HomeMy WebLinkAbout01-05-07
.
Joseph A. Ricci, Esq.
Pa. ID 49803
Lavery, Faherty, Young & Patterson, P.C.
225 Market Street
Suite 304
Harrisburg, PA 17101
(717) 233-6633
Counsel for Carlisle Regional Medical Center
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY PENNSYLVANIA
IN RE: John Brennman
: DOCKET NUMBER: 2007-15
: GUARDIANSHIP
CERTIFICATE OF SERVICE
And now this 5th day of January, 2007, I, Joseph A. Ricci, Esq. herby certify that on
Thursday January 4th, 2007 I personally served the EMERGENCY PETITION FOR
PLENARY GUARDIANSHIP OF THE PERSON AND ESTATE upon the following
individuals in the following manner:
John Brenneman
Room 6, Intensive Care Unit
Carlisle Regional Medical Center
45 Sprint Drive
Carlisle, PA 17013
By personal service and by having the nursing staff read the order of court to
the patient.
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Michael Palermo, Esq.
155 S. Hanover Street
Carlisle, P A 17013
Counsel for John Brenneman
By service of the Petition and Order of Court by placing the documents in the
Courthouse mail folder located in the office of the Prothonotary.
Respectfully submitted,
titioner,
onal Medical Center
Page 20f2
Joseph A. Ricci, Esq.
Pa. ID 49803
Lavery, Faherty, Young & Patterson, P.C.
225 Market Street
Suite 304
Harrisburg, PA 17101
(717) 233-6633
Counsel for Carlisle Regional Medical Center
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: IN THE COURT OF COMMON PLEAS N
: CUMBERLAND COUNTY PENNSYLVANIA
IN RE: John Brennman
: DOCKET NUMBER: 2007-15
: GUARDIANSHIP
PETITION FOR EXTENSION OF EMERGENCY PLENARY GUARDIANSHIP OF
THE PERSON AND ESTATE
AND NOW comes, Carlisle Regional Medical Center, by and through its counsel,
Lavery, Faherty, Young & Patterson, P.C. by Joseph A. Ricci, Esquire, and requests that
this Honorable Court extend the Order granting emergency plenary guardianship of the
person and estate of Mr. John Brenneman for the following reasons:
1. Pursuant to 20 P.S. ~ 5513 a court is permitted to enter an order granting an
emergency guardianship for up to seventy-two (72) hours.
2. On Thursday January 4,2007, this Honorable Court entered an order granting
temporary emergency guardianship of John Brenneman to Richard Hess.
3. The temporary emergency guardianship expires on Sunday January 7, 2006.
4. The need for the temporary emergency guardianship will continue beyond the
expiration of the current court order since John Brenneman is currently in an unresponsive
state and his medical condition is unlikely to improve.
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5. This Honorable Court has scheduled a guardianship hearing for Tuesday January
9, 2007 at 11:00.
6. It would be reasonable to extend the temporary emergency guardianship until the
time of the hearing scheduled for Tuesday January 9, 2007 since it will be necessary to have
an individual who can attend to the healthcare and financial needs of John Brenneman until
this Honorable Court can issue an order based upon evidence received at the guardianship
hearing scheduled for January 9,2007.
WHEREFORE, it is respectfully requested that this Honorable Court issue an order
extending the Emergency Temporary Guardianship until completion of the January 9, 2007
guardianship hearing and entry of subsequent order of this Court.
Respectfully submitted,
Date: ~16 I d7
CERTIFICATE OF SERVICE
And now this 5th day of January, 2007, I, Joseph A. Ricci, Esq. herby certify that on
Thursday January 4th, 2007 I personally served the EMERGENCY PETITION FOR
PLENARY GUARDIANSHIP OF THE PERSON AND ESTATE upon the following
individuals in the following manner:
John Brenneman
Room 6, Intensive Care Unit
Carlisle Regional Medical Center
45 Sprint Drive
Carlisle, P A 17013
By personal service.
Michael Palermo, Esq.
155 S. Hanover Street
Carlisle, PA 17013
Counsel for John Brenneman
By service of the Petition and Order of Court by placing the documents in the
Courthouse mail folder located in the office of the Prothonotary and by postage paid
first class United States mail.
Respectfully submitted,
~~
ner,
edical Center
. _j 1 ..
Joseph A. Ricci, Esq.
Pa. ID 49803
Lavery, Faherty, Young & Patterson, P.C.
225 Market Street
Suite 304
Harrisburg, PA 17101
(717) 233-6633
Counsel for Carlisle Regional Medical Center
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: IN THE COURT OF COMMO~EAS. ~_.
: CUMBERLAND COUNTY PENNSYLVAMA
IN RE: John Brennman
: DOCKET NUMBER: 2007-15
: GUARDIANSHIP
PETITION FOR PLENARY GUARDIANSHIP OF THE PERSON AND ESTATE
AND NOW comes, Carlisle Regional Medical Center, by and through its counsel,
Lavery, Faherty, Young & Patterson, P.C. by Joseph A. Ricci, Esquire, and requests that
this Honorable Court enter an Order granting plenary guardianship of the person and
estate of Mr. John Brenneman for the following reasons:
1. The alleged incapacitated person is Mr. John Brenneman, an adult male aged
80.
2. Ms. Brenneman is currently a patient in the Intensive Care Unit at the
Carlisle Regional Medical Center, 45 Sprint Drive, Carlisle, Cumberland County,
Pennsylvania.
3. Prior to his hospitalization, Mr. Brenneman was receiving care at the Forrest
Park Health Center, 700 Walnut Bottom Road, Carlisle, Cumberland County,
Pennsylvania.
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4. Prior to the need for medical care in early December 2006, Mr. Brenneman
resided at 17 Shirley Lane, Boiling Springs, Cumberland County, Pennsylvania. Mr.
Brenneman had resided at this address in excess of twenty (20) years.
5. Mr. Brenneman was married to Harriet Brenneman. Harriet Brenneman is
deceased and Mr. Brenneman has never remarried.
6. Mr. Brenneman and Mrs. Brenneman did not have any children.
7. Mr. Brenneman is an only child and has no siblings.
8. Mr. Brenneman's parents are deceased.
9. Mr. Brenneman has no known relatives.
10. Richard A Hess is an adult male who resides at 15 Shirley Lane, Boiling
Springs, Cumberland County, Pennsylvania. See Affidavit of Richard Hess attached hereto
as Exhibit "A"
11. Richard A Hess is the next door neighbor of the alleged incompetent, Mr.
Brenneman. Id.
12. Richard A Hess and Mr. Brenneman have known each other for 19 years and
have become close personal friends. Id.
13. Richard A Hess has been providing assistance to Mr. Brenneman since his
hospitalizations in early December of 2006 in the form of caring for Mr. Brenneman's home,
retrieving Mr. Brenneman's mail, organizing and making arrangements for the payment of
Mr. Brenneman's bills, depositing checks in Mr. Brenneman's accounts and such other
duties as have been required from time to time. Id.
14. Richard A Hess has no interests adverse to the interests of Mr. Brenneman.
Id.
. ... . ..
15. It is believed that the Last Will and Testament of Mr. Brenneman makes no
provision for Richard A. Hess and that the entirety of Mr. Brenneman's estate is to be left
to an educational institution which had been attended by his wife. Id.
16. Richard A. Hess has agreed to serve as Plenary Guardian of the Person and
Estate of John Brenneman, the alleged incompetent. Id.
