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Home My WebLink About06-6408IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA 902 Magnolia Drive Enola, PA 17025 COLLEEN T. KUBEIKA 902 Magnolia Drive Enola, PA 17025 Plaintiff(s) & Address(es) PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue A Writ of Summons in the above-captioned action. Defendant(s) & Address(es) X Writ of Summons Shall be issued and forwarded to ( )Attorney (XX)Syeriff W. Scott Henning, Esquire 1300 Linglestown Road Harrisburg, PA 17108 Signature o omey (717) 238-2000 Supreme Court ID o: K 3 Name/Address/Telephone No. of Attorney Date: October 31. 2006 WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF(S) HAS/HAVE COMMENCED AN ACTION AGAINST YOU. &'4?zz' Pro onotary ` Date:. .)o(j , a OD(Q- ( ) Check here if reverse is used for additional information PROTHON. - 55 versus ( ) Equity No.nt. =Z.1 6 Civil Action - (XX) Law EDWARD L. KYLE 301 S. Filbert Street Mechanicsburg, PA 17055 by Deputy C Ca ^1 M1 L V C? 1 1 1 i F . -dill JOHN J. KUBEIKA and COLLEEN : IN THE COURT OF COMMON PLEAS T. KUBEIKA, : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff(s) V. NO. 06-6408 EDWARD L. KYLE, CIVIL ACTION -LAW Defendant(s) JURY TRIAL DEMANDED PRAECIPE TO THE PROTHONOTARY OF CUMBERLAND COUNTY, PENNSYLVANIA: Please re-issue the Writ of Summons in the above referenced matter. Please instruct the Sheriff of Cumberland County to serve the Writ upon Defendant Edward L. Kyle at: 301 S. Filbert Street Mechanicsburg, PA 17055 HANDLER, HENNIAIG & ROSENBERG, LLP By / 3v -6 Date: W. Scott Henning, q. /( I.D. #32298 1300 Linglestown Road Harrisburg, PA 17110 (717) 238-2000 Attorney for Plaintiff o Q 1 1 ?.. rCK' t-a 5 it 1 SHERIFF'S RETURN - REGULAR CASE NO: 2006-06408 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND KU13EIKA JOHN J ET AL VS KYLE EDWARD L WILLIAM CLINE , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon RDWARD L. KYLE the DEFENDANT at 1935:00 HOURS, on the 30th day of November 2006 at 301 S FILBERT STREET MECHANICSBURG, PA 17055 by handing to EDWARD KYLE a true and attested copy of WRIT OF SUMMONS together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: So Answers: Docketing 18.00 Service 19.36 Postage .39 Surcharge 10.00 R. Th mas Kline .00 47.75 12/01/2006 1•03.07 HANDLER HENNING ROSENBERG Sworn and Subscibed to By: before me this day 15eputy Sheriff of A. D. J . ? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, Plaintiffs v. EDWARD L. KYLE, Defendant CIVIL ACTION - LAW NO. 06-6408 CIVIL TERM JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE PURSUANT TO PA.R.C.P.1012 TO THE PROTHONOTARY: Kindly enter the appearance of Michael B. Scheib, Esquire, of Griffith, Strickler, Lerman, Solymos & Calkins, as attorney for the Defendant, Edward L. Kyle, in the above-captioned matter and mark the docket accordingly. GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS Date: January A 2007 1 f By: MICHAEL B. SCHEIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this A n d day of January, 2007, I, Michael B. Scheib, Esquire, a member of the firm of Griffith, Strickler, Lerman, Solymos & Calkins, hereby certify that I have this date served a copy of the Praecipe for Entry of Appearance Pursuant to Pa. R.C.P. 1012, by United States Mail, postage prepaid, addressed to the party or attorney of record as follows: W. Scott Henning, Esquire 1300 Linglestown Road Harrisburg, PA 17108 GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS By: MICHAEL B. SCHEIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle CZ2 9A } IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. EDWARD L. KYLE, Defendant PRAECIPE TO THE PROTHONOTARY: NO. 06-6408 CIVIL TERM JURY TRIAL DEMANDED Please enter a Rule upon John J. Kubeika and Colleen T. Kubeika, Plaintiffs, to file a Complaint within twenty (20) days from the date of the service of this Rule or suffer Judgment non-pros. Date: January J, , 2007 GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS , By: F U v"v_ MICHAEL B. 'CHEIB, ES 01 Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle NOW5 , 2007, RULE ISSUED AS ft ha A-x't 12 Prothonotary Deputy IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiff V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this ;Iq d day of January, 2007, I, Michael B. Scheib, Esquire, a member of the firm of Griffith, Strickler, Lerman, Solymos & Calkins, hereby certify that I have this date served a copy of the Praecipe for Rule to file a Complaint by United States Mail, postage prepaid, addressed to the party or attorney of record as follows: W. Scott Henning, Esquire 1300 Linglestown Road Harrisburg, PA 17108 By: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS MIC14AEL B. SCHEIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle r-? C? o ? ? ?? i?': ? '"' ?° ,?' ..r .?'-,??' 'r' {. ..?, ? -? ?-.: =? cr r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK . ss. Before me, a Notary Public in and for said Commonwealth and County, personally appeared Michael B. Scheib, Esquire, who, being duly sworn according to law, deposes and says that he caused to be served on W. Scott Henning, Esquire, Esquire, a true and correct copy of the original Rule to File Complaint filed in the above captioned matter, by U.S. Mail, Certified delivery, at 1300 Linglestown Road, Harrisburg, PA 17108, on the l Ph day of January, 2007. Date: January 2007 GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS l By: MICHAEL B. SCHEIB, ESQUI Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle Sworn and subscribed to before me this / V-"' day of January, 2007. Ca??taaoA- Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Carole E. Slagle, Notary Public City Of Yak, York County My Commission Expires July 26, 2008 My Commission Expires: Member, Pennsylvania Association Of Notaries F . - • Complete Iterrt$1, 2, and 3. Also complete Mm 4 if R bided oelh," Is desired. . PNnt you?.;ar1d address orr the reverse 10 tiffat Vile Call IbttlCl? 016 Card t0 your • A tech this card to the back of the maApiece, or on the front If space permits. 1. AvWo Addressed to: p)q 17i08 AW* B. RecoAd by (Parted Marne) { C. Det4 of D. Is delivery address different from Item 19 JU Yok If Yts, enter delivery address below: 0'I9o 3. SWYIWIWm EVOwdfied man O evess Meal 0 Registered m Receipt for MerdwWbo 0 Insured Matt 0 C.Q.D. 4. Restricted DellvW P ft Fee) 0 v" 2. AdMe Number 7004 2890 0004 4762 3804 (Arnow ism emit a leW fe Fpm 3811, Febury2w4 Domnic Return R.oepe iommae.wim IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. ; NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this / day of January, 2007, I, Michael B. Scheib, Esquire, a member of the firm of Griffith, Strickler, Lerman, Solymos & Calkins, hereby certify that I have this date served a copy of the Affidavit of Service, by United States Mail, postage prepaid, addressed to the party or attorney of record as follows: W. Scott Henning, Esquire 1300 Linglestown Road Harrisburg, PA 17108 (Counsel for Plaintiffs) GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS /1) A. i ! ! n !' 4 By: MICHAEL B. S , ESQL Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle ? r _? r' ,? ,?-,? m:?.a c : ? _ ? ? _.. ii ? ? °'C; i -, = ,. r 1? .?_> .? ? ti? `T,1 C •? ;.? ?.: W. Scott Henning, Esquire I.D.#32298 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorney for Plaintiff Fax : (717) 233-3029 E-mail: Henning@HHRLaw.com JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, his wife, Plaintiffs V. EDWARD L. KYLE Defendants : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-6408 : CIVIL ACTION -LAW 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 Plaintiff. 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Service 4th Floor, Cumberland County Courthouse Carlisle, PA 17013 (717) 240-6200 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan m6s adelante en las siguientes paginas, debe tomar acci6n dentro de los pr6ximos veinte (20) dias despues de la notificaci6n de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar acci6n como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamaci6n o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted puede perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Service 4th Floor, Cumberland County Courthouse Carlisle, PA 17013 (717) 240-6200 HANDLER, HENNING & ROSENBERG, LLP By: FAWP Directories\TFC1Complaints\MVA\Backingup\Kubeika.wpd JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, his wife, Plaintiffs V. EDWARD L. KYLE Defendants : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-6408 CIVIL ACTION - LAW COMPLAINT AND NOW come the Plaintiffs, John J. Kubeika and Colleen T. Kubeika, by and through their attorneys, HANDLER, HENNING & ROSENBERG, LLP, by W. Scott Henning, Esq., and make the within Complaint against the Defendant, Edward L. Kyle aver as follows: 1. Plaintiff, John J. Kubeika, is an adult individual currently residing at 902 Magnolia Drive, Enola, Cumberland County, Pennsylvania 17025. 2. Plaintiff, Colleen T. Kubeika, is an adult individual currently residing at 902 Magnolia Drive, Enola, Cumberland County, Pennsylvania 17025. 3. Defendant, Edward L. Kyle, is an adult individual currently residing at 301 S. Filbert Street, Mechanicsburg, Cumberland County, Pennsylvania 17055. 