ F,,,....b-' ;SENSORY;:;P'RtEl'1iJAi;'MdfuR~--'E.ssME"'7 iD:U~e"&;WNI:f.;w " ;'iMP.'F....., .' ':.~"~r." trH';""~t;,~~~ ___.____.1.']:.. . .'.'. e".~. __ l{.I;.!.... ...._....l'l.~,<<r.l'!I^'-i/il__,.....zh_~".l<.~.~..I'1l]lp"'Iml!.!'1t. Sensory: sbarp / dull. laUCh. pressure. Ie:mpcnture ~ ( \ Y'. ir.. k' S~RGJnosb I Proprioception: rv" Vision: acuity (r;!3.ssu) / ~u':lr pu.rsuitS I visual rleld t.lI'FL- Visaal Pct'Ccpdoo: visual ollanilation I dts.crimination / spatial relations I neglect rt.,.. Auditory I Communication: 'M.i ~li' CommenlS~ {lJ. ~NmONd"'ccESSMEmr;iddi1~tt{{j~~~-:'tAif5~~r-~~~~~~~~~.t~~~\~ ."'-""'t. .,=......_.... ...~'..a!;;!~....\~"'.."".=,.-...i:...._.,.",..+>~ ,~A"',...",:~......'__'" Alertness WFl..- Attentlol1 wf't- Memory; LTM /14- STM II+- Foltow-In. Dirtcllons W;::~ Judgment 'U- Pttlbltm SoMDI ''''"' Sequendng W,oV CommcaLS: :~~~~~~,TX:7J--:~~P@J~q~~ffi)\1':qS,~~~i~t/tf~.J;~;'f~~?~~~~%~~:~~~~~~.~~~-w:~~ LEFT RIGHT FUNCTIONAL ASSESSMENT MMT ROM P I A ~IMT ROM P I A lnd;,"', WilL WR. IMP. NT. !/A ...<-s",11II1''t.. A J3~t Shoulder Fte:c.iol\ .t.\'\II.,C/~ A ~II' Re~\h Om Head ,I Function l R Function l R i.J!fl, wft- Cross Legs !Jf" I-r( .\....- J,' Hand to Mouth )Vr;/, t.fl- "f /J'l Reacb fof"Hald t<4i iJW Ra<h Behind Bad or BuaQ:u , ,:f '~r Open &; Oose Hand , tV Commenls: Shoulder Exten. Shoulder Abduct 1 Touch top &:. bad:, of hud 1..l' . Shoulder Adduct. Rol.ltc Trunk. Sholl.tder lot Rot. Jauch Knees Shoulder Ex!. Roc. Touch Feet Elbow Flexion Tone, ttI Wi'lL pvG o Abnormal Elbow EXleotion SupinOltion Functional Endurance Good I Fa;r I roor ?1IC> V' P3in I Location /?..Lt:. (0/10 none - 10/10 high level) Skin lnttgrt!)": hf.. r1~ Edem3: \eI-' Functional Tolerance include posicion &: duration :;,;;' ,r,7( Pronation Wrist Flex.ion Coordination: " \'.J .l; , Fine Molor 6 tJe? Grou Motor u.J fv \J COMMENTS, Wrist Excef'\sion Hand & Finger" ROM. Strength &. Function (tm q r:r ;tIr'UJk.. 'JtlZ>& @~!~ /W...v~ J-<//-L ....1 OOOO;:o,.~ Therapist Sif,na.tun: I Cftd~tlti3\S /\ J ~"'T""""C>'I 11'___ n... ,/ .~.< OCCUI'AflONAL HIERAI'Y SUMMARY HCR.ManorCare Activities or Daily living Key: Eadnl &; Feeding '. OBI Hygiene LU0L- Grooming 't" Balbina Upper Body _I!"~,~D& Lo,!~t' Body Druslo8 Uppct' Body Dressing lower Body Cognitive.Perceptual Status: ToUtt Hyglenc (f.-+o X J ( ('uJflu qJj') f'rv..n ,,<:. ~ -fU- 0J1[l ~ Bcd Mobility ADt Transrcrs Wheelchair Mobility Wheelchair Set.up Foot Rests I Brakes Home Management Safety & Other Related Issues: Comments on Progress / Summary / Assessme : (lQ. a...\::h.'-L. c::LciYm l' n.v-.d..(d @ f ~ bw~{::;a.. ~'I'ih- "6' fQ. c\...uhq'}~ ~ ~S}d\ du1 ~. ~ ~ ~ CY-cch;r p ~CK.L pu rn':~ Q?J.u'. ~c..5t 11 LI...d. 61 . ~rt~~~$E'tJ~&.~T~f.~~;!~-~.:.~~~1~~~~'~~$!!fdl~~}~~~~~~::]-~~~;,.~~ ~.~i~,~~~:~tt~f~~~~~~t~;$llX~.~D:t~~i~~1}~i.~r~~.~ 7f Refer to above ADt Chan for ole Goals ~ Refer to above ADl Chart for STGs Frequency: Days per week Per Day: 0 Q.D. 0 B.LD. Duratioo: o Patient / Family / Caregiver education. teaching and training to prepare ror discharge from therapy. I ~rYtA TOT/-{ ~ · ~G 0\ d-.' ~ 000053 o Patient I Caregiver instrucled in Home Program Therapist's Signature I Credentials I Date cb-ill 30 Day Summary Only - Physician Recertification o I have reviewed Uti, plan and recertify a continuing need for )0 more days of services. o Discontinue .A4-0nz..! o Recertification not necessary REHABILITATION PROGRESS NOTES o Physical Therapy HCR...ManorCare ~Ch Language Pathology. . o Occupational Therapy Medical Record " , ,: " . .. :PI"~lpilllll'l~m'll:~'nlrl IRil~__rCare ~p~ent Prob ~ Progress Nole Time {NvtS,ng, N . P.T., eel.