Stories written by Jo Ciavaglia, award-winning multimedia newspaper reporter at the Bucks County Courier Times in Bucks County, a suburb of Philadelphia, Pa.
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These days, Kathleen Kurtz feels less self-conscious when she visits her doctor. Now that the 31-year-old Northampton woman is a mom of three, she fits right in at the pediatrician's office, where both she and her children are patients.
She isn’t the oldest patient at the practice, either. The oldest is 35.
Kurtz is an unusual example of a small, but some believe growing, number of young adults who haven't outgrown their childhood doctor.
Kathleen Kurtz, 31, of Northampton is a mom of three, so she fits right in at the pediatrician's office, where both she and her children are patients. Kurtz is an unusual example of a small, but some believe growing, number of young adults who haven't outgrown their pediatricians.
Kathleen Kurtz with her son Thomas during a recent interview.
Jo Ciavaglia/Staff
Pediatric office visits among those 19 and older jumped from fewer than 1 million in 2002 to 2.4 million by 2012, according to the Annual National Ambulatory Medical Care Survey. But there is debate within the medical community whether the increase is a real trend, or reflects more visits by young adults with special needs who tend to stick with their pediatricians longer.
Some suspect the rise is related to the implementation of the Affordable Care Act, which allows young adults to be covered under their parents’ health insurance plans until age 26. The change alone has added 6 million people between ages 19 and 25 to insurance rolls since 2010, according to the U.S. Department of Health and Human Services.
Some in the medical community express concern about whether pediatricians should be treating young adults, and when the transition to an adult doctor should occur. When young adults such as Kurtz are asked why they've stuck with their pediatrician, continuity of care is one reason that's given, along with convenience, same-day appointments and comfort levels.
“I just feel comfortable with him. It’s easy to go to him. He’s available whenever I need him. I can be seen right away,” Kurtz said. “I’m actually nervous about when he retires.”
Kurtz has been seeing Dr. Isaac Abir at his practice in the Richboro section of Northampton since she was an infant. When she was diagnosed with thyroid cancer at age 24, Abir was very involved in her care. He recommended her surgeon and other specialists, and reviewed her scans and other treatment records. In recent years, she sees him mostly only when she is sick or for her annual flu shot.
In her 20s, Kurtz admits that she felt self-conscious sitting in the waiting room, with its walls of handmade crayon artwork, a laundry basket brimming with children’s books and giant baby bottle.
“Before I had kids I felt uncomfortable sitting in the waiting area because I’m obviously older,” she said. “But now that I have kids I feel I have an excuse to go to him because I don’t feel as odd when I’m there.”
Research has found that people between the ages of 18 and 34 have historically shunned doctors until they have a medical need, and so-called millennials in their 20s are more likely than other age groups to use retail clinics and emergency rooms rather than visiting a doctor's office. Yet recent data suggests young adults who still see their pediatricians are bucking those trends.
A study by the American Academy of Pediatrics found pediatrician visits among those between 19 and 28 grew by slightly less than 1 percent between 2007 and 2012. The study, which is still being finalized, was done using National Ambulatory Medical Care Survey data prepared for Got Transition/Center for Health Care Transition Improvement. The organization is a national resource center run by the National Alliance to Advance Adolescent Health.
Patients ages 18 and older accounted for nearly 7 percent of pediatrician visits in 2012-13, according to the National Ambulatory Medical Care Survey.
Dr. Heidi Weinroth of Cooper University Pediatrics in Moorestown, Burlington County, talks with patient Bridget Fynan, 20, of Delran
Dr. Heidi Weinroth and colleagues in Cooper University Pediatrics in Moorestown, New Jersey, typically see patients until they graduate from college. She estimates fewer than 10 percent of patients in her medical practice are in their 20s, but their reluctance to leave doesn’t surprise her.
With more young adults living at home longer and attending college closer to home, it makes sense to them to stay with a doctor they know and trust, she said. Weinroth added that she is careful not to overstep her medical bounds and refers young adult patients to specialists as needed.
But for general health issues, she said he finds the combination of continuity of care and the longtime doctor-patient relationship makes patients more receptive to talking frankly about their health issues.
“You bond with your pediatrician differently. We know them as well as they know us. These patients have had the same doctor for all their lives, literally,” she said. “Most of us haven’t seen our doctor 10 times. It’s no wonder they don’t want to leave us.”
Not every doctor wants to keep seeing patients into adulthood.
For example, most pediatric practices associated with Grand View Health in West Rockhill don't allow patients to remain in their practice after age 22, health system spokeswoman Susan Ferarri said. Many pediatric practices see age 22 as “really a stretch,” Ferarri said.
