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HomeMy WebLinkAbout03-31-06 IN RE CHARLES W. OVERTON, An Alleged Incapacitated Person IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL DOCKET NO.: 21-06-257 ORPHANS' COURT DIVISION PETITION FOR APPOINTMENT OF PLENARY GUARDIAN OF THE PERSON AND ESTATE AND NOW, comes the petitioner, Helena Train, by and through ABOM & KUTULAKIS, L.L.P., and files this Petition pursuant to Title 20 Pa.C.S.A. ~ 5511 and in support thereof avers the following: The alleged incapacitated person is Charles W. Overton (hereinafter "Overton"), 1. Overton's date of birth is January, 9, 1915. Overton is 91 years old. 2. Overton is currently a resident of Loyalton of Creekview, 1100 Grandon Way, Mechanicsburg, Cumberland County, Pennsylvania. 3. Overton was predeceased by his wife, Patricia Overton, on July 31, 2005. 4. Insofar as the Petitioner has been able to ascertain, the persons who are heirs under the intestacy statute in Pennsylvania are: Name Charles Overton, Son Address c/o Linda Overton, Guardian 85 Gay Street, Salisburg, Pennsylvania 15558 Helena Train, Daughter 3802 Dorset Drive, Mechanicsburg, Pennsylvania 1705Q \. ') Each of the above will be notified of these proceedings ---I 5. The following-named agency from which Overton is receiving assistance Will be, notified of the proceedings: Loyalton of Creekview, 1100 Grandon Way, --'..1 Mechanicsburg, Pennsylvania 17050. c.) -.J (,) e:1 (.Il 6. Bill Webster is the biological son of Overton. Mr. Webster was adopted by another man and Overton's parental rights were terminated when Mr. Webster was adopted. Therefore, Bill Webster is not a presumptive adult heir and will not be notified. 7. Petitioner is Helena Train (hereinafter "Petitioner") of 3802 Dorset Drive Mechanicsburg, Cumberland County, Pennsylvania. Petitioner is the daughter of Overton. 8. Petitioner has no interest adverse to the alleged incapacitated person, Overton. 9. Petitioner is legally qualified and suitable to be Guardian of the Person and Estate of Overton. 10. Guardianship is sought to protect Overton's health and property. 11. Overton was diagnosed by Doctor Yolanda Agredano in California on Marth 17, 2006 with demential Alzheimer's disease. (See Diagnosis labeled Exhibit "A.") 12. Overton is incapacitated by this mental disease to the extent that he lacks sufficient understanding or capacity to make or communicate decisions to meet the essential requirements for his health or safety or to manage his estate. 13. Overton was removed from his home by Bill Webster in late February. 14. Bill Webster is a biological son of Overton with Overton's first wife. After Overton and mother of Mr. Webster divorced, she was remarried. Her new husband adopted Mr. Webster, which terminated Overton's parental rights and responsibilities. 15. Bill Webster removed Overton from Arkansas without giving notice to either of Overton's children, who are Helena Train and Charles Overton. 16. Bill Webster had Overton involuntarily committed to a VA hospital in California on February 28, 2006. The involuntary commitment lasted 72 hours. 17. Overton "voluntarily" committed himself for an additional 14 days on March 3, 2006. 18. Once Petitioner became aware of Overton's location, she traveled to California and brought him to Pennsylvania. 19. Overton was placed in the Loyalton of Creekview in Mechanicsburg, Pennsylvania on March 21, 2006 in the dementia unit. 20. In Doctor Yolanda Agredano's diagnosis, which is attached as Exhibit "A," it is stated that Overton's mental condition affects his ability to make medical decisions. 