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HomeMy WebLinkAbout02-0977IN RE: ESTATE OF CASEY HIPPENSTEEL, a minor, by and through her parents and natural guardians, GARY and DIANNA HIPPENSTEEL COURT OF COMMON PLEAS OF CUMBERLAND COUNTY - CIVIL DIVISION PETITION TO APPROVE MINOR'S COMPROMISE TO THE HONORABLE JUDGES OF SAID COURT: The Petition of Casey Hippensteel, a minor, by and through her parents and natural guardians, Gary and Dianna Hippensteel, seeks Court approval of a settlement in favor of their minor daughter, Casey Hippensteel, in support thereof, provides as follows: 1. Gary and Dianna Hippensteel are the parents and natural guardians of Casey Hippensteel, a minor, age 15 (DOB: 08/06/86) (SSN: 170-68-5077) who sustained injuries on or about February 16, 2001, as a result of being a passenger in a motor vehicle that was involved in an accident at or near the intersection of Airport and Gilbert Roads, Southampton Township, Cumberland County, Pennsylvania. 2. The minor resides with her parents and natural guardians, Gary and Dianna Hippensteel at 243 Neil Road, Shippensburg, Pennsylvania 17257. 3. According to the Police Report completed by Trooper John Lutz of the Pennsylvania State Police Department, the minor was injured while riding as a passenger in a vehicle heading south on Airport Road that struck the driver's side of a vehicle being operated by Austin Myers traveling east on Gilbert Road. The vehicle being operated by Karen Lauver did not stop for a posted stop sign and as such proceeding into the intersection causing the accident. A true and correct copy of the Police Report is attached hereto and made a part hereof as Exhibit "A". 4. As a result of the above-mentioned accident, minor suffered injuries consisting of a concussion and facial lacerations. A copy of the Chambersburg Hospital records pertaining to the evaluation and discharge of the minor are attached hereto and made a part hereof as Exhibit "B". 5. No out-of-pocket expenses have been incurred by the minor or Petitioners with respect to the injuries sustained by the minor. There are presently no outstanding liens or claims on behalf of any medical supplier, Medicare or Department of Public Welfare, ERISA plan or other entity. 6. No attorney fees are being charged to Petitioners nor are the settlement proceeds as being offered to the minor subject to a reduction for payment of attorney fees. 7. Karen Lauver, who according to the Police reports is the party responsible for the accident, is covered as a resident relative insured under a policy of insurance issued by State Farm Mutual Automobile Insurance Company to Rose Lauver. Under the policy as issued by State Farm Mutual Automobile Insurance Company, the total coverage available for the payment to third parties for personal injury liability is $30,000. A true and correct copy of State Farm's Certificate of Coverage is attached hereto and made a part hereof as Exhibit "C". 8. In addition to the injuries sustained by the minor as set forth in this Petition, one (1) other individual who was an occupant of the vehicle in which the minor was a passenger was also injured. Specifically, this individual is Mandy Grove (who sustained a concussion and fractures of the pelvis, clavicle and first metatarsal bone) Additionally, the driver of the other vehicle, namely Austin Myers sustained injuries consisting of a fractured sternum and fractured scapula. 9. Each of these other individuals (Mandy Grove and Austin Myers) has agreed to accept $10,000 in full and final settlement of their respective claims. Therefore, the providh3g of settlement proceeds in the amount of $10,000 each to the minor, Mandy Grove and Austin Myers has resulted in a complete exhaustion of the policy limits available under the policy of insurance issued by State Farm to Rose Lauver. 