HomeMy WebLinkAbout10-18-78
'I'N THE MATTER OF
STEVEN DAVIS
An Alleged Incompetent
IN THE ORPHANS' -COURT OF
CUMBERLAND COUNTY.
No.
of 19
COMMONWEALTH OF PENNSYLVANIA,
COUNTY OF SNYDER
ss. :
H. Charles Thomas, PSAIII , being duly sworn
according to law, deposes and sa~ that
1. He is a licensed or licensable, practicing
psychologist, who is employed at the State Center or Mental
Retardation Unit known as Selinsgrove Center located
at selinsgrove, Pennsylvania
where on October 18 , 19 78, he examined a resident therein,
viz: (Name) Steven Davis (Age) 18 (Sex) M
who was admitted from Cumberland County
on March 3 , 19~, with a history of Profound
Mental Retardation and Encephalopathy
At the examination of the following symptoms were observed
Non-verbal with no basic skills. Did not respond to financial
questions.
from which the diagnosis made is: Profound Retardation -
SA .79 years - SQ 5. No understanding of financial affairs.
, "
with a prognosis as follows:
Poor
2. On the basis of the foregoing history and
examination, the affiant is of the opinion that Steven Davis ,
"because of mental infirmities of old age, mental illness,
mental deficiency, drug addiction or inebriety, is unable to
manage his property, or is liable to dissipate it or become
the victim of designing persons," and is, therefore, incompetent
under the provisions of the Incompetents' Estates Act of 1955
as amended.
Sworn to and subscribed
before me this /f z;{day
,
t?)~
(./ e.--(;
~/Y
M.x& .
of
19/K
Psychologist
License No. PS-00053-L
LJ
~7_ -.--.
/' -<---'L,~ y ~ ~~1------
, Nota~ Public
TERRY L. SHCE.:~-:, ~.,!~-:t:::-y Public
S(;!!nsgrov[~,S~iycL:j Co.! Pe1.
My Commission E;-;pi;os Jail, 11, 1982
-2-
'IN THE' MATTER OF
IN THE ORPHANS' COURT OF
steven C. Davis
CUMBERLAND
COUNTY.
An Alleged Incompetent
No.
of 19
COMMONWEALTH OF PENNSYLVANIA,
COUNTY OF ~~,..
.,
ss. :
Donald H. Eister, ~ID
, being duly sworn
according to law, deposes and say that
1. He is a regularly licensed, practicing physician
who is employed at the hospital or institution known as
Selinsqrove Center
Pennsylvania
located at Selinsgrove,
where on sept. 28
, 19 78,
he examined a patient therein, viz: (Name) Steven C. Davis
(Age)
18 , (Sex) M
2. As a result of this examination it is the opinion
of the affiant that:
A. Said patient is in such physical or mental
condition that he/she is capable of appearing in court
and his/her presence in court will not endanger others
in the court room.
OR
~ Because of the physical or mental condition of
said patient, his/her welfare would not be promoted by
his/her presence in Com: t, and/or his/he~~~,-<!'ill~
..
~nn~- J~L "'""CJLll~.::> .tt:::'L4\~ c~ L 'L~
Sworn to and subscribed
before me thi.S--~ day
&iuIrJ}+., r,;;t;;,
,
H.D.
6',,;;:r-- .. '. 19 7 y: ~
~'-~~
t", ~rt;:"'~_...~__
of
-----)
1/ ---k'-'YL.-< ~
c>, "/
! C\;. ';' . . ~:':.
~i',: C-c" 0-;,
~,~;:... P'~'bllic
.,1,.1;].
~.,-- :
~ 1. ] 932
-7
.
.
, ",
~SENT OF proPOSED GUARDIAN
I, Bonita J. Stahl
Guardian Officer
of
Selinsgrove Center
, do hereby certify that I
and ~ successors in office are willing to act as Guardian for the
estate of
steven C. Davis
, an alleged incarpetent, if
the Court shall so appoint.
Further, I do hereby certify that I am not a fiduciary of
any estate in which the alleged incx:npetent has an interest, nor have
I any interest adverse to the alleged inconpetent.
'lhe facts and opinions contained herein are true and correct
to the best of ~ knavledge, infonnation and belief.
:ff.-nL Q. JMt.