21. In Doctor Yolanda Agredano's diagnosis, which is attached as Exhibit "A," it is stated that Overton's mental condition affects his ability to manage his own cash resources. 22. In Doctor Yolanda Agredano's diagnosis, which is attached as Exhibit "A," it is stated that Overton's mental condition affects him so he is unable to leave the facility on his own, therefore he needs constant supervision. 23. There is presendy no Guardian of the Person or Estate for Overton. 24. There is presendy no known Power of Attorneys for Overton. 25. Overton does not have the mental capacity to consent to a Power of Attorney. 26. An appointment of a guardian is only remaining option to protect Overton's health and property. 27. Overton is unable to handle his financial affairs; therefore an appointment of a plenary guardianship over his estate is requested. 28. Overton is unable to make informed decisions about his healthcare including decisions regarding medical procedures and prescription medicines; therefore an appointment of a plenary guardianship over his person is requested. 29. The guardianship is sought to protect Overton from unscrupulous or designing persons that may take advantage of Overton. 30. Overton is living in a monitored demential Alzheimer's wing of a nursing home. 31. The Petitioner is Overton's daughter and she is qualified to be the guardian. 32. Petitioner is unable to access Overton's personal accounts or information, which is needed to ffianage Overton's income flow and property. 33. It is believed and therefore averred that damage to or loss of Overton's property may occur if a guardian is not appointed to handle his financial matters. 34. It is believed and therefore averred that Mr. Webster may have access to certain personal property of Overton and it is unknown if he has disposed of any of Overton's assets. 35. Insofar as Petitioner is able to ascertain, Overton's assets and income consist of the following: a. A bank account, certificate of deposit, personal vehicle, furniture and personal possessions with a combined total value in excess of $50,000; b. Pension and retirement benefits totaling approximately $6000 per month; c. Home located at 1180 Rivercrest Drive, Little Rock, Arkansas, value unknown; d. And potential assets of the Estate of Patricia Overton, Overton's deceased wife, value unknown, which have not been probated. WHEREFORE, in order to prevent irreparable harm to the estate and health of the alleged incapacitated person, Petitioner respectfully requests this Honorable Court appoint her to be the plenary guardian of estate and person for Charles W. Overton. Respectfully Submitted, 3-Y""tJ ~ Date J on P. Kutulakis, Esquire. ttomey LD. No. 80411 36 South Hanover Street Carlisle, P A 17013 (717) 249-0900 Attorney for Petitioner 1M & KUTULAKIS, L.L.P. MAR-31-2006 13:33 OHA, HARRISBURG, PA 717 236 3150 P.007 VERIFICATION 1, HELENA TRAIN, hereby verify 1hat the statements contained in this oomplaint are ttue and col'rect to the best of my knowledge, information~ and belief. I undetstmd that false statements herein arc made subject to the penalties of 18 Pa.C.s. $ 4904. relating to unswom fa1si6cation to authorities. .1.t a\ \dOO CQ Date -l:lJP~lL ~~ HELENA TR.J\IN ;";"1." "~'I or CAlIFOf.(N'A . J.iFAl11-4 AND i-Il,~.l"..N : :EP'/Il:es /-CENGY CALIr(lf'NII> 'j(p^n'Mu~r i;!" ',,')Ci,'l ;,j:r.\, PHYSICIAN'S REPORT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RePE) I. FACILITY INFORMATION (To be completed by the licensee/designee) 1. NAME OF FACILITY l75~E'~ fV(ft(v.AL:..