10. After discussions between the minor's parents, Gary and Dianna Hippensteel and State Farm Mutual Automobile Insurance Company, the insurance provider for Karen Lauver, a settlement has been reached for $10,000.00. Gary and Dianna Hippensteel as parents of minor, fully understand that the settlement of this claim releases and forever discharges Karen Lauver and State Farm Mutual Automobile Insurance Company, their heirs, executors, administrators, agents, assigns and all other persons, firms or corporations were liable or who may be claimed to be liable as a result of the accident of February 16, 2001. 11. Minor's parents, Gary and Dianna Hippensteel, agree to put the entire amount of the settlement proceeds into an interest bearing account with a federally insured financial institution until the minor turns 18 years of age. 12. Petitioners believe and therefore aver that considering the liability issues in this case and the fact that the minor's injuries were relatively minor, the aforementioned settlement and resolution of this claim is in the best interest and welfare of the minor. 13. In order to reduce the mutual exchange promises referred to in Paragraphs 10 and 11 hereof to writing, Petitioners request authority to execute a release in the form identical to that attached hereto as Exhibit "D". WHEREFORE, Petitioners, Gary and Dianna Hippensteel, individually and on behalf of their minor daughter, Casey Hippensteel, request this Honorable Court to approve the Minor's Settlement. Respectfully submitted: Ga"tT'N~pe~tee~, as I~rarent ~nd Dia~'~a-i-iil~P~nstec~,-~Tp~re~t-~nd natural guardian of Casey Hippensteel, natural guardian of Casey Hippensteel, a minor a minor Date: .,~~ Date: EXHIBIT "A" POLICE ACCIDENT REPORT 72001 1168 Means Hollow Rd. . ~ c,w s~^~ Shil~:)ens~rg. PA 17257 777 Oakville Rd. P,~O~ 01 Penn Oper. # I , N. Gnwe P.O? ~ 144 ~. PA 17240 C~- M. H~ 243 Nd Rd. S,~.~_-~._--,~urg..PA t M. Lluver 1168 :~-~'~- ~ Rd. ~. PA 17257 Oper. # 2 Tire Ruts. del)ds in field · · w- I 518 South Mtn. Estate Rd. , 532-9373 Unit # 1 call phone not present Unit # 2 cell phone present not in use. This accident occurred as unit # 1 travelled SB on Airpod Rd. and failed to stop at a properly posted stop sign. Initial impact occurred as Unit # 1 entered the intersection with SR3002 and struck Unit # 2, which was travelling EB, on the lee side driver's door with its front end. The force of the collision spun unit # 1 into a counterclockwise rotation and forced Unit # 2 off the roadway where it landed in an adjacant field and rolled over as the vehicle turned sideways. Unit # 1 came to a final rest facing WB partially on the EB berm of High Rd. Unit # 2 came to a final rest facing NB and on its fight side. Physical evidence: debris field at point of impact, heavy front end damage of Unit # 1, heavy left side damage of Unit # 2. On 02/19101 at approx 1500 hrs. this R.O. interviewed Oper # 1 via telephone, she related that she did not remember anything about the accident and didn't know how it happened. Continued.. C ~,,~,~.~ ..SUi~NCE i COW'ANY State Farm Insurance ~ ~ ~ - -~"~'~ ..... 940 Forest Coull Cadisle, PA 17013, G~a Ec~oar~ Manet .TN~SSE[S I ~SS Stop S~s & Yield Sig~s Erie thsu~.,~ c1062580116 218-8~5 L ! None where I was going so I wasn~ goino very fast, mayoe arouno ~o Mr'ri. ~ =am~ up u~ .,= -,,,~ saw the other car coming at me aS I looked out my window and then I got hit. On 02/21/01 at approx 1030' hfs this R.O interviewed the right front seat Passenger, Man JYN- or°ye' . . . . . .. via telephone.' we got closer to, .U~ ~{op si~nl'~to myself if she w~....gin, rig. to stop..As we. got ~_tl~__st~.~s~,~n "' a'nd...k~e~1~t the other car. ~ mink she may nave ~K.. 'm oow, ou~ '!~' was too late't?~a.y, anything tour, sure she didn.!, st~.??~.':: :-...~ ' On 02116~/01 this R.O. interviewed the witness on scene. He related, I was right behind the GMC Jimmy, he was going around 35 to 40 MPH and he got hit from the side by tt~ gid driving the other car. She completely ran the stop sign. Both vehicles removed from scene by Chuck's Auto Repair, Shippensburg, PA SP7-0015 Mailed to owners of Units I & 2. 