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I.AW OFFICES
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CARLlSU PA 17UIJ
(717) Z4J-6U9U
ATI'ORNt:V FOR Ot:n:NllANT
VI.
: IN 'I'In: COllin' 01" COMMON IILEAS 011
I CUMU.:IU,AN() COlJNTV, 11!!:NNSVLV ANIA
I CIVil. ACTION. LAW
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: NO, 'J6. LJ':l CIVIL nmM
: IN 'I'IU:SI'ASS
SHARON M. MOOlU:. Illlrelllllllll
II1llUrld llullrllhlll of
COR!!:V O. MOOJU:. milllll',
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'V.M.CA. Of' CAI{L1SU:. INC.
Defelldllllls
ORDER OF COURT
NOW, thl. ~ ~ ofl',bru." 1996," ,,,,.,,, oft'" ,I.,IIW"" " ""'" of
Harold S, Irwin, III, Esquire, attorney for the plaintltl1l, leRvc is hcreby granted to the plainlilflo
sellle and discolltinuc this action for the sum of Seven Thousand Fivc Hundred and no/l00
($7,500.00) Dollm, said sum bcing allocated liS tollows:
1. $2,953,57 to Harolll S. Irwin, III, Esquire, attorney for plaintifi; to be distributed
as follows:
A, $42.81 to Corrcspondcncc Mllnllgcmcnt, Inc" tor medical records;
B, $22,77 to Smart Corporation, tor mcdical records;
C, $1,012,99 to thc Commonwcalth of Pcnnsylvania, Department of Welfare,
to satisfY thc subrogation licn held by said Departmcnt for Ihe
reimbursement of medical expenscs and cash assistance;
D, $45,50 tor court costs to file this petition for approval ofselllement; and
E, $1,875.00 lor attorney tees; and
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SHARON M. MOORE, 1)lIrtllt IlIId--t~i'HE COUl\T 01' COMMON PLEAS m'
IInturlll Kunrdhllll/r I CUMBERLAND COUNTY, PENNSYLVANIA
COI\EY D. MOOIU:,lIIhlllr, t CIVIL. ACTION. LAW
1'llIllItllT t
V8. I NO, 96 . ,J.J...c:J- CIVIL TlmM
Y.M.C.'\, OF CAIUJSU:, INC, I
I>d~lIdnlllS : IN 'I'IU:SI'ASS
PETITION FOR APPROVAL OF SETTLEMENT
AND DISCONTINUANCE OF CLAIM
NOW comes Shnl'OIl M. Moore, parent and natural guardian of Corey 0, Moore. aminoI',
by her attorney, Harold S. Irwin, III, Esquire, and presents this petition for approval of settlement
and discontinuance of daim, representing as follows:
I I'etltioner is Sharon M. Moore, an adult individual residing at 1345 Grandvlew
Court. Carlisle, Cumberland County, Pennsylvania 17013.
2, Petitioner is the parent and natural guardian of Corey 0, Moore, a minor child,
born on April 17, 1986
3. The child suffered personal injuries on July 17, 1995, in that he was negligently
given an overdose of prescription medication over a three day period while he was attending
Summer camp at Camp Thompson, owned and operated by the defendant Y,M,C,A. of Carlisle,
Inc" a Pennsylvania non-profit corporation.
,
4, A~ thc rc~ultof Ihis ovcrdosc, thc child su~tained vuriou~ elevutcd chemicltllevel~
In hl~ blood~trcam cnuslng vllrlous physlcalnllllndlcs Including swcau, hcart palpltallon, diz;r.inc~s.
~tol1lach Cl'lllllpS, hcndllchcs IInd mood ~wlngs.
5, Sincc Ihc tlll1c of lhc ovcrdosc, thc child's physlclllrcuctlons havc sub~ided
coinddcllllllly with lhc dccrcllsc Inthc IIbnonnlll chcmlcllllcvcls clluscd by the ovcrdo~c und at
this timc mcdlculrcports indicntc Ihutthc child will hnve no long Icrl1l cnecl~ tromthi~ incidcnt,
6, As Ihc rcsullofthcsc physlcnl problcll1s, pctitioncr incurred II1cdlcul cxpcnse~ in
the amount 01'$2,22237, which wcrc covcrcd by the II1cdicnlnssistuncc progrllll1 of the
Departll1cnt of Public Wcllilre (DPW), DPW hus udvanccd thc tolal sum 01'$577,99101' thc
puymcnt ofmcdicul cxpcnscs IIttributablc to Irclltmcnt rcndcrcd to thc child and $435,00 in cash
IIssistancc (II cOll1bincd totlll SUIlI of $1,0 12.99) lor which DPW holds a subrogationlicn as
providcd inthc Public Wcllilrc ('odc, liS IIl11cndcd by Act 1980-105, 62 P,S, Scction1409 (b)(1)
ct scq. IInd Scctionl974 ct scq. [\Ild thc Sodnl Sccurity Act, 42 U,S,c. Scction 1396[1 (25) and
Scctlon 1396k,
7, Inthc coursc ofthc invcstigntlon of this claim, petitioncr incurrcd cxpenses of
$42,81 and $22,77 10 oblllin copics ofthc child's mcdical rccords\rOlll Correspondence
Manllgclllcnt, tnc" IInd SllIlIrt ('orporlllion.