-/2(' r E 3, ADDRESS .. .~~~._.._.tw:)4 . f~ve---~- 4. LICENSEE'S NAME ~ '. ; ~'~- 11' 7? .' e'5t;[j I i~7 -t'YItt I LiLt ..J(i, \ V ({CVUIL : h ~) 7" ( 7?(} I) 1 I .. ... II. RESIDENT/PATIENT INFORMATION (To be completed by the resident/resident's responsible per$OI 1. NAME :2. BIRT DATE '3. AGE C \\L~~} C\Je~--fGi~ r / 9 15 i q I III. AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION (To be completed by resident/resident's legal representative) 2. TELEPHONE (c:':".V ) '! / I ~ . ~ .. ~(, -, f'" t CITY LJ~: I'Y1Jf2 ~...-'.. .~~~. f':'.,. ..- : 5. TELEPHONE zfp CODE . Cl I Sl.5~~c 6.' FAC,UTYLiCENSE NUrVlBI I hereby authorize release of medical information in this report to the facility named abOVE 1. SiGNAfUREO'F RESloENTANOioFrREsTI5ENfis LEGAL REPR'ESENfAfiVE' 2. ADDRESS i:-f bATE ! .L IV. PATIENrS DIAGNOSIS (To be completed by the physician) NOTE TO PHYSICIAN: The person named above is either a resident or prospective resident of residential care facility for the elderly licensed by the Department of Social Services. The license requirE the facility to provide primarily non-medical care and supervision to meet the needs of that persDI THESE FACILITIES DO NOT PROVIDE SKILLED NURSING CARE. The information that you provlc about this person is required by law to assistin determining whether the person is appropriate for care i this non-medical facility. It is important that all questions be answered. (Please attach separate pages if needed.) ..--...-.-.-.......-......--............-.----..y-..--..... .... .c....-............ -.. .,. ....-......................-.............. .... .. 1. D J"E 9f EXtM. i 2. SEX i 3. _HEIGHT : 4. WEIGHT .1 5. ~LOOp P~ESSLiRE ;)'()) blD I ~v\ttk : .> : ,,1-5./x I ,:f(-( 77 6. TU ER ULOSIS (TB) TEST ' ~I~6i ~TvenrJr;rQibea-d,C:r[l! Th~f .. }~:~~eck.jffB;:~:~: e. Results: mm -6.P____ f. Action Taken (if positive): _____________________ g. Chest X-ray Results: _______________________________ h. Please Check One of the Following: ,~~.~~.~,~~-~s. .~;~"~~,~==-~. ,.. ~~,?,:,~~~~,~,~...'~:e:~~~~... ,~~/~O, ~~~d~~~e of~B" Infect~~n .or...~is~~se LIe <02... (1210<) (CONFIDENTIAL) . PAGE 1 or ( EXRIBIT I 1+ 7. PRIMARY DIAGNOSIS: a. Treatment/medication (type and dosage)/equipment: Al~liC!l\le(S den \C{m~9. kelincu\.h .h~, l ~ ~"'-) '^" Q H <) i\'\t;n~t.,\:ti \'\ t... ~ ~ \7'0 U/f\"M Can patient manage own trea!ment/medicafion/equipment? b. . Yes ~o c. If not, what type of medical supervision is needed? lv\ed\lL.~,-,\;\0V'- 14t~v'\U""l ~ ~ ~t..-kDf\ 8. SECONDARY DIAGNOSIS(ES): hv pe.r Tt-~.\SI'CV\ a. Treatment/medication (type and doLge)/eqUiPment: (.LMloJ.ie\ne- I bft\a1eel11' '1- Cttp5uJe. ~?lj)c.{J ~ rt~~ Jr( I'\'l&~ ('f ~D b. Can patient manage own treatment/medication/equipment? yO QP [J Yes ~No c. If not. what type of medical supervision is needed? v'v-.U.:'L 0~C'\, ~~~Jfv c~~ (JV'V -.-.--------------..-----.--------------.---..-..-....--~.._-._,--_.._--.._- - -..-----,..---..--.--..--- -'---..-'. 9. CHECK IF APPLICABLE TO 7 OR 8 ABOVE: U Mild Coanitive Imoairment: Refers to people whose cognitiye abilities are in a "conditional state between normal aging and dementia. y?ementia: The loss of intellectual function (such as thinking, remembering, reasoning, exercisin! judgement and making decisions) and other cognitive functions, sufficient to interfere with al individual's ability to perform activities of daily living or to carry out social or occupational activities. .-. ....-.---.-----.--.-- -'~---" ----------~._. .--.- ----_.~- --_.- 10. CONTAGIOUSIINFECTIOUS DISEASE: .J..