0.__% i-i u~ *.^~* 03 PennDOT - ri ri [] [] YES I~ NO [] EXHIBIT "B" Casey M. Hippensteel March 7, 2001 She is here for a F/U mostly in the area of the and some back pain. She Mr. Peligrino last week, and some were negative. She is not having any other symp~ except some left rib pain as well. PHYSICAL EX~INATION: Her laceration has healed up well. The remainder of her exam of her neck and back are relatively unremarkable. I would like her to get a C-spine film to F/U on her neck to make sure that there is no injury there. Otherwise, we are going to refer her to physical therapy, and she can F/Uwith me as needed. Also, she is complaining of some swelling in her right leg with a little discomfort there. I am going to send'her for a duplex scan also. We will F/U with her pm. REO/csg ~ March 19, 2001 Her C spine and rib studies were all negative, on, the duplex study showed no evidence of DVT.. She is ~Sing to go ahead and start physical therapy. R~G/csg Casey H. Hippens~:eel 02/16/0!-. Dr.~,Go~n admitted a motor vehicle accident. D~, 02/17/01 - Patient discharged from hospital, bJp February 21, 2001 Casey is a 14-year-oid female who I had seen in ~!e emergency room trea~ed last week after she had been in a car accident. Her work-up revealed no evidence of any significann injuries, but she is complaining of a lo~ of symptoms. She has headaches. She has had some nausea, some pain in ~he right side of her face. also some back pain. The laceration on her forehead appears to be improved and healing well. ! removed all sutures today. I would like to see her back again in a couple of weeks. We gave her some cream for her scar. ! will get a i~,osacrai series. REG/csg February 22,2001 Casey!s mom called the office lnregards to Casey's c/o pain in her neck and back after she had turned her head. Order for her spine films stat and faxed the orders to Shbg facility. They will have the xrays done and we will contact Dr Gorman with those results, tsj February 22,2001 Results of xray showed that Casey has a mild acute fx of T4&T6. Dr Corman aware and ordered a consult from Orthopedics for this. Mr Peligrino will see her on 2/27 at 9am. tsj February 23,2001 Casey's mother called the office in regards to the report of her spine films. Dr Guthrie had them reviewed by Dr Sebri and Dr Creagen. She understands that there is no fx but Mr Peligrino will still see Casey for her back pain. tsJ ( THE CHAMBERSBURG ,_ _~SPITAL 112 N. SEVENTH ST. CHAMBERSBURG PA 17201 HIPPENSTEEL, CASEY M patien~ #i '3 i~2i 51 Surgery Date: 02/I 6/2001 R. E. German, M.D. Patient Rm: Pag~ l cOPY PREOP DIAGNOSIS: POSTOP DIAGNOSIS: OPERATION: Repair of laceration of forehead. SURGEON: R. E. Gorman, M.D. INDICATIONS: The patient was in a motor vehicle accident, multiple abrasions and also a concussion. She has a laceration of her forehead that measures approximately 7 cm in length. PROCEDURE: The patient was prepped and draPed. The skin was anesthetized with 1% lidocalne with epinephrine. The wound was irrigated out copiously with saline under pressure. The skin was cleaned with hydrogen peroxide. The skin was then closed with interrupted 5-0 nylon sutures of either vertical mattress or mostly simple, She tolerated the procedure well. Bacitracin ointment and clean dressings were applied. The head was wrapped. The patient tolerated the procedure well and was admitted. REG/rlr D: 02/16/2001 T: 02/20/2001 R. E. Gorman, M..