17. A Plenary Guardianship of the Person and Estate of John Brenneman is
necessary for the following reasons:
a) Mr. Brenneman first began to experience health complications in late
2006 when he was hospitalized for evaluation of a mass found in his throat. See
Medical Record attached hereto as Exhibit "B."
b) Although the mass was found to be benign its origin was undetermined.
Id.
c) Following the evaluation of the mass in his throat, Mr. Brenneman
presented to the Carlisle Regional Medical Center Emergency Room on December
10, 2006 with complaints of difficulty swallowing(dysphagia), nasal congestion,
shortness of breath, worsening appetite and weight loss. Id.
d) At this time Mr. Brenneman was admitted to the hospital for evaluation.
Id.
e) Mr. Brenneman was diagnosed with low sodium levels, hypertension,
benign protatic hypertrophy (enlargement of the prostate), and significant
peripheral vascular disease. Id.
'4 . II
f) Mr. Brenneman was discharged from the hospital, however, he sought
admission to the nursing home, Forrest Park Health Center, because of worsening
dysphagia, weight loss and increasing weakness. Id.
g) During the time Mr. Brenneman was a resident of the Forrest Park
Nursing Home his condition continued to deteriorate and he went from being
independent in his activities of daily living to requiring the assistance of two aides.
Id.
h) On the morning of December 28,2007, Mr. Brenneman was found to be
unresponsive by the staff at Forrest Park Health Center. Id.
i) Emergency Medical Technicians called for assistance found Mr.
Brenneman to be unresponsive with only a pulse rate of 10. Id.
j) Resucitative efforts resulted in the restoration of a heart rhythm but Mr.
Brenneman required intubation and assistance with breathing. Id.
k) Mr. Brenneman was transported to the Emergency Room of the Carlisle
Regional Medical Center where he was found to be completely unresponsive and in
need of mechanical ventilation. Id.
1) At the time of his admission, Mr. Brenneman was found to be
unresponsive to deep painful stimuli, he seemed to be posturing in a decerebrate
manner which suggested significant brain injury, he had an irregular heart rhythm,
but he did have some sluggish reaction of his pupils. Id.
m) Since the time of his admission, Mr. Brenneman's condition has worsened
and by December 29,2007 neurologic evaluation revealed that Mr. Brenneman's
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pupils had become fixed and non-reactive to light. Mr. Brenneman continued to be
dependant upon a ventilator to breath. Id.
n) Mr. Brenneman's condition has been diagnosed as anoxic encephalopathy
or oxygen deprivation to the brain. Id.
0) Examination of Mr. Brenneman's brain waive pattern revealed patterns
consistent with severe metabolic or hypoxic encephalopathy. The brain waive study
was further described as severely abnormal. Id.
p) The medical prognosis for Mr. Brenneman has been listed as poor. Id.
q) Mr. Brenneman's physicians believe that he has little to no chance of
recovery from his current unresponsive state. See Affidavit of T. Alex Boshnakov,
M.D. attached hereto as Exhibit "C."
r) In his current condition, Mr. Brenneman cannot communicate.
s) In his current condition, Mr. Brenneman cannot participate in any
decision making in regard to his medical care and treatment.
t) In his current condition, Mr. Brenneman cannot attend to his personal and
financial affairs.
u) Because of Mr. Brenneman's current unresponsive state, the medical staff
of the Carlisle Regional Medical Center is unable to obtain necessary consents to
provide care and treatment that may become necessary. Id. See also Affidavit of
Donald J. Kovacs, M.D. attached hereto as Exhibit "D."
v) Because of Mr. Brenneman's current unresponsive state, his personal and
financial affairs cannot be addressed and his bills will remain unpaid, checks will
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not be deposited in his accounts, and financial and personal obligations will be
unmet.
w) The medical doctors responsible for the care of Mr. Brenneman believe
that the current condition will continue without relief or improvement.
18. Attempts have been made to locate legal documents such as an Advanced
Directive for Healthcare, a Durable Power of Attorney or other expression of Mr.
Brenneman's intent in regard to his care should he become incapacitated.
19. It is the Petitioner's belief that Mr. Brenneman did not execute Advanced
Directives or a Durable Power of Attorney for the following reasons:
a) Communication with the Forrest Park Health Center has revealed that
Mr. Brenneman advised the staff that he did not have an Advanced Directive for
Healthcare at the time of his admission.
b) No Advanced Directive for Healthcare has been presented to the staff of
the Carlisle Regional Medical Center.
c) Communication with attorney Hamilton Davis, the attorney responsible
for the drafting of Mr. Brenneman's Last Will and Testament revealed that Mr.
Brenneman declined attorney Davis's advice to prepare a Durable Power of
Attorney.
20. No other alternative with lesser restrictions than the imposition of a Plenary
Guardianship is available in this circumstance for the protection of the rights and interests
of Mr. Brenneman.
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21. Because of Mr. Brenneman's profound disability and complete inability to
care for himself or his affairs, it is necessary to seek a Plenary Guardianship of the Estate
and Person so that Mr. Brenneman's wishes can be fully met and discharged.
22. Because of Mr. Brenneman's profound disability and complete inability to
care for himself or his affairs, it is necessary to seek a Plenary Guardianship of the Estate
and Person so that Mr. Brenneman's rights and obligations can be protected and fulfilled.
23. Because the Petitioner is a health care provider and does not have access to
Mr. Brenneman's personal records or accounts it is unable to determine the size or extent of
Mr. Brenneman's Estate.
24. Because the Petitioner is a health care provider and does not have access to
Mr. Brenneman's personal records or accounts it is unable to determine Mr. Brenneman's
net income.
25. It is believed that Mr. Brenneman's neighbor, Richard Hess, with the consent
and cooperation of Mr. Brenneman, has been responsible for Mr. Brenneman's finances
during the period of time between his hospitalization in December of 2006 and the date of
his incapacity.
26. It is believed that Richard Hess is a mature, responsible adult who is fully
capable of meeting the obligations of a Plenary Guardian for the following reasons:
a) Mr. Hess had been assisting Mr. Brenneman with his financial obligations
and responsibilities prior to Mr. Brenneman's incapacity. See Affidavit of Richard
Hess attached hereto as Exhibit "A."
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b) Mr. Hess has been authorized by Mr. Brenneman to receive private
healthcare information. See Affidavit of Donald Kovacs, M.D. attached hereto as
Exhibit "D."
c) Mr. Hess has been Mr. Brenneman's closest friend for the past 19 years
and is the best position to know and understand Mr. Brenneman's wishes. See
Affidavit of Richard Hess attached hereto as Exhibit "A."
d) Mr. Hess is a close personal friend who has indicated that he promised
Mr. Brenneman prior to the time of his incapacity that he would always be available
to assist Mr. Brenneman in what ever way was necessary.
WHEREFORE it is respectfully requested that this Honorable Court issue an
Order appointing Richard A. Hess, Boiling Springs, Cumberland County, Pennsylvania as
Plenary Guardian of the person and estate of John Brenneman.
Lavery, Faherty, Young & Patterson, P.C.
Date:
1/5'/07
.
. cci, Esquire
Attorney . No. 49803
arket Street
Suite 304
Harrisburg, Pa 17101
(717) 233-6633
Counsel for Carlisle Regional Medical Center
r... .."