While the medical community agrees the relationship between pediatricians and patients is special, experts generally believe it shouldn't last too far into adulthood.
The Institute of Medicine and the National Research Council recently released a report that found that ages 18 to 26 represent a critical developmental period, and that group should be treated as a distinct subpopulation for medical reasons. Among the report’s recommendations for improving health care for this age range is transitioning from pediatric to adult medical and behavioral health care.
Got Transition encourages pediatric practices to set age-out policies so the deadline is known far in advance, said spokesman Daniel Beck. As early as ages 12 or 14, parents should start thinking about transitioning their child to an adult-focused doctor, he said, adding that his group believes the transition should be done between ages 18 and 21.
“We understand it’s a new (doctor) and trust needs to be formed, but it’s certainly something that needs to be happening,” Beck said.
While pediatric office visits by young adults are growing, Dr. Patience White, co-director of Got Transition, suspects a large number of those visits are by young adults with chronic illnesses who require more frequent medical care than their healthier peers.
“Change is hard, and for those with special needs, it’s especially hard,” said White, a professor emeritus of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Some pediatricians agreed that the transition to an adult-focused doctor can be difficult for patients with special needs such as Attention Deficit Hyperactivity Disorder or asthma. Frequently, a new doctor will want to start over to reaffirm the original diagnosis or adjust medications, which she said can be time-consuming.
But that's another reason the transition from pediatric to adult-focused health care is critical, said Dr. Katie McPeak, medical director of the Center for the Urban Child at St. Christopher’s Hospital in Philadelphia. St. Christopher's treats patients until age 21. McPeak recommends a two- or three-year transitional planning period, starting at age 15, for patients with chronic conditions.
"You are just prolonging the inevitable,” she added. “We can’t keep kids forever.”
Most pediatricians aren't credentialed to treat patients after age 21 and that can make it difficult to get an insurance company to cover the visit, McPeak said. Pediatricians also aren't necessarily skilled in substance abuse management and also may not be trained in sexual health and women's health issues, she said.
For those looking to delay the transition, a compromise could be a doctor board-certified in pediatrics and adolescent medicine since those specialties require additional training in behavioral and sexual health, White and McPeak said. Abir, Kurtz's pediatrician, fits into this category. He has extra training and experience in adolescent and adult medicine, and formerly was medical director for a residential center for children and adults with mental and physical disabilities.
Abir enjoys treating adults and children, but decided on the latter when he opened his solo pediatric and adolescent medicine practice in 1970.
He sees no reason to move his longtime patients to adult-focused practice once they turn 21, though he doesn’t accept new young adult patients. Abir believes the lifelong connection with patients is mutually medically beneficial.
“I have their whole history of life,” he said. “It’s like they are family.”
The minority owner of an Upper Makefield horse farm that is the centerpiece of multimillion-dollar civil suits filed in Bucks County Court wants a judge to evict her business partners from the 36-acre property.
The eviction complaint is the latest maneuver in an ongoing, bitter legal dispute between Patricia "Penny" Silcox, who until January ran Hickory Run Farm on Pineville Road alone for 30 years, and her one-time clients, Michael and Michelle Gara. The couple is suing Silcox to force her to honor an alleged verbal agreement to essentially sell them her farm for a stake in a new business worth no more than $150,000. An appraisal last October valued the property at $1.5 million.
While the Garas, who also live in Upper Makefield, have majority ownership of the horse farm business and its assets, they do not have any ownership of the property it sits on. That's held in a separate company, RSPC Inc., which is controlled by Silcox and her brother Roy Silcox Jr.
Penny Silcox’s attorney, Daniel Sweetser, filed a formal complaint in Bucks County Court on Friday seeking to have the Garas’ business evicted from the property, alleging they are “currently illegally occupying and conducting business on the property” without legal title to the property or a valid lease.
“Due to the deterioration of RPSC’s relationship with the Gara defendants (as evidenced by their various lawsuits) RSPC does not want any further dealings with the Gara defendants and seeks to terminate their illegal occupation of RPSC’s property,” according to the complaint.
Sweetser said his client is well within her legal rights to evict the Garas, who are essentially her tenants. Hickory Run Farm has a lease agreement with RSPC Inc., but the lease was not updated after the Garas allegedly obtained majority ownership of the business. The complaint also alleges the Garas' “illegal occupancy” has deprived RSPC of the “use and enjoyment” of the property and seeks unspecified damages.
“(Silcox) and her brother are the owners of the property,” Sweetser said. “The Garas and their company do not have a lease with my clients and my clients want them off the property.”