4. At all times material hereto, Plaintiff, John J. Kubeika, was the operator of a 2004 Chrysler Sebring bearing Pennsylvania registration number FBY4048, owned by his employer, Dryfoos Insurance (hereinafter "Plaintiff's vehicle"). 5. At all times material hereto, Defendant, Edward L. Kyle, was the owner and operator of a the vehicle that struck the Plaintiff's vehicle (hereinafter "Defendant's vehicle"). 6. At all times material hereto, Plaintiffs, John J. Kubeika and Colleen T. Kubeika, were covered under an automobile insurance policy issued to, John J. and Colleen T. Kubeika, by Geico Insurance Company. Said policy included the full tort option pursuant to 75 Pa. C.S.A. § 1705. 7. At all times material hereto, there were no adverse weather or road conditions. 8. On or about November 5, 2004, at approximately 8:48 am, Plaintiffs vehicle was lawfully stopped at a stop light at the intersection of Lambs Gap Road and Carlisle Pike in Mechanicsburg, Cumberland County, Pennsylvania. 9. At approximately the same time and place, the Defendant's vehicle, was stopped directly in front of Plaintiffs vehicle at the stop light driven at the intersection of Lambs Gap Road and Carlisle Pike in Mechanicsburg, Cumberland County Pennsylvania. 10. At approximately the same time and place, Defendant's vehicle moved backward suddenly and without warning, striking Plaintiffs vehicle. 11. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, sustained personal injuries, as set forth more specifically below. -2- COUNT I - NEGLIGENCE JOHN KUBEIKA v. EDWARD KYLE 12. Paragraphs 1-11 are incorporated herein as if fully set forth below. 13. The occurrence of the aforementioned collision and all the resultant injuries to Plaintiff, John J. Kubeika, are the direct and proximate result of the negligence, carelessness, and/or recklessness of the Defendant, Edward L. Kyle, generally and more specifically as set forth below: (a) In driving his vehicle in careless disregard for the safety of persons or property in violation of 75 Pa.C.S.A. § 3714; (b) In failing to be reasonably vigilant to observe the Plaintiffs' vehicle lawfully stopped; (c) In failing to have his vehicle under such control that it would not move backward into Plaintiffs vehicle; (d) In failing to operate his vehicle in such a manner that would allow him to apply the brakes and stop before striking the Plaintiffs vehicle; (e) In failing to have sufficient control of his vehicle, which would have allowed the vehicle to be stopped before doing injury to any person or thing likely to arise under the circumstances; and (f) In failing to be continuously alert, in failing to perceive any warning of danger that was reasonably likely to exist, and in failing to have his vehicle under such control that injury to persons or property could be avoided. 14. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, sustained injuries including, but not limited to, a cervical spine strain/sprain. -3- 15. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, has suffered a loss of income and will in the future continue to suffer a loss of income and/or earning capacity, to his financial detriment and loss. 16. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, has suffered physical pain, discomfort, and mental anguish, and he will continue to endure the same for an indefinite period of time in the future, to his physical, emotional, and financial detriment and loss. 17. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, has been compelled, in order to effect a cure for aforesaid injuries, to expend money for medicine and medical attention. 18. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, continues to receive treatment and incur expenses as a result of said injuries, and will most likely continue to do so in the future, to his detriment and loss. 19. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, has suffered a loss of life's pleasures and he will continue to suffer the same in the future, to his detriment and loss. 20. As a direct and proximate result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, John J. Kubeika, has been, and will in the future be, hindered from attending to his daily duties, to his detriment, loss, humiliation, and embarrassment. 21. Plaintiff, John J. Kubeika, believes and therefore avers that his injuries are permanent and serious in nature. -4- WHEREFORE, Plaintiff, John J. Kubeika, seeks damages from the Defendant, Edward L. Kyle, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interest and costs. COUNT II - LOSS OF CONSORTIUM COLLEEN KUBEIKA v. EDWARD KYLE 22. Paragraphs 1-22 are incorporated herein as fully set forth below. 23. As a result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, Colleen T. Kubeika, has suffered a loss of consortium, society, and comfort from her husband, John J. Kubeika, and she will continue to suffer a similar loss in the future. 24. As a result of the negligence of the Defendant, Edward L. Kyle, the Plaintiff, Colleen T. Kubeika, has been compelled, in order to effect a cure for her husband's injuries, to spend money for medicine and medical attention and will be required to spend money for the same purposes in the future, to her great detriment and loss. WHEREFORE, Plaintiff, Colleen T. Kubeika, seeks damages from Defendant, Edward L. Kyle, in an amount in excess of the compulsory arbitration limits of Cumberland County. Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP Date: C)- ? By: VV. Scott Henn' sq. I.D. # 32298 1300 Linglest n Road Harrisburg, P 17110 (717) 238-2000 Attorneys for Plaintiff -5- VERIFICATION The undersigned hereby verifies that the statements in the foregoing document are based upon information which has been furnished to counsel by me and information which has been gathered by counsel in the preparation of this lawsuit. The language of the document is of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the document are that of counsel, I have relied upon my counsel in making this Verification. The undersigned also understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. John J. Kub- a Zo07 Date: /0 /EAld^ HANDLER, HENNING & ROSENBERG, LLP W. Scott Henning, Esquire ID #32298 1300 Linglestown Road Harrisburg, PA 17110 717-238-2000 JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, his wife, Plaintiffs V. EDWARD L. KYLE Defendants : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA NO. 06-6408 CIVIL ACTION - LAW CERTIFICATE OF SERVICE On February 22, 2007,1 hereby certify that a true and correct copy of Plaintiffs Complaint with Notice to Defend, was served upon the following by depositing in US certified mail: Michael B. Scheib, Esq. GRIFFITH STRICKLER LERMAN 110 South Northern Way York, PA 17402-3737 Respectfully Submitted, HANDLER, HMNIN Date: February 22, 2007 By: `/ l? W. Scott Hen ,\F-Iqui RG, LLP C) ti3 ? ; N .13 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED NOTICE TO PLEAD TO: John J. Kubeika and Colleen. Kubeika c/o W. Scott Henning, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 You are hereby notified to file a written response to the enclosed New Matter within twenty (20) days from service hereof or a judgment may be entered against you. GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS Date: March 5, 2007 By: MICHAEL B. ?SCHEIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF THE DEFENDANT, EDWARD L. KYLE COME NOW, the Defendant, Edward L. Kyle, by and through his attorneys, Griffith, Strickler, Lerman, Solymos & Calkins and Michael B. Scheib, Esquire, and responds to the allegations in Plaintiffs' Complaint as follows: 1. Denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 1 of Plaintiff's Complaint, and the same are denied and strict proof thereof is demanded. 2. Denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 2 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 3. Admitted. 4. Admitted in part, and denied in part. It is admitted that Mr. Kubeika was the operator of said vehicle. The remaining allegations are denied. 5. Admitted. 6. Denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 6 of Plaintiff's Complaint, and the same are denied and strict proof thereof is demanded. 7. Admitted. 8. Denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 8 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 9. It is admitted that Defendant's vehicle was stopped at said intersection. The remaining allegations are denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 9 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 10. It is admitted that the vehicles came into contact with one another. The remaining allegations are denied. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 10 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 11. Denied. This paragraph states a legal conclusion to which no response is required. 2 COUNT I - NEGLIGENCE JOHN KUBEIKA v. EDWARD KYLE 12. Paragraphs 1 through 11 of Defendant's Answer with New Matter are incorporated herein as though fully set forth at length. 13. Denied. This paragraph states a legal conclusion to which no response is required. On the contrary, and at all times relevant, Defendant, Edward L. Kyle, acted in a lawful, careful, safe and prudent manner and with due care as required by the circumstances. 14. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 14 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 15. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 15 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 16. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 16 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 3 17. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 17 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 18. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 18 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 19. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 19 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 20. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 20 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 21. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the 4 allegations set forth in paragraph 21 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. WHEREFORE, the Defendant, Edward L. Kyle, respectfully requests this Honorable Court to enter judgment in his favor, together with the costs of this lawsuit. COUNT II - LOSS OF CONSORTIUM COLLEEN KUBEIKA v. EDWARD KYLE 22. Paragraphs 1 through 21 of Defendant's Answer with New Matter are incorporated herein as though fully set forth at length. 23. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 23 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. 24. Denied. This paragraph states a legal conclusion to which no response is required. To the extent a response is required, after reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth or veracity of the allegations set forth in paragraph 24 of Plaintiffs' Complaint, and the same are denied and strict proof thereof is demanded. WHEREFORE, the Defendant, Edward L. Kyle, respectfully requests this Honorable Court to enter judgment in his favor, together with the costs of this lawsuit. 5 BY WAY OF FURTHER DEFENSE: NEW MATTER 25. Paragraphs 1 through 24 of Defendant's Answer with New Matter are incorporated herein as though fully set forth at length. 26. Plaintiffs injuries, if any, were caused by events which either predated or postdated the motor vehicle accident which is the subject of this lawsuit. 27. Plaintiffs injuries, if any, were caused by the acts and omissions of a third party over whom Defendant had no control. 28. Plaintiffs injuries, if any, were caused by his own contributory and/or comparative negligence. 29. Plaintiffs injuries may be barred or limited by the Pennsylvania Motor Vehicle Financial Responsibility Law. 30. Plaintiff's recovery, if any, may be barred or limited by a Limited Tort selection. WHEREFORE, the Defendant, Edward L. Kyle, respectfully requests this Honorable Court to enter judgment in his favor, together with the costs of this lawsuit. GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS aidFF- Date: March 5, 2007 By: MICHAELIB. S EIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle 6 VERIFICATION I, Edward L. Kyle, the Defendant in the foregoing action, hereby verify that the statements made in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my personal knowledge or information and belief, as well as reports, records, conferences and other investigatory material made available to me. To the extent that the foregoing contains averments which are inconsistent in fact, I verify that my knowledge or information is sufficient to form a belief that one or more of them is true, although I am currently unable, after reasonable investigation, to ascertain which of the inconsistent averments are true. To the extent that the foregoing contains legal conclusions or opinions, I hereby state that my Verification is made upon the advice of counsel, upon whom I have relied in the filing this document. This Verification is made subject to the penalties of 18 Pa.C.S. § 4904 related to unworn falsifications to authorities. Date: S 7-A 12007 f Edward L. Kyle IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and CIVIL ACTION - LAW COLLEEN T. KUBEIKA, Plaintiffs V. NO. 06-6408 CIVIL TERM EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this 5th day of March, 2007, I, Michael B. Scheib, Esquire, a member of the firm of Griffith, Strickler, Lerman, Solymos & Calkins, hereby certify that I have this date served a copy of the Answer with New Matter of the Defendant, Edward L. Kyle, by United States Mail, postage prepaid, addressed to the party or attorney of record as follows: W. Scott Henning, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 (Counsel for Plaintiffs) GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS By: MIC L B. S EIB, ES UIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle r? t C7 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and NO. 06-6408 COLLEEN T. KUBEIKA, Plaintiffs V. CIVIL ACTION - LAW EDWARD L. KYLE, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE AND NOW, this 18th day of March, 2008, I, Michael B. Scheib, Esquire, a member of the firm of Griffith, Strickler, Lerman, Solymos & Calkins, hereby certify that I have this date served a copy of Defendant's Answers to Plaintiffs' Interrogatories, by United States Mail, postage prepaid, addressed to the party or attorney of record as follows: W. Scott Henning, Esquire Handler, Henning & Rosenberg, LLP 1300 Linglestown Road Harrisburg, PA 17110 (Counsel for Plaintiffs) GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CALKINS By: MICHAEL B. SCHEIB, ESQUIRE Supreme Court I.D. No. 63868 110 South Northern Way York, PA 17402-3737 Attorney for Defendant, Edward L. Kyle r-a ? ? -r? ? ?". ? ...? .. ,?,? t ? .?" r ??. W; "?' f. ? ? , 4 ? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, Plaintiffs V. EDWARD L. KYLE, Defendant CIVIL ACTION - LAW NO. 06-6408 CIVIL TERM PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE JUDGES OF SAID COURT: Michael B. Scheib, counsel for the defendant in the above action respectfully represents that: 1. The above-captioned action is at issue. 2. The claim of the plaintiff in the action is less than $50,000.00. The defendant has not filed a counterclaim. Only the attorneys and firms representing the parties to the action are interested in the case and disqualified to sit as arbitrators. WHEREFORE, your petitioner prays you Honorable Court to appoint three arbitrators to whom the case shall be submitted. Date: GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CA INS By: MICHAEL B. S HEIB, ESQUIRE #63868 110 South Northern Way, York, PA 17402 Attorney for Defendant, Edward L. Kyle ORDER OF THE COURT AND NOW, this day of , 2008, in consideration of the foregoing petition, , Esquire, , Esquire, and , Esquire are appointed arbitrators in the above captioned action as prayed for. By the Court: Edgar B. Bayley, P.J. ?? d rw? r ? 41? cc? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, Plaintiffs CIVIL ACTION - LAW V. EDWARD L. KYLE, Defendant NO. 06-6408 CIVIL TERM PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE JUDGES OF SAID COURT: Michael B. Scheib, counsel for the defendant in the above action respectfully represents that: 1. The above-captioned action is at issue. 2. The claim of the plaintiff in the action is less than $50,000.00. The defendant has not filed a counterclaim. Only the attorneys and firms representing the parties to the action are interested in the case and disqualified to sit as arbitrators. WHEREFORE, your petitioner prays you Honorable Court to appoint three arbitrators to whom the case shall be submitted. GRIFFITH, STRICKLER, LERMAN, SOLYMOS & CA INS Date: By: MICHAEL B. S HEIB, ESQUIRE #63868 110 South Northern Way, York, PA 17402 Attorney for Defendant, Edward L. Kyle ORD OF THE COURT N NOW, this day of 008, in consideration fthe foregoi g p ition, Ah. Esquire, , Esquire, and Esquire are a ointed arbitrators in the a love captioned action as prayed for. B Qu_? Edgar B. Bayley, P.J. r _a c Cz? I t: Cs l LL LL- C-j M? W 4? W. Scott Henning, Esquire I.D.