I Bonita J. iJtanl
Guardian Officer
EXHIBIT "B"
MH/MR 35-E-6 - 9-77
.,: REPORT OF COlV\PFrENCY EXAMINATION
NAME
.:..iteven :0avis
INSTITUTION
~elinsqrove Center
EXAMINER
Joseph Gallauher
I DATE
5-30-78
ADDRESSOGRAPH PLATE
INSTRUCTIONS: Set forth below your opinion as to whether the patient/resident meets the legal standards of incompetency
Include the medical and factual basis for that opinion. If you have u$ed a competency worksheet (state centers and MR units
only) it can serve as the factual basis for your opinion. Attach a copy to this form. Under Pennsylvania law, a person may be
adjudicated incompetent if he or she, as a result of mental illness, mental retardation, or old age:
(1) is unable to manage h is or her property; or
(2) is likely to dissipate that property; or
(3) is likely to become the victim of designing persons; or
(4) lacks sufficient capacity to make or communicate responsible decisions concerning the use and
management of his or her entitlements.
Vour opinion regarding competence must make reference to at least one of these standards. Use as much space as needed and
be as detailed as possible. Medical basis should refer to both diagnosis and its manifestations. Factual basis refers to questions
and answers regarding the four standards above. Please sign on bottom. If additional space is required, use an attached sheet.
Because of profound retardation, steven is unable to handle
money. His ~ocial (:uotient is less than 10 points.
steven is non-verbal, has no reading skills, and. is not
capable of identifying coins.
CONCLUSION: (Please respond Ves or No)
o Ves ~ No
0Ves oNO
0ves DNo
The patient/resident is capable of managing his/her financial affairs.
The patient/resident is incapable of managing his/her financial affairs.
(If Ves, respond to the following question.)
If the patient/resident is incapable, is the patient's/resident's incapability to manage his/her
financial affairs a product and/or manifestation of his/her mental retardation, mental illness,
or old age?
o Incompetent
VAL BY SUPERINTENDENT
COMMONWEALTH OF PENNSYLVANIA
51 533 - 7-77
~
"
D-l~;'{l 'lll'[ 1 ~d
, ...iciinscl-OVC Center
-- ._---_.__.....~-~-~--,-
EXMlIllER 20~~l2.!1 Gallagher
~
Q.
P-
'1
(l)
Ul
((l
o
t-1
'"
'0
;r
'"U
I-'
tll
n
(l)
DA'l'E
5-30-7L'
INS'l'l~1JCTIO;~S: The administration of the Competency ASf,essmcnt
Inve~~'t-~~y(G\l) should con [01'10 carefully to the direc tions pro-
vided herein. The staled questions and tasks are designed to
elicit responses which will be used in determining whether or not
a resident is capable of managing his personal propcl'ty and/or is
susceptiLle to the deceptions of others. (Pennsylvania Bulletin,
April 19, 1975, Volume- 5, Number.l7).
If the resident's response is correct, place the exact number of
points in the space provided. One point will be given for each
correct response, except where indicated. The examiner should
provide the resident's/patient's name, age, and center/hospital
number if an addressor,raE!~ate is not available.
PART I - SCREENING QUESTIONS
SCORE :
o 1. Ask the individual to state his/her full name.
(Score one (1) point if full name is given).
o 2. Have the individual write his/her full name.
(Score one (1) point if the individual writes his name accurately).
Individual's Signature
o 3. Ask the individual to name the current day, month, and year.
(Score one (1) point if the individual responds correctly to all three).
o 4. Ask the individual where he lives.
(Score one (1) point if name of institution or family address is given).
o 5. Ask the individual to read the following:
FIVE BANK
ONE SIX
TWO TWENTY
TEN FOUR
CHECK NINE
(Score one (1) point fqr 1-5 words
correct; and three (3) points for
THIR'IY-ONE
EIGHTEEN
NINE BUNDREll
DEPOSIT
SEVENTY-SEVEn
correct; two (2)
11-15 correct).
points. for 6-10 words
o 6. Currency Identification
Materials: Penny, nickel, dime, quarter, half dollar.
Randomly place the coins in front of the individual and ask:
(a) Show me the dime
__ (b) Show me the quarter
(c) Show me the nickel
(d) Show me the h.:llf dollar
(e) Show me the penny
(Score two (2) points if four (4) or more responses are correct).