~ CHAMBERSBURG IIOSPI'I~, SUMMI'I~ ~,ALTII CENTER RADIOLOGIWI" Name: HIPPENSTEEL, CASEY M D a t e~ ~0~: ,~ ~,~00l '- .' · Order~ Nuts Stat: O/P Faculty Dr: M.D., HENRY CHING Room no.: Admittin9 Diag: X/US/BLOOD CLOT DVT TEND Rsn for Exm: N/A Date of Birth: 08-06-1986<~ Patient phone: 7175325538 ACCOUNT NO: 600175 ** FINAL ** *** F/C: 14 *** HISTORY: 14 YEAR OLD MALE; HISTORY OF TRAUMA, CHECK FOR DVT, TENDERNESS 3/14/01 DUPLEX VENOUS ULTRASOUND OF THE RIGHT LOWER EXTREMITY: VENOUS BLOOD FLOW WAS EVALUATED AND APPEARS TO BE NORMAL WITHIN THE COMMON FEMORAL, SUPERFICIAL FEMORAL, POPLITEAL, AND POSTERIOR TIBIAL VEINS. RESPONSE TO COMPRESSION AND AUGMENTATION APPEARS TO BE NORMAL WITHIN THESE VEINS. THERE IS THEREFORE NO EVIDENCE OF DEEP VEIN THROMBOSIS. IMPRESSION: THERE IS NO SONOGRAPHIC EVIDENCE OF DVT. 83971 729.5 Signed by DR. HENRY CHING M.D. CHAMBERSBURG IIOSPIT( % SUMMYI { ~ALTIt CEN'I~,, BraKe Shreiner RADIOLOGIST'S REPORT Name: HIPPENSTEEL, CASEY M Date Done: 03-14-2001 ordering Dr: GORMAN, RICHARD Nurs Stat: O/P Faculty Dr: M.D., HENRY CHING Room no.: Admittin9 Diag: X/US/BLOOD CLOT DVT TEND Rsn for Exm: N/A Date of Birth: 08-06-2 Patient phone: 7175325538 ACCOUNT NO: 600175 ** FINAL ** *** F/C: 14 *** HISTORY: 14 YEAR OLD MALE; TRAUMA CERVICAL sPINE: AP, LATERAL, AND OBLIQUE X-RAYS OF THE CERVICAL SPINE WERE OBTAINED. MULTIPLE VIEWS OF THE CERVICAL SPINE DEMONSTRATE NO EVIDENCE OF COMPRESSION FRACTURE, DISC SPACE NARROWING, NEURAL FORAMINA ENCROACHMENT, CERVICAL RIBS, APICAL PULMONARY MASSES, OR OTHER SIGNIFICANT ABNORMALITY. IMPRESSION: NORMAL CERVICAL SPINE SERIES. LEFT RIBS': THERE IS NO EVIDENCE OF RIB FRACTURE, OR BONY DESTRUCTIVE CHANGE. THERE IS NO EVIDENCE OF UNDERLYING PULMONARY CONTUSION, PNEUMOTHORAX, PLEURAL FLUID, OR OTHER SIGNIFICANT ABNORMALITY. IMPRESSION: NEGATIVE RIB STUDY. 82050 80055 724.5 786.5 Signed by DR. HENRY CHING M.D. HIPPENSTEEL, Room/Bed: NursiT~ Station: OUTPATIENT Priority: ROUTINE ReqSeq#: 1009870 Film#: 518233 EXAM: ..... COMPLETE ..... INCOMPLETE IMMEDIATE READING N/A 'AGREE ........... " DISAGREE ........ NO SIGNIFICANT ABNOI~MALITY ....... CH, A vlBERSBURG HOSPI" ('- SUMMIT( ALTH CIZNTER · Summit Dia RADIOLOGIST'S RF PORT ..... Name: HIPPENSTEEL, CASEY M Date Done.;/'.02~22-2001 Ordering Dr: GORMAN, RICHARD Nurs Stat: O/P Faculty Dr: M.D., KEVIN M.CREGAN Room no.: Admitting Diag: X/ C SPINE MVA Rsn for Exm: MVA CALL REPORT Re( Date of Birth: 08-~'06~1986 Patient phone: 7175325538 ACCOUNT NO: 588022 ** FINAL ** *** F/C: 14 *** HISTORY: 14 YEAR OLD FEMALE; MVA 2/22/01 CERVICAL SPINE: IMPRESSION: 1. NEGATIVE STUDY. 2. AN ODONTOID VIEW IS NOT .SUBMITTED FOR INTERPRETATION. ONE SHOULD BE OBTAINED TO COMPLETE THE SERIES. COMMENT: THE CERVICAL SPINE IS NORMALLY ALIGNED FROM C1 THROUGH Ti WITHOUT EVIDENCE OF FRACTURE OR SUBLUXATION. THE LATERAL COLUMNS ARE INTACT. THE NEURAL FORAMINA ARE WIDELY PATENT BILATERALLY. I DO NOT HAVE AN ODONTOID VIEW. THORACIC SPINE: IMPRESSION: 1. NO DEFINITE EVIDENCE OF AN ACUTE FRACTURE. 2. MILD CONCAVITY OF THE SUPERIOR ENDPLATE OF T4 WHICH APPEARS TO HAVE BEEN PRESENT ON A RADIOGRAPH FROM 10/17/2000. IF PAIN PERSISTS, A BONE SCAN COULD BE OBTAINED TO COMPLETELY EXCLUDE AN ACUTE DORSAL SPINE INJURY. COMMENT: THE THORACIC SPINE IS NORMALLY ALIGNED FROM Ti THROUGH T12. THERE IS MILD LOSS OF VERTICAL HEIGHT AT T4 WITH CONCAVITY OF THE SUPERIOR ENDPLATE. THERE IS NO STEPOFF IN THE SUPERIOR, ANTERIOR OR INFERIOR ENDPLATE. THE CONCAVITY SEEN APPEARS TO HAVE BEEN PRESENT ON THE LATERAL CHEST RADIOGRAPH FROM 10/17/2000. IT IS DIFFICULT TO BE CERTAIN OF THIS AS THE SCAPULAE OBSCURE THIS VERTEBRAL BODY SOMEWHAT. THERE IS MILD LOSS OF VERTICAL HEIGHT ANTERIORLY AT T6 WHICH WAS PRESENT ON A PREVIOUS CHEST RADIOGRAPH. THE PARASPINAL SOFT TISSUES HAVE A NORMAL APPEARA/qCE. CI,iAI~.IB.ERSBURG HOSPI? ('- SUMMIT A, LTI-I Name: HIPPENSTEEL, S2050/S2072 723.1/724.1 CASEY M Signed by DR. KEVIN M.CREGAN M.D. PAGE 2 Patient TELERADIOLt..~Y IMMEDIATE BEADING ~;IPORT'"' ~' ~"~'~'~Ot~/~6.~ctt~ REPORT: [~]No SJgntficaat D Agree a ~L Disagree (Specify)/q~ d,..