THE COURTS
NORTHAMPTON COUNTY
Presentation of Expert Testimony by Written Deposition to Support a Finding of Incapacity in Guardianship Hearings; Administrative Order 2016-01
[46 Pa.B. 6826]
[Saturday, October 29, 2016]
Order of Court And Now, this 21st day of July, 2016, it is hereby Ordered and Decreed that in order for this Court to accept expert testimony by written deposition pursuant to 20 Pa.C.S § 5518, the following conditions must be met:
1. The individual providing such expert testimony must be licensed to practice medicine, osteopathy, or psychiatry in Pennsylvania, or be otherwise qualified by training and experience in evaluating persons with the type of incapacity as alleged by the Petitioner.
2. The requested information must be provided on the following form and must be complete and clearly legible.
3. The answers must be signed and verified subject to the penalties of 18 Pa.C.S. § 4909 (relating to unsworn falsification to authorities) by the individuals providing such testimony.
4. At the hearing, the Petitioner shall present the Court either (1) the completed written deposition, with verification bearing the expert witness' original signature, or (2) a time-stamped copy of the written deposition and verification demonstrating that the original has been filed with the Clerk of Orphans' Court.
5. Expert testimony by written deposition will be accepted only when the issue of incapacity is uncontested. When the alleged incapacity is in dispute, expert testimony must be provided via live testimony or telephone testimony.
Counsel for Petitioners and pro se Petitioners are responsible for compliance with these instructions. The failure to comply with the foregoing may result in the rejection of proffered expert testimony by written deposition, at the Court's discretion.
By the Court
EMIL GIORDANO,
Judge
IN THE COURT OF COMMON PLEAS OF NORTHAMPTON COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION
IN RE: ______ ) No. AN ALLEGED ) INCAPACITATED PERSON )
WRITTEN DEPOSITION OF PHYSICIAN OR LICENSED PSYCHOLOGIST PURSUANT TO 20 Pa.C.S. § 5518 Physician or Licensed Psychologist (Name): __________
Office address: __________
Current position: __________
PROFESSIONAL BACKGROUND (In lieu of providing responses to questions 1-6, you may attach your curriculum vitae. Please provide any requested information not addressed in the curriculum vitae.)
1. Provide the following information concerning your education:
Name of Institution Degree received Date of Graduation Undergraduate Graduate Post-Graduate 2. List all of your active professional licenses, the state/name of the issuing agency, and any board certifications, along with the dates each was issued/awarded.
3. Do you have experience in evaluating individuals to determine their mental capacity?
Yes ____ No ____
4. If your answer to the above question is ''Yes'', please indicate the basis of your experience and describe your specialized qualifications and training with respect to evaluating persons to determine their mental capacity.
5. Have you ever testified in court or in an administrative proceeding, or have you provided testimony by deposition or by written interrogatories regarding an individual's mental capacity, prior to today?
Yes ____ No ____
6. If your answer to the above question is ''Yes'', please provide an estimate of the number of times you provided testimony by deposition or by written interrogatories regarding an individual's mental capacity, prior to today: _________________
INFORMATION CONCERNING THE ALLEGED INCAPACITATED PERSON
7. In your professional capacity, have you had the opportunity to meet with, examine, evaluate or assess the alleged incapacitated person?
Yes ____ No ____
If your answer to the above question is ''Yes'', provide the dates within the past two (2) years that you have met with, examined, evaluated or assessed the alleged incapacitated person:
8. Identify any tests that were administered to evaluate/assess the alleged incapacitated person's mental capacity (e.g. mini mental status exam—MMSE), along with the date of each tests and the results/conclusions drawn from each test:
Date Test Results/Conclusions 9. Identify all medical and psychiatric diagnoses that you believe impact the alleged incapacitated person's mental capacity, along with the symptoms/manifestations of each diagnosis, and the prognosis for each:
Diagnosis Symptoms/Manifestations Prognosis 10. List all other current medical diagnoses/conditions of the alleged incapacitated person of which you are aware:
11. List all medications presently prescribed for the alleged incapacitated person, and the diagnosis for which each medication was prescribed:
Medication Diagnosis 12. Indicate the alleged incapacitated person's abilities with respect to the following activities of daily living by placing an ''X'' in the appropriate space below:
No Impairment Needs Some Help Totally Impaired Insufficient Information Eating Bathing Dressing Toileting Transferring Preparing meals Basic housework Personal hygiene Managing medication Complying with medical treatment 13. Indicate the alleged incapacitated person's abilities with respect to the following activities by placing an ''X'' in the appropriate space below. Additional information will be requested for all items/activities marked ''needs some help''.
No Impairment Needs Some Help Totally Impaired Insufficient Information Understanding medical conditions and any physical limitations Making appropriate living arrangements Managing finances/paying bills Applying for financial or medical benefits Avoiding financial exploitation Communicating decisions Receiving and evaluating information Short term memory Long term memory Responding to emergency situations Providing for his/her physical safety
14. For all items/activities in the above chart (Interrogatory 13) in which you indicate that the alleged incapacitated person ''needs some help'', provide details as to the type and extent of assistance needed.
15. List any services that, to your knowledge, are being provided to meet essential requirements for the health and safety of the alleged incapacitated person, or to assist the alleged incapacitated person with management of his/her finances.
16. What, if any, recommendations do you have concerning services necessary to meet essential requirements for the health and safety of the alleged incapacitated person?
17. What, if any, recommendations do you have concerning services necessary to assist the alleged incapacitated person with management of his/her finances?
18. Do you believe that the alleged incapacitated person is capable of making reasonable decisions regarding his/her personal care, medical care, and safety?
Yes ____ No ____
19. Do you believe that the alleged incapacitated person is capable of making reasonable decisions regarding his/her finances?
Yes ____ No ____
20. In your professional opinion, is the person who is the subject of this hearing incapacitated?
Yes—totally impaired ______ Yes—partially impaired ______ No ____
21. Do you expect the alleged incapacitated person's mental condition to significantly change or improve?
Yes ____ No ____
Please provide a basis for your answer:
22. Would any less restrictive alternatives to the appointment of a plenary guardian be sufficient to protect the alleged incapacitated person from physical and financial harm?
Yes ____ No ____
If your answer to the above question is ''No'', explain why less restrictive alternatives would be insufficient to protect the alleged incapacitated person from physical and financial harm?
23. Do you believe that it would be harmful to the alleged incapacitated person's physical or mental condition if he/she was to be present in court for the hearing in this matter?
Yes ____ No ____
24. Are you able to provide any additional information that would assist the Court in determining the alleged incapacitated person's need for a guardian and/or person(s) who would/would not be appropriate guardians?
25. Are your answers to all of the above questions provided within a reasonable degree of medical certainty?
Yes ____ No ____
VERIFICATION I verify that the foregoing information is true and correct to the best of my knowledge, information and belief. I am aware that this verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities.
______ _________________
Date Signature
_________________
Name (type or print)_________________
Address_________________
City, State, Zip Code_________________
Phone
[Pa.B. Doc. No. 16-1856. Filed for public inspection October 28, 2016, 9:00 a.m.]
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