#32298 HANDLER, HENNING & ROSENBERG, LLP 1300 Linglestown Road Harrisburg, PA 17110 Telephone: (717) 238-2000 Attorney for Plaintiffs Fax : (717) 233-3029 E-mail: Henning@HHRLaw.com JOHN J. KUBEIKA and COLLEEN T. KUBEIKA, his wife, Plaintiffs : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA V. EDWARD L. KYLE Defendants : NO. 06-6408 : CIVIL ACTION -LAW PLAINTIFF'S ARBITRATION EXHIBITS In accordance with Pennsylvania Rule of Civil Procedure 1305(b), the following documents are attached which the Plaintiff intends to introduce into evidence at the time of the arbitration of this case: 1. Medical Records from Keystone Care PT 12/22/2004 through 1/19/2005 2. Medical Records from Orthopedic Institute 12/28/2004 3. Medical Records from Hershey Medical Center 12/15/2004 4. Medical Records from Family Medicine Center 11/17/2004 5. Medical Records from Seidle Hospital 11/05/2004 Respectfully Submitted, Date: December 1, 2008 HANDLER, WNNIN By W. Ott Henn , LLP Milton S. Hershey Medical Center ® College of Medicine PHYSICAL THERAPY REFERRAL NAME: KUBEIKA, JOHN J MD: SHEEHAN JONAS M MR#: 1446763 DOB: 08/19!1961 INS: AUTO INSURANCE LOC: SURG OOS#: 5013233 MD#: 89110 SL-X: M STANDARD VISIT DATE: 12/15/2004 Admission Date: i Z- 2.2 _ 0 Patient's Name: Age: Outpatient: Inpatient: Room Number Doctor: Service: Phone: Diagnosis: g- j„i_k_f L Rx Frequency: ? Wt Date Rx: Rx: I Hot Pacs Ice Massage JOBST Compression Massage Moistaire Paraffin (d Traction Cervical Pelvic ___.1.Altrasound Ultraviolet/Cold Quartz Whirlpool Other EVALU,TION AND TESTING PROCEDURES T HERAPEUTIC EXERCISE Consult Coordination/Balance Activities of Daily Living Evaluation Gait Training Cardiac Rehabilitation Full Weight Bearing Cybex Partial Weight Bearing Goniometry/ROM Toe Touch Weight Bearing JOBST Measurement Non Weight Bearing 7 Manual Muscle Test Home Exercise Program Splint Fabrication Static Dynamic Isokinetic Exercise Other , Muscle Re-education Neuromuscular Facilitation MODALITIES Posture Training Cold Pacs Pre-prosthetic Training and Stump Conditioning Contrast Baths Progressive Resistive Exercise /Diathermy Prosthetic Training Electrical Stimulation ROM Active Active Aesistive * ENS HVGS Low Volt Electrostim 1801 Passive *TENS: Transcutaneous Electrical Nerve Stimulation', HUGS: High Volt Galvanic Stimulation Tilt Table Wheelchair Skills Other COMMENTS: 0 ?,, 0 L IU q_? Pap. Physician Signature 041VC1(%AI T44F12ADV 12=C=00A1 -- ,?? YSTNE CARE PHYSICAL' THERAPY { y Professional Therapy Services ` Hsf ' PATIENT INFORMATION SHEET p-S DATE: ^l??p '-? DIAGNOSIS: Nei/l i,,Ion' RwiN • 'wyLr/.CERIiiew4 ?J;st 13v4G"rEs- PATIENT INFORMATION RESIDENT: Y \ N SEY F vAME: I4yi+/ A -'054--i A DATE OF BIRTH: I/ -AGE: 43 kDDRESS: !?d o? M#40A 4L-:4 DW Af APT #= ZIP:1 boa 5' HOME PHONE: J^/7- 73Q7 / 34 CITY: 61-Wa4d STATE: SOCIAL SECURITY:---/. $5 - 6 6 ?O REFERRED BY. Dr. J-04; VIARITAL STATUS: (CIRCLE ONE) SINGLF ED DIVORCED WIDOWED DATE OF INJURY: ?(L A-Z I/ - [S YOUR CONDITION RELATED TO. AUTO ACCIDENT WORK RELATED \ FALL \ OTHER (Please describe) IF AUTO RELATED WERE YO : DRIVER PASSENGER BRIEFLY DESCRIBE YOUR INJURY: EMPLOYER INFORMATION STATU : FULL-TIME PART-TIME \ RETIRED STUDENT: FULL-TlME\PART-TIME WORK PHONE#: OCCUPATION: 1XfS1ZVA1r EMPLOYER: ZNSy.Pi?N S/?/? GLG EMPLOYER ADDRESS: tail- __A,&, WAY ??. rJX WIV ?+++++?+++?++++++?+++++++++++++f++?+++++++++++++i++++++++++++++++++++++++++++++++++ INSURANCE INFORMATION PRIMARY INSURANCE: 4115 - A-WNTi C 6 RV W0 INSURED: ADDRESS: Pd. PBX ??d /[ e*H nonD 1A 0W 3 O? 1 CLAIM\ID#: C/' I qw & ? 2 GROUP\POLICY#: ADJUSTER: rhn e4#64?k4a CO-PAY: DEDUCTABLE: PHONE#:j84?z 83 //?"3 PRE-CERT REQUIRED: YESWO PRE-CERT#: NUMBER VISITS ALLOWED: SECONDARY INSURANCE: INSURED: ADDRESS: CLAIM\ID#• GROUP\POLICY#: 1 South Front Street, Milton, PA 17847 - (570) 742-2453 - Fax (570) 742-2468 YES INO YES ?NO YES NO YES ?/ NO YES ,/ NO YES ? NO YES INO YES ? NO YES ? ?O YES " NO YES __7?NO YES ? NO PATIENT INFORMATION SHEET ALLERGIES ASTHMA\EMPHYSEMA ARTHRITIS CHEST PAH AANGINA DIABETES DIZZINESSWAINTING DIAGNOSED CARDIAC DISEASE HEADACHES HERNIA HIGH BLOOD PRESSURE YES -/ NO YES NO YES NO YES ? NO YES ? NO YES ? NO YES ?/ NO YES ? NO YES V? NO YES _2NO KIDNEY DISFUNCTION LUNG DISEASE METAL IMPLANTS OSTEOPEROSIS PACEMAKER SEIZURES SHORTNESS OF BREATH USE OF STEROIDS ARE YOU PREGNANT CIGERETTES (HOW MANY) RECENT OR EXCESSIVE WIGHT CHANGE? IF YES, EXPLAIN CANCER? IFYES, PLEASE SPECIFY ??iiiiiiiiiiiiiiiiiiiiiiliiiiiiiiiilili??iiliiiiiiiiiiiiiiiliiiiiiiiiiiii?iliiiiii? HAVE YOU EVER HAD ANY OF THE FOLLOWING FOR YOU CURRENT INJURY\CONDITION? YES el NO DATE Ct SCAN YES NO DATE EMG j l ? YES NO DATE hiRI t YES NO DATE /I X-RAYS'; t' t k 1 YES ? NO DATE BONESCAN i?iiiiiiiiiiiliiliiiiiiii!?iiiiiiiii?iiiiiiiiiiiiiiiiliiiiiiii?iiiiiiiiiiiiiiiiiii? PLEASE RATE YOUR HEALTH SEPARATE FROM YOU INJURY\CONDITION POOR IZ GOOD FAIR EXCELLENT DO YOU HAVE ANY ADDITIONAL QUESTIONS\MEDICAL CONDITIONS WE SHOULD BE AWARE OF? KEYSTONE CARE SPHYSICAL in Professional Therapy Services PHYSICAL THERAPY INITIAL EVALUATION ADMISSION DATE: 12-22-04 SOCIAL SECURITY #: 188-58-6670 PATIENT NAME: AGE: DOB: SEX: PHYSICIAN: John Kubeika 43 8-19-61 M Jonas Sheehan, MD Diagnosis: Neck and left upper extremity pain, multi cervical disc bulging. Patient's Present History: Patient is a 43-year-old white male who reports to our clinic with orders from Dr. Sheehan secondary to a motor vehicle accident which occurred on 11-5-04. Patient was sitting in car and was hit in the front by a backing up vehicle causing whiplash results and immediate pain. Patient continues to work full duty without restrictions. He continues to drive from Harrisburg to Milton for his work where he is required to sit approximately 50% of the time. Patient's Complaints: Patient reports pain in the cervical spine and right shoulder to approximately 8:10. It is constant changes or intermittent, depending on movement. Patient has some difficulty sleeping due to this pain. Patient denies any functional deficits at this time. Patient's PMH: Patient denies any pertinent past medical history at this time. X-ray report was requested but not received. NM report reveals the following: Disc osteophyte complexes at C4-C5 through C6-C7. There is posterior central disc protrusion at these levels with possible anular tear at C5-6. There is significant canal stenosis at these levels most pronounced at C4-C5 and C5-C6 with indentation upon the anterior aspect and flattening of the cord. Medication: Vicodin and Flexerii. OBJECTIVE RANGE OF MOTION Cervical Spine: Forward bend 38 degrees with increased stretch sensation. Backward bend 15 degrees with increased original symptoms. Side bend: left 20 degrees, right 20 degrees. Rotation: left 42 degrees, right 40 degrees with some reproduction. Upper Extremities: Within functional limits all planes and all joints. STRENGTH Cervical Spine: Not tested due to pain. Upper Extremities: Appear to be 515 all planes and all joints. 1 Soulh Front Street, Milton. PA 17847 • (?70) 742-2=153 • Fax (` 71.1)'742-2468 PHYSICAL THERAPY DISCHARGE SUMMARY DISCHARGE DATE: 1-19-05 SOCIAL SECURITY #: 188-58-6670 PATIENT NAME: AGE: DOB: SEX: PHYSICIAN: John Kubeika 43 8-19-61 M Jonas Sheehan, MD John Kubeika was treated in our clinic from 12/22/04 until 1/19/05 for a diagnosis of neck and left upper extremity pain, multicervical disc bulges. He received the following interventions: 1. Various modalities such as moist heat and ultrasound to control inflammation and pain. 2. Mechanical traction to control restrictions and increase range of motion. 3. Manual therapy techniques of myofascial release to reduce restrictions and increase range of motion. 4. Home-exercise program education with demonstration. 5. Therapeutic exercise to increase range of motion of the cervical spine. Mr. Kubeika tolerated treatment well and achieved the following status: 1. Patient denies any pain at this time. 2. Patient's cervical spine range of motion is now within normal limits all planes. 3. Patient is independent with home-exercise program consisting of subscapular cervical spine stretching. Closing Statement: Patient has achieved all stated goals and should fare well discharged at this time. Patient has been informed to contact myself or physician if any further problems or questions. Signature: ", &z= DATE: z- /?- Cc: Jonas Sheehan, MD 2-11 j o s I SmAh, Frnnt Strut, mi?ton, PA 17847 • (570) 7.42-2453 . Fax (?70) 71,7-24:64 r KEYSTONE CARE THERAPIES 0 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 k - Code Patient Name: u o vt 95831 Musde testing Date: 2 O 95851 Goniom Subjective: 97001 I nitial Evaluation-PT G ' ` 97002 Re-evaluation-PT 97003 i nitial Evaluation-OT 97004 Re-evaluation-OT 97750 FCE i eatment with: i t B ti b k a , h r O n eg ve: jec --y 4,1 -- 97010 Nblst Heat/Cold Pac T 97012 Mechantcat Traction 97014 Electrical Stimu4ation-unaittended o Therapeutic Exercise as per flow sheet 97016 vasopneumatic device 97018 Paraffin Bath f i i ? 97022 M _ st ng o anual Therapy cons 97032 EW*Icd stimulation-attended 97033 1 Is Modalities consisting of: i 97035 Ultrasound 97039 Unlisted 97110 Therapeatio exercises -15 min o Electric Stimulation 97112 Neuromuscular re-education 15 min 97113 A PT 15 min 97116 Gait training 15 min o Ultrasound 97124 Massup 15 min 97140 Manual therapy 15min ( O ' j h 97504 Fitti 15 min ti th O t er: 97530 o c r Therapeutic wUv#M (one on one 97535 FRO ex video 97546 97548 Work harden conddion kti W 2 hours Each additional hour o e per Assessment: 97E01 session/wound care Wound Care 970 Unilated Modality_ 9'9071 Education supplies 29125 on of short arm splint 99x70 s es renapo Plan: ontinue toward goals rogress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future a Other: Therapist signature ?? KEYSTONE CAPE THERAPIES Vr1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 Code Patient Name: ?.1 , c c 95831 Musde test) t Date: ' -L G 95851 Gonio Subjective: 97 0 0 1 trift Evaluation-PT 97002' Re-evaluation-PT ut ez-tti r - ??f 97003 10al Evaluation-OT 97004 Re-evaluation-OT 97750 FCE j ` 97010 MoW Heat/Cold Pack Ob ective: Begin treatment with: J X 7 .r !? a 97012 Mechanical Traction f 'YL 8 , 97014 Electrical Stimulation-unatttended o Therapeutic Exercise as per flow sheet 97016 VasopneumaW device 97018 Paraffin Bath 97422 wwripoof (v/Manual Therapy consisting of: 97432 Etect+lcal Stimulation-attended 3 97433 1 oresie M d' i i ' f 97035 Ultrasound o t es cons g : 97039 Unlisted Modality 97110 exercises -15 Mtn o Electric Stimulation 97112 Neuromuscular re-education 15 min 97113 Aquatic PT 15 min 97116 Gait training 15 min Ultrasound 97124 Massage 15 min 97140 Ma u l th 15mtn a ere n 97504 Orthotic Fittin 15 min q„-.