CERTIFICATE OF SERVICE
And now this 5th day of January, 2007, I, Joseph A. Ricci, Esq. herby certify that I
personally served the PETITION FOR PLENARY GUARDIANSHIP OF THE PERSON
AND ESTATE upon the following individuals in the following manner:
John Brenneman
Room 6, Intensive Care Unit
Carlisle Regional Medical Center
45 Sprint Drive
Carlisle, PA 17013
By personal service.
Michael Palermo, Esq.
155 S. Hanover Street
Carlisle, PA 17013
Counsel for John Brenneman
By service of the Petition by placing the documents in the Courthouse mail
folder located in the office of the Prothonotary and by United States Mail, first class
delivery addressed as above.
Respectfully submitted,
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AFFIDAVIT OF RICHARD A. HESS
AND NOW this
1\ ~"'
.
day of January 2007. I, Richard A. Hess., do hereby swear .and
affirm:
1. I am adult individual who resides at 15 Shirley Lane. Boiling Springs,
Cumberland County. Pennsylvania.
2. I am the next door neighbor of John Brenneman. currently a patient in the
Intensive Care Unit of the Carlisle Regional Medical Center.
3. I have known Mr. Brenneman for 19 years.
4. Mr. Brenneman is a widow who has no children. no siblings and no known
extended family.
5. Mr. Brenneman has authorized me to receive Private Healthcare Information
from his primary care physician, Dr. Donald Kovacs.
6. Since Mr. Brenneman became ill in December of 2006 I have been authorized
to assist Mr. Brenneman with his financial matters and have reviewed his mail, deposited
checks and assisted with the payment of bills.
7. Since Mr. Brenneman became ill and was a resident at the Forrest Park
Health Center I was instructed to contact his attorney. Hamilton Davis. Esq. in the event it
was necessary to obtain a copy of Mr. Brenneman's will.
8. I have been advised that representatives of the Carlisle Regional Medical
Center have been told by Attorney Davis that the entirety of Mr. Brenneman's Estate is to
be left in trust for the University attended by Mr. Brenneman's deceased wife.
9. I have no financial interests in the Estate of Mr. Brenneman.
1. 1..
10. As Mr. Brenneman's closest friend, I am in the best position to be able to
respond to inquiries about Mr. Brenneman's medical care.
11. As Mr. Brenneman's closet friend, I am in the best position to see that Mr.
Brenneman's wishes are carried out.
12. Mr. Brenneman has on numerous occasions had conversations with me in
which he expressed his wishes that he not receive medical treatments which would only
prolong his dying and not effect a cure.
13. I am willing to accept an appointment from the Court of Common Pleas of
Cumberland County as Guardian of the Person and Estate of Mr. Brenneman.
Respectfully Submitted.,
Date:
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Richard A. Hess
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71796033f' ~
i
CARLISLE MEr:" . '. CE
'.1014 pm.
12~14~2r
(
3/29
BRENNEMAN, JOHN
MS2 0205 W
CHIEF COMPLAINT: Dysphagia.
HISTORY OF PRESENT IllNESS: Th~ BO-ye''''rnd wMe male Presen~ to the emerQency room wilh
progressNely worsening dysphagia, nasal congestion, shortness 01 brealh, progress,," worsening
hoarseness, poor appetite, and weighl loss. He was _nfly in !he hospital wIlere biopsy Of lhe
nasopharyngeal mass was obtained al lhat time. Biopsy report was apparenlly negollve but etiology of the
mass - not clear althis time. He - sent home from lhis admission and has persisting and worsening
symptoms at this time.
PAST MEDICAl HISTORY: Past Medical Histoty ~ POSfflve for polio at the age Of 20. He also carries
lhe diagnosis of h_sion, benign prostatic hypl!f1rophy end peripheral vascular disease.
PAST SURGICAl HISTORY: Pas, Surgical H"lStory ~ POsitive for left Inguinal hemla and repair and
TURP. He also had biopsy of his throat done.
951466
ALLERGIES: No known drug allergies.
MEDICATIONS: Aspirin, Augmentin, and ChlOrthaJidone.
SOCiAl HISTORY: He is a nonsmoker, nondrinker, lives alone.
FAMll Y HISTORY: FamDy Histoty is not s\:lnlRcant. His falher had ml'CCard1a1 infarction at lhe age of 52.
REVIEw OF SYSTEMS: He lhinks !hat he has a right inguina; hernia noted. He also has signtficant
bruistng of his '-" abdom... after admission from before and he stales lhat he has had foot pain
blJa_,y for awhile end this has progressively WOISened. He denies any chest palo er shonness of
breath. Denies any COUgh er wheeztng. He denies any Jla/pilatjons. He denies any nausea, -iting,
conslfpation, 0< diarrhea, h_m, in<#gest;"" black or bloody ~ movements. Denies dysuria,
frequency, or urgency since the surgery to his prostate.
GENERAl_ His exam f6VeaJs him to be alert and 0_ X3 in no _t disb'ess.
PtfYSICAL EXAMINATION
VITAl SIGNS - Blood Pressure is 143/71, respiratory rale 18, lNOight 165 /lOUnds, temp _ 95.6F, pulse
84.
HEENT - Head - nOl'll1Ocepha;~. E)mS - PERRlA, EOMt. E... _ no inJectlon or bulging of the
1)Irnpan~ membnlnes, canals are patent. Nose - Mildly boggy Iurblnalas. Throat_ without signilicant
injection. MoUth was Without lesions. Dentition was stable.
NECK - SUjJple aJlhoogh /here was some decreased range Of motion of his neck bDaleralJy. No neck vein
distention, no bruits or thyromegaly noted.
CHEST - Clear to aUSCUltation.
BACK - Was positive for somewhat significant kyphosis. .1
HEART - Regular rate and rhythm with ectopy at times, no mtinnurs or gallops.
Page 1 of 2
TrilS DOCUMENT IS NOT A LEGAL Copy UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL ~INAT/ON
9356223
BRENNEMAN, JOHN
MS2 0205 W 951466
12/10/2006 09/10/1926
KOVACS, DONALD J
I
717960339;;--
(
CARLISLE MED!C - . CE
\
1 a 28 p m
12-14-700-
4/29
BRENNEMAN, JOHN
MS2 0205 W
ABDOMEN - Abdamen was nantende" na masses na hepatosplenomegaly. Bowel saunds we,. heart
tIl/'OUghaut. Lowe, abdomen 'eveals a left ingUina' hernia "pal, scar and "ght inguinal hernia. He hes a
significant amount of bruising across his lower abdomen.
951466
EXTREMITIes -Lawe.- """emiltes reveal full ,.nge al mation af h~ Joinls. Thece Was -eased pUlses
of th. -is podia and posterior //blat PU~.. wilh significant edema of balh lower """.millas, right
WOes. Ihan the I.n, significant onychom)'COSis and on ill. right there were "'Yihemataus cold toes, on ill.
feft there were warm erythematous toes noted. Both were mildly tender.
SKIN - Without rashes, lesions and breakdown.
NEURO - Crenlal nerves lIi11l'OUgh XII w.... intact. Na focat neurologic signs ...... noted. Na weakness
or decreased sensation af the uppec exlremm.s. The,. was Qeflere/ized Weakness of boill 10_
extremities bilaterally.