In the complaint, Sweetser said he served the Garas with an eviction notice on Aug. 25, giving them until Sept. 30 to vacate the farm.
This news organization was unsuccessful in attempts to reach Neal Jacobs, the attorney representing the Garas in their civil suit, for comment. But in an August email, which is referenced in the complaint, Jacobs told Sweetser that his clients had no intention to comply with the eviction notice, labeling “any such attempted action by RSPC as unlawful, invalid and ineffective."
Penny Silcox
Silcox is currently barred from taking any action involving Hickory Run Farm under a temporary restraining order the Garas obtained in July, after they filed their lawsuit against her.
In their lawsuit, the Garas contend that Silcox made a verbal agreement in May 2015 to consolidate Hickory Run Farm and RSPC Inc. and transfer them into a new business, Newtown Equestrian Center. The Garas hold 90 percent ownership interest in Newtown Equestrian Center. Silcox holds 10 percent and, under the verbal agreement, she would continue to work on the farm as a full-time horse trainer.
The Garas then invested $1.3 million into the failing farm’s operations and to pay off Silcox’s personal and professional debts, according to their lawsuit. The couple contends that Silcox took two private mortgage loans with them using her Pineville Road property as collateral, which would be satisfied after she transferred the businesses into the Newtown Equestrian Center.
On Dec. 31, 2015, Silcox transferred 37.5 percent ownership interest in Hickory Run Farm to each of the Garas and retained 25 percent ownership interest. Silcox maintains she gave the Garas an ownership interest after Michael Gara told her that was the only way he could get a tax benefit from lending her money. Sweetser said Gara told Silcox he'd reduce her loan amount by the amount of his tax credit, which Sweetser said hasn’t happened.
Silcox also has denied that she agreed to either partner with the Garas or sell them her financially troubled farm, according to Sweetser. She also denied that she gave the Garas a second mortgage on the property for nearly $890,000, three months after she agreed to give them a $309,000 mortgage against the property last year.
In court filings, Sweetser has maintained the Garas' claims are moot because they have not produced written, legal documentation memorializing the alleged verbal agreement, as required by Pennsylvania law.
“Nowhere in these various lawsuits filed ... do the Gara defendants allege the existence of a document signed by RPSC (or Ms. Silcox) transferring an ownership interest to any one of them, which is a fundamental legal requirement for an enforceable claim to any ownership interest in real property in this commonwealth,” according to Sweetser’s latest motion seeking to evict the Garas.
In a Sept. 8 email, Jacobs, the Garas' attorney, said that the "general rule" about oral agreements did not apply in his clients' case.
“Most attorneys will give you the general rule and stop there,” he said. “I can tell you that oral agreements are enforceable when specific circumstances exist, the very circumstances that exist in this exact case.”
Several real estate and mortgage professionals interviewed by this news organization, however, said they believe the Garas might find it difficult to convince a judge to enforce the verbal agreement. They uniformly stated that verbal agreements involving transfer or purchase of real estate are not binding in Pennsylvania.
“That is a joke," said John Councilman, a former president of the National Association of Mortgage Brokers and president of the AMC Mortgage Corp. in Fort Myers, Florida. "The court should not recognize a verbal contract for real estate.”
Posted Oct. 2, 2016 Cris and Valerie Fiore would have done anything to keep their son alive. Even if that meant putting him in drug treatment against his will.
Anthony Fiore struggled with an opiate addiction starting in high school, and died of a heroin overdose in 2014 at age 24. His parents never knew court-ordered treatment outside the criminal justice system was an option.
“And I would have had to force him (into rehab)," said Cris Fiore, of Warrington. "I would have — if I knew about it.”
Like the Fiores, many parents struggling to get their underage children into drug treatment don't know the law is on their side. Since 1998, a little-known piece of Pennsylvania legislation called Act 53 has allowed parents or guardians to obtain court-ordered drug treatment for children between the ages of 12 and 18, removing teens' ability to refuse treatment or sign themselves out of rehab early.
Only a handful of counties, however, have put into place the necessary court and behavioral health coordination to seamlessly and quickly move families through the commitment process, according to state and local drug treatment professionals. Bucks County is the latest to do so.
State and local drug and alcohol professionals say there's a lack of knowledge statewide about the law's existence, as well as a lack of infrastructure to manage requests and move them through the process. Counties need coordination and cooperation not only from the court system, but local law enforcement and schools, advocates said. The expense involved with involuntary commitments also can be a burden for families.
Act 53 is one of many state laws involving drug and alcohol treatment that people don’t know about because counties lack resources to get them fully implemented, said Gary Tennis, secretary of the Department of Drug and Alcohol Programs. His department does not track how many counties have Act 53 policies in place or how many are using the law regularly, but he said to his knowledge, few are taking advantage of the law.