} o. j ~ Slgnaturetrrtle 0'(10 <""''''~ I , ,,'\,JS'::;~--'.-----. ~~-.,. Date <g(J0 37 f . N~..{ ~ 034) ~ .v'~o ~ , '/ /Y3 . ~I ' 01)/0 I): (jP..-w - fUSe.. .tJ . {.... \ ~. II !Z, r\ Attending Physician Aoom Nume( Patient Number Patient's Name (Lasl, Rrst. MI) FMC-11.14B ~ ~^^r->-j I ITJ::Qnl~{'IDI i3 .---- -z ,te .\. . r., ,~ . -".;. :-. ~L "'. .,.'t. _,~. ~~_ !!~. , . ...., (' .' r. V;." ...1, IJ .",; ',/ i', Department Prob ~ Progress Note ',~' Time , {NursIng:" N ' fI"'''''' ,P.T., eel} o. i ~ SlgnaturelTiUe f r'; ~ ) C! ---../ ,. ..-" HCR.'ManorCare ,- - "i-- ~. ~ ~;.\---' '. t,5/0 ~ ~O 9r 7-3'''' I.:lSGo G: '" -\- ~ <l -\- c:; I',f{. (.''', ~ f ~7 ICe,." n Q4"/1.J en /24, Cc.,((; Jr/v,.,) InN dfZlt, q: ch ), tcJ-."z J/u,).) hr,,_ . 7_ P,r-... I ~ f'OS<. ,,..r It r;'cu j/.fj_ IU,~ i / ~6'V toP I'S Name (Lasl, Firsl, MI) Room Numer Patient Number JntJ Li4) HCR..ManorCare te ~part!"ent PrOb, ~ PrO'Jress Note Time (Nurslr1g, N . P .T., eo!.) 0, i <C SlgnaturelTitle ( OI'kJ N 0'100 ,-".5 / l' I.J /I;!_ .Fe ''''''' ".. , '" .- 7r: - - Name (Lasl, Flrsl. MI) c Attending Physician r-- Room Numer Patient Number ./LA.. 0'"-<~"\.c. d/,?N / Cry] HCR.ManorClre SKIN RISK ASSESSMENT Instructions: Assess the resident upon admission and quarterly for Skin Risk, Enter the score in the appropriate Columns c then total. Proceed to care plan with interventions/approaches based upon the total points and needs of the resident. an Indicators Risk Factors to Skin Management Quarterl scores Assess each indicator and assign a point value, Total these points. 1 st Quarter 2nd Quarter Srd Quarter 4th Qua/ter See below for score, o te Date Date Date fll;!J? , . 0- Excellent (Eats all o. most) Nutritional Intake 1 - Adequate (Eats> n Q! TF/TPN meets n.ee~s) / 2- Probably Inadequate (Generally eats < ~) , 3- Very Poor (Rarely eats more than 113) 0- Alert 1 0 I level of 1. lethargic Consciousness 2. Semi-conscious 3. Comatose I I - I o. Ambulant I Activity 1. Walks/help d.... 2. Chair bound - I 3- 8edfast 0- Full I 1 - Slightly limited Bed Mobility 2- Very Iimiled ^ Immobile 0- 0- Not inconlinenl i 3 1 . Occasionally inconlinent f t , Incontinent 2- Frequently incontinent I 3 - Incontinent . . TOTAL POINTS ,7, , ." ' INTERPRETATION: A score 01 0-3 indicales no skin risk (no interventions are indicated) and 4 or greater indicates that the resident is at risk 01 developing skin problems requiring preventative inlerventions. ignalure:~.L0'7 'J.)~/L______// 1 st Quarter / I 2nd Quarter 3rd Quarter 4th Quarler Resident Name .;1 COd) ,;;/;~ 6'i... G/ C.3124 (Rev. 3/99) ~>CG1.tw.............",~.x;.s '~'h'''U.l _11''''''. Medical Record Number I 'l\pl~~lLJ~~lIfiNE:>:~ genetic tubsUt\i~~ . ~ 01 ca..- and 1M Goal &II atltH on cw. P'In. 1 :1, RESIDENT IS CAPABLE 0; JNCAPASLE OF UNDERSTANOOIG RESIOEIIT RIGHTs. If INCAPABLE, STATE REASON C.. h F t.v,;>, m RESIDENT IS I!NAAE OF CURRENT CONOITION,.AND PROGNOSIS: YES 0; Nq&' If NO, STATE REASON C.. I'> f t<.L>, /'>-l ANCILLARY ORDERS LEVEL OF CARE: 0 SKILLED 0 NON-SKILLED 0 OTHER REHAB POTENl1A1..: 0 GOOD 0 FAIR 0 POOR 0 MAlmENANCE DISCHARGE PLAN: 0 RETURN HOME 0 OTHER FACIUTY ~ONG TERM PLACEMENT 0 OTHER MAY SEE: PODIATRIST 0 YES 0 NO OPTH/OPT 0 YES DNO DENTIST, ;I:'YES 0 NO LAB o YEARLY LAB IF REOUIRED BY FAGUTY IS DUE EVERY o OTHER THERAPY EVALUATION