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HomeMy WebLinkAbout94-04307 "I' ~, t~t k;,~ , J J r- ~ -=r - . I' ~,-,~ ,~-~ ,..-..---..."'....... .. ........ ....~.. ..-...-...............-. '. SHERIFF'S RETURN CCM>lONWEAL'Ill OF PENNSYLVANIA. COUNl'Y OF ClMBERLANo In The Court of Common Pleas of Cumberland County, Pennsylvania No. 94-4307 Civil Term Complaint in Civil Action Law and Notice Loretta F. Runk, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased VS Bruce G. Kipp, III, P.A., Robert A. Hollen, M.D., Harold G. Kretzing, M.D., Carol K. Robison, D.O., and Family Practice-Belvedere Medical Cen ter Robert L. Fink , lSNl~lSr Deputy Sheriff of Cunberland County, Pennsylvania, who being duly swom according to law, says, that he served the within Com laint in Civil Action Bruce G. Kipp, III, P.A.; Robert A. 0 en, upon Carol K. Robison, D.O.; and ,the defendant, at Family Practice-Belvedere Medical Center A.M. Kn / EDST, on the 04 day of August Notice re zing, M.D.; o'clock , l~at 850 Walnut Bottom Road, Carlisle , Cunberland County, Pennsylvania, by handing to Kathy Lebo, Medical Assistant and adult in charqe, accepted for all defendants a true and attested copy of the Complaint in Civil Action Law and Notice and at the same time directing her attention to the contents thereof and the "Notice to Plead" endorsed thereon. Sheriff's Costs: Docketing Service Affidavit Surcharge So answers. 30.00 2.80 ,./?// ~ r~'d'?=~-r~E:r( ~ R. Thanas Kline, Sheriff lO.OO 42.80 Pd. by Atty. 8-05-94 by &~'* ~:I~I:.J Sv- Deputy Sheriff I Sworn and subscribed to before me this 'l'~_ day of () L- " J" .r 19 q'f A.O, ~'-- C, 'htd:C,_ I" y,ry . Prothonotary LORETTA F, RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased v, BRUCE G. KIPP, III, P,A" ROBERT A, HOLLEN, M,D" HAROLD G. KRETZ INGER , M.D" CAROL K, ROBINSON, 0.0" and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Docket No. 4307 civil 1994 Civil Action - Law JURY TRIAL DEMANDED ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance for all Defendants in the above- captioned case, POST & SCHELL, P,C, , SQUIRE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 I.D. No, 17884 Attorney for Defendants Bruce G, Kipp, III, P,A" Robert A, Hollen, M,D" Harold G. Kretzinger, M,D., Carol K, Robinson, 0.0" and Family Practice-Belvedere Medical Center AUG 23 l)f 1 "' i..tn., .:. ':: :,~.. ......_,..'- "'A. J <, . 2 "Ii PH '9~ ;;;, tC[ ,'[,1)'1: T ,\hY ','d', (>'1, :~ rY n '~.\}ll-~ .' """",' .. .~.-..~,... .~"",,..,. ,.., ft . . , " -.~-'''~'''''';'~-' r 1 . . --, ''''-'-1 , ..- '-'-"'- . ,\ .' .' i' '---.; , .. : ',,- ....,: -. "~ ' ~:~!~~2~':;;~'~~'?j:;~;).~ :{:i;~elh,~,; , ~:~~~~:,><, ;".; ~;.,,;,:~ :~':~.. \,",,';;iOST,:iii'5Oi;'11\,;~~,' TO' - . ~: , ~;. .. '~"~:';~:'!::~1-~~,:~~.r'}' -,"__ 81;,.." ", _ -"J', , YOU Me HEIDt 1'1.II 'A :'.;",",~;'! ""\;l1fJ^~'^r:I.AW;""'i,, ~'" RnPOIIIIT01HE EIClOEl :i,.'::<1>. ,:"'fIOr'NoiTif~.'SlUlt'i " V<<THII'M9flYlICIlIA'lI_8ElMCE', ,'.,<,~ !/'~iIci.( ~i.\"IIO , HEREOF OR A ,,~ 'INt MAY.. "':';}.:.~,:.i:':"?l~; \!.u~!C- ".' v '." ;--"" ..,' . "," '''._ i'~;At~,:~ t~<~ t TfRED~.~. 'l!'!Aq~l-j '.["'~.::-';~'{~ii11~'r,:(717)UZ.S9).~\;',;5T;i;::_ ;, BY An~~ ',~': ;;~~Y~~\t{(iL ~;~"~;: :~,',:,';,:,~'p,,:,'i;;,',-: ',-~"~"",''i,,',',-'-,,','';,,l'-,~~,,,:,:,,',~;,,_,..,.,.""",,',h f -",' :.,~':7.\'~;i&Jl~,~l~;fi:~\, " .;" ,,' , ,,.... ""'"V4< '\, I I I I " 'I ", I . ~ LORETTA F. RUNK, Individually I and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 BRUCE G. KIPP, III, P.A., ROBERT A, HOLLEN, M.D" HAROLD G. KRETZING, M,D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER Civil Action - Law JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OP DEPENDANTS TO PLAINTIPP'S COMPLAINT AND NOW come the Defendants, Bruce G. Kipp, III, P,A., Robert A, Hollen, M.D., Harold G, Kretzing, M,D., Carol K, Robison, D.O., and Family Practice - Belvedere Medical Center, by and through their attorneys, Post & Schell, p,C" and aver the following Answer with New Matter to Plaintiff's Complaint: 1. Admitted upon information and belief. 2, Admitted upon information and belief, 3. Admitted in part and denied in part, "Family Practice - Belvedere Medical Center" is properly known as the Family Practice Department of Belvedere Medical Corporation, 4, Admitted in part and denied in part, "Family Practice - Belvedere Medical Center" is properly known as the Family Practice Department of Belvedere Medical Corporation, 5. Admitted in part and denied in part, "Family Practice - Belvedere Medical Center" is properly known as the Family Practice . , .' Department of Belvedere Medical Corporation. 6. Admitted in part and denied in part, "Family Practice - Belvedere Medical Center" is properly known as the Family Practice Department of Belvedere Medical Corporation. 7. Admitted in part and denied in part. "Family Practice - Belvedere Medical Center" is properly known as the Family Practice Department of Belvedere Medical Corporation. 8. Admitted, 9. Admitted in part and denied in part, "Family Practice - Belvedere Medical Center" is properly known as the Family Practice Department of Belvedere Medical Corporation. 10, Admitted, 11. Denied, After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant, 12, Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint, Strict proof is demanded at trial if relevant, 13, Denied, A family history was obtained from Mr. Runk. -2- I -", 14. Denied. Mr. Runk had findings consistent with his visit note of September 9, 1993. The patient denied any chest discomfort. 15. Admitted. For further answer, the visit was an acute visit. 16. Admitted and for further answer, all of the referenced office visits were for acute problems. The patient was urged to have a complete physical examination, 17, Admitted, 18. Admitted in part and denied in part. The visit of September 20, 1993, was an acute visit. It is denied that at any time any Defendant or any agent or employee of any Defendant held Mr, Kipp out as a physician. Denied for the reasons stated in Paragraph 11, above, 19, Admitted. 20. Admitted, For further answer, the impression was early COPD, 21. It is admitted that a diuretic was prescribed. For further answer, denied for the reasons stated in Paragraph 11, above, 22, Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding -3- .. paragraph of the Complaint, Investigation is ongoing. Strict proof is demanded at trial if relevant, 23, It is admitted that the report of the chest X-ray so stated. Otherwise, after reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Proof is demanded at trial, if relevant. 24. Denied, After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Proof is demanded at trial, if relevant. 25. Denied for the reasons indicated in Paragraphs 3 and 11, above. 26, Admitted. 27. Denied as stated and for the reasons indicated in Paragraph 22 above, 28. It is admitted that Mr, Runk was to return in three weeks for follow up, 29, Admitted. 30, Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form -4- I,"'.d~'~ , a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Investigation is ongoing. Strict proof is demanded at trial if relevant. 31. Admitted. 32. Denied as stated. Mr. Runk had a complete cardiac exam, 33. Admitted. 34. Denied as stated, Mr. Runk reported shortness of breath on October 18, 1993, only on exertion and the repeat chest X-ray ordered on that date revealed significant improvement, according to the ::-eport, 35. Denied as stated, The Defendants undertook additional investigation. 36. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint, Investigation is ongoing, Strict proof is demanded at trial if relevant, 37, Denied as stated. Mr, Runk did not complain of shortness of breath at night as of the last office visit, For further answer, denied in that Mr. Runk was diagnosed with COPD. 38, It is admitted that the theo-24 was continued and that the high blood pressure medication and the diuretic were halted. 39, It is admitted only that Mr, Runk was instructed to have -5- his blood pressure checked every two weeks and that blood pressures were recorded November 5 and November 12, 1993. 40. Admitted in part and denied in part. It is admitted that Mr, Runk went to the office on November 22, 1993. For further answer, denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Investigation is ongoing, Strict proof is demanded at trial if relevant, 41, It is admitted that Mr. Runk was told to return in two months. 42. Admitted upon information and belief, 43, Admitted upon information and belief, 44. To the extent that the autopsy report on Mr. Runk contains the information alleged in the corresponding paragraph of the Plaintiff's Complaint, admitted, Otherwise, to the extent the autopsy report does not so reflect or contradicts the allegations of the corresponding paragraph, denied in that after reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Investigation is ongoing, Strict proof is demanded at trial if relevant, -6- 45. Denied. After reasonable investigation Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint, Strict proof is demanded at trial if relevant. 46. Denied, After reasonable investigation Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint, Strict proof is demanded at trial if relevant, -7- (.~'-'"\' ~ COUNT I Loretta P. Runk. Individuallv and as Administratrix of the Estate of Larrv J. Runk. Deoeased v. Bruoe G. RiDD. III. P.A. 47, The incorporated paragraphs are denied for the reasons indicated above, 48. Denied as a conclusion of law, Answering Defendants deny allegations of negligence by reason of: (a) failing to recognize Mr, Runk's classic symptoms of congestive heart failure; (b) failing to treat Mr. Runk's classic signs of congestive heart failure; (c) failing to evaluate the cause of Mr, Runk' s classic congestive heart failure; (d) failing to order tests to evaluate Mr, Runk's classic congestive heart failure; (e) failing to refer Mr, Runk to a cardiology/cardiovascular specialist upon evidencing classic symptoms of congestive heart failure; (f) failing to take a complete family history of Mr. Runk; (g) failing to identify the underlying cause of Mr, Runk's heart disease; (h) failing to identify the precipitating cause of Mr. Runk's congestive heart failure; (i) failing to apprise Mr, Runk that the Defendant was actually a physician assistant and not a physician; (j) failing to have Mr, Runk seen by a physician as required by the laws and regulations governing the practice of physician assistants in the Commonwealth of Pennsylvania; (k) exceeding the scope of authority of a physician assistant -8- (,,:;,.. as prescribed by statute and regulation; (1) failing to discuss Mr. Runk's care with a physician supervisor as required by statute and regulation in Pennsylvania; (m) failing to identify himself as a physician assistant in violation of the statutes and regulations of this Commonwealth; (n) writing pre-signed prescriptions and ordering tests without identifying himself as a physician assistant as required by the statute and regulations of this Commonwealth; (0) failing to assure that Mr. Runk was seen by a physician at least every third office visit as required by statute and regulations of this Commonwealth; and (p) impersonating and/or misrepresenting himself as a doctor. WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation, demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. COUNT :I:I Loretta F. Runk. :Individual Iv and as Administratrix of the Estate of Larrv J. Runk. deceased v. Robert A. Hollen. M.D.. Harold G. Kretzina. M.D.. and Carol K. Robison. D.O. 49, The incorporated paragraphs are denied for the reasons indicated above. 50. Admitted, 51, Denied as a conclusion of law. Answering Defendants deny any and all allegations of liability, -9- 52. Denied as a conclusion of law. Answering Defendants deny allegations of negligence based on: (a) failing to recognize Mr. Runk's long-standing hypertension; (b) failing to treat Mr. Runk's long-standing hypertension; (c) failing to assure that Mr. Runk was advised to and did have periodic physical examinations; (d) failing to assure that the rules and regulations of the Commonwealth of Pennsylvania with regard to physician assistants were followed; (e) failing to see Mr, Runk, examine and assess him despite his classic signs of congestive heart failure; (f) failing underlying cause disease/congestive to order appropriate tests to diagnose the of Mr. Runk's classic symptoms of heart heart failure; (g) failing to order appropriate tests to diagnose and then treat Mr, Runk's underlying cardiac disease: (h) failing to refer Mr, Runk to a cardiology and/or cardiovascular specialist; (i) history; (j) failing to assure that Defendant Kipp, a physician assistant, was identified to Mr, Runk as a physician assistant; failing to take a full and complete family medical (k) failing to assure that Mr, Runk knew Defendant Kipp was a physician assistant; (1) failing to assure that Defendant Kipp at all times wore a tag in at least 16 point type identifying him as a physician assistant; (m) failing to assure that Mr, Runk knew he could see a medical doctor instead of Defendant Kipp if he so desired; (n) allowing Defendant Kipp to impersonate and/or -10- . misrepresent himself as a licensed physician; (0) failing to examine and evaluate Mr. Runk personally at least every third visit as required by statute and regulation of this Commonwealth; (p) pre-signing prescription blanks in violation of the statutes and regulations of this Commonwealth; and (q) failing to thereby violating Commonwealth, supervise Defendant Kipp's care of Mr. Runk, the statutes and regulations of this WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation, demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. COUNT II:I Loretta F. Runk. :Individuallv and as Administratrix of the Estate of Larrv J. Runk v. Familv Medicine - Belvedere Medical Center 53, The incorporated paragraphs are denied for the reasons indicated above, 54, Denied for the reasons stated in Paragraph 3 above, Answering Defendants were the employees of the Family Practice Department of Belvedere Medical Corporation at all times alleged in the Complaint, 55, Denied as a conclusion of law, Answering Defendant denies all allegations of liability, 56, Denied as a conclusion of law. Answering Defendant -11- denies negligence in: (a) failing to develop appropriate guidelines and procedures for patient monitoring when the patient is seen by a physician assistant; (b) failing to select, monitor, and supervise properly physicians and other medical personnel to whom it entrusts the care and treatment of its patients; and (c) failing to have in place proper procedures to enforce the statutes and regulations applicable to physicians and physician assistants in the Commonwealth of Pennsylvania. WHEREFORE, Answering Defendant denies any and all liability to any party to the within litigation, demands that the Complaint against it be dismissed with prejudice, and that judgment be entered in its favor. CLAIM I - Wronaful Death Loretta F. Runk. Individuallv and as Administratrix of the Estate of Larrv J. Runk. deceased v. Bruce G. KiPD. III. P.A.. Robert A. Hollen. M.D.. Harold G. Kretzina. M.D.. Carol K. Robison. D.O.. and Familv Practice - Belvedere Medical Center 57. The incorporated paragraphs are denied for the reasons indicated above. 58. The corresponding paragraph of the Complaint requires no response. To the extent it may require a response, denied as a conclusion of law. 59. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form -12- -13- a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. 60. Admitted upon information and belief. 61. Denied. After reasonable investigation. Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. 62. The corresponding paragraph of the Complaint requires no response. To the extent it may require a response. denied as a conclusion of law. 63. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. 64. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. 65. Denied as a conclusion of law. 66. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. 67. Denied. After reasonable investigation, Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation, demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. CLAIM II - Survival Action Loretta F. Runk. Administratrix of the Estate of Larrv J. Runk. deceased v. Bruce G. KiPD. III. P.A.. Robert A. Hollen. M.D.. Harold G. Kretzina. M.D.. Carol K. Robison. D.O.. and Familv Practice - Belvedere Medical Center 68. The incorporated paragraphs are denied for the reasons indicated above. 69. The corresponding paragraph of the Complaint requires no response. To the extent it may require a response, denied as a -14- conclusion of law. 70. Denied as a conclusion of law. 71. Denied. After reasonable investigation. Answering Defendants are without knowledge or information sufficient to form a belief as to the truth of the averments of the corresponding paragraph of the Complaint. Strict proof is demanded at trial if relevant. WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation. demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. CLAIM III - punitive Damaaes Loretta F. Runk. Individuallv and as Administratrix of the Estate of Larrv J. Runk. deceased v. Bruce G. KiDD. III. P.A.. Robert A. Hollen. M.D.. Harold G. Kretzina. M.D.. Carol K. Robinson. D.O.. and Familv Practice - Belvedere Medical Center 72. The incorporated paragraphs are denied for the reasons indicated above. 73. Denied as a conclusion of law. For further answer, at no time relevant to the Plaintiff's Complaint did the physician assistant impersonate or misrepresent himself or conduct himself as though he were a physician. To the contrary, at all relevant times, the physician assistant was appropriately identified as such -15- ,.... and not as a physician. 74. Denied as a conclusion of law. 75. Denied as a conclusion of law. WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation, demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. -16- NEW MATTER DIRECTED TO PLAINTIFF Answering Defendants hereby raise the following New Matter pursuant to Pa. R. Civ. P. 1026, 1030. and 1032. 76. Plaintiff may have failed to state a cause of action upon which relief may be granted. 77. Investigation and discovery may indicate that the applicable statute of limitations expired before the institution of this action. 78. Answering Defendants were not negligent nor did they engage in any liability-producing conduct at any time relevant to the cause of action alleged by the Plaintiff. 79. Any acts or omissions of Answering Defendants alleged to constitute negligence were not substantial causes or factors of the subject incident nor did they result in the injuries or losses alleged by the Plaintiff. 80. Investigation or discovery may indicate that the incident or damages described in the Plaintiff's Complaint were caused or contributed to by the Plaintiff and/or Plaintiff's decedent. 81. Investigation and discovery may indicate that the negligent acts or omissions or other liability-producing conduct of other individuals, person, or entities constituted intervening, superseding causes of the damages or injuries alleged to have been sustained by the Plaintiff and/or Plaintiff's decedent. 82. Investigation and discovery may indicate that the Plaintiff's decedent assumed the risk of his conduct. 83. Investigation and discovery may indicate that the Plaintiff's claims against Answering Defendants are either diminished or barred by the Pennsylvania Comparative Negligence Act. 84. The incident, injuries, and damages alleged to have been sustained by the Plaintiff and/or Plaintiff's decedent were not proximately caused by the Answering Defendants. 85. Pennsylvania Rule of Civil Procedure 238 is unconstitutional on its face and as applied herein. 86. Answering Defendants hereby raise all affirmative defenses of the Health Care Services Malpractice Act of 1975, as amended, including but not limited to Section 602 and Section 606. -17- .. __. ,,~""oioJ WHEREFORE, Answering Defendants deny any and all liability to any party to the within litigation, demand that the Complaint against them be dismissed with prejudice, and that judgment be entered in their favor. Respectfully submitted, ;; .';;;1 EVAN BLACK, ESQUIRE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 I.D. No. 17884 Attorney for Defendants Bruce G. Kipp, III, P.A., Robert A. Hollen. M.D., Harold G. Kretzing, M.D., Carol K. Robison, D.O., and Family Practice - Belvedere Medical Center , I" HI II 'I , -1 R- " I' I .1 ~, , , , "..0,"--- . 82j62 VERIFICATION I, Robert A. Hollen, M.D., do hereby swear and affirm that the facts and matters set forth in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. 54904 relating to unsworn falsification to authorities. DATE: 9/9/94 ~aJ.Od_ ROBE T A. HOLLEN, M.D. . DATE: 9/9/94 l~'~B~o~~~'~ ~ 82362 VERIFICATION I, Carol K. Robison, D.O., do hereby swear and affirm that the facts and matters set forth in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. 54904 relating to unsworn falsification to authorities. I' I' ,. , , ,.... ,.,~""'- 82362 , , . ,. , VERIFICATION I, Harold G. Kretzing, M.D., do hereby swear and affirm that the facts and matters set forth in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. 54904 relating to unsworn falsification to authorities. ~!~ ~.D. DATE: 9/9/94 II II :1 I' ;1. ,! ... ! ,.~:'- 82362 . " . . II . VERIFICATION I, Bruce G. Kipp, III, P.A., do hereby swear and affirm that the facts and matters set forth in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. 54904 relating to unsworn falsification to authorities. DATE: 9/9/94 ~Cli:.rr&. BRUCE G. KIPP, III, .A. , '82362 . " . . of . VERIFICATION I,Joseph E. Green. III. M.D.. President; Agent for Belvedere Medical Corporation do hereby swear and affirm that the facts and matters set forth in the foregoing Answer with New Matter to Plaintiffs' Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. 54904 relating to unsworn falsification to authorities. DATE: 9/9/94 ~(?- r. Belvedere Medical Corp. t'.,~~.._, ,.. 'H . . . . . .f . CERTIFICATE OF SERVICE I, Kathy L. Sitler, an employee of the law offices of Post & Schell, P.C., do hereby certify that on the date listed below, I did serve a true and correct copy of the foregoing document upon the following person(s) at the following address (es) by sending same in the United States mail, first-class, postage prepaid: Pamela Shuman, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110 DATE: September 14, 1994 "-/!~-~ )1 ,,'5 f 1:11-1 KATHY L. flHTLER , .i;. ~ . . '" Sf' IS 3 :La r~ ~9~ , ~:!, ;;'OffIOE Of ~I'( ;'iiOitlOH'jl,\f,Y CUI~llEltllNO CQmlTY PEtlHSll'/AI11A "/'" , ',,' ~'-,,", '" - ",' " .',"" ,.., " I . . , ;.~;.' .-",' t- li;~"~ 'll '-;" ~ .~ _..' ; , :::i,;-: ..~;" i " ;,;:,_~,,;:.~,,:;". . ^', ,~'",;'"",,' ,,(:, -,' ," <-~~W~t;:;?~~j: ~+:",F'" ",-','-" -''7l"'' ,,j..,. "f, ~;-,;", '-,- 'yl,- ~ ',;;.' ,. ,. ., , . ..-i I I I ~~~{"" ''i-'7~~~- "'~-'-.-' .:." ,..-..... ",- , "?~'-;'t.' ""1 -'-.\,:_.,':~'\;';:",~, , ".+\:; 1 '1"'" ,Mr. ~'(!'-""~- :,:.....';r"'~ -:r D'1l --: ,.... '. . :=r= -.... .7 ::r = - '.' C7"l \....J "" .., ....., ~i~ 1Il1lilii-: ~~!2~ iEOO~ Oa:lE. ~oll~li! 500iil ZZ!!! -..,0: Cleo: ZIIl< c(,,:z: . . .."lOfo..,. .O:'"....,..,'...'.,li... f"<"!tOt O]."""""OI1IUI"" ~ '" ... CD ~ N ;:: ~ !:: LORETTA F. RUNK, Individually and as Administratrix or the Estate or LARRY J. RUNK, Deceased, Plaintirf IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 Civil 1994 v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants JURY TRIAL DEMANDED PLAINTIPP'S REPLY TO HEW MATTER Loretta F. Runk, individually and as Administratrix or the Estate of Larry J. Runk, deceased, in reply to the New Matter of Defendants avers as follows: 76. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that Plaintiff may have failed to state a cause of action upon which relief can be granted. Instead, Plaintiff's complaint, incorporated herein by reference, clearly states causes of action against the Defendants, for which she should be granted relief. 77. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that the applicable statute of limitations may have expired before the institution of this action. Mr. Runk died in January, 1994, and the care at issue occurred in 53653/BJS f' . the Fall of 1993. Therefore, as set forth more fully in the complaint, incorporated herein by reference, this case is clearly timely filed. 7B. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that the Defendants were not neqliqent and that their neqliqence did not harm Mr. Runk. As set forth more fully in the Complaint, the death of Larry J. Runk was a result of the neqliqent care he received from the Defendants. 79. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that the acts or omissions of the Defendants were not substantial factors in causinq the death of Larry J. Runk. Instead, as set forth in the Complaint, incorporated herein by reference, the Defendants were proximately responsible throuqh their negliqence for the death of Larry J. Runk. Moreover, the Defendants are responsible for all damaqes arisinq therefrom. BO. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' avermsnt is deemed factual, it is denied that the damaqes suffered were caused or contributed to by the Plaintiff or the Plaintiff's decedent. Instead, as set forth more fully in the Complaint, incorporated herein by reference, all damaqes are attributable to the neqliqent actions of the Defendants. Bl. Insofar as Defendants' averment constitutes a conclusion 2 " i. de.med factual, it i. denied that intervening or .uper.eding cause. were responsible for the damages and injuries suffered by the Plaintiff. Instead, as set forth in the Complaint, incorporated herein by reference, all damages were as the result of the negligent actions and omissions of the Defendants. 82. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' avermsnt is deemsd factual, it is denied that the Plaintiff's decedent assumed the risk of the negligsnt medical care provided to him by the Defendants. Instead, unless the Defendants are willing to admit that their negligence is so well known that any patient who comes to them assumes the risk of that negligence, they have no basis upon which to assert that Larry J. Runk assumed the risk of their nsgligence. Instead, as set forth more fully in the Complaint, incorporated herein by reference, all injuries suffered as alleged in the Complaint were as a result of the negligent conduct of the Defendants. 83. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' avermsnt is deemed factual, it is denied that the damages are either diminished or barred by the Pennsylvania Comparative Negligence Act. As set forth more fully in the Complaint, incorporated herein by reference, all negligence was that of the Defendants, and all responsibility for such damages is theirs. 84. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment 3 .. ,f /' . .,..... of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that the damages as alleged in the Complaint were not proximately caused by the Defendants. Instead, as set forth more fully in the complaint, incorporated herein by reference, all damages suffered were as a result of the negligence of the Defendants. 85. Insofar as Defendants' averment constitutes a conclusion of law, no response is required. Insofar as Defendants' averment is deemed factual, it is denied that Pa. R. C. P. 238 is unconstitutional. Instead, it is valid and applicable to damages potentially recoverable in this action. 86. Insofar as Defendants' averment constitutes a conclusion of law, no response is requirsd. Insofar as Defendants' averment is deemed factual, it is denied that any affirmative defenses of the Health Care Services Malpractice Act of 1975 are applicable to this claim. As the Defendants well know, the major portions of that Act were declared unconstitutional many years ago, and it has no application to this case. Respectfully submitted, ANGINO , ROVNER, P.C. ~~~ Pamela G. Shuman I. D. '41696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: September ~ 7 , 1994 4 . . ,~..., ",_. .....,.".,.- CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Anqino , Rovner, P.C., do hereby certify that I have served a copy of the foreqoinq Plaintiff's Reply to New Matter directed to Defendants upon counsel for Defendants by placinq same in the United states mail, postaqe prepaid, on the .21 day of september, 1994, addressed as follows: Evan Black, Esquire Post, Schell, P.C. 101 North Front Street Harrisburq, PA 17101 /L.L" If c/-d~ Barbara J. smIth Lr> ~ ,.~ "l ' ,0.-'._ \);: . ' .~ -~ : ~, C"- ... -:r ~ ....J - ,1 .. -'., ~ :'L.: ~ ?:: ~I~ 13ei!z< - ~~o~ I~ oa:1l:1I: gj ~ oil ~ Ii ~ ~oiil _;: ..zen c:l"'~ ~~:c ~ . .. MAY 15 !~'95, , !/<'~ ; , LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants .. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 JURY TRIAL DEMANDED I_~ ORDBR I (I day of AND NOW, this , 1995, upon consideration of the Stipulation of Couns l, IT IS ORDERED that the caption in this matter is henceforth amended to correct the name of Defendant Belvedere Medical Center to Belvedere Medical Corporation. BY THE COURT: J. ..'..' ,\ \,,' ,\ r'''\. ,\ \,l .. t.,S\~\ ,- '. LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA . . . . . . CIVIL ACTION - LAW Plaintiff : NO. 4307 CIVIL 1994 v. . . . . . . BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - DELVEDERE MEDICAL CENTER, Defendants . . . . . . . . . . JURY TRIAL DEMANDED STIPULATION OF COUNSEL IT IS HEREBY STIPULATED between counsel for the parties that the caption in this matter should be amended to correct the name of Defendant Belvedere Medical Center to Belvedere Medical Corporation. ANGINO & ROVNER, P.C. DATED: r rh~ '1, \ 'tq~ ~~~ Pamela G. Shuman, Esquire I.D. 1141696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff 65119/BJS ,. ~ DATED: '1).5 .f)' POST & SCHELL, P.C. f2i! Evan Black, Esquire 101 North Front street Harrisburg, PA 17101 (717)232-5931 Counsel for Defendants 2 .,. en - ~... <..~ .....:r ~,. . ;..f <'.l:z.';;:;".T ~:: <;) L> <l, a..~'~ ,. ';' ~:: 1i ~~ ..,ll;' ~;..,. ;r. ;; ,jJh.I';r. _ J.;!n~ .,.:'"C I~.:.:'I 0'" :s:: a- N ... C"? -=r z -=: ut::O D:m:: 13ei~~ ~ u i!:!;; ~ l!.! ~~~!Ii_ ~ oil ~ a: ... ..J 0 O::::l - ZZm t:: a"~ z51.o: <cot: . . l, olt ~ ~ .1 ~ ~ , , JUN 1 5 1995 P' LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON. D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA . . . . . . CIVIL ACTION - LAW : NO. 4307 CIVIL 1994 . . . . . JURY TRIAL DEMANDED ORDER AND NOW, this 1(, , day of , 1995, upon - J.......... consideration of Plaintiff's Motion to Compel Discovery, IT IS ORDERED that the Defendants shall provide full and complete responses to Plaintiff's Supplemental Interrogatories and Supplemental Requests for Production of Documents within twenty days of receipt of this Order. BY THE COURT: o/Jp[ J. ,..,~, ".. :',.. JUH /6 10 53 AH '95 " "jH/fJf r)! ; ..;. . r10S--T.~"y r~JH' :.li',I~J".~i" ll, :.,. .' i, ; "~. .- LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIFF'S MOTION TO COMPEL DISCOVERY Plaintiff, Loretta F. Runk, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased, by her attorneys, Angino & Rovner, P.C., hereby moves to compel the Defendants to file full and complete answers to Plaintiff's Supplemental Interrogatories and Supplemental Request for Production of Documents. In support of her mocion, Plaintiff avers as follows: 1. This is a medical malpractice action arising out of the care and treatment provided to Larry Runk by the Defendants. 2. suit in this matter was instituted on August 1, 1994. 3. Deposi tions of the Defendant doctors were taken by Plaintiff's counsel. 4. Thereafter, Supplemental Interrogatories and Supplemental Request for Production of Documents were forwarded by Plaintiff's counsel to counsel for the Defendants on March 30, 1995 and March 70339/BJS 14, 1995, respectively. copies or the supplemental Interrogatories and Supplemental Request ror Production or Documents are attached hereto as Exhibit A and B. 5. When no response to the supplemental Request ror Production or Documents was forthcoming within thirty days, by letter dated April 20, 1995, Plaintiff's counsel indicated to counsel for the Defendants that if responses were not received by May 8, 1995, a Motion to Compel would have to be filed. 6. When no answers to Supplemental Interrogatories were forthcoming within thirty days, by letter dated May 9, 1995, plaintiff's counsel indicated to counsel for the Defendants that if answers were not received by May 22, 1995, a Motion to Compel would have to be filed. 7. No responses were filed to Plaintiff's Supplemental Interrogatories and Request for Production of Documents. 