~. P091I/ CI!,A .MBERSBURG HOSPIT{r- % SUMMIT~ ,LTH CENT~. · Rhonda Bra,~e Shreiner Wome' ~ ~'~¢~-~'~q~c~,O RADIOLOGIST'S Name: HIPPENSTEEI Date Ordering Nurs Stat: 205 Faculty Dr: M. D., THOMAS L. Room no.: 026901 Admitting Diag: MULT TRAUMA Rsn for Exm: CARTER Date of Birth': 08-0~ ~1986 Patient phone: 7175325538 ACCOUNT NO: 318215 ** FINAL ** *** F/C: 14 *** HISTORY: 14 YEAR OLD FEMALE SUSTAINED INJURIES FROM AN MVA. 2/16/01 LATEP~ CERVICAL SPINE: A I_~TEP,.AL VIEW OF THE CERVICAL SPINE SHOWS A NORMAL ALIGNMENT AND STATURE OF THE CERVICAL VERTEBRAL BODIES. THERE IS NO DISPLACEMENT NOTED AT THE UNCOVERTEBRAL JOINT. IMPRESSION: A SINGLE VIEW OF THE CERVICAL SPINE DOES NOT SHOW OVERT FRACTURE OR DISPLACEMENT. PORTABLE CHEST: THE PORTABLE ERECT CHEST EXAMINATION SHOWS NORMAL AERATION OF THE LUNG FIELDS. THERE IS NO INFILTRATE, PNEUMOTHORAX, CONSOLIDATION, OR FLUID. THE CARDIOMEDIASTINUM IS NORMAL. THERE IS NO OBVIOUS RIB FRACTURE. IMPRESSION: THE PORTABLE ONE VIEW CHEST EXAMINATION IS UNREMARKABLE. PELVIS: AP VIEW OF THE PELVIS WAS TAKEN WITH THE PATIENT STILL ON THE TRAUMA BOARD. PELVIS AND SI JOINTS ARE NORMAL. BOTH PROXIMAL FEMURS ARE UNREMARKABLE. IMPRESSION: NO OVERT FRACTURE OF THE PELVIS OR PROXIMAL FEMURS. 62020 61012 62170 723.1 786.5 724.6 signed by DR. THOMAS L. CARTER M. D. CHAMBERSBURG I-IOSPI2(f .tLTH : '": ..... RADIOLOGIST'S R PORT Name: HIPPENSTEEL, CASEY M Date Done~'~02~16~2001--.~-;~, Ordering Dr: C.V.E.A, C. V. EMERGENCY Nurs Stat: 205 Faculty Dr: M.D., PHILIP J. SABRI Room no.: 026901 Admitting Diag: MULT TRAUMA Rsn for Exm: SUMMIlf., · Rhgnda IOC. Pat Date of Birth: 08-06-1986 Patient phone: 7175325538 ACCOUNT NO: 318215 *** F/C: ** FINAL ** HISTORY: 14 YEAR OLD MALE INVOLVED IN MVA 2-16-01 CERVICAL SPINE: PORTABLE CROSS TABLE LATERAL EXAM DEMONSTRATES NO EVIDENCE OF FRACTURE OR PREVERTEBRAL SOFT TISSUE SWELLING. NO MAL ALIGNMENT IS NOTED. CERVICAL SPINE (FULL SERIES): OPEN MOUTH, AP, OBLIQUE, AND LATERAL VIEWS DEMONSTRATE NO EVIDENCE OF FRACTURE. OR MAL ALIGNMENT. NO SOFT TISSUE SWELLING IS NOTED IN THE PREVERTEBRAL SOFT TISSUES. NO DISC SPACE NARROWING IS NOTED. LUMBOSACRAL SPINE: AP, LATERAL, OBLIQUE, LATERAL L5-S1 SPOT FILMS DEMONSTRATE NO EVIDENCE OF FRACTURE OR COMPRESSION DEFORMITY OR DISC SPACE NARROWING OR MAL ALIGNMENT. THERE IS A LARGE AMOUNT OF GAS IN OVERLYING SMALL BOWEL LOOPS WHICH MAKES VISUALIZATION OF THE BONY STRUCTURES SOMEWHAT MORE DIFFICULT. IMPRESSION: NO FRACTURE DEMONSTRATED. PROMINENT OVERLYING GAS IN NONDISTENDED SMALL AND LARGE BOWEL MAKES VISUALIZATION OF THE SPINE SOMEWHAT LESS THAN OPTIMAL. THERE IS CONTRAST IN THE RENAL COLLECTING SYSTEMS. RIGHT ANKLE: NEGATIVE STUDY WITH NO EVIDENCE OF FRACTURE, DISLOCATION, OR BONY DESTRUCTIVE CHANGE. 14 *** LEFT KNEE (THREE VIEWS): NEGATIVE STUDY WITH NO EVIDENCE OF FRACTURE, DISLOCATION, OR BONY DESTRUCTIVE CHANGE. THORACIC SPINE: VERTEBRAL BODIES AND DISC SPACES ARE WELL MAINTAINED IN GOOD HEIGHT AND ALIGNMENT. THERE IS NO EVIDENCE OF FRACTURE, OR BONY DESTRUCTIVE CHANGE. THE ALIGNMENT IS NORMAL. SOFT TISSUES ARE UNREMARKABLE. IMPRESSION: NORMAL THORACIC SPINE. CI-.Ip, M, B.ERSBuRG IIOSPIT~'''~ · Rhonda Bra,~e Shreiner WOmed Name: Date LEFT SHOULDER: NEGATIVE STUDY WITH NO EVIDENCE OF DISLOCATION, OR BONY DESTRUCTIVE CHANGE. 62050 62110 63610 562LT 62072 63030 959.1 959.6 952.0 952.1 959,7 Signed by DR. PHILIP J. SABRI M.D. PAGE 2 ,CltAMBERSBURG HOSPITf RADIOLOGIST'S REPORT SUMMIT(-- tLTH · Rhonda Brake Shreiner oSummil HIPp~EL, .CASEY M Name: Date Don~: '62~16-2001 Ordering Dr: C.V.E.A, C. V. EMERGENCY ASSOC. Nurs Stat: 205 Faculty Dr: M. D., ROBERT S PYATT Room no.: 026901 Admitting Diag: MULT TRAUMA Rsn for Exm: TRAUMA AUTO ACCIDENT OMNI 150 CC Patient phone: 7175325538 Pat Date of Birth: ACCOUNT NO: 318215 ** FINAL ** *** F/C: 14 *** HISTORY: 14 YEAR OLD MALE, MVA. 2-16-01 CRANIAL CT: SOFT TISSUE SWELLING IS NOTED OVER THE FOREHEAD NEAR THE VERTEX. THERE DOES NOT APPEAR TO BE EVIDENCE OF A SKULL FRACTURE, INTRACRANIAL HEMORRHAGE, OR OTHER SIGNIFICANT ACUTE ABNORMALITY. IMPRESSION: NEGATIVE STUDY. FACIAL BONES: AXIAL AND REFORMATTED CORONAL IMAGES DEMONSTRATE NO EVIDENCE OF ORBITAL FLOOR FRACTURE THE ZYGOMATIC ARCHES ARE INTACT. THERE IS NO EVIDENCE OF ORBITAL EMPHYSEMA. EXAMINATION IS OTHERWISE UNREMARKABLE. IMPRESSION: NORMAL FACIAL BONE CT. CT