-1
o .~
7.
Hatl:rlnl~: 'One (1) twenty, ten, five, t\.Jo, and one dullar Lillo
'-..-
Place the bills in front of individual and ask:
(a) Show me the two dollar bill
(b) mlich bill is worth the most?
(c) Show me the ten dollar bill
(d) mlich bill is the smallest amount?
(e) Show me the five dollar bill
(Score two (2) points if (4) or more responses are correct).
STOP here if the individual has a total score of six (6) or less points - for items one (1)
through seven (7).
~
PART II - FINANCIAL HANAGEHENT
SCORE :
8. If you wanted to buy a radio at the lowest price (lenst expensive), and
saw three radios marked, $7.00 $11.00 $8.00, which radio would
you select?
(Score one (1) point if the .$7.00 amount is selectf'd).
9. Give the individual one dollar ($1.00) in mixed change, and ask:
(a) If you bought something for 65 cents, show lI:e
how much change you would have left?
___ right
(b) If a pencil costs 25 cents, show me how much money
you need.
wrong
right
wrong
(c) If you bought something for 85 cents, how much change
would you have left?
right
wrong
(Score two (2) points if all three items are
answered correctly).
10. If you only had $200.00 a month to spend, what would you do with this money?
(Score one (1) point if the following three items arc mentioned:
(1) food; (2) clothing; (3) housing).
11. Place fifty-two cents (quarter, 2 dimes, nickel, 2 pel-.nies) in front of
individual and ask, "How much money is here?"
(Score one (1) point for correct response).
12. Ask the question:
If a stranger approached you and asked you for ten dollars, what would
you do?
(Score two (2) points for any response(s) whereby the individual
does not give money to the stranger).
13. Financial Concepts
Ask the individual to explain the following:
(a) checking account (any mention of checking account functions,
i.e., payment, withdrawal of funds).
(b) savings account (savin~s of monies in a bank; interest)
(c) social security (a source of monies from Federal Government)
-2
.
- .
-,
.
.'
,(d} J'(~:1~!~; (1)l)rrl\!Jl'q'j (<1 11j~t.h(ld uf p".tUng 1li('1.c)' frO'Il a sUurCI')
~e') 111(' in~;l\l-;lIlU' (l'ii)'I\lLllt of lllDHies upon ue.1t11 of o\;'ner or
belle 1 i ci il ry)
(f) saLlry (...:ag(::;) (monIes earned for \,'ork complet<:d)
(r,) taxes (money deducted or paid to governmellt for community
senrlces [lnd l',nVCnll'lCllt support)
(h) postage stamps (Item botl~ht to be used for mailing letters
and pad.ages)
(SC01'C two (2) points if the individual responds correctly to four (4)
of the eight (8) items.
14. If someone came up to you on the street and wanted you to buy two w~tches
from them for $100.00. what would you do?
(Score two (2) points if the individual does not buy the watch).
15. Place eighteen dollars (ten, five. 3 ones). in fV03t of individual and ask,
"How much money is here?"
(Score one (1) point for correct response).
16. The examiner or the unit staff should complete the following questions by
answering yes/no.
1. Does the individual receive money regularly?
2. Does the individual give money and/or possessions away
indiscriminately?
3.
Does the individual frequently lose and/or have
money and/or possessions stolen?
one (1) point if 112 and 1/3 are marked "no""}.
his/her
(Score
-~
- -. -- .- - --.--.-- -- -.--.-....-
__~ "W'_ .____~~__.._
NOTE: It is sugges ted that a total score of sixteen (1&) or more points be used
as a cut-off score for rp.lldering an opinion of ccr;.petence. A score of
fifteen (15) or less points would be used for the opinion of incompetence.
HATERIAJ,S LIST:
-----
Coins: 5 pennies; 3 nickels; 3 dimes; 3 quarters; 1 hnlf-dollar
Bills: 3 ones; five; ten; twenty
_..._.-_.__.~.-.~_._._--_._,...- .,~.- ------_.,--- _.- ---- ---'---' -----.--..-----
--.- . -.-.---.---
Is the resident's inability to h~ndle his/her monies and!~r possessions a yroduct
of his/her disability?