-Other: 97530 Therapeutic actMfles one on one) 97535 exm" pc vkleo 97546 9750 Work hardenin condbon Initial 2 hours Each additional hour per d Assessment:' 97001 care sesstonAvoun 97602 Wound Cate 97039 UnWed Modality 99071 Education suppUes 29125 A of short arm splint 99070 S es ITransportation Plan: o--Continue toward goals 0---progress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future 0 Other: Y Theraist siLX.^ature:. -Y IL KEYSTONE CARE THERAPIES 0 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 KEYSTONE CARE THERAPIES to/ 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 Muscle )3 I nitial Evaluation-0T i` 34 Re-evaluation-OT 50 FCE to Moist Heat/Cold Pack 12 Medonical Traction 14 Electrical Stimulation-unatilended 16 Vasopneumatic device 18 Paraffin Bath 22 Whirlpool 32 Electrical Stimulation-attended 33 1 is 35 Ultrasound 34 Unlisted Mods 10 Therapeutic eaeroiees -15 min 12 Neuromuscular n education 15 min 13 Aquatic PT ISM 16 Gait 15 min 24 Massaae 15 min 40 Manual theca 15m1n 04 Orthotic Fitt! 15 min 00 Therapeutic actWes (one on one) care arm Patient Name: ; z/ = r f y °7 Date: ; ?) Cr Subjective: Objective: Begin treatment with: o Therapeutic Exercise as per flow sheet Manual Therapy consisting of Modalities consisting of: o Electric Stimulation Itrasound Z. 2 o Other: Assessment: Plan: Continue toward goals o rogress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future o Other: Therapist si afar ?, ; ,?,?. l ri KEYSTONE CARR THERAPIES .er l South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 Code Patient Name: YL-b e- ' Kc, , .acs 1 >1 95831 Muscle tests Date: 3 - 95851 Goniomet Subjective: - " T C 97001 I nitial Evaluation-PT 7 ' T r, l i G 1 002 . 9 Re-evaluation-P 97003 I nitial Evaiuation-OT 0 97004 Re-evaluation-OT - ` ` 97 ith t t t i B i ck ld P tlC w : men r n ve: eg Object 970010 10 a o Moist Hea 97012 Mechanical Traction 97014 Electrical stimulatkxwnatttended .Si Therapeutic Exercise as per flow sheet 97016 Vasopneumatic device 7ol Paraffin Bath -..G. Manual Therapy consisting of: ,-f ex (A r Electrical Stimulation-attended I $ Modalities consisting of Ultrasound UnUded Modality 97110 Therapeutic exercises -15 min o Electric Stimulation 97112 Neuromuscular' re-educadon 15 min 97113 Aquatic PT 15 min 97116 Gad trains 15 min o' Ultrasound 97124 IMaeffe 15 min 97140 Manual theca 15min ? l 97504 15 min Orthotic Fittin ler-- _ cr ' Ot 97530 g T ic actWities (one on one) 97535 Home exercise pftraW back school video 97545 Work harden' condition Initial 2 hours 97548 Each addidwai tour per Assessment: - _? , • - _ 97[901 sessionAvound care 97602 Wound Care 97039 Unlisted Modality SS c C: 99071. Education supplies _ . r. 20125 R ion of short arm splint 99070 supplies ranspo Plan: _.e- Continue toward goals Progress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future o Other: Therapist signature: 112?? KEYSTONE CARE THERAPIES .e 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 Muscle Initial Evaluation-PT Re-ewaluatwn-PT Initial Evaluatlon-OT FCE Moist HeaVCold Pack Mechanleal Traction Electrical Stimulation-unatltertded VasopneumaW device Paraffin Bath Stimulation-attended Thempeudo exercises -15 min Neuromuscular re-education 15 min Aquatic PT 15 min Gait tneinkV 15 min_ Mnsssge 15 min Manual therapy 15min Orthotic Fitting 15 min ThwaDo tic activities (one on one) sess;onAvound care Wound Cane UnNsted Modality Education supple s Application of short arm Patient Name: u b e. ''`c_ , `?? 1rh r? Date: Subjective: Objective: Begin treatment with: .la- Therapeutic Exercise as per flow sheet t 7t. <.er Manual Therapy consis ' g of: Modalities consisting of- • Electric Stimulation o Ultrasound .a' Other: i Assessment: , rl W\ Plan: -e Continue toward goals ,,a- Progress program as per flow sheet to patient tolerance o Prepare patient for discharge in near fixture o Other: Thera ist si ature: A kl-. KEYSTONE CARE THERAPIES .,e>' 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 Code 95831 Muscle testing 95851 Goniometry 97001 initial Evaluation-PT 97002 Re-evaluation-PT 97003 Initial Evaluation-OT 97004 Re-evaluation-OT 97750 FCE 97010 Moist HeatfCoid Pack 97012 Medhantcal Traction 97014 Electrical Stimulatiarunatitended 97016 Vasopneumatic device 97018 Paraffin Bath 97022 WNti 97032 Electrical stimulation-attended 10 Therapeutic; exercises - 15 min 12 ldeurom6ecular re-education 15 min 13 Aquatic PT 15 min 16 Gait trains 15 min 24 Mas 15 min 40 Manual therapy 15min 04 OdWic Fain 15 min 30 Therapeutic activities (one on one) care arm Patient Name: obe- KKcL, Date: ! _ o Subjective: _ ?. "Cl cc ? Objective: Begin treatment with: o Therapeutic Exercise as per flow sheet ra- Manual Therapy consisting of: L _ s Modalities consisting of. o Electric Stimulation o Ultrasound o Other: Assessment: • s ?a . , c- C -1 l MT- ?5?tci1 Le- Plan: .o Continue toward goals .G- Progress program as per flow sheet to patient tolerance o Prepare patient for discharge in near fixture o Other: Therapist signature >S KEYSTONE CARE THERAPIES ,ef 1 South Front Street Milton, PA 17847 o Springfield Square South, 1001 Baltimore Pike Suite 109 Springfield, PA 19064 10 12 Nuade testing ,odometry Initial Evaluation-PT Re-ewsk ation-PT Initial Evaluation-0T Re-evaluation-OT FCE Moist Neat/Cold Pack Mechanical Traction Electrical Stimulation-unatttended yasopneumatic device Paraffin Bath whirlpool Electrical stimulation-attended font esis uttmeound unM.d Modality ft exercises -15 min :racular re-education 15 min PT 15 min ring 15 min a 15 min therapy 15min Fitting 15 min :utlc acttvitke (one on one) care arm Patient Name: 6\1b e-z-Vv-1 Date: Subjective: S n V-11 <r Objective: Begin treatment with: -e- Therapeutic Exercise as per flow sheet o--Manual Therapy consisting of: ' r, ? Modalities consisting of. o Electric Stimulation .e- Ultrasound . .e"- -7 - a-It o Other: Assessment: ra- \ ?- :Fs, c!)- UL"'- Plan: -cr Continue toward goals ?a Progress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future o Other: Therapist si tore: f /? l KEYSTONE CARE PI3YSICA? THERAPY Professional Therapy Services Daily Soap Notes "`=`` l Code: 95831 Muscle Testing 95851 Goniometry 97001 Initial Evaluation PT 97002 Re Evaluation PT 97003 Initial Evaluation OT 9.7004 Re Evaluation OT 97750 FCE 97010 a oluist Heat/ Cold Pack 97012 Mechanical Traction 97014 Electricat Stimulation (Unattended) 97016 Vasopneumatic Device 97019 Paraffin Bath 97022 Whirlpool 97032 Electrical Stimulation (Attended) 97033 Ionotphoresis 97035 Ultrasound 97039 Unlisted Modalities 97110 Therapeutic Exercise 15 min 97112 Neuromuscular Re education 15-min 971,13 Aquatic PT 15 min 97116 Gait Training 97124 Massage 15 min 97140 Manual Therapy 15 min .? 97504 Ordrotics fitting/ training 15 min 97530 Therapeutic Activities 97535 HEP/ Back to school video 97545 Work hardening) conditioning initial 2 hrs. 97546 Each additional hour 97601 Hon selective Drebridement per ses- sion Mound care 97601 Wound Care 97039 Unlisted modality 99021 Educational Supplies 29125 Application to Short arm splint 97070 Supplies 97082 Transportation south Front Street, Milton, PA 17847 Patient Name:.u b e? J"?p h n Date: Subjective: N ." objedive_ Begin-treatment with: y,-Therapeutic Exercise as per flow sheet -M- AaW Therapy co fisting of - t Mocfaliti nsistin of o Electric Sti mulation itrasound o Other: Assessment: 5 •e Plan: ,Q-Continue toward goals ,S>--P?rogress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future o tither: ?? ! IJfJ I J Therapist Signature: al-ilzz t 1001 Baltimore Pike- Suite I OCR.-- Snrinefield PA 19064 ! 5• ?v jL vi. u %.,LIkA%JU 1 111 011.1iL -J. rILt IKAr Y Professional Therapy Services Daily Soap Notes Milton 0 Springfield Code: Patient Name: K O3 c?, ?? w1 -19 0 S' 1 95831 Muncie Testing Date: 95851 Goniometry Subjective: 97001 initial Evaluation PT 97002 Re Evaluation PT 97003 Initial Evaluation OT 97004 Re Evaluation OT 97750 FCE 97010 Moist Heat/ Cold Pack 97012 Mechanical Traction 97014 Electrical Stimulation (Unattended) 97016 Vasopneumatic Device 97018 Paraffin Bath 97022 Whirlpool 97032 Electrical Stimulation (Attended) 97033 lonotphoresis 97035 Ultrasound ?- 97039 Unlisted Modalities 97110 Therapeutic Exercise 15 min 97112 Neuromuscular Re education 15-min 97113 Aquatic PT 15 min 97116 Gait Training 97124 Massage 15 min 97140 Manual Therapy 15 min 97504 Orthotics fitting/ training 15 min 97530 Therapeutic Activities t 97535 HEP/ Back to school video 97545 Work hardening/conditioning initial 2 hrs. 97546 Each additional hour 97601 Non selective Drebridement per ses- sion /wound care 97601 Wound Care 97039 Unlisted modality 99021 Educational Supplies 29125 Application to Short arm splint 97070 Supplies 97082 Transportation 1 South Front Street, Milton, PA 17847 Objective: Begin treatment with: o Therapeutic Exercise as per flow sheet I e Manual Therapy consisting of, fv., ?- 4) 1 Modalities consisting of I o Electric Stimulation Ultrasound o-' Other. ?1 _ U C -1 U _ ? 1 _ ` . 