ASSESSMENT:
1. Nasopharyngeal mass wilh es_ dysphagia, hoarseness, nesal coogaslIon, we;ghtloss.
2. 'Wona11emia, etiology is un_. Could iII~ be a~ WiIh the mess. We.... going 10 get
a CT of the chest, CT of the head. ,
3. Dysphagia. POSSibly there Is dj;sphagia beYOnd the nasop/Jaryngeat mass, iII_. we will
consull gastroenterology and a/so go ahead with barium swallow. ~
4. He has iIIe h~tory of h_nslon, benign _ hYPBrlrophy, sign/flcan, ~I vaSCUlar
disease WiIh OI1_}<:OS~ of ill. "'- axframities Is noted. Althls point we w;ll go ahead WIIh
his workup as ordered and replace his sodium and watch him closely.
JAP/nw
D: 1211012006 16:38:35
T: 12/11/2006 06:51:19
C: Joseph A. Picn, D.O.
-Joseph A. Pion, D.O.
Page 2 of 2
THIS DOCUMENT IS NOT A LEGAL Copy UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL ~MINATlON
9356223
BRENNEMAN, JOHN
MS2 0205 W 951466
12/10/2006 09/10/1926
KOVACS, DONALD J
i
717960.339/
CARLISLE MEDlr . CE
11 20. pm
12-14-2o.P-
I
8/29
BRENNEMAN, JOHN
MS2 0205 W
CONSUL TATION TO:
ATTENDING PHYSICIAN:
DATE:
TYPE OF CONSULTATION:
Gregory l. Lewis, M.D.
KOVACS. DONALD J
12/10/2006
GASTROENTEROLOGY
951466
HISTORY OF PRESENT ILLNESS: This pleasant 80-year-old gentleman was admitted to lhe Carlisle
Regional Medlcal Center tonight by Dr. Pion because ",e patient has had a progressive sore throat and
difficully swallowing, ChoIdng and hoarsen.... Apparently this problem began many j8OI> ago but was
intermittent and has become more constant and jl/1lgressive in the las,_ _So The paffent says
'hat he had polio In 1947 and since then he has had In'ermittenl "",....,..s and choking.
He had a recent admission one _k ago. He was admitted by Dr. Kovacs and seen by Dr. FOITan:>.
Ini,"",y Dr. FOITan:> felt lhe patient had a mass althe base of his longue but a biopsy was _ and felt
that he just has a sfrange/y shaped UVU'a. He felt his focat COrds..... llOmJaI but h. did reet there was
much el}'lhema ;, the back of his lhroal. He apparently amll1ged for a video swatlOWing study, the resuI~
of wh1ch are not known other than /he paffent was placed on a _ diet by the s_theraplst. The
Patlan I. however. las, n/r1Jt bagsn to choke and had trouble breathing and came to the emergency room
today for his admission.
PAST MEDICAl. HISTORY: Hi. pa., mad;ca/ histo'}' inclUdes a /eft inguinat hernia '"PO. by Dr. Frltchley
In 2001. H. had a 'ra'"ll/relh'al prostate resection in 2000. The patient been laking "-Ion 25 mg daily
for hypertension, baby aspirin daily.
ALLERGIES: He has no known drug allergies.
SOCIAl.HISTORY, Social history rewa's tha, he Is retired from the Air Fon:e. He Is a widower wIlo lives
in BOiling Springs.
FMIL Y HISTORY: Family hlsloly reveals that his falher had a "'l'OCardIaI Infarction at age 52.
REVIEW OF SYSlEMS, On review of -~,lhe Pallen' has _ dyspnea, _ 10 choking. He
has no heanburn, no abdominai pain, noonal bowel function. He has had a reduced _ and weight
loss recently. He also has Som. ap""""" discomfort ""'r his right inguinal area where he has a hernia
and is Scheduled to see Dr. Hardesty for right inguinal hernia repair.
PHYsICAl. EXAMINATION: GENERAl - On ph~ca/ exami1atton, lhe pallen, Is ;, no acute dlstr.... He
is hoarse. lilT AI. SIGNS - His ............... is 97 d"",- F_en. pulse 87 per minute, fllSpirato,y....
18 par minute. blood pressure 145183. HEENT - Pup;ts, equal, IOUIld and and reactive 10 light. There Is no
cervical lymPhadenopathy. Tongue Is moist. CHEST - Chest exam Is dear. HEART _ Heart exam Is
regular without a muonu,. ABDOMEN - Abdominal exam """"". .ome ecd1jmoses in the righ' ingu;,..
area of uncena;, etiology. He appears '0 have a rlght Inguinal hernia. However, U is nonlender. There is
no organomegaly. EXTREMITIES - Extremlly exam reveal. no edema or Phieb/tls. NEUROlOGIC _ He Is
oriented to person, place, and time.
DIAGNOSTIC STUD/ES, Dalabes. includ.. hl'POna.emla wilh a sodium 123 and a chloride of B6 of
uncenain eIlology. liver functions are noona" Albumin Is .lIghUy low at 3.1. Hemoglobin 13.6, while cell
count 10.100.
Page 1 of 2
THIS DOCUMENT IS NOT A LEGAL COpy UNLESS SIGNED.
CARLISLE REGIONAl MEDICAL CENTER
CONSUL TATlON
ASSESSMENT AND PlAN, I caued Dr. Ferraro .no felt lhls patient's problem was not -lnanlly ear,
nose and lhroal. He did nof have a mass. lherefore. !he paUent~ hoarseness and choking may be poo,
9356223
BRENNEMAN, JOHN
MS2 0205 W 951466
12/10/2006 09/10/1926
KOVACS. DONALD J
717960339;;'
CARLISLE MEDIr:-.-' CE
i
BRENNEMAN, JOHN
MS2 0205 W
- 11 38 p.m
12-14-200--'
(
9/29
951466
polio syndrome which is a syndrome where the patient distantly years after exposure to Polio, may
develop progressive swallowing difficulties. , cannot totally rule out a stricture of his esophagus and as
part of his video swallowing study there may be images of his esophagus but I am uncertain.
I suggest reconsulting the speech therapist 10 get her opinion. The patient may need to have his
esophageal anatomy and function studied further. I feel a neurology evaluation may also be helpful in
confirming postpolio syndrome.
He has hyponatremia. One wonders whether this is related 10 either diuretics or diet or even syndrome of
Inappropriate AOH. I wol lake the liberty of ordering some urine electro/yles and a urinalysis to look for
specific gravity. He may need a nephrology consult.
Thank you.
GLUsap
D; 12/101200619:57;34
T: 12/1112006 06:30:25
C: Gregory L. Lewis, M,D.
KOVACS, DONAlD J
Page 2 of 2
THIS DOCUMENT IS NOT A LEGAL Copy UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
CONSULTATIOll
Gregory L. Lewis, M.D.
9356223
BRENNEMAN, JOHN
MS2 0205 W951466
1211012006 09/10/1926
KOVACS, DONALD J
. .
71 79603~f\:>
j. (
CARLISLE ME\J''''\L CE
.....''3:10:39 p m
(
12-14-~('.'-
(
5/29
BRENNEMAN, JOHN
MS2 0205 W
CONSULTATION TO:
ATTENDING PHYSICIAN:
DATE:
TYPE OF CONSULTATION:
Mohammad K Ismail, M.D.
Donald J. Kovacs, M.D.
12/11/2006
NEUROLOGIC EVALUATION
951466
REASON FOR CONSULTATION: Dysphagia.