8. The discovery that the Plaintiff rsquests is all relevant to this medical malpractice action and discoverable under our Rules of Discovery. WHEREFORE, Plaintiff respectfully requests that this Court grant her Motion to Compel and direct the Defendants to provide full and complete responses to her supplemental discovery requests 2 .--- . within twenty days. Respecttully submitted, ANGINO & ROVNER, P.C. r~JJ.~ Pamela G. Shuman 1.0. '41696 4503 North Front street Harrisburg, PA 17110 (717)230-6791 Counsel for Plaintift DATED: June Ii ' 1995 3 r:.r-~'" EXHIBIT A ..;.~~. _~_~-w..-.~'-" _...~......__:.-:.:.~~.... .' , . (- r. LORETTA F. RUNX, Individually : and as Administratrix of the Estate of LARRY J. RUNX, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 . . . . . . Plaintiff v. BRUCE G. XIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, H.D., CAROL X. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants JURY TRIAL DEMANDED PLAINTIFFS' SUPPLEMENTAL INTERROGATORIES PROPOUNDED UPON DEFENDANT To: Defendants and Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 Attorneys for Defendants Plaintiffs, through their attorney, hereby propound the following Interrogatories upon Defendants pursuant to Pennsylvania Rules of Civil Procedure 4005 and 4006 to be answered within thirty (30) days from service thereof. These Interrogatories shall be deemed to be continuing Interrogatories. If between the time of your answers to said Interrogatories and the time of the trial for this case you or anyone acting on your behalf learns the identity and whereabouts of any other witnesses not identified in your said answers, or if you obtain or become aware of additional requested information not supplied in your answers, you shall promptly furnish the same to plaintiff's attorney by supplemental answers. 65126/BJS l.. -.... '~.' : "-1 t . ~ , ... . . ".~' ','" ".... . ,", ....~~.6 .... '.,.' io).......C~w"'Iio.S:cIl..~'";l.~...~ l~.... .' -, " r, For the purposes of these Interroqatories, "~" or "~" refers to the defendant and his or her files, the defendant's insurance comDanv and its files, the defendant's attornev and his files, and all other Dersons. aaents or reDresentatives of the defendant and their files. "You" shall further include all persons on whose behalf defendant prosecutes this action and all persons who will benefit or be legally bound by the results of this action. Your answers to the Interrogatories shall reflect and contain the knowledge of all of the above persons. References to plaintiff and/or defendant shall be interpreted as singular or plural, depending upon the particular circumstances of each case. The term "description" or "describe" as used herein shall mean that the defendant shall set forth the name and address of the author or originator, dates, title or subject matter, the present custodians of the original and of any copies, and the last known address of each custodian. "Document" shall mean any written, printed, typed or other graphic matter of any kind, whether handwritten, typed or printed, whether distributed or undistributed. It shall include without limitation letters, memoranda, articles, studies, notebooks, diaries and notes, as well as all mechanical and electronic sound recordings or transcripts thereof in the possession or control of the defendant or known by him/her to exist. It shall also mean all copies of documents by whatever means made. 2 '" ...,....,.',,..._'......~ _.~ .....'...If."..!c..~-!. 'i'.' ...._.... ~ (- r) Answer each interrogatory in the space following the interrogatory. supplemental sheets may be attached for answers which require additional space. Please take notice that you are required to serve upon the undersigned your answers in writing within thirty (30) days pursuant to the Pennsylvania Rules of civil Procedure 4006. These Interrogatories are to be deemed continuing and supplemental answers should reasonably be provided. ANGINO & ROVNER, P.C. ~1j.~ Pamela G. Shuman, Esquire I.D. No. 41696 4503 North Front street Harrisburg, PA 17110 (717) 238-6791 Counsel for plaintiff DATED: March ~ , 1995 3 t' ".-'. (' -~ ,.. .... .... t'l-I""" '. &. ., " r" r , 1. Please state the salary that Mr. Kipp earned as a physioian assistant in 1993, from the Family Practice Department of Belvedere Medioal Corporation. 4 ~~-- (' jtjt-.l:,,~'Hi~! , ' . ........ ',~ . ~" . . .... " '."-'.~4"':',.. " . ,', . '. ..... ~...........:i. . : :.; ~ :;.:...~-!.1*1 :_\,..:": :~<:'f:.:';:;~.i.<\'!.i!~~:t'i.t.~..,:~~.~.u;..llf"i{ -.. '.- ",' '.,......... .. ,... ~.. .-.'.' -. -, (-' r CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's Supplemental Interrogatories directed to Defendants upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the ,r 0 day of March, 1995, addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front street Harrisburg, PA 17101 Ail ~ d. A..-c/ cL-r/ Barbara J. smith ~. ~.... ,. - EXHIBIT B !f~.; t")' \ II . r ,.... LORETTA F. RUNK, Individually : and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA plaintiff CIVIL ACTION - LAW NO. 4307 CIVIL 1994 v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants JURY TRIAL DEMANDED PLAINTIFF'S SUPPLEMENTAL REOUEST FOR PRODUCTION OF DOCUMENTS TO: Defendants and Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 Attorney for Defendants PLEASE TAKE NOTICE that, pursuant to Pennsylvania Rules of civil Procedure 4003.4 and 4009, you are required to furnish, at our expense, at our office, on or before thirty (30) days after service hereof, a photostatic copy or like reproduction of the materials concerning this action or its subject matter that are in your possession, custody or control, and which are not protected by the attorney/client privilege; or, in the alternative, to produce the requested materials at said time and place in order to permit inspection and copying thereof. In responding to this request, you shall utilize the definitions and follow the instructions hereinafter set forth, each of which shall be deemed to be a 64030/BJS ~ ,-,... '" " ~ , , material part of each request. Instructions 1. with respect to each of the followinq requests, you shall identify and/or produce all documents which are known to you or which can be located or discovered by you throuqh diliqent effort on the part of you, your employees, representatives, attorneys or accountants, includinq but not limited to, all documents which are in the business or personal files of your employees, in the possession of your representatives, attorneys or accountants, are accessible to you, your employees or your representatives, attorneys or accountants. 2. The fOllowing requests shall be deemed to be continuing so as to require further and supplemental production of documents by you in accordance with Rule 4007.4 of the Pennsylvania Rules of civil Procedure. 3. If any documents requested herein have been lost or destroyed, and no such copies of such documents exist, you shall provide in lieu of a true and correct copy thereof a list of the documents lost or destroyed along with the following information: (a) the date of origin of the document; (b) a brief description of each document; (c) the author of each such document; (d) the date upon which the document was lost or destroyed; (e) a brief statement as to the reason why the document was destroyed; and 2 4' ., . . r r (f) a brief statement as to the mannsr in which the document was lost or destroyed. 4. If you refuse to produce any requested documents on the grounds of any claimed privilege from discovsry, state each ground for such claimed privilege, describe the document withheld by date, author, recipient (including all persons who are shown or received a copy), and give a general description of the subject matter of the document. S. In the event that more than one copy of a document exists, the original shall be produced, as well as every copy on which appears any notation or marking of any sort not appearing on the original. 6. For any documents which are stored or maintained in files in the normal course of business, such documents shall be produced in such files, or in such a manner as to preserve and indicate the file from which such documents were taken. 7. If you object to a request because a portion of that request seeks a document shielded from discovery by the attorney/client privilege or the attorney work product doctrine, provide those documents sought in the request which are not protected by such privilege or by the work product doctrine. Definitions 1. "You" and "your" shall mean the Defendants as well as their agents, attorneys, employees, accountants, consultants, independent contractors and any other individual or entity associated or affiliated with the Defendants or purporting to act 3 t' .., on their behalf with respect to the matter in qusstion. 2. "Document" shall mean all written or printed matter of any kind in your possession, custody or control, which is either known to you or can be located or discovered by diligent effort, including the originals and non-identical copies, whether different from the original by reason of any notation made on such copies or otherwise, including without limitation, correspondence, memoranda, notes, speeches, press releases, diaries, calendars, agenda, statistics, letters, telegrams, minutes, contracts, purchase orders, reports, studies, checks, statements, receipts, returns, summaries, pamphlets, books, inter-office and intra-office communications, offers, bulletins, printed matter, computer printouts, teletypes, telefax, invoices, work sheets, work papers, records of telephone calls or other communications or conversations, and all drafts, alterations, modifications, changes or amendments of any kind of the foregoing, graphic or aural records or representations of any kind (including without limitation, photographs, charges, graphs, microfiche, microfilm, videotapes, records and motion pictures) and electric or mechanical records of representations or information of any kind (including without limitation, tapes, cassettes, computer disks, and recordings). 3. "Relating to" shall include pertaining to, recording, evidencing, containing, setting forth, reflecting, showing, disclosing, describing, explaining, summarizing, concerning or referring to, whether directly or indirectly. 4 ,'. . . r {' 4. The conjunctions "and" and "or" shall be interpreted to mean "and/or", and shall not be interpreted to exclude any information otherwise within the scope of any request. 5. "Person" shall mean any individual, firm, partnership, corporation, association, business or governmental entity or subdivision, agency, department, and any "person" acting by or through, directly or indirectly, any other "person", as well as any "person" by whom such "person" was controlled with respect to the matter in question. ANGINO & ROVNER, P.C. p~!j.S~ Pamela G. Shuman I.D. '41696 4503 North Front street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiffs DATED: March l'-f ' 1995 5 ~ 04' .' (- . . I REOUESTED DOCUMENTS 1. Appointment sheets for each date on which Mr. Runk was seen in the office of tho Defendants in 1993. 2. Please produce a photocopy of the sign posted in the Defendants' office to the left to the receptionist's desk relative to Physician Assistants, indicating when the sign was prepared, when it was put up in the office, and the name, business address and position of all persons responsible for preparing the sign as well as all persons responsible for posting the sign. 3. Please produce a photocopy of the tag worn by Defendant Kipp in the period September, 1993, through the end of the 1993. If more than one tag was worn, please produce photocopies of all such tags, indicating the dates during which each tag was worn. 4. A copy of the patient information booklet of Belvedere Medical Center in effect in the Fall of 1993. If more than one such booklet was in effect during that time, please supply copies of all information booklets, indicating the dates when each was available to patients. 6 ,".... ...... ._,,,,,. I' " r f CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served .8 copy of the foregoing Plaintiff's Request for Production of Documents directed to Defendants upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the /Lj day of March, 1995 addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front street Harrisburg, PA 17101 If~ J c/ -,-J, Barbara J. Smith {l- --.-. .....J.<!' .' ;:it Barbara ~ . L-9J: V cf-# J. Sm th CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino & Rovner, P.C., do hereby certify, that I have served a copy of the foregoing Plaintiff's Motion to Compel Discovery directed to Defendants upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the /~ day of June, 1995, addressed as follows: Evan BlaCk, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted In duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY (Check one) Please list the following case: ( XX) for JURY trial at the next term of civil court. ( ) for trial wllhout a jury. . -------- CAPTION OF CASE (entire caption must be stated In full) LORETl'A F. RUNK, Individually and as Mministratdx of the Estate of LARRY J. RUNK, De~ased (check one) Assumpsit ( ( ) ( ) ( ) Trespass Trespalls (Motor Vehicle) (other) (Plaintiff) vs. BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZKING, M.D., CAROL K. ROBISON, D.O., and FJlMIL'l PRJlCTICE - BELVEDERE MEDICAL CORPORATION, " Ths trial list will be called on 08/15/95 and Trials commence on 09/18/95 (Delendant) s Pretrials will be held on 08/23/95 , (Brlels are due 5 days belore pretrials.) (The party listing this case lor trial shall provide forthwith a copy 01 the praecipe to all counsel, pursuant to local Rule 214.1.) vs. No. 4307 , 19 Jl1- Civil Indlcats the attomey who will try case for the party who flies this praecipe: Pamela G. ~.hl!lJ!lll, Esqu' Anqino & Rovner, P.C.. 4503 N. Front St.. Harrisburq, PA 17110 (717)238-6791 Indicate trial counsel for other parties II known: Evan Black, ES!E~,-~~!.2_ Sc:!)elJ.,_,I:.C., 101 North Front Street, Harrisburq, PA 17101 (717)232-5931 This case Is ready for trial. Slgned:~ tJ. ~~ Dale: JWle z.. /P, 1995 Prlnt,Name: PJlMELA G. SHUMlIN, Esquire AttnmAV Inf' Plaintiff "..,-...- ',~' ,'< JUN Z7 I 21 PH '95 " H.Eu'01 FICf or 1 'IE I'R\17'J/ONOI ,I~t CUH~ElIlAHV C~t~n PfIlNSYLVAII'4 ',' rt ? " ,. ",A~..;I <'<lot ~',' ,c", ", a t " I . , . . ,..I .." , . " , .' ,,- 'j. ;;} " " 1< I I 1 I i , \ , . . I \'I ,. ~ , . .' . " " " " , . , " *":.;~ ~-- , .~' ..~ J . LORETTA F. RUNK, Individually I and as Administratrix of the I Estate of LARRY J. RUNK, I Deceased, Plaintiff I I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. . . CIVIL ACTION - LAW BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants . . I I . . . . NO. 94-4307 CIVIL TERM upon consideration of . . AND NOW, this ORDER OF COURT l"1l. day of August, 1995, Plaintiff's Motion in Limine, a RULE is hereby issued upon the Defendants to show cause why the relief requested should not be granted. RULE RETURNABLE at the pretrial conference scheduled in this matter for Wednesday, August 23, 1995, at 10:00 a.m., in chambers of the undersigned judge. BY THE COURT, Pamela G. Shuman, Esq. 4503 North Front Street HarriSburg, PA 17110 Attorney for Plaintiff Evan Black, Esq. 101 North Front Street Harrisburg, PA 17101 Attorney for Defendants ~~.... ,-m..:..I....t 'if /,,/r;.s. A.f. :rc n 1." _~'l ".. c: L~ I' ~ :" '..""1 ',' .: ,~ .-" ;r:r- :T1t;l -, "." . .l'.:-;j~~~ ~_.-~C.'t ::! .....':)'7':(') .: -::- ~~ '" .:-~ ~~ -: -' .::.. o C> -a :J:: - c.a c.n .... ~ - ~~ ..- " '.;'" &:MJ,.' .. ,:?:or ',.' '-~ ,....:.-)( ..... '!~ ~.J i =-= <L- ,... N (Y) " ~ " .., :::> .,.. ", ~ ", . cj...o o:Ll.I- 15~!: e!e!;;~~ ~ IE 0 0 I:l: o a: IE i'i d ... ~.i:", - ..1013iil ~ zzen t::: aMa! z51'" CI:"~ A /I{' ~ UG 4 1995 ~~ . .. LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants ORDER AND NOW this day of , IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 JURY TRIAL DEMANDED , 1995, upon consideration of Plaintiff's Motion in Limine, said Motion is granted. The Defendants, their counsel and witnesses are precluded from arguing or eliciting testimony as to changes in Defendant Kipp's status in 1994 after his care of Mr. Runk was completed. BY THE COURT: J. { . ... , LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW Plaintiff NO. 4307 CIVIL 1994 v. BRUCE G. KIPP, III, p, A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIFP'S MOTION IN LIMINB Plaintiff, Loretta F. Runk, personal representative of the Estate of Larry J. Runk, deceased, by her attorneys, Angino , Rovner, P.C., hereby moves to preclude the Defendants, their counsel and witnesses, from arguing or eliciting testimony that in 1994, after Mr. Runk received treatment by the Defendants, Physician Assistant Kipp was allowed to write prescriptions for drugs. In support of her Motion in Limine, Mrs. Runk avers as follows: 1. Larry J. Runk was a patient of the Defendants from 1986, and he was last seen in the Defendants' offices on November 22, 1993. 2. On or about January 24, 1994, Mr. Runk was found unconscious next to his forklift at his place of employment, PPG, and subsequent efforts to resuscitate him were unsuccessful. 74149/IJI ;. I (' 3. Mr. Runk was seen by Physician Assistant Kipp on or about September 20, September 29, October 18 and November 22, 1993, and on two occasions in early November he went to the Defendants' offices to have his blood pressure taken. 4. At all times when Mr. Runk was seen by Defendant Kipp in 1993, Defendant Kipp was prohibited from signing prescriptions for drugs. 5. In 1994, Physician Assistant Kipp was permitted to sign prescriptions for drugs. 6. At all times when Mr. Runk was seen in the Defendants' office in 1993, the law prohibited the Defendant doctors from signing blank prescription forms for Mr. Kipp, a physician assistant, to complete. 7. Subsequent changes of the law and expansion of Physician Assistant Kipp's ability to sign prescription forms occurring in 1994 are irrelevant to this case, and they may confuse the jury into believing that the actions taken by the Defendants in 1993 in regard to Mr. Runk's care were proper and appropriate. 8. Therefore, Plaintiff moves to exclude mention of subsequent changes in Defendant Kipp's ability to write prescriptions for patients. WHEREFORE, Plaintiff respectfully requests that this Court preclude the Defendants, their counsel and witnesses from arguing or eliciting testimony as to changes in Defendant Kipp's status in 2 1994 after hi. care of Hr. Runk was completed. Respectfully submitted, ANGINO , ROVNER, P.C. R[ ) hcL, fj. ~ttLlvLI-'---" Pamela G. Shuman I.D. 141696 4503 North Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff DATED: August II, 1995 3 (. ". ,.,- CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino , Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's Motion in Limine directed to Defendants upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the II day of August 1995, addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 .6IL---I.-JJ . II< (/cL_zL Barbara J. smith UI::O A:m:: .1" ... ffil5ln": u~!o~ ~li!~~ ~oll~g .J005 zzcn aMa: z:il'" <..~ . i \,:, ,\ AU '('r", 1'It' G ~ 1.,;j;J, ')I- . . .. Ol I~ ... t: I LORETTA F. RUNK, Individually I and as Administratrix ot the I Estate ot LARRY J. RUNK, I Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintitt . . . v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Detendants JI ,/~ ~J ~ ~-.J/ ~' PLAINTI..' S PRIITRIlI.: I. Statement of BllBic Facts on Lill' Larry J. Runk, was 52 yearo ot employee ot PPG, he had Health Ameri 1986 on, his primary physicians were ...... . .......~ . _______ __ __. Belvedere Medical Corporation in Carlisle. In 1986, Mr. Runk had his records transterred from Dr. Blacksmith's office to Belvedere. Mr. Runk was treated by the Detendants in the late 1980's tor a small testicular mass and tor muscular-skeletal problsms. He was seen once in 1992 and again in 1993 for prssumed carpal tunnel syndrome and lett arm strain and sprain. Over the course ot time, he had been treated with Naprosyn, an anti-inUammatory non- steroidal medication on several occasions without adverse effects. Eleven days atter bsing seen tor lett arm strain and sprain, on September 20, 1993, Mr. Runk went to Belvedere Medical Center 741ZS/lJS LORETTA F. RUNK, :Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintiff v. . BRUCE G. KIPP, II:I, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIFF'S PRETRIAL MEMORANDUM I. Statement of Basic Facts on Liabilitv Larry J. Runk, was 52 years of age in 1993. As a long-time employee of PPG, he had Health America HMO health coverage. From 1986 on, his primary physicians were the Family Practice Group at Belvedere Medical Corporation in Carlisle. In 1986, Mr. Runk had his records transferred from Dr. Blacksmith's office to Belvedere. Mr. Runk was treated by the Defendants in the late 1980's for a small testicular mass and for muscular-skeletal problems. He was seen once in 1992 and again in 1993 for presumed carpal tunnel syndrome and left arm strain and sprain. Over the course of time, he had been treated with Naprosyn, an anti-inflammatory non- steroidal medication on several occasions without adverse effects. Eleven days after being seen for left arm strain and sprain, on September 20, 1993, Mr. Runk went to Belvedere Medical center 74125/IJS , i : d .' because of .ignificant shortne.. of breath. At that time, he was seen by a person he knew as "Dr." Bruce Kipp. Mr. Runk was having shortness of breath, worse with lying down, and increa.ed .hortne.. of breath on exertion. He was diagno.ed by "Dr." Kipp with probable early chronic obstructive pulmonary di.ea.e ba.ed on the fact that he was a .moker and po.sible mild conge.tive heart failure. "Dr." Kipp sent Mr. Runk for a che.t x-ray that demonstrated congestive heart failure with a..ociated enlarged heart, pulmonary swelling and .mall right pleural effusion. "Dr." Kipp prescribed lasix, a diuretic, and theo-24, for the COPD. Mrs. Runk was present with her husband during this vi.it, and it was her custom to go with her husband to doctor'. appointments. Nine days later, Mr. Runk returned to "Dr." Kipp with improvement in his shortns.. of breath, but it was .till pre.ent. High blood pressure was noted, and had been .een on prior occasions. Therefore, high blood pre.sure medication was started by "Dr." Kipp. Mr. Runk told the Defendant. that he had never had a complete physical examination, and they urged him to have one. On October 18, 1993, a "complete" phyaical examination waa performed on Mr. Runk by "Dr." Kipp. A follow up cheat x-ray was done that .howed residual changes compatible with continuing borderline congestive failure. Despite Mr. Runk'. .trong family history of heart disea.e, and de.pite hi. diagno.ed congestive heart failure, the only examination of Mr. Runk'. heart conducted during the "complete" physical examination by "Dr." Kipp was listening to Mr. 2 Runk'. heart with a stethoscope. Accordinq to Mr.. Runk, "Dr." Kipp pronounced Mr. Runk's heart to be sound, and Mr. and Mrs. Runk went out to dinner after the appointment to celebrate. At "Dr." Kipp's request, Mr. Runk returned on two additional occasions to have his blood pressure read and was seen aqain by "Dr." Kipp on November 22, 1993. "Dr." Kipp indicated that he wanted to see Mr. Runk in two months. Almost two months to the day later, Mr. Runk was found dead next to hi. forklift at PPG. Attempts to revive him were unsuccessful. An autopsy was performed, and it confirmed that Mr. Runk had severe cardiac disease, with several prior heart attacks, one several month. before his death at the tims he was seeinq "Dr." Kipp and complaininq of shortness of breath. The week followinq Mr. Runk's funeral, his wife of thirty-four years received a call from a person she knows who indicated that "Dr." Kipp was not a doctor at all, but a physician assistant. Mr. Runk was not seen by a doctor on September 20, September 27, October 18, or November 22. At each of those visits he saw only "Dr." Kipp. The Physician Assistant Act, 49 Pa. Code U8.l2l n... eg. specifically provides that each office utilizinq a physician assistant must have a primary physician assistant supervisor. In the case of Defendant Family Practice Group - Belvedere Medical Corporation, that primary physician assistant supervisor was Dr. Kretzinq. He alonq with the other Defendant doctors indicate they were unaware that the law requires that each patient seen by a 3 physician assistant must be seen every third visit by a doctor. 49 Pa. Code 518.144(4). Moreover, it is the testimony of all the Defendant doctors that they provided Mr. Kipp with signed, blank prescription forms that he filled in in direct violation of the Physician Assistant Act, 49 Pa. Code S18.l58(d) (2). All Defendant doctors and Defendant Kipp indicated that they were unaware that the signing of blank prescription forms was prohibited. Moreover, the Physician Assistant Act provides that within twelve hours of seeing a patient, the physician assistant must report either orally or in writing to the physician assistant supervisor the substance of all medical regimens he put into effect with patients who were not seen by a physician. 49 Pa. Code 5l8.l53(c). None of the Defendant doctors nor Defendant Kipp has any recollection of ever having discussed Mr. Runk or any care that was provided to him by Defendant Belvedere Medical corporation at any time, let alone within twelve hours of its rendering. At no time did Mr. Kipp ever refer Mr. Runk for any testing to find out the cause of his congestive heart failure. No EKG was performed. No stress test was ordered. No echocardiagram was performed. No referral to a cardiologist was performed. This last point is particularly important in that all the Defendants admit that since Mr. Runk was a msmber of an HMO, he had to have a referral from the Defendants in order to go to a cardiologist or have cardiac testing performed. II. statement of Basic Facts on Damaaes Mr. Runk left a widow and two adult sons. He was 52 years old 4 at the time of his death, and he had been employed for over twenty years at PPG as a head loader and forklift operator supervising six to eight other workers. Mr. Runk earned $35,563 in 1993, and his employer paid $9,201 in 1993 for fringe benefits for him and his family. Additionally, Mr. Runk performed twenty to thirty hours of household services per week, tending a large garden, freezing and canning fruits and veqetables, undsrtakinq virtually all cookinq for the family, assisting in qrocery shoppinq and household chores, mowinq the lawn, maintaininq the property, performinq maintenance and renovation on the family's home, and maintaininq the family vehicles. He was an avid hunter, and he reloaded bullets for friends as a hobby. Based upon the ~verage life expectancy of Mr. Runk at the time of his death, Actuary Harry Leister projects net economic losses of $669,000. Mr. Runk experienced pain and sUfferinq prior to his death. His funeral and burial expenses totaled $9,369.50. Additionally, Mrs. Runk asserts her claim for loss of society and companionship. III. statement of PrinciDal Issues of Liabilitv and Damaaes Since this is a medical malpractice action, the usual issues of liability, causation and damaqes to such actions are present. Additionally, Mrs. Runk asserts a claim for loss of society and companionship. Plaintiff's medical expert witness, Dr. Gary Viqilante, is prepared to testify that in a 52-year old man with complaints of shortness of breath usually at night and worse with lying down, such classic siqns of conqestive heart failure mandate additional 5 testinq and investiqation to rind the source of the conqestive heart failure. It is Dr. viqilante's opinion that if an EKG or other heart test had besn performed on Mr. Runk, it would have been abnormal, warrantinq referral to a cardioloqist. Additionally, Dr. viqilante, who is active in medical committees for the utilization of physician assistants, will testify that the Defendants' violations of the Physician Assistant Act are also causally related to Mr. Runk's death. Instead of merely confidently relyinq upon Mr. Kipp, the Defendant doctors had a duty to see Mr. Runk, evaluate his problems, and order appropriate testinq. Dr. Kretzinq, as primary physician assistant supervisor, and Drs. Hollen and Robison as substitute physician assistant supervisors, are leqa11y responsible for the neqliqence of Mr. Kipp and of violations of the Physician Assistant Act causally related to Mr. Runk/s death. IV. Summarv of Leoal Issues Reaardina the Admissibilitv of Testimonv. Exhibits or other Matters Plaintiff is aware of only one leqal issue reqardinq these matters other than the normal leqal issues found in most medical malpractice actions. That involves the Defendants' placinq into evidence that in 1994, after Mr. Runk's treatment, Mr. Kipp was permitted to writs prescriptions. Plaintiff believes that the chanqe in the law after the care qiven to Mr. Runk is irrelevant to this case and should be precluded. Plaintiff has prepared and is filinq simultaneously with the filinq of this Pretrial Memorandum a Motion in Limine to preclUde testimony in this reqard. 6 v. witnesses to be Called Loretta Runk Defendants as on cross-examination Dr. Gary vigilante - Plaintiff's medical expert Harry Leister - Plaintiff's actuarial expert Scott Runk Larry Runk Plaintiff reserves the right to supplement this list in a timely fashion and to call witnesses identified by the Defendants. VI. List of Exhibits Medical records and medical records summary Medical bills and medical bills summary Physician Assistant Act Videotape showing Mr. Runk prior to his death Additionally, Plaintiff reserves the right to use medical charts, models or other such demonstrative evidence. Plaintiff reserves the right to supplement their list of exhibits in a timely fashion and to utilize exhibits identified by the Defendants. VII. CUrrent Status of Settlewent Neaotiations Counsel for the Defendants requested a demand in mid-June, 1995. Plaintiff's counsel indicated that she would recommend that Mrs. Runk accept $769,000 in full and final settlement of all claims arising out of this matter. There has been no response from 7 the Defendant. DATED: August I ( , 1995 Respectfully submitted, ANGINO , ROVNER, P.C. /)(' 'r-j C/\ ~l"}h,-l" .~. ~lA..t.....L('.___ Pamela G. Shuman I.D. '41696 4503 North Front street Harrisburq, PA 17110 (717)238-6791 Counsel for Plaintiff 8 ,.. t.,.". . ...-- CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino , Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's pretrial Memorandum directed to Defendants upon counsel for Defendants by placing same in the United states mail, postage prepaid, on the If day of August, 1995 addressed as follows: Evan Black, Esquire Post , Schell, P.C. 101 North Front street Harrisburg, PA 17101 /./;!- .J~-e.~ .~ rL-2-'- Barbara J. Smith -, , , .~ , " :l , " 'I. 1 I , ;1 i " 1 , I 'I " ... "1 .. i .>';1 ':1'," I ~tI 1 "'J j) r I ~.