8. Pctitioncr hilS Incurrcd thc costs of $45.50 to liIc this petition,
9, Pctilioncr hilS agrccd to pay attorncy fecs bascd on 25% of the total al110unt
recovercd in any out-ol~court scttlcment of this maller,
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LAW OFFICES
IIAlWLD S, IRWIN, 1/1
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IIAROLD S. IRWIN,IJI, f:SQIIIJU:
A'n'ORNEV ID NO, Z')II1I1
J6 SOU1'II Pi'.... SnU:.:T
CARLISLE PA 1711lJ
(717) Z4J~1I911
An'ORN.:V JlOR IU:JI.:NIlANT
SIIARON M. MOOIU:, 1IIII'tlllllllll
IIl1lurlll KUltrllhlllllr
COREY I). MOOIU:, mhllH',
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Y.M,C.A. (W CAIU.IS...:, III/C"
Ih.rtllcJlIlIl.
I IN Tilt: COURT 01<' COMMON Pl.EAS OF
I ClIMln:IU.ANI) COUNTY, PENNSYLVANIA
I CIVIl. ACTION. LAW
I
I NO. 96 . ..fJ+- CIVIL TERM
I
I III/ TIU:SI'ASS
Ol{ n:l{ OF COURT
NOW,lhlN
.IllY 1Ii'I'chIlIllI'Y, 11)%,1111 pctltloll ofthc ShllrOIl M, Moore Ilnd Oil
111011011 ul'llllwld S hwlll, III, hq~, Ilt[.'IICy.lilr t~c Ictltlollcr,lcllve is hereby grnl1lerlto the
pclltlollcr 10 wilhlhllw thc Mill I IIi' \ , , ' ) Dollars Irom the
sequeHtcrcd IICCOlllI1 CNlllhlishcd IiiI' ('urcy 1>. MUllrc, said Hum to bc uHed for the purchase of
bcdrooml\lI'lIltlllc IIIl1I c1uthllll! 1111' Corcy D, Mlllll'll.
By thc Court.
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4, As fhc re~ult lI"'hl~ overdo~e, Ihc child suslalned various elevated chemical levels
In his bloodslrelllll cllu~lng vllrlou~ physlcalmallldlcs Including ~wcals, heart palpitation, dl:zzlne~s.
stomach crumps, hClldllches IInd mood ~wlngs.
S, Slncc Ihc IllI1c of the overdosc, Ihe child's phy~lclll rellcllons have sub~lded
coincidentally wllh Ihe decreu~c jnlhe ulmonnlll chemlcullevels cau~ed by Ihc ovcrdo~c IInd at
this lime medical rcporl~ jndicule thlllthe child will have no long IeI'm ellccts ti'U1nlhl~ incident,
6, On or IIbout Fcbruury 7, 1996, pelltloner Wll~ glvcnlcllve by thl~ Court 10 seule
nnd dl~contlnue Ihl~ mUlier und to rdeuse the defeudant uJlon puymcnt of the amount of
S7.S00,OO by the defcndull1.
7, Aller pllymelll of counsel fce~, mcdleal bills and e"pcn~es rclated to this claim as
approved by thc Court, the nct Jlroceeds oflhe selllcmcnt in the lllllount 01'$4.546,43 was paid
over to petitioner with Ihe lill'lher direction by the Court that sllid sum be deposlled Into a
sequeslered accountlhr the benellt ofC'orcy f), Moore,
Court.
8, A sequestered llCCOUIll was therellller established by pelllioner as directed by the
9, The minor child, Corey D. Moore is In need of bedroom furniture and clothing as
his present bed is old and broken down and Ihc child has outgrown all or most of his clothing,
10, The petitioner, Ihe child's mother and naturulguardllln, has no other funds to
provide these nece~sities.
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WtIlm~:I"OIU:, petillonel' I'eque~t your Honorable Coul'tgrant her leave to withdl'llw the
Bum of 5500.00 Il'olllthe scqucBtcrcd accoLlntlor the IILlrllo~cs dc~crlbed llbove.
J ullc!..1::.1996
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JlAIWLD S. litWIN, 1
AlIllrllcy rlll'llClillllllcr
36 Sllulh 1'111 Sh'ccl
Clllilslc, I'A 1701l
(717) 243.6090
SUllrclllc Cllul'llD Nil. 29920
VERI FICA TION
The foregoing petition is based upon inlol'llllltion which hils been gathered by illY counBel
inlhe preparlltlon of this Illwsuit. The lungullge of the documcnt is the Illnguage of my counsel
and not my own. [huve reud the petltionllnd to the extenlthlll it is bllsed uponlnlonnatlon
which [ have given 10 my counsel, It is Irue and correclto the best of my knowledge, informalion
and belief To the extent thntthe content of the petition Is thllt of counscl, 1 hllve relied upon
counsel in making this veriliclltion, I understllnd lhlltlillsc SllltCJl1ents Jl1l1de herein lire subject 10
the penalties of 18 [)u,C.SA Section 4094, reluting to unsworn Iillsiliclltionto lIuthorities,
JIIIICl1, 1995
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ATTOIIHIY 'Oil 'LAIHT'"
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IIN THI COUIIT 0' COMMON 'LIAI 0'
I CUM.IIILAND COUNTY, 'INNIYLVANIA
I CIVIL ACTION. LAW
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I NO. II . I" CIVIL TlIIM
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I IN TIIIIPAII
IHARON M. MOOIII, parant Ind
nltural luardlln of
CO lilY D. MOOIII, minor,
Plllntlff
YI.