"The reason Act 53 doesn’t get used is because it’s difficult,” Tennis said.
Montgomery County has had a policy in place since 2005 outlining the steps for an involuntary commitment of minors to drug and alcohol treatment, but it has not held any Act 53 court proceedings and does "not foresee that changing anytime soon,” spokeswoman Jessica Willingham said. She added that the county's Office of Drug and Alcohol Services receives a handful of calls annually about Act 53, but it has been successful in offering families alternatives that can be tried first.
Under its policy, Montgomery County parents can petition the court for an involuntary commitment of up to 45 days. Parents are responsible for costs including legal representation for the minor, court fees, assessment and treatment, and related fees. Families without financial means can apply for funding through the county.
Until recently, Bucks County didn't offer any guidelines on how parents could apply for an Act 53 hearing, and there were no readily available court applications, which slowed down the commitment process, newly appointed Bucks County District Attorney Matt Weintraub said. It could take several weeks before a child appeared before a judge, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.
“It doesn’t do any good if you have to wait a month for treatment,” Weintraub said.
The new, streamlined process is expected to shorten the wait to a week from start to finish, Rosati said.
To ease the financial burden, the Drug and Alcohol Commission will pay for initial drug and alcohol assessment and legal representation for the minor, Rosati said. Parents or guardians will be responsible for court-related fees and treatment costs if they have insurance coverage, Medicaid or county funding. If a private insurer denies the recommended level of care, the county would consider funding the treatment, Rosati said. The length of treatment varies.
Bucks County’s decision to update its Act 53 policy was largely in response to increasing calls from parents with concerns and questions about what options they have for a child showing signs of substance abuse, said Rosati.
In the past, her office received a few calls a year from parents asking about involuntary commitments for juveniles, but none reached the petition stage, she said. Since the new policy was rolled out in August, three families started Act 53 proceedings, but in each case the juvenile eventually entered treatment voluntarily, Rosati said.
Under the revamped process, Bucks County Drug and Alcohol Commission social workers take the initial call and determine if the involuntary commitment route is necessary or if other, voluntary options are viable, Rosati said. If social workers determine the parents have been unsuccessful with other methods, they are directed to complete an online Act 53 court petition available through the Bucks County government website.
After the petition form is completed, a court hearing can be scheduled. Act 53 cases will be heard once a week. Counselors from Aldie Counseling and Penn Foundation will perform the post-application drug and alcohol assessment on-site the day of the court hearing at the Bucks County Justice Center, Rosati said. At any point in the process the family can change its mind and cancel the court hearing, she added.
As a Bucks County judge overseeing juvenile and adult proceedings, Rea Boylan can’t think of a day when she hasn’t seen at least one defendant who is a substance abuser. On one day while serving in juvenile court, three of 20 teen defendants before her were addicted to opiates, she said.
“I see it every day. All day long,” Boylan said. “Parents ask if they can take their child home. They don’t recognize it as a life-threatening disease. They still think a heroin addict is an unattractive, smelly bum on the street, not their beautiful daughter or handsome son who played football.”
Boylan, who was part of the committee that streamlined the policy and will hear Act 53 petitions, hopes it will get more young people into treatment early.
Mary Lynn Keyte, a therapist with Rehab After Work in Warwick Township, has worked with addicted adolescents for decades. She, too, only recently learned about Act 53.
“It’s so hard to watch kids self-destruct and not be able to do anything about it,” she said. “When adolescents get to a point that they are so out of control and parents are at their wit's end after trying everything, it’s a great idea that there is another way to get them placed in treatment.”
Keyte sees the law as a way for parents to get their kids help without involving the juvenile court system, a route that parents turn to as a last resort.
“There they don’t always get what they need, and it becomes more punitive than therapeutic,” she said.
Rosati pointed to Allegheny, Beaver and Berks counties as those with the most active Act 53 programs in place.
Beaver County revised its policy and commitment process in 2014. The goal is to have the child placed in treatment within 24 hours after initial contact, said Kate Lowery, who heads the Beaver County Behavioral Health, Drug and Alcohol Program. It has required a “monumental” coordination effort with local police and schools for locating and transporting children to commitment hearings.
“With each case we learn more and more what to do to smooth the process for the next time it happens,” Lowery said.
Over the last two years, the county has received 21 applications under Act 53 that resulted in 16 commitments. The other juveniles entered drug treatment voluntarily, Lowery said.