1 1 Plan: o-'Continue toward goals 0 ogress program as per flow sheet to patient tolerance o Prepare patient for discharge in near future o Other: Therapist Signatt}t`e f?L 1001 Baltimore Pike, Suite 108, Springfield, PA 19064 ORTHt EDIC INSTITUTE OF PENNSYLV, __.1A (717) 761-5530 Patient: John J. Kubeika Chart #: 08094806 SOB: -------- 08/19/61 SSN: 188 58 6670 --------------------------------------- Page # 2 12/23/2004 ERNEST R. RUBBO, M.D. NO SHOW NOTE 12/28/2004 ERNEST R. RUBBO, M.D. OFFICE VISIT Hershey Office JOHN J. KUBEIKA was seen in consultation at the request of Dr. 1<atherine Gallagher for evaluation of neck pain. HISTORY OF COMPLAINT: He is a 43 year old gentleman who was involved in an automobile accident on November 5, 2004. He was a restrained driver when a van backed into his vehicle and he sustained a whip lash injury to his cervical spine. He complains of pain in his lower cervical region. Initially he complained of some numbness and tingling in his left upper extremity, particularly in the middle and ring fingers. This subsequently has subsided. He denies ever having had any problem in his neck. He does have pain in certain areas of his motion. With lateral bending and twisting to the left and right. Pain is mostly localized to his lower cervical region. Paresthesias in his left upper extremity have subsided over the last several weeks. He is not taking any type of anti-inflammatory medicine or undergone any type of formal physical therapy for this condition. He recently had an x-ray evaluation which showed no definite acute cervical spine abnormalities. There was some narrowing at the C4-C5 interval by radiographic criteria. A subsequent MRI evaluation was done which showed evidence of disc desiccation as well as bulging at C4-5, C5-6 as well as C6-7. He is here for further evaluation. REVIEW OF SYSTEMS: The patient's review of systems, past medical history, family history, and social history have been recorded and reviewed. PHYSICAL EXAM: Physical exam shows a pleasant, awake, alert and oriented gentleman in no acute distress. Exam of his neck shows pain with forward flexion past 15 degrees. This was mostly localized to the lower cervical region. He has pain to palpation over the C5-C6 spinous processes. There is no paraspinal muscle spasm noted. Lateral bending to the left and right did cause some pain localized to his lower cervical region. Reflexes to his biceps and triceps are +2/4. Motor and sensory exam are otherwise within normal limits. Straight leg raising was limited. There was no hyperreflexia noted to his lower extremities. No ankle clonus was noted. DIAGNOSTIC TESTS: !-rays of his cervical spine were reviewed which showed some mild narrowing at the C4-5 as well as C5-6 interval. MRI evaluation was also reviewed with the patient. This did show some posterior disc bulging at C4-5 as well as more focal disc protrusion centrally at C5-6 with some slight indentation of the anterior aspect of the spinal cord. A similar appearance is noted at C4-5. -CONTINUED- DIAGNOSIS: HNP C4-5 and C5-6 with no upper extremity radiculitis or + ORTH,,,._EDIC INSTITUTE OF PENNSYLV-IA (717) -761-5530 z,. ?iatient: John J. Kubeika Chart #: 08094806 )OB.: 08/19/61 SSN: 188 58 6670 Page # 3 ----,---------------------- 12/28/2004 ERNEST R. RUBBO, M.D. -CONTINUED- OFFICE VISIT weakness. PLAN: The patient and I had a discussion today regarding the natural history of this condition. At this time I have given him a booklet on the care of his neck for him to read as well as talking to him about the natural history of disc herniations. Proper back mechanics were instructed to the patient. I have also told him that should his pain get worse, we may consider a trial of physical therapy or undergo a trial of epidural steroid injections. He .?' would like to give it time and do the exercises on his own. I will see him back if he has any further problems or concerns. ERR/raf LTR-DR RUBBO CONSULT LETTER (Ref) GALLAGHER, M.D., KATHERI HEALTH HISTORY FORM NAME: KUPFIKA, JOHN J (3 PAGES) MD: SHE ' JONAS M MD#: 89110 MR#: 14- 3 SEX: M DOB: 08/19/1981 STANDARD INS: AUTO INSURANCE LOC: SURE DOB# VISIT DATE: 12/15/2004 : 5013233 DATE HMC # NAME J(Jr/N ??/ ?? DOB /9 6 / _AGE NAME OF PERSON COMPLETING FORM (IF OTHER THAN PATIENT) RELATIONSHIP TO PATIENT WERE YOU REFERRED BY ANOTHER PHYSICIAN? J YES NO IF YES, PLEASE COMPLETE THE INFORMATION BELOW: PHYSICIAN Xc4mi Iy Qzg2e E F,v?r6Q ?F ?'Airli° Ii'a (7 / 7) yes 9 00 ADDRESS MMIWIEr sf/ Ef CITY, STATE & ZIP CODE CAItI/? K7`G, ?LI 70/? IF YOU HAVE A PRIMARY CARE PHYSICIAN OTHER THAN YOUR REFERRING PHYSICIAN, PLEASE COMPLETE THE INFORMATION BELOW: PHYSICIAN ADDRESS CITY, STATE & ZIP CODE IF YOU WOULD LIKE THE INFORMATION FROM TODAY'S VISIT SENT TO A PHYSICIAN OTHER THAN THOSE LISTED ABOVE, PLEASE COMPLETE THE INFORMATION BELOW: PHYSICIAN ADDRESS CITY, STATE & ZIP CODE WHAT IS THE REASON FOR TODAY'S VISIT? ivovE2 aaa? / IS THIS THE RESULT OF A SPECIFIC ACCIDENT OR INJURY.9 _ V YES NO IF YES, PLEASE ANSWER THE FOLLOWING: DATE OF ACCIDENT/ NJURY TYPE OF ACCIDENT Alfar d4/a ARE YOU INVOLVED IN LITIGATION REGARDING THIS CONDITION? YES ? NO ARE APPLYING FOR OR RECEIVING WORKER'S COMPENSATION FOR THIS OR ANY OTHER CONDITION? YES NO ARE YOU APPLYING FOR OR RECEIVING DISABILITY. FOR THIS OR ANY OTHER CONDITION? _ YES NO MEDICATIONS PLEASE LIST ANY MEDICATIO1, 2RESCRIPTION AND NONPRESCRIPTION) Th. _ i YOU ARE CURRENTLY TAKING MEDICATION DOSAGE NUMBER TAKEN DAILY HAVE YOU HAD ANY ALLERGIC OR UNUSUAL REACTIONS AFTER CONTACT WITH ADHESIVE TAPE, MEDICATIONS, FOOD OR DRUGS? YES NO ITEM REACTION PERSONAL HISTORY OCCUPATION AfeflPAr AL4.4iA/, jgKV6S.IF NO LONGER WORKING, LAST DAY WORKED - TOR400VA#f70V MARITAL STATUS SINGLE MARRIED - DIVORCED SEPARATED WHO LIVES WITH YOU? _Cy/F? GW4e?2ArJ HAVE YOU EVERY SMOKED? f YES(%G/14) O ?D IF YES HOW MAY PACKS PER DAY ? !J HOW MANY YEARS? IF YOU DISCONTINUED, HOW MANY YEARS AGO? DO YOU DRINK ALOHOLIC BEVERAGES V/ YES NO IF YES, WHAT KIND ? /.?EE,? HOW OFTEN? HOW MUCH ? llZ. DO YOU USE ANY RECREATIONAL DRUGS (COCAINE, MARIJUANA, ETC.) _ YES NO IF YES, WHAT KIND? HOW OFTEN? LAST TIME USED FAMILY HISTORY DOES OR DID ANYONE IN YOUR FAMILY (PARENTS, GRANDPARENTS, SIBLINGS, CHILDREN, ETC) SUFFER FROM.-ANY OF THE FOLLOWING: ASTHMA CANCER HEART. DISEASE HIGH BLOOD PRESSURE .WHICH, IF ANY, OTHER DISEASES RUN. IN YOUR FAMILY? IS THERE ANYTHING ELSE THAT WOULD BE HELPFUL FOR US TO KNOW,? Ak/i/6 L? ARIs?G, 4114 ?E?,PEsIEa GAtEL y tr ,vs ?./?GC? /7i fGri„?Go,Qr? /?i? ?C/lr??G, ?NTG?PES? i PENNSTATE NAME: KUBEIKA, JOHN J MD: SF '4N JONAS M Milton S MR#. Her, Medical Center DOB: l DOB: Oor19/ 1 961 INS: AUTO College of Medicine L OC: SURG INSURANCE OOS#!: 5013233 PROGRESS REPORT Date/Time I PROGRESS NOTES: (Include Name, Title) 4 MDi#: 89110 SEX: M STANDARD VISIT DATE: 12/15/2004 r? / s olov \JN"?Ttl l? I / q W, ? 1 •? lam,` ? A ' I ,? n ?p '[/_ c,6 (6 (\1 \l(? k44) PENN-STATE Milton & Hershey Medical Canter College of Medicine Patient Name: KUBEIKA, JOHN J Patient Sex: Male Patient Location: SURG, , Visit Type: Clinic Penn State Milton S. Hershey Medical Center Tel: (717) 531-8055 Penn State College of Medicine Health Information Services, HU24 500 University Drive P.O. Box 850 Hershey, PA 17033-0850 PSUHMC MRN: 1446763 Date of Birth: 8/19/1961 Visit Number: 5013233 1 O u t p a t i e n t L e It It e r D o c u m e n It Final Document Electronically Signed by: Sheehan, Jonas M OUTPATIENT LETTER December 15, 2004 Name: KUBEIKA, JOHN J HMC Number: 1446763 DOB: 08/1911961 Katherine Gallagher-Shrift, MD 4076 Market Street Camp Hill, PA 17011-0000 Dear Dr. Gallagher-Shrift: 12/28/2004 12:29:42 PM John Kubeika is a 43-year-old gentleman seen in Neurosurgery Clinic today for the first time for a chief complaint of neck and left arm pain. On November 5, 2004, he was sitting at a red light. When the light turned green, a contractor's van backed up into the patient's car. He heard a "crunch in my neck". He then developed neck pain. One to two weeks later, he had an achy, constant pain in the medial aspect of the left arm with paresthesias in the left third and fourth digits. The neck pain is worse than the arm pain. He has no weakness of the upper extremities. He has had no bowel or bladder incontinence. Sneezing makes the neck pain worse. Flexion, extension, right and left lateral rotation also increases neck pain. He does wear a soft collar at times to help decrease his pain. He has had no physical therapy, epidural injections, or oral steroids. He does take ibuprofen 800 mg twice a day. This does not help. He currently is taking regular strength Vicodin three tablets per day. This does help to decrease his pain. Past medical history is positive for only neck and back pain. Past surgical history is for surgery on the right leg and ankle due to a fracture in 1994. He has no known allergies. Current medications are Vicodin and ibuprofen. He is married and lives with his wife. He is a president of a financial service organization. He smokes in occasional cigar. He typically drinks one beer a week. He does not use recreational drugs. A review of the family history is positive for heart disease and hypertension. Date Printed: 211712005 Time Printed: 12:12 PM PENN STATE WO Milton S. Hershey Medical Center College of Medicine Patient Name: KUBEIKA, JOHN J PSUHMC MRN: 1446763 O u t p a t i e n t L e t t e r D o c u m e n t Final Document Electronically Signed by: Sheehan, Jonas M 12/28/2004 12:29:42 PM On physical examination today, his height is 71 inches, blood pressure 130/88, pulse 72 beats/minute. He walks with a normal stance and arm swing. Heel, toe, and