ABDOMEN: CT SECTIONS WERE OBTAINED AFTER THE ADMINISTRATION OF 150 CC. OF OMNIPAQUE-300. ORAL CONTRAST WAS ALSO ADMINISTERED. THE VISUALIZED PORTIONS OF THE LIVER, LUNG BASES, SPLEEN, GALLBLADDER, AND PANCREAS ARE NORMAL. THERE IS NO EVIDENCE OF FREE INTRAPERITONEAL AIR, OR FREE INTRAPERITONEAL FLUID. THE KIDNEYS ARE NORMAL. IMPRESSION: NORMAL ABDOMINAL CT. CT PELVIS: CT SECTIONS WERE OBTAINED IN STANDARD TRANSAXIAL PROJECTION AFTER THE ADMINISTRATION OF IV CONTRAST. THERE IS NO EVIDENCE OF FREE INTRAPERITONEAL FLUID. THE BLADDER IS CATHETERIZED. THE LATERAL PELVIC SIDEWALLS ARE UNREMARKABLE. PRESACRAL SOFT TISSUES ARE ALSO NORMAL. THERE IS NO EVIDENCE OF CI-IAMB~ERSBURG HOSPIT~-. ~iOLOGisT'S'~ORT ACUTE ABNORMALITY. IMPRESSION: NEGATIVE PELVIC CT. 60450 60486 66375 64160 959.1 62193 SUMMIT~- ,LTH CENTE~ Brake Shreiner · J~'~ . Signed by DR. ROBERT S PYATT M. D. PAGE 2 EALTH SERVICES TO: FROM: DATE: RE: Richard Gorman, M.D. Mark Maynard, MSPT 03/22/01 HIPPENSTEEL, CASEY MR//: 000518233 INITIAL EVALUATION DIAGNOSIS: EVAL DATE: Upper back and neck pain, status post motor vehicle accident -03/13/01 PROBLEM AREAS: 1. Complaint of pain with head movement in all planes. 2. Decreased strength on muscle testing in the bilateral upper extremities throughout. 3. Oswestry score of 26% indicating minimal functional difficulties. LONG-TERM GOALS (Patient will accomplish the following by the time of discharge): 1. Full pain-free range of motion in all planes of the cervical spine. 2. Full strength of the upper extremity and neck musculature for normal activities of daily living and work activities. 3. Independent correct posture to reduce stress on healing tissues in the upper back and neck. PLAN: 1. Modalities PRN. 2 Stretching· ' · . ~ll/~ ~ L~ it I~1 l_~l~ 3. Strengtl~ening. 4 Posture and body mechanics 5. Stabilization of the upper back and peri-scapular musculature· J FREQ.: Three times per week DURATION: Four to six weeks - REHAB POTENTIAL: Fair IMPRESSIONS: The patient was evaluated over a two-week period due to the mother's insistence that she have her x-ray results prior to continuing with direct physical therapy. X-ray results were obtained and were negative. Therefore the evaluation was completed on 3/21/01 and treatment is able to proceed. This patient has severely poor posture which is most likely reducing her healing potential, and she will benefit from a course of physical therapy as outlined above. Page I PHYSICIAN D: 03/22/01 T: 03/24/01 Page 2 PHYSICIAN THE CHAMBERSBURG HOSPITAL 112 N. Seventh St. Chambersburg, PA 17201 HIPPENSTEEL, CASEY M. R. E. Gorman, M.D. DISCHARGE SUMMARY Medical Record #: 518233 Admission Date: 02/16/2001 Discharge Date: 02/17/2001 ADMITTING DIAGNOSIS: 1. SPECIFIC DIAGNOSES: 2. 3. Multiple trauma secondary to motor vehicle accident. Laceration to the forehead. Multiple contusions and abrasions. HISTORY: This is a 14-year-old female, unbelted, rear seat driver's side passenger who was T- boned in a motor vehicle accident which subsequently struck a telephone pole on the driver's side. She lost consciousness and she has amnesia related to the events of the accident. Her vital signs were stable in the field and en mute. She was complaining on admission of some pain in her head, her left shoulder, her back throughout the' thoracic and lumbar regions. Her past medical history is significant for asthma. Medications include Singulair and Albuterol. Physical examination: She was awake and alert and in no distress. Vital si~tms were stable. HEENT: There was noted to be a laceration on her forehead, just beneath the hairline extending transversely that goes deep down to but not through gale, a/ Pupils were equally round and reactive. TMs were clear. Neck was supple, minimally tender posteriorly. Lungs were clear. Heart was RRR. Abdomen was soft without masses. Pelvis stable.' Rectal: Guaiac negative. On examination she is noted to have an abrasion of the left shoulder and left