“Sometimes it’s the legal hook that keeps them compliant,” she said. “These are good, good parents that are trying so hard to stop the trajectory of addiction for their children. By the time you come to the court to petition for an Act 53 hearing, these are parents that have exhausted all other efforts.”
One reason that Lowery suspects more counties aren’t using the law is that drug and alcohol treatment is often considered a client-driven process; treatment is seen as less effective if the addict is not motivated to get sober.
“In the drug and alcohol world historically there is not a process of involuntary commitment the way it is in the mental health field,” she said.
But DDAP Secretary Tennis noted that people who voluntarily enter substance abuse treatment frequently do so under duress.
“When someone goes into treatment, they don’t usually feel that hopeful they’ll get better. Usually they are going in because the judge said, 'Go in or I’ll lock you up,' or a spouse said, 'Go in or I’ll leave you.' They’re kind of coerced,” he said. “Commitment has to be there, but it usually isn’t there when they walk in the door.”
Cris Fiore doesn't think involuntary treatment will solve the addiction problem, but it could give parents and juveniles more time.
“At least you give them 30 more days of life to maybe come around,” he said. “It’s a chance.”
ACT 53 allows a parent/legal guardian to get a drug and alcohol assessment for their child, and if warranted, compel the child to enter treatment.
Criteria:
The parent/legal guardian believes that their child has a drug or alcohol problem;
The child is unwilling to participate in a treatment program;
The child must be a resident of Bucks County; and between the ages of 12 and 18.
If the above criteria are met, The Bucks County Drug and Alcohol Commission will guide the parent/legal guardian through the Act 53 process. The ACT 53 hearing and assessment process can be completed within a week.
The first step is for parents to call Renee or Joseph at BCDAC Inc. at 215-773-9643, for guidance and resources.
Information on how to access Act 53 will be provided, along with direction on how to complete applications and the two court hearings to be conducted. A confidential drug and alcohol assessment will be conducted by credentialed staff from Aldie Counseling Center or Penn Foundation. The assessment will occur at the Bucks County Justice Center. If the child is found in need of treatment, a court order will be written and arrangements will be made for the child's treatment to begin as soon as possible.
Parents/legal guardians are responsible for court-related fees, including a $58 sheriff fee and $28.50 filing fee. Funding for legal representation for the child will be through the Bucks County Drug and Alcohol Commission. Treatment costs are through parent/guardian private insurance, Medical Assistance or county funding. Guidance on funding process will be provided to parent/legal guardian.
As business partnerships go, the one between the owners of an Upper Makefield horse farm is about as smooth as a bale of hay.
This much Patricia “Penny” Silcox and Michael and Michelle Gara agree on: Silcox is a better horsewoman than a businesswoman; Hickory Run Farm, which Silcox owned and ran for 30 years, has a recent history of financial problems, including delinquent taxes; last year, Silcox borrowed $309,273.34 from the Garas, using the farm as collateral; and the Garas now hold the majority ownership of the farm.
Michelle & Michael Gara
The list of what they dispute is much longer and more complicated. The dispute has evolved into a legal battle in Bucks County Court, where the Garas sued Silcox in July.
Key among the concerns for Silcox is the ownership of the Pineville Road farm. Through her lawyer, Daniel Sweetser, Silcox said she made the Garas partners because Michael Gara told her that was the only way he could get a tax benefit from lending her money. Sweetser said Gara told Silcox he'd reduce her loan amount by the amount of his tax credit, which Sweetser said didn't happen.
Hundreds of pages of new court documents, filed earlier this month by the Garas, boil down to this: They want a judge to force Silcox to fulfill what they say was a verbal promise to transfer the assets of the horse farm, including 36 acres appraised at $1.5 million, into a new company in which the Garas would have a 90-percent ownership and Silcox would own 10 percent. The Garas' lawyer estimates the 10-percent ownership is worth a maximum of $150,000.
The Garas also seek a court injunction to bar Silcox from the farm and from conducting business on its behalf. In July, they received a temporary restraining order barring Silcox from conducting farm business. A few weeks later, a judge postponed a contempt hearing charging Silcox with violating the restraining order. She retains a 25-percent ownership of the farm, but the Garas have removed her from its board of directors and terminated her employment.
“The Garas never wanted to be in litigation or have any trouble whatsoever,” according to their amended lawsuit, which was filed Aug. 4. “They could have bought any other horse farm and not had any of the angst and aggravation that has resulted from defendant Penny and her actions. Simply put, this matter is a lesson in the old adage that no good deed goes unpunished.”
Sweetser contends his client never planned to sell her farm or even partner with the Garas. He said Silcox borrowed $309,273 from the Garas, using the horse farm as collateral. But, he added, Silcox didn't sign a second note borrowing an additional $889,706 from the Garas, as the lawsuit claims. He also said Silcox didn't understand that she gave the Garas 75 percent ownership of the farm when she made them partners on Dec. 31, 2015.