tandem gait are normal. Flexion and extension, right and left lateral rotation of the neck caused him some increased neck pain. Sensory examination - there is decreased touch and pin in the left middle finger only. Touch and pin sensation is normal in the lower extremities. Vibratory and position perception are normal in the upper and lower extremities. On motor testing, strength is 5 out of 5 in all muscle groups individually tested in the upper and lower extremities. Deep tendon reflexes are 1+ and symmetrical at the biceps, triceps, and brachioradialis, knees and ankles with toes downgoing. There is no evidence of clonus or Hoffmann's sign. I reviewed the MRI scan obtained on 11/22104. This shows some slight disc bulges at several levels and without significant central canal neural foraminal stenosis. The spine is well-preserved and the alignment is intact. I don't see any surgical lesions on this man's MRI scan. He describes a sort of focal paraspinous muscle source of his pain. I suspect with physical therapy, this irritation and muscular spasm will be resolved. I don't think there is a surgical option for him at this time and I am fairly confident that conservative measures such as PT will forward him the sort of benefit that he desires. Thank you again for referring this man to me. Please feel free to call with any questions or concerns that you have. Date Printed: 211712005 Time Printed: 12:12 PM PENNSTATE Milton & Hershey Medical Center , College of Medicine Patient Name: KUBEIKA, JOHN J PSUHMC MRN: 1446763 O u t p a t i e n t L e t t e r D o c u m e n t Final Document Electronically Signed by: Sheehan, Jonas M 12/28/2004 12:29:42 PM #1980384198050 Sincerely, Jonas M Sheehan, MD Assistant Professor, Department of Neurosurgery Penn State Milton S. Hershey Medical Center PO Box 850, Hershey, PA 17033 (717) 531-8807 JMS /PSC DD: 12/15/04 DT: 12/16/04 14:45 CC: Katherine Gallagher-Shrift, MD 4076 Market Street Camp Hill, pA 17011-0000 CC: Kristine Kuzma, APRN, BC Penn State Geisinger Health System Milton S. Hershey Medical Center Nursing Hershey, PA 17033-0850 CC: Kristine Kuzma, APRN, BC Penn State Geisinger Health System Milton S. Hershey Medical Center Nursing Hershey, PA 17033-0850 Date Printed: 211712005 Time Printed: 12:12 PM PENNSTATE WTI Milton S. Hershey Medical Center 40 College of Medicine PHYSICAL THERAPY REFERRAL NAME: KUBEIKA, JOHN J MD: SHEEHAN JONAS M MO#: 89110 MRN: 1446763 DOB: 08/19/1961 SEX: M INS: AUTO INSURANCE STANDARD LOC: SURG OOSII: 5013233 VISIT DATE: 12/15/2004 Admission Date: Patient's Name: Age: Outpatient: Inpatient: Room Number Doctor: Service: Phone: Diagnosis: Rx Frequency:? u?? Date Rx: `?Yl?._L ?Q 1 1 a,u &.R ? Q?j O l ? uJ?? T EVALU TION AND TESTING PROCEDURES HERAPEUTIC EXERCISE Consult Coordination/ Balance Activities of Daily Living Evaluation Gait Training Cardiac Rehabilitation Full Weight Bearing Cybex Partial Weight Bearing Goniometry/ROM Toe Touch Weight Bearing JOBST Measurement _ Non Weight Bearing Manual Muscle Test Home Exercise Program Splint Fabrication Static Dynamic Isokinetic Exercise Other Muscle Re-education Neuromuscular Facilitation MODALITIES Posture Training Cold Pacs Pre-prosthetic Training and Stump Conditioning Contrast Baths Progressive Resistive Exercise Diathermy Prosthetic Training Electrical Stimulation ROM Active Active Assistive " TENS HVGS Low Volt Electrostim 180) Passive Hot Pacs Ice Massage JOBST Compression '' M ssage Moistaire Paraffin ?ction (? W Cervical Pelvic _,.Zd1trasound Ultraviolet/Cold Quartz Whirlpool Other "TENS: Transcutaneous `lectricai Nerve Stimulation; HVGS: High Volt Galvanic Stlmulailon __ . I* foal Tilt Table Wheelchair Skills Other COMMENTS: 0 I-AJ-Y QV ?? - i PA t Physician Signature r%LJVC%1r%AI TLJCInAnV nGCCnnAI 11/17/2004 KUBEIKA, JOHN DOB: 08/19/1961 S: John was involved in a motor vehicle accident on the 50 of Novemb? A truck went into reverse and backed into him. He states that his nE began hurting right away. He was seen at Seidle and was put in a neck brace. Unfortunately, he has to drive an hour and 20 minutes to and from work each day and the neck pain is unbearable. He was given Ultracet but it makes him too dopey. He was able to get in to see a. neurosurgeon, Dr. Shahan, on the 151" of December. A; 1. Status post motor vehicle accident with parr wing of the C4-C5 space. We are going to get him set up for an RI and go from there. Patient understands instructions. Katherine Gallagher, M.D./ hmr DD: 11/17/04 DT: 11/24/04 Form 1009 (PM) Fffedlr Pax SUSEee I January 11, 2005 Katherine Gallagher, M.D. 4076 Market Street Camp Hill, PA 17011 RE : KUBEI KA, JOHN J. lee 50 6610 Dear Dr. Gallagher: Thank you for consulting me on JOHN J. KUBEIKA whom I saw in the Hershey Office on December 29, 2004 for evaluation of neck pain. HISTORY OF COMPLAINT: He is a 43 year old gentleman who was involved in an automobile accident on November 5, 2004. He was a restrained driver when a van backed into his vehicle and he sustained a whip lash injury to his cervical spine. He complains of pain in his lower cervical region. Initially he complained of some numbness and tingling in his left upper extremity, particularly in the middle and ring fingers. This subsequently has subsided. He denies ever having had any problem in his neck. He does have pain in certain areas of his motion. With lateral bending and twisting to the left and right. Pain is mostly localized to his lower cervical region. Pareathesias in his left upper extremity have subsided over the last several weeks. He is not taking any type of anti-inflammatory medicine or undergone any type of formal physical therapy for this condition. He recently had an x-ray evaluation which showed no definite acute cervical spine abnormalities. There was some narrowing at the C4-C5 interval by radiographic criteria. A subsequent MRI evaluation was done which showed evidence of disc desiccation as well as bulging at C4-5, C5-6 as well as C6-7. He is here for evaluation. :5t REVIEW OF SYSTEMS: The patient's review of systems, past medical history, family history, and social history have been recorded and reviewed. PHYSICAL EXAM: Physical exam showe a pleasant, awake T--r'iW"or anted gentleman in no acute distress. Exam of his neck shows pain with forward flexion past 15 degrees. This was mostly localized to lower cervical 0 is region. He has pain to palpation over the C5-C6 spir?rnndad no paraepinal muscle spasm noted. Lateral bending to 1 did cause some pain localized to his lower cervical rP on. his biceps and triceps are +2J4. Motor and sensory exam -e n-"- normal limits. straight leg raising was limited. There walexia noted to his lower extremities. No ankle clonus was'ed. HadiC Fax SystOw RE: KUREIKA, JOHN J. PAGE 2 January 11, 2005 DIAGNOSTIC TESTS: X-rays of him cervical spine were reviewed which showed some mild narrowing at the C4-5 as well as C5-6 interval. MRI evaluation was also reviewed with the patient. This did show some posterior disc bulging at C4-5 as well as more focal disc protrusion centrally at C5-6 with some slight indentation of the anterior aspect of the spinal cord. A similar appearance is noted at C4-5. DIAGNOSIS: HNP C4-5 and CS-6 with no upper extremity radiculitis or weakness. PLAN: The patient and I had a discussion today regarding the natural history of this condition. At this time I have given him a booklet on the care of him neck for him to read as well as talking to him about the natural history of disc herniations. Proper back mechanics were instructed to the patient. I have also told him that should his pain get worse, we may consider a trial of physical therapy or undergo a trial of epidural steroid injections. He would like to give it time and do the exercises on his own. I will see him back if he has any further problems or concerns. Thank you for having me participate in the care of your patient. Sincerely, Ernest R. Rubbo, M.D. ERR/raf Dictated but not read - faxed. 11/17/2004 KUBEIKAI JOHN DOP 08/19/1961 SI Jahn was involved in a motor vehicle accident on the Stn of November.. A#truck went into reverse and backed into him.. He states that his neck b4gan hurting right away. He was seen at Seidle and was put in a neck btace. Unfortunately, he has to drive an hour and 20 minutes to and from work each day and the neck pain is unbearable. He was given Ultracet but it makes him too dopey. He was able to get in to see a neurosurgeon, Dr. Shahan, on the 15" of December. f? 1009 (AM) A: 1. Status post motor vehicle accident with parr wing of the C4-C5 space. We are going to get him set up for an RI and go from there. Patient understands instructions A/ Katherine Gallagher, M.D./ hmr DD: 11/17/04 DT: 11/24/04 (wd) 8001 u-. DATES: TIME: Dr. Dr's Reply: s URGENT 1,_j Caller: C1 t`?C ?``?t? i I C? L y r? Telephone Patient: ? r Reason for Calling: _h i Action Taken by Staffs 11 Memb Returned Call - i ell.ed in RX/ • r r duted p Staff Member's Initials: forn64i8'96i •+? c,?