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II\""I~,'" /110'42>>94-01
IN RE: SANDRA L KERN II Plr.nt
Ind nlturll gUlrdlln Of
DAVID L. KERN, JR., I minor
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 84. .5 .:1.-+"
CIVIL TERM
NOW COMES Sandra L. Kern, parent and natural guardian of David L. Kern, Jr" and petitions
this Honorable Court as follows:
1, Petitioner Is Sandra L. Kern, the parent and natural guardian of David L. Kern, Jr., a
minor, who was born on October 2, 1978.
2, On October 19, 1993, while driving In an automobile with his father, David L. Kern, Sr"
David L. Kern, Jr, was Injured when his father lost control of the vehicle, and the vehicle left the
road, striking a tree. This accident occurred In Hershey, Pennsylvania at approximately 7:00 p.m,
3. As a result of said accident, the minor was taken to Poly Clinic Medical Center
emergency room where he was treated with sutures for two lacerations to his head. The child was
released on the same evening for return home. A copy of the emergency room records of Poly
Clinic Medical Center are attached hereto as Exhibit "A".
4. The minor child followed the visit to Poly Clinic with visits to his doctors, Good Hope
Family Physlclan$, for removal of the sutures and recurring neck pain. A copy of the treatment
notes of Good Hope Family Physicians Is attached hereto as exhibit "B".
5. Any pain In the minor's neck resulting from the accident has been resolved by neck
exercises given by minor's physician, and there has been no need for follow-up treatment since
March 24, 1994.
II\""I~,,,, /110 141>>94-01
6, The Insurance company for the minor's father has been proposed with $1,400,00 In
compensation for the Injuries to the minor. Pursuant to an Employment Agreement with Petitioner,
attached hereto as exhibit "CO, attorneys' fees of 25% total $343.34; costs advanced total $26.64,
The balance, therefore, for the minor child Is $1,030.02.
7, Petitioner Is willing to enter Into the compromise as parent and natural guardian for the
child, because she believes that the child's relatively minor Injuries are appropriately compensated
by the compromise figure.
6. The minor resides with and Is maintained and supported by Petitioner,
WHEREFORE, Petitioner prays this Honorable Court that It:
A. Approve the compromise stated above; and
B, Direct payment of the net fund due to the minor be deposited Into a savings
account with no withdrawal therefrom until said minor reaches maJority, except
as authorized by Court Order.
FLOWER, MORGENTHAL FLOWER. LINDSAY
Attorney. for peti tioner
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ID '* 44693
11 East High Street
Carlisle. PA 17013
(717) 243.5513
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:-.; COCl ACe 0.. 11,11 AO;i[j~:"TIO;;---_m___._-' _..._.--~- .'0_-
E 1'.1/19/93 l8:30 HERSHEY
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TIME OfINJURV I ONSET OF SYMPTOMS:
&':.11. 'UNLABOREO
o SHALLOW
OLABOAEO
OWHWlNO OL DR
o RETRAC110NS
o RALEMUlONCHI 0 LOR
OCOUGH
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o OUSKY
o PAlE
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OCOOL
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o JAUNOICE
o RASH
OBRUlsEs __
o OTHER
au OOENIES
o FREOUENCY
o URGENCY
o RmNTlON
ODYSURIA
o HEMATURIA
o INCONTINENCE
o URETHERAl OISCHARGE
DOTHER
GYN . OOENIES ~ '
OG__P:_G:_
o VAGINAL BLEEDING
o NORMAL FLOW
o ABNORMAL FlOW:_
OOISCHARGE:
o OTHER: _
o NUMBNESS
LATlOH O~E;:~';;.f'\
lSESIIIIII: ~
ESENTOASSENT EIl0TlONAl ~PERATlVE
G Owm OUNCOOPEIW!'IE Q/ OOENIES ~A
REGULARO IRREGULAR 0 AN~OUS 0 DYSPHAGIA .
EM.\; OCOMBATIV( OANNOREJlIA
OJVO o HYSTERICAL o NAUSEA
OCAPILlARY REFlLl: _ OWY OVOMITING
o OTHER OOIARRHEA
mUIIA ODENIES DNA o CONSTIPATION
ONOTIl/NGVlsIBLE PAIN. qOENIES DNA DHEMATEMESls
OABRASlONs: AREA .J#UlJ I~ ':iL 08;~EN
O~ERATlO~: ~"L~ ,'kevERITY (MOnI' "'''I) 8~1~~ENOEO
l:::)!J>'c. ~ , 234 5 I 1 8 9 10 IJ
o BLEEOINn 0 CONSTANT TENOER
o BURNS OINTERMImNT
OoeVlOVS DEFOIWIT'f OlWllAnNG
ElNT c;(OENIEs 0 NA
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o PHOTOPHOBIA
o SORE THROAT
o NASAL CONGESTION
OEAAACHE DR OL
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OOTHER
o BOWEL SOUNDS
o SWELUNO:
o OTHER:
, OTHER:
o SHARP
o DUll
OHEAVV
o BURNING
T IA E NUR E SIGNATURE m L',~~-d= /
AS~SS CO lETEOa;Z60~ J/2'-r/tlfY~____
t I. -1,/h"7lJ ~1",7n'041I/~ I
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213 SUSQUEHANNA AVENUE '
, [NOLA PA 170Z5
1.10/19/93 15' 10/02/78"
..l NO FMD PER PT
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TRIAGE D1UOS1T1ON:
TRIAGE INTEAVlNTlQN
o IPUNTS 0 ICI
o BTlA'" CAlli/NO 0 OTHIR.