Y.M.C.A. 0' CAIILI.U, INC.,
Daf.ndant
ORDER OF COURT
NOW, this ~day of December, 1997, on petition of the Sharon M, Moore and on motion of
Herold S. Irwin, III, Esquire, attorney for the petitioner. leave Is hereby granted to the petitioner to withdraw
the sum of Five Hundred and no/100 ($500,00) Dollars from the sequestered account established for
Corey D. Moore, as requested in said petition,
By the Court,
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VERIFICATION
The foregoing petition Is based upon Information which has been gathered by my counsel In the
preparation of this lawsuit. The language of the document Is the language of my counsel and not my own,
I have read the petition and to the extent thai It Is based upon Information which I have given to my
counsel,llISlrue and correcllo the best of my knowledge, Information and belief, To the extent that the
content of the petition Is that of counsel, I have relied upon counsel In making this verification, I understand
that false statements made herein are subject to the penalties of 18 Pa,C,S,A, Section 4094, relating to
unsworn falsification to authorities,
December 17,1997
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SHARON M. MOORE
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N."OLD .. IRWIN, III, ..aul".
.TTOIINIY ID NO. .....
IlIAIT NlaN IT".IT
C."LIILI .. 11.n
(T111 .a.....
.TTOIINIY 'Oil 'LAINTI"
IHAIlON M. MOOIII, pI rent Ind
nlturll gUlrdlln or
COIIIY D. MOOIII, minor,
Plaintiff
VI.
Y.M.C.A. O' CAIILlILI, INC.,
Derendlnt
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IIN THI COUIIT O' COMMON 'LlAI 0'
I CUM.IIILAND COUNTY, 'INNIYLVANIA
I CIVIL ACTION. LAW
I
I NO. II . III CIVIL TIIIM
I
, IN TIIIIPAI.
ORDER OF COURT
NOW, this M day of May, 1998, on patltlon of the Sharon M, Moore and on
motion of Harold S, Irwin, III, Esquire, attorney for the petitioner, leave Is hereby
granted to the petitioner to withdraw the sum of Five Hundred and no/100 ($500.00)
Dollars from the sequestered account established for Corey 0, Moore, as requested In
said patltlon,
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4, On or about February 7, 1996, petitioner was given leave by this Court to
settle and discontinue this matter and to release the defendant upon payment of the
amount of $7,500,00 by the defendant.
5, After payment of counsel fees, medical bills and expenses related to this
claim as approved by the Court, the net proceeds of the settlement In the amount of
$4,546.43 was paid over to petitioner with the further direction by the Court that said
sum be deposited into B sequestered account for the benefit of Corey 0, Moore,
6, A sequestered account was thereafter established by petitioner as
directed by the Court.
7, The minor child, Corey 0, Moore, 15 requesting a $500,00 withdrawal from
his sequestered account. Said request Is supported by petitioner, his mother and
natural guardian, as Indicated In her letter, attached hereto as Exhibit "A" for the
Court's review,
WHEREFORE, petitioner requests your Honorable Court grant her leave
to withdraw the sum of $500,00 from the sequestered account for the purposes
described above,
May -,1998
t:/4/t/6/4i /
HAROLD S. IRWIN, t
Attorney for petition ,.
35 East High Street
Carlisle, PA 17013
(717) 243.6090
Supreme Court 10 No. 29920
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HAIIOLD .. lIlWIN, Ill, I.OUIII.
AnOIlNIY III NO. ...11
n IA" HIOH ITIIIIT
IlAIILI.LI 'A 17IU
1717' 10.....
AnOIlNIY '011 PLA'NT'"
IHAIlON M. MOOll., p.rent .nd
n.tur'l,u.rdl.n of
COll.Y D. MOOR., minor,
P1.lntl"
I IN THI COUIIT 0' COMMON 'LlAI 0'
I CUM'.RLAND COUNTY, '.NNlnVANIA
I CIVIL ACTION. LAW
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I NO. II . ... CIVIL nRM
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I IN TIl.IPAII
YI.
Y.M.C.A. 0' CAIUIILI, INC.,
D.flnd.nt
ORDER OF COURT
NOW, this ~ day of ----1 -.J l ") , 1990, on petition of the Sharon M,
Moore and on motion of Harold S Irwin, III, Esquire, attorney for the petitioner, leave 15
hereby granted to the petitioner to withdraw the sum of Four Hundred and no/100
($400,00) Dollars from the sequestered account established for Corey 0, Moore, as
requested In said petition,
By the Court,
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