HISTORY OF PRESENT IlLNESS: Mr. Brenneman is an ao;..a, -old ve", pleasant ll9l1lleman for whom
' was consulted by Dr. Kovacs for evaluation for his dysphagia The Pallenl is a _ hislorfan and _
thai he has dilfiaJlty w;o, Swallowing s~ce the age of 19 when he had Polio thaI alfected his neck and
Shoo',"" musdes. He _ed thai he was In !he Army _ at thai lime he always had an issue w;o,
swallowing anyth~g bigger than llOp/rin tablet. He also ec:knowledge<J W he was sick this problem is
BQ9IaVaIed. He r_ thaI for the Past two ~'" his voice Is gelling low and he cannot _loudly. He
has had more dlfficul1y WIth swalloWIng and _ for the past few 11lOll1hs. The _, was seen by Dr.
Ferraro a few months ago and allhatllme there was !he _Ity of some mass that was 0lCp/0red in the
nas~....... He has been ruled out for any hJmor. He,. now admitted to the h_ for
evaluation of worsening dYSPhagia.
The patient denies W he has dcubte vision. He denies W he has droopy eyes or excessive amount ot
tatigoe. He has 110 numbness or _oss or any other part of the body. He has some crlflicUty with
urinatton and -uleo /his to prostate _s. The pallent denies any signillcmt 1M>IgIrt loss or nighl
sweats.
PAST MEDICAL HISTORY: Past Medical History is significant:
1. for polio at the age of 19.
2. history of hypertension,
3. history of benign prostatic hypertrophy, and
4. history of peripheral vascular disease.
PAST SURGICAl HISTORY; Past Surgical History is signifICant for
1. left inguinal hernia repair and
2. transurethral resection of prostate.
3. He recently had a biopsy of his throat and was reportedly negative.
ALLERG'ES; None.
FAM'L Y HISTORY: Noncontributory.
MEDICATIONS: Aspirin, Augmentin and Chlorthalidone.
HABITS: He does not smoke, drink Or Use illicit drugs at the moment
SOCIAL HISTORY: The patient lives alone. He was in the Army.
REVIEW OF SYSTE~:
Resplralooy: The palientFllporis some COugh and shortness of breath. He denies any chest pain or
dyspnea.
Neurological: The patient reporis some difflCUtty _ his right arm due to his eIlron~ shO<Jlde, t>roblems
due to polio. He has swalloWing and speech prOblems as described above.
Constitutional: Denies fever, eIl"s, night sweats, welghl gain or loss " recent past
Page 1 of 3
THIS DOCUMENT is NOT A LEGAL Copy UNLESS SIGNED.
CARLISLE REGIONAl MEDICAl CENTER
CONSUL TATION
9356223
BRENNEMAN. JOHN
MS2 0205 W951466
12/10/2006 09/10/1926
KOVACS, DONAlD J
'lit ,..
BRENNEMAN, JOHN
ICU 0005 0
951466
CHIEF COMPLAINT: Cardiac arrest.
HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old gentleman followed by Dr. Kovacs. He
just recently moved into a nursing home. He has had progressive dysphagia, weight loss and weakness.
He is felt to have a post polio syndrome. In reviewing the nursing home records, over the past week, he
has gone from doing his AOLs independently to needing assist of two. This morning, he apparently was
found unresponsive. When paramedics arrived, he was in PEA with a pulse of about 10. He was
resuscitated to atrial fibrillation at a controlled rate. He was profoundly hypotensive requiring dopamine. In
the emergency department, the patient is completely unresponsive on a ventilator. To the best of my
knowledge, the patient has not had any recent complaints of chest pain or respiratory problems. He is on
Protonix for some recent diagnosis of esophagitis and had his esophagus dilated as well. He apparently
also had a mass in the back of his throat, which was biopsied and was negative.
PAST MEDICAL HISTORY: As above. He also has benign prostatic hypertrophy, peripheral vascular
disease and hypertension.
PAST SURGICAL HISTORY: Transurethral resection of the prostate and left inguinal hernia repair.
CURRENT MEDICATIONS: Protonix 40 milligrams twice a day, chlorthalidone 25 milligrams daily and
p.r.n.'s
ALLERGIES: None.
SOCIAL HISTORY: He moved into a nursing home a couple weeks ago. He is a nonsmoker, nondrinker.
He is widowed and has no children.
REVIEW OF SYSTEMS: Obviously unavailable since the patient is intubated. On reviewing the nursing
home notes, again, he has gotten weaker and more fatigued, had significant dysphasia and decreased
p.o. intake and weight loss. \
PHYSICAL EXAMINATION
GENERAL: The patient is not responsive even to deep pain. He seems to be posturing in at decerebrate
manner.
HEENT: Pupils were equally round; they were sluggish to react. Oropharynx reveals an ET tube in place.
NECK: Neck is supple. He does have external JVD when lying flat.
LUNGS: Lungs reveal loose rhonchi anteriorly bilaterally. There was no wheezing, no crackles noted.
HEART: Heart exam reveals irregularly irregular rhythm. There was no murmur auscultated. He has a
concave sternum. PMI was not laterally displaced.
ABDOMEN: Abdomen is soft. He has no reaction to palpation to suggest tenderness. Normal active bowel
sounds. No masses.
EXTREMITIES: Extremities were mottled and cold. He has onychomycosis of all of his ten toenails.
I.,
Page 1 of 2
THIS DOCUMENT IS NOT A LEGAL COpy UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
9357702
BRENNEMAN, JOHN
ICU 00050 951466
12/28/2006 09/10/1926
KOVACS, DONALD J
".' ..
BRENNEMAN, JOHN
ICU 0005 D
951466
NEUROLOGICAL EXAM: No response to painful stimuli. Decerebrate posturing at times. Toes are
downgoing bilaterally.
SKIN: Skin is cold and mottled.
LABORATORY STUDIES: BUN 22, creatinine 1.3, sodium 119, glucose 112, bicarbonate 28. Chest x-ray
does not show an acute infiltrate. pH 7.31, C02 57, 02 109. White count 15.7, hemoglobin 13.3.
Electrocardiogram shows atrial fibrillation. CPKs are pending.
ASSESSMENT:
1. Pulseless electrical activity cardiac arrest.
2. History of progressive decline with weight loss, weakness and dysphasia.
3. Hyponatremia of unclear etiology.
4. Atrial fibrillation.
PLAN: At this point in time, we will support the patient on a ventilator, continue dopamine drip and
aggressive IV fluid rehydration. Because he was becoming less ambulatory over the past week and had a
PEA arrest I do want to rule out PE, especially in the setting of atrial fibrillation. I will see if radiology will do
a CT angio, but because his BUN is 22, I think he may not qualify. Therefore, I will order lower extremity
Dopplers instead. If his CAT scan of his brain is negative, I will place him empirically on subcutaneous
Lovenox twice a day. The patient is normally followed by Dr. Kovacs and he requested that while the
patient is in the ICU, he remain on our service and then get transferred back to Dr. Kovacs' service when
he is out of the ICU. I attempted to reach the patient's only contact, which is a friend, and did leave a
message on his phone, that is Mr. Richard Hess, phone number 580-7814.
CC/jn
0: 12/28/2006 16:06:32
T: 12/28/200619:29:40
C:
Christina Collins, M.D.
Page 2 of 2
THIS DOCUMENT IS NOT A LEGAL COpy UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
HISTORY & PHYSICAL EXAMINATION
9357702
BRENNEMAN, JOHN
ICU 0005 D 951466
12/28/2006 09/10/1926
KOVACS, DONALD J
".' ...,
BRENNEMAN, JOHN
ICU 0005 0
951466
CONSULTATION TO:
ATTENDING PHYSICIAN:
DATE:
TYPE OF CONSULTATION:
Mohammad K. Ismail, M.D.