VITAL SIGNS
lOSS OF
CONSCIOUSNES
AIRWAY
o DYES
ONASAl OORAL DEl TUBE
OXYGEN
o MASK ~ASAL 9
o APPUEO 0 INFLA reD
LJMIN
MAST
SOLUTION sire
IV THERAPV
SPLINT
Dc COLLAR OBACKBOARD
o OTHER:
DYES
o NO TIMelBEGUN:
.
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MEDICATIONS
ADMINISTERED
IN ROUTE
OATE/P//U~IME
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POL YCLINIC MEDICAL CENTER
DIVISION OF PATIENT CARE SERVICES
EMERGENCY DEPARTMENT
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INT AI<E
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OUTPUT: .1:'.', j
URINE EMESIS OTHER
DAT!II1ME UP P R
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,_', :",.. NURIlU PROGRESS NOTllS
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PUPILS
DAWTIME R I L
NEURO CHECKS
RA LA RL U OlliER INT
DAT&IT1ME
NOTIFIED
CXlNSULTS
PHYSICIAN/SERVICE TIME SEEN
INT
MEOICATIONS
DATE.'TIME ORUG AMOUNT AOiJTE SITE INT
,,~ ~i...d (..,. W) ~'hItJ('
IV SOLUTIONS
OATEIlIME OWME CAlli SITE SOLUTION
. OISPOSITION
~il'SCHARGEG TO _--1- ~ OATE. ~'1liiE ~ n../.c.
DISCHARGEO IN THE CARE OF 0 SELF 0 SPOUSE ~RENT 0 GUARDIAN
o OTHER:
INSTRUCTIONS GIVEN L:l)(s 0 NO (REASONI ,
MOOE: I)(MBULATORY OWHEELCHAIR OAMBULANCE OCARRIED OOTHER'
RATE INT 0 ADMITTlD TO MEOICAL CENTER
ADMISSIONS CALLED' BED ASSIGNMENT'
BEO READY REPORT CALLEO:
ACLS PROTOCOL: 0 YES 0 NO TO UNIT
MOOE IJAMBULATORY OWHEELCHAIR OSTRETCHER DomER
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[T R ' H.ne..... OIi;C~;RG. E NUREES SIGNATURE ~ ~nlH\' ~ \
'. K~~~-~a-!>775 717-728-0431:. POLYCLINi'e't'MSnlcALCE@
21J SIISOIlEHA . OHIO L JR "
hOLA NrlA ApV ~"IIEI DIVISION OF PATIENT CARE SERVICES
.. 7025
10119/9] I5T J 0/02178 " EMERGENCY DllPARTMENT
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NURSING PROGRESS NOTES
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'j months B90 WBS in Bn MIlA. He WBS driving Bnd probBbly go.i.ng 45 to 55 mph when
he lost control of the vehicle on a wet I'OBd. His pickup truck spun around end
. they hit fBcing bBC:kwBrds, striking the bBck of his head on the bBck window. He
quired sutures. Ever since then he has noticed intermittent PBin in the
trBpezius areBS bilBterBlly. Seems to be II.lprse saretimes if he is turning, his
head Bnd then serrething will snBp into position. He often has serre noises in his
neck with rotBtion, Bnd this was very concerning to Devid Bnd his rrother. The
1J1ll'- If /tU. " ~~ ~ere for only brief periodS of time IYld does not inhibit' his functioning
" Bt Bll. His only regu1cr exercise is 'kung fu twice weekly.
d~ )., 01 Exam of the neck does not reveBl BnY t,anderness of the neck
10 Iq/93 musculBture or the spinal area. IU1 is'quite good, but he has PBin
. Bt the extremes of IU1 in all directions.
Intermittent neck pain SIP MIlA, probBble cervicBl strBin.
PI Neck exercises given. llecoornended he do them regularly. lleassured h.l1n Bbout
the noises. Doubt any significBnt injury. Ee in touch if David Bnd his mother
feel that the symptoms are still greater than they accept Bnd would refer to
P.T. No return Bppointment scheduled. PUI. .' G~'
CI<S/liw 3/25
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EMfLQYMENI.AG.BEEM.ENI
THIS AGREEMENT, made this /6"f(. day of 4tH'v I'''': ,( , 1994, by and
between SANDRA KERN, of 213 SusQuehanna Avenue. Enola. PA 17021;, hereinafter called
CLIENT, and FLOWER, MORGENTHAL, FLOWER & LINDSAY, Attorneys, of11 East High Street,
Carlisle, Cumberland County, Pennsylvania, 17013, hereinafter called ATTORNEY,
WITNESSETH:
WHEREAS, CLIENT'S minor son, DAVID L. KERN, JR., sustained Injuries as the result of an
accident on October 19, 1993 at Hershey, Pennsylvania.
WHEREAS, CLIENT desires to constitute and appoint ATTORNEY as her attorney to
prosecute a claim for damages arising out of the aforesaid accident.
NOW, THEREFORE, Intending to be legally bound hereby, the parties hereto mutually agree
as follows:
1. That CLIENT employs ATTORNEY as her attorney to prosecute a claim for
damages arising out of the aforesaid accident, and ATTORNEY accepts such
employment.
2, That the parties hereto agree that the fee of ATTORNEY shall be wholly
contingent upon a recovery being made and shall be twenty-five percent (25%) of
whatever amount Is recovered If the case does not go to trial or thirty-three and one-
third (33 1/3%) percent of whateller amount Is recovered If the case goes to trial.
3. That all costs of suit shall be paid by CLIENT regardless of whether or not
there Is a recovery on behalf of CLIENT, ATTORNEY shall be reimbursed for all costs
and expenses reasonably Incurred.
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