~.. . I ~ , I I '; , ('. . , , , I ) , ~ -, LORETTA F. RUNK, Individually I and as Administratrix ot the Estate ot LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 . . . . Pldntirt . . v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants . JURY TRIAL DEMANDED PLAINTIFF'S PRETRIAL MEMORANDUM I. Statement of Basic Facts on Liabilitv Larry J. Runk, was 52 years of age in 1993. As a long-time employee of PPG, he had Health America HMO health coverage. From 1986 on, his primary physicians were the Family Practice Group at Belvedere Medical Corporation in Carlisle. In 1986, Mr. Runk had his records transferred from Dr. Blacksmith's office to Belvedere. Mr. Runk was treated by the Defendants in the late 1980's for a small testicular mass and for muscular-skeletal problems. He was seen once in 1992 and again in 1993 for presumed carpal tunnel syndrome and left arm strain and sprain. Over the course of time, he had been treated with Naprosyn, an anti-inflammatory non- steroidal medication on several occasions without adverse effects. Eleven days after being seen for left arm strain and sprain, on September 20, 1993, Mr. Runk went to Belvedere Medical Center 74125/BJS because of significant shortness of breath. At that time, he was Been by a person he knew as "Dr." Bruce Kipp. Mr. Runk was having shortness of breath, worse with lying down, and increased shortness of breath on exertion. He was diagnosed by "Dr." Kipp with probable early chronic obstructive pulmonary disease based on the fact that he was a smoker and possible mild congestive heart failure. "Dr." Kipp sent Mr. Runk for a chest x-ray that demonstrated congestive heart failure with associated enlarged heart, pulmonary swelling and small right pleural effusion. "Dr." Kipp prescribed lasix, a diuretic, and theo-24, for the COPD. Mrs. Runk was present with her husband during this visit, and it was her custom to go with her husband to doctor's appointments. Nine days later, Mr. Runk returned to "Dr." Kipp with improvement in his shortness of breath, but it was still present. High blood pressure was noted, and had been seen on prior occasions. Therefore, high blood pressure medication was started by "Dr." Kipp. Mr. Runk told the Defendants that he had never had a complete physical examination, and they urged him to have one. On October 18, 1993, a "complete" physical examination was performed on Mr. Runk by "Dr." Kipp. A follow up chest x-ray was done that showed residual changes compatible with continuing borderline congestive failure. Despite Mr. Runk's strong family history of heart disease, and despite his diagnosed congestive heart failure, the only examination of Mr. Runk's heart conducted during the "complete" physical examination by "Dr." Kipp was listening to Mr. 2 Runk/s heart with a stethoscope. According to Mrs. Runk, "Dr." Kipp pronounced Mr. Runk's heart to be sound, and Mr. and Mrs. Runk went out to dinner after the appointment to celebrate. At "Dr." Kipp's request, Mr. Runk returned on two additional occasions to have his blood pressure read and was seen again by "Dr." Kipp on November 22, 1993. "Dr." Kipp indicated that he wanted to see Mr. Runk in two months. Almost two months to the day later, Mr. Runk was found dead next to his forklift at PPG. Attempts to revive him were unsuccessful. An autopsy was performed, and it confirmed that Mr. Runk had severe cardiac disease, with several prior heart attacks, one several months before his death at the time he was seeing "Dr." Kipp and complaining of shortness of breath. The week following Mr. Runk's funeral, his wife of thirty-four years received a call from a person she knows who indicated that "Dr." Kipp was not a doctor at all, but a physician assistant. Mr. Runk was not seen by a doctor on September 20, September 27, October 18, or November 22. At each of those visits he saw only "Dr." Kipp. The Physician Assistant Act, 49 Pa. Code 518.121 ~ wm. specifically provides that each office utilizing a physician assistant must have a primary physician assistant supervisor. In the case of Defendant Family Practice Group - Belvedere Medical Corporation, that primary physician assistant supervisor was Dr. Kretzing. He along with the other Defendant doctors indicate they were unaware that the law requires that each patient seen by a 3 physician assistant must be seen every third visit by a doctor. 49 Pa. Code U8. 144 (4) . Moreover, it is the testimony of all the Dsfendant doctors that they provided Mr. Kipp with signed, blank prescription forms that he filled in in direct violation of the Physician Assistant Act, 49 Pa. Code S18.l58(d) (2). All Defendant doctors and Defendant Kipp indicated that they were unaware that the signing of blank prescription forms was prohibited. Moreover, the Physician Assistant Act provides that within twelve hours of seeing a patient, the physician assistant must report either orally or in writing to the physician assistant supervisor the substance of all medical regimens he put into effect with patients who were not seen by a physician. 49 Pa. Code S18.l53(C). None of the Defendant doctors nor Defendant Kipp has any recollection of ever having discussed Mr. Runk or any care that was provided to him by Defendant Belvedere Medical Corporation at any time, let alone within twelve hours of its rendering. At no time did Mr. Kipp ever refer Mr. Runk for any testing to find out the cause of his congestive heart failure. No EKG was performed. No stress test was ordered. No echocardiagram was performed. No referral to a cardiologist was performed. This last point is particularly important in that all the Defendants admit that since Mr. Runk was a member of an HMO, he had to have a referral from the Defendants in order to go to a cardiologist or have cardiac testing performed. II. statement of Basic Facts on Damaaes Mr. Runk left a widow and two adult sons. He was 52 years old 4 " at the time of his death, and he had been employed for over twenty years at PPG as a head loader and forklift operator supervising six to eight other workers. Mr. Runk earned $35,563 in 1993, and his employer paid $9,201 in 1993 for fringe benefits for him and his family. Additionally, Mr. Runk performed twenty to thirty hours of household services psr week, tending a large garden, freezing and canning fruits and vegetables, undertaking virtually all cooking for the family, assisting in grocery shopping and household chores, mowing the lawn, maintaining the property, performing maintenance and renovation on the family's home, and maintaining the family vehicles. He was an avid hunter, and he reloaded bullets for friends as a hobby. Based upon the average life expectancy of Mr. Runk at the time of his death, Actuary Harry Leister projects net economic losses of $669,000. Mr. Runk experienced pain and SUffering prior to his dsath. His funeral and burial expenses totaled $9,369.50. Additionally, Mrs. Runk asserts her claim for loss of society and companionship. III. statement of PrinciDal Issues of Liabilitv and Damaaes Since this is a medical malpractice action, the usual issues of liability, causation and damages to such actions are present. Additionally, Mrs. Runk asserts a claim for loss of society and companionship. Plaintiff's medical expert witness, Dr. Gary Vigilante, is prepared to testify that in a 52-year old man with complaints of shortness of breath usually at night and worse with lying down, such classic signs of congestive heart failure mandate additional 5 testinq and investiqation to find the source of the conqestive heart failure. It is Dr. Viqilante's opinion that if an EKG or other heart test had been performed on Mr. Runk, it would have been abnormal, warrantinq referral to a cardioloqist. Additionally, Dr. Viqilante, who is active in medical committees for the utilization of physician assistants, will testify that the Defendants' violations of the Physician Assistant Act are also causally related to Mr. Runk's death. Instead of merely confidently relyinq upon Mr. Kipp, the Defendant doctors had a duty to see Mr. Runk, evaluate his problems, and order appropriate testinq. Dr. Kretzinq, as primary physician assistant supervisor, and Drs. Hollen and Robison as substitute physician assistant supervisors, are leqally responsible for the neqliqence of Mr. Kipp and of violations of the Physician Assistant Act causally related to Mr. Runk's death. IV. summarv of Leaal Issues Reaardina the Admissibilitv of Testimonv. Exhibits or other Matters Plaintiff is aware of only one leqal issue regarding these matters other than the normal legal issues found in most medical malpractice actions. That involves the Defendants' placing into evidence that in 1994, after Mr. Runk's treatment, Mr. Kipp was permitted to write prescriptions. Plaintiff believes that the change in the law after the care given to Mr. Runk is irrelevant to this case and should be precluded. Plaintiff has prepared and is filing simultaneously with the filing of this Pretrial Memorandum a Motion in Limine to preclude testimony in this regard. 6 ",',.;', v. Witnesses to be Called Loretta Runk Defendants as on cross-examination Dr. Gary Vigilante - Plaintiff's medical expert Harry Leister - Plaintiff's actuarial expert Scott Runk Larry Runk Plaintiff reserves the right to supplement this list in a timely fashion and to call witnesses identified by the Defendants. VI. List of Exhibits Medical records and medical records summary Medical bills and medical bills summary Physician Assistant Act Videotape showing Mr. Runk prior to his death Additionally, Plaintiff reserves the right to use medical charts, models or other such demonstrative evidence. Plaintiff reserves the right to supplement their list of exhibits in a timely fashion and to utilize exhibits identified by the Defendants. VII. CUrrent Status of Settlement Neaotiations Counsel for the Defendants requested a demand in mid-June, 1995. Plaintiff's counsel indicated that she would recommend that Mrs. Runk accept $769,000 in full and final settlement of all claims arising out of this matter. There has been no response from 7 the Defendant. Respectfully submitted, ANGINO , ROVNER, P.C. 'J(, . ~j. 01 ~l )htll ' . ~ ltt..I..,,,,-r'.-"".-- Pamela G. Shuman I.D. #41696 4503 North Front street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: August I ( , 1995 8 (' CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Anqino , Rovner, P.C., do hereby certify that I have served a copy of the foreqoinq Plaintiff's Pretrial Memorandum directed to Defendants upon counsel for Defendants by placinq same in the United States mail, postaqe prepaid, on the 1/ day of Auqust, 1995 addressed as follows: Evan Black, Esquire Post , Schell, P.C. 101 North Front street Harrisburq, PA 17101 /!;L ..J,""",,_~ .l/. oL.zL Barbara J. Sm th ~'.<'.'! LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M. D. , HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIFF'S PRETRIAL MEMORANDUM I. Statement of Basic Facts on Liabi1itv Larry J. Runk, was 52 years of age in 1993. As a long-time employee of PPG, he had Health America HMO health coverage. From 1986 on, his primary physicians were the Family practice Group at Belvedere Medical Corporation in Carlisle. In 1986, Mr. Runk had his records transferred from Dr. Blacksmith's office to Belvedere. Mr. Runk was treated by the Defendants in the late 1980's for a small testicular mass and for muscular-skeletal problems. He was seen once in 1992 and again in 1993 for presumed carpal tunnel syndrome and left arm strain and sprain. Over the course of time, he had been treated with Naprosyn, an anti-inflammatory non- steroidal medication on several occasions without adverse effects. Eleven days after being seen for left arm strain and sprain, on September 20, 1993, Mr. Runk went to Belvedere Medical Center 14125/BJS because of significant shortness of breath. At that time, he was seen by a person he knew as "Or." Bruce Kipp. Mr. Runk was having shortness of breath, worse with lying down, and increased shortness of breath on exertion. He was diagnosed by "Dr." Kipp with probable early chronic obstructive pulmonary disease based on the fact that he was a smoker and possible mild congestive heart failure. "Dr." Kipp sent Mr. Runk for a chest x-ray that demonstrated congestive heart failure with associated enlarged heart, pulmonary swelling and small right pleural effusion. "Or." Kipp prescribed lasix, a diuretic, and theo-24, for the COPD. Mrs. Runk was present with her husband during this visit, and it was her custom to go with her husband to doctor's appointments. Nine days later, Mr. Runk returned to "Dr." Kipp with improvement in his shortness of breath, but it was still present. High blood pressure was noted, and had been seen on prior occasions. Therefore, high blood pressure medication was started by "Dr." Kipp. Mr. Runk told the Defendants that he had never had a complete physical examination, and they urged him to have one. On October 18, 1993, a "complete" physical examination was performed on Mr. Runk by "Dr." Kipp. A follow up chest x-ray was done that showed residual changes compatible with continuing borderline congestive failure. Despite Mr. Runk's strong family history of heart disease, and despite his diagnosed congestive heart failure, the only examination of Mr. Runk's heart conducted during the "complete" physical examination by "Dr." Kipp was listening to Mr. 2 Runk's heart with a stethoscope. Accordinq to Mrs. Runk, "Dr." Kipp pronounced Mr. Runk's heart to be sound, and Mr. and Mrs. Runk went out to dinner after the appointment to celebrate. At "Dr." Kipp's request, Mr. Runk returned on two additional occasions to have his blood pressure read and was seen aqain by "Dr." Kipp on November 22, 1993. "Dr." Kipp indicated that he wanted to see Mr. Runk in two months. Almost two months to the day later, Mr. Runk was found dead next to his forklift at PPG. Attempts to revive him were unsuccessful. An autopsy was performed, and it confirmed that Mr. Runk had severe cardiac disease, with several prior heart attacks, one several months before his death at the time he was seeinq "Dr." Kipp and complaininq of shortness of breath. The week followinq Mr. Runk's funeral, his wife of thirty-four years received a call from a person she knows who indicated that "Dr." Kipp was not a doctor at all, but a physician assistant. Mr. Runk was not seen by a doctor on september 20, September 27, October 18, or November 22. At each of those visits he saw only "Dr." Kipp. The Physician Assistant Act, 49 Pa. Code U8 .121 ~ ~. specifically provides that each office utilizinq a physician assistant must have a primary physician assistant supervisor. In the case of Defendant Family Practice Group - Belvedere Medical Corporation, that primary physician assistant supervisor was Dr. Kretzinq. He alonq with the other Defendant doctors indicate they were unaware that the law requires that each patient seen by a 3 physician assistant must be seen every third visit by a doctor. 49 Pa. Code 118.144(4). Moreover, it is the testimony of all the Defendant doctors that they provided Mr. Kipp with signed, blank prescription forms that he filled in in direct violation of the Physician Assistant Act, 49 Pa. Code S18.l58(d) (2). All Defendant doctors and Defendant Kipp indicated that they were unaware that the signing of blank prescription forms was prohibited. Moreover, the Physician Assistant Act provides that within twelve hours of seeing a patient, the physician assistant must report either orally or in writing to the physician assistant supervisor the substance of all medical regimens he put into effect with patients who were not seen by a physician. 49 Pa. Code S18.l53(C). None of the Defendant doctors nor Defendant Kipp has any recollection of ever having discussed Mr. Runk or any care that was provided to him by Defendant Belvedere Medical Corporation at any time, let alone within twelve hours of its rendering. At no time did Mr. Kipp ever refer Mr. Runk for any testing to find out the cause of his congestive heart failure. No EKG was performed. No stress test was ordered. No echocardiagram was performed. No referral to a cardiologist was performed. This last point is particularly important in that all the Defendants admit that since Mr. Runk was a member of an HMO, he had to have a referral from the Defendants in order to go to a cardiologist or have cardiac testing performed. II. statement of Basic Facts on Damaaes Mr. Runk left a widow and two adult sons. He was 52 years old 4 .' at the time of his death, and he had been employed for over twenty years at PPG as a head loadsr and forklift operator supervising six to eight other worksrs. Mr. Runk earned $35,563 in 1993, and his employer paid $9,201 in 1993 for fringe benefits for him and his family. Addi tionally, Mr. Runk performed twenty to thirty hours of household services per week, tending a large garden, freezing and canning fruits and vegetables, undertaking virtually all cooking for the family, assisting in grocery shopping and household chores, mowing the lawn, maintaining the property, performing maintenance and renovation on the family's home, and maintaining the family vehicles. He was an avid hunter, and he reloaded bullets for friends as a hobby. Based upon the average life expectancy of Mr. Runk at the time of his death, Actuary Harry Leister projects net economic losses of $669,000. Mr. Runk experienced pain and suffering prior to his death. His funeral and burial expenses totaled $9,369.50. Additionally, Mrs. Runk asserts her claim for loss of society and companionship. III. statement of PrinciDal Issues of Liabilitv and Damaaes since this is a medical malpractice action, the usual issues of liability, causation and damages to such actions are present. Additionally, Mrs. Runk asserts a claim for loss of society and companionship. Plaintiff's medical expert witness, Dr. Gary vigilante, is prepared to testify that in a 52-year old man with complaints of shortness of breath usually at night and worse with lying down, such classic signs of congestive heart failure mandate additional 5 " I testing and investigation to find the source of the congestive heart failure. It is Dr. Vigilante'S opinion that if an EKG or other heart test had been performed on Mr. Runk, it would have been abnormal, warranting referral to a cardiologist. Additionally, Dr. Vigilante, who is active in medical committees for the utilization of physician assistants, will testify that the Defendants' violations of the Physician Assistant Act are also causally related to Mr. Runk's death. Instead of merely confidently relying upon Mr. Kipp, the Defendant doctors had a duty to see Mr. Runk, evaluate his problems, and order appropriate testing. Dr. Kretzing, as primary physician assistant supervisor, and Drs. Hollen and Robison as substitute physician assistant supervisors, are legally responsible for the negligence of Mr. Kipp and of violations of the Physician Assistant Act causally related to Mr. Runk's death. IV. Summarv of Leaal Issues Reaardina the Admissibilitv of Testimonv. Exhibits or Other Matters Plaintiff is aware of only one legal issue regarding these matters other than the normal legal issues found in most medical malpractice actions. That involves the Defendants' placing into evidence that in 1994, after Mr. Runk's treatment, Mr. Kipp was permitted to write prescriptions. Plaintiff believes that the change in the law after the care given to Mr. Runk is irrelevant to this case and should be precluded. plaintiff has prepared and is filing simultaneously with the filing of this Pretrial Memorandum a Motion in Limine to preclude testimony in this regard. 6 ..'. V. witnesses to be Called Loretta Runk Defendants as on cross-examination Dr. Gary Vigilante - Plaintiff's msdical expert Harry Leister - plaintiff's actuarial expert Scott Runk Larry Runk Plaintiff reserves the right to supplement this list in a timely fashion and to call witnesses identified by the Defendants. VI. List of Exhibits Medical records and medical records summary Medical bills and medical bills summary Physician Assistant Act Videotape showing Mr. Runk prior to his death Additionally, Plaintiff reserves the right to use medical charts, modelH or other such demonstrative evidence. plaintiff reserves the right to supplement their list of exhibits in a timely fashion and to utilize exhibits identified by the Defendants. VII. CUrrent Status of Settlement Neaotiations Counsel for the Defendants requested a demand in mid-June, 1995. Plaintiff's counsel indicated that she would recommend that Mrs. Runk accept $769,000 in full and final settlement of all claims arising out of this matter. There has been no response from 7 the Defendant. DATED: Auqust I ( , 1995 Respectfully submitted, ANGINO , ROVNER, P.C. J1, 'r-i (/\ (i:lhl-l6 ..J. 1:) tu,,'-(.___ Pamela G. Shuman 1.0. 141696 4503 North Front street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff 8 ,. --. -,... ". CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing plaintiff's Pretrial Memorandum directed to Defendants upon counsel for Defendants by placing same in the United states mail, postage prepaid, on the If day of August, 1995 addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front street Harrisburg, PA 17101 AIL J~~_ f d-.U Barbara J. smith - 1--,' '.. ~, . .~~ "if~;~~~~J ~\:.;..:::~:~~:::~ E~'2itf~:,T "~.'.'(l:M:iIJ: ;i~~';~ ..~.:Ii {ti,\ """"'.'...< "", "I'. >"".' '.d.,'...."'... :_ ~' ~-t'~.f~':.,.l'~~-".~",.,.,,-,._,. .., ~~._,,,,,, '';!tj '~~ !tOllAIIIIllllDY NOTIPIID,101'II.I,~:lj "AjA',WIIITTIH, lI"I'OH",:'J'O:;;rn';.~;J l' " 'J!NCI.OIID'" ': . '.' :':q,,!; (r~~h. >AF--,~ " 1,wrtIlIII TWINTv (10) DA.,,''''. . oM"*.Jl 'lIIIIVICe H!REOP 011 A JUDCl"'II(l".:.,." . " ': ~~ MAY. EN'f"IREDAOAINITYOU:Y>,: :'h':. " ':'0 . If": '.' Anot..~~'~!':\t~1, ',_ ~,i;\- ';",,".: < > '\' f I , I 'I -:";1 " I /'. 1 I h? 1 f~~' 'j '.' .'~ I J.t' : ~;f **. f.~' . 'f' '.I r' . ~ I, I' ,.. , . I , , I I .. -, .. LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No, 4307 Civil 1994 BRUCE G. KIPP, III, P.A" ROBERT A, HOLLEN, M,D" HAROLD G. KRETZING, M.D" CAROL K, ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law JURY TRIAL DEMANDED PRE-TRXAL MEMORANDUM OF DEFENDANTS UNDER RULE 212-4 1. Background. Plaintiff's decedent was seen in a period of time September, 1993, through November, 1993, at the offices of the Defendants. On the first office visit pertinent to the litigation, decedent was seen by Dr, Carol Robison. In September and October, he complained of shortness of breath, but it was improved, as was the radiology findings on the cardiac status of the decedent. Decedent was examined by Bruce Kipp, P.A. Mr. Kipp was under the supervision of Drs. Kretzing, Hollen, and Robison, as Physician Assistant supervisors. Dr. Robison and Dr. Hollen were the assistant supervisors. On October 18, 1993, Mr. Kipp performed a physical examination, including a cardiac examination of the decedent. Subsequent to that time, he was monitored for blood pressure and was seen for the last time on November 22, 1993. He apparently suffered a heart attack while at work in January, 1994, and was pronounced dead at Carlisle Hospital. 2. Damages. Please see Plaintiff's Memorandum. 3. Issues of Liability and Damages. As to the Defendants, negligence and agency. Regarding damages, Plaintiff must establish that the conduct of the Defendants fell below the standard of care and that, as such, the conduct was the substantial factor in the injuries, death, and damages in the case, 4. Legal Issues aD to Testimony, Exhibits, and Other Matters. No unusual issues are anticipated. S. Witnesses to be Called. The parties. Office employees of the Defendants, Witnesses identified by all other parties, both in discovery and in the Pre- Trial Memoranda. Records Custodians of health care providers to Plaintiff's decedent. Defendants reserve the right to amend this Pre-Trial Memorandum, 6. Exhibits. Pleadings. Discovery. Depositions of witnesses and parties. Office records of the Defendants, Employment records of Plaintiff's decedent. Autopsy. Medical models. Medical drawings. Medical illustrations. Medical pictures, Exhibits identified by the other parties. Defendants reserve the right to amend this Pre- Trial Memorandum. -2- H~:~;'''"'-~ '.' . .. 7. Settlement Negotiations. Plaintiff has entered a demand. The demand is under consideration and review at this time by the Defendants, Respectfully submitted, POST & SCHELL, P,C, ~;i'RE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 I.D. No, 17884 Attorney for Defendants Bruce G. Kipp, III, P,A" Robert A, Hollen, M.D., Harold G. Kretzing, M,D., Carol K. Robison, D.O., and Family Practice - Belvedere Medical Center -3- ,., , .' '1. 1 , '.:~ " .' " (" ~:j.f~~~ .. LORETTA F, RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased ;' IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v, Docket No. 4307 civil 1994 '- BRUCE G, KIPP, III, P,A" ROBERT A, HOLLEN, M,D., HAROLD G, KRETZING, M,D., CAROL K. ROBISON, D,O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law JURY TRIAL DEMANDED PRE-TRIAL MEMORANDUM OF DEFENDANTS UNDER RULE 212-4 1. Background. Plaintiff's decedent was seen in a period of time September, 1993, through November, 1993, at the offices of the Defendants, On the first office visit pertinent to the litigation, decedent was . seen by Dr. Carol Robison. In September and October, he complained of shortness of breath, but it was improved, as was the radiology findings on the cardiac status of the decedent. Decedent was examined by Bruce Kipp, P,A. Mr, Kipp was under the supervision of Drs. Kretzing, Hollen, and Robison, as Physician Assistant supervisors. Dr. Robison and Dr. Hollen were the assistant supervisors. On October 18, 1993, Mr. Kipp performed a physical examination, including a cardiac examination of the decedent. Subsequent to that time, he was monitored for blood pressure and was seen for the last time on November 22, 1993. He apparently suffered a heart attack while at work in January, 1994, and was pronounced dead at Carlisle Hospital. ,., 3. Issues of Liability and Damages. As to the Defendants, negligence and agency, Regarding '. ,. - 2. Damages. Please see Plaintiff's Memorandum. damages, Plaintiff must establish that the conduct of the Defendants fell below the standard of care and that, as such, the conduct was the substantial factor in the injuries, death, and damages in the case, 4. Legal Issues as to Testimony, Exhibits, and Other Matters. No unusual issues are anticipated. S. Witnesses to be Called. The parties. Office employees of the Defendants. Witnesses . identified by all other parties, both in discovery and in the Pre- Trial Memoranda. Records Custodians of health care providers to Plaintiff's decedent. Defendants reserve the right to amend this Pre-Trial Memorandum. 6. Exhibits. Pleadings. Discovery. Depositions of witnesses and parties, Office records of the Defendants. Employment records of Plaintiff's decedent, Autopsy. Medical models, Medical drawings. Medical illustrations. Medical pictures. Exhibits identified by the other parties, Defendants reserve the right to amend this Pre- Trial Memorandum. -2- ... .- 7. Settlement Negotiations. Plaintiff has entered a demand, The demand is under " consideration and review at this time by the Defendants, -. Respectfully submitted, ~lC' EVAN B CK, ESQUIRE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 I.D. No, 17884 . Attorney for Defendants Bruce G, Kipp, III, P,A" Robert A, Hollen, M.D" Harold G. Kretzing, M,D" Carol K, Robison, D.O" and Family Practice - Belvedere Medical Center -3- LORETTA F. RUNK, Individually I and as Administratrix of the I Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . . . . I I I I I I I CIVIL ACTION - LAW . . I . . NO. 94-4307 CIVIL TERM ORDER OF COURT AND NOW, this 2 ~, J day of August, 1995, upon relation of counsel that this case has settled, the Motion in Limine previously filed in this matter is DEEMED MOOT and the hearing scheduled for August 23, 1995, is CANCELLED. BY THE COURT, - eu..~..... />>";..14C ;, /..:zq (1S. J:, . <'f', Pamela G. Shuman, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff Evan Black, Esq. 101 North Front Street Harrisburg, PA 17101 Attorney for Defendants :rc ~: N ':',~,"':.. ~ _j 4, APiiJO Q~;~ ~ ,~\JL C~OH; ~:"IJI~;' "'\T.> 1:) 56. HV I1E 6 rZ onV \. , .. "-. . ,,~i)',lJ.,',,}'" ">\:/i~'!,'~~~ ./iiYClU.MI HIIIDY NOTlPlID TO "IUb";"~,iL;: " ~;l;~-=N ....'.I'OH..'..~..IH':~;?{~:4~1 . :;'..Wl1'HIN 'rWINTY . (10)' DAY' ,,,ciiiV,.~.'{. f~.;;~.; , :IIII\YICI HIMO' 011 AJUDOIUIllT i' :,,',l,'h' '; 1IAY.I!HTIIIIlllI4AlNlTVOU '." ';.;., ;,'/it ,'~' 'rif"" , ",' >J).,' J":.:i:'ii.T../. . ATTOfINEY '1':'''' "ii,,,'''';' ,;f?i,;~;~~" ( ,<" " LORETTA F, RUNK, Individually I IN THE COURT OF COMMON PLEAS and as Administratrix of the CUMBERLAND COUNTY, PENNSYLVANIA Estate of Larry J. Runk, Deceased v, Docket No, 4307 Civil 1994 BRUCE G, KIPP, III, P,A" ROBERT A. HOLLEN, M,D" Civil Action - Law HAROLD G. KRETZING, M,D., CAROL K, ROBISON, D,O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER JURY TRIAL DEMANDED ORDER OP DISMISSAL AI'Icl Uew, il.,~ ,t ~7' J SC'~..../,.d, ,"$ '(SO , Pursuant to the attached Stipulation, it is hereby Ordered that Defendants, Belvedere Medical Corporation, Carol K, Robison, D.O., and Bruce G. Kipp, III, P.A., are hereby dismissed from the within action. BY THE COURT: J. \ ;01" ,.t "I " ~ 56, W' ItD S S d3S . LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J, Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v, Docket No, 4307 Civil 1994 BRUCE G. KIPP, III, P.A., ROBERT A, HOLLEN, M,D., HAROLD G, KRETZING, M.D" CAROL Y.. ROBISON, D,O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law JURY TRIAL DEMANDED STIPULATION OF DISMISSAL OF BELVEDERE MEDICAL CORPORATION, CAROL K. ROBISON, D.O., AND BRUCE G. KIPP, III, P.A. It is hereby stipulated and agreed by and among all parties and their counsel that Defendants Bruce G. Kipp, III, P,A., Carol K. Robison, D.O., and Belvedere Medical Corporation are hereby dismissed from this case with prejudice, This Stipulation is effective as of the time that it is signed by all counsel. ?Wr)~ ~.. ~ PAMELA G, SHUMAN, ESQUIRE ;:~ntif' EVAN BLACK, ESQUIRE Attorney for Defendants " ! '.,' Sn , 2 O~ rK '95 fIWj-Off,OIi . OF TlI~ ri1OTI\O"~'A.~ IY CUMBERLAlID 00 KTV PEHIISYI,VMII '," " 0) , -v> ..,- " 1 '" tr<-<'; - ",...". ~... '1/t./9r' ..&.~, ---i;-}7;,:~::l.~"';'~--;:-~:-~'"""V' """"-"''''., f~~7;,:';.;-'..',-_;':: ,",7'1' .~... .' ~:. ~;;''''- ~. -_~:'r:'~" . - _.::~::~t~~_r~:~f~'+:_.~~-.~r~~t~,: ~. r' .,.:..." ~, . '&J~'\:':'E.~~~~' .; , ~'::~;:~~~~1:,~if.'.~~~\,<: <>:- ~ - - - - 7'~ :\ J''\ . " ~ " , "',' .. tI' ;.", " . . --~ ' r I i ! J "'I . ::(\ _.I "''',1 .. A , r '., , .\ . ~~~ I. I, I r I i j LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law . . JURY TRIAL DEMANDED ORDER AND NOW, this Istl. day upon consideration of the Defendants' of ~, 1995, Petition to Seal the Record in the above captioned matter, it is hereby Ordered and Directed that the Defendants' Petition is hereby Granted. IT IS FURTHER ORDERED that all pre-trial discovery and all pleadings or other documents whether hereto for or hereafter,:to be had and filed, shall be and remain sealed of record, with access thereto or released in any form or manner of any of the contents ," " thereof by or to anyone strictly prohibited. -4::. l--".:l ul BY THE COURT: J. LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law : . . : JURY TRIAL DEMANDED PETITION TO SEAL RECORDS AND NOW, come the Defendants, by and through their attorneys, Post & Schell, P. C., and in support of their Petition to Seal Records aver as follows: 1. Plaintiff commenced this action by Complaint filed on or about August 1, 1994. 2. The Plaintiff's action was dismissed with prejudice by Stipulation of Counsel on or about August 24, 1995. (See attached Exhibit "A"). 3. The parties to this action have agreed that the terms of any settlement should be held in strict confidence. 4. The Defendants in this action practice their profession in a small community, and sealing of the record is necessary to protect the reputations and standing of the Defendants in the community. 5. Further, at all times relevant to the above captioned action, there existed a physician/patient privilege between the Defendants and the Plaintiff herein, and an Order sealing the record is necessary to protect the privacy expectation of the parties to that physician/patient privilege. 6. Due to the nature of the Plaintiff's action and also due to the fact of the small size of the community, any public dissemination of information concerning the settlement or the action could be extremely detrimental to the Defendants. 7. As the Plaintiff's claimn have been settled, the sealing of the record will not impede any parties rights or abilities to move towards the resolution of the Plaintiff's claims. 8. Opposing counsel has been contacted, and is not opposed to the court entering an Order Sealing the Settlement in this matter. WHEREFORE, Petitioning Defendants respectfully request this Honorable Court enter an Order sealing all records in the above captioned matter. P~P.C' BY: c; . Evan Black, Esquire 101 North Front street Harrisburg, PA 17101 (717) 232-5931 1.0. No. 17884 Attorney for Defendant, Bruce G. Kipp, III, P.A. Carol K. RObison, D.O., & Belvedere Medical Center DATE: 2 CERTIPICATE OP SERVICE I, Jamie M. Dengler, an employee of the law offices of Post & Schell, P.c., do hereby certify that on the date listed below, I did serve a true and correct copy of the foregoing document upon the following personCs) at the following address (es) by sending same in the united states mail, first-class, postage prepaid: Pamela Shuman, Esquire ANGINO , ROVNER, P.C. 4503 North Front Street Harrisburg, PA 17110 DATE: ct \Id.-\C\S- ~mJ.o m.~n~or JAMIE M. DENGLER -- .'; ~, ! -'., .: :,\ ,". m.te.OfFIOE or iiiET',~TIIOIlO'f.~Y VJ"~~ Hc~UO llQUlIU i'C;H$l\.VA~IA ~ ' Z sa r~ '9S . SEP \1\ ""," .'C "."-' ;",' l'~ . . " . . . ~i ':''1i_!!",.''''!t~ '", .'"~ ,,-~ ' ,,";~~' ",':"';....,-".- " '':''51~1~i:'l~-i''''':<~ ,.;~ ~'~:: :;.;:;'.__ ;':"1~l_ ,:.::' ._ ',' ",. c__l" ,~~!:o\ . _~ 1'. _~.'- . ;1t~., ~~ ;!~:{' I - r ", . .. , LORETTA F. RUNK, Individually 1 and as Administratrix of the 1 Estate of LARRY J. RUNK, 1 Deceased, 1 Plaintiff 1 1 1 1 1 1 1 1 v. BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW . . 1 . . NO. 94-4307 CIVIL TERM ORDER OF COURT AND NOW, this ~L.Lday of September, 1995, upon consideration of Plaintiff's Motion for Reconsideration, a conference is scheduled in chambers of the undersigned judge for Monday, October 2, 1995, at 3130 p.m. Pamela G. Shuman, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff Evan Black, Esq. 101 North Front Street Harrisburg, PA 17101 Attorney for Defendants :rc G-I .IF '.[ '- 'tyL vI. C. / COC1JL .~V\ )'-V j /1 i\l il BY THE COURT, J ~"'.~"-.( 9/ ;p-!9S"- A.-r: . ~ , J/' 4~1\,. ';\ ::'j. ; ft>; 56, IIV rz 1/ ZZ d3S ~ - , -.. 1,.,; ~ f..... " " L. ,C) ..... ~-'l") = ,--... ... .... c"r. ., ~. ,. .t.. .r'.: " .. . cliO A: :: . " lfil5!Z~ !.!~Oi!': ~a:IE~ ~oll~~ 500ii! ZZUl a~ii! ~..;! ~ , ~LI _ 1 IJJJ\ I' - CJ> I~ " - !: . .' . , LORETTA F. RUNK, Individually : and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants AND NOW, this . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW . . . . . . : NO. 4307 CIVIL 1994 . . . . : . . . . . . . . . . . . JURY TRIAL DEMANDED ORDER day of , 1995, upon consideration of Plaintiff's Motion for Reconsideration, said Motion is granted. The Order dated September 15, 1995, is hereby vacated, and argument is scheduled for the , 1995, at day of .M., in Courtroom No. . o'clock BY THE COURT: J. ,. . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIPP'S MOTION POR RECONSIDBRATION Loretta F. Runk, individually and as administratrix of the Estate of Larry J. Runk, deceased, hereby requests reconsideration of the Court's Order dated September 15, 1995, granting the Defendants' Petition to Seal the Records in the above-captioned case. In support of her Motion for Reconsideration, Plaintiff avers as follows: 1. The Defendants filed a Petition to Seal the Records in this matter on september 13, 1995. 2. It was received in Plaintiff's counsel's office on September 14, 1995. 3. Prior to the filing of the Defendants' Petition to Seal the Records, Plaintiff's counsel conveyed to the counsel for the Defendants her opposition and the opposition of her client to the Petition to Seal the Records. 76659/BJS 4. Despite such opposition, the Defendants asserted in their Petition that Plaintiff did not oppose same. 5. Plaintiff prepared an opposition to Defendants' Petition to Seal Records, a copy of which is attached hereto as Exhibit A. 6. Additionally, plaintiff prepared a Brief in opposition to Defendants' Petition to Seal Records, attached hereto as Exhibit B. 7. Moreover, plaintiff prepared a Praecipe for Listing the Matter for Argument, a copy of which is attached hereto as Exhibit C. 8. On september 19, 1995, the date that these documents were being forwarded to the Court for filing, Plaintiff received the Court's Order dated September 15, 1995, granting the Defendants' petition, signed by the Honorable J. Wesley Oler and attached hereto as Exhibit D. 9. Plaintiff requests that this Court reconsider its decision in light of the Plaintiff's opposition to the sealing of the records. 10. Plaintiff further requests that the Court rescind its September 15, 1995, Order and grant oral argument on the issue, after which Plaintiff respectfully request that the Court deny the Defendants' Petition. 11. plaintiff respectfully requests that the Court address her Motion for Reconsideration expeditiously, for the filing of this Motion does not toll the thirty day appeal period, while the granting of the Motion for Reconsideration does. 2 f.. ..-. WHEREFORE, plaintiff respectfully requests that this Court grant reconsideration in this matter. Respectfully submitted, ANGINO & ROVNER, P.C. DATED: September 17 ' 1995 -f>~!J.~ Pamela G. Shuman 1.0. 141696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff 3 . EXHIBIT A ,> LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW Plaintiff : NO. 4307 CIVIL 1994 v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIFF'S OPPOSITION TO DEFENDANTS' PETITION TO SEAL RECORDS Loretta F. Runk, Individually and as Administratrix of the Estate of Larry J. Runk, deceased, by her attorneys, Angino & Rovner, P.C., hereby opposes the Defendants' Petition to Seal Records, and she avers as follows: 1. Admitted. 2. There is no Exhibit A attached to Plaintiff's copy of the Petition to Seal Records. It is admitted that a settlement was reached in this matter, and it is further admitted that the Court approved the settlement. While it is admitted that Plaintiff's counsel entered into a stipulation to dismiss Defendants Kipp, Robison, and Family Practice - Belvedere Medical corporation, that is the only stipulation of Counsel into which Plaintiff's counsel entered. 3. Admitted. It was for this reason that the Plaintiff 76569/BJS ,. filed a Motion to Seal the Settlement Documents. 4. Denied. Plaintiff opposes sealing of the entire record in this matter. Except under extraordinary circumstances, all court records are public, and Plaintiff opposes any action that would stop others who may have been wronged by these Defendants from reviewing the facts of her case. 5. Denied. When Mrs. Runk brought an action on behalf of her husband against the Defendants, she specifically waived the physician-patient privilege. It is hers and hers alone to assert, and it is hers and hers alone to waive. 6. Denied as irrelevant. All court records are matters of public record except under the most extraordinary of circumstances. While the Plaintiff has agreed to the sealing of the settlement documents, she opposes making any other documents in this matter unavailable to anyone in the public who may care to look at them. Specifically, the Plaintiff believes that if others who may have been wronged by the Defendants wish to review the records in this case, they should be able to do so. 7. Denied as stated. While it is admitted that the Plaintiff's claim has been settled, the Plaintiff strongly believes that if others have been wronged by the Defendants and wish access to the records in her case, they should have such access. Sealing of an entire file is an extremely unusual occurrence, is unwarranted in this case, and it should not be granted in this case. 8. While it is true that Plaintiff agreed to the sealing of 2 t. the settlement documents, any implication that the Plaintiff agreed to the sealing of the entire record in this matter is specifically denied. Instead, counsel for the Defendants contacted Plaintiff's counsel to get her agreement, and Plaintiff's counsel informed counsel for the Defendants that the Plaintiff does not agree to sealing of the entire record in this case. WHEREFORE, Plaintiff respectfully requests that This Honorable Court deny the Defendants' Petition to Seal the Record. Respectfully submitted, ANGINO & ROVNER, P.C. !?t'})\LC" d. SiuLI1<-"-~ Pamela G. Shuman I. D. #41696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: September Ie; , 1995 3 " CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's Opposition to Defendants' Petition to Seal Records directed to Defendants upon counsel for Defendants by placing same in the United states mail, postage prepaid, on the I Cj day of september, 1995, addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 All L~ Barbara J. 4 tf at... -rl. Smith ,- EXHIBIT B (' LORETTA F. RUNK, Individually : and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintiff v. : BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants . . JURY TRIAL DEMANDED PLAINTIFF'S BRIEF IN OPPOSITION TO DEFENDANTS' PETITION TO SEAL RECORDS I. Procedural Historv The instant action was commenced by the filing of the Complaint on or about August 1, 1994. Larry J. Runk, age fifty- two, was a patient of the Defendants for seven years. In the Fall of 1993, he went to see the Defendants with complaints of extreme shortness of breath, worse at night and worse on lying down. He saw a practitioner whom he believed to be a doctor, who diagnosed congestive heart failure. This diagnosis was confirmed on chest x- ray. Mr. Runk returned to the Defendants on three additional occasions. Despite clear signs and symptoms of congestive heart failure, he was never referred to a cardiologist. Moreover, when a "complete" physical was performed on him, no electrocardiogram or other test to evaluate his heart was performed. Instead, Mr. Runk's heart was listened to with a stethoscope and pronounced 76575/BJS sound. When last seen by the Defendants in November, 1993, Mr. Runk was advised to return in two months. Almost exactly two months later, he was found dead at his place of employment, PPG, from a massive heart attack. The autopsy report revealed a prior heart attack that occurred during the time he was seeing the Defendants. Following her husband's funeral, Mrs. Runk learned for the first time that the "doctor" who had cared for her husband was not a doctor at all. Instead, he was a physician assistant. In violation of the laws regulating physician assistants, the Defendant doctors signed blank prescription forms that the physician assistant later filled in. The doctors failed to require the physician assistant to discuss patient plans with them within twelve hours of seeing Mr. Runk, as required by law. Moreover, Mr. Runk was not seen at least every third visit by a doctor. Instead, on all four visits he was seen by a physician assistant, in violation of the law. When deposed, the Defendant doctors indicated they had no knowledge of the law's requirements, despite having employed a physician assistant for more than twenty years. After all discovery was complete in this matter, and after the case was listed for trial and scheduled for pre-trial conference, a settlement in this matter was reached. with the concurrence of defense counsel, Mrs. Runk asked that the settlement documents be sealed, and the Court granted that Motion. This matter has already been Court-approved by the Honorable Wesley Oler, who also entered the Order to seal the settlement documents. 2 contrary to what appears to be the assertion of the Defendants in their Petition, plaintiff's counsel, when consulted as to whether the Petition to Seal the Records was agreeable to her, clearly indicated to counsel for the Defendants that her client opposed same. Moreover, it appears that the Order that the Defendants submitted to the Court covers not only pleadings, but pre-trial discovery that has or mav be in the future filed in this matter. Such a step is unprecedented and vigorously opposed by the Plaintiff. II. Issue WHERE THE DEFENDANTS OFFER NO EVIDENCE TO OVERCOME THE COMMON LAW PRESUMPTION OF OPENNESS. SHOULD THIS COURT DENY THEIR PETITION TO SEAL THE RECORDS? suggested answer in the affirmative. III. Araument WHERE THE DEFENDANTS OFFER NO EVIDENCE TO OVERCOME THE COMMON LAW PRESUMPTION OF OPENNESS. THIS COURT SHOULD DENY THEIR PETITION TO SEAL THE RECORDS. Article I, Section 11 of the Pennsylvania Constitution states that: all Courts shall be open; and every man for an injury done him in his lands, goods, person or reputation shall have remedy by due course of law and right and justice administered without sale, denial or delay. As our appellate courts have said: The common law rule, which also confers a public right of access to 3 court records, is that every person is entitled to access 'provided he has an interest therein for some useful purposes and not for mere curiosity.' c. v. c., sUDra, [320 A.2d 1717] at 723; 23 Am. Jur. 2d Divorce and Separation 5341, at 410 (1983) . Katz v. Katz, 356 Pa. super. "All Courts Shall Be Open: proceedings and records, 52 461, 467, 514 A.2d 1374, 1377 (quoting The pUblic's right to view judicial Temple L.Q. 311 (1979)). There are two methods of analysis of the competing interests involved in a request for closure. In the First Amendment, or Constitutional analysis, the presumption of openness may be rebutted by a claim that the denial of public access "serves an important governmental interest and there is no less restrictive way to serve that government interest. II Publ icker Industries. Inc. v. Cohen, 733 F.2d 1059, 1070 (1984), cited with approval in Hutchinson bv Hutchinson v. Luddv, 417 Pa. Super. 93, 611 A.2d 1280,1291 (1992). The second method of analysis is the common law balancing approach, where a party must show that his personal interest in secrecy outweighs the traditional presumption of openness. ~, Bank of America National Trust & Savinas Ass'n v. Hotel Rittenhouse Ass'n, 800 F.2d 339 (3d. Cir. 1986), cited with approval in R. W. v. HamDe, 426 Pa. Super. 305, 626 A.2d 1218, 1220, n.3 (1993). In order to overcome the well-established presumption of openness, and to obtain closure of judicial records, a party must demonstrate that closure is "necessary in order to prevent a clearly defined and serious injury to the parties seeking" it. Goodrich Amram 2d 5223(a): 7, cited with approval in R. W. v. HamDe, 626 A.2d at 1221. 4 The Defendants cite no compelling reasons for closure in this matter. In their petition they claim three bases for secrecy. First, they indicate that in light of their practice in a small community, sealing of the record "is necessary to protect the reputations and standings of the Defendants in the community." Petition to Seal Records at paragraph 4. Surely, every defendant in every action could say that records need to be sealed to protect his reputation. However, that is not sufficient to overcome the presumption of openness. As the Superior Court held in the case of R. W. v. Hampe, such secrecy is inappropriate even where the plaintiff seeks protection from disclosing her identity in a malpractice action that involved her mental health and claims of intimate personal details of her life and sexual practices. surely, there are no such intimate claims here, for the claims asserted against the Defendants involve actions within the purview of their practice, and, therefore, are all the more properly open to the public. Secondly, the Defendants claim that an Order sealing the record is necessary to protect the privacy expectation of the parties to physician-patient privilege. Petition to Seal Records at paragraph 5. such an argument is totally fallacious, since it is black letter law in Pennsylvania that the physician-patient privilege belongs to the patient and only she can waive it. As the Court noted in R. W. v. Hampe, the Plaintiff waives any protection under the physician-patient privilege when she files suit. R. W. v. Hampe, 626 A.2d at 1222. ~ AlAQ, Moses v. McWilliams, 379 Pa. 5 ,. Super. 150, 549 A.2d 950 (1988). Further, by statute, the physicians, when suit has been brought against them, are permitted to disclose patient information in civil matters brought by the patient for damages. 42 Pa. C.S.A. 55929. Thus, it is absurd for the Defendants to argue that they ever had any expectation of privacy in this matter based on the patient-doctor privilege. Third, the Defendants argue that "any public dissemination of information concerning the settlement or the action to be extremely detrimental to the Defendants." Petition to Seal Records at paragraph 6. Apparently, the Defendants are concerned that the public will learn of their malpractice. The Defendants assert that for the public to become aware of the facts in this matter could hurt their reputation in the community. However, under every set of circumstances in every case, parties could argue that if the public became aware of the information in the action, it could be detrimental. To adopt the Defendants' rationale would mean that the record would be closed in every case. The Defendants did not pay money in this case to have this record closed. Instead, they paid to have the action settled. They got what they paid for. Moreover, the Defendants' assertion that dissemination of information concerning the settlement would hurt the Defendants is fallacious, since the Plaintiff has already agreed to, and the Court has already sealed the settlement documents. A review of the kinds of cases in which courts have declined to seal the record clearly demonstrates that the Defendants in this case fall far short of meeting their burden of overcoming the 6 presumption against openness. Records involving claims of sexual abuse by Roman Catholic priests have been held to be properly open to the public. Hutchinson bv Hutchinson v. Luddv, 611 A.2d 1280 (1992). Likewise, our courts have not allowed initials to be used for a party to conceal identity under circumstances where the party contracted AIDS, had sexual intercourse with, a therapist, or alleged sexual abuse by a priest. stenoer v. Lehioh Vallev HosDital center, 382 Pa. Super. 75, 554 A.2d 954 (1989); Hutchinson bv Hutchinson v. Luddv, 398 Pa. super. 505, 581 A.2d 578 (1991); and R. W. v. HamDe, 626 A.2d 1218. Surely if such intimate matters shall be open to the public, what basis do the Defendants have to shield their medical negligence? IV. conclusion The Defendants have clearly failed to meet their burden in a balancing test to have the records sealed in this case. The Plaintiff does not want the records sealed, for she is concerned that others who may have been the victims of malpractice of the Defendants have access to the record in this matter. Moreover, the Defendants' proposed Order would allow the Defendants to hide behind a cloak of secrecy in clear contravention of public policy favoring access. Plaintiff's counsel clearly informed counsel for the Defendants that she would not agree to the sealing of the record, and, indeed, except under the most extraordinary of circumstances would never agree to such extreme secrecy. Because the Defendants have failed to meet their burden of overcoming the presumption of openness, Plaintiff respectfully requests that this 7 Court deny Defendants' Petition to Seal the Record in this matter. DATED: September I~, 1995 Respectfully submitted, ANGINO & ROVNER, P.C. t6:')nJ(( ,~. S:J'-t.~l1L<tr-~ Pamela G. Shuman I.D. #41696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff 8 CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's Brief in opposition to Defendants' Petition to Seal Records directed to Defendants upon counsel for Defendants by placing same in the united States mail, postage prepaid, on the L~ __ day of september, 1995, addressed as follows: Evan Black, Esquire Post & schell, P.C. 101 North Front street Harrisburg, PA 17101 A~ .I,,--< l~/~ -:rd, Barbara J. Smith EXHIBIT C PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be Iypewrlllen and subrnilled In duplicate) TO THE PROTHONOTARY IOF CUMBERLAND COUNTY: Please lIS1the within matter for the next: o Pre.Trial Argument Court I]] 'Argument COUll ---------------------------------------------------------------------- CAPTION OF CASE (entire caption must be stated in full) LORETl'A F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, (Plaintiff) vs, BROCE G. KIPP, III, P.A., ImERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISCJIl, 00.0., and FAMILY PRlCl'ICE - BELVEDERE MEDICAL CORPORATION (Defendant)S toe CivU 19~ No, 4307 1. State mailer to be argued (i. e" plalntifrs motion for new trial, defendant's demurrer to complaint. etc,): Defendants' Petition to Seal Records 2. Identify counsel who will argue case: (a) for plalntlff: Pane1a G. Shunan, Esquire (b) for defendant: Evan Black, Esquire 3. I will notify all parties in writing within two days that this case has been listed for argument,_ ANGUlO & ROVNER, P.C. ~l1U ~ II f:j, ~'11.L"hL(W_ (Attorney for Plaintiff ) Pamela G. Shunan, Esquire Daled: September 19, 1995 EXHffiIT 0 I' SEP , 5 \OB~if LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER civil Action - Law JURY TRIAL DEMANDED ORDER /stfv ~-"'-44...1 AND NOW, this day of , 1995, upon consideration of the Defendants' Petition to Seal the Record in the above captioned matter, it is hereby Ordered and Directed that the Defendants' Petition is hereby Granted. IT IS FURTHER ORDERED that all pre-trial discovery and all - pleadings or other documents whether hereto for or hereafter to be had and filed, shall be and remain sealed of record, with access thereto or released in any form or manner of any of the contents thereof by or to anyone strictly prohibited. BY THE COURT: 1</ g., ur~",J.'t tge"-!, 'Ju' cr J. -.. AL~4- ~~ Barbara J. smith CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing Plaintiff's Motion for Reconsideration directed to Defendants upon counsel for Defendants by placing same in the United states mail, postage prepaid, on the /9 day of September, 1995, addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 .... . LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION - LAW BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants NO. 94-4307 CIVIL TERM ORDER OF COURT AND NOW, this Z..Jday of October, 1995, upon consideration of Plaintiff's Motion for Reconsideration, and following a conference in chambers at which Pamela G. Shuman, Esq., appeared on behalf of Plaintiff and Dean F. Picarella, Esq., appeared on behalf of Defendants Hollen and Kretzing (the remaining Defendants having been dismissed from the action), and it appearing that the court in entering the sealing Order dated September 15, 1995, was under the misimpression that Plaintiff's counsel was in agreement therewith, the Order dated September 15, 1995, is VACATED as improvidently entered, and the record is unsealed except as to the settlement agreement between the parties, the Answers of Defendants to Plaintiff's Interrogatories and the Response of Defendants to Plailltiff's Request for Production of Documents, all of which shall remain sealed. NOTHING herein is intended to preclude Defendants from moving for the sealing of additional portions of the record. BY THE COURT, "-"""- OCT 3 1110 AH '95 1:. ~ Ie: '('~L AJ~' l~)~, t ,..,' j< f;'-,~1IY l". ~ ,.: .~ ~ / ~ . Pamela G. Shuman, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff Evan Black, Esq. Dean F. Picarella, Esq. 101 North Front Street Harrisburg, PA 17101 Attorneys for Defendants :rc e.,......... I>>_'..t. /0/3} 9.["' ",J,6', This order has been superseded by a more limited sealing. The unsealed items have been removed and put in the file. Wes Oler 10/2/95 LORETTA F. RUNK, Individually : and as Administratrix of the Estate of Larry J. Runk, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 . . BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER : Civil Action - Law : JURY TRIAL DEMANDED ORDER AND NOW, this Jst~ day Of~, 1995, upon consideration of the Defendants' Petition to Seal the Record in the above captioned matter, it is hereby Ordered and Directed that the Defendants' Petition is hereby Granted. IT IS FURTHER ORDERED that all pre-trial discovery and all pleadings or other documents whether hereto for or hereafter~to be had and filed, shall be and remain sealed of record, with access thereto or released ill any form or manner of any of the contents Ll . thereof by or to anyone strictly prohibited. ~ , . ~ (-'..") ..Il BY THE COURT: -, ~,~ .wd c.} Ls ~"'''Jl S'Jj'Y') s-drr/ l, "I ::. VVfr))c. \, ...,J;j t' t- rn c..(' > I ') \ , " l~ \1/\ ~(' ,(, i r ~ S \" I' r ~ n I) 'r " ~~ "v~ J )'1C'l pv1\'l F.-!c.. G...) t :::. 0\(( · \o\d"I.!:.- J. / " .' 'L 1 , " .r I ~;.l ~: I ,.:, J " . I, . ,I i' I, I ,.. . r I , , I j .. '";. .'.. LORETIA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY , PENNSYLVANIA v. NO. 4307 CIVIL 1994 BRUCE G, KIPP, Ill, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M,D.. CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, CIVIL ACTION - LAW JURY TRIAL DEMANDED Defendants ANSWERS OF DEFENDANTS TO PLAINTIFF'S INTERROGATORIES 1. Unknown at this time. Pursuant to the Rules of Civil Procedure. this answer will be supplemented. 2. See answer to Interrogatory No. I, 3. Unknown at this time, Pursuant to the Rules of Civil Procedure, this answer will be supplemented, 4. Answering Defendants are not in possession of any statements or discoverable investigation materials. Pursuant to the Rules of Civil Procedure, this answer will be supplemented, should the need arise, 5. See answer to Interrogatory No, 4. 6, Aside from the parties involved in this matter, unknown at this time. Pursuant to the Rules of Civil Procedure, this answer will be supplemented, should the need arise. "w .., 7. Aside from the medical records of Larry J. Runic, unknown at this time. Pursuant to the Rules of Civil Procedure, this answer will be supplemented, should the need arise. 8. Harold G. Kretzing, M.D. 9. Robert A. Hollen, M.D.. Harold G. Kretzing, M.D., and Carol K. Robison, D.O. 10. Robert A. Hollen, M.D.. and Carol K. Robison, D.O. 11. Robert A. Hollen, M.D., Harold G. Kretzing, M.D., and Carol K. Robison, D.O. 9120/93 9/29/93 10/18/93 11/22/93 9:45 a.m. 8: 15 a.m. 2:00 p.m. 4:45 p.m. Harold G. Kretzing, M.D. Carol K. Robison, D.O. Robert A. Hollen, M.D. Robert A, Hollen, M.D, 12. See attached copy. Answering Defendants are unable to get copies of other prescriptions written. 13. Karen Robitaille. ReceDlionisl. Office Clerk Home Address: 127 Cumberland Road Eno1a, PA 17025 No home phone number Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Amv Boudreau. Receptionist. Office Clerk Home Address: 4507 Carlisle Pike Gardners. PA 17324 (717) 486-4386 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 2 Kathv Lebo. Recentionist. Office Clerk Home Address: 1406 Trindle Road Carlisle, PA 17013 (717) 243-8721 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Carol Yentzer. Office Manal!er. SecretarY Home Address: 1146 South Pitt Street Carlisle, PA 17013 (717) 249-6036 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Sheila Thesen. Part-Time ReceDtionist. Office Clerk Home Address: 1419 Pheasant Drive South Carlisle, PA 17013 (717) 249-9690 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Linda Dortv, Medical Assistant for Mr, Bruce KiDD. P.A, Home Address: 603 South Mountain Estate Road Shippensburg, PA 17257 (717) 532-9062 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Kathy Evelhoch. Part-Time ReceDtionist Home Address: 1004 Pheasant Drive North Carlisle, PA 17013 (717) 249-6635 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 3 Diane Shulenberl!er. Part-Time Receptionist Home Address: 263 Walnut Street Carlisle, PA 17103 (717) 249-7938 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Carol K. Robison. 0,0.. Phvsician Home Address: 1004 Shannon Drive Carlisle, PA 17013 (717) 258-1008 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 Catherine Tavlor. Medical Assistant for Dr. Robison Home Address: 1395 Williams Grove Road Mechanicsburg, PA 17055 (717) 697-6670 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 14, Linda Dortv. Medical Assistant for Mr. Broce Kioo. P.A. Home Address: 603 South Mountain Estate Road Shippensburg, PA 17257 (717) 532-9062 Office: 850 Walnut Bottom Road Carlisle, PA 17013 (717) 243-1515 15. See answer to Interrogatory No. 13. 4 16. 9/9/93 9/20/93 9/29/93 10/18/93 11/22/93 Datej~1)r F''O' "._"~. Carol K. Robison, D.O. Broce G. Kipp, III, P.A. Broce G. Kipp, III, P.A. Broce G. Kipp, III, P.A. Broce G. Kipp, III, P.A. Respectfully submitted, POST & SCHELL, P.C. i .' ,/ ./ ~ .;/. ' / ," .---' By: /, W/ /' /};,?---- EVAN BLACK, ESQUIRE KRISTEN L. BEECH, ESQUIRE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 J.D. No. 17884 J.D. No. 66491 Attorneys for Defendants 5 ,. 82362 VERIFICATION I, HAROLD G. KRETZING ,agent for Belvedere Medical Center, do hereby swear and affinn Ihat Ihe facts and matters set forth in Ihe foregoing Answers of Defendants to Plaintiffs Interrogatories are true and correct to Ihe best of my knowledge, infonnation. and belief. The undersigned understands that Ihe statements made Iherein are made subject to Ihe penalties of 18 Pa. C.S. ~4904 relating to unsworn falsification to aulhorities. BELVEDERE MEDICAL CENTER L~ J ~J:f7 DATE: 10/18/94 OI!PARTMENT 01' I'AMIL Y PRACTlCI! R DERT A IJOlLEN .. 0 BELVEDERE MEDICAL CENTER 0 MO'02S718'"'" .~n WAf NI IT oonoM nOAD I..' I ,,'/I I,I"/O"II/':I,j 11'/"'.11I" jAnOlOG, knETZING, M,O, I '"'ll!;r "''''I' ,,"1111 III ,I" I'~I 1.40027302 lll","'j/",r",( fl.' ~i.III' "I r.A'lOL K,nOBISON. 0,0. I.."'.'.." 11'//,'11/'/\ """"/1'1 OSOO57l0L "" II ,'t, I'" 'HII ,',,, '!II I ",,' '11 ',11'1."1,'1\',," 'If', 1'~.'lt_t~I. NAME L/PIl'1 ,0, nL ADDRESS I ~ DATE PHARMACY FILING NUMBER MEDICAl ION 'llo lOt. NO, OR CC, DIRECTIONS 30 REF I 2 3 ~ 5 SUBSrtTUllONflEnMfSIJIDLE - ), ~i:'I{,('tJ "0.- DEA. r.~M2l11rI~I1ANO NAME rnooucl 10 lIE DISrENSED, litE rnE RIDER INSI IIANDWRllE '!IRAND NECESSARY. OR '!IRANI) MEDICAllY NECESSARY. IN '1'-20' MAY REFILL TIMES . , CERTIFICATE OF SERVICE I. SHERRY L. MOUERY, an employee of the law finn of Post & ScheU, P.C., do hereby certify that on the date set forth below, I did serve a true and correct copy of the foregoing document upon the foUowing person at the foUowing address indicated below by sending same in the United States mail, first-class, postage prepaid: Pamela G. Shuman, Esquire Angino & Rovner. p.e. 4503 North Front Street Harrisburg, PA 17110 .Q.h.Cil\)'jQ ~ '--l"QO^~cr- SHERRY . MOUERY Dale: \0 ':;}'l-Cf><{ ;, '. OCT 28 3 31f PH '9~ fiLED-OffiCE Of THE PROTHONOUr.y CUH8ERLAND COU/ITY fENNSYLV:.IIIA -.".......--- v '~' , t I . I" . " -' .._...""..-,~...~-~...'" '.- . ". .- ":~.. l~ "'f'~ 1 , . .t~ f . ;'~ t1 <"', . , ...::---- - . . ,- . I' , I I , -I' l' .' I' .. . 'I.. , I I " .~:!".~ " .i' .., .' " f.~; ,,' (: I , i , . r I , I ) , -, . , , '" LOREITA F. RUNK, Individually and as Administratrix of the Estate of LARRY 1. RUNK, Deceased, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 4307 CIVIL 1994 BRUCE G. KlPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, CIVIL ACTION - LAW Defendants JURY TRIAL DEMANDED RESPONSE OF DEFENDANTS TO PLAINTIFF'S REOUEST FOR PRODUCTION OF DOCUMENTS I. Answering Defendants are not in possession of any statements concerning this action. Pursuant to the Rules of Civil Procedure, this answer will be supplemented should the need arise. 2. Aside from the medical records of Larry ,. Runk, unknown at this time. Pursuant to the Rules of Civil Procedure, this answer will be supplemented. 3. Unknown at this time. Pursuant to the Rules of Civil Procedure, this answer will be supplemented. 4. See attached. S. See attached. 6. These materials were unable to be obtained. It is believed that copies are located at BMC Pharmacy. , , . 7. See attached. 8. See attached. Respectfully submitted, POST & SCHELL, P.C. 8Y/(; >'i;(/ EY AN BLACK, ESQUIRE KRISTEN L. BEECH, ESQUIRE 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 J.D. No. 17884 J.D. No. 66491 Attorneys for Defendants Date: 11./;1/9/ 2 , . ...... /. .' , , C~EALTH OF PENNSYLVAHIA OEPARTHEHT or STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS ItARRUIURO, PA 17111-2'4' ROBImT ARTHUR 1I0LLEN 850 WALNUT BOTTOM ROAD CARLISLE, PA 17013 Substitute Physician Assistant Supervisor Reqistration Havinq fully met the requirements of the State Board of Medicine, the followinq have been approved and the physician and physician assistant are authorized to practice in accordance with, and subject to, the provisions of the Medical Practice Act of 1985, and the rules and re';llllations promulqated by the Board. ROBERT ARTHUR HOLLEN Roglotorod Subotltulo Phyolclon AOllolont Suporvlocr HAROLD GEORGE KRETZING Regl.t.red Prl.ery rhy.lolen A.,l.tent Supervllor BRUCE G KIPP III rhyolclon Aoolllont Effective Date. JANUARY 5, 1994 . RIchard H. Utle)' A.U", c._It II...., ., ,,.,...1.,,.1 .It' o..",.u.".. A".I" . O"ICIAL USE ONLY IMlsl- D IAlplplLI D STATB BOARD OF HBDICIHB P.O. BOX U4lI HARRISBURG, PA 17105-2&49 711-783-1400 Trans. No. AIIlount Date ~~lW I'ClIk ~.. M . nutl"'" ft18WU MItI'IUt nta'ftlca INSTRUCTIONS - Complete and sign this application. agreement along with drug list, if applIcable. . ' Attach fee and written FEE - $55.00 MAKE CHECK PAYABLE TO "COMMONWBALTH OF PENNSYLVANIA." FEE IS NOT REFUNDABLE. NOTE. A PROCBSSING FBB OF $20.00 "ILL BE CHARGED FOR ANY CHECK OR HONBY ORDER RETURNED UNPAID BY YOUR FINANCIAL INstITUTION. REGARDLESS OF REASON FOR NON-PAYHENT. 'PLffASE PRINT OR TYPE ALL .INFORHATION NAME HOLLEN ROBERT A. LAZtI rlK:t1 "IUULIC M'Utlll BUSINESS ADDRESS 850 WALNUT BOTTOM RO/\D :1II"tl:' CARLISLE PENN/\. 17013 ~III :'''''1: 'It' L.Wt -- . HOME ADDRESS 601 SOUTH MIDDLESEX ROAD :II1"tCI CARLISLE, PENN/\ 17013 '-I " ::aIlUC 'It' ,"we TELEPHONE ( 717) 243-1515 HOME ( 717) 245-0600 WORK . MEDICAL LICENSE # MD-n71171Rl. NAME OF PHYSICIAN ASSISTANT BRUCE G. K1PP, Ill, P./\. t"KIJII CERTIFICATION # MA- t.\. 1.\ I.J [ 1 . . (SPOA 1419 10/93) " List apeci~lties Do YOU hold a membership x'lc YI!IS NO' It yes, list Board(s) FAMI LY P,IlAC'l'LCE: , " in any American Boards of Medical Specialties? Family Practice If you have hospital or staff privi~eges, indicate hospital name(s). r-ARr.T~r.F. J.I0RPTTAr. CARI.UH.F.. PF.NNA. 17013 VBRIFICATION J: AORI!II!I TO. ACT IN THE CAPACITY OP A SUBSTITUTB PHYSICIAN ASSJ:STAJIT 8UPI!IRVISOR POR THB NAMED PHYSICIAN ASSISTANT BHPLOYED BYI HAROLD G. KRETZING. M.D. rMI"1 "^"c ur rM.ftftKl r"I~I~lftN ft~~I~lftNI DU~c"VIDUK I verifY that the statements in this application are true and correct to the best of my knowledge, information and belief. I understand that false statements are~e subiect to the penalties of 18 Pa. C.S. Section 4904 relatinq to sw n faIsif cation to authorities and may result in the suspension or r~v cation o17JJ.)registration. ~ 10/26/93 U'''c . . 