knee. Point tenderness in the medial aspect of the right ankle. Neurologically she was grossly intact. LABS: Amylase was 98; white count elevated at 16,000. Beta HCG was negative. X-rays: Chest x-ray, pelvis x-ray, C-spine films, thoracic lumbar films, ankle films, CT scan of head, facial bones, abdomen and pelvis all were negative. HOSPITAL COURSE: The patient was admitted. In the Emergency Room she underwent repair of the laceration of her face by myself. She was kept under observation and was discharged the following day with prescription for pain medications and to follow-up with me in the office in a week. REG/TK:Ias/268881 D: 02/26/2001 T: 02/9_7/2001 R. E. Gorman, M.D./ EXHIBIT "C" CERTIFICATE OF ( OVERAGE.... The undersigned is a [] State Farm County [] State Farm Lloyds, Inc. [] State Farm Indemnity Company [] State Farm Florida Insurance Company This certifies that policy number. 1984 Dodge Charger and was in effect on the accident date of 6853-448-38W (002) ,covering a , wasissued to February 16, 2001 Rose Lauver . The coverages and limits of liability for this policy on that date were A 15/30/25, C2 10 ~ 000 ~ U-B ! 15/30, F 1500, W 15/30, Z "The effective policy period was 2-5-01 1;o 8-5-01." State of Pennsylvania ) ) SS. Franklin ) County of Subscribed and sworn to before me this 71;h day of. June ,(Year) 2001 Notary Public My Commission Expires: Notarial Seal Carol D. Had3augh. Nolary Pub{k; Ch&'rlber~3ul'~ Boro~ Franklin Counly My Gommi~on Ex,res Oct. 15. Member. Pennsylvania Association of Notarlel 160-5276.6 Rev. 03-1999 Printed in U.S.A. EXHIBIT "D" RELEASE AND SETTLEMENT AGREEMENT The undersigned, GARY and DIANA HIPPENSTEEL, individually, and as the parents and full legal guardians of the minor CASEY HIPPENSTEEL(hereinafter referred to as "Releasors"), declare that, for and in consideration ofTEN THOUSAND and NOI100 DOLLARS ($10,000.00), the receipt of which is hereby acknowledged, for themselves, their heirs, administrators, successors and assigns, and for Casey Hippensteel, her heirs, administrators, successors and assigns do forever release, acquit and discharge ROSE LAUVER, KAREN LAUVER and STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, their predecessors, heirs, successors and assigns, their officers, directors, owners, employees and agents, and all other persons, firms, corporations, associations, partnerships, affiliates, subsidiaries and entities whatsoever (hereinafter collectively referred to as "Releasees"), of and from any and all actions, causes of actions, claims, demands, damages, costs, loss of services or use, expenses and compensation of whatever kind or nature on account of or in any way growing out of any and all personal injury and property damage and consequences thereof, and for any damages which may develop at some time in the futura, and for any and all unforeseen developments arising from known or unknown injuries or property damage, including all claims resulting or to result from an accident which occurred on or about February 16, 2001, while traveling on Gilbert Road at or near the intersection of Airport Road in Southampton Township, Cumberland County, Pennsylvania. It is expressly understood and agreed that this Release and Settlement Agreement is intended to apply to and does apply to not only all known injuries, losses and damages, but further operates to release, acquit and forever discharge any and all claims or actions for any further injuries, losses and damages which arise from or may be related to the occurrence set forth in the lawsuit noted hereinabove, even if said injuries, losses, and damages are unknown at the this time and develop in the future. Page 1 of 3 It is understood and agreed that this settlement is a compromise of a doubtful and disputed claim, and that payment made is not to be construed as an admission of liability on the part of the parties hereby released, and that said Releasees deny liability and intend merely