- v\...uv a. Treatment/medication (type and dosage)/equipment: b. Can patient manage own treatment/medication/equipment? [i Yes c. If not, what type of medical supervision is needed? CJ No -..., __'.m_.__________.__..__.~____..._._,_____ - -.' .-______.__.___ _"_H_.__ ...-_______.__..._ ..---"..---___.___........___...___.__u...._..._,..._..__.__..__'.......__. _.. _..._._. _ uo ...---.-.-------.--....------ -- -,,-'--'-'- -_.---_....--"_.. ._.-_.,._---_..__.._-.__..._-~--._.~.._-----_..._--.. -_._-_..---,----_._~.- .-............ --- ..---..--.-.- -". C 002A (12/0.4) (CONFIDENTIAL) PAGE 2 OF B 11. ALLERGIES: _N(,.'~\-\ a. Treatment/medication (type and dosage)/equipment: b. Can patient manage own treatment/medication/equipment? c. If not, what type of medical supervision is needed? : Yes No 12. OTHER CONDITIONS: a. TreatmenUmedication (type and dosage)/equipment b. Can patient manage own treatment/medication/equipment? [J Yes c. If not, what type of medical supervision is needed? i] No -.---------------.--.-- u_ ------ --,----- ,- nU T-- ----. - -. ----P-.. 13. PHYSICAL HEALTH STATUS I YESt~O jASSISTIV~ DeVICE (If applicable) -- ----------- ...--.--1--.- - -- -,. ----- --- - - ----- -.-- -.--- -.---- - - --- - ~ :~~:::~~~-==- - - ~~=~~- f-~~=!~~.-=: -: ==-=---=--:~==~-- ;~:;:J.~:;lthe~i" --u--L ~ f--l~' )~'. ".~~ ~-(.,j-~'--- -~ '..:--lg-l~O---~ - - ------- r' -' +------ _____.._.___.(1I.v____) b I__.\c~v.ttul t..- --- ~-- f. Substance Abuse Problem! ! /" I -- -.--.,..---.-.-- ------. ---------.... -- +- -. .- -'-r---'-'--- -1" --.-.. ..----... -. .--_. - _.--. -.r..... g. Use of Alcohol i,. I .-.-.---- --- -- - -. -- _______.._.u - - ".'-i --- ...-- }L_._ --..t---- --.-----.- ------ - . --.....- . ---....,--- -... - ..---.--....-- - -...-- h~.~:.e_?.!~~ga~~e~__..__ _ .__! f./ ~ __ I i. Bowel Impairment '! ....... L T ---.-.------.---...-----...-.------....- _-1-.. -"--' -.-------...---.h.---.t---- ------.---- ...-------......--.-- ..--..----- j. Bladder Impairment ! i""-! : ..-------------------..--- -.-. --1-- _1_ .....-.-------..-- ________1_.__________._. --------..------- ---__..__.. k. Motor ImpairmenUParalysis! ! ,/' I i -- ------.-------------,---- ,.--- -- . - -- 7'-- .- .+- -----.... ---.. -------- .-....--- .-T---- - .-.-,..- -,,--- -.--.. --- .. -. .- --.---- I. Requires Continuous f! ! /" I Bed Care I i -_. ----------------------. ____po '---- -- ..--.-- ---t--- . -_.1__ ------- ------.---. - ... --... ------.._----, ----- ---- ---, _n________ --- .. -.--- --. m. History of Skin Condition , I / I --" cocc ~~ Br.e~~~~~. ,.""=~"-==,~=" 7 --~ c,_."Jc"", ___-__=-..1,,,_ _,-==l=c,,~,_=-""cc, =-~",,=,---_~=J=7" _.,_.=__-~"'_"=- '_=__7""'__=='=-'="""..0_"" _"'".. EXPLAIN 602A j12m<l) (CONFlOENllAL) PAGE 30F6 t~. MENTAL COND.I!ION a. Confused/Disoriented b. Inappropriate Behavior YES NO ----. EXPLAIN .~ !/ ...,,/ i I ...---- ; r" .~ .. f. Able to Follow Instructions i.-----. _.. ._ ..,.-- ,. - - '.- f ..... .. - L " g. Depressed ,i /'" i ...._........_ -- .- ...---.... . ..-....p t- -. ......,---... I- h. Suicidal/Self-Abuse ::/ I l_A~~_~~ ~~~":~~~~t~t>leed~_I< l I j. At Risk if Allowed Direct I I Access to Personal k /f" Grooming and Hygiene Items I - .-..,..-. ---_._. _.._.-.-.< .~... ..-- .._,,- ,- ---~.,._,-_. - k. Able to Leave Facility ~~ Unassisted "'V 'Ii c. Aggressive Behavior d. Wandering Behavior e. Sundowning Behavior 15. CAPACITY FOR SELF-CARE EXPLAIN a. Able to Bathe Self i 1"..- j,/.....-. b. Able to Dress/Groom Self c. Able to Feed Self /... ./ d. Able to Care for Own ToUeting Needs -. --.-.------------.- ".