2 (SPOA 1419 1~/931 WRITTEN AGREEMENT . Print or type name IIAROLD G. KRETZING. M.D. ~.,~.' ~"'.'~Ift. ftalIIIAN. aur~.YI~ BRUCE G. KlPP. Ill, P.A. ~"'.I~IA. AII'IIA., ROBERT A. 1I0LLE,N, M.D. ~~IIIUIC r"'.I~IA. A~"IIARI aurCMVI.uN IH8TRUCTIONSI Please provide the following information on 8 1/2 x 11 sheets and attach to this form. Number each sec~ion on the attachment.. 'BM,l't:1'At:~lJiif ' 1. Describe the functtonlJJt:asks to be delegated to the Physician assistant, including the manner ih which the physician assistant w ll'be assisting each named physician, instructions for the use of the physiQ an assistant in tHe performance of delegated functionsl.tasks ana medical reg mens to be administered or relayed by the physician assistant. 2. D~scribe the time, p'lac~ and manner of supervision and direction you Will provide the physioian assistant! including the frequency of 'persona1 contact with the physician ass stant. 3. Identify the location and practice setting where the physician assistant will serve. . 4. Identify who will assume primary' responsibility for the physician assistant when the physician assistant supervisor is unavailable? Will the physician assistant prescribe and dispense drugs? xx YES NO If yes, please complete page 5. 5. VERIFICATION I verify that the statements in this written agreement are true and correct to the 6est of my knowled e, .information and belief. I understand that false stateme1:~e made sect to the penalties of 18 Pa. c.S. Section 4904. . relatip to unsworn a ification to authorities and may result in the .uspe~os'or r v ost 0 ,ny ~trstios or oe~ "'"' *,.,.., ".."U.~dh""~' ..,....,."" , 3 (BPOA 1419 10/93) \ by the physician \ I " . . P1e~se list specific drugs to be prescribed and dispensed assistant and submit this page witn the written agreement. DRUGS FROM LIST I ~~M"::'" ~A~"";' . ~ ,.. " . "., ."t', 'I " '; UIIC t' .. '1" ~~I_,..ut'uvnUK , . . .. ; ~ r. . . 5 COIItollWEALTII or PENNSYLVANIA DErARTNENT Dr STATE BUREAU OF PROFESSIONAL AND OcCUPATIONAL AFFAIRS IIARRuaURO, PA 171o&'26~' IIAROLD GEORGE KRETZING 850 WALNUT BOTTOM ROAO CARLISLE, PA 17013 Primary Physician Assistant Supervisor Registration Having fully met the requirements of the state Board of Medicine, the following have been approved and the physician and physician assistant are authorized to practice in accordance with, and subject to, the provisions of the Medical Practice Act of 1985, and the rules and regulations promulgated by the Board. HAROLD GEORGE KRETZING Regl.t.r.d Prl..ry PhyeJcl.n A..l.t~t Superv180r BRUCE G KIPP III rlty.lel.. A....tant Effective Date: JANUARY 5, 1994 Vlnaent G. Guest .Iltll' C,_It.h..., I' ,."""h"ll 1"'4 OUW""I"I. A'h.,. v .",.. .. J// ' RroA 1~~8 (RKV. 10/931 . . o"ICIAl USE oNLY . ,*' IMI..I- ........tatlW .. una"".. u ~ .....101.. Mil'" ........ . Oi "'Jl'......r.~'"I~~ f ,.1' .,' INSTRucTt'oNIl - cor' plll~a 'AI1dillil;lh1 t:his llPl>HcaHon. ^t:t:Ilch ft!l;! lIhd \.It:! Hen agreement: alohg ~ th dtUl;I 1 lit:, f applIcable. I I _ ! ST^~! DUAnb.b~ HBbtU1NI P.o. bOI 2'" IIMlttSIIUAcJ, l'A iUU"UU 111-183-1400 . l '. Tranlt. Nd. J\IIIount: DA t:I FEB - $55.00 I 1 HAKEN CIIECK I'AYAbLR' '1'Ui.'IICdMMdkttl!lAt'1'lt OF 1>BNNllttYMlU, II lIEE 19 No1' REFU bAIlLE.' If",' <'''' " , NOrB' ^ PIlOCBSSIN.Cl. In tltij'Jrj.Orj"II.ttt JJB eI/AJla!/J tall Allr cl/BCR tilt, HoIIBr ollnkA IlkrlJltllkb UNPAID sr rOUR FINnnCIAL IN TIrUTIUH, RBGARDLESS OF REASON FOR HOH-PnrHEHT. l'I;BilsB PRINT OR WPll A.tt tNrdwtMIoN NMIE KRETZINo HIIROLb G. "IUUL~ lA51 tlte:"1 . ' ,bStl WALNUT BOTTOM ROM BUSINESS AbbltESS C/\RLISLr;: . ..,. I. '0 ., I.- ~Ikttl : peNN/\. ,. . IIIIAlb I.IIl 1I0ME AbDRI!:SS CI\RLISLE .lit 80 r;:/lst HlbGE StREET t ,11. :uktb. ",,',' , I?ENMI\. '.: . I i1 ~ , . ~, " :'1" I t. , 243-1!;15 D ~D MIUt" 17013 d ~ tbJk .. . 17013 uj) Lwt HoME ( 717) 243-4010 WolU< MRDICI\L LICENSE # MD- 021302L TELEl'1I0NE( 717) 11Al1R OF l'IIYSICI^N ASSistANT BRUCE G. K1PP. 111. P./\. I'I!IRf Cr.RTIFICI\TION , MA- l ''-'c.o 1.J.. L . 1 . SPOl\ 1439 (RKV. 1l'/~11 '. List: Specialties F!\HIL'i PRl\C'1'lCE .. I I t" . .;, Do YQU hQ1d a membs~bh!p lh hhy American Boards of Medical Spec1a1t1ell y! yilt I ' ,No If yes, UstBoard(s) I I F/'1>>1/lV P,U(]"I(~ I_I' , \ If you have hospital utatt privileges, CML1SLE 1l0SP'lT^L CAltLtb~~I,,; '~I;:~N^ ' indicate hospital hame(s). I. .~' LIST NAME OF A PltYSittA,n4H6: li:l' ~ILLING TO ACT AS SUBSTITUTE PHYSiCIAN ASSISTANT SUPERVISOR IN YOUR AI3SENCE! , . ROBERT ^. noLtEN MD- 02671BL 1'R'.rl"RTS1\;IIU' :. ''''l'Ilt LIUftn II NOT!I.. AN APPLICAT10N'brott~ttE~ISTRATIONMAS A SUBSTITUTE PH'iSICIAN ASSISTAN1 SUPERv1s0R MUST BE C IMPL..'l'ED AND SUB ITTED TO TilE BOARD OFFICE BY ALL PIIYSICIANS WIIO ARE '1'O'Ac1' AS A 'SUBSTITUTE PIIYSICIAN MSISTANt SUPERVISOR. , .' VERIFICATION I will direct: and eKer~lse buperviei91 over the named physician aesis/ant: il accord~nCetwi,t:h ths EU.1M~ "fd recjU18t ons of the st:at:e Board ~ftJM~diC ne'th] recolJn1Ze ,hat: I ts"aih J:U: 1 profesl'l on!ll and le<1111 raspohs1b Uty ot I perfQrll1ance of tHis, ,phyufdiah assil'lt!lht and the care and Usa l1Ient bf hI phys1c1an asd!U l1t1e 1'1 patH!!ttl'l, ,"1' . . .1" . ~ .. -! t .. I verifY that th~l dt:uClllllht:a lht:~1s appl1catiotl are hut! ahd Cdttl~t to t:h. best of my knoW QdfJl!ll t1tCltllla oh ana belief. I' Uhderstand t at: falSI statemehts ate lIIad~ flub tlc:!t1'to 1 he ~pehl1lt: eslof 18 pa, C.s. S&Hl,HIlt 490' re1atil1Cf t6 UhlIWof8.. fA Ail /jilt: btt d ,!1ut or Hes and may tesU1 il1 thl suspensIon or revo~a~iOh ijt ~y re<1is t~"ion. 4JLl~ ldM~26/9~ , '- oroA 1438 (REV. 10/93) . , WRITTEN AGREEHeN~ . , Print or type name "^1101.U G. KI1E'l'ZlNG, M.U. "IJlWtf"1'1rTftClKrKftll'tAIlII lIiu..uw 15UM U1ll1CE ll. KIPI', Ill, I'.^. PnTSlt1ft~lft~1 110nRI1T ^. nOLLEN. M.u. WRlTTUTrl'lIJrtetRnmmJlI ~Ut't"yJ~UH INSTRUCTIONS I Please provide the following information on 8 1/2 x 11 sheets and attach to th s form. NumbGr each section on the attachment. , 1@~~t,AT't^t:IIED 1. Describe the functiohfl/tasks to be delegated to the physician assi'lltant, including the mantle!;' in Which the physician assistant will be aSSisting each named physiClilln, instructions for the use of the physic;: an assistant in tOG parformance of de1eqated functionsl.itasks ana medical reg mens to be administerud or relayeCl by the physic an assistant. 2. lliscribe the time, p'lace land manner of sl\perviaion and direction you w 11 llrovide the physid an assistant including the frequency of personal contact with the llhysician assIstant. J. Identify the location and llractice setting where the physician assistant will serve. 4: Identify who will assume llrimary. responsibility for the physician assistant when the physician assistant supervisor is unavailable? 5. Will the physician assistant prescribe and dispense drugs? xx YES No If yes. please complete page 5. VERIFICATION r verifY that the state~ents in this writ:ten agreement are true and correct to the 6est of my khOW1Gdge'L information andi belief. I understand that false statements are made sUbiep" to the penalt es of 18 Pa. C.S. section 4904 ., relating to unsworn fa!s1fioation to authorities and may result in the "U"P."~~o" or~'::;~~.f 'Y f..i.tr.tio" or ~~fic.ti~~~._ , "~~'~' AAMUPEIIVlSUll j1/M '!/liiiii' lftn- ( '.-: Ir.,.,' (('J- it.a? ,- S'r~K'UHt ::,ulI:i11 Et'Rmt1Jnr~ssrS'rWAI ~ut't"Y'::'UK J SPOA 1438 (R!V. 10/931 rle"se list: speoifIo drugs t:o'be prescribed and dispensed by the phys~cian assistant and subm t: t:his p~ge wit:h the written agreement. URUGS FROM LIST I I:tUM Cit """'~' t-::.t VI ~" ...m1lIIr; , , " ,-I r ....... . .......,., ..... , 5 '. ...... .' . C~HWEAlTH Of P[~YlVAHIA DEPART"EHT Of STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS HARRISBURG, PA 17105-2649 CAROL KOWITSKI ROBISON 850 WALNUT DOTTOH ROAD CARLISLE, PA 17013 Substitute Physician Assistant Supervisor Reqistration Havinq fully met the requirements of the state Board of Medicine, the followinq have been approved and the physician and physician assistant are authorized to practice in accordance with, and subject to, the provisions of the Medical Practice Act of 1985, and the rules and requlations promulgated by the Board. CAROL KOWITSKI ROBISON Regl.t.red sub.fttut. Physlol_n A..I.t.nt SuparvJ.or HAROLD GEORGE KRETZING Reglat.red Prl..ry PhYllo1en A..l.tent Supervl.or BRUCE G KIPP III PhYII.lon A..I.t.nt .. Effective Datel JANUARY 5, 1994 VIncent G. Guest Allin, C,_I....",., I' r""uh"ll ,n' Oceu,.th",1l A".I,. (' I~J'lIn 1419 10/93) '-- .---- ,*, . orrlCIAl USE ONLY ST^TB DO^RD OF HEDICINe r.o. DOll 2549 IIl\nnlSnURG, pJ\ 17105-2549 1I/'1n,l-14UO F~~ - 0 1.-'=r~J=D~ 0 Trans. ~o. IIrnount Date Utt.lf*t'Ib'M .. Mt~"1W M A 'nrltltll'fta tltllbtM Ntltlrblfto '".IIl.t1M* INSTRUCTIONS - Complete and sign this applicntloll. ht:tach fee and writtell ngreemellt alollg with drug list, if applIcable. FFlFl - $55.00 ~II\KE CHECK PAYABLE TO "COHHOtnfEJ\LTIt OF PE~NSYLVJ\HIJ\." FEE IS No'!' REFUNDABLE. IIU7'S. ^ PROCBSSIIIG FBS OF $20.00 lilLL DB C/lIIRGsn lOR ANY C:/lF.CI< OR 1I0NEY ORDER RETURNED ImPAID BY YOUR FlNANCIAL INSTITUTION. REGnRDLESS OF RF.M;c1I rOR NON-PAYIIENT. "'.1':1\.';1': PRINT OR 'l'YPB M,L INFORHJI'l'ION "A"P. RonlSON CAROl. K. IftSr r 1":11 "'UULI: III1S1NF:SS I\lllJRESS 850 WALNUT nOTTOM ROAII :tIKt,d CARLISLE, PENNA. .l71l!.! '....--.Clh :tIJllt. II0l1E AlJlJRESS 1004 SIIANNON r,ANI': :tIKttl CARLIsr,E, rENNA. 17111.l .....-Tln :.fKTt 'I'P.I ,P.PHON F. ( 'II.") H3-ISlS 1I0MF. ( '117 259-11l1lR ) Illllour (I,.. LWt .. ll'- l.Wt WORK 11P.IlIl'AI.. I.ICF.IISF. , MD- OSOO'i71IlI, ,,/\lIP. OF' rllYSJ ClAN ASSISTAN'1' DRUCE G. KIPI', Ill, !'.A. t'N'.' -- -- -----... I'PoIl'I" F1l'A'J',1 Oil I MA- 1I00Iln-l. -------.. ,1 CRro~ 1419 10/93) , I.lst specialties FI\HILY PRI\CTICF: 110 you hold a membership in any I\merlcnn nonrds of Medical specialties? ..~ YES NO If yea, list Board(s) I\HERICI\N USTEUPI\Tll!~ DOl\nU UFGENF:RI\I, PRI\CnCE . , \ \ If you have hospital or staff privileges, .Indicate hospital Ilame(s). CI\RLISLE llUSPITI\I, rAn!.1 en,,," P"""lbIA.._...J.1.OJJ---- VERIFICATION I AGREE TO ACT IN THE CAPACITY OF J\ SUBSTITUTE PIlYSICIAN ASSISTANT SUPERVISe FOR TilE NJ\HED PHYSICIAN ASSISTANT EMPLOYED BY: III\ROLD G. KRETZING, H.U. rKINI """I:. VI 1'''1",,"' t'"':'I,"I~STJnlrSUrE'RV'SUR 1. verifl that the statements in this application are true and correct to tl best 0 my knowledge, information and belief. I understand th"t fall statements are made subiect to the penalties of 18 Pa. C.S. Sectiol1 49' relating to unsworn falsification €o nuthorit es and may resUlt ih tl suspensIon or revocation of my rec;listration. >IU""'C~,- f}()b,)~J 12/20/93 ulUt: . ? ~ A,1~19 ,10/931 , , , ~~ AGRBEHB"~ I',. I II t: or type name 1I^,IClI,II n. KRF:1'?INll .., '-'rRlnft., mlsrcr..-.nlll.., 'UI'..vml!l-- 111111('" t:. 1;'1"', Ill, ",^. rnlllcl~SlIII..' C^"UI. K. RURISON, D.O. "--1:Imn"D1rnr1S1CIllll'"m~'1 .UP..v,.... U1STnUCTIONSI Please provide the following informaHol1 on 8 1/2 X 11 sheets nllll attach to this form. Number each sect'lon on the attachment. 1. I)escribe the functionIJ/tosks to be delegat:ed to the physician assil\ltant:, including the manJ1er in which the physician Rssistant will be OSSil\lt!ng each named physic an, instructions [or the use of the physic;: an assistant in tHe performance of delegated functionsl.tasks ~na medical regimens to be administered or relayeil hy the physician assistant. SE!': ^TT^CIIED "iscdbe tIle time, p'lace and manner of sllperv is ion and direction you w 11 prov de the physician assistantl Including the frequency or personal contact with the physician ass stant. ~. 3. Identify the location and pracHce set:l:ing, where the physician assistant: will serve. ,,~ Identify who will aSSUl1\e primary' responsibil1ty fQr t:he physician assistant: when the physician assistant allpervisor is unavailable? will the physician assist:ant: prescribe and dispense drugs? _._~ YES NO If yes, please complet:e poge 5. 5. VERIFICATIoN I verify that: the stotements in this written agreement: are true and correct to the lJest of my know1e~el information and belief. I understand that false atatements are made sub ect to the penaltIes of 18 Pa. C.S. Section 490~. relatIng to unsworn fa siflcation 1:0 authorities and may result in t:he allspenslon or revocation of my registration or ceriflcation. I ,)1 I , ,~ttd d, /.l' ''UI I ;';-' '1" ,t '~.. --t<_,~~, ~'""_ ,-?~".,.. (.~ u,., '-sr~~~'I~~SI~;.'?-.~~t,fr) J (/lrllll 1419 10/931 ,- -.. . f . . I'le"8e Ust specific dr\lgs to be p'rescribed and d1spens~d by the physician AAllistant and submit this page w1t:h the written agreement. CM'EGORY 1 CM'EGORY 11 with lhe llml.lnl: lOlls J.l.II ted ~I~~~~J~ A~:1,,,,,., .ue.....uo ~1r.wKnmt9~,~~~f~(.])-o ) / /'))/ " \.-. I'/,: .y~~~ .I~" mrr- .. 5 " . (' ". ~------_. BELVEDERE MEDICAL CENTER SlSO WALNUT SOTTOM nOAD cARLISLE. PENNsYLVANIA 17013 I'AMILY rnAcTICE nOBEnT A. llOLLEN, Io4,D. HAnOLD 0, kRETZINO. Io4,D, CAnOL K, ROBisoN. O,D. PIIOHEI Z43,llSl!l Vecember 6, 1993 Re: ^pplical:ion for re!listral:ion as a Physician ^ssistant Supervisor ^pplication for re!listration as a substitute Physician ^ssistant Supervisor state Board of Medicine P. O. BOK 2649 lIarr!sbur!l, Pa. 17105-2649 Vear Sir: We completed and sent the above applications alon!l with a check in the amount of $110.00 but need to make a correction to item " 5 re!lardin!l preseribin~ snd dispensin!l dru!ls. Mr. Bruce Kipp. Physicisn Assistant. in our office will be prescribin!l dru!ls ih Cate~ory I and Cate!lory II with the limitations listed in Cate!lory 11. Sorry for any inconvenience we have causnlyou. Sincerely, . . Robert ^. 1I011en. M.b. "arold G. Krel:zin!l. M.D. clOy enclosures: copy of applications ori!linally sent . , "';Or. '* COHHONWEALTII OF PENNSYLVANIA OEPARTHENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS STATE BOARD OP HEDICINB P.O. BOX 21149 HARRISBURG, PA 17105-2&49 717-783-1400 717-787-2381 October 21, 1993 Dear Doctor: According to the records oC the State Board oC Medicine you are registered as B physician assistant supervisor and you are supervising a currehtly certified physician assistant. The Board desires to in Corm you oC regulations which were recently revised that affect physician assistants and physician assistant supervisors. A copy of the revised regulations is enclosed for your information. The revised regulations made it necessary to develop new application forms which are hereby enclosed. An application for registration as a physician assistant supervisor along with the written agreement form and drug listing and an application for registration as a substitute physician assistant supervisor and an application for approval of a satellite location are enclosed for your use. If you desire to be registered as a physician assistant supervisor under the revised regulations, you must complete the newly developed application form and submit it along with the required fee in order to reregister with the Board. All substitute physician assistant supervisors must now register with the board by submllling the completed application form and the required fee. The revised regulations require at least one substitute physician assistant supervisor. Physician aS$istants are not required to complete a new application or reregister. . If you currently have a satellite office or wish to establish one, you must complete the application for approval of a satellite location. Previously, such approval was not required. Currently application forms must be ~l1bmilled for all satellite offices, whether they are newly established or not. . If you have any questions regarding the regulations or the applications, please contact the Board Office at 717-787-7768 or 717-787-2568. Sincerely, ~J.L- A. ~~h Joshua A. I'erper, M.D. Chairman JAI':slll CnI'''1I IHo 1lI/9,ll '13.r ~,~' PRESCRIBING AND DISPEN8ING DRUGS BY PI\Y8ICI~N ~SSIST~NT J f thl! phys.lci/ln assistant supervisor intol'dS to author.h:e n physlcinn U,,", !;1 tn Ill'. tu prp'lJcribo or lllspenne drugs, (I I ,,,1: o[ tho"l dt'nqf1 (r.om UIl! ^l1lrol'\(mn "onpttnl Formulary servicr.! I'hnrmncoluylc 'l'ht'rfl'ollIC ClnllsJrlcatlon mllst: IIA providell based on l:he information anll categor eB I sted below: I. Categor ies [rom which a physician nssistant may pr.escr ibe and dispense without limitation are as follows: II t il) iv) ~l) ~Hl ix) ) ~Il xill xli ) xiv) xv) I\ntihistamines. I\nti-infective agents CardiovaSCUlar drugs. cQntraceptives - for example, foams /lnd devices. DiagnostIc agents. Disinfectants - for agents lIsed on objects other skin. Electrolytic, caloric and water balance. Enzymes. I\ntItussives1 expectorants and nucolytic agents. Gastrointest nal drugs. Local anesthetics. Serums, toxoids and vaccines. Skin and lnUCt;lIlR membrane agents. Smooth muscle relaxants. vitamins. than :'.. categories from which a physician assistant may prescribe and dispense subject to exclusIons and lImitations listed: Categories Corm which n phYR.lcinn lll,Rpense are as ColI ows: I\ntineoplastic agents. Dental agents. Gold compounlls. "eavy metal antagonists. oxytocics. RaaJoactive ngf?nbl. Unclassified (I1f:!rnpelltle Uevices. !'IHI rmncl'ut I en I a IlIR. ( l) ( li) (ili) (iv) (v) I. II ILl) iv) ~II vi I v I J ) Ill) Autonomic drugs. Drugs excluded under this category: Sympathomimetic (adrenergic) ngents. Blood formation and coagulation. Urugs excluded under this category' ll\l I\ntl-coagulants and coagulants. , B Thrombol~tic agents. Central nervous system agents. Drugs excluded under th\,s categorrt 11\ General anesthetics. B Monoamine oxidase inhibitors. Eye, earl nose and throat preparatioDs. Drugs limited under th c r.ategory: Miotics and mydriatrics used as eye preparations require specific approval from the physician assIstant supervisor. for a l)am4;!a patient. llormones and synthetic substitutes. Drugs excluded under this category 1 ll\l Pituitary hormones and synthetics. B Parathyroid hormones and synthetics. . aRRIRtnnt may not prescribl' or. aqelll.n. 4 ,- ..- , : .' I November i8, i993 state Bd8rd ot Medicine P.O. BOJt 2649 H.rrisbur~j PA 17108-2649 RBI ha~old O. kretzino, M.D. I'UllIlll'Y 'hy' Idc1an As!tishmt Supervisor Bruc@ o. k pp, 111. P.A. Physician Assistant i) The phY~ician assistant will see patients in the office. ~e will function both when we are here. and occasionally when no physician is in the office, but is available bY,telephone. It is anticipated that this will be for several hours on a Saturday morning while . ,.. .. , the phy.idi~n is at the hospital makino rounds and also po.aibl~ for an hour or two on a Monday eveninu over the sUpper hour. If the physician is not in '.'" " the facility. he will be in immediate phone contact .' , with the physician assistant. The physicianls assistant will also be used in local nursing homes where th~ ~hy.lcians are on staff. His work there will be primlll'iJ9 ddJng History & Physicais ort an annUal bd8i6 fdr ~atient. at Forest Park Nursing Home' and SW6im NurS!hU Home at Green Ridge Village in Newville. He wl11 aiso see sick patients along with the phyalt:lan at the Alliance Home and respond to them r C' /) .. ' if the house phvsician is not available. ~ in the office Will consist of doing routine physical exams, school phyeical. and general medical care. He will contact the physician after each visit for any cases he haa a problem with. 96~ of the time. the physician will be immediately available after each :7 ( /1. ./ , visit. The practice location is primarily at Belvedere Medi I ,~ I ' oal center, Sbo Walnut, Bottom Road. carlisle. He will also will be working at the nursing homes previously mentioned: The Alliance Home. 110 South Hanover Street, . Carlisle, Forest Park NUrsin~ Home. 100 Walnut Bottom Road, carli81e: and Swaim Nursing Home at Oreen Ridge Village in HeW~illc. Dr. Robert Hollen will assume primary responsibility , , for the physician's assistant when Dr. Kretzing is j. . t. unavailable and as a bsck up to him there will be ,.., t'" . Dr. Carol nobi8bn. D.O. Physician aseistant will be able to prescribe & dis- pense drUgs, Drugs prescribed and/or dispensed will be those drugs in list one and thJs will be reviewed with the physician assistant on a periodic basis. - . HAROLD O. KRETZING, M.D. , - RULlI AND REGULATIONS nl7 . " . _vial. .be_ lIy IDjecUoe, labal.tloa. InIQtlo.. .Ida .ppUcatlM or ... ...... .... tlIe Ilody 01 . p.tI.DL ,DMft-Aa IDIl1iama& or &001_.".11I &II. .dmio. IlvatlM 01 .tdlcatlM or .1"'<", can. OWe, ,u~rWlcII,-T1lt ph)'1lcaI ;'...HIIea 01 &!Ie ph)'.I. ,du uaI.l&II& IUparvlIor oa &IIa p...m1H. .. &11.1 Ih. phytldu u.I....llUptrvil<<lIlmmtcll.laly .yall.hl. 10 UII.ph,.ldu ullal,llll .hlll Dtedtd. DII,.",,-To daIIvv . dru, or d.ylce .. or lor an a1U..1I 11MI' lor Um/loId or cooUauID, II... D",.-A lanIIalld 10 dMCribe . dru,. d.vlce or .,.nl .lLIda a phy.ld.. u.I....1 pracn'ba or dbpeD'u !lDdu t lUll lnI'llDa ,10 prucribln, IDd dUptn.III, dru,.I. E""".M"Y mttlkol CfIIW ,,'dll,-A heallh e.n IIUIII, .lLIda 11 ullblWlld 10 provld. 'lDu,.nl)' mtclleal ell. U III prim.". pIIlpOII. The lanD doe. DOl lndlld. . HIIlDa .1LIc11 provldu pDUal or .peclaIIucI mtclleal III'Ylca &1111 ." Dot 1'OII1iD.ly 'lDlrpDe)' In DIIII1' .ven &holl.h &h.1 HIIiD, proY/d.. .mUpDI)' mtclleal ell. Irom tlma 10 tlma. Mttllal C4I'I ,"IUt:/-Az1 IDUI)' Ueanled or .pproved 10 ruder b.aI&h ..... IUYIcu. Mttllcolll6i1MII-A &her'JIIIIue. eorTeCUv, or dI.coOl' tic -.un Ordnd b)' . pbylldID u.l....1 l\lpervlsor .bIda II raquInd lOll &he lDID.,.mIDI 01 a .peclfie CODd/tIoa 1IIi1 wlLlda II lllcorponLld !D1D &h. wrillaD &III ~L MtdJcol "nkt-AlI actlvll)' .1LIc11 Uu wlthlD &h. ICOpI of &h. prlCl/ca oIl111d1clD. &Dd '111(V7. , NCCPA-T1lt NallODal CommluloD OD CAttlfIcatlOD 01 PIl1llclaD AuII...L 1'lY*ia-A IIIIdIcIl doctor or doc:&or 01 OI&Iopa&hle ~~ .. . PIlYtklM ..."....,-AlI IDdIvldllal wbo 11 ctrtUIld U . pbyalclaD ""''''1 b1 &hi Boud. , PAyrlc/&II ..."...., UCIIIIlll4do~-A.D aamlD.tlOll 10 laI& .be&hll' &D IDdIvldual bu .ccwowllld 1\I111d'DI .~.~_... kDowlldp 10 ClUaIIIy lor cenl/lc.atlOD U . pb)'lllclu uaIIl&IIL T1lt BOard nco(Dlza &hi canlIylD, ...-.....tiOll 01 .,.. NCCPA. .. . . PAytldM ..",...., p~rram-A prO(l'am lor &h. &raiD. IDe Uld edllcallOD of ph)'lldID u.IIlIDtI .hlcll II '1" prilvedb)'&h.Board. PA~ ..d.....' ~u,."'''o'-A pb)'lld&D wbo II Ida u a IUpt/'YIIIDC pbylld&D 01 . pby.ld&D aub&aDI III &h. wriu.o qnemal &Dd II "(i.ll.uId wllh &hI1loud U 1\Ich. Pracripdo,,-A wri&laD or onf oreIu lor . dru, or cItvlct 10 be d!IllcDIId 10 or lor III wdmall lieu. n. lanD dOM Dol IDcJucla &D ordtr lOll . dru. wlLlda II cIIapaMd lor ImmedJ.II ."_I~I'lntloD .. &h. wUma.. ur. ,. uampla. &D ordar 10 cIIIpeua . dru, .. . ~t lor 1_'-"1,.. ."_I~I'&r.tlOD III ID olllea or tIllI Dol . pruaiplloll. I'ri1II4ry pAy./dIlII .""...., 'UIHIlI"o,-A ph)'IIdlll ......1 I\Ipvv\1or who It rqlltand wI&h &h. Board aDd dal(Da1ad ID &hi wriUal .........1 u h.viIII priJII&I7 I'IIpCIUIbIl/I7 ,. cIInc&lDc &Dd rapervWq 1M pbrDclaD uN&IDL s.ul1lu locadoll-A '-ofj_ oIhtr tIWa &hi primary pIaca II .bIda &hi ph1llclaD UUIIDI Illperv1tor ~ AdmbW,",doll-T1lt dInct appIJcatloa of . drq. YIdtt -.41..1 -nc. 10 patla&a. when . pbyllc:llll .hola blood. Il/ood COIIl(lOGGl&a. dIapoatlc pr~. or """.1 prvvIdaa mIdlcaI ....1caa. . PDCNIYLYAI!IA IUL.UTIN. VOL 23. MO. ". AUCIUIT '.. ,ta .. CHAfn:JlII. Sf ATE lOUD OF MEDiaN!:- PRAcnnONERS OTlWt 11IAN MEDICAL DOCTOas . SlbchplU D. PKYSJClAH ASSISTANTS GENERAL PaOY15l0NS I 11.121. ~rpotI. , TblI I\Ibcluplar ImplemeAtlI 1K&l0D 13 of Ill. IC& fA P. S. I 422.131 peruiDIDa 10 phylld&D ulltllDlI ADd pro~ lor &h. clalaptlOD 01 cor&alD medIca1 &uU .. quall8ld pb)'llc:llll ullt&aDlI b1 pbymcllll ...I."~t IU- perv\Ion w. &hi dtl.ptlOD II, CODIiataDI willa &hi wriUal Ip'IIlDIlIL I 11.111. Ddlalllou. T1lt IoDowIq .onb &Dd Ianu. .ba '1IIId ID &hit I\Ibchap&ar. lsave &hi loIIowIDa IDI.~I~... aDIau &ba COD&ts& durlrlDdlca&al o&hanrlIc nil RULES AND flEGUCATIOHS .. SM6.d,u"" ,,,,.idM U.1I1M1 ,uplIVlIor-A' ,Ia;~ I 11.14 'A'rll1ft ."..,.... uw....t rupcm.. ... .. nclalond wltII tio loud III no wrlU."1l - ..t ..;...,.... la, IOClloo ur., 01 IIId dealpoiod .. ~ wrltta ........D' u II;f\I&IDc .. ..,...._ prim.". ruPODll\iIIl1 for I p1a,1Idu uoll....' .... tIIi 11M oct ta P. & t 4zt.1'I.. oIioII IIUII)t tho loUowiq prim.". ph"ldlll llllltul tII~ 10 UAlYIllIIalo. l'IqlIlro-.la. no ea. IlIt IIaIII: . 1II IduW, ODd IN IfPed .Ia, ... ,1al't/cllD ulll....t SUIHNllloII -no _ltoI IIId,.,..a1 dWctloD u.. ODd ucla pla)'IicIID ODd pb,1Idu u,l,....t wbo will IN clNcl b, the pb,1Idu lllUl&Dt ru~ OY., ... '..1__ A.... b""'. b-II L. aI lIledlcal NMUI pnMdeel by I playoldu ullI....L Coa. UI.._, t t - p y_ I ... _ I lMdIc IlaDt pbYlleal p_ oIllle pla,lIdID UllllaDt ru,... doctor. ~ II Dot nqulnd 10 Ioac II Uao pb,oIdlD uoIIlaDt 121 o-ibo ... 11I_ II wblcll th. pbyt/dlD ullI. .upcrvilor IIId llle pbylldu lllUl&Dt _ . CIA lilli, l&Dt will bt ua.dq ucla DIlDId pbyold... TIle d-npo bt. ID CODtoCt willi ucla ocMr b, racll4, l&ItpboDl . tloe oblllllt& IIaodJGu 10 bt dtllplod 10 th. pbyliellll toJecommUAlcatlou. Suporvlt/OD ~ th. IYlIIoblllt)' UllalaDL 1DcIadlq:' , of lb. phYllellD wlllaDt tIIptn!jor &0 Lb. ,h,t/dlll III StJec(.ecI proc.dlll'll t.DUlDuaLld ID f 18.151 I~ u.inlDL All Ipp,opnlto d..,.. oIrupav\lloD lDi:ludu: IllIor t.o roI. of pbylldoo u.btlllt,ud oUl.r d.l.pLtd III Actly. ud coolloulor 0YII\'ftw 0' Lb. ,byoldlD lUlu. , ...Utlllt'l .ctlvlllu t.o d.lUmID. thot Lb. plaYlldlll'l IUI IDI1nIclloat I. th. UIt 01' Lb. pby.lellD ...btlDt dlncllooa ~ btlor flDplllDt.DtocL ID llle pufono_ 0' daltpLtd lUlu. llIl Immedllto ,vllllblllt, 01 tho pbYllcI.ID UIUtlllt 001 MecIIcoJ radmtu t.o bt ""~lftl.lued or rellyeel by .ulltlVltor t:p tb. pbyt/du uWl&Dt for D_'II)I COlI- llle pbyt/cI.ID uilltUL , .uJc.ello.... 'f2' DucrIbt tho t1mt. p.... ud IllIIUIU 0' .upeMIIClll IWI PUSODaI Illd reruLv-it ....t wllkly-r.vI.w by Illd cIlnctJOll ucla DlIDeeI pbylidlD will provld. tb. the pby.ldu uWlIlll IU~ 0' tho plllut NCorda pbyt/elu uWtIlIL IDdudIDI UIt frtqU'DCY of pusooal upoo wbleb .otrlu an iliad. la, the pbyoldlD ..,lalllll. cootoet wfth llle pbyllcI.ID IllUlIIlL WIi,r.II ""',"""'-TIle fInIIDCIt bttw_ Lbl pby... 14' n-rv.to ClIlO 01 11M DIlIlOd pbyold... wbo IbaD bt cI.ID ullltlllt ud pbyolcloo ualIlIIlt rupcrvltOr. wblcla I lDedleal doc&<< u' 11M prlmoi)o pbylicI.ID uwlIIlt =t.D~j. Nqu!rul&all 01 f 1"~42 fro1&tlq t.o writtID toc~u". the IocotlODl ud Pncuc. NtllDp wb.re PHYSICIAN ASSISTANT EDllCAnONAL PROCiRAMS tho pbylldoo Ullttut wID_ Ibl TIle wrlua ocr-t Iblll IN Ipproved by ... f 11.131. A"ro..~ "'.cad,"1 ,roan- Board u I&tbf1loc tho IonroiD, raqulrtmt.DlI ID IUb_ III n. Boord 'P(l__ phylldoo uoIIlIIlt ee1ucatloaal tloa lllllld u !lUc CIIlIlSIttat willi reI.Vlllt provftlODl prorrllDl d.vtloptd by the ICI:ndJtolfoa ravln CiOIDIDIto oIllle IC& ud W. IIIIbclIopW. ' lot lor the pbYllclu IIIltlIIlL ODd teeradJLId '" ... lcl A pbJlldu Ullttut . pb,aIclao uWlIIlt rupa- ColDllllllot 00 AllIeeI Httlth Educalloo ud Accndltotloa vw. aIiaII pnrrid.t '--""1," __ 10 llle, writws CCAHEAI of th. AlDtric&o MtdIcaI ~ltlOL WOnDO- III'MlDGlt t.o IIQ'ClIlO ~ t.o -arm the ICOpI 01 the tloo reronllDr Ipproveel Procr.... lDI7 bt obl&lDod pbyllcI.ID ualIt&ot., IUlIIorf17. dlnctJy from CAHE"- 111I NortJa Stoto StntL CbIcqo. I 11.10. Oflate ,... nablnd.. u ,brsldu willi.. n. IL 60610. pmbot.. ' lb' n. altull ror CItItlacatloa '" ... Boud 0' pbya!. 11/ Tho Board wID IpprllVe lar ncUlntlClll u I pb)'ll. du UlulIllt ee1uullooal prorroiu wID IN lclaotli:of t.o dill uaItlIllt tuptI'viI<< u appllcaiit wbo: ... the UM/lllw d.vtloped liy lbo vuioul orrlAlutlOOl III POI..._ I CUlftDt Ilc:aM wI'L-',. -trlctJClII .. IlILtd ID tblI ItCtloD . othtr iccrocIIlIDa IIWAdu .po' _. . _ _ proved by the Boan!. practice lIledlc,lDt IIId tlUaa7 ba W. CommoowulLh. I .1 131 IR d 121 Hu IUblDlttod I COlIlplotod IppUulloD 1CC01Ilp.' . . tlCnc I. a1ed by tho writtID IJl'IUIIIOI f_ f 11',142 Irdallol t.o CEATtJ1CAll0N OF PHYSICIAN ASSISTANTS AND wriua 1CI-lIl1ud llle raqulrad ,. UDder f 1&,13 RUil5TRA1l0N OF PHYSICIAN ASSISTANT frt1tWac t.o IIcootaro. cort:IllcotlGli. .ullll.-.t1oo IIId relit. 511PEAVISORS tntloo I... ",. ~1...tI... ~ d.tIlIed lDIorm., I IWI. Criteria ror artiflcodoLu a ,bJ1ldla usIslaaL :: ~. '::J~~~e::::~p~~~ n. Boud will approw 'or cortUIcatloo U I pbyolcI.ID CClDlIoulDr odt.....1oa. _btnbIp ba "-ic&D BoonU of ulittlllt III 'PpUCOlIt who:, lIlIdIcal .podoI17. h<.pItaI ar tt&ff Jlrivlltca aod other lIlfonollloo ... BoercIIIIa, roqaIN. , III S.u.tIOlI the cat.lScalloe requlrtmuto ID f IU2 131 IDcIudeI wlLb the IppIIc.ttlOL I IItL lcIutUyiq by lrellWac t.o ,..o.ral quaWlcallooa lor Il~_ ud con!Bo Dame ud U- DIUD_. llle oc.bor pb,oId... who an cate.ll. tttvfq u pb7Did&D utitl&Dt rupervltOn 0' the desir' 121 Mu rr.du.tod frolll I pb,lidlll uwlIIlt prorrom Dated pblllcloo uIiIlIIlt IIDdor oc.bor wrlltID arr- 'ppr:oveel by the BIlan!. 1Ilt.Dla. C31 Ru NblDlltod I colllpl.LId .ppUcatloo lopthu Ibl "th. .ppllcaot 1I1ut to otlll&o pbnldlll UlUWlII wltb tb. required fN. UDder t 1"'3 lrelltlDr &0 ID ullWto Ioi:otlollo. llle 'Pf"('.,,~ alWI provld. Ill. Uc.olun. c.rtJRcalloa. llamlD,UOD ud rer\llralloo 800n! witll IIIpp/lIDtlItaI lDfClnDltloa II Nt lorLb III f...l. f ILlII lnIou.., &0 I&laIIIto "",..loat) ud Iddllloot/ 14' Hu puMd tb. ,byddu .....lIIlt ulIDID.lloo. ::.~~ ~ b, 1M BoercI cllractJy rtIollllr t.o Pb!HSn,VAHIA IUl.UT1H. VOL. n. 110. '" AUOUIT I" Ita RULES AH$) ~YLATIOHS leI Th. Board .W kMp a currut rqilc.r 0' .pproved I'I,uWwd eupe~ pllyalc.lau. Tbi rqilc.r Will ... dud. &he pby.ldlll" 1IUlI.. &he tddreu 0' ..111-_. cunwot bu.ID... adclrMa. &he d.1e of .pprovl1. NteWIII Joe.llona U .ppllcabla. &Ia. 0_ 0' curno:J:.aIdIII ...I.Wlu und.r ilia .upervl.loo and tb. phy ..w- IDr 10 "rovid. eubeUtUIII ,uplrvltloa. ' I 1..1.... R"po.slbUU,., prim." pb,lIcb. UIIJU.. ..per. ollOr. A pMU)' phy.lclan ...I.&&IIt .upervlaor .ball U.UDl. th. fOllowr rt,poDllbWU... Tbe aupervllOt .ba11: III MoAilOr Ihl COlllpUIDCI of all partltllO thl .mttlll I"..DI.DI wllh Ih. .Wlducl. conlalned ID thl .mIUD qrIInI'DI. thl 'Ct IDd Ihb .ubch.ptu. 12' AdviN any party 10 thl .mluo 'I1..DI.DI of th. fallllA 10 cODform .Ith th. .&&IIdardt cooUloed ID &be .mlleD 'I1"OI.nl. lb. acl ILIId &lIlI nbcbapc.r. 131 AlrID" for a eubltlluu pby.lellD ...b&&lll 'Upll" vi.or. Set I 1'~.154 fr.I.&Ior 10 .Ub.lllulll pby.ldlD ...bllD~ 'UpeM.or'. .' 141 See ..eb p.tI.DI In hi. olfiet IVU)' IhItd vi.it. but '1 1...1 ODCO . y.u. f5' See .aeb paU'DI wbil. bo.pltalhed .t reut ODco. 181 Provid. acca. 10 the .mIIllD ',",DI...t UpoD requut.-lIId provide darlflcaUoo of ordUl aad prescri~ UODl by tb. pby.lc:iaD U'''&&III nJayed 10 oUMr bulth can praeUUoDUI. 171 AccepI tuU p",r'UIODa! IOd I.p! I'I'PODtlbWty ror lb. performaae. of the pby.iclaa u.b&&lll aad th. CON aad trutID'Dt or ilia paU...... I ".145. II.DOW naJstnU.. nqolnDltDlJ; nae... a' pb,. tIel.o willi.' tttllllcallo.. , laI A pby.idlll UlIlI&&III abiD NCIlIc.r billllliaDy 0C0 c:ordlac 10 the P~lIA ID I 18.18 1nI.u.. 10 billlllla! I'Ir1l1tratloa: IDaeUv. .taIU. aod lWq\Iurecf ltatull. Ib' Th. ree ror the bitDDla! rerIlItr.Uoa or . pby.lc:iaD u.I.&&II1 ca'tllIcalll III lit rortll ID . 18.13 lralaUoc 10 lie'DlIUI. e.rtlllcaUoa. lllamiD.Uoa and ncl.tr.Uoa f_l. fe) To be .liribl. for rea.wa! of pbytldlD ..Iis&&llt certUicalloo. the pby.ldlD ..Iis&&llt .baD IDIIotalJl ilia N,UODa! certlllcaUoo by comploUoc CUImIt ~c:a- UOD mecbaol'lDI avall.bl. 10 th. prof.uloD IDd f'ICOI" Dized by lb. Boud. Id) Th. Boucl .w keep a c:urnot "cI.ler of ptnODI certified u pbysldlll uIis&&ll... Tha nrltter wiD ... elude: 111 Th. aam. of uch pbytldlD usl.&&IIt. 12' Th. pl.CI of reeid_ C31 Th. CIIITlIat bualoes. .ddNu. 141 Th. dau of IoIUaI certllicaUoo. bitllDlaJ reoewa! reconlllld cuneot p'bYlldao uIis&&llt au~. PH\'SICIAN ASSISTANT UTILlZAnON I 11.151. Role 0' pb,lId.o wlstu.. Th. pby.lcllll u.IlI&&11t .baD. lIDd... IPProprialll cIInc- Uoa aod ,upervlaioa by I pbyliclc ..N&&IIt eu~. .u"....t thl pbytlcllll'l data ,.thvlor .bWU. ID ordtr 10 ..list the pbyrlc:iaD ID r:eadIIoc dtcltlOClllDd iDltltut. Ioc can pIaU for .:-...r.bytldaD.. I?atlata. Pbyalcllll uu&&llu m.y be IlIIcI 10 pa10rm &be followlq fuoeU..., 1'hIa lilt fa Dot IDtllldacllO be aJl.loc1utIv.. . . .' :171. . CIl s.:r- pa....u 10 d.tannIna alld for IIIIdIctl .t. lIIIlLlOL 121 R.vInr patJat -.sa (0 dllllrmIM health .utu.. 131 Tak. a pa&ltDt bIlItory.: C41 Ptrf_. phytlullll&llllo.uon. 151 P.rf_ dtvalopm.atal -"Dlnr .lunIn.llon on e!Uldrao. , III ReconI peniDtoL p,U"'L d.... 171 Makl dtcllloDl reruellor d.ta rlthlrinr and lpo propriau IIIID........L aad .lIe.Lm..t of pall'Du belnr - for thl IoJUaI 'Va/U,UOD of . probl.m of. the foUow.up 'Va!U.tlOD of . pnviou.ly dllmoNd IOd .I.bl. Iiud CODdllloD. IS) Prepare p.tI.Dt 'WDlIltrill, ' 191 IoIU.1II nqUtlU for eOlllDlonly parformed IoIUa! IlborllOry .tudlu. , 1101 CoUect .peclm.DI for and eitry out eoromoAiy performed blood. uriol IIId .1001 aoa!YII' aod euJlurtl. 