„? Staff Member's Initiajs_ f '-? r ??c7 s2?, r'r r r l r .1 C'. -- v` O S1NW41NOD 31b(] 'ON 3153 3Jdd S31ON SS3d)08d 3AI.LdH1dVN NOI1d0I311N30I1N31lbd DE/ 3129322 FAMILY MEDICINE CENTER OF CAMP HILL • KATHERINE A. GALLAGHER, M.D. 4076 MARKET STREET • SUITE 100 CAMP HILL, PA 17011 717-975-9800 PA Lie No. MD 043531-E NAME ADDRESS DATE Y10Y PA (Please Print) I s r REFILL TIMES PRN NR SUBSTITUTION PERMISSIBLE M.D. IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, THE PRESCRIBER MUST HANDWRITE "BRAND NECESSARY" OR "BRAND MEDICALLY" NECESSARY IN THE SPACE BELOW. I i-NOV--02 - TRI9,211 _1 -251 ,29906_0001 a /f DE :3129322 FAMLY MEDICINE CENTER OF CAMP HILL A. GALLAGHER, M. D. KATHERINE ET 4076 MARKET STREET TREET - SUITE UITE 100 CAAtF HILL, PA 17011 717.975.9800 PA L1c No. MD 043531-E NAME c' ADDRESS DATE 4 / (P6- Print) V) %, ?S REFILL TIMES PRN NR SUBSTITUTION PERMISSIBLE M.D. IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, i THE PRESCRIBER MUST HANDWRITE "BRAND NECESSARY" OR "BRAND MEDICALLY" NECESSARY IN THE SPACE BELOW. I II.NOV-02 TR1021111_100582514.14_Ot 29906_11001 MEDICAL 99CORD a PINNACLEHEALTH TIME OUT: Hospitals ? FIRST PLACE PHYSICIAN LEVEL OF CARE: Non-ED Physician: ? 1 ? IV MED. EMER, El Y E] After Hours ? Private Attending ? 111 ? Critical Care MEDICAL RECORDS REQUESTED ? YES ? NO ? DENIED ? AUTHORIZATION # IF ACCIDENT, WHERE OCCURRED DATE &yT}iAqCIDE f] n 4 F MEAiI C?F (fA17i1VliL ("1 { ATTEtJ?iNQ:P iYSIJ IAN C.C. PER PTJSIGNIFICANT OTHER FAMILY PHYSICIAN lw11 TIME IN DEPT6 q6a TIME DR IN U I? ONDITI N N ARRIVAL C1 El El El PO ? F 7 71 FAIR GOOD CRITICAL POOR DOA , ? VITAL SIGNS AT TRIAGE ? VITAL SIGNS IN DEPT. BP P R T ,5 KEE NURS PHYSIC 'S REPO (HP , MPRESSION + TX) L- 1 ' TE : >5 Y • S, <5 YEAR: I,> CONSULT NAME TIME DICTATED TIME ROOM # SERVICE / MD ? ADMITS ? TRANSFER BED TYPE H. TI Ev FOLLOW-UP REFERRAL CONDITION ON DISCHARGE i OTHER PHYSICIAN'S ASSISTANTIMEDICAL STUDENT E.D. PfPSICIAN OTHER LAST DIS. RESIDENT a PRIVATE PHYSICIAN NURJ? AST ER F GUARANTOR NAME GUARANTOR EMPLOYER INFORMATION ..v ,? ^..-.. .., ., ..., ,.... ! HOME F,.. _ p..(.1..J NOTIFICATION NAME r=E f PATIENT EMPLOYER INFORMATION ,t HOME l .t. I{. -WORK ! s( tr ;i_ ij;t;l ',;tiril/i ,•'! i !t SERV HOSP AREAS TO VISIT DIAG. CODE RELIGION !t M J( it PATIENT # DATE TIME AGE DATE OF BIRTH S M R SOCIAL SECURITY # P/T F/C MEDICAL RECORD# I PATIENT NAME AND ADDRESS INSURANCE CO. NAME GROUP NO. POLICY NUMBER SUBSCRIBER NAI ??? PINNACLEHEALTH PinnacleHealth System FIRSTPLACE AT SEIDLE 120 South Filbert Street Mechanicsburg, PA 17055 EMERGENCY DEPARTMENT KUBEIKA, JOHN RM#: MRN: 188-58-6670 CASE: 00250110314 ADM: 11105/2004 CHIEF COMPLAINT: Neck pain and back pain, secondary to motor vehicle accident. HISTORY OF PRESENT ILLNESS: John is a 43-year-old male in with a chief complaint of back and upper thoracic area pain. He was stopped at a light. The van in front of him drifted backward and hit the grill of his car. Airbag did not deploy. No history of loss of consciousness. No vomiting. Was able to self- extricate, but had a moderate degree, two to three out of five level, of pain of the neck and upper thoracic area. Decided to come in for evaluation. No previous history of auto accident, bike or motorcycle accident. No injury. REVIEW OF SYSTEMS: No history of heart, lung, kidney disease. All other system review is negative, except as above. PAST HISTORY: Past medical history: ALLERGIES: NO KNOWN ALLERGIES. Current medications: None. SOCIAL HISTORY: Married; one son and one daughter, who are in good health. Denies smoking and drinking. FAMILY HISTORY: Father, age 70, in good health. Mother is in good health. Has one brother and one sister, who are in good health. PHYSICAL EXAMINATION: Vital signs: Temperature 96.1; pulse 60; respirations 18; blood pressure 132/88. Head: Normocephalic. No exostosis or skull depression. Eyes: PERRLA, EOMI. Neck: There is quite limited motion due to pain. Flexion/extension is slow. Flexion is about 15 degrees; extension is about 30 degrees. Lateral rotation is about 30 degrees both sides. He seems to have some sort of jumpy type of painover upper thoracic area. Palpation of the cervical spine is quite tender to touch, but there is no swelling. No redness. No evidence of abrasion or skin discoloration noted. He also complains of pain, upper thoracic area, T1 to 4-5 area; quite tender on palpation and subjective complaining of pain. Examination otherwise: There is no unusual problem. Palpation does not show any pain. No open wounds. Range of motion is very slow and limited markedly. Heart: Regular without murmur. Lungs are clear to auscultation. The abdomen is soft and nontender. Extremities/Musculoskeletal: Joint: Capable of free range of motion without pain or crepitation. No effusion or erythema. Bone: No misalignment, asymmetry, defect, tenderness or effusion. Capable of full range of motion of joint above and below bone. ER REPORT ER REPORT ER REPORT CHART COPY KUBEIKA, JOHN RM#: 4 FINN A CLEHEALTH MAN: 188-58-6670 CASE: 00250110314 ADM: 11/05/2004 EMERGENCY DEPARTMENT Muscle: No crepitation, defect, tenderness, masses or swellings. No loss of muscle tone or strength. Mental: Oriented times three. He wants to stay kind of tilted, neck forward. Tenderness on palpation of the posterolateral cervical muscle area. EMERGENCY DEPARTMENT PHYSICIAN TEST INTERPRETATION: X-ray interpretation: Cervical spine negative. Thoracic spine: There are a couple DISPOSITION: Ibuprofen 600 mg every eight hours. Flexeril 5 mg three times a day. Use soft collar of the cervical spine. Follow above sprain instruction, which is ice compress twenty minutes on, ten minutes off, two days, and then warm heating pad thirty minutes three or four times a day. DIAGNOSTIC IMPRESSION: 1. Cervical muscle strain. 2. Upper thoracic muscle strain. c: REVIEWED AND ELECTRONICALLY SIGNED BY: CELL U. KIM, DO 11/09/2004 15:18 CELL U. KIM, DO Patient: DD: 11/05/2004 DT: 11/09/2004 /tm/jlh D#: 1520710 ER REPORT ER REPORT ER REPORT CHART COPY Date Time LEVEL G. INTENSITY L01.: (Please complete a Level of Intensity Order Form for any LOI II-V) ALLERGIES: Procedures / Supplies Lab X-Ray Iac Monitor T ii e / Initials: ? HIV Time/ Initials: E]ECG ?Nasogastric tube ? ABG ? Acetone lase ? A ? Li ase ? PTlINR Portable: ?C-spine Spine: `C ?CXR ?Pelvis T ? L/S ?Foley Catheter ?Straight Catheter ?IV: ?Oz LPM ?Pulse Oximetry ?Peak Flow ?Aerosol Treatment: my ? Basic Metabolic Profile ? Cardiac Panel ? CK -Total ? CK - MB ? CK - Relative Index ? Troponin I ? CBC ? Complete Metabolic Panel ? Electrolytes ? ETOH ? Glucose ? Hepatic Panel ? H & H ? PTT ? Qualitative HCG ? Quantitative HCG ? Repeat Cardiac [so ? CK - Total ? CK - MB ? CK - Relative Index ? Troponin I ? Rh Factor ? ? TP ? Tyypee and and Cross Screen ? Unnalysis ? Ankle L ? CXR ? Elbow L ? Facial ? Femur L ? Finger L ? Foot L ? Forearm L ? Hand L El Hip L El Hume 0 Na alrus L R tYkn- L R ? KUB R ? Ob Series ? Pelvis R ? Ribs L R R ? Shoulder L R R ? Skull R ? Tib/Fib L R R ? Wrist L R R R CULTURES: DRUG SCREEN/LEVEL: SPECIALIZED STUDIES: . ? Blood Culture x_ ? Herpes ? Chlamydia ? Sputum ? Acetaminophen ? Phenytoin ? Aspirin ? Phenobarbital ? CT: ? MRI: ? GC culture ? Throat/strep ? GC/Chlamydia ? Urine (gene amplification) ? Wound: ? Carbamazepine ? Theophylline ? Digoxin ? Urine ? Lithium ? Valproic acid ? Ultrasound: ?Venogram: ? Venous Doppler: ? V-Q Scan ? Other: D to , Time Additional O ers: Physician's signature: PINNACLEHEALTH Hospitals EMERGENCY DEPARTMENT PHYSICIAN'S ORDERS Patient Identification IIII?IIIIIIIIII?IIIIII?IIII?IIIII?IIIIIIIIIIIIIIII??I MR:188586670 CASE:2501 1 031 4 KUBE/KA ,JOHN M -" ?'V`+ DOB: 08/19/1961 Form 0742-20 (08/02) MR Ph#: 717 732-1305 AGE: 43 (PM) np. . 111 J,?ile~?;i TRIAGE TIME C/1TEGORY T- P- f i B/P ALLERGIES &7'f CURRENT MEDS PMH L.M.P. TETANUS HX VISUAL ACUITY O.D. O.S. WEIGHT INITIAL ASSESSMENT - p 6 C??,C/ ? C Z d 9c f/1 TIME T P R BP NOTE progress, Complications, Consultations, Instructions, Condition on Discha . 1 .i Oi ?- I , . sEtDLE HOSPITAL PI N NAC LE H EA LT H . First Place . 120 S. FILBERT STREET MECHANICSBURG, PA 17055-6591 HealthCare (717) 795-6656 Name 7 No. Address Date R MUST HANDWRITE RIB E IN ORDER FOR A BRAND NAME PRODUCT TO BE DISPENSED, THE PRESC "BRAND NECESSARY" OR'BRAND MEDICALLY NECESSARY' IN THE SPACE BELOW. y? SUBSTITUTION PERMISSIBLE Refill times Form 0666-04 (06/04) PM' Dr. D.E.A. Reg. No. -- entifi`c'ation IIIIIIIIInIIII??II CASE: 250110314 A NURSE ASSESSMENT Form 0666-60 (04/01) Formerly INV 2858 AunriAlm ,%/w"1v DATE: 11/05/04 DOB: 08/1911961 Ph#: 717 732-1305 AGE: 43 DR: SSN:188586670 C JOHN J. AND COLLEEN T. KUBEIKA, IN THE COURT OF COMMON PLEAS OF PLAINTIFFS CUMBERLAND COUNTY, PENNSYLVANIA V. EDWARD L. KYLE, DEFENDANT 06-6408 CIVIL TERM ORDER OF COURT AND NOW, this '2 day of December, 2008, the appointment of a Board of Arbitrators in the above-captioned case, IS VACATED. Dale F. Shughart, Jr., Esquire, Chairman, shall be paid the sum of $50.00. -Dale F. Shughart, Jr., Esquire Court Administrator sal By the Edgar B. Bayley, J. ev '? I'a cfcC I .J i? . -d/s2 5315 CI C--j JOHN J. KUBEIKA and : IN THE COURT OF COMMON PLEAS COLLEEN T. KUBEIKA, his wife, : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 06-6408 EDWARD L. KYLE CIVIL ACTION - LAW Defendants PRAECIPE TO THE PROTHONOTARY: Please mark the Docket in the above captioned matter as Settled, Discontinued and Satisfied. Respectfully submitted, HANDLER, HENNING & ROSENBERG, LLP By: W - 4?? W. Scott Henning, Esquire Supreme Court I.D. # 32298 1300 Linglestown Road Harrisburg, PA 17110 (717) 238-2000 DATED: -l z y--0 Attorney for Plaintiff OF THE y 2009 APP 27 Psi 3= 0:.,