--"- e. Able to Manage Own Cash Resources ,,/ 16. MEDICATION MANAGEMENT YES NO EXPLAIN a. Able to Administer Own Prescription Medications I / ._u -. - .--.--- -,---- --.- ------- .-- .--- r ---.- ---- -- - -- ... .......-- .-""-- .-..., ". ,..............-. :_~:;Z;~;;~:wn-- +-+~t - ...... - .-.-. d. ;~;~:;;~~;:; o~---I- --tt--~-~-- ~----- - --- -- ..... . ;--' -.t.....p....4- .............h_.._.. ..... ........_ ..'_h_ ...... e. Able to Administer Own ! I ~p.., i Oxygen I: I f-~~:i:~~~: Own. ]-j;7(- - uw.__._u mu____ --===-,-:';..:::=--=-~_~-==-~R~:'::::::::_ ':-._'"'_-_-::"=-~:-_ .,::-=:-=~-;- .-..""::.':. - ~ _.--~- =~-~==~===- --~::;:=-=- -:=-_::=.:;.;.:;~-.:=::---==---~=--~:...-=.- '~':';;:_-':-"::'=::",=-:-:=-:-"':'=:::'~:':' ::~~~:-;--,.- .":-.::.:;."":.._. Lie 002" (1211>1) (CONFiDeNTIAl I PAGE 4 Of" 6 L 1'1. AMBULATORY STATUS: a. This person is considered: /Ambulatory Nonambulatory , Bedridden Nonambulatory: Means persons unable to leave a building unassisted under emergel conditions. It includes any person who is unable, or likely to be unable, to physically and ment respond to a sensory signal approved by the State Fire Marshal, or to an oral instruction relatin~ fire danger, and persons who depend upon mechanical aids such as crutches, walkers, E wheelchairs. (Health & Safety Code Section 13131) Bedridden: Means either requiring assistance in turning and repositioning in bed, or being unable independently transfer to and from bed. except in facilities with appropriate and sufficient care st mechanical devices if necessary, and safety precautions. No residentshall be admitted or retainec a residential care facility for the elderly if the resident is bedridden, other than for a temporary illne or for recovery from surgery. (Health & Safety Code Section 1569.72) b. If resident is nonambulatory, this status is based upon: r i Physical Condition Mental Condition i ! 8.oth Physical and Mental Condition c. If a resident is bedridden, check one or more of the following and describe the nature of the illnes surgery or other cause: i~' IIness: ! : Recovery from Surgery: U Other: NOTE: An illness or recovery is considered temporary if it will last 14 days or less. ..../~ d. If a resident is bedridden, how long is bedridden status expected to persist? ,~r 1. (number of days) 2. _________ (estimated date illness or recovery is expected to end or when resident will no longer be confined to bed) 3. If illness or recovery is permanent, please explain: e. 15 resident receiving hospice care? ,~ i~.: Yes If yes, specify the terminal illness: G02^ 112KM1 ICONFIOEtIlIAL) PAGE50FG 18. PHYSICAL HEALTH STATUS: !. Good /Fair Poor 19. COMMENTS: 20.-PHysfClAN'S-NAME AND ADDRESS (PRlNT)"----- - ---.--.-..-.. - - - ----- ____._m -- -..--- ",\1 Wt.~;' -P\t\ 1i~~'"W \v\,P 21.--TELEPHONE- --- ---- .-- -.--!-22.-Te-NGTii- OF- TIMERESiDE~lfHASBEEN-VbuifpAtiE~tf 2;~Y~I~~5~';~;T~EL_-J':L~---:24:DAf- --.. ____d_ .~&~f?<~~_Cj~_d~ \(5 is-~<Sd_d~._ e,<i~it . ........-....----. ......_---,..-."-",,, PRN AUlb()riz~ltjon Let:ter Hate: near Dr: Rc: Your Pllticnt: C. ~1\1:t {L \x",]; () t~fl:h"~>IJ To receive nonprescription and prescription PRN medications, state licensing requires that either: 1. your patient he capable of determining hislher own need for the medication, or 2. for nonprescription medication only, be able to clearly communicate his/her symptoms. If your patient cannot determine his/her need for a medication, or clearly commlmicate the symptoms for a nonprescription medication, then you the physician, must he contacted before the PRN medication