KOVACS, DONALD J
12/29/2006
NEUROLOGY
REASON FOR CONSULTATION: Decreased mental status.
HISTORY OF PRESENT ILLNESS: Mr. Breneman is an 80-year-old gentleman followed by Dr. Kovacs
and was recently admitted to the hospital for the evaluation of dysphagia. The patient has a history of
post-polio syndrome and no significant intervention was recommended. The patient was in a nursing
home and in the morning was found unresponsive. The paramedics were called to the scene and they
found him in PEA with a pulse of about 10. The patient was resuscitated through ALS and intubated. He
was brought to the emergency room where he was noted to have a pulse of 110 and blood pressure was
66/46. He was noted to have atrial fibrillation. His temperature was 96.3. The patient was unresponsive
at that time and he was admitted to the Intensive Care Unit for further management.
Since his admission, the patient has not made significant recovery in his mental status. He is not able to
wake up and communicate. The patient has remained unresponsive although his vital signs have been
stable. In reviewing the nursing home chart, it was noted the patient did not complain of any chest pain,
shortness of breath, on the night prior to this incident. In fact, he was making good recovery since his
discharge from the hospital and he was doing his ADLs fairly independently.
PAST MEDICAL HISTORY: Significant for:
1. Hypertension.
2. History of peripheral vascular disease.
3. History of prostatic hypertrophy.
4. History of post-polio syndrome.
PAST SURGICAL HISTORY: Significant for transurethral resection of the prostate and left inguinal hernia
repair in the past.
MEDICATIONS: Protonix 40 milligrams twice a day, Chlorthalidone 25 milligrams daily.
ALLERGIES: None.
SOCIAL HISTORY: The patient moved to a nursing home a few weeks ago. He is retired. Habits _ He
does not smoke, drink or use illicit drugs.
REVIEW OF SYSTEMS: Not obtainable. The patient is unresponsive.
PHYSICAL EXAMINATION:
General:
This is an 80-year-old gentleman laying on a bed, intubated and unresponsive.
Vitals:
EYES:
Blood pressure: 104/70. Pulse: 101 and regular. He was afebrile.
Pupils were 3.5 mm and nonreactive to light. Extraocular movements could not be checked and
Doll's eye test was negative. Cornea; reflex was minimally present bilateral/y. Examination of the
fundi was difficult but no apparent hemorrhage or bleed was noted.
Page 1 of 2
THIS DOCUMENT IS NOT A LEGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
CONSULTATION
9357702
BRENNEMAN, JOHN
ICU 00050951466
12/28/2006 09/10/1926
KOVACS, DONALD J
... ....
BRENNEMAN, JOHN
ICU 0005 0
951466
Cardiovascular:
Heartbeat is regular in rate and rhythm. Auscultation reveals no murmurs, gallops, or abnormal
sounds. Pedal pulses are palpable, both dorsalis pedis and posterior tibial. Carotid artery exam
reveals no bruits and full and equal pulse.
Extremities have no edema or varicosities.
Respiratory:
The patient was on a ventilator with respiratory rate of 14. Breath sounds were present bilaterally.
Musculoskeletal:
Inspection, palpation: of spine and both upper and lower extremities, unless stated otherwise,
showed no misalignment, deformity, asymmetry, tendemess, mass, or swelling.
ROMs were assessed in spine and upper body and lower extremities and found to be normal.
Muscle tone was slightly increased in all four extremities. The patient was having a few .
spontaneous projecting type of movements in the upper and lower extremities. However, he is not
showing any sort of response on stimulation from sternal rub and suborbital pressure.
Neurological:
Mental Status: Patient was unresponsive. Not showing any sign of grimace or movement with
deep sternal rub.
Language: Not examined.
Cranial Nerves: Limited. Pupils are fixed and corneal reflex is minimally present. There was no
apparent facial droop.
Reflexes:
The patient has absent ankle jerks and knee jerks bilaterally. Reflexes in the upper extremities
are also diminished. Babinski was negative.
LABORATORY AND X-RAY: CT of the head was ordered yesterday and showed no intracranial bleed.
He also has CT of the chest and thorax that showed extensive mucous plugging within the airways of both
lower lobes. EKG done showed that he has sinus arrhythmia with a heart rate of 117 when he presented
to the emergency room. White count 15.7, hemoglobin 13.3, platelet count 268, BUN 22, sodium 119,
potassium 3.3, blood sugar 112. CPK level 2,105. MB fraction was 28.1. Troponin-I 1.15.
IMPRESSION: This is an 80-year-old gentleman who has a history of hypertension, peripheral vascular
disease and now presents to the hospital with the sudden onset of loss of consciousness and was noted
to be in a cardiac arrest. Most likely the cause for the decreased mental status is anoxic encephalopathy.
His neurological examination showed that he has fixed pupils and minimal reaction even 12 hours after
the accident. I believe the overall prognosis is poor. Other differentials that need to be considered is
nonconvulsive status epilepticus or infection to the CNS, overdosage of some sedative medications.
PLAN: At this time, I will order an EEG. I would also like to explore other causes for his decreased
mental status as described above. I will continue to follow this patient with you.
MKI/le
0:
T:
12/29/200614:49:18
12/29/2006 21 :06:45
C: Mohammad K. Ismail, M.D.
KOVACS, DONALD J
Mohammad K. Ismail, M.D.
Page 2 of 2
THIS DOCUMENT IS NOT A LEGAL COPY UNLESS SIGNED.
CARLISLE REGIONAL MEDICAL CENTER
CONSULTATION
9357702
BRENNEMAN, JOHN
ICU 00050 951466
12/28/2006 09/10/1926
KOVACS, DONALD J
.. .PAg1~0
1/03/0715:28:52
CARLISLE REGIONAL MEDICAL CTR
Heart
Coid:
Page:
858
1
Report status: TRANSCRIBED
Pat Nbr: 9357702 BRENNEMAN, JOHN
Req By: 4510 KOVACS, DONALD J
Med. Rec: 0000951466
Type: MED Diet.: 12/30/2006
Physician: ISMAIL, MOHAMMAD
Pat.Type: 11
16:48 350424
K
Admit...: 12/28/2006 16:00
Discharg:
Location: ICU ,0005,D
Trnsc.: 12/31/2006 11:42
-------------------------------------------------------------------------------
BRENNEMAN, JOHN ELECTROENCEPHALOGRAM 12/30/2006
CLINICAL HISTORY: This is an 80-year-old gentleman who had a cardiac arrest
and was brought to the hospital with decreased mental status. The patient has
been unresponsive since then. This EEG was ordered to evaluate further
prognosis and rule out nonconvulsive status epilepticus. The patient is not
on any sedative medication.
TECHNICAL SUMMARY: This is a 17-lead, 10-20, bipolar and referential, digital
EEG recording done on a patient who was unresponsive and on the ventilator.
The record opened with the patient unresponsive and with his eyes closed. No
well-defined background alpha rhythm was noted. There was diffuse depression,
and slowing was noted in the theta to delta range. At the time, the rhythm
was 3 to 4 Hz, 10 to 30 microvolts, but generally symmetrical. Unfortunately
this EEG was contaminated with a lot of artifacts related to the intensive
care unit and electrical activity that made it somewhat difficult to interpret
this record. There was poor reactivity in this EEG record. There was no
frank epileptiform discharge noted. Photic stimulation was done at several
frequencies, and eyes were opened manually. No response was noted in the
occipital leads. Overall there was minimal variability in this EEG record.