AND TR~TMENT AS INDICATED . ~jlJtISSION OCCUPATIONAL THERAPY riVES 0 NO SPEECH THERAPY"f( YES 0 NO PHYSiCAl THERAPY ~ES 0 NO THERAPEUTIC RECREATION 0 YES 0 NO RESPIRATORY THERAPY 0 YES 0 NO . SEE THERAPY ORDERS & REPORT FOR FURTHER ORDERS RECREATIONAL ACTIVITY PROGRAM MAY PARTICIPATE IN RECREATIONAL ACTMTlES: CHOOSE 1 OF 4: 0 WITH NO RESTRICTIONS 0 UMflAnoNS: o ONLY NON,EXERTIVE PROGRAMS 0 BEDSIDE ONLY: CHOOSE 1 OF 2: 0 MAY HAVE OCCASIONAL AlCOHOL 0 NO AlCOHOL CHOOSE 1 OF 4: o MAY GO LOA/PASS UNATTENDED WITH MEOICATlONS o MAY GO LOA/PASS ATTENDED Wl1H MEOICATIONS o THERAPELmC PASS ONLY 0 MAY NOT GO LONPASS DIET d ORA~ ~ ' SUPPLEME /N URISHMENT: AMOUNT: ..... FREQUENCY: ENTERAL NUTRITION PRODUCT _ STRENGTH_ CAL/24 hr _ ROUTE_ CYCLES/FREQ FL<:NI RATE SIZE R,EASON FOR TUBE TUBE CHANGE FREQ ~EASON FOR PUMP, IF USED , , FLUSH TYPE AMOUNT HYDRATION TYPE AMOUNT FREO FREQ ed this f~sident's medication program and: ] No irregularities were noted. l See s.eparate report lor statement or irregularmes and/or observations. ,Ph. SIGNATURE & DATE ~u _ '. rI Y,) (iJ ,I.nu 4" ,MAY ADMINISTER 2 STEP MANTOUX SKIN TEST ON ADMISSION AND ONE STEP ANNUALLY IF NO, STATE REASON: IDENT FREE FROM ACTIVE T,B, AND COMMUNICABLE DISEASE 0 YES 0 NC MAY HAVE ANNUAL FLU VACCINE PER CENTER POLICY 0 YES 0 NO MAY lWlE PNEUMOCOCCAL VACCINE PER CENTER POUCY 0 YES 0 NO CATHETER CATHETER:XYES ONO L F:>/clf :;; 0<:- W/c../ / CHANGE .-<.----,.e Dale J'; /3 " DOES RESIDENT IF YES, JUSTlFIG TYPE Physician's Signature ~h Reside,,' Type Olagnosi$ (; / c...v~ C,,)'1rot..(.s,;--..., . J~ AI!.ndiltg pr.ysiclan A....... NlIIJOtv/~ I n Numb 'I . " HCR.ManorCare :J Initial aRe-admit.. Q Change of condllloi'l.'8 Annua' Nam~~"I"'.rJ::1" Birthdate / I ~/ 1/}'!l1 Birthplace .~~-)r( . living a"angements prior to admission: 'hYm.&' Marital status: Q M Q 0 'l2f ~ S If married, spouse's name: Language spoken L!::'/)' --< Speech: rJ Clear 0 Unclear, explain Former occupation M"?;7c:::,,o/~ .c~ Education (able to read and write?): !I ~ .t? ~ Clubs/Organizations ~ Voting Interests: Registered voter? ;;{ Y~s...;:J No . ,Interested in voting? ~ Yes :J No It yes :J Absentee 21Go to polls Spirituallnvolvern,ent: Faith identity .;c:f#"Pr~. Active participation ' ChurCh ' . ;2/1#-. Town ,,4- P"- Phone # Should facility contact? :J Yes A'NO 0 No spIritual contact desired Is more support desired? 0 Yes ~rNo If yf.'s ~sits 0 Prayer 0 Special Counseling :J Other Has life condition affected faith? fP Yes Q No Finds strength in faith? >.b Yes :J No Refe"a1 Q Yes Q No Date of referral To whom? .10'1 11'IID'-'.0 :illl_';, 0 0 0 . ~rnp::l ,~~~ pjci!:j ACTIVITY PC Nt ACTIVITY P 9 N ACTMTY PC N ACTIVITY P ~ ; '" Animals I v I Current Events Parties J-- WaIl<ingNlheerl!\g Shopping '-'1' ArtslCralts . Newspaper I J.- Coffee Weight Training Museums l/. Nee<1leworl< .' ChUdren Tea Aerobic. Zoo (Ceramics Chu(ch Smoking S...vimming Special Events i Cooking ... Bible Study Sports v Games Volunteering iY" Music P Reading Bowling r...- Bingo Other. V I G,ptertainment P' Books Galt Dominoes Other: I ,..... Singing l--' Magazines Volleyball '~Cards Olher. Y Radio Tapes Fishing I v Board Gar.:es Other: ,; rTelevision Writing Hunting 1 y Trips Other: i (" Movies f/ Gardening Exercise 1- Ser:ior Cer:ter Other: When would you prefer to participate in scheduled activities? Jl Mo~~ing ,;l Afternoon ;6 Evening o No~e'of these, explaIn . y '>-< : , Preferred activity setting: 'p-Own rOom T" Day/activities rporli )4'nside facility/off unit, XOutside facliity o None of these. explain o::-r9 Resident,prelerred wake up' in the morning? 7~' Resident preferred time to renre?,9'-h V /!j . Resident naps? Q Yes '1( No It yes, what time of day and how long? Would you like to have a facility volunteer job position? :J Yes "~NO If yes, type .111"-",.rOl,'\,,r,I\'_ sX:'Yes :J No 0 Not Sure 0 N/A iYes :J No Cl Not Sure 0 N/A Yes ::l No 0 Not Sure Q NlA Yes ::J No 0 Not Sure 0 NlA o Yes (J No 0 Not Sure Q N/A '" Yes Cl No !J Not Sure 0 NlA "'. ' Irol, ACTIVITY/RECREATION , , :. ..~AS,S.S~,~MENT Alchoholrrobacco Use Date of admission % i/g I?-;') = Veteran? 0 Yes 0 No Do you feel that leisure time is important? Are you satisfied with your current leisure lifestyle? 00 you like to participate in activities on a regular basis? Do you consider yourself a social person? Do you consider yourself a person who prefers being alone? Do you enioy new challenges? Summary 000074 Residenl Nilme; // A " TAecord No.: I ///,0/'-' I AOOE1 NO) r: IMonptt':... / '7 ..i2/-~~J' " ~( ~ e .. '1l % !' . .. i " ..0 st ~!: .... -% .... r.. gP ~' ~~ .." ! ,,~ %s ~ " ... .... -< .. ;0:: '" ~ ~ ,7 \ Cl t 9 " 2- ~ ( "'- ;j l::> !!. 0" . . ~Cl ..~ ~~ g~ '" " 0- - ~ ~ <e- o. .. ~ ;l. , z " ? , \ I 10 L- .. ~ " III i ofl ,;;", n~ ~~ ",'" "''" ~~ I \ \ \ \ \ \ \ \..1- ~ u00016 ----- ~"". ' ....,.,. :, ' " , '~';: .:,".!.\~'." '" \ \,\,\ 1 ,- 'I p! 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'DATE . - . - ;.OATE ", IDENTIFIED '..I..,. ,RESOLVED rJ/:fh;J t~t;~~..'-~~' .. .... 'X" f\-( f< "," -. J "'~,:.. ....:' . , , . -- - - -,,- --- ------.--t;r- .:-~ .,:. :i,~:,,_:~'~'::':-:i~'~..i "t.-.:., - ._~: L'. ,-, .._ ~ . ~...-: :-... ..... ," _', .. . "." :. ':-' _,: ,: ,.~. ~':,; r'; '.;;.:'i._ .~.';'.:~ .: ~:" : .-. t _' ;:;?\~-':-~~'-'h:;=! :"':"'<.~:.;_=:~_~r. ~-'~:-'Y":~;$l\~1'-tt.:f.:::::.' .:-'; , ...,,,.. . '.. ... -::-" ;:r.~r:: ...:.....::.::::;...::.:::':.:-. .- _ ~;-..-~.,.-.....~.1,J.~.'.,-' ',,; .. ", ," 4ame Last ".> , First ;.":.- ,":' :'!-"".. .,-.'..... .-.-. ..; -"_-::~' ;'. i:.!:~:") ~:. ~...(: ::.~':.:;.:: ':.';,:':1 ". ~'''..'~'~'~''"';::'.:'-: ~.~- "1nilial ,..'.,:... .' .>: "- ,12-);;jz:k:~,' -;,;!'::~j;;;.;-h.,,,:;~._~:~,::~~.,:.,:: .:.,,~, n . .,..,.,.,."..".(i-' ",'""'" ,.~-' '.'::f:'" C30U IA.!'i"")99) elbCQt,e~'.....;......\l.S4Jo.. ,aooi,iMJ'" 'O-'.__"'.~-":'. ': _0.'" '. '- .. .. 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S'~ ~~ n('-. 0 F'" 11\ f!- '''',,?;i i\;;if<-. 1~~ -~h' ~\N .~ . en 1<' C> en N' " 8 ~ 3 3 3 3 ~ ~ o '" 3 ~ 3 " C> OJ ~'O ,,'< !?- ;:; ~ o ., o '" 3 5' :; " o ~ " " ~~ 0. o o 1- '^ 1- '^ o o o o !!' ~~ ~~ ~; 1"(-1 ~ ~ ~ ;:;'" n IT] :>> i;;. 3 ::t ~ g S' "'0 p... ~ 0 ~ ;. ;;;' [ i> rr g, :> g z a ~. om ~ - _, :r 02. :1 ? ri" ~~ ~ ~ " ~ .. ""'- n ':' !! ~ _il o' ~ 2 ~\ C\~ ~ ~ i "'- k. ~ ~g: 0" ;d ~g ;1-= rZ o " o 3 ~a' ()" ~ ? Cl .. =' c:r ~ c: - Vl '" o "'\ C/) c: a a ~ ., '< ~ rl o a. 6 z c: ;; :r " ITJ m~ " .. ~n ~9, " ~ > g 0. ::-3 !i;' '" g' ~ ~~ g OJ o~ II; . '" rrl t9] l~ ~ :J 0" ... o:~.." ::s c> 0 '< '-"I 0 ~ a "'1 "J~ a Z :c o -. :J ., , " :I: ~ ;;;" 0: " ., :J Fi' HCR.ManorCare \;:7/)'1 /J.- y /.ddteU (SlmI. ~....) J?tJO P/,r//ld ~ e_ /'.71':2'1 P11iO~(F~Wl."lI)- , -D~17~ ,( till'" _No. County ~,pa,lt / LJ''l'J "-Wb", /~~.f ill!;,) AtltntlIngl'llysK;an I'" " j../ a/ J- {fl e bl" .Il$pOl1$ibIe PaI1ynn em_ No'~ ./ , -rh ~rn Ii .5 f/I? n 17 ' '1 ,"Il\; Home Add/e$& 1:2..:>'5' e,,-,::r5-P"- BlJsi,{ess Address / . i -: /J-?~("c1.'n.' j ,<-'" Maide<lNarne Citizen to - 5exr tie" 0I1<irli\1l Emelgency No.ty ..5 C;;'" <../ tlcme"~te$3 Rela~ / T~ " '/7 . J 9",'/7 T alephone --... Admitt~ From /r/.> 1.'/ Casewor'l:ar Address )P;-;7 ;):> S (7' Case Number R<!fqiou$Atfll.ialicn Dentist Md'ess Telephotl6 Funeral Oirector Acldtess Te/ephol1e Tran>lerringFed'iIy Add,.., Mode Ot Transportation Tran>lj'J:5 t-l c;a~lt 01 Onsetol'rogn0$3 pJ~n7.v1 57A/~ ~~~ .rr C'dP? IlillI1""""SIati!lColJn Cletgy !n$urance Claim No. ".A.~r 0." <./' ( C. Palitnt\<n<ffl$ I" j Y$, .;>, do'.:; Rola""""ip Te!ephcna TeJephotle Telepl\Ol1e Soc; SecJH,LC- No. Veteran Ye.O NoD TelepMM T"",, Y.. 0 No T P R SP Hl WI. TreatmentsIMedieatioAS Including TlfJle lAst Given '/?w.'d~'. CuvJ.. J/~/>'7// /;y ,.. :/ d n v r. Co ..J. J c/.J /:7 cI71 J e./ Oiet ~2't~;;tF::j~;~:~iJ;~~'n7i~:';~~~!t~t~'~.:';:iJ:~;il~kW-~'~ LS,o J :J. c:l /7.5 -\lies' /:.:' .', \~ P t, f (dr." OY"-'t./.r77G- {"/tr '/1?. ~nr::, ~r>'j(r'.'",:,'-;< Ro/labG_eollal: ,".:: 0 Good . 'c. aIr.- '0 Poot "0 _.ena"",'" u,S. ',:,.;I:~?~.....:~"':_;>0~Jt.;:![~!~rg~$;~~~~I?;hi...~..'.:"C~:~3;~:~~~~~i : po!J C o PlOblem"ApplOachlSlal1l' o Emergency Situation 111"- p<>J'J_ State Ombudl'lman Address o Skin Intact II Nol Detail AbOVe lterr'l$ Accompanying Patient f~~~;4i' ;e J.'-/ 00 a Cj'f r~ ::r (' r' For ad,.,..,';" P/'lOne ':' ;.tHFf:::)~(:;~' ....--....>. .. " ;._',<:-.:;-.,. Rec:.eiWlg Party', SiqnalUre NUlse'~ s~r:aI1J(~e ./ ~ /' J];;.e X"~r (.,)<. :/./,:;..( ~ir./' I~'/:J X FQ( Emergency T(~sfets, -c.ompl~ UMMded. SecOOns Ocly Oa.e HCR,jHanorCare '- ." RESIDENT INFORMED CONSENT: INFLUENZA VACCINATION ~:lr..~ \SeA~ &,' \ ~[R:;:-' y u."'"S ! aeknowledg~ c."::le ! b\'e cee~i"ed and undecsand eh.e imocr.:\'lcion cev-celln,;: ehe iniluenza ,.acClc.ation...! h:l\.e h:ld the oopo",~nin' eo ask questions, and h:l'-e had :n': c';escoc.~ answered s:lcis€:lc':otUy. ~. . ~ ,? ! acknowledge c.~:lC I ha,'e been informed and undecst:l~_d the ::sks of noe ceceiving ehe ,'accination. I furcher L!nderscnd chae b)' noe cecci'ing che ,'accinacion, I molY be ae an incceased risk of contr:lcting the t'.u. I undecstand chac the oPPOttUnicy co receh-e the vaccination is being offecea to me in an effoce co reduce the risk of becominS!: intecced "ith the flu. I undecsoc.d ch:lc the \'accination \\ill reduce c..'1.e risk of my becoming infe~ed "ich the flu, bue does noe g<!:lr:lmee me chae I "ill noe become infeceed with the t1u. I am a'\-are chat there maY be risks and side effects associatd "ith the , , ,'acdc.:lcion. ! aek.'1owledge thae I am noe pcegnane. I underscnd c..'lae if I were pregulae I ,,'ould need auchonZltion from my ph)'sician co reeeh'e che vaccination. receive the vaccination freei,., and of m,' 11 . . I /j ,I ,'ill, knO\\ino- and understanding che possible risl6 and consequences of the vaccination. "8/1"3/03 D:u: R(~iJct1t O( R.e:1pocuiblc Pu'ty '" 000088 [nCcclion Clln[(ol M:t.nlJ.:ll Dise:uc Specific GuidclinclO i:>HCR M:onot C"", , " Dat.: 041081O~ p~~<: 60 i ( c. ~ ! ' , .J '- .# .