can be given. Your completion of this form will serve to document your patient'! current ability to determine hislher own need for these medications. As a licensed care provider, it is my responsibility to monitor your patient's continued ability to determine his/her own need for PRN medications and inform you of any changes which indicate he/she can no longt::r make these decisions. Thank you for your assistance. Signature Title (F :lei I ity represcnl ati yc) Facility Telephone No. Facility Fax No. Please check which circumstance descrihes your patient: '. ~y patent can determine and clearly communicate his/her need for prescription and nonprescription "medication on a PRN basis o . My patient cannot determine hislher own need for prescription and nonprescription PRN medication, but can clearly communicate hislher symptoms indicating a need for a nonprescription medication. [l My patient cannot determine his/her need for prescription and/or nonprescription PRN medication and cannot communicate hislher symptoms indicating a need for nonprescription medication. (must contact physician before each dose) Physician' Signature: '\\ 1''' \ ---f\v-+v'fJ (/ ..-1 ">- .---- ~bate: () /~- / ") \.. .' 3\. \) \ C<c. Standing PRN Orders Facility Name: -, ') tI er0 ~\t11'"\(jC~C: f t Facility Address: :3~~ b &\s-l -A-vf' . Facility Phone No: \.1.S- 4-~1- ^8770 Resident Name: C/ ({ C \.Q.,j ') BQ~';J Facility Fax No: as - tf'l-7- C~S-C~S PRN and ore Medications Please verity the PRN/OTC medication orders for your patient. Please initial and amend as necessary next to each medication order approved. /_.[J~OM... ............. ... EJ, ./ ./ . My/anta............... ../ //....r;epto-Bismol........ ./ .B TylenoL.........;... J// I Neosporin Oint. ... /r::l .........t.::::J Motnn..... .......... ~/Kao~e.......... 2 Tablespoons PRN for constipation. May repeat in 4 hours if no bowel movement. Not to exceed 4 Tablespoons in 24 hour period. 2 teaspoons every 4 hours PRN for stomach upset. Not to exceed 6 teaspoons in 24 hour period. 2 Tablespoons every 4 hours PRN for diarrhea. May repeat in one hour If no formed stool. Not to exceed 8 Tablespoons in 24 hour period and for no longer than 2 days 500 mg tabs. 2 tabs every 6 hours PRN for pain. Not to exceed 8 tabs in 24 hour period. Apply a small amount BID for minor first aid. 200 mg tabs. 1 tab every 6 hours PRN for pain. Not to exceed 4 tabs in 24 hour oeriod. 2 Tablespoons PRN for diarrhea. May repeat one time in 6 hours Patient is capable of determining hislher own need for PRN medications: 0 YES oNO Additional PRN Orders According to Title 22, Division 6, Chapter 8, Section 87575, all PRN orders must include: meclication name, specific symptoms indicating need, exact dosage, minimum hours between doses, and maximum doses in a 24 hour period. au r;\ Date f Q~. ~l. ~.. -r\O J-/ .; \ \ ~ \ O~. T~O.~ :~O'). \ (u ) I- \..-l q ~ ~-O D D)(. :}J-:) D~'- .J .. CERTIFICATE OF SERVICE r AND NOW, this ~ day of March, 2006, I, Kathleen A. Engle, Esquire, of Abom & Kutulakis, L.L.P., hereby certify that I did serve a true and correct copy of the foregoing PETITION FOR APPOINTMENT OF PLENARY GUARDIAN OF ESTATE AND PERSON upon the following: VIA UNITED STATES POSTAL DELIVERY FIRST CLASS MAIL Charles W. Overton c/o Jane Adams, Esquire 64 South Pitt Street Carlisle, P A 17013 Charles Overton c/o Linda Overton 85 Gay Street Salisburg, P A 15558 Ms. Sandra Gainor Executive Director Loyalton of Creekview 1100 Grandon Way Mechanicsburg, P A 17055 ABOM & KUTULAKIS, L.L.P. ~~ 36 South Hanover Street Carlisle, PA 17013