Single-lead EKG monitoring throughout the record showed some artifacts and
irregularly irregular rhythm.
IMPRESSION: This is a severely abnormal electroencephalographic record due to:
1. Lack of well-defined background alpha rhythm.
2. Lack of variability and reactivity in this electroencephalographic record.
3. Diffuse depression and slowing throughout this electroencephalographic
record.
COMMENT: This EEG pattern is compatible with the diagnosis of severe
metabolic or hypoxic encephalopathy. No apparent epileptiform discharge was
noted to explain the patient's decreased mental status.
MKI/am D: 12/30/2006 16:48:11 T: 12/31/2006 11:31:21
C: Donald J. Kovacs, M.D. Juliusz C. Nitecki, M.D.
Mohammad K. Ismail, M.D.
Dictated by 1141 - ISMAIL, MOHAMMAD K
~ w>. .. ~CwlstE
----CZ::~
351 AJexan~er Spring Road. Carlisle, PA 17015-9129 . (717) 249-1212
COLLABORATIVE CARE WORKSHEET
16:00:00
Patient #: 9357702
patient Name:
A. drn i t D ate :
A tt Phys:
R. Dam/Bed:
DOB:
BRENNEMAN, JOHN
12/28/2006 Time:
KOVACS, DONALD J
OOOS/D
09/10/1926
Med Rec #: 0000951466
Sex: M Age: 080
DISCHARGE ASSESSMENT/SOCIAL SERVICE
~ssessinent Date/Time: 12/29/200615:40:00
Discharge needs are unclear, will follow
Mental Status: Unresponse
r:..i.ViIlg Arrange: In nursing home
AC tivities: Total dependent
Agency Support and DME already in home:
EQUIPMENT COMMENTS USER
Re ferral Services:
FACILITY SERVICE REFERRAL ACCEPTED
D.ischarge Plan:
12/29-per review, pt is from Forest Park. Recently admitted there on 12/15.
pt is widowed with no children. Will check with Darlene B. @ Forest Park
rei bed status. 1jk
Last Updated: 12/29/2006 15:42:11 LKEEN
DISCHARGE ASSESSMENT/SOCIAL SERVICE
Assessment Date/Time: 01/02/2007 09: 18 : 00
Care Conference: 01/01/2007 00: 00: 00
0830: Discussed current medical status W/Dr Boshnakov,Hospitalist and nurs
ing staff at ICU unit. This writer will tic attorney: Hamilton Davis &
neighbor,exp1oring whether or not there is a POA or family member avail
able to make end of life decisions regarding pt.
0930: T/C Hamilton Davis,Esquire: spoke with receptionist. Introduced self
& role related to pt. Per receptionist,Rick Hess,neighbor called Hamilt
on Davis last week,Mr Davis was unsure if he was pt's attorney or not,
possibly being other attorney in the office is pt's attorney. This writer
requested that Mr Davis be consulted to determine if he is pt's attorney
or not, notifying this writer. Receptionist said OK. Return phone number
provided.
T/C Darlene @ Forest Park NH: Discussed above information. She reports that
when pt was admitted to their faci1ity,pt did not have a Living Will nor
POA. No additional information obtained.
T/C Rick Hess,Neighbor @ 258-6023 1ft message requesting return tic. T/C
RiCk Hess @ 580-7814: discussed at length pt's current status. Mr Hess
reports that he would write pt's checks out,pt would then sign them. To
his know1edge,there is no living relative. Pt always told him if somethi
ng happened to him to contact Hamilton Davis,Esquire. Mr Hess did contact
Mr Davis last week,but to date, has not received a return tic by him. Per
pt,the bank was his POA,but Mr Hess is not sure whom to contact at the
bank,this writer requested that he check the bank statements & obtain an ad
dress/phone number for this writer to contact. He will return tic with
1IIIIIIlRII 11111111111111111111111111111111
8995'-1"
1111/111111111111111111111111111 DIll 1/11 IIII
Jo .' r'l7G
~~
361 Alexander Spring Road. Carlisle, PA 17015-9129. (717) 249-1212
COLLABORATIVE CARE WORKSHEET
Patient Name: BRENNEMAN, JOHN
Patient #: 9357702
DISCHARGE ASSESSMENT/SOCIAL SERVICE
Care Conference:
this information as soon as possible. This writer provided my return tic
number.
0950: Received return tic Sarah @ Hamilton Davis,Esquire's office: she repo
rts that Mr Davis drew up pt's will in 1983,but has not had any contact
w/pt since 1991. Sarah reports the will does not provide any living will
or POA information. This writer requested that the will be checked for any
relative information. Sarah will check and return tic.
1010: T/C Office of Aging: 1ft message requesting information ref: no POA
available & assistance needed.
T/C Coroner's Office: spoke w/Mr Norris. He reports that unless there is a
named family member in the will,the hosital will need to seek guardian
ship of pt.
1200: Recd tic Jennifer Mann @ Office of Aging: she reports that unless pt
received current services via OOA, the hospital will need to seek guardi
anship of pt. If pt was currently receiving OOA services, they may be able
to assist.
1430: Spoke w/Bill Ziesmer,CFO/Admin on Call for hospital. Status update
provided regarding need for guardianship of pt. Joe Ricci: 233-6633 is
hospital attorney. T/C Joe Ricci: status update provided regarding need
for hospital to seek guardianship of pt. Mr Ricci request that this writer
tic pt's attorney & request copy of will, name of funeral home that pt's
mother was buried at. He will meet w/hospitalist tomorrow 1/03/2007. This
writer will tic neighbor: Rick Hess & advise of hospital's plan of care.
1630: T/C Hamilton Davis: 717-532-5713 1ft VM for Sarah - requested retur
n t/c,notified that Joe Ricci,CRMC Atty pursuing guardianship & request
ing copy of pt's will along w/name of funeral home for pt's mother.
T/C Rick Hess,pt's neighbor: 1ft VM w residence notifying that hospital
atty: Joe Ricci will be contacting him due to seeking guardianship of pt
along w/need for neighbor to report what pt always told him regarding
end of life issues.
Notified Dr Boshnakov that hospital attorney will be coming to hospital to
discuss guardianship with him 1/03/2007. Said OK.
Last Updated: 01/02/2007 09:31:41 SWASTLER
DISCHARGE ASSESSMENT/SOCIAL SERVICE
Assessment Date/Time: 01/03/2007 09:46:50
Care Conference: 00/00/0000 00:00:00
0930: Recd VM Rick Hess - he reports that he found some information,pt used
M&T Bank in Boiling Springs,PA. Additionally,he does have a safety depos
it box at that bank. Perhaps there is some documentation as to his wish
es in this situation there.
0950: Per Dr Boshnakov,Hospitalist. He has spoken with Dr Kovacs,pt's fami
ly physician, Dr Kovac is to review his chart at the office & obtain any
documentation regarding pt's end of life wishes.
1010: T/C M&T Bank,Boiling Springs,PA: spoke with Branch Manager: Rebecca
Dorwart. Status update provided regarding current situation and need
for POA/Living will or pt's wishes to be provided. Notified that possibl
y pt had safety deposit box at their branch, and M&T was trust holder.per
1/111111111111111111111111111111 111111111111/
8995210
. 1111111 1IIIIIIlIIIIIII 1111111111 1111111111111
9357702
)r ..