111/ Id...uty 1I0rma! IOd .bDorma! fIodlnr' on bIlIlOry, pby.lcaJ ..amiD.tlOD aad eonuooAiy per/onl!ed labor.. lOry .tudl... C121 IoIIJ.u .ppropri.u 'Va!U.tlOD IDd Im.r,.ney manaa-t for lDItr'JlWlIey .ituIUo... for .xample. eu. dlac 1lT'Mt, nsplnl4ry dIlItrua. lnJuri... bW1l. aod him. 0IThap. 1131 ~trfono cIIoIcaJ proctduree .uch u: W Vtolpuoeturt. WI lal"dumallata. lUU ElectrocarcIIorram. (M CoG aocIauturioc 01 miDor lacerlUODl, 1vI Cutior aod epllilUoc. IvII CoatroJ of ..tar1Ia! hlDlorrh.... (vii) AppUceUoo of dnaliors ODd band.,... , CvWJ AdmlolItratloo of mtdIcalloaa. ..capt u 1pId' lied 10 . 18,188 lnIaUoc &0 pracriblor IOd dIlIpen.ID, cIruc1l. IDtr'VIDOlU Dulell. wbOl. b100cl aod blood eODlpoo aIDu ..cept .. lpIcirJed Iq. 18.157 (n1a&lor 10 .dmIziis, trlU" of CODtnlUed aub.taoca ODd wbol. b100cl and- blood compoo'Dul. Uxl lWoovtl of aupufida! roreip bodi... III Carcllo-pulmoDU)' ruulcitaUolI. IIlI Audiometry tcnIDIor. lIlU VIlIua! 1CnIDIoc. IzWl Can)'ior out _pUe aod IIoI.UOD technique., 1141 Provid. CO\IDIAII"r aod ID.tnIeUoD reCuellor com- mOD patiIDI probl..... I 11,152. ProblblUou. fll A pbytlc:iaD uslJ&&IIl m.y DO&: III Provi~ IIlIdIcaJ IIlViCII ..cept u dtlcn'btd 10 Ihe .ml... arr-mcot. 12' Prescribe or dI.pe... ,aru,. Uctpt .. dtlaibtd ID the writlllD "",,,*,t., (3) Malotalo or mID.,. I IIIIIWIII 1oc.aUoo IIIIdu f 18.155 (relaUoc 10 llteWlIIlocaUODI) uoJI.. .pproved b1 th. Board. 14' IDdtptlldtlltl, bW palllDu for IIl'VIc:a provided, 18' lodlptlldlDtly daI"'1II . t.uk IpIdIJcalJy ...llIled 10 him by the 1U/lUVIIlDr pbYllclao 10 IOOth" betlth can provider. 'j PUlHIYl.VAHIA llIU.ITlH. VOL ~. NO, ". AUGUIT 14. .11:I 3710 RULlI AND REGULATIONS . ISI L1it hi. 1I&m. IIIdtplDd'Dlly III a leItphoDt dlrtco &0". or olhar dlrtc&o". fot pubUc lilt III a lIWUlu .hIcII IndJcate. Ih.t h. fwlclloa:. u u Ind.ptDd'Dt pracUo Uon.r, 111 p.rform .cupunctlllt IIc.pl u ptrmlll4d by _ Uon 13lkl 01 Ih. .ct 153 P. S. I 422,13/kll. 181 PrOOOWlC.. ~.L1.01 d.ld. (" p.rform I IIltdlcal Nrvice wlllIOIII lb. IIIptrvilloa 01 . pbYllclu ualllaDllUptrvilor. Ibl A phYllclu UIIlIaDI IIIptl'Yltot IIlIY Do&: III P.rmll I phYlldu UlillUt &0 IIIPI' III cooducl prolCribtd IIIlubltClIoD III, , 121 Hlv~ primlt)' rlli'OollbllilY lor 1Il0N Ihlll 1.0 phYliclan l..lslul.. I .1.1". E...ulln. Ind "'I,ln. m.dlCII ..."D.... III A pbYllda,a ullslaDt IIlIY IIlCIIte I IIltdlcal Nil' III.D or m.y ral.y a IIltellcal rec!mlll &0 be UlClllad by I b.allh carl prlclltiooar IUbjocl &0 &b. requlrtmlO&' 01 thit _L10.. Ihl The phYllclu uslllanl lball report orally or III wrllln,. &0 a pbYllcfu ullllaDt IUpervilor. wilbiD 12 hoW'll. mtellcal Nc!mlllllUClllad ot rtIlyad by him .blIt lb. pbYl1claD uli.laDl IU~ .u Dol pbyslcaDy prts.Dl. U1d lbe bull lor .acb dtclsloD &0 UlCllte ot ..IIY a medical nr!m11L lc) Th. pbYllclu uslllaDl sball neon!. dlte IIId IU- lbt1l1lclit &b. medical rqim'D OD &b. plLlIIII'1 chill II &b. lIm. II II UtClllad or rellYed. The pbyalclu .... laDl IUpuviaor lbaII COWlt.enlp &bt pallllll'. neon! wllhiD . rtUODlbl. t.Imt. Dol &0 u..s 3 clay.. WII_ COWllerslpllllrt II required _au bT rel\llallolL polIq . wllbiD &b. lIledlcal CUt ItcIIIly ot &b. tequlrtmlll&. of I lhird'pllly payor. Idl A pbYllclu wlllaDl or pbyslclaa uslslaDllUptI' visor mall provld. ImlIltdlate __ &0 &b. wril&cl al"llllllll &0 IIIYOD. ,"kiD, &0 coallrm &b. phYllclu UllslaDl'. IUlhorlly &0 rellY a mtcIJcaI rqilDeD ot IdmiDlller a lbarlpeullc or dJ'lllottlc IIltullrt. I 1I.1~. SUb.lllul. pb,s1du ~IIDlllIptntsor. lal II lhe primlt)' pby.lclUI uslslaDl lllpervilor II Wllvlillble '" IUptrvist &b. pbyslclUl uslslaDl. &bt primlt)' pbYlldUl ..llllaDl 1Upervia<< IDaY Dol del.pte p.lIeDI CUt '" lb. pbylidu utlalaDI iIAI.. be bu midi Ipproprilte UTU....t1l&. fot IUb.lIlute IUptrvl- IloD In lb. wrilteD "I"CItDl ud &bt IUhalllute phyal- ciUl II Nllllend U a phyalclUl UsislaDllUpervlaor wl&b lh. Boud. Ibl II II lb. respcmslbWly of lilt IUb.lIlute physlclu ,,"i" lUll 'Upervisor '" 0DIIIrt &bll IUpervialoa II maiD- laiDed ill lb. IbseDce 01 lbl prim&ry phY.liclaa ualllaDl .upervisor. leI OurID, lb. period 01 lllpervisloD by &b. IIIbllllute pbYllciu UslslaDl III~. be rttaIu tun prol.. IloDaI U1d Il,aI respowbWly lor lb. llerlOnDIDCII of &bt pby.ldUl ualllaDl ud &bt CUt aa4 &rtllmllll of the pllllD&. lrallad by &b. phylidtll uslslaDl. ' I IL 15.1. St..III.. lecall.u. laI Approuel 0' It,tllI,. Ioario... A phyllclu uli.laDl IDaT 110& provide lDtdJcal Mr.-x. a& a ..teWte IocatloD IIIIIeaa &biI 1UptrV\aIll, phtlictu bu ob&alDtd IJ*UIc approval from the Bari .' ' . Ibl &poroll appUcario.. requl",,,,..., A Npllate appU- calloa Ihall be m.d. lor IIch llteWte locatioa. To obI. ,pproval lor .Icb ..laWIa locILlOD a pbYllc/u U.lllanl IUpervlaor "'all d.moD.lrlte thll: III TIlt pby.ldUl u'lIlaDl wIIJ be ullllzed III UI ana 01 medical Deed., (21 ThIN II adaqUlte provlsloD for cllrtcl cOlllDlWllea. 1I0D bel...D &bl pby.lclu ulI.laDl ud &b. pby.lcIaA uslslaD& luperviJOr U1d lhlt lh. dJllanC. bel.lt\! lhl loelLloD .b... lh. phYllc/U1 provld.. IIrvic.. ud lh. ..teWte location II Dol 10 ","1 U '" prohlbll or Imped. Ipproprllte .upport servlcel. 131 Thl IUpuv/aoj. wiIJ _ .Ich pIll.Dl IV.", lhird vIsll. bul II f.Ul ODce I Y'u, 141 Th. luptrvisor wlII vlsll lh. ..teWte loealloD II leul .ttkJy ud devote 'Dou,b lIml OOlite &0 provlcla IUpuvlsloD ud penoDally ..vii. &b. IIC4rc1a 01 .acb plllllll .... by &b. pbyliclu 1I11.laDl III lhIa NlUll" lei F.u..,., /0 co",ply ",irA 'AU "",rio... FaiIIIrt to IllalDlaiD &b. .laDdu'dli reqlllnd for a ..leIUte IocatloD . :Z NIIII& Dol ODIy III &bt 1011 01 &be prlvIIap &0 laiD a ..leIUte IocaUOD but a1ao In cIIac;lp1iD.uy acUOD ..aiDIl &b. phy.lcitll ualllanl ud &b. pbYliclu uslslaDl.upervlaoio. I 11.156. Moallolin. lad r..la. 01 p.,sldll UII.III' .1lI" ado.. (.f ReprtMDlallVII 01 &bt Board wlII be aulborlztd to coaduc& achadulad tDd Wlachadultd owte wpacllooa 01 &b. Iocallooa -hart 1II1 pbyaIcIaD uablaDla an ull1lzed <lurIq pbyalclu uslslaD& IIlpuvli<<a' olflct houn '" ravIeW &bt loUowlq: , '. III SupervllloD 01 lb. pbYllcl.. 1..llhD&. S.. II 18.\44 U1d 18,154 (relaUll, &0 ruponslbWly of prl. Dl.It)' phYllciu U.blaDl IIIptrvilor; ud IUb.1I1ute pby- liclaa ulblUlllllparvilorj. .. 121 PrtMDce' 01 &bt wrlllaD ."..mul ud compUtllct . wl&b lte larIu. SIt I 18.\42 lrellllDc &0 wrilleD ..... lIlIDlal. (31 UllllulloD ID cOD/ormllY wllb tb.' ICI. lbl. . IUbcbapllr U1d &b. wrillaD ........IIIL 141 Approprllte Idlllll.llcalloD 01 pby.lc/u u.blaDL SIt I 18.\71 Irtllt.Iq to pbYllclu ..llslaDl Idlllll.lle.- I/ODI, 151 Q)mpUUlct wilb c:ertUlcalloa ud rellllrlLlOD ,.. qulramente, SIt It 18.141 U1d 18,1451rtlat.lq &0 crllerla lot c:ertUlcalloD U a pbyalclUl lIalalaDl: ud bllDllial Nr!alrallOD NqUlrtmIllla; rIllI.aI 01 pbyslc/u ualllaDl certUlcatloDl. ' 181 MalDtenlllce o/llCorcla evIdlllc:ID, pIll..& IIId, III' perv\Ior)o eODlIc& by the pbyalclaa ..llIlaDl .uptrVllOC'. (b) R.por&a .ball be IIlbmlllad to the Board U1d ~ a parmtDul record WIder &bt phylidu uslslaDl IIlpervlaor". rtr!alrallOlL Dtllclad.. reported ahaJ1 be ravlewad bT &hi 80anI U1d IDaY provlcIa a bula lot lot. (dl FaiJlIrt to properly IUparvIse IDaT provldt pouacla 01 the prlvlltp '" IllalDlaiD a ..leIUte Iocal/oa ud lor dJsclp\lDlf)' acllOD aploat the IIIblt/lute pbyalclaa d1IdpllD&ry acl/oa aploat the phJrldaD U.lalaDl IIld U.blaDllUpervlI<<. ' the Pbylidaa uablaD& Illperv\1oio. . . , , I'UIIlSY\.VANA IUU.IT1N. VOL. Do NO. Do AUOUtT '.. ,ta RULES AND REGULATIONS 31" . ,t . . .. (el Thl Baud rnervll Lbl ~ht to mriIw pb)'IidaD llllI&ant ulWnllon wlLbout prfor nollCII to IIlbor Lhe pbYllclan Ulfl&ant 1M' Lhe phYI/dan UlftWIt IU~, 1& 11 I Yiollll.. 01 LhIli lubdllpW lor I plar*lan UlII&ant IltpervU<< 1M' I phYllclan uslIWlt to NluM to comply wllh Ihl reqUllt by Ih. Baud (or Lhe lDtorm.. lloo In lubllClIon (II, Idl Addillonal Inlpec&lonl. lncludlnr 10Uow'up m.1*' &lonl mlY be conduc~ U Ihl Baud bu Nuon to beUlvl Ibll I coodillon I&JIII wblcb Ihrulenl Lhe pubUc heallh. "'lly or wallIN. ' I 11.151. Admln/Ill'lllol 01 coalrolled lubsllacn I.d ..... bloocl Ind blood compo.nll. . II' Thl phYliclan ulb&ant mlY Idmlnbtu conlnlUed lubl&anCII and whole blood and blood cOOlponanll U Ibl luLhorily to IdlDlnlster &bl,. medlclllollJ and DuldJI 11 I.pra..ly HI (orlb ill Ih. wrillen II""Ollnt and thl admlnlllralfon 01 &bill madJcaUona and DuldJI II HPI' ralely ordered 'by Ihl physician uWIIDI IUpem- and Ihe phYI/clan ISsll&an1 supervisor Iptclliu a n&Dled drur for I narped plllent. Ibl Th. phYliclan usll&anl IhaU cOOlply wI&b lbe mlnlIllum s&andud. for IdmlnlSlerinr cootroUecI 1Ub- I&anCII lpeclfled ill 1 16,92 Iralallnr to prnaiblq. admlnl.W'inr and dilpeosior conuoUed IUbl&ancesl. I, '1..151. Practlbl., Ind dlspeos'., drvlL (II 'l'ha Board adopll &be Amll'icu HOlp11ll Formu- lary ServIce IAHFSI Pbarmacoloi\c-TbeuptUllc C1ualII- callon to idenllly dNgs ..bleb I pbylician uW&ant may pracribe and dirpelUl IUbject to &b. reslricllona spacI' fled 10 IUb_lIoo (cl. , Ctl ClleJOrilS from whleb I pbyllclan usbllDI mlY pNscribe and d/spen5a wilboul IlmIIIUoo IN u laIIowr. W ADllbIIlImloll. UlI ADll'lolecllva "'011. UUI Cardiovucular drugs. (ivl Conulcepllvu-Ior ..aropl.. I_ and davlces. Iv' DIlIDolUc qe.all. (vi, Dlslnfoclanll-for ...nll UMd 011 obJecll olbar &ban IIdn. , IYilI ElectrolytJc. caloric and Wlter balance. (vWl Eoz)'IDu, llal Anlllllssivu, upectoranls and .ucolytJc 1ItIl1l. Ixl Gulrolnuslloal drup. bIll LocalanlSlbellca. (sill Serums. toxoldJI and vlcciou. laWl SkIn and mucoul membrma qalll, Ixlvl SOloolb muscle reluanll. Inl Villmlo., 121 Caterories from ..bleb a pbyslciu UlII&an1 may p~scribe and dispeD.Se IUbject to udus;...., and IlmIlao Ilona 1lIted: . III AUlonomic drv,l. Dru,l Ixcluded uodar thlt calilOt)': S)'IDpllbomlmlUC Ilclranllric'ipJllI. WI BIDod 'ormari4/1 0IId cooplori4/1. Drugs ucluded WIder thlt caleJOry: IAI ADll....quIanlland coquIanll. CBI ThrombolytJc IpIIII. . (W) c./lfNI "''''''"1 1)111"" alllft'" Drup axduded uncIarlJll.caleCGf7: (AI G_a! -lha&Ica. . IBI Monoamloe olldue loblbllOrl. (lv) Eye. ...... 11<I1. '1lI4 ,11,..., pre}I<Wri4111. DNrl Dmlted under thlt calelOt)': Mlollcaand mydrialrica uHd u ay. pllpulllona Nq1Ilre lped/Ic approval from the pbYlidan UIIIIIDllUptn'iaor ror . IWIlId pltl&nL (vi HOmuJlII. IlI4 'yfttlwric lublti"'''.. Drup ... duded Wldar t.blt calerory: IA) P1lUltuy bormon.. and l)'Dlbellc:a. IBI Parllbyrold bormontl and l)'Dlbella. 13' Clu,orl.. frorn wblch I p~Yllcian "llllanl OllY Dol prucribe or diSpeDH arl U foUoWI: III ADr.lnlOplullc ",DII. IU) Deotal "'011. IW) Gold compoilodJI. (!vi Heavy mllllanlqoolsll. IvI Oz7t<<lCl. Ml Radio.cllve IIInll. IvW UDd...lflad Lhuapeullc IItIlIl. CVW) D.Yi-. Us) Pbarm.cauUcaI aleIL '.1 NI.. drugs and DI'Ir 0_ lor drup wID be coosid. ered approved lor pr.scrilllll& and dbPeDllocJUlpOHs by pbyllc:iD ullltallll go 01'" Iller IpproV by the P:adtra! Drq AcIrnlD1sllltlOIl DlllUI ..dudad 10 pari' craplui 121anlt (3~ . lbl II &be pbyllclan IIIlstanI IUperv/I<< IollDu to lu&borlu I pbyslclan UIislItII to pl'lscribe Dr cIiIpeosa drup. lb. 111~ ahaJ1: , 111 Establllh I Ibt 01 drup, butd 011 lb. cateaorl.. ' IlIlad 10 I1Ib_UOD lal. wblch lba pbyllclan uaII&an1 mlY prescn'bt ClI' diIpeua, Tha p~~an Ulb&anllUper. vlaor, IbaJJ UINN &b.1 lba pbyll uw&anl II Ible to.. compellDtly p~ or dlipeua &b_ drup. 121 Submll Lhe Ibt of drup to lbl Boan!. 10 dupUcate. 011 . form IUp,PUed by tbl Boan!. &lid t/rDed by bOlb Ihe pbYlician UIU&ant luptn'iaor and lbe phYllcian Ulis. &ant. Th. UIl will bacorna pan of &ba pbyslclan UIII&ant'. WTitllli qTIIIDeot 1111 11 COllJlllenl wilb tbe approved da.ulllcalloa. 131 NoUly t.ba Boan!. 10 dupUcall. 00 I form IUppUed by t.ba Board. 01 an eddlllozi or deletion to &be IlII of drugs. Th. IDllllclmeol will becollll put of &bl pbrlldan auls&anI'1 WTi~ arr-mllll U It 11 COIlSlslenl with Lbft approved cl&salllcallon. ' C.' AlSume fuU respoadbDlly lor evlry pl'llCliptloo lauecIand druc diJpIIlatd by a pbysidan UsU&ant WIder bIalUpervialon. C61 Malal&lo a ""P1 01 t.ba Ibt of drup I1IbmlUtd to Lhe Board 10 bit principal ofllce IIld II aU locallonl ..bat lba phyllclan IIIlItanI pracll_ WId.. bIa 1UptrV/. 11011 for revlaw or lupectloli wllboul prior DOUce by patlaall. Lhe Board, or lle Ip/III. Tba pbylldan &baU prcrvlde I plwmacy with . copy 01 Lhe druc Ibt apoD Nq\IIR b7 Lhe Pb&rmaciIL 'EHHSYI.VAHlA '1IUI.LIT1N. YOI.. ~ NO. ~. AUOUIT U, I fa 3782 RULES AND REGULATIONS . III ""-Ipliol bl&llk. .ball t-eu &It. Clrt.UlC.liOD ..wa- ber 0' &be phy.lcllD 1IIlI&ID& ..d &be aUM of &be pbyllcIID ..11I&&11& Ia prilIled 'onno& 1& &!Ie beadI.aa 0' 11M blull. aad I Ipam for &be 1DII7 of &he 1)1\1, Ea'GnlIlIIIO& Aclmlaiitnliall rac\lt"tloli IlImber .. .~ proprilt.a. Tbe phylicllD UlI.l.aD& IllpeM10r .hall a110 IlIId.aliOId .. reqlllNcl iii . IUl lril.lIn, &0 Id.alily. lac lIIIorm.liol oa pNlCripliOD' IDd ord.n for equJ~ moa& IDd llrvlcel. '. 121 Tbe phy.lcIlD u.b&IDt lllpervllor .. prohlblled from pl'ltlplDl pNlCriplioa blllllU or aIIowlq &h. pby. MID u.b&IDt 10 \1M . dlYica for atazIaf I .11ll.lure copy oa &It. prllClipUoa. Th. .JllIllure 0 I phy.Jclu us"&lD1 .hall be foUowld by lh. lnlUaI. "PAoC" or .lmlIu dullll.tloa 10 ld.atlly &h. .Ip.. u I phy.lclu ulbluL 131 Th. physlciu U.ISl&lll ni.r II" . prascripUoa blank pnul&ed by . ho.plUl I th. Iafona.lIon III P.......ph III .ppean oa lh. blank, f., Recorcik..pill, roqulnm.at. UlI .. foUow.: III Wblll prncriblq I cInl,. &he pby.lclu USb&Ul .hall liMp I copy of &It. prucrlplloa. Iadllcllac &It. O\lDlber 0' rafllb. Ia . ra.dy raflNaCl m.. or record &It. allD" &DIOWIt aad do_ 0' &It. cInl, preocribocl. &h. D\lDlhor 0' re6lb. &It. dlta 0' &he prllCliptlOD ud &he pb,..lclaa u.b&ID&'. DIID. Ia &It. Pltleat'. mlCllcal rec:oniL 121 Wbea dIIllClIiD, I druc. th. phy.lcllD ...b&IDt .ha11 'NCOn! bit aam.. &be DIIIII ,0' &ltl mtdlcadoa cIiapea,ed. &It. IIDOIIDt 0' mlCllcatloD cIlapeDNd. &It. d_ o, &he IZlIC!IcaUOD dlspeasecl IIId &It. d.ta dlspeDHd Ia &he pat.HDt'.lIIIdIcal recorda. 131 Tbe phyalclu ulll&IDt .haI1 report. orally or Ia wrItlac. 10 &It. phyrlclu ulll&IDt Illpav1aor wI&hIa 12 hClllrl. I cIrq preacribed cw IIIIdlcatlOD dllpeDIId by hlm whilt &It. pbyllclaa ulls&lDt IlIperv1s<< wu DOt phyll. caII~t. IIId &It., bulo for Uch cIeclaloD &0 pr'lleribe or , 141 The physldlll IIIb&IDt lllporvbor .ball CO\IDtar- lieD &It. prllCliptlOD copy or mldlcal record eall7 'or ucb pracriptloa or dllpauloa witbla I reuoD.blt ~.. DOt &0 uceed 3 clayw, IIDI... COWlllrsllll.t\Ire .. J'IClIIlNcI lOCIaer by re,w.tloa. poUc:y wI&hIa &It. mlCllcal care '.ciLlly or tho requ!remIDLI 0' . third.pany p.yor, (5) Th. phy.lclaa ulll&IDt IDd lhe pby.lcl~ u.b&IDt Illpuvi10r .ha11 provide lmmedlata 1CCelI. 10 &h. wrIu'D qr.mIDl 10 IDYOD. aeeldo, 10 coollrm the {Ihy.lcl&o ISIls&IDt'. III&ltority 10 preocrihe or dllpeDIe I We- I 11.15'. M..,1caI nconll. Th. physldu ...u&ID& Illpuv1sor .hall Umily rI'Yie'W &It. mlCllcal reconll proplrlcl by &It. physlcllD ..lIIlaDt 10 IIUIInI &ltl& tIl. requlnm.ala 0' I 18.95 lrel'"lq 10 mtclical reconlll have tieeo ..lblled. 181 Irumtcli.lIly .dviJt tIl. pIU.Dl.. aotlly tII. pbyll. ciu 'U'l:lllAt IIlcl. In &h. CUI 01 . wrItllD PrncripUoa. .dvia. &h. phana.cy. if th. phy.lcllD ...illaDt .. p,.. ICribin, or eII.penain, I cIruc 1n'PJ'roPri.taly. Th. phy.. cien .hall .dvill the pl&leli& 10 aouty lb. pby.lcl&o ...lltenl 10 eII.contlnlM uIac lh. cInl" ud Ia th. CUI of . -rill,a preacripUoa. .hAll DOlily th. phann.cy 10 eIIICODlInll. the preacripUoa. The order to cllKODlInll' 1111 0' lh. cInl, or prncriplloD .hall be DOled Ia th. p.U.at'. ",tclical rICord bYlh. phy.lciao. Icl RIIlriclloas OD . phy.lcllll u.l.laDt'. presciiplloa cd eIIlplnsioa pr.ctlcII .... II 'oUow.: , 111 A phYllcien ...I.tant "'IY oaly prescribe or .u.. pea.. . cInlr .pprovec! by lh. 80ud /ro", thl call1Ori.. .pecilled UI.ubltCtlon 1./. 121 A phy.lclan ...lIlU' m.y oaly prelCribe or .u.. peDS' a cInl, 'or. p.U'Dt who I. \IlIder lh. CUll or lh. phy.lciu respon.lbl. for th. sllperviloloD of lh. phy.ldu ..SISluI ud oaly UI accordlDc, ori&h lh. pbyslciu'. illslnlctlons ilId wrilllD ....ee"'.DL , . , 131 A physlciu uslSlaDt .hall comply wllh the mIDI. mlllll .tuducl.t for prllcribla,ud cll.rpeDsUlr coatroUId IIIb.laDCII specilled Ia.' 1&,92 (..laUil, 10 Prucrlblac. .dmilIl.lIriD, IIld eIIsplnllar conlroUed IIIb.laDCIII ud th. reruJ.Uoa. 0' 'lh. D.partmlDt or H."&h ralIUc, 10 CoDlroUed SlIb.laDce.. DNp. Devices IDd Co&m.Uca. 24 PL Cod. It 2UI-2U8~~ 10 prucripUoDal. ud pacltacia, IIId l.heIIoc dnlp. s. It 18.93 ud 18.94 lrel.tlac 10 pedlliDl: lid ,,""11ft, 0' .u.. peDled cInlplud 24 PL CocIi " 25.91-~,95 lrtIaUDc 10 labelloc 0' cInlp. dlYi_ ud coam.Ucal., 141 A physlda. .....laDt ';"y DO&: I/J Prescribe or dIIptl1H I pure 'orm or camblalUoa of cInlp U.led Ia IIIbllCtloa la!IIDIIS' th. cInl, 01' c1u. 0' cIru, I. U.t.d II permllllbl. ror prllcrlptloD or dlspeDlfon. IUI Prucribe or eII.pe... Schldwl I or II eOD&roIJed IIIb.laDCIlI II d.JUled by 1<<&l0D 4 0' &It. Coo&rollld SlIbSlaDca.. DNI. Device. cd Cosm.tle Act 135 P. S. . 780.1041. IWI Pr.scn'be or dllpe... . cInl, 'or I 11II DO& penalt. ted by lh. FoodlDd Dru, AcImIalStraUoa. llvl Prescribe or cIlspeall . pDlrie or bruded prep.... Uoa or I cInlr &hll h.. DOt betD approved by th. Food ud Dru, Admlolstr.Uoa. ' CvI Prescribe or eIIlpOIIlI pareDlara! prepUllUoD. o&lter thu WUUO, lIDerpoc:y allerI)' IdLl ud o&lt.. approvld cInlp 1l.tted UI'lIbaecUoo la!, lvil DlIpID.. . cInl, IIDI... 1& II peckapd lD acconI, lOCI wI&It IppUcahl. Flderalud Stata law per&alolo, 10 paekarlD, by pby.ldu., See II 18,93 aad 18.94. _ Ivill Compo\llld Iarrtcli'Dla whID eII.peasln, I druc. ezcopt 'or .della, w."r. MEDICAL CARE FACTUT1ES AND EMERGENCY lvilll li.lle . preacriptloD 'or more l1wI I 3o.dlY MEDICAL SERVICES IIIpply. ueepl Ia ~ 0' chroalc Ulo_ _hIN . 9O-cIaYlllpply m.ybe Pl'lla1'b1ld. The pbyliclu .....t&o& I 11.161. ,_,1IcIu UIIsII.1 'lDpIa," .,. ...,leaI CIIrt fica. may III&ltoriul re6lb lip 10 8 mOD&'" fiom &he dlta 0' &It. llIea. oriciou' prascripUoa U Dot otbenriM preclllded by la..., A'_':' h _...... . fa! A phya/cl&o ualIlaD& ma,. be 101.....,_ y......... Cell The NqII/nmeola fOl' pl'IICriptloa blaaU ... U caI care facl1lty. but Ihall compl, wI&It &he Nq\IINmlDla lOUD.... 01 &he let aad lbIa auhchaptar. PINHIY1.VAHIA IUUZTWc. 'lOL.. D. NO. Ill, AUOUIT I., Ita RULES AND REGULATIONS 37.3 . ' . .' . ICI Failura Lo aoUfy th. Boud of chan... i.a .roploy' m.nt or . wlTAin.Uoo ill tb. phy.leianlphy.ielan UIII' Lant r.lltioolhJp II . bull for eIllcipUnary actioo .,Illlll th. phYllcian'. UCIII... p~l.~Ul u.llLant lupervl_'1 ralillF.Uon andth. phYll u.I.tant'. c.r\llIcaw. DISCIPLINE I 11.111. DI..lpllnl., .nd COmell.. m.llum. i.l A physician u.l.tant ...ho .0'.... In unprof.., slonal conduct II .ubjoct Lo eIllcipUoary .ction und.r IaCtion 41 01 tb. act 183 p, S. t 422,411. Unprol.llioDaI eODduct Laclud.. lb. IDUowillr. III Mlsr.prallDwtloo or conc.aIm.nt 01 . m,wrlal I.ct La obtaJnla, . cartillc.w or . r.inluwm.nt th.rlOI, 121 Commlllioo 01 an oll.nll ..ala.t th. It.tuW. 01 the COlDlDon....altb ral.tiD, Lo tb. pr.ctlc. of phYSIcian ...lltaats or ..,w.tlOft. .dopted th.reund.r, 131 Commillloft 01 an .ct Lavolvla, moral t\ltllitud., eIl.hon.sty or cOmlptlon ...h.n tb. .ct cIlractiy or incU, ractly aflecu lb. b.alth. ....lIan or laf.ty 01 citinns 01 ' I .1.111. PhYllcI.a 1I.lsllnlldtOlIllnUon. thl. COlDDlOft....altb. If tb. .ct eonltltullt . cnro., 1.1 A pbYllclUl ...inant m.y not r.ad.r rutdlcal conviction tb.reol 10 . Climlaal procHdla,m.y aot be . ..rvlen Lo . p.tl.at until lb. p.tI.at or th. p.U.nt'. coaelltlon prtcedoot to dbclpUaary .ctlon. 1.,aI l\Iuelllll bu btaa Wormed that: 141 COnvlctloa 01 I Itlony or convlctlon 01 I mild.. C1l Th. pby.lellll uabtaatll not. pbyslclUl. m'lIIor ralltlq Lo I baalt.lt prol...lon or racelvill, probltlon wilbout vtrdlct. eIl.potltlon 10 UtU 01 &tial or 121 Thl pby.ldUl ...iltaat mlY perform lbl etrvlce Ul .ccaI.rlted rah.bWutlv. cUlpo.ltlon 10 tba dllpotition ,.qlilrad u lb. ...nt 01 tb. pbYllellll IIId oaly u of f.lony ebarps. 10 lbl c:ourta of tbb COlDlDOft....altb, . dlr'ected b)' tb. pbYliclUl utlttaatsupervllOr. Ftcleral court or I court. 01 1II0thar Suw. urritory or 131 Th. Pltl.nt bu tb. rI,bt Lo be trelted by tb. couot.ry. pby.ldUl II lb. p.tI...t dllirat. 151 MllCoftduct La prlCtlce u I pby.ldlll ulistaat or (hI It II lbl pbYlldlll ...iltaat IUpervltor'. rapoa.sJ. parformitla taaka frludlllaatly. beyond Ita IUtbori&td bWty to be alan Lo p.tlant complllllta conctnIiDc tba 1COpI. wilb locompttlaca. IW wi&b ne,u,.nce on I pirtle- type IW quaUty of trilCIS provided by tbl pbyaldatt war occ:uIon or n.,u,.ace on rapaatad OCCulOB ...iltaaL . 181 Performance of talkl u I pby.lcIUl u.lltaat whO. leI In &b. phy.lclan I..i.tlllt supervlstw'. olfice and &bl IbWty to do 10 II lmpalrad by alcobol. drup. ..taWta loc.tloDl. I aotlce plaIaJy vitlb.. Lo patlaata pby.lcal dI..bWty IW lDIJ\taIlatubWty. .baU be potted 10 . promlunt place .zplaJalq that I I U b b "pby.lellll u.iltaat" .. .u&borWld Lo u.ilt I pb)'.iclaa 171 Imparsoaltlon 0 I caattd p )'.Iclan or 1II0t .r 10 &b. provision of mtdical can IIId trilc:es. Th'J:bYIi. cart.llltcl pbYlIcIUl uabtaaL _ ellII u.lltant suparviaor t1taU dlspl.y bit raliltn Oft 10 181 Oil... uodtrtak. or ..... to CUI'I or UUt dlstu. by IUperviM 10 bI. ofllce. The ,pby.lclan ualttaat'. certUl. I MCret m.&bod. procedure. treltmtat or ottdiclor. tb. CIW sbaU be promlttantly dlIplayad at lilY locatlon It trutiD.. prncriblatr flW I b_ qlIIeIltlon. by I m.tbod, ..bleb b. provld.. str\i_. DupUCIU c.rt.lIIcat.es mlY be 10'11I' or proctdun ..bleb tb. pbYlician uliltaDt r.Iu... obtalatd from tbe doara it required. to eIlvuJp upon dtlDaDd 01 the 6oard: or use 011l""~0QI ldl Th. pbyslcllll u.iltaat .baU ...er III IdlJlLlllcatlon or uutal.nt ..bleh an not La .ccordane. wilb trntm.at tq ..bleb u... lb. tam "Pby.icllll AuiltaaL" 10 18 proc..... ~ttd by I rauoft.bl. MIID.nt 01 lb. polot type or larPl'. The tq IbaU be coasplcuoua1y ..ora. mtdlcal profallOD. I 11.172. Nollflcallo. of c....a 10 ....plo)'lll..t. 191 Violation of I provlaloa of tbIl subcbaptn fWq . .taadanl of profasload coaduet. (al Th. pbyslclaa u.lltaat II raquJred to aotify the Board. 10 Mitlo.. of a cbaap La or tarmiaatlon 01 nOl Contlauatlon of pr.etlc. ..bII. the pbyslciaD emplo)'DllJlt or I cb.aap 10 mal1lac addraa withla 15 u.l.taat'. certlflcaw bu 'llplrtd. iI aot ralittUtd or iI dlY', FaUun Lo aotify &b. 80ard ill writlq of . eblll" sulpaadad or revoked. 10 mallia, .ddrua may result 10 laUun Lo recalv. pettlDant m.terial d1s&tibutad by lb. Board. Tbt phyli. 1111 DaJa..tlq I mtdIcaI ra'JlOIIIlbWty Lo . penDlI dill uaiataat IbaU provida lb. Board wi&b bit new ..ban &b., physician ualttaat Imo.... or bu rauoft Lo addrua of ruid_ addra. 01 amplo)'DllJlt and IWDt 01 laIo.. &b.t the ~ II not quaWIacl by traiaiDl, I"IIiattNd phy.lclaa uaiataat supervltor. uparianca. UCIDM 01' certlllcatlaa to perform tbe d.l.. lcl ..ttd talk, lbl The pby. III utlttaat supervilor II ~ to notify lb. Board. 10 writlq. 01 . chili" or tarmlaatloa 112l Th. failurt Lo aotify the phYllcllll Ulllllllt super. of bit IUparvlaIoa of I pliytlclatt uslltaat withla 15 vlatw that the pbytlciaa utlttaat hu wi&bclr...... c... d.y., . from a p.tlaaL PEHNSY\,VANIA 1UUZT1N. VOL. 2:1, NO. 3:1. AUGUST 1.. 1m lbl n. 80IrcI wlU orelll' the .merpDCY N.peoalor. oil the cer1lllcaee 01 I phy.lcllD ualataDt who PllMAtI UI lznIIIecIl.1e UId cl.u dID.... &0 the pubUc h.alth IIId ..IllY, u ..-qulnd by _&loa 40 01 the .ct 113 P. S. f 422,401, leI Th. cartinclle of I phy.lctan Uli.t&llt .hiLII .UIOo D1IUciLlly be .u.peaded. WIder conelll..n. iD _UoD.40 01 the act. . fell TII. Baud mlY r.fu... r.vok. or .u.pead . phy.ldUl'. .pproval &0 .UpervtM . phy.IclUl ualstllll for 1D1..m1 lD lilY 01 the conduct prolClibad 01 Board. nl\llalad ptactltloa.ra lD I<<tIoa 41 of the act '13 P. S. t 422.411. :a7t. .. . , . " RULES AND REGULATIONS . ~ .............-..................,........................,....-........,.--................ ACI" 7l5' LORElIA F RUNK 1ElEPHOIIE I 17111 W'4Q41 16 W nAlN STAm COURTESI :,. . POBOX '1 .smt GPl IYP' PLAINfIElD PA 170BI DUN ell I kUN' V COll1ENI' nnl PlAN' ,00 .........--......................--.-...--.------.--------------.-..------.......-.....--.. PERSONAL INSURANCE COLLECIION WORK conp ACCOUNI TOIAL ,00 ,00 ,00 .00 ,00 .....-..---...........----...-------.........---......--.---....----....--..---............ LAST STnl' Ol/07/" slnl DELAY' STnl COUNTER' 0 LAST CHARGE. OB;/l/~4 LAST PERS PAY' 05/1'/9' CUR PERS PAY' 10,00 CREDIT DATE' CREOIT nESSAGE' -.-.-.-.-.--..---------.-.-.-.------------.----------------------------.-...----....------- ACCOUNI NOlES PERSONAL AGEIHG CUR' ,00 liD. .00 lO . ,00 IlO' .00 60 . .00 IBO' ,00 90 . ,00 FIN' ,00 ----..------------------.-----------------.--------------------..-----...--------..------.. PATI' 1 LARRY J RUHK HOnE I' 17171249'4B42 16 W nAIN STREET EnER I' f 1 POBOX 92 B1RIH DAlE' 09/05/41 PLAIHFIELO PA 170BI SEX' n nARITAl' n SOC SEC' IBI'l2.7454 OIHER 10' PRIMARY PROU' INSURAHCE GROUP' POLICY' SUBSCRIBER HAME RElAllOH I HlAlV1 OO4B9200 LARRY J RUHK I 2 mCII LARRY J RUHX I l /P l -------------..---------------..---------------------------------------------....-------... EllI'lDYER NAnE' PPG TElEPHOHE I' /11714B6-312l AOORESS L,' ~~~~~~'AiEizIP' CAAllSlE PA 170ll ........--.-.......-----------.----...------......-------.-..-.-----------.....-.--.----... FIRST/lAST VISIT'09/09/ll 05/19/94 RECAll' REF PHYS' CHRONIC OIAGHOSIS' 496 .. .. . --.....--------..........-..--....-.....-----..--.-------..-....-------.-...--------....... .......-----..---...-..-------.......--------......-----.......-------....-.-----.--.------ POS en PATlEHT DOC TRNCODE/no OESCRIPTIOH IHS AMOUHT DAlE TOTAL DUE l B72 lARRY 5 99212 OFF/OP UIS1T. HlAM/IH 27,00 09/09/9l 27,00 B72 'AOJnEHT. CAPH HlAM CAPITATIOH AOJ 27,00' 09/09/9l ,00 l02262 ..IOTAl" DUE FROM HlAlVlH AGE' 0 ,00 . . , . . . . . . . . l 96B lARRY 4 99211 OFF/OP VISIT. HlAIVIH 17,00 0912O/9l 27,00 96B 'AOJMEHT' CAPH HlAM CAPITATIOH ADJ 27,00' 09120/9l ,00 l05554 ..TOTAL" DUE FROM HlAlVlH AGE' 0 ,00 . . . . . . . . . . l 56l lARRY 4 99212 OFF/OP VISIT. HLAIVIH 17,00 09l29/9l 27,00 56l 'AOJMEHT' CAPH HlAM CAPITATIOH AOJ 27.00' 09129/9l ,00 lOBOIB ..TOTAL" DUE FROM HlAlVlH AGE' 0 ,00 . . , . , . . . . . l 726 LARRY 4 992ll OFF/OP VISIT. HlAIVIH BO,OO 10/IB/9l BO.OO 726 'AOJnENT' CAPH HlAn CAPITATIOH AOJ BO,OO. 10/IB/9l ,00 1mB7 "TOTAL" DUE FROM HlAlVlH AGE' 0 .00 . . . . . . . . . l 726 LARRY 4 B1270 BlOOO/OCCUlT/F HlAM/IH 7,00 10/IB/9l 7.00 726 .AOJMEHT' CAPH HlAM CAPITATIOH AOJ 7,00' 10/IB/9l ,00 mm "TOTAL" DUE FROM HLAIVIH AGE. 0 ,00 . . . . . . . . . l 726 lRRRY 4 BI002 URIHAlYSIS. W/ HlAn/IH 7,00 10/IB/9) 7,00 726 'AOJnENI. CAPH HlAn CAP !TATION AOJ 7,00' 10/IB/9l ,00 A ........................................................................................... 1Il18' "TOTAL" DUE FROM HlAM/IH ACE. 0 ,00 . , . ., I . . . . . . . l 66l lARRY 4 mil OFF/OP VISIT. HlAM/IH . . il,on 1I1lll9l 11,00 - .. , 66l ,AOJMEHT. CAPH HlAM CAPITATIOH AOJ 1/,00- 11/21I9l .00 114686 "TOTAL" DUE FROM HlAM/IH ACE' 0 ,00 . . . . . . . . . . AeCT, TOTAL PER SOHAL PAYMEHTS' ,00 ACCT, TOTAL IHSURAHCE PAYMEHTS' ,00 AeeT, TOTAL AOJUSTMEHTS' 229,00. ACCT, TOTAL CHAms. 229,00 A .. ,... ,.,......- . 0.' . ...0 . . t' . CERTIFICATE OF SERVICE I, SHERRY L. MOUERY, an employee of the law firm of Post & Schell, P.C., do hereby certify that on the date set forth below, I did serve a true and correct copy of the foregoing document upon the following person at the following address indicated below by sending same in the United States mail, first-class, postage prepaid: Pamela G. Shuman. Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg. PA 17110 Date: /I-:)Q - CJl"J NOllJ ~ 01 r~'9q f,\',t.uFf\\,i Qf1;i( l<;,l\\QI\,'J!~{\'t CliIO~~l:,I.l) G"",1~'t PElili;,~ViA"II~ '.; .,' "i ..-t '77'~; .1r_~\l"'r:~'-''':'~ ',,:":','r, <~'-'~,:;.:~ -.~ '~-', ~_~'-;'I:'-' . -,' " ,:~-"1'-,tt-..~f;~.,;'-;'f. -~;- ;:~.-.--, ~-;,---t;.-,;~,"- ,,', ...., ">;.' ,,",- --,~,.;'~' ','> , . ,"f J ., ~; . . -".~ .'~""'~~~i~;:;~~' , i~ :fit.}~7' ,;, . ' ',--_:, ' .... . :,"}_~,,3 ..: ~ ( ,. .-:,. '-,-. >,,, ,. j If!; . .:;~:b"-" . '",...'4-:"_ ~;...: ~ ;. j.'~': ~~~.'.tL:l~j~~~, J.'.'.I",' , j~.<-::. ..' " . -~ - . . ~.~ .''''- . .{l;:'_-'-'~'-~~" ~~;::~:1~:t~~':~~~'n~~'~~G~~:-' " ,- <,'. ,<," ,-,', ,:L "' \.' " .:;' ; ~.:;:}>-;.; ;-~'~ ~-\ ;}:;]i~J;{f.':.~;.':"'.. '.r: -/:.:',.:" ':l' ',,':-' " >"-;',:.:,.:, ~,- <':~;~\;} 'c. ... ",- .\1.:\ :"~',\~~~ .' v.: ", ,; ;.'~'.;,"~":' , ' - >,' SefrJ-- e J) ;31 .t,', ~ J,e.oe R t/r c. (J1/;2 / ?/dt/l'~ \ ~ ,',;~ '''V rY) ,~ -~ Ci- , 4" 'r. . -'~"":'j '.'.: !!";/, 4:, q:' f . '~~ 1) ~-:J. ., L. 1 ~ Lr> en ~~": i i ,~ ,:.- ~/ ..... " , N ~lf'" '.... L1 .;~ cjt;~ G:w.. ffi~~ ;;; ~~a:~i I; o ... ;; oil ~ li? ;:: :Sooii! E zzcn -Mil! ~51< <"" . , .' /:TJ(J /' V-?j I'J,)~J ,;' M LORETTA P. RUNK, Individually 1 and as Administratrix of the Estate of LARRY J. RUNK, Deceased, . . . . . . Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants ORDER AND NOW, this 2<is 1f, day of t. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 JURY TRIAL DEMANDED A "o~ Sot , 1995, upon consideration of the Motion to Seal Settlement Documents, on which counsel for all parties join, IT IS ORDERED that the settlement documents in this matter shall be sealed. BY THE COURT: ~"~'lIt"<<",,'. J. ~,~ <~;1~{l*,:~fH~ ,:1 t ' ~~; r~'~~:-' .;{::.~ f, 'f'S'. ,...'-' ~ :: ,~:{.r:~'~::t;~i;,;.::i,fl~'~'~'{:j~~~. '.. ,..)t, .....,,,.. ", llj,l't"fo" .- ':~::\~?tJ.i~::~,<,~~2 \p;},;,i.: ~;iN~ .' '"'''>'I!,,., ,{'j:"J.::: ':<<l".:L", ""/'f""!J"'" ..' "-." ~'l'; , ,. ,,1>, ':'.' L :~,li~'~"'" i~f;.,,'~,,;' t.~, :'t~ . h~' " Y:~~";,,,.,:,; 'r, "". .,..:, :';:' t" : :,,:iI {~_J,. 'i,J 0;~!*',q, '~"7' /v,~ .0<11 . ': .;./".. :t~~ ,', ic ' )3~~:;~f~~:' L", ;;;J~:,,~. ; '?".:-" . :~__ . ",. -- .. :~" ,,;,:~-. -~ ,~ '< ,;::'?~,.. t,:.;;; ',,' , '::~:':r~,i~: ,'.;:. , ,.:;:,r:,:~~~g~~)~~." . ;:' 't~_ ~-;..J.. :_:f ;'1;~~f;iiJ:)i-'>':' '; _.< . ". '.:.;f'$(", ';L:,;l'~_.'~.:r4~?:;.,J' _':. .. """"';''''f:;k,ll''","I'''' ..~~~~~~ . -.'C. W i'b ..~t . w-p' '(t ~" ~r ,~ e "'''''' ,,;\ -, ~F -,rw ~,~ c. -';-,', ;..~ <.,': "'-i .':t.) +~~ (:"-':' ',,' -:-,,' -".,;1 ~". ' "',y,' "..:._:' .,~ '-' f"\ i , ] j j I .., ....-:!' .r:- '....-'-...,.,,..-"':,...~ ".-<~..:'- .. ""~.' <~; ~)i<, " ~, -,..., ~ O. j3' 'C " "'",1. " 'W ;>';' ,;.<< ,." :'\,"."" '"',.~ f ~~! t:' "'.,( t'J fJ ", ;;; ..;:; :1' .:1. M .,~ '^,~ ~. '-\-', ','j ',.~ ';.y: " ", .-", ';5' ',;' <0 , , ,~ , ^ ~~."~: ",~"'.l.":!$."'''_~" " Aoc 28 _"'_"'l"'!~..'~,:;. 4:;, '" ','.'M _ . ~:,~''''. I 3Z PH ISS i::; ["OI'FICE Of tn, P;;I'T//OH01AA\' CUH;'EIILAHO a'UNa r'lN"SYl,.\~IA :-<-'-~:..~?:""" .., ",,#" .,,'~~';;r .~>i~, '<~{~i -- ; ;, . '"'~ :f.' ",'< '". ._ 'q".d'T~ ~";'-',=., "y' ., . .r t }'''" .. '. J . . . -' " . ., " U',f ,~~ ""'~ (.8 J~ ~;"'''~;'', 'I"" :,' ~:~,r,;..' LORETTA F. RUNX, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 Plaintiff v. BRUCE G. XIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL X. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED PLAINTIPP'S MOTION TO SBAL SETTLEMENT DOCUMENTS Plaintiff, Loretta F. Runk, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased, hereby moves that the Court enter an Order sealing the settlement documents in this matter. In support of her Motion, Plaintiff avers as follows: 1. This case arises out of the medical care provided to Plaintiff's husband, Larry J. Runk, deceased, by the Defendants in late 1993. 2. suit was commenced in this matter against the Defendants on August 1, 1994. 3. This case was listed for trial by the Plaintiff for the September, 1995, Civil Trial Term, and a pre-trial conference was scheduled with the Honorable J. Wesley Oler, Jr. for August 23, 1995. 4. On August 21, 1995, a settlement was reached in this matter with regard to all claims. 75136I8JS Ij H ;} ~ II II ] 5. Plaintiff, Loretta F. Runk, is concerned that the term. of the settlement may become public through the news media, and she does not want that to happen. 6. Plaintiff's counsel was notified by the Court Administrator's office that upon the simultaneous of this Motion and Petition for Approval of Settlement, if the Court deems it appropriate, an Order could be entered sealing the settlement docUlllents. 