“She never intended to give them any interest in the property,” Sweetser said. “There is not one document, and I’ve been through thousands of documents, and there is not one document I am aware of that talks about that at all.”
Michael Gara, who works as a financial adviser, and his wife became acquainted with the 64-year-old Silcox, who is well known in the local equestrian community, in spring 2013, according to their attorney. The couple started boarding horses at her farm and hired her to give their daughter riding lessons in 2014. Hickory Run Farm is about 1 mile from the couple’s Pineville Road home.
The couple allege that early last year, after Silcox learned they were looking to buy a horse farm, she “manipulated” them into investing more than $1 million in what the lawsuit called her failing farm. They said the money was used for improvements and to clear Silcox’s personal and business debts.
Penny Silcox leading a riding lesson
Among the allegations in the Garas' lawsuit, which seeks damages in excess of $2 million:
In late 2014 or early 2015, Michael Gara paid $27,508 to enclose a metal arena, which allowed Silcox to board horses in the winter. Gara alleges Silcox offered him a lien on a farm-owned horse to assure repayment but didn't follow through.
In May 2015, the Garas, Silcox and attorney Dawn Burke, who represented the Garas, met to consolidate the operations and assets of Hickory Run Farm and RPSC Inc., which owns the land on which the horse farm is located. Silcox and her brother own RPSC. Under terms of the verbal agreement, the assets would be transferred into a new company, the Newtown Equestrian Center, before the end of the first quarter of 2016. The transfer hasn't happened and Burke didn't answer multiple requests for comment.
The $309,273.34 loan the Garas made to Silcox was to repay the couple for money they had already advanced Silcox for the farm and her debts.
Silcox refused to follow financial and billing protocols the Garas implemented, “misappropriated” company money and sold horses without their authorization.
Sweetser contends his client agreed to give the Garas credit toward training lessons and boarding to repay the $27,508 to enclose the barn. He said the Garas were "well aware" of similar barter arrangements Silcox had with other horse owners.
Bucks County and state tax records show multiple liens for unpaid taxes were placed against Hickory Run Farm over the past decade.
The farm’s 2012 property taxes were paid in full as of December 2014, records show. The 2013 and 2014 tax bills — totaling $54,899.32 — remained unpaid until April of this year, Bucks County Tax Claims Bureau records show. The property was advertised for tax sale in 2011, 2012, 2014 and 2015, but the sales were called off after the taxes were paid, tax claims bureau Director Marguerite Genesio said.
When they first started loaning Silcox money, the Garas knew about the tax liens and other debts, according to attorney Neal Jacobs, who represents the couple. However, Jacobs said financial information Silcox provided the Garas convinced the couple the farm could break even if what the suit called "normal" business practices were followed.
Jacobs acknowledged there was only a verbal agreement about restructuring the farm's ownership but said emails, notes taken by Burke and other documents confirm the deal. Silcox was well aware that, under the deal, the farm would essentially belong to the Garas, and she would remain on the board as a minority shareholder and continue working for the Garas as a trainer, Jacobs added.
“Penny wanted to see the land continue as a horse farm and the Garas liked the opportunity to preserve a local farm,” Jacobs said. “The Garas made clear to Penny that if they agreed to work together, that the Garas would have control over the business operations so that they could implement normal business policies, hire the right people and run the farm the way any good business should be run. Penny would focus on what she loved, horse and rider training. Penny agreed to all of this.”
The Garas at Hickory Run Farm
In recent court filings, Sweetser contends the alleged deal is moot since no formal documentation exists. He also argued the Garas have no ownership claim to the farm's land since RPSC owns it, not Silcox.
As the Garas became more involved in the business, the suit said they realized its financial state was worse than Silcox had told them and that she was using company money for personal expenses.
“Simply put, now that her wrongdoing was being uncovered, Penny is trying to take advantage of the Garas by trying to kick them off the farm after she had milked them of over $1.3 million advanced for the benefit of her and the farm,” according to the lawsuit.
Sweetser denied Silcox misappropriated any money or signed the $889,706 loan agreement with the Garas. “She did not sign it. She did not know about this (second) mortgage. She was not aware of it until after this lawsuit started,” the lawyer said.
He also said she wasn't aware she was no longer the majority owner of the farm until the Garas removed her as its manager in March. "That is when it was clear to her that this was not her company anymore, and that she had given away control," Sweetser said.
Sweetser said Silcox was the one manipulated by the Garas, not the reverse as claimed in the Garas' suit.