to finalize and avoid litigation and buy their peace It is further understood and agreed that this is the complete Release and Settlement ^greement, and that there are no written or oral understandings, or agreements, directly or indirectly connected with this Release and Settlement that are not incorporated herein. It is expressly understood and agreed that this Agreement and Release shall be binding upon and inure to the benefit of the successors, assigns, heirs, executors, administrators, and legal representatives of both Gary and Diana Hippensteel, individually, and as the parents and full legal guardians of the minor, Casey Hippensteel and Casey Hippensteel, individually, and the Releasees. GARY and DIANA HIPPENSTEEL, INDIVIDUALLY, AS THE PARENTS AND FULL LEGAL GUARDIANS OF THE MINOR, CASEY HIPPENSTEEL, HEREBY DECLARE THAT THE TERMS OF THIS RELEASE AND SETTLEMENT AGREEMENT HAVE BEEN COMPLETELY READ; THAT THEY HAVE HAD THE OPPORTUNITY TO DISCUSS THE TERMS OF THIS SETTLEMENT WITH LEGAL COUNSEL OF THEIR CHOICE; AND THAT SAID TERMS ARE FULLY UNDERSTOOD AND VOLUNTARILY ACCEPTED FOR THE PURPOSE OF MAKING A FULL AND FINAL COMPROMISE OF ANY AND ALL CLAIMS ON ACCOUNT OF THE DAMAGES AND LOSSES MENTIONED ABOVE AND FURTHER FOR THE EXPRESS PURPOSE OF PRECLUDING FOREVER AND FURTHER OR ADDITIONAL SUITS BY THEMSELVES OR THE MINOR, CASEY HIPPENSTEEL, ARISING OUT OF THE AFORESAID CLAIMS. [Remainder of page intentionally left blank] Page 2 of 3 of IN WITNESS WHEREOF, we have hereunto set our hands and seals this 2002. day CAUTION~ READ BEFORE SIGNING Gary Hippensteel, individually and as the parent and full legal guardian of the minor, Casey Hippensteel On this day of 2002, before me personally appeared Gary Hippensteel, known to me as the person who executed the foregoing Release, and who acknowledged to me that he voluntarily executed same. NOTARY PUBLIC Diana Hippensteel, individually and as the parent and full legal guardian of the minor, Casey Hippensteel On this day of 2002, before me personally appeared Diana Hippensteel, known to me as the person who executed the foregoing Release, and who acknowledged to me that she voluntarily executed same. NOTARY PUBLIC Page 3 of 3 VERIFICATION We, Gary and Dianna Hippensteel, Petitioners in this action hereby verify that the statements made in the foregoing Petition to Settle or Compromise Minor's action are true and correct to the best of our information, knowledge and belief. We understand that the statements in said Petition are made subject to the penalties of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities. Gary I~pen~teel: p~rent and natural guardian of Casey Hippensteel, a minor DTar~a~il;:)p~m~t4e~, parent and natural guardian of Diana Hippensteel, a minor Dated: IN RE: ESTATE OF CASEY HIPPENSTEEL, a minor, by and through her parents and natural guardians, GARY and DIANNA HIPPENSTEEL COURT OF COMMON PLEAS OF CUMBERLAND COUNTY - CIVIL DIVISION No. - 9'77 ENTRY OF APPEARANCE Please enter my appearance in the above-captioned action. Respectfully submitted, McKissock & Hoffman, P.C. Date: By: B. Craig Black, Attorney I.D. No. 36818 Edwin A.D. Schwartz Attorney I.D. No. 75902 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 IN RE: ESTATE OF CASEY HIPPENSTEEL, a minor, by and through her parents and natural guardians, GARY and DIANA HIPPENSTEEL COURT OF COMMON PLEAS OF CUMBERLAND COUNTY- CIVIL DIVISION No, 02-977 Civil Term PRAECIPE Please mark the above captioned matter as settled and satisfied and dismissed with prejudice. Respectfully submitted, Gary Hipp~nstee~ as the parent and legal guardian of the minor, Casey Hipensteel Diana Hippenstee ,'17'as'~h'e parent and legal guardian of the minor, Casey Hipensteel On this g~, day of '~002, before me personally appeared Gary Hippensteel and Diana Hippensteel, known to me as the persons who executed the foregoing Praecipe, and who acknowledged to me that they voluntarily executed same. NOTARY PUBLIC