7. Plaintiff's counsel contacted the office of the attorney for the Defendants, who is in agreement that the settlement docUlllents should be sealed. WHEREFORE, Plaintiff respectfully requests that this Court enter an Order sealing the settlement docUlllents in this matter. Respectfully Submitted, ANGINO & ROVNER, P.C. 1GA~ f:J. Sh.u.~ Pamela G. ShUlllan I.D. 141696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: August 25, 1995 2 VERIFICATION I, PAMELA G. SHUMAN, hereby verify that the facts set forth in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are made subject to the penalties of 18 Pa. C.S. 14904, relating to unsworn falsification to authorities. WITNESS 1 IJI..~.;. ~ at -rJ., V~f:L~ Pamela G. Shuman DATED: August 25, 1995 46660/IJS If R J~ -<- J' cf. -; J, Barbara J. Smith CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino & Rovner, P.C., do hereby certifY that I have served a copy of the foregoing plaintiff's Motion to Seal Settlement Documents upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the 25th day of August, 1995, addressed as followsl Evan Black, Esquire Post & Schell, P.C. 101 North Front Street Harrisburg, PA 17101 L.. ~ ~ ~ :5? ... ~ - ,. - ~~: ,". c.:= 'j .... .' ~;: I;"') '..... ~? ~ ...-.:, tilO a: :: . .. Ili - i~~i I~ ~ oil ~ Ii ~ .JCos - j!;zen t: ~~iil ~..~ , \ , . /./-' e, ~l' /..i . . v .. . , LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZ lNG, M.D., CAROL K. ROBISON, D.O., and PAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants . . : AND NOW this ~ 1l. ORDER day of consideration of the Petition for . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 JURY TRIAL DEMANDED A .. ~.:o >t , 199;; upon Approval of Settlement, IT IS ORDERED that the said settlement is hereby approved. The Settlement Fund of $769,000 shall be allocated as follows: Total Proceeds Angino & Rovner Legal Fees Expenses $769,000.00 307,600.00 7,946.47 To Estate of Larry J. Runk for Survival Action 113,363.38 To Estate of Larry J. Runk for Wrongful Death Action 340,090.15 BY THE COURT: . . J. ~;> 'p, ';,:; '~ ,h 't,..;. ,;t ...~ ,~ ,,~~-.,. -",. -'-~ .> :--' "," .,,-", AUG 28 I 3Z rK 195 (If f ~l, !~'OHlC~ Tilt ,';,OHION . CUH:l""cPID ^ OTA~Y rr:N~<vl ,,:,,9,U.IHY "'''''-''''1:1 ,:' , il ,'t :~ ~ tf', ~, Ill, ._,'$:. ~.. ; ~., ~"'~ :;{:!.';::<,: kl;l~. ..~}. 1) "~~\::: ::,:'1~ i'~ ;g::l t} c ~~;l !'~ 'Ii . .,'f' ,~l,l;!' ,,'" ':";;I'l'f;~;~'iit; '" :it,;~.,~t l . ~i~'~~(~Ti.t II ~ ijf~t j i , .~"~, {~~,,~;;~~,'.'~i>,' ;,tj '~~' . ",~._~,,;. ," ", -,."f':'4 ,~ ~, .' "~;k~ :.Qi,'. - ..I" ~\, ';i'~,r~'~~"-::',<;!:: ,,;;' l' ._ 'l\; ,1" ", ~1, . \~Wf:'~~: .~ 1 ., t.:., c,~~r,'" ~- '~,;i .~t ,';, t.""ci A'f' ',t;,' ~:i "" \J ";0/- . ',~'; .::-~ ,:;}. Of' t~ -~ .;,) ;',,'~ fj " ,'40 " ~~-' ~~~. ~:; . '1"/ ~~-, '1<'~,\\ ' -"':to" ~.; -;"'. ~ 'mt; ; t '. ., -, I,.: I': I' I" I '~ j'",!. I, ' , , 'M il~ " I,' , . , ,',_:,:. ':J '.. in:> t. .. ! ; t r t I \ ! , ';:\11 ,;!~'4 j ~ \0 i ~. . " .. .. . .,.. I , -':""::---:--7~>V; , ~ '.~" ',C ,--,."':':~ '.:;'< ;..~l~';.'Y'~t.:.../':~, ,h,-., fN~?+~ ' : " "'.'. , . ~ :~ -,'" , . ;Ji 't~ !t"'~ " " ., LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants JURY TRIAL DEMANDED ORDBR AND NOW this day of , 1995, upon consideration of the Petition for Approval of Settlement, IT IS ORDERED that a hearing is scheduled for the , 1995, at o'clock day of . M., to be held in Courtroom No. . BY THE COURT: J. . LORETTA F. RUNK, Individually 1 and as Administratrix of the Estate of LARRY J. RUNK, Deceased, . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 . . . . plaintiff . . v. . . . . BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants . . . . . . . . . . . . . . JURY TRIAL DEMANDED PBTITXOH POR APPROVAL OP SBTTLEMENT Loretta F. Runk, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased, by her attorneys, Angino & Rovner, P.C., hereby petitions Your Court to approve the Wrongful Death, Survival Act settlement reached with Defendants in the above-captioned matter. In support of her Petition, Mrs. Runk avers as follows: 1. Loretta F. Runk is the Administratrix and widow of Larry J. Runk, deceased, by Letters of Administration granted to her by the Register of wills of CUmberland County, Pennsylvania. 2. Mrs. Runk was married to her husband, Larry J. Runk, for over thirty-two years, and they have two adult sons. 3. Larry J. Runk died on January 24, 1994, as a result of negligent care and treatment he received from the Defendants. 4. Between September and November, 1993, Mr. Runk was seen on four separate occasions by a member of Belvedere Family Practice 74834I8JS whom he believed to be a doctor, but who was actually a physician assistant. 5. Despite being diagnosed with congestive heart failure and despite having a complete physical examination, no EKG, stress test, echocardiogram, or referral to a cardiologist was ever made, nor was Mr. Runk seen on any of these occasions by a physician. 6. Such actions fall not only below the standard of care in the medical profession, but also they violate the Physician Assistant Act, 49 Pa. Code 518.121 ~ ~. 7. Indeed, Mr. and Mrs. Runk called Physician Assistant Kipp "Dr." Kipp throughout the entire time that Mr. Runk was under his care, and it was only after Mr. Runk's funeral that his wife learned that "Dr." Kipp was not a doctor. S. Mr. Runk was 52 years of age at the time of his death, and for over twenty years he had been employed at PPG as a job loader supervising six to eight men and as a fork lift driver. 9. Plaintiff produced two expert reports, namely the report of Dr. Gary Vigilante, a board certified cardiologist who also is involved in physician assistant utilization in Philadelphia (Exhibit A hereto), and the expert report of Harry Leister, an actuary (Exhibit B hereto). 10. Dr. Vigilante was prepared to testify that any middle- aged man with a strong family history of heart disease as Mr. Runk had and who complained of shortness of breath, worse at night and worse on lying down, had clear signs and symptoms of congestive heart failure warranting further testing. 2 .' 11. It was further Dr. Vigilante's opinion that had an EKG been done on Mr. Runk as it should have been, it would have been abnormal, warranting referral of Mr. Runk to a cardiologist. 12. Dr. Vigilante further was prepared to testify that since the Physician Assistant Act requires a doctor to see each patient every third visit, prohibits physicians from signing blank prescription forms to be later filled in by a Physician Assistant, and requires a doctor to discuss each patient seen by a Physician Assistant within twelve hours of the visit, the Defendants' violations of all of those legal requirements were causally related to Mr. Runk's death. 13. It is undisputed in this case that Mr. Runk saw Belvedere Family Practice from 1986 through the time of his death as participating members in the HealthAmerica HMO, and he needed a referral from the Defendants to go to a specialist, which referral was never proffered. 14. Based upon Mr. Runk's prior earnings and the many activities he performed around the house, including cooking, cleaning, home maintenance, vehicle maintenance, gardening, canning and freezing vegetables and fruits, etc., his net economic losses totaled $669,000, to which actuary Harry Leister would testify. 15. This case was listed by the Plaintiff for trial to occur during the September, 1995, civil trial term. 16. The pre-trial conference was to be held on August 23, 1995, pre-trial memoranda had already been filed, and the Court had issued a Rule to Show Cause on the Defendants as to why Plaintiff's 3 Motion in Limine to preclude subsequent changes in the Physician Assistant Act from being entered into evidsnce should not be granted, when the settlement was reached on August 21, 1995. 17. The Defendants deny liability for the death of the decedent I however, they nevertheless have agreed to pay in compromise all claims arising out of the death of Larry J. Runk $769,000 subject to approval of Your Honorable Court. 18. In view of the uncertainty of securing a verdict in excess of $769,000, your Petitioner and her counsel believe it is in the best interests of the Estate that the proposed settlement be accepted and approved. 19. Should the Court deem it necessary to schedule a hearing to approve the settlement, Mrs. Runk and her attorney will be present at the hearing to testify. 20. In order to obtain this settlement, the law firm of Angino & Rovner, P.C., initiated a lawsuit, sent out Request for Production of Documents and Interrogatories to the Defendants, responded to the New Matter of the Defendants, filed Supplemental Requests for Production of Documents and Supplemental Interrogatories, responded to six sets of discovery from the Defendants, filed a Motion to Compel when discovery was not forthcoming from the Defendants, and took the depositions of all Defendants. 21. Additionally, Plaintiff's counsel retained highly qualified experts and fully prepared the case for trial, settling only two days before the pre-trial conference and three weeks 4 before trial was to begin. preparation included extensive medical and legal research, employing and utilizing trial consultants for a "mock trial," and discussions with Plaintiff's liability expert. 22. In the course of preparing the case for trial, Angino , Rovner, P.C., incurred expenses of $7,946.47. Itemization of these expenses is attached hereto as Exhibit C. 23. The Petitioner entered into a Power of Attorney and Fee Agreement, the terms of which provided for a 40' contingent fee in the event of settlement after the case was prepared for trial. A copy of the Power of Attorney and Fee Agreement is attached hereto Exhibit D. 24. Plaintiff's counsel contacted the Department of Revenue, Office of Chief Counsel regarding division of the net settlement funds, and the Department of Revenue is in agreement that 75' of net settlement funds shall be allocated to the Wrongful Death Action, while 25' shall be allocated to the Survival Action. ~ correspondence memorializing this agreement attachod hereto as Exhibits E and F. 25. In light of all of the circumstances set forth in this Petition, Petitioner requests that the Court approve the settlement and find the following distribution fair, just and equitable: Total Proceeds $769,000.00 307,600.00 Angino & Rovner Legal Fees Expenses 7,946.47 To Estate of Larry J. Runk for Survival Action 113,363.38 5 To Estate of Larry J. Runk for Wrongful Death Action $340,090.15 WHEREFORE, Petitioner prays Your Honorable Court grant her Petition and approve the settlement under the terms set forth above so that distribution of the Medical Malpractice Catastrophe Loss payment can be made as of December 29, 1995. Respectfully submitted, ANGINO & ROVNER, P.C. ?~L.- Jj. S~ Pamela G. Shuman 1.0. 141696 4503 North Front street HarriSburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: August 25, 1995 I 6 VERIFICATION I, LORETTA P. RUNK, hereby verifY that the facts set forth in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are made subject to the penalties of 18 Pa. C.S. 14904, relating to unsworn falsification to authorities. WITNESS: Y~.b.~ ~ r. 12..~-" Loretta F. Runk DATED: August 25, 1995 46660IIJI EXHIBIT A PI~ILADELPHIA HEAr~T INSTITUTT: . Presbyterian Medical Center 39th and Market Streets Philadelphia. PA 191 04 G.ny'. Vlgll.mtc. M,I). (,,,,/iO\'f.I'CI,/,,,/J/\I""'I'\ .lUJH6NOO fAX,' ;U.66/,'J/ f' July 5, 1994 Angino & Rovner, P.C. 4503 N. Front Street Harrisburg, PA 17110 Attention:: Pamela Shuman, Esq. RE: Larry Runk Dear Ms. Shuman, I have been asked to submit an expert medical opinion re~arding the case of Mr. Larry Runk. I am an Attending CardiologJ.st at the Philadelphia Heart Institute located at Presbyterian Medical Center in Philadelphia as well as Assistant Clinical Professor of Medicine at the University of Pennsylvania School of Medicine. I am board certified in both cardiology and internal medicine. I am a member of several major medical and cardiology societies. This opinion is based on intensive scrutiny of the records provided to me. These documents include copies of records from Belvedere Medical Center, the emergency room of Carlisle Hospital and the autopsy report on Mr. Runk. I also reviewed your letter dated June 21, 1994 addressed to me. This communication will first summarize the apparent sequence of events with regards to Mr. Runk's medical problems and eventual death. I will then provide several observations and opinions. Mr. Larry Runk was a 52 year old man with known heavy cigarette smoking, obesity, strong family history of coronary disease and some degree of hypertension. He was apparently first seen at Belvedere Medical Center on April 1, 1986 for a small testicular mass. He was next seen in 1989 for a musculoskeletal problem. During this time, it was noted that his blood pressure was mJ.ldly elevated. He apparently was not seen again at this medical facility until 1992 at whJ.ch time he was treated for presumed carpal tunnel syndrome. His next visit was on September 9, 1993 at which time he complained of left arm pain with a negative physical exam. He was diagnosed as having "left arm strain and sprain especially of the left forearm" and he was treated with an anti-inflammatory medication. Mr. Runk presented to Belvedere Medical Center on September 20, 1993 because of significant shortness of breath. At that time, he was evaluated b~ Mr. Bruce Kipp, a physician assistant who worked at this medical facJ.lity. Mr. Runk was having shortness of breath when lying down and having increased shortness of breath on exertion. The 1'1.".1,\11'11,11' \l,',lu.t1 (l'lllt" ", .111 ..1'11',11,.,,, 1110 1'111\"",'1\ ,,'I"'11I1',\h.1I11.1 Angino & Hovner, P.C. He: Larry Hunk -2- July 5, 1994 impression was "probable early COPD and possible ~ild f~ilure secondary to recent non-steroidals~. lie was treated wJ.th ~asJ.x and Theo-24. A chest x-ray at that tJ.mo demonstrated "congestJ.ve heart failure with associated pulmonary edema and small right pleural effusion". It appears that Mr. Hunk was not actually seen ,by a physician at that time and it ~s. ullcleali" as to wheth~r th~ phys~cian assistant reported to the physJ.cJ.an assJ.stant supervJ.sor J.II a tJ.mely fashion. Mr. Hunk next came to the medical facility on September 29th with an improvement in his symptoms in ~hat he was lesl,l short of breath. He had some degree of hypertensJ.on and AccuprJ.l was started. . He subsequently came back on October 10, 1993 for a "complete physJ.cal exam". He was noted to have a low blood pressure of 90/64 at that time. A follow-up chest x-ray showed "residual chan~es compatible with borderline congestive failure". At that time, hJ.s Theo-24 was continued. It is unclear as to whether Lasix was continued. Follow-u~ blood pressure determinations were within normal limits. He once agaJ.n presented for an evaluation on November 22, 1993 and he was felt not to be in congestive heart failure by the physician assistant. He was not taking LasJ.x at that time. A note was then made on January 25, 1994 that the patient was found dead at work and that a follow-up phone call from the Coroner notified the ph~sician that the patient had expired due to severe atherosclerotic dJ.sease. Ap~arently, the correspondence on January 25, 1994 occurred with a physJ.cian and not the physician assistant. The emergenc~ room records from Carlisle Hospital documented that Mr. Hunk did arrJ.ve to this facility in ventricular fibrillation and that extensive resuscitative efforts were not effective in reviving him. The autopsy report emphasized Mr. Hunk's severe cardiac disease. He had severe three vessel coronary disease with multiple old myocardial infarctions as well as a probable acute myocardial infarction or heart attack. He had significant enlargement of his heart with thickening of his heart muscle. These factors were the cause of his death. In summary, Mr. Larry Hunk was a 52 year old gentleman with multiple significant cardiac risk factors which included heavy cigarette smoking, obesity, at least mild hypertension and a strong family history of coronary disease. He developed severe underlying cardiac disease which had been progressive for many years and was clinically evident in the fall of 1993 as he did present with congestive heart failure. However, there was no other evaluation other than two chest x-rays and urinalysis as well as blood work. Apparently, there was no EKG performed and there was no consideration as to the cause of this patient's congestive heart failure as well as the patient's long term treatment. He suffered a sudden cardiac death on January 24, 1994 because of severe underlying coronary disease and its complJ.cations. would like to make several Based on the above information, observations and opinions: 1. . On Septemb~r 20, 1?93, Mr. ~ilrry Hunk I?resented to Belvedere MedJ.cal Center wJ.th classJ.c congestJ.vc heart faJ.lure that was noted on the history with "shortness of breath usually at night time. Angino & Rovner, P.C. He: Larry Hunk -3- July 5, 1994 Worse with lying down". Physical e~am wa!1 also consistent with congestive heart failure with a "a few faJ.nt rales noted at the bases". The chest x-ray was also consistent with severe congestive hoart failure with associated pulmonary odema. Even though it was realized that this relatively young and very physically active patient presented with claosic congeotive Iwart failure, he was only treated wi th Lasix for a ohort period of Lime. Very import an t,ly, no other evaluation of this patient'o heart status occurr~d. It J.s we~l kno~n that, by far, the most conunon cause of congeotJ.ve heart faJ.lure J.n middle aged men io coronary disease. 'i'he average family phyoician would have initially ordered an EKG followed by non-invaoive cardiac stu<;lies such as stress,testing and echocardiogr~phy. Alternatively, a patJ.ent such as tllJ.s would often be qUJ.ckly referred to a Cardiovascular Specialist. As stated in the 12th edition of lIarrison's Principles of Internal Medicine (a conunonly referenced text book in medicine): "The establishment of a correct and complete cardiac diagnosis often requires the use of six different methods of examination: 1) history, 2) ph~sical exam, 3) electrocardiogram, 4) chest roentgenogram, 5) non-J.nvasive graphic examinations..., and occasionally Ii) specialized "invasive" examinations, such as cardiac catheterization, angiocardiograph~, and coronary arteriography....an electrocardiogram should be obtaJ.ned in every patient suspected of having heart disease". (Page 842) Harrison's Principles of Internal Medicine also states the following: "In evaluating patients with heart failure, it is important to identify not only the underlying cause of the heart disease but the precipitating cause of heart failure as well". (Page 090) It is clear that the health care professionals involved in the management of Mr. Hunk's congestive heart failure did not evaluate this patient's con~estive heart failure adequately. It is inconceivable that thJ.s gentleman would have had a normal EKG at the time of his presentation with CHF. The routine standards of care in evaluating such a patient with congestive heart failure would have dictated the need for further testing which would have included stress testing at a minimum. Without question, these test results would have been abnormal and further evaluation and/or therapy would have occurred. This gentleman certainly would have been placed on anti-anginal medications and very possibly may have required cardiac catheterization and revascularization had an initial cardiac evaluation been properly performed. In view of this above information, the care provided by the medical professionals at the Belvedere Medical Center clearly fell below the accepted standards of care in the evaluation and treatment of middle aged men with congestive heart failure. It is because of this substandard care that Mr. Runk received less than adequate medical therapy as well as an inadequate cardiac evaluation. !lad an adequate evaluation and treatment plan been performed on Mr. Runk, it is much more likely than not that severe coronary disease would have been recognized while he was still alive and that appropriate therapy could have occurred. It is also more likely than not that al?propriate therapy of his severe coronary disease would have improved llJ.s Angino & Rovner, P.C. He: Larry Runk -4- July 5, 1994 prognosis thereby decreasing his chance of premature death. 2. It is documented that Mr. Hunk was seen by the physician assistant on September 20, 1993, September 29, 1993, October 10, 1993 and November 22, 1993. I can find no notes from a physician regarding these visits. There is a lack of documentation as to whether Mr. Hunk's serious medical problems were discussed with a physician at the time of his visits. 'l'he rules and regulations in the Commonwealth of Pennsylvania require that a physician assistant be closel~ monitored with regards to patient care. As noted in the Pennsvlvanl.a Bulletin Vol. 23, No. 33, August 14, 1993, Page 3789: "A primary I?hysician assistant supervisor shall assume the following responsibilitJ.es. The supervisor shall:...See each patient in his office every third visit, but at least once a year". It does not appear to be documented that a physician supe:rvisor did see Mr. Runk at least every third visit as the rules and regulations stipulate. In addition, (page 3790): "The physician assistant shall report orally or in writing, to a physician assistant supervisor, within 12 hours, medical regimens executed or relayed by him while the physician assistant supervisor was not physically present and the basis for each decision to execute or relay the medical regimen.. .The physician assistant supervisor shall countersign the patient's record wJ.thin a reasonable tJ.me, not to exceed three days, unless counter signature is required sooner by regulation...... There is no documentation that Mr. Itunk's medical care was discussed b~ the physician assistant with a physician within 12 hours of his vJ.sit. There is also no documentation that the patient's record was countersigned within three days of his visits. The care provided by the frimary physician assistant supervisor and ~hysician assistant did fa 1 below the accepted standards of care if, J.n fact, they did not abide by the above mentioned Pennsylvania rules and regulations guiding physician assistant practitioners. Certainly, strict adherence to these guidelines would result in a lower chance of the inappropriate diagnosis and management of severe medical problems such as that presented in Mr. Runk's situation. 3. You have indicated that Mr. and Mrs Runk were unaware that Mr. Bruce Kipp was in fact a physician assistant. Once again, as stated in the rules and regulations for the Commonwealth of Pennsylvania with regards to physician assistants (page 3793): "A physician assistant may not render medical services to a patient until the patient or the patient's legal guardian have been informed that: The physician assistant is not a physician....The physician assistant shall wear an identification tag which uses the term "Physician Assistant.. in 16 point type or larger. The tag shall be conspicuously worn". Therefore, there is a concern that the physician assistant may have been misrepresented as a physician. It certainly would have been the prerogative of Mr. Runk to see a physician rather than a physician assil,lt~nt had,he been aware that he was actually being evaluated by a physJ.cJ.an assJ.stant. Angino & Rovner, P.C. Re: Larry Runk -5- July 5, 1994 In conclusion, Mr. Larry Runk presented to a physician assistant with significant congestive heart failure that was inadequately evaluated. This resulted in improper treatmcnt which more likcly than not contributed to his early death. 'l'here is also the concerns as to whether the rules and regulations of the Commonwealth of Pennsylvania with regards to physician assistant conduct were being properly followed at the Belvedere Medical Center. This may have contributed to the inadequate evaluation of this patient's CHF. Finally, there is the concern as to misrepresentation of the physician assistant to the patient at Belvedere Medical Center. I would be unfortunate available. happy to revise my opinions with regards patJ.ent's case should any further information to this become S' Gary GJV:tr M.D., F.A.C.P., F.A.C.C. EXHIBIT B Conrad l\tt. Siegel, Inc. Actuarics/Bcnefits c.."od M. SI.,eI, ".S.A. lIil1ry M. 1.e1'1t<, Ir., ".S.A. IIn.n S. Sann, F.S.A. Clyde I!. Olo,rl<h, I'.S.A. Iiul L. Mumm.rt, M.A.A.A. Rohe" I. IA.lan, A.S.A. lJavld F, Slirllna, A.S.A. Rohe" I. Mratlk, ".S.A. IJ..id II. KUlick, ".S.A. Jefrr.y S. My..., ".SA Thum3' L. Zimmerman. I:.S.A Ol.nn A. lI.r.r, F.S.A. 1'ly"1 S. Oonntlillele. A.S.A. Frank S. Rhod.., F.S.A., A.C.A.S. ChMI.. a. Friedland.r. A.S.A. 1I0lly A. ROSl, F.S.A. Enrolled A'luuiu (ERISA) Kevin A. P~b, A.S.A. lIe.llh ACIUIf)' --'. - . --.-. - -- -. - ---- --.'-- SOil Natiollwide Ilr;I'c 1', O. Jlox 59(111 lIarri,hur~, I'A 1711ll-...,9lKJ (717) 6'.2-56:1:1 Fax (717) ,),11I-9106 May 4, 1995 Pamela G. Shuman, Esq, Angino & Rovner, P,C, 4503 North Front Street Harrisburg, PA 17110-1708 RE: Larry J. Runk Dear Ms, Shuman: You indicated that Larry J. Runk was born on September 5, 1941 and that he died on January 24, 1994. As of the date of his death, Larry J. Hunk wss 52.4 years of age. The life expectancy for a white male age 52.4 is an additional 23,3 years, This implies an expected age at death of75,7 (52,4 + 23,3), The life expectancy is based upon a publication of the V,S, Department of Health and Human Services entitled" V.S, Decennial Life Tables for 1979-1981", Mr. Runk was employed by Pittsburgh Plate Glass from March 1972 until the date of his death. His position was that of a "Head Loader", a job that required him to supervise about 6.8 other loaders to run a forklift and to run an overhead crane, In 1993 he earned $35,563, I assumed that had it not been for his death he would have continued to earn $35,563 per year. In accordance with the Raczkowski vs. Bolubasz decision, it is permissible to take into account the value of fringe benefits, You provided me with information indicating that the employer spend $9,201 per year to provide Mr. Hunk and his family with fringe benefits. Fringe benefits consist of hospital, surgicsl and medical benefits, pension benefits, etc. Mrs, Hunk has estimated that her husband performed 20.30 hours of household services per week, For example, Mr, Runk did almost all of the cooking, He assisted with the grocery shopping and with the housework, He was a skilled gardener. He preserved a lot of the produce that he grew by canning and freezing, He mowed the lawn and otherwise maintained the property, He renovated and performed all of the upkeep on the family home. He maintained the family vehicles, For the purpose of this preliminary report, I assumed that had it not been for his death Mr, Runk would hsve provided 25 hours of household services per week, I conservatively valued the household services at the rate of $8,00 per hour. In a death case, it is necessary to deduct the cost of maintenance. The cost of maintenance consistent with the McClinton vs, White decision consists of the necessary and economical sum which a decedent would be expected to spend, based upon his station in life, for food, clothing, shelter, medical aUention and some recreation. Information provided by the V,S. Department of Labor, Bureau of Labor Statistics indicates that the cost of maintenance would amount to about 29% of the carnings capacity, ,. ~-_._._, ~ Conrad M. Si<:Wl, Jne. Pamela Shuman, Esq, May 4, 1995 Page 2 The following table shows the total value of the net loss on the basis of the data previously described: Earnings Capacity Fringe Benefits Household Services Cost of Maintenance $448,094 115,932 235,041 .129.947 $669.120 Net Loss The figures in the above table arc based upon a work life expectancy to age 65 except I assumed that had it not been for his death, Mr. Runk would have provided household services until sge 75. The calculation of the value of the future amounts docs not reflect a discount for interest in view of the Raczkowski vs, Bolubasz decision. This is preliminary report. With best regards, HML:dss Yours sincerely, . '",- ,\ . _L. ll' l . Leister, Jr., F~~kA ng Actuary <i ) Enc. EXHIBIT C AHOINO , ROVNER, P.C. .. C.uI/ACCOUJITUlG UQ18T1R .. ,RlPARBDI ./25/.5 'IU ..UK8IR............. .UlI PAQIII I CLI.NT.................. RUWl, BITAr! 0' LARRY J. DATI IN or'ICI.......... 5/03/f4 TIIB 0' CAli............ MH DIr&NDANT(8)...........1 DR. lIP'8 An'ORHIY IN CHARGI...... ,as roRNARDBR..............1 unRRAL...... .......... speclAL NOtIC........... ---------------------------------------------------------------------------------------------------. ... '1LII: lXPusa ... DESCRIPTION ..... OUAIIT:TY UNITIPRICE AItOUIlT PERSON 'AX CHARGlS ePER PAGI) 'I,o/n .00 1.00 3.00 PAX CHARan IPER PAGI) '1IIIn 2.00 1.00 2.00 'AX CBAAGZ8 (PER PAGI) ./25/15 2.00 1.00 '.00 PAX CUARClS CPER PACiI) 8/25/95 2.00 1.00 2.00 -----------.. IDENSI TYPE 'l'OTAL1 PAX ClWtaES IPIR 'ACEl 9.00 . t. ItOIlLBAAS - IUIHSES ./02/94 1.10 C. DRlaast - UPINSIS 11/03/94 5.50 pOI _ IXPBHSI8 '1'7fn 8.30 POI - EXPBHSIS '/31/n 25.20 DLJ - UPBHSIS 5f'lIn 10.S0 Hl88INCER RUN EXPENSI ./u/n 5.00 IXBIBIT BOARD , POSTER CBARGIS '/04/95 19.00 EXHIBIT BOARD , POSTER CHARGIS ./04/95 11.00 EXHIBIT BOARD , POSTER. CUARaIS ./04/95 61.50 -----....----- IDINSI TYPI 1'O'1'AL1 INVESTIGATION IXPINSI 110.40 . LONQ DIITAHCI 11/2'/94 4.31 LONG DIS':AHCI .I,5fn 20.00 --------..-- IIPIIISB Tn. TOTALI LONG DISTANCE 24.31 . PBOTOCOPIU 8/22/94 t.oo .25 '.25 PBarocOPIU 1/2C/n 2.00 ,25 ,'0 PBOTOCOPIU "o5fn 36.00 .2> '.00 'Baroe:OPIU "lOin 3.00 .25 ,,. PBO'l'OCOPIU ",o/n 15.00 ,25 3.15 PBarocoPIU ",o/n 10.00 .2' 2.50 AHOINO , ROVNER, P.C. .. CAIII/ACCOUN'1'%NO UOIITlR .. rILl NUHBIA............I '.21' CLIIN'1'.................I RUN~, ISTA1'Ior LARRY J. " ,RlPARlD. 1/2S/.S PAa. 3 ----------.---------------------..-------..-----.-------------------------------.-------------------- PH_IU PHOTOCOPIII PHOI'OCOPIII PHOTOCOPIIS 'II01'OCOPIIS PHOTOCOPIES PHOTOCOPIII P80T0C0PIII PHOTOCOPIII Pllaroeo.111 '''7115 U2.00 8/01115 1.00 8/01115 25.00 8/01/15 15.00 8/0./15 10.00 1/04/15 234.00 8"'/15 60.00 8"'/15 10.00 8/3'/15 250.00 8"'/15 85.00 IUDlU Tn. 'I'OTAIo. 'UO'l'OCOPIBS POSTMI POaT_ POaT.... POSTMI 1/01/14 10/241,. 7111/15 8/3'/15 IUINSI TYPE 'I'OTAIo1 PCI8TAG1: UNITID PARCEL elRVICS 1/14/15 IUINSI TYPI 'I'OTAIo. PUR01.\I'OR .25 105.50 ,2' .2' .25 '.25 ,25 3.75 ,2' 2,50 .25 58.50 .25 15.00 ,25 2.50 ,2' U.50 ,25 21.25 ..----------- 21S.75 . .2' .2' .32 50.13 -------.---- 51.83 . 11.50 .--------..-- 11.50 . ............ SUB-TOTAL 551.7t .. ..---..--------..-------------------------.-----------------------------..--..-..----.....---..-------------- ... CHECK BXPIH8!8 ... DUatJP'rlotf ....TI CUECKI AHCUNT BBLVlDERJ: MEDICAL CORPORATION "08/14 8349 25.00 GARY ". VIGIlAHT3, H.D. 7120/14 Int 815.00 sDIU,r 0' CUKBIJU.MD COUNTY 7/29/,. 9184 75.00 .ROTH OP CUKBaIU.AKD COUNTr 7/29/" 9181 .'.50 PRarB 0' CUKBaIU.AKD COUNTY 10/10/U 1045' 2.00 CU8'l'OOlAN 0' RZCORD8 10/'41'" 10614 10.00", 8HAR'l' CORP. 11/02/14 10862 23.13 HARI.IHB L. DEPAHPILI8 DIBIA 2/15/15 12413 215.00 HARLIHI: L. DEPANrlLI8 D/B/A 3/14/95 12'11 141.70 HAR.LINB I.. DIPAHPILIB DIBIA 5/17/15 1422' 251.30 CONRAD H. BIIGEL, IHC. 5/171" 14230 500.00 '1'IUAL CONSULTANTS, INC. 1/24/95 15331 5,000.00 DIlLY R. CUJUt, CP, CH 8/02/95 15413 125.25 ............ SUB-TOTAL 7,341.88 .. ..--...... 'l'OTAL EXPENSES 7,t03.n ... ..... RlCEIP'l'S ..... -....-....--------....--------------..--..--------------.-.-.---....-----------..------..--.-------------------.. BOUlICll IUWION ....TI AHCUNT ANOI"O . ROVNER, '.C. .. CABI/ACCOUHTINC galaDR .. ,,,,ARID. .,a"" rILl NUMI&R............. 'f21' 3 .AGI. a.J1HT.................. RUNK, IITATI or &.\IUlY ". ---------------------------------------------------------------------------------------------------- IWIIIl IWIIIl 1/23/14 1/22/n IBlUFF RI'l'UIUI VIDIO QIMI. n.ao 75.00 ..----- UClIPTI TO'l'AL 107.20 -..-....- gaJ:P1'B AJfD DJ:8IUUDCDmI 'l"O'l'AL.. 7,7".47_ --------------------------------------------------------------------.-----.. .. END or rlu .. . -0.' 7, '/9(, . 4 '/ . Or. ~1.,i1A.r<tc.. 125. Oil . p. fO(.. 5, ou + (fS-9f . 15'00 . disc , fee. 5 1111 + ",911 Ii fL" EXHIBIT D b. Settlement following suit but prior to trial or arbitration 35% 65% .....