“Penny has been a horse farmer her entire life and she is not a business-savvy person in any way. The Garas had to know there was no way, ever, Penny Silcox could ever pay back the $1 million they claim they loaned her,” Sweetser said. “Why are you throwing all this money into this property you don’t own? My personal opinion is they were ultimately interested in taking over the property.”
The Bucks County District Attorney’s Office says five police “incident” reports filed in 2014 and last year involving the home of a Lower Southampton man awaiting trial in the high profile case of a child who allegedly was "gifted" to an older man are not public records, citing them as part of a “criminal investigation.”
Assistant District Attorney Joanna Dombrowski, the office’s open records appeal officer, determined a sixth incident report involving Lee Kaplan, 51, was a public record, and this news organization was entitled to access to it. That Nov. 22, 2013, report involved one of Kaplan's neighbors complaining that Kaplan was openly burning trash on his Old Street Road property.
Lower Southampton police identified the six incident reports in response to an open records request this news organization filed following the June 16 arrest of Kaplan. He is accused of sexually abusing a now 18-year-old woman and fathering her two children, ages 9 months and 3 years old. Police allege the woman’s ex-Amish parents “gifted” her to Kaplan when she was 14 after he helped her parents financially.
Lower Southampton police denied the Right to Know request, saying the documents requested are protected as “criminal investigative records” under the state’s Criminal History Records Information Act. The request sought access to records, including public and resident complaints, welfare checks, police visits, citations and violations to Kaplan’s home covering Jan. 1, 2008, to June 21, 2016.
The news organization appealed to the state Office of Open Records, which transferred the appeal to the Bucks County District Attorney’s Office for a final determination. The district attorney's office released its determination — supporting the initial denial of the records — on Aug. 26.
After reviewing the documents, Dombrowski denied access to five reports, citing them as “related to a criminal investigation,” and not public records. The reports were filed June 30, 2014; July 7, 2014; July 23, 2014; Oct. 29, 2014; and April 28, 2015, according to the determination. The document does not describe the records beyond calling them “incident reports.” The source of the reports is unknown.
This news organization was unsuccessful in reaching Lower Southampton Public Safety Director Robert Hoopes for comment on the nature of the incident reports and if they relate to the case against Kaplan.
Dombrowski declined to confirm if the documents denied to the news organization were related to the “gifted child” case or any other investigation involving Kaplan, citing state law that prohibits comment on the content of criminal investigation records or reports.
Lower Southampton police faced public criticism that they did not act sooner after neighbors complained about suspicious activity at Kaplan’s house, where authorities say he lived with the alleged victim, their two children, and her nine sisters ranging in age from 3 to 17. Police said the victim's children and her siblings do not appear to have been abused.
The alleged victim and the 11 children were discovered after a neighbor called a child abuse hotline with concerns about the welfare of children living in Kaplan’s house, which prompted Bucks County Children and Youth Social Services Agency workers to do a welfare check. The social workers were accompanied by Lower Southampton police and resulted in the arrests of Kaplan and the young woman's parents.
The young woman’s parents are charged with endangering the welfare of children and her father is charged with conspiracy. This news organization is not identifying the parents in an effort to protect the identities of the children. All three defendants remain in Bucks County prison awaiting trial.
In response to neighbors' claims that they contacted police earlier about Kaplan and the children, Hoopes acknowledged that neighbors had contacted police, but the complaints mostly involved nuisance issues, such as trash-burning, overgrown grass and animals. Some complaints included a passing mention of girls in Amish-style clothing, and nothing to suggest they were in danger, he said.
Bucks County emergency dispatch records for Kaplan's property from Jan. 1, 2008, through June 21, 2016, did not show any calls suggesting concerns about children. The 911 records — also obtained through a Right to Know request — show that police responded to nine calls involving Kaplan’s address, including a chimney fire, reports involving alleged violations of local ordinances, harassment and a civil complaint. There were no 911 calls involving the home in 2010, 2012, 2013 or 2015, according to the records.
Previously, police sources confirmed that Lower Southampton police visited Kaplan’s house in 2014 after they received a complaint about excessive smoke from an outdoor grill. During that visit, police officers saw a small child, a baby and an older woman, later identified as the mother of 10 of the children found at Kaplan's home in June. Kaplan, who claimed he was Amish, said the older woman was the wife of his business partner and that her family would also be living in his home while their Lancaster home was renovated, a police source said.
As mandatory child abuse reporters in Pennsylvania, police are required to report any complaints or incidents involving suspected child abuse or neglect to child welfare officials for investigation. Police also have the ability to conduct a parallel criminal investigation involving suspected child abuse or neglect, according to child welfare advocates.
Police officers are not obligated to forward information to child welfare authorities if they don’t suspect abuse or neglect occurred, a standard that is far more broad and nuanced than the evidence threshold for criminal behavior, child welfare advocates said.
Child welfare agencies, however, are required to forward information to law enforcement if an alleged abuser doesn't fall under the state definition of a perpetrator under the child protection law or an abuse or neglect report involves a possible crime, under the child protection law.
The newest and deadliest mix of street heroin that health officials worry might soon circulate in Pennsylvania is so dangerous the body will respond to a dose the size of a grain of salt.
“That is how sensitive humans are to carfentanil,” said David Fialko, a prevention specialist with the Council for Southeastern Pennsylvania. “This is deadly.”
And state health officials say they are uncertain about whether the popular opiate overdose reversal drug naloxone would work with the drug.
On Thursday, Pennsylvania health officials issued an urgent warningthat heroin laced with elephant tranquilizer known as carfentanil, which is believed to be responsible for overdoses and deaths in neighboring states, appears to be headed to Pennsylvania. It was news to local drug and alcohol treatment experts, and first responders said they were warned about at least a month ago.
Carfentanil is one of the most powerful opioids in existence. It can be absorbed through the skin or inhaled, which makes it potentially fatal for not only drug addicts, but first responders, medical workers and others who come into contact with it, officials said.
The so-called copycat chemical is 10,000 times stronger than morphine and 100 times more powerful than black market fentanyl, a powerful copycat version of the prescription painkiller found in street heroin over the last three years. Carfentanil commonly is used to sedate large animals such as elephants and it was not designed for human consumption, according to state health officials and local first responders.
“If it can take down a large animal, you can imagine what it can do to a person,” Fialko said.
Fialko described the drug as so powerful the body will response to a dose that is one microgram — a measure equal to a 1 millionth of a gram. A typical heroin bag contains one-tenth of a gram of heroin, which typically is 80 to 90 percent pure, he said.
"Given that such a small amount of carfentanil can be deadly and most users of heroin mixed with carfentanil do not realize that is what they are getting, the chances of overdose death are very high,” said Gary Tennis, secretary of the state's Department of Drug and Alcohol Programs.
The potential lethalness of the drug at such small exposures prompted federal authorities to discourage law enforcement from field-testing suspected heroin or fentanyl. Instead, the office recommended sending samples straight to a lab for testing.
Bensalem police typically respond to three to as many as 14 heroin and opioid overdoses a week, according to Public Safety Director Fred Harran. Recently, there were three overdose deaths in a weekend in the township, he said.
Four months ago, Harran implemented new safety precautions in anticipation of seeing carfentanil. They included changes in protocol for field testing suspected drugs; now only specially trained officers are allowed to do the tests with suspected opioids.
“Of course, I have concerns,” Harran added. “One is for the poor addicts trying to get that ultimate high. They’re not going to get high and die. The second concerns are for first responders and people who come into contact with it not of their own choice.”
Local first responders say they haven’t seen carfentanil laced heroin yet, either, but they already exercise universal precautions, such as wearing gloves and facial covering when dealing with overdose patients. Their biggest concern is whether naloxone will work.
Since carfentanil isn’t meant for human consumption, there aren’t any studies that can help health officials identify how effective naloxone would be.
Local medical personnel believe naloxone can reverse a carfentanil overdose, but it would require a far higher dose than what is normally given.
Second Alarmer's Rescue Squad in Upper Moreland already has had to give greater doses of naloxone to patients who have overdosed on heroin laced with fentanyl, assistant chief Ken Davidson said.
Another concern for Davidson is the over-the-counter availability of naloxone means more untrained people are administering it; those family and friends might not realize that one dose of naloxone might not be enough to fully revive a person, and they can slip back into an overdose without further medical treatment.
An ambulance can use all of its on-board naloxone supply to revive an overdose patient, added Dr. Gerry Wydro, medical director for Bucks County Emergency Medical Services. While rescue squads typically carry multiple doses of the drug, police officers typically don’t, he said.
In 2015, more than 3,500 Pennsylvanians died from a drug overdose. Heroin and opioid overdose are the leading cause of accidental death in Pennsylvania, officials say.
In Bucks County, which saw a 4-percent increase in overdose deaths last year, heroin was present in nearly half of the 117 reported fatal overdose and fentanyl appeared in more than one quarter of the cases, according the federal Drug Enforcement Agency. The drugs appeared in similar concentrations in Montgomery County, where 136 reported overdose deaths represented a 16 percent decrease from 2014's numbers.