'rn
ME~
361 Alexander Spring Road. Carlisle, PA 17015-9129 . (717) 249-1212
COLLABORATIVE CARE WORKSHEET
Patient Name: BRENNEMAN, JOHN
Patient #: 9357702
Care Conference:
Rebecca Dorwart,she reports that per their file,pt is a individual hold
er,M&T is not POA. She does see where they are listed as a possibly hold
er at another location,she will tic that location & return tic with this
writer.
1100:Recd return tic Rebecca Dorwart,Branch Mgr @ M&T,she reports that pt
did not have a safety deposit box @ M&T,nor at any of the branches in Car
lisle,PA - she checked prior to returning tic with this writer.
1130: T/C Rick Hess @ 580-7814 w/status update regarding above information.
He reports that the other bank pt dealt w/was F&M in Boiling Spring,per
haps they have something in his safety deposit box there.
1140: T/C F&M Bank,Boiling SpringS,PA: requested to speak w/Branch Mgr _ sp
oke w/Kevin Stoner. Status update provided regarding need for POA/Living
Will,etc. Mr Stoner will check & return tic with this writer. Per his reg
uest,telephone # provided to Rick Hess,Neighbor.
1200: Recd tic Kevin Stoner,F&M Bank,reports that following investigation
at their bank,pt did not have any safety deposit box at their bank.
1300: Per Dr Boshnakov,per Dr Kovacs,pt would not accept any preventive
care or treatment,always stating "I am too old and dying",refusing various
types of life sustaining tx.
1500: Dr Boshnakov,this writer,Mr Ricci,Esg met to discuss current status.
Last Updated: 01/03/2007 09:46:50 SWASTLER
DISCHARGE ASSESSMENT/SOCIAL SERVICE
1111111111111111111111111I111111111111111 I11I
8995210
I 111111 11111 11111 111II gill 1111/11111 11111'"
9357702
Ir. .' .. ~ .
AFFIDAVIT OF T. ALEX BOSHNAKOV. M.D.
AND NOW this ~ day of January 2007, I; T. Alex Boshnakov, M.D., do hereby
swear and affirm:
1. I am a physician licensed to practice medicine ill the Commonwealth of
Pennsylvania.
2. My medical practice is limited to the specialty of Internal Medicine.
3. I am one of the attending physicians for Carlisle Regional Medical Center
patient John Brenneman.
4. Mr. Brenneman became a patient of the Carlisle Regional Medical Center on
December 28, 2007.
5. Mr. Brenneman is a patient suffering from severe hypoxic encephalopathy as
a result of cardiopulmonary arrest which occurred at the Forrest Park Health Center. This
condition renders Mr. Brenneman severely disabled with significant and irreversible
damage to the brain.
6. Mr; Brenneman is currently comatose and requires mechanical life support
including ventilatory support.
7. Mr. Brenneman is unable to communicate and therefore cannot meaningfully
participate in decisions about his medical care.
8. Mr. Brenneman currently requires breathing support with a ventilator;
accordingly, he is currently in need of the use of an endotracheal tube.
9. The long-term use of an endotracheal tube will cause the patient to suffer
painful pressure ulcerations of the throat and lips.
'f lOt.. ·
10. Painful pressure ulcers caused by an endotracheal tube can be avoided if the
patient undergoes a surgical procedure known as a tracheostomy.
11. A tracheostomy involves the surgical entry into the trachea to allow the
placement of a breathing tube.
12. A tracheostomy is a surgical procedure which requires a patient's informed
consent.
13. Mr. Brenneman's medical condition prevents him from being able to provide
his informed consent to any medical care which he may require.
12. Failure to obtain the necessary consents for surgical intervention will subject
Mr. Brenneman to painful and unnecessary pressure ulcers of the throat and lips.
13. Mr. Brenneman is unable to obtain adequate nutrition without the surgical
insertion of a feeding tube.
14. Insertion of a feeding tube IS a surgical procedure which reqUIres the
patient's informed consent.
15. Given Mr. Brenneman's current medical condition, the prognosis is grim and
further interventional care will not result in a cure of the patient's condition but will only
prolong his dying.
16. Information provided to the hospital by Mr. Brenneman's pnmary care
physician, Donald Kovacs. M.D. suggests that Mr. Brenneman would not consent to further
interventional care.
17. Without proper authority the Carlisle Regional Medical Center is required to
continue to provide care that the patient may not desire and for which the patient may not
have provided his consent.
'( t'.l.... ·
18. Mr. Brenneman has no family. He is widowed. He has no children. He was
an only child and has no siblings. Both of his parents are deceased.
19. Mr. Brenneman's current medical condition prevents him from being able to
provide his informed consent to any medical care which he may require.
20. Mr. Brenneman's inability to communicate prevents the medical staff at the
Carlisle Regional Medical Center from effectuating the wishes of Mr. Brenneman.
Date: ~
submitted.,
~~THOF~V~
NoIDiiii SIii
Susan J. ~'-' NotIry PUIIIc
Sou1h IIldcIeeon Twp, Cumberfalld County
Comm!lalon Nov. 10 _
...... PeiiliijiWin/l AllciCiItion 01 NoIiriii
Y' -.....) ·
t
AFFIDAVIT OF DONALD J. KOVACS. M.D.
AND NOW this l1."-- day of January 2007, I, Donald J. Kovacs, M.D., do hereby
swear and affirm:
1. I am a physician licensed to practice medicine ill the Commonwealth of
Pennsylvania.
2. My medical practice IS limited to the specialty of Family Practice and
Geriatrics.
3. I am the primary care physician for Carlisle Regional Medical Center patient
John Brenneman and have served in that capacity since 1989.
4. Mr. Brenneman became a patient of the Carlisle Regional Medical Center on
December 28, 2007.
5. Mr. Brenneman is a patient suffering from severe hypoxic encephalopathy as
a result of cardiopulmonary arrest which occurred at the Forrest Park Health Center.
6. Mr. Brenneman is currently comatose and requires mechanical life support
including ventilatory support.
7. Mr. Brenneman has indicated on numerous occasions that he did not wish to
receive care which would prolong his dying and not effect a cure.
8. Mr. Brenneman has, on numerous occasions, refused diagnostic tests to
identify preventable and treatable illnesses such as prostate cancer, colon cancer, and
chronic illnesses such as high cholesterol.
9. Mr. Brenneman's refusal of care is rationally based upon his realization that
he has no family to support, that such illnesses if treated could result in prolonged survival
with a poor quality of life which would be hampered by potentially serious disability.
'r -,-'" ..
l
10. Mr. Brenneman has no family. He is widowed. He has no children. He was
an only child and has no siblings. Both of his parents are deceased.
11. Mr. Brenneman has indicated that he has a close friend by the name of
Richard Hess who has been permitted to receive Private Healthcare Information.
12. Mr. Brenneman has indicated that Mr. Hess is a neighbor who has been
providing assistance with financial matters when he has been unable to handle those
matters himself.
13. I had occasion to meet Mr. Hess while Mr. Brenneman was hospitalized in
early December 2006 and found Mr. Hess to be a responsible individual to who expressed a
desire to provide what ever assistance was required for the benefit of Mr. Brenneman.
14. Mr. Brenneman's current medical condition prevents him from being able to
provide his informed consent to any medical care which he may require.
15. Mr. Brenneman's inability to communicate prevents the medical staff at the
Carlisle Regional Medical Center from effectuating the wishes of Mr. Brenneman.
Respectfully submitted,
r/ LtltJr
~~I~f1d)
Donald J. Kovacs, M.D.
Date: