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HomeMy WebLinkAbout10-24-05 JOHN M. HUME, M.D., J.D. -- 875 Valley Street Marysville, PA 17053 Telephone: (717) 957- 2401 October 17, 2005 The Hon. Edgar B. Bayley Court of Common Pleas Cumberland County Courthouse I Courthouse Square Carlisle, PAl 7013 RE: In re Guardianship of Nellie Tabb Dear Judge Bayley: In accordance with your court order of September 23,2005, I saw Nellie Tabb for evaluation as to whether or not she is incapacitated and in need of the appointment of a plenary guardian of her person and/or estate. In conjunction with the evaluation, I spoke at length with Clarissa Elizabeth Jones and Arlene Davies, who testified during the transcript of hearings on Wednesday, September 7,2005. I also spoke by telephone with the patient's natural sister, Mabel R. Hanna-Tabb and reviewed the transcript of the proceedings of September 7,2005, minus pages 38-40, which were not included in the material that I was given. I also reviewed her chart at the Beverly Nursing Home at Erford Road, where she is currently a resident. Ms. Tabb was well aware ofthe purpose of my visit and was fully cooperative. Clarissa Jones and Arlene Davies had arrived ahead of me and sat in on the interview with the brief exception of a time when Ms. Tabb talked about her specific financial resources. When asked what she thought the purpose of the evaluation was, Ms. Tabb spontaneously reported, "I have wanted out of here since February 7,2005. I had a specific plan to go to Polyclinic or any facility in Dauphin County to continue healthcare recovery. I went for eleven days to Osteopathic Hospital before coming here. I went there under dubious or unscrupulous circumstances. I have complete medical coverage as a result of working for the state for 27 years. I worked with Ms. Arlene Davies for 3 ~ years. Before going to the Osteopathic Hospital I was residing at 407 Heister Road in Susquehmma Township. For 37 years before that I had lived in an apartment on Briggs Street, until I had an accident in July, 2003 when I lost my balance. I had a rocker recliner that my half-sister has gotten me instead of a stable rocker because there was a hardwood floor and I wasn't used to it. I had had to leave my apartment anyway, as the landlord was ill and was planning to sell it. That takes a '-.,.' r\..,) .' -) ,- I ) 5 .) - Page Two RE: In re Guardianship of Nellie Tabb back burner to what I want to do now. I paid my dues to society through perseverance so as not to be a burden to society. Not having some place to live led to me to relying on my half-sister, who I thought I could trust, who would pay my bills and take over my money affairs. I expected to be located with her after I fully recovered. With that original accident I was in the hospital secondary to becoming very ill. I was then in Blue Ridge Haven from September of 2003 until March of 2004, shorter than here. That was for legitimate reasons. I did not expect to be here (meaning her current placement in Beverly Nursing Home). I think this was a way to get me out of the house so my half-sister could have it to herself. I was forced to go to the hospital in December of2005 against all reason. I landed in the hospital as a skillful eviction by my half-sister. She couldn't have gotten that house without my support. I prefer to be a private person and self-attending. I've cared for myself better than any other member of the family. They say when you retire your expenses are less because you don't have to buy clothing or transportation. I had money to share with my family; my two nieces, my half-brother for funeral expenses. Then things turned around where I felt I could be exploited. They had built a ramp to accommodate my wheelchair at that house. There were even a lot of official connections with a Blue Ridge Haven Nursing Home administrator who helped me get out of the nursing home. As far as I know no Medicare claims were filed that I know of. There have been no claims from this nursing home because they would have been forwarded to Pennsylvania Employees Benefit Trust Fund (PEBTF). They are the mediator and they are our watchdog and they know everything about medicare and a provider. They're supposed to look after things. I thought I could trust my half-sister, Ellie, even though she's just a half-sister. When you reach out for help you trust that you will not be taken advantage of. I had the house because her place on Berry Hill Street was not wheelchair accessible. Ellie said she needed $20,000.00 to buy the house that was handicapped accessible. Ijust have one room there, and I was allowed to use the stove and the refrigerator. I would probably have liked to move on to ultimately get an apartment for myself. There was no ,'!otten agreement and my name was not 011 the deed. My biologic sister in California knows about it. The money that I provided was from my savings." When asked specifically about the sources of her income, she stated that she received approximately $872.00 a month from the State Employees Retirement System and $760.00 a month from Social Security. She is aware that there will be a 4% cost ofliving increase, which takes effect at the first of the year. When asked to explain further the relationship with her half-sister, she continued, "Ellie misused her power of attorney to get me out of the house into the hospital, which was a clear eviction. She undercut me as much as possible. If! was out of here I would pay my own bills. I don't like to lend money. I prefer to give to people if I'm able. I would never co-sign a loan." When asked if she had a will she replied in the negative, but indicated that she has a named beneficiary regarding her retirement benefits, which are the largest part of any assets that she has. Page Three RE: In re Guardianship ofNelIie Tabb When asked about current medical problems she stated, "I have none that a private physician could not care for. I'm still recovering my ability to walk again. I care for myself in this nursing home. I would need a complete evaluation by a physician of my choosing. I wanted to connect with a doctor at Osteopathic, Dr. Schwartz, who looked after me in 2003. He was so attentive and caring. He didn't push medications on me, making me sick. He did a great professional job. I felt so confident when he came into the room. When asked what her current medical problem was she acknowledged that she had a marked swelling of her left leg, which has been an ongoing problem for a number of years (the leg is approximately 4 times the size of her right leg and shows marked reddening, as well as stasis dermatitis ofthe skin. When asked to explain her interaction with Dr. Myers, who testified at the hearing on September 7, 2005, Ms. Tabb stated, "I first saw him a couple of days after I got here. He didn't say he was here for service if I needed him. It was like he imposed himself on me. I didn't need his services. It was such an unusual approach I can hardly verbalize how the visit took shape. It was mostly after the front office had issues with my conduct and my disagreement with what was happening to me that I requested services not be given. I felt that I was being harassed by the aides, and they saw my complaints out of control. Dr. Myers stated when he came that the front office said I was crazy and he wanted to give me a test (a mini mental status exam, on which the patient scored 29 out of 30, which would negate the idea of organic brain impairment). Ijust couldn't consider having a relationship with somebody who approached me like that. I would resist anything not in my best interest or very prolonged. This place is 'do as I say' and there's no other way to deal with it. In a setting of proper scientific equipment that can provide a proper exam so I can move on to a better life, then I would be in agreement with what they suggested." At this point Clarissa Jones offered spontaneously, "Nellie was brought up not to let just anyone in on their business. That's cultural. In the past there were problems for people of color. Nellie then remarked, "I had asked for a fluid pill to reduce the fluid because I was wheezing at the time, but the doctor said lose it naturally. The next doctor I saw treated me with fluid pills without any difficulty. I need to trust the person, be comfortable, have confidence that they have the proper professional credentials. I wasn't comfortable with Dr. Myers, and I didn't ask for him. I didn't have trust in him." Nellie went on to explain the difficulties that she had dealing with the social worker who had been assigned to her. There were difficulties attempting to follow Nellie's wish to be transferred elsewhere because the patient, from the chart, was reported as difficult and paranoid, and generally uncooperative. Her need for nursing home care of a skilled nature was determined to be unnecessary after February of 2005, so that she no longer had hospital coverage under Medicare with a pick-up by PEBTF. The one thing Nellie did not understand was this element which accounted for the idea of her bills being covered by Medical Assistance. Nellie described some of these difficulties as follows: "I have been in touch with the Area Agency on Aging since I - -- Page Four RE: In re Guardianship ofNelIie Tabb was hospitalized in March of2004. The ombudsman gave me a number to call if! had trouble, but I haven't received that number here. This admission here was under a cloud. I haven't been able to get a discharge. It's not clear or authentic. Under usual circumstances you should be able to go back where you came from. I'd never have been involved with Ella if! knew then what I know now. The administration and the social worker should have helped me. My sister in California didn't feel that good about the arrangement with the house and the $20,000.00. When you're in need and your observations and calculation of the situation are not as good as somebody stepping outside, you may not make the best decision. She warned me about past situations. My sister in California had told Ella (half-sister) when she was cleaning out my Briggs Street apartment, not to discard anything. My sister in California, Mabel, wants to come here to help arrange a decent living, but she has a brain aneurysm and can't come at this time. I spoke with Mabel Henna Tabb by telephone in California, who confirmed the information noted above and her concern about Ellie, the patient's half-sister, treating her fair and square. She states as soon as she has her aneurysm problem resolved she will come east to help Nellie get re-established in some other place. In summary, it is my opinion, with a reasonable degree of medical certainty, that Nellie Tabb does not suffer from an organic brain syndrome and that she is not psychotic and that what has been interpreted as paranoid attitude and behavior is, in fact, partially reflected from cultural attitudes and also from the fact that although this patient was declared not medically in need of skilled nursing care, she has remained at this facility since that determination was made back in February of 2005, and efforts to make other provisions for her have not been carried forth with sufficient interest or energy to achieve some better disposition for her. In speaking with Clarissa Jones and Arlene Davies, who testified on her behalf on September 7, 2005, they are in full agreement to assist Nellie in any way they can to obtain improved living circumstances and to assist her removal from the nursing home and aid her as necessary in re-establishing control over her financial resources. Ms. Jones indicates that there will be an accounting of the guardianship, which was maintained by Ms. Tabb's half-sister, Ellie Irby, which may demonstrate that this responsibility was not carried out in a financially responsible manner. Essentially, the nursing home does not provide any active treatment, and exists primarily as a custodial residence for Ms. Tabb. It is my opinion, with a reasonable degree of medical certainty that Nellie Tabb is not incapacitated and in need of the appointment ofa plenary guardian of the person or her estate. Page Five RE: In re Guardianship of Nellie Tabb Thank you for the opportunity to evaluate this interesting lady. Very Truly Yours, (1JtWA1~ / John M. Hume, M.D., J.D. JMH/asap