Yes X
No
0.. L Lc) ~Af.h_
~ (Ll cen..ed P:SYC~ ::ar:xRs:y:nhj;;n;r.j;.sr..t{
5-30-78
Date
6/77
-3
rn THE MATTER OF
IN THE CDURI' OF CX)Mv1()N PLEAS OF
: CUNBERLAND CCiL'NTY, PENNSYLVANIA
S'Th'VEN C . DAVIS
(narre )
ORPHA."JS' CDURI' DIVISICN
An Alleged Incanpet:ent
NO.
19
PEl'ITICN FOR APPOINIMENI' OF GUARDIAN
The Petition of Joseph J. Scartelli
, Superintendent of
Selinsgrove Center
, respectfully represents:
1. Your Petitioner has custody of the alleged incaupetent
at Selinsgrove Center
2. The alleged incx::mpetent was admitted to the aforesaid
institution on Barch 3, 1971
3. The alleged incx::mpetent is daniciled at
74 Cave Hill Drive, Carlisle, Pennsylvania 17013
4 . The alleged in<XJIl"q')etent is 18 years of age, having been
born on September 13, 1960
5. The alleged incaupetent I s military status is:
Never served in the armed forces.
6. The alleged incaupetent' s marital status is:
Never married.
7. Those persons, if any, who are the alleged ina:mpetent' s next
of kin and their relationship to same, of whan your Petitioner has knowledge
are as follows:
Mr. Lewis G. Davis, father, 74 Cave Hill Drive, Carlisle, Pennsylvania 17013
8. No other Court wi thin this Camonweal th of which Petitioner
has knowledge has appointed a guardian for the alleged incaupetent.
MH/HR 35- E-l - 9-77
9. '1' ,0 all<,:qe-c1 :ll1cx:ttpetent M..s incc.rne aJIlSisting of:
(a) Money due fran Social Security Administration
in the arrount of $ 121.8..2.-__ per month
(b) Ml:::mey due furn
in the aIIDunt of $____ per
(c)
10. The alleged inc;cnpetent has Cesset.s I real and personal, of
which the Petitioner is aware, in the amount of $ 5440.69
oonsisting of:
fa} Noney held by the Guardian Officer of Selinsgrove
in the CIOOUl1t of $J::.677.57__ as of October 10 , 1978 .
(b) "Vecchione Iefund" Ironies in the a'1Dunt of $ 763.12
title to which is in dispute.
Center
(c)
11. The al1et'Jed incanpet.ent has debts outstanding in the arrnmt
of $3943.00 , as of October 10 , 19 _1~_-, consisting of:
(a) $. 3299.50 <:JWi.nJ to the Carman wealth of pennsylvania
as pCi.yment for care and maintenance received fran the period April
19~, to October 10 ,1978, in acoorda_l1ce with 50 P.s. SS 4501 and 4504
and regulations promulgated thereunder.
(b) $ 643.50 ONing to the Carrronwealth of Pennsylvania as
payrrent for care and imaintenanCE rendered between J"uly 11, 1974, and
April 4, 1975,
in dispute.
which relates t:o the "Vecchione Refund", title to which is
(c)
12. The alleged incarpetent 18 incapable of handJ.ing his
financial. affairs for the reasons set forth in the attached Affidavit
and Carpetency Rep:>rt, prepared by Joseph V.I. Gallagher
maIked as Exhibit A and made a part hereof.
-2-
MI/I<lF 35-E-2 ... 9-77
13.
Bonita J. Stahl
, Guardian Officer at
the aforesaid institution, and his successors in office, having no interest
adverse to the alleged inccmpetent, has agreed to act as Guardian if this
Honorable Court shall so appoint. The oonsent of the proposed Guardian
to so act is attached hereto and made a Part hereof as Exhibit B.
14. If appointed as Guardian,
Bonita J. Stahl
is required to act in oonpliance with regulations pranulgated under Court
Order in 5 Pennsylvania Bulletin 931 et seq. (April 19,1975).
15. In light of these provisions and in furtherance of
Paragraph 7 of the aforesaid regulations, petitioner requests preference
be given to a bank, trust oorrpany or other individual willing to accept
appointnent as Guardian.