- POWER OF ATTORNE~Mi~ FEE AGREEMENT ..., ........... BV signing this Agreement. I (wel acknowledge tho' I (we) have engaged the law firm of Anglno & Rovner, P,C,. to represent me (us) under the following terms and conditions: 1. Anglno & Rovner, P,C, mav on my (our) behalf secure medical, work and other similar records, conduct an Investlgetlon, negotiate, and If necessary slart SUil against anvone responsible for mv (our) Injuries end losses with respect to l,.., nt d.a.l\vv.l ~ "'-r. l2u.....k- , wllh full power and aUlhorltv to appear on behalf of the undersigned In anv Court of record or In anv administrative or olher proceeding, to do and perform all and every act and thing whatsoever that mav be requisite and necessarv to be done In connection Wllh the above claim as fullV as the undersigned might or could do If personallv present; herebv ratlfvlng and confirming all that said attornevs shalllawfullv do or cause to be done therein bV virtue of this power of attornev. 2. I (we) agree to pav Anglno & Rovner,P,C" anv out.of.pocket expenses thev Incur to secure records, experts, etc" plus a contingent fee thaI Is totallv dependent upon their obtaining monies for me (us) as follows: Anoino & Rovner, P.C. Me (UsI a, Settlement prior to starting sull 30% 70% c, Settlement or verdict at trial or arbitration, after trial, arbitration, or appeals or shortlV before trial and after the case has been totallv prepared 40% 60% d. If n ben 01h s ($400) excee -40 of the total recoverv of value of benefit ~b5 Settlement or verdict If for anv reason I (we) negotiate direct1v or engage other counsel to represent me (us) e. 20% 80% f. Other cases 3. In the event that anv settlement is made on a structured or deferred pavment basis, attornevs shall be entitled to receive their percentage based on the present value of the structured settlement, If paid as a lump sum at the time of settlement, I (we) agree not to settle or discuss settlement of mv (our) case without the written consent of Anglno & Rovner. P.C. BV signing this Agreement. this /2 (l1 dav of ~, 19 q '+1 (we) acknowledge that I (we) have read, understood, and received a coPV of same and agree wllh lIS termS'iirld conditions. WITNESS: ~Jj g!,u~ - .. - -- L 1"'0/ r ~ _AA.-L (SEAL) (SEAL) EXHIBIT E /- JUSIlPII M. MEJ.JU1I nRRV S.IIVMAN DAVID I.. Ltlrz MIClIAEL E. KOSIK PAMI!U o. SIIUMAN CAnlERlNE M. MAIIADV.SMml RJellARD A SADLOCK DAVID S. WISNIlSKI ANGINa & ROVNER, p, C, NnoUl C. OLSON MIClIAEL I. NAvmKV ROBIN I. MAJll.JUJA LAWRENCIl P. BARONE DAWN L. IENNINOS snWIIEN R. PEOERSIiN SOLOMON Z. KREVSKV JOSIlPII M. DORIA L1SnDIN TIlE 8FSr LAWYERS -IN- AMERICA RICIIARII c. ANGINO NIllL'. ROVNER August 22, 1995 SENT VIA PAX TRANSMISSION Ms. Vicky Trimmer, Senior Assistant Counsel Office of Chief Counsel Commonwealth of Pennsylvania Department of Revenue Strawberry square Harrisburg, PA 17101 Re: Runk v. Kipp, et al, No. 4307 civil 1994 (C.P. Cumberlandl Dear Ms. Trimmer: This is to confirm our telephone conversation of August 22, 1995. At that time, I explained that a settlement was reached in this medical malpractice matter under which the Defendants will pay $769,000 to resolve this case. You agreed to a 75%/25% allocation between the wrongful death and survival actions. We assume that goes to the net recovery after deduction of court-approved attorneys' fees and expenses. Please verify that your office is in agreement so I can represent same to the Court in Cumberland county. Thank you for your cooperation in this matter. Very truly yours, WJ1.~ Pamela G. Shuman PGS/bjs 74882/BJS 'S03 NORTH FRONT STREET, HARRISBURG, PA 17110-1708 (717)238-6791 FAX (717)238-$610 I'~ EXHIBIT F ~24-1995 16:3<3 FRCJ'1 llEPT IF REU/a-tIEF cou;a TO 8';'1723856113 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OFFIC! OF CHIEF COUNSEL DEPT. 281061 HARRISBURG, PA 17128-1061 AugU9t 23, 1995 Pamela G. Shuman, EDq. Angina and Rovner, P.C. 4503 North Front Street HarriDburg, PA 17110-1708 Re: Inheritance Tax Survival Action Dear Ms. Shuman: This is in response to your August 22, 1995, letter requesting that I review your correspondence for B survival action allocation. After review, The Department of Revenue has no objection to the allocation of 25% to the Survival Action, This portion must be reported on a Pennsylvania Inheritance Tax Return and the appropriate tax paid. I trust this responds to your request. Please do not hesitate to contact me if I may be of further assistance. Very truly yours, ~A.~2J Vicky A.," Trimmer Senior Assistant Counsel cc: Estate File VAT:JAA at....~!..~..f ".0;;;: roTA.. P.02 (,..."",.... .r'li~""i CERTIFICATE OF SERVICE I, Barbara J. smith, an employee of Angino , Rovner, P.C., do hereby certify that I have served a copy of the foregoing Petition for Approval of Settlement upon counsel for Defendants by placing same in the United States mail, postage prepaid, on the 25th day of August, 1995, addressed as follows: Evan Black, Esquire Post, Schell, P.C. 101 North Front Street Harrisburg, PA 17101 Ife.- ~ ,<- ~ -d..; Bar ara J. Sm th \ l "---, , .. i" ':;;'iJ: , :;~ ','Yl 1;-';;r '};N loli' c ,~~~i:~~i~8.~;;,,:~; ~:\~;,:.:;: ~'~,x{tJ ~,VOU"'" IIIllDY JIOTlJllIO ,10 ..... (if' :')'. .A: WIIITTIN. """O.~I' :T9,!TII',~J , ,.-ENCLOIID. -",,' ',-,' :_,"_'-~--,_--'~;',",:~,~..';i_,.'r)lt':,:- , 'WITHIN TWENTY IIOIOAVli: 'ROM"b) llIMe& H_ OR It. JUOGIlIENT/:r: . J MAY 81 ENTERED AGAIN8TVOU'":!'!i::;...;t~,.~~: IV - ',. - 'i.,-.~.-..,l":.:i_:;:::'l!;.';,'i;'Jf AnORNEY ; __i,:",,;,/,,";:f~ "','{;,'j~~~~ '.. " I , ,. "..., "ho;i"n.'''' LORETTA F. RUNK, Individually and as Administratrix of the Estate of Larry J. Runk, Deceased . . . . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. Docket No. 4307 civil 1994 . . . . BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER . . civil Action - Law JURY TRIAL DEMANDED DEFENDANTS RESPONSE TO PLAINTIFF'S MOTION FOR RECONSIDERATION AND NOW, come the Defendants by and through their attorneys, POST & SCHELL, P.C., and file the within opposition to the Plaintiff's Motion for Reconsideration, averring as follows: 1. Admitted. 2. Denied as stated. Counsel for the Defendants does not have sufficient knowledge as to when the Defendant's Petition was received by the Plaintiff's counsel. 3. Admitted. However, Plaintiff's counsel did not state any objection to the sealing of the Settlement in this matter, and in fact, the Plaintiff's counsel agreed to the sealing of the settlement documents. 4. Denied. To the contrary, the Defendants never asserted in their Petition that the Plaintiff did not oppose the sealing of the records. Counsel for the Defendants only stated that the Plaintiff was not opposed to sealing the settlement of this matter. S. Admitted. 6. Admitted. (" ....' .- 7. Admitted. 8. Denied as stated. The Defendants are without knowledge as to when the Plaintiff's documents were being forwarded to the Court for filing, and when the Plaintiff received the Court's Order. 9. No response required. To the extent that a reply may be deemed required, Defendants request that this Honorable Court affirm its decision. 10. No response required. To the extent that a reply may be deemed required, Defendants request that this Honorable Court affirm its Order of September 15, 1995. 11. No response required. WHEREFORE, Defendants respectfully request that this Court deny reconsideration of this matter. POST & SCHELL, P.C. BY:.o~ r:: p~~ Dean F. Picarella, Esquire 101 North Front Street Harrisburg, PA 17101 (717) 232-5931 I.D. No. 65896 Attorney for Defendants 2 (' . , CERTIFICATE OF SERVICE I, Jamie M. Dengler, an employee of the law offices of Post & Schell, P.C., do hereby certify that on the date listed below, I did serve a true and correct copy of the foregoing document upon the following person(s) at the following address (es) by sending same in the United states mail, first-class, postage prepaid: Pamela Shuman, Esquire ANGINO & ROVNER, P.C. 4503 North Front Street HarriSburg, PA 17110 DATE: q \~lo\C\'5"" cdcJ.Y\W \'i\~~ JAMIE M. DENGLER J ) ,_":'~{~l!:,, 'f'~': !" . ..!.'- .,', "','( <-,,, " ".,' .".,:;, .' d'> . , ,",' -'\ ~ I i' . \ . ,;j !;~ ..~:2]_~.:::::''::'::':::::':::==:;~' ~~;\ '~'''''~'-, . ~'-;":'~;:;.~' ;':-4i ';:..5;:/; ;; SEP ZB 3 5li fK '95 I "L-omCf or l,tl 'i'l'iiION~lAh't CUlmERLAl1tl Cl'UIITl OEl\l\~YLV'\/II^ P' "":-,"_...-.-,..-~". . " " #I' " t i ) ....... :""", ~'-,':~~.' -- . . _. l . $- ~ 1 . , . ,-" 'j '\"':l"-"*"~' c.','" . . . ,,- .,-',' -' " .: .. .. " , '.1. , :t,..';'::~~ " .... '0 ~- [.1; ""J L~ ~: .. -". u,Q M :1..... '- "'\ . ~. C"J<. ." .. ~ f~l,) c:.: ;',)<' ,. . (~' 0'.., .. { . m .- ,_ L. ~'_. hi ! ',:-: -~ l~tl.! ~ . . ".j -rl: " t',:l~... ..~ ; 1:- '" :-:i L, C> lJ ~~~ 15~t: _ i~I~11 ~oll~~i !: .JCo .. ZZ - a~ii! ~.~ '. , . ...... M;. ,.. .l.055U,t.,. tlu.t'... ISllt ()toI...o,O).I."""1'I1l1111'11'''' : .... ... .' i . LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, Plaintiff v. BRUCE G. KIPP, III, P. A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CORPORATION, Defendants ,- \ , IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 4307 CIVIL 1994 JURY TRIAL DEMANDED TO THE PROTHONOTARY: PRAECIPE TO SETTLE. SATISPY AND DISCONTINUE Please mark the above-captioned action as settled, satisfied and discontinued, and issue a Certificate of Settlement. DATED: January 2..;', 1996 84150/BJS ANGINO & ROVNER, P.C. +2C'YvLZ elf J. ~kc(v~-- Pamela G. Shuman I.D. 1/41696 4503 North Front street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff .. , , CERTIFICATE OF SERVICE I, Barbara J. Smith, an employee of Angino & Rovner, P.C., do hereby certify that I have served a copy of the foregoing Praecipe to Settle, Satisfy and Discontinue directed to Defendants upon counsel for Defendants by placing same in the United states mail, postage prepaid, on the ;lh day of January, 1996, addressed as follows: Evan Black, Esquire Post & Schell, P.C. 101 North Front street Harrisburg, PA 17101 /!,? /~ J -:I rL.:t:-L Barbara J. Smith -::r en . :c C>.. a> N N CJ => -.. ~~ .. ,- wt:-, :fi:-' l'.lz'-"r uoc.,:,..\ 1..:::-('\',.. ',; J';': ~ .,' .,;" .'~@ "7.' :; (.... .....11'-..-.. .~, a..I- ~a("....... rill. r"""e-' ("~ . ,~.,"~ '.f))1 10'" 11'1 ~ ;:) V'l I V"'I I ~k) \~ .~\~ ~ ~ "- l- I.<) \\..:, '" ~ N) ......... N) '\) .,... ~ U"'O a:W:: "' ffi ~ ~ tl~!ij!; ~a:~~ :l;oll~C) 5oo~ ZZ\!1 -"'II: ~~~ ;;; I~ ,.. ~ t:: , tr ~0 " LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY PENNSYLVANIA . CIVIL ACTION - LAW NO. 14- J/307 &l-t~J~ Plaintiff v. BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants . . . . . . . . : JURY TRIAL DEMANDED COMPLA:IHT 1. Loretta F. Runk is the Administratrix and widow of Larry J. Runk, deceased, by Letters of Administration granted to her by the Register of Wills of cumberland County, Pennsylvania. 2. Plaintiff, Loretta F. Runk, is an adult individual who resides in Plainfield, cumberland County, Pennsylvania. 3. Defendant, Bruce G. Kipp, III, P.A., is a physician assistant for Defendants Robert A. Hollen, M.D., Harold G. Kretzing, M.D., Carol K. Robison, D.O. and Family Practice - Belvedere Medical Center in Carlisle, CUmberland County, Pennsylvania. 4. Defendant, Robert A. Hollen, M.D., is a physician licensed to practice medicine in the Commonwealth of Pennsylvania, and he practices with Family Practice - Belvedere Medical Center in Carlisle, cumberland County, Pennsylvania. 4892J/BJS ,. " LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. Plaintiff v. BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, M.D., HAROLD G. KRETZING, M.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants JURY TRIAL DEMANDED NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take aotion within twenty (20) days after this Complaint and Notioe 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 OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Lawyer Referral Service Court Administrator Cumberland County Courthouse Carlisle, Pennsylvania 17013 (717)240-6200 45026/BJS r;~,'#':~:t'..-,.. LORETTA F. RUNK, Individually and as Administratrix of the Estate of LARRY J. RUNK, Deceased, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. Plaintiff v. . . . . BRUCE G. KIPP, III, P.A., ROBERT A. HOLLEN, H. D. , HAROLD G. KRETZING, H.D., CAROL K. ROBISON, D.O., and FAMILY PRACTICE - BELVEDERE MEDICAL CENTER, Defendants . . . . . . . . . . . . . . JURY TRIAL DEMANDED NOTICIA La han demandado a usted en la corte. si usted quiere defenderse de estas demandas expuestas en las paginas sugnuientes, usted tiene viente (20) dias de plazo al partir de la fecha de la escrita 0 en persona 0 por abogado y archivar en 1a corte en forma escrita sus defensas 0 sus objectiones alas demandas en contra de su persona. See avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO IMHEDIATEMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME FOR TELEFONO A LA OFICINA CUYA DlRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Lawyer Referral Service Court Administrator Cumberland County Courthouse Carlisle, Pennsylvania 17013 (717)240-6200 .i " 5. Defendant Harold G. xretzing, M.D., is a physician licensed to practice medicine in the Commonwealth of Pennsylvania, and he practices with Family Practice - Belvedere Medical Center in Carlisle, cumberland county, Pennsylvania. 6. Defendant Carol X. RObison, D.O., is a physician licensed to practice medicine in the Commonwealth of Pennsylvania, and she practices with Family Practice - Belvedere Medical Center in Carlisle, CUmberland County, Pennsylvania. 7. Defendant Family Practice - Belvedere Medical Center, is a group practice with offices located in Carlisle, CUmberland county, Pennsylvania. 8. At all relevant times hereinafter, Defendant Xipp was the agent, apparent agent, servant, and/or employee of Defendants Hollen, Xretzing and Robison. 9. At all times relevant hereinafter, Defendants Xipp, HOllen, Kretzing and Robison were agents, apparent agents, servants, and/or employees of Family Practice - Belvedere Medical Center. 10. Mr. Runk began going to the Defendants for health care on April 1, 1986, when he was 44-years old. 11. Unbeknownst to Mr. Runk, he had a history of hypertension, or high blood pressure, that was known to the Defendants but not treated. 12. Mr. Runk had a strong family history for coronary artery disease and carjiac disease. 2 13. At no time did the Defendant. eUci t from Mr. Runk a complete family history for cardiac and coronary artery disease. 14. Mr. Runk was lIeen by the Defendants on September 9, 1993, at which time he complained of left arm pain with a neqative physical examination. 15. At that time, September 9, 1993, Defendant Robison diaqnosed Mr. Runk as havinq left arm strain and sprain especially of the left forearm. 16. Despite havinq been a patient of the Defendants since 1986, for the first time on September 9, 1993, Defendant Robison suqqested that Mr. Runk have a complete physical examination since "he has never had one." 17. Mr. Runk presented to the Defendants on September 20, 1993, with complaints of shortness of breath, usually at bedtime and worse with lyinq down. 18. At that appointment on September 20, 1993, Mr. Runk was seen by Defendant Kipp, whom he believed to be a physician and who the personnel in the Defendants' office referred to as "Dr." Kipp. 19. At that September 20, 1993 appointment, Mrs. Runk told Defendant Kipp that she had noticed her husband to become more short of breath and fatigued when doinq physical exertion throuqhout the daytime. 20. Defendant Kipp diaqnosed Mr. Runk's symptoms as "probable early COPD (chronic obstructive pulmonarj disease) and possible mild failure secondary to recent non-steroidals." 3 21. Defendant Kipp prescribed for Mr. Runk lasix, a diuretic, and theo-24, for COPD. 22. The prescription blanks Defendant Kipp used to write the prescriptions at this time and at all other times had been pre- siqned by one of the Defendant doctors, none of whom were consulted before the prescriptions were qiven to the patient. 23. Defendant Kipp also had Mr. Runk underqo a chest x-ray that showed "conqestive heart failure with associated pulmonary edema and small riqht pleural effusion." 24. Mr. Runk was not seen by a physician on september 20, 1993. 25. On September 29, 1993, Mr. Runk returned to the Defendant Family Practice - Belvedere Medical Center where he was aqain seen by Defendant Kipp and was not seen by a physician. 26. At that time, Mr. Runk reported that he was less short of breath than he had been nine days earlier. 27. Hr. Runk showed siqns of hypertension, and for the first time medication for hypertension was prescribed for him by Defendant Kipp. 28. Defendant Ripp directed Hr. Runk to return in two to three weeks for follow-up on his hiqh blood pressure. 29. On October 18, 1993, Mr. Runk aqain went to the Defendants, this time for a "complete physical exam." 30. Mr. Runk was seen only by Defendant Ripp on October 18, 1993. 4 31. Mr. Runk was noted to have low blood pressure on October 18, 1993, and the high blood pressure medicine was discontinued. 32. The "complete physical exam" included as the only test of Mr. Runk's heart, Defendant xipp listening to his heart with a stethoscope and reporting it as normal. 33. No EXG was ever ordered by the Defendants for Mr. Runk. 34. On October 18, 1993, Mr. Runk reported shortness of breath with exertion and activity. A repeat chest x-ray ordered on October 18, 1993, showed "residual changes compatible with borderline congestive failure." 35. No further investigation as to the causes of Mr. Runk's congestive heart failure or shortness of breath was undertaken by the Defendants. 36. On October 18, 1993, only Defendant Xipp saw Mr. Runk, and he was not seen by any physician. 37. Despite complaints of shortness of breath, both at night and on exertion, Defendant xipp diagnosed Mr. Runk as a "Healthy male with history of hypertension, controlled." 38. Defendant Xipp continued Mr. Runk on theo-24, halted his high blood pressure medication, and halted the diuretic. 39. Defendant Xipp instructed Mr. Runk to return to the office to have his blood pressure checked every two weeks, which Mr. Runk did on November 5 and November 12, 1993. 40. On November 22, 1993, Mr. Runk again went to the office of the Defendants, where he was again seen only by Defendant Xipp and not by any physician. 5 41. He was told by Detendant Kipp to return in two months. 42. On January 24, 1994, Mr. Runk was tound unresponsive at work. 43. Attempts to revive him were unsuccessful and Mr. Runk was declared dead at Carlisle Hospital. 44. An autopsy was pertormed on Mr. Runk that determined his cause ot death to be as a result ot chronic hypertension and cardiovascular disease, and determininq that Mr. Runk had had at least one previous heart attack, approximately two months betore. 45. Prior to his death, Mr. Runk was 52-years old, married, and employed as a laborer at Pittsburqh Plate Glass tor twenty-one years. 46. The death of Larry J. Runk was the direct and proximate result ot the neqliqence and/or qross neqliqence of Detendants Bruce G. Kipp, III, P.A., Robert A. Hollen, M.D., Harold G. Kretzinq, M.D., Carol K. RObison, D.O., and as aqents, apparent aqents, servants and/or employees ot Defendant Family Practice - Belvedere Medical Center. COUN'l' I Loretta ~. Runk. IndividuallY and as Administratriz of tbe __tat. of Larrv J. ~uftk. n.a....4 v. Bruce G. KiDD. III. P.A. 47. Paraqraphs 1 throuqh 46 of the Complaint are incorporated herein by reference. 48. Defendant Kipp acted negliqently with respect to Mr. Runk by: (a) failinq to recoqnize Mr. Runk's classic symptoms 6 of congestive heart failure, (b) failing to treat Mr. Runk's classic signs of congestive heart failure, (c) failing to evaluate the cause of Mr. Runk's classic congestive heart failure, (d) failing to order tests to evaluate Mr. Runk's classic congestive heart failure, (e) failing to refer Mr. Runk to a cardiology/ cardiovascular specialist upon evidencing classic symptoms of congestive heart failure; (f) failing to take a complete family history of Mr. Runk; (g) failing to identify the underlying cause of Mr. Runk's heart disease; (h) failing to identify the precipitating cause of Mr. Runk's congestive heart failure; (i) failing to apprise Mr. Runk that the Defendant was actually a physician assistant and not a physician; (j) failing to have Mr. Runk seen by a physician as required by the laws and requlations governing the practice of physician assistants in the Commonwealth of Pennsylvania; (k) exceeding the scope of authority of a physician assistant as prescribed by statute and requlation; (1) failing to discuss Mr. Runk's care with a physician 7 supervisor as required by statute and regulation in Pennsylvania, (m) failing to identify himself as a physician assistant in violation of the statutes and regulations of this commonwealth, (n) writing pre-.igned prescriptions and ordering te.t. without identifying himself as a physician assistant as required by statute and regulation. of this Commonwealth, (0) failing to assure that Mr. Runk was seen by a physician at least every third office visit as required by statute and regulations of this Commonwealth, and (p) impersonating and/or misrepresenting him.elf as a doctor. WHEREFORE, Plaintiff, Loretta F. Runk, individually and as Administratrix of the Estate of Larry J. Runk, deceased, demands judgment against Defendant Bruce G. Kipp, III, P.A., in an amount in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT :II Loretta .. Runt. Individual Iv and .s Administr.triz of the Z.tat. of Larrv J. Runt. d.o....d v. Rob.r~ A. RolleD. K.D.. Barold G. Kret.ino. K.D.. aDd Carol K. Robi.OD. D.O. 49. Paragraphs 1 through 46 of the Complaint and Count I are incorporated herein by reference. 8 50. At all times relevant hereto, Defendant lCipp was the agent, apparent agent, servant and/or employee of Defendants Hollen, lCretzing and Robison. 51. Defendants Hollen, Kretzing and Robison, acting through their agent, apparent agent, servant and/or employee Defendant Kipp, are liable to Plaintiff Loretta F. Runk, individually, and as Administratrix of the Estate of Larry J. Runk, deceased, for their negligence as set forth in paragraph 46, incorporated herein by reference. 52. Additionally, Defendants Hollen, Kretz1ng and Robison are liable to Loretta F. Runk, individually, and as Administratrix of the Estate of Larry J. Runk, deceased, for their negligence in: (a) failing to recognize Mr. Runk/s long-standing hypertension 1 (b) failing to treat Mr. Runk's long-standing hypertension 1 (c) failing to assure that Mr. Runk was advised to and did have periodic physical examinationsl (d) failing to assure that the rules and regulations of the Commonwealth of Pennsylvania with regard to physician assistants were followedl (e) failing to see Mr. Runk, examine and assess him despite his classic signs of congestive heart failurel (f) failing to order appropriate tests to diagnose the underlying cause of Mr. Runk's classic symptoms of heart disease/congestive heart failurel 9 (q) failinq to order appropriate tests to diaqnose and then treat Mr. Runk's underlyinq cardiac disease, (h) failinq to refer Mr. Runk to a cardiology and/or cardiovascular specialist, (i) failinq to take a full and complete family medical history, (j) failinq to assure that Defendant Kipp, a physician assistant, was identified to Mr. Runk as a physician assistant, (k) failinq to assure that Mr. Runk knew Defendant Kipp was a physician assistant, (1) failinq to assure that Defendant Kipp at all times wore a taq in at least 16 point type identifyinq him as a physician assistant: (m) failinq to assure that Mr. Runk knew he could see a medical doctor instead of Defendant Kipp if he so desired: (n) allowinq Defendant Kipp to impersonate and/or misrepresent himself as a licensed physician: (0) failinq to examine and evaluate Mr. Runk personally at least every third visit as required by statute and regulation of this Commonwealth: (p) presiqninq prescription blanks in violation of the statutes and regulations of this Commonwealth: and (q) failing to supervise Defendant Kipp's care of Mr. Runk, thereby violatinq the statutes and regulations 10 of this Commonwealth. WHEREFORE, plaintiff, Loretta F. RUnk, individually and as Administratrix of the Estate of Larry J. Runk, deceased, deaands jud9lllent against Defendants Robert A. Hollen, M. D., Harold G. Kretzing, M.D., and Carol K. RObison, D.O., in an amount in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COURT III Loretta ~. Runk. Individuallv and as Administratrix of the .state of Larrv J. Runk v. ~amilv Medioine - Belvedere Medioal Center 53. Paragraphs 1 through 46, and Counts I and II of this Complaint are incorporated herein by reference. 54. At all relevant times herein, Defendants Kipp, Hollen, Kretzing and Robison were agents, apparent agents, servants and/or employees of Defendant Family Medicine - Belvedere Medical Center. 55. Defendant Family Medicine - Belvedere Medical Center, acting through its agents, apparent agents, servants and/or employees is liable to Plaintiff Loretta F. Runk, individually and as Administratrix of the Estate of Larry J. Runk, deceased, for its negligence as set forth in Counts I and II, incorporated herein by reference. 56. Additionally, Defendant Family Medicine - Belvedere Medical Center, acting through its agents, apparent agents, servants and/or employees is liable to Loretta F. Runk, 11 individually and as Administratrix of the Estate of Larry J. Runk, deceased, for its neqliqence in: (a) failinq to develop appropriate quidelines and procedures for patient monitorinq when the patient is seen by a physician assistant, (b) failinq to select, monitor and supervise properly physicians and other medical personnel to whom it entrusts the care and treatment of its patients, and (c) failinq to have in place proper procedures to enforce the statutes and requlations applicable to physicians and physician assistants in the Commonwealth of Pennsylvania. WHEREFORE, Plaintiff, Loretta F. Runk, individually and as Administratrix of the Estate of Larry J. Runk, deceased, demands judqment aqainst Defendant Family Practice - Belvedere Medical Center, in an amount in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requirinq compulsory arbitration. CLAIM I - Wronaful Death Loretta ~. Runk. Individual Iv and as Administratrix of the Estate of Larrv J. Runk. deoeased v. Bruce G. KioD. IIZ. PeA.. Robert A. BolleD. K.D.. Barold G. Kretsina. M.D.. Carol K. Robison. D.O.. and ~amilv Praotioe - Belvedere Medioal Center 57. Paraqraphs 1 throuqh 46, and Counts I, II and III of this Complaint are incorporated herein by reference. 58. Plaintiff Loretta F. Runk brinqs this action for the wronqful death of Larry J. Runk, deceased, on behalf of all persons 12 ,. entitled to recover damage. under and by virtue of the Act of 1976, P.L. 586 No. 142, 12, 42 Pa, C.S.A. 18371. 59. The decedent did not bring an action for injuries during his lifetime. 60. Plaintiff, Loretta F. Runk, an adult individual, is a resident of Plainfield, cumberland County, Pennsylvania. 61. Plaintiff, Loretta F. Runk, is the widow of Larry J. Runk, deceased, who died on January 24, 1994, and she is the Administratrix of the Estate of Larry J. Runk, deceased. 62. Pursuant to Pennsylvania Rule of civil Procedure 2202, Plaintiff Loretta F. Runk brings this action for wrongful death on her own behalf and on behalf of all other persons who are or may be entitled to share in damages. 63. The name, last known address and relationship to the decedent of each person entitled by law to recover damages is as follows: HAD RELATIONSHIP ADDRESS 16 West Main street Box 92 Plainfield, PA 17081 R. D. n Millerstown, PA 17062 16 West Main street Box 92 Plainfield, PA 17081 64. During his lifetime, Larry J. Runk did not commence an Loretta F. Runk Wife Larry J. Runk, II (age 32) Son Scott A. Runk (age 27) Son action to recover damages for the injuries which caused his death, and no other action has been filed to recover damages for the 13 wrongful death of Larry J. Runk. At the time of his death, Larry J. Runk was 52-years old, having been born on september 5, 1941. 65. Defendants Kipp, HOllen, Kretzing, Robison, and Family Medicine - Belvedere Medical Center are jointly and severally liable to the aforementioned beneficiaries of Lan"Y J. Runk, deceased, for damages as set forth herein. 66. As a result of the death of the decedent, his wife, Loretta F. Runk, has suffered a pecuniary loss and has been and in the future will be deprived of the decedent's contributions, support, services, and claim is made therefor, as well as claim for any other damages which are recoverable under the wrongful death statute. 67. As a result of the death of the decedent, plaintiff, Loretta F. Runk, has incurred medical, funeral, burial and related expenses, for all of which claim is made. WHEREFORE, Plaintiff, Loretta F. Runk, individually and as Administratrix of the Estate of Larry J. Runk, deceased, demands judgment against Defendants Bruce G. Kipp, III, P.A., Robert A. Hollen, M.D., Harold G. Kretzing, M.D., Carol K. Robison, D.O. and Family Practice - Belvedere Medical Center, in an amount in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. 14 CLAIM 1% - survival ActioD Lor.tta .. Duftk. Adainiatratriz or tb. ..tat. of Larrv J. Dtlftk. d.a....d v. Brua. d. KiDD. %1%. >>.A.. Rob.rt A. Boll.D. M.D.. Harold G. zr.tsina. M.D.. Carol K. .obi.OD. D.O.. and paailv Pr.o~ioe - Belvedere .edioal CeD~er 68. paragraphs 1 through 46, Counts I, II and III, and Claim I are incorpora~ed herein by reference. 69. Plaintiff, Loretta F. Runk, brings this action on behalf of the Estate of Larry J. Runk, deceased, under and by virtue of the Act of 1976, July 9, P.L. 586, No. 142, 52, 42 Pa, C.S.A. 58302. 70. Defendants Bruce G. Kipp, III, P.A., Robert A. HOllen, M.D., Harold G. Kretzing, M.D., Carol K. Robison, D.O. and Family practice - Belvedere Medical Center are jointly and severally liable to the Estate of Larry J. Runk, deceased, for damages as set forth herein. 71. Plaintiff, Loretta F. Runk, as Administratrix of the Estate of Larry J. Runk, deceased, claims on behalf of said Estate the damages suffered by the Estate by reason of the death of the decedent, for the pain and suffering decedent underwent prior to his death, loss of earnings and earning power for the decedent's life expectancy, and all other damages sustained by the said Estate by reason of the death of the decedent. WHEREFORE, Plaintiff, Loretta F. Runk, Administratrix of the Estate of Larry J. Runk, deceased, demands judgment against Defendants Bruce G. Kipp, III, P.A., Robert A. Hollen, M.D., Harold 15 G. Kretzinq, M.D., Carol K. RObison, D.O. and Family Practice - Belvedere Medical Center, in an amount in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requirinq compulsory arbitration. CLAXM XXX - Punitiv. Dam.a.. Lorett. ~. Runk. Xndividu.llv .nd .. Adaini.tr.triz of the ..t.t. of L.rrv J. Rml1.. d.o....d v. Bruce Q. XiaD. 1%1. P.A.. Robert A. Boll.D. K.D.. B.rold O. Br.t.ina. M.D.. C.rol K. Robi.on. M.D. .nd .amilv pr.otio. - B.lv.dere Medio.l Cent.r 72. Paraqraphs 1 throuqh 46, Counts I, II and II, and Claims I and II are incorporated herein by reference. 73. The actions of the Defendants in violatinq the statutes and requlations of the Commonwealth of Pennsylvania and by allowinq a physician assistant to impersonate and/or misrepresent himself and conduct himself as thouqh he were a physician involves bad motive or reckless indifference to the riqhts of others sufficient to warrant an award of punitive damaqes to punish the Defendants for their outraqeous conduct and to deter them and others like them from similar conduct in the future. 74. The Defendants' conduct in violation of the statutes and regulations of the Commonwealth of Pennsylvania represents reckless indifference to the riqhts of others, recoqnizinq a hiqh deqree of chance that serious harm will result as it did in this case. 75. The actions of the Defendants represent neqliqence per se, and, therefore, warrant an award of punitive damaqes. ,. WHEREFORE, Loretta F. Runk, individually and.. AdlIIini8tratrix of the Estate of Larry J. Runk, deceased, demands judgment against Defendants Bruce G. Kipp, III, P.A., Robert A. Hollen, M.D., Harold G. Kretzinq, M.D., Carol K.Robison, D.O., and Family Practice - Belvedere Medical Center in an amount of punitive damages in excess of Ten Thousand Dollars ($10,000.00), exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. Respectfully submitted, ANGINO & ROVNER, P.C. ?ome PQ., J::J . ~u..mev- Pamela G. shuman, Esquire Attorney No. 41696 4503 North Front Street Harrisburg, PA 17110 (717)238-6791 Counsel for Plaintiff DATED: July 29, 1994 17 ''''-l..-:'. . , VERIFICATION I, LORETTA F. RUNK, hereby verify that the facts set forth in the foreqoinq Complaint are true and correct to the best of my knowledqe, information and belief. I understand that any false statements therein are made subject to the penalties of 18 Pa, C.S. 54904, relatinq to unsworn falsification to authorities. WITNESS: ?~ JJ ~ ~#;. .{ ~ Loretta F. Runk DATED: July 29, 1994 46660/BJI