-_.. -:- HCR'lHanorCare ,. RESIDENT INFORMED CONSENT:. PNEUMONIA VACCINATION ~~m~: ~-e~ C~ :\fR :" I 'lckno\\'ledg~ that I 'r.a,'e teceived and und~tsund the imot:n~cioc; te?':ltdinz th~ oCl~umonj~ '- . - '- . \':J.cci~:.l.tion. I h.l\oc: n:lQ the oppom.mlcy co ask qu~SciOClSo 3.C\d have h:ld ~y qu~scior~ ans\\O~=ed sacs t"Ctorily.' I acbou'ldd'ge that 1 hl"e been informeil and und~rm,nd ch~ asks 0: nor receidng t,l,e ~ '~ ,.accination. I turther l!ndersund thar by nor recei,-ing the \':\,ccim.tion, I m:>.y b~ at:>.Cl increased risk ot contr:lcring pneumonia. I understar:d chat the opportUnity to recei'.e the \':1ccinacion is being of~ered to me in an effort to reduce che risk of becoming infected -.x.ith pneumonia. I undersWld th,u the vacci..uiion will reduce the risk of my becoming infected uith pneumonia, but does nor guaranree me that I will not become infected \\ith pneumonia. I :>.m :>.wue that there may be risks and side effects associ:l.ted v.ith the '.-accinacion, and I accept am' and aU resoonsibili,,' tOor an,. adverse conditions and side efiects thar ma,' occu! due to the o . 0 . 0 ,oa.ccina.cion. I acknowledge thar I am not pregnant. I understand that iiI were pregnant I would need authorization irom my physician to receive the, vaccina7on"i , , , I II . I acknowledge that I a~to receive the ;accinacion freely. and of my own will. I?2::::Possible risks and copsequences Oithe;c;:~o:~ R~ftdrnt O( Re~?JQ$ibr~ Put;1 0." 000089 lnrcclion CorUfol ~bt'lUJl Oi~ue Specific Guiddin.:~ .oHCR Manor Cue Dace: ()..1JOlJlO~ P:ll:cg.l <.. And CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached First Amended Complaint on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo, Esq, McKissock & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Kathryn C. Mason, Esq. McKissock & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Date: /c,J;9/~ Barbara G. Graybill Id, No..-39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs 26 ~ :;T 0' "" OJ f )(~\h;t 13 4J . ~ef~ral to:, JJj1 I.Il.or C/JJ<. ljJest , /EXTENDEO CARE 0 REHAB 0 OTHER PRINCIPAl OIAGNOSI~ESJ: ~ T>vl @~~@l1Jf.~ ~~ 1)( -+ cof'D dnf#N' ~oYV -, SURGICAL PROCEDURErSI AND DATErSI: 8!lliQRMAL I"ABSlXRAY RESULTS/PHYSICAl FINDINGS (present at time of discharge): >- a: <( ~ ~ :;) en z < o C/) >- :I: a. ALLERGI~S: (DRUG/FOOQ) . I I., . ,j...j.a ~ I/~. 'L. m'1I ~~ no.,GQTiC-;., ~~ 1'~ p~::t; ~(C"Cle) GOOD ~I~ POOR GUARDED PTIFAMILY AWARE 0 GNOSI YE NO POOR GUARDED o Patient requires skilled nursing care for conditions for which the patient was' receiving care while hospitalized_ HOLY SPIRIT HOSPITAL CAMP HILL, PA 17011 Transfer of Care Page 1 FORM 11.5_1 l=Ie"ised 3101 . "-7r . . Activity: Oxygen: Lab Tests: ,/ rsf.l tu V lfA I~ (.+-5 Physical Therapy: Occupat.onal Therapy: Other Orders' ~_c~ ;'~~~JL' ~ ---e~;;J/Jh~d, Date 21lf~:S3S3 ~R 05HH (l~:l .~fllr I HO 011 l')b~, 7( H l[~Oll[ RO iU"~"C~~clR( n 17<)S5 ! ,} 7 / .l J / ) J Q ~ 7 -l 'S l f II I P r r , JIIJ:/I'il4 g( 7'1 BRIll' n:Tt.R' C\:tR . HTl .qO l6BH<;j1411 SS l68-lt-~IH RUG 13 20eJ 11:48 WHITE - FACILITY copy CIl,NAHY - C14:AJ::r. COpy 7: 73?2432e P8GE.02 --------------- - ~ ::> o '" (" C ~)(~\ b d .------ ,,- ;~ ,>;:.. ~:;; oj. ~1. ~~ s ~ :;; ~ s~ 8-\q -03 c e...OO$ ~;J<:'(4("'\ J '1' -Sy/1-1ir-01o 10 0/0 Su6 .so !"me /7JiJ Time PhySician's Signature Dale ;; ~ . t. . . . !SiqnallJre // i~?~, /' .-. ../' I IOa!e TJ0 P'hYSl<:;;an '-->~,"r :;~ ,~' Med;TX S~,"'" f " i/ '~~:J' i/~~- ?:ll;e'll -'~~~ '-':;;~ ~:"":;S;C" ,'1::; . -~enn:'C1~'~_I" '. . ... ;1"'0 /--/ S H EK ~"" I I -~-J Dale I by e~.4' /??S cA '" /1 \7ZJ;r r; /;J t'.-! ~/~ Signature of N~~AeCei~;;:;g Orde;:- -- 1ime Phymciall's Signature . ~ o > ., .. . ' '. P-ar'':lnt =,~:'= ?'J~ 0'"_,,,<" ~'.'C'. ;-"-.~Q I ~ ~ ,,~- ; : -". i ~vu-!4~#??7Y-!7 r:;f!Jtf~. ..7' ?t>.