WHEREFURE J' the Petitioner prays that a citation be issued
directing
steven C. Davis
, and those
persons, if any, listed in paragraph 7 of this Petition, to show cause,
if any there be, why
he
should not
be declared an inoonpetent and a Guardian of the estate a};lPOinted, and
why distribution of assets and incx:>rre as payment of debts listed in
paragraph 11 should not be made. Petitioner further prays that a guardian
ad Ii tern be appointed to act for the alleged inccmpetent regarding such
hearing.
BY:
-j~l< .J JCcl1 tz (I. ·
i Jo eph J. ~cartelli
Superintendent
-3-
MH/MR 35-E-3 - 9-77
C~TH OF PENNSYLVANIA
CX>UN'I"f OF
SNYDER
Joseph J. Scartelli
1 peti tianer in this
matter 1 being duly sworn acoordimto law 1 do depose and state that
lam
Superintendent
of Selinsgrove Center
and that t.l1e facts set
forth in the foregoing Peti tiOll are true and oorrect. to the best of
my kna"" J.e(:k:Je 1 infmmation and belief.
swom 'ill .AND SUB..SCRlBE;D BEFORE
,.~z;(
ME, TIIlS ~?f _rAY OF
__,___& ~;r,- 19~
~'
~-----'" '
~ -r~ - .-//
JJ~ ~,--5 M"~
NOTA1{Yr:' UBLIC .'
1.. SHoO -_~c'~?, t'L';\-J"Y PUU~IC
r ,~:'):"iV::; S~iy(le( (0.; Po.
~I..;' Cn:r;"',,:S'or I'xpir8s Jon. 11, '1982
nVI'-fR 35-E-4 - 9-77
'.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
S:NYDER
ss
I, Joseph Gallagher , being duly sworn
according to law, depose and say that I am a Psychologist
th C Ith f P 1 10 d t Selinsgrove Genter
in e omrn0 m>lea 0 ennsy vania emp ye a
.______" and I have examined the pat ient,
steven Davis
,
an alledged incompetent, with care and diligence and based upon said
examination and observations am of the opinion that said patient is
incompetent to manage his/her own affairs for the reasons set forth in the
attached Competency Report, and that the facts and opinions contained
therein are true and correct to the best of my knowledge, information and
belief.
(r~L 1-,/ (J~~
I Joseph \~. Gallaghe
SWORN TO AND SUB~~ED BEFORE
ME THIS IT. DAY OF
. -
/2./!/(' " 19.7rr
=----.) ~~-'
/-;;:~y ;"C~~--
TERRY L. Si1C'E~<ER., Notary Public:
'=:.C\;''''':::~!':'',I!'::' :::;nv""j~'" Co. Pa.
;/\' Cr'~r"issicr' Expires' Jan. 11, 1982
EXHIBIT "A"
MH/MR 35-E-5 - 9-77
..'
IN THE MATTER OF
IN THE COURT OF COMMON PLEAS
Steven C. Davis
AN ALLEGED INCOMPETENT
OF
CWillERLAND
COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 19
AFFIDAVIT OF SERVICE
-
L--
; t
i<- ft11m 0 NfJ
&p~being duly sworn according to law,
deposes and says that he/she personally served the within
Citation and Petition upon
Steven C. Davis
at Selinsgrove Center, Selinsgrove, Fa.
on
<; c??T. :us--" ICf 7 Y
at .J~ : L(.J a. m. (f;jji), by reading to
him/her the contents of the Citation and Petition and leaving
with him/her a copy of said Citation and said Petition.
~~/Cc~d ~
SWORN TO AND SUBSCRIijED
BEFORE HE THIS J Aco(
DAY OF (Per-, 19 7K
~/~J ~~_
NO~;~~~ s:~;;ary Public
SC:::j~~";~~'\'2.. S:-",'d,"?!' ('.:.' Pa.
'i;'", C:,l'~" E.' :<re3 J,~n. 11, 1982
-.
~~i~~:~~
.(I
~
~ ~.
."
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT or PUBLIC WELFARE
HARRISBURG. PENNSYLVANIA 17120
JAMES R. ADAMS
GENERAL COUNSEL
September 27, 1978
TELEPHONE NUMBER
787.6398
AREA CODE 717
~1r. l81is G. Davis
74 Cave Hill Drive
Carlisle, PA 17013
HE: STEVEN C. DAVIS
Dear Mr. Davis:
Mr. Joseph J. Scartelli, Superintendent of
Selinsgrove Center, has petitioned Judge Dale Shughart of
Cumberland County Orphans' Court to declare the above
listed patient incompetent and to appoint Bonita Stahl;
Guardian Officer at Selinsgrove, guardian of his/her estate.
Although your relative has been a resident at Selinsgrove
for some time, without an adjudication of incompetency, such
an adjudication is now necessary because a Federal Judge has
decided that a Pennsylvania State Employee may not fulfill
the role of guardian without an official court adjudication
of incompetency.
A hearing on Mr. Scartelli's petition has been set
for Thursday, October 19, 1978, at 1:00 p.m., at Selinsgrove
Center, with George Vaughn, Esquire, Master. Unless you have
some objection to the appointment of Ms. Stahl as guardian
you need not attend the hearing. I have, nevertheless,
attached a copy of the Court's Citation which has been
served on your relative. If you do intend to be present
please give me a call at the above number. Also, if you
have any questions about this matter please feel free to
call me.
Sincerely,
-. 1 .
CZ~f."-;'''-fJJ / {6\AJ..l
Edward P. Carey
Assistant Attorn y General
EPC: j h
Attachment
CERTIFIED MAIL RETURN RECEIPT REQUESTED
~ I 0 SENDER: Complete item, I. 2. ;md i.
6' Add your address in the "RETURN TO" space on
3 reverse.
--.-~'...==
w
e
<D
....
....
1. The prl10wing service is requested (check one) .
~how to whom and date delIvered......... ._-<1
o Show to whom, date, and address of delivery. .-<1
o RESTRICTED DELIVERY
Show to whom and date delivered. . . . . . .-<1
o RESTRICTED DELIVERY.
Show to whom, date, and address of delivery. $_~
too ;fbTa-&~~TMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
)>
~
:0
~ Mr. Lewis G. Davis
c
~ 74 Cave Hill Drive
~ Carlisle, PA 17013
8 3. ARTICLE DESCRIPTION:
~ REGISTERED NO. I CERTIFIED NO.
~ . 742611
~ (Always obtain signature 'Of addressee or agent)
;;l I have received the article described above.
~ SIGNATURE D Addn'sSl'l' D Authoriz('d a~ent
,0 ./ ,,~'~
I d -/ ..
:'.e.t-"U~ ,- L-O--U-t",1
TE OF ELIV R / POSTMARK
a~~ "7
INSURED NO.
\..
6. UNABLE TO DELIVER BECAUSE,.
~
CLERK'S
INITIALS
i:
~
...
...'I GPO : 19n-O-234-337
~
I
~~g
<w"'"
::=2"
~~ui
",ll..C.!l
oo~
...._CIl
00
~~o..
-' ....
~Q~
~W
CIl
::>
\'0.
~. ~'~---
w J ~~~
~ .,.::0.
5 en ~5~::~
C/) z :5~~~~ .
..JCI> Qc::e,SOGl
< ~ ....._.c _ex
.... Z U i:;~'~~
~ Cii ~ u ~:; ~~ Z
~ ~ ..... ~"'C"O 5{O:: a:
{j)N~='fC:
en..JZ~'~";; ::;)0
l.U < - coN~=1U I ~ ~
I- U .,; ~G)oo: LIJ
~ u: ffi ~:'i:i; . a::
en~ Q~~EE~il
Z tt:':: g ~~ e
C LIJ";G:ltlOo...~
~ en ~:;~~:ll~
_ C:E-;~o-
z 5Q'OUl"'OC:
=> ~U2:~~ fi
... .. .
.t
ll..
.--ii
ca'
~I~ \~
&\] ~ ,0
~n ~ \~
.\ " OJ
~ 7. <1J 11:;
~ ~~ I~
Ul lH III ~
~Qj~N
m"i~ ~
.r-l fi
~.--ird
C)~<1J
. ::r::
p.. lH ..
rejOM..o
~ . ~.~
~~&~
..
(;
~
~
;;
W
~.
5
p..._IlIIfi"*'_""'"
_......;...,...0.-..
''''._"'''-"...._'''-~~~-"~"'';<...,.. -