\iSIC:a~' C'cerSi-.e?1 ',Iedt';;{ 3~L""'1 ~L.rs" '; '1c'~:; "-: .,/' . ~ ,- :-i:s! ~.J;:;..,._e I Reorn No ; Attenaing Physic'ail ! :'CrciSs'ICfl No . . ... .. '.... . .. '. '~ /~ n~---------.1 Date TIme Physician's Signature .. .' - ~. . .' i '3;"~}[,..,,,, , " 'C~,~ " ,;",,: > ..J :.::,-:r'c~ .J ~~-.( .. ;-='--~, ~~ ,::;'",-, ="r:~ '--' Press Firmly - Use Ballpoint Pen :";,-i :3;\....-;,~;\1..:. ,;:,-c,-";-;",;,-,= .,JROERS ) I ) r-~,.) (:J " ~--- .-f I rn I '.D ~:, ) C,) :_}rn , r--, !7' ~"::D \....') .-< .. - CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: ELIZABETH CARR, ET AL vs, MANOR CARE, ET AL Court of Common Pleas - Cumberland County, PA TERM: I I CASE No: 05-3732 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009,22, RecordTrak on behalf of MARIA R GRANAUDO Defendant certifies that (I) A notice of intent to serve the subpoena with a copy ofthe subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) No objection to the subpoena has been received or it has been waived, and (3) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena, Date: 01/03/2006 ~. j(CU/t. .. j - /.-" I ~'>-Gu ~ RecordT rak on behalf of 151 MARIA R, GRANAUDO Attorney for Defendant .. RT#: 139087 CASE NAME: BETTY CARR ELIZABETH CARR, ET AL vs, MANOR CARE, ET AL. COURT: Court Of Common Pleas - Cumberland County, Pa TERM: II DOCKET: 05-3732 NOTICE OF INfENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS TO: KENNETH WISE GRAYBILL & WISE 126 LOCUST STREET P.O, BOX 11489 HARRISBURG PA 17108 (717) 238-3816 Dcccmber 12, 2005 Please take notice that on behalf of MARlA R. GRANA UDO, allorney for Defendant, RecordTrak intends to serve a subpoena identical to the one(s) attached to this notice, You have until January 3, 2006 to file ofrecord and serve upon the undersigned an objection to the subpoena(s), If no objection is made, the subpoena(s) will be served, IF PLAINTIFF'S COUNSEL AGREES TO WAIVE THE 20 DAY NOTICE PERIOD, PLEASE INDICATE BELOW AND FAX SAME TO THE UNDERSIGNED AT YOUR EARLIEST OPPORTUNITY. IF YOU WISH TO PURCHASE COPIES OF THE RECORDS, PLEASE CONTACT RECORDTRAK FOR PRICING AND FAX THIS CORRESPONDENCE BY January 3, 2006 TO (610) 992-1416 OR REPLY THROUGH OUR WEB SITE AT RecordTrak.com. All records will be provided (including no record statements) as produced by each record location, Lisa Kaub 610-354-8321 REcORDTRAK 651 Allendale Road p, 0, Box 61591 King of Prussia, P A 19406 LIST OF RECORD CUSTODIANS AND SUBPOENAS TAG 5 CORD CUSTODIAN HEAL THSOUTH HABILITATION OF CHANICSBURG A TERIALS BEING OBTAINED 1. ALL BILLING RECORDS IN YOUR POSSESSION, INCLUDING ALL STATEMENTS, ITEMIZED BILLING RECORDS, INSURANCE RECORDS ND ANY OTHER PATIENT ACCOUNT RECORDS IN YOUR POSSESSION, 2. ALL MEDICAL RECORDS IN YOUR POSSESSION, INCLUDE OFFICE AND AND WRITTEN NOTES, TEST RESULTS, CORRESPONDENCE, QUESTIONNAIRESIHISTORY & RECORDS RECEIVED BY OTHER HYSICIANS, PLEASE ALSO INCLUDE THE PATIENTS INFORMATION SHEET. PLEASE BE SURE TO INCLUDE ALL ARCHIVED RECORDS AND ALL CORDS LOCATED IN STORAGE, ~ ELIZABETH CARR, ET AL vs, MANOR CARE, ET AL. COURT: Court Of Common Pleas - Cumberland County, Pa TERM: II DOCKET: 05-3732 _ Yes, I would like a copy of all of the records listed above, _ Yes, I would like specific records I have indicated above, SIGNATURE: Date: FIRM: Note: An order for records from plaintitl" s counsel will signifY that plaintitl" s counsel has agreed to waive the notice period effective as of the date of the record order. ------------------------------------------------------------------------------------------------------------------------------------ YES, J AGREE TO WAIVE THE 20 DAY NOTICE PERIOD, Signature of Plaintiff's Counsel: Date: FIRM: Page 2 ,. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Elizabeth Carr v File No. 05-3732 Ancor Care, Inc., et aI., SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: MANOR CARE, ET AL, HEALTHSOUTH REHABILITATION OF MECHANICSBURG (Name of Person or Entity) Within twenty (20) days after servi<:e of this subpoena, you are ordered by the Court to produce the following documents or things: ALl billing records and medlcal records in your possession. at RecordTrak. 651 Allendale Rd. PO Box 61591. Kina of Prussia. PA 19406. You may deliver or mail legible co pies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You may have the right to seek in advance the reasonable cost of preparing copies or producing the things sought. If you fail to produce the documellts or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it, THIS SUBPOENA WAS ISSUED A'r THE REQUEST OF THE FOllOWING PERSON: Name: RecordTrak, Address: 651 Allendale Rd. PO Box 61591 Kina of Prussia. PA 19406 Telephone: 800-220-1291 Supreme Court 10# Attorney for: Defendant BY THE COURT: DATE: (}~LL,. l3 f.Jool Seal of the Co~rt Cl ......' C' c;::; C) <. :.! '-..,.... -n '.... T nl 0 r:? ., -" en . "." .......~ ':-n _I -<.: ELIZABETH CARR and TERRI DOUTRlCH, Plaintiffs v. MANORCARE HEALTH : SERVICES, INC., D/B/A : MANORCARE CAMP HILL and MANORCARE, : INC., also known as HCR MANORCARE, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LAW NO. 05-3732 CIVIL TERM ORDER OF COURT AND NOW, this 20th day of January, 2006, upon consideration of Motion of Plaintiffs for Enlargement of Time to File Certificate of Merit, a Rule is hereby issued upon Defendants to show cause why the relief requested should not be granted, RULE RETURNABLE within 20 days of service. c;ra;bara G. Graybill, Esq, 126 Locust Street P,O, Box 11489 Harrisburg, PA 17108-1489 Attorney for Plaintiffs ~ria R, Granaudo, Esq. 1818 Market Street Philadelphia, PA 19103-3933 And ~athryn C. Mason, Esq. 1818 Market Street Philadelphia, PA 19103-3933 Attorneys for Defendants BY THE COURT, \ (~ . "} ;, (1 '.,;.,.' . Barbara G. Graybill, Esquire Attorney 1.0. No. 39859 Graybill & Wise, P.C, 126 Locust Street p, O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA Elizabeth Carr, Plaintiff, Terri Doutrich, Plaintiff, CIVIL ACTION - LAW NO: 05-3732 v. MANORCARE HEALTH SERVICES, INC., D/B/A MANORCARE CAMP HILL And MANORCARE, INC" also known as HCR MANORCARE, HEALTH CARE PROVIDER PROFESSIONAL LIABILITY CLAIM JURY TRIAL DEMANDED PRAECIPE TO: Prothonotary Plaintiffs voluntarily discontinue their actions as to the above-captioned Defendants, Please so note the record. .2-!olob Date I I .A6, ~W/ arbara G, Graybill, squire Attorney 1.0. No, 39859 126 Locust Street P. O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs . . CERTIFICATION OF SERVICE I hereby certify that I am this day serving a true and correct copy of the attached Praecipe on the following by First Class U.S. Mail addressed as follows: Maria R. Granaudo Gesty, Esquire McKissack & Hoffman, P.C, 1818 Market Street Philadelphia, PA 19103-3933 And Kathryn C. Mason, Esquire McKissack & Hoffman, P.C. 1818 Market Street Philadelphia, PA 19103-3933 Date: ;2/ft> ~~~ /Barbara G. Graybill, quire I.D. No. 39859 126 Locust Street p, O. Box 11489 Harrisburg, PA 17108-1489 (717) 238-3838 Attorney for Plaintiffs c:: , '1 ';h .-' -~~:~ '? ~.. \-;"\ G~) -- C ...-'" c.:~) c,..,