Doctors Hospital Of Augusta v. Alicea

Facts

Stephenson executed an advance directive for health care, designating as her health care agent P, the granddaughter with whom she lived. P was “authorized to make all health-care decisions for me, including decisions to provide, withhold, or withdraw artificial nutrition and hydration, and all other forms of health care to keep me alive.” Stephenson repeatedly told her family members that “she was ready to go when the good Lord called her,” and said, “when it's my time, it's my time, don't prolong it.” She told P specifically that “[s]he did not want … to rely on a machine to have to live,” including a ventilator to breathe for her. Stephenson initialed the option that said: Choice NOT to Prolong Life. Two years later Stephenson developed a persistent cough and P feared that Stephenson was having a stroke and drove her to the Hospital's emergency room; P brought the Advance Directive with her. P was suffering from pneumonia, sepsis, and acute renal failure, and she was admitted to D. The Advance Directive was placed in Stephenson's medical record, but not in the front behind the admission tab as required by D policy to ensure its ready availability to all doctors and D staff. P gave D her contact information, including her home, work, and cell phone numbers and her husband's cell phone number, so that she could be reached. Stephenson was unable or chose not to make significant health care decisions for herself, triggering P's authority to make those decisions pursuant to the Advance Directive. Dr. Catalano called D and said that he planned to perform a computed tomography scan to better assess her condition. P did not object to the CT scan, but she told Dr. Catalano about Stephenson's Advance Directive and specifically instructed that “by no means was CPR [cardio-pulmonary resuscitation] to ever be administered” and that “no heroic measures were to be used” to prolong Stephenson's life. Dr. Joseph called P and ask her to consent to a right chest thoracentesis, which would involve a small incision and the insertion of a tube into Stephenson's chest to drain the infection from her lung; this procedure does not involve intubation. P consented and repeated the instructions that “no heroic measures” were to be used and that Stephenson was not to be given CPR. D directed the doctor to call her before intubating Stephenson and putting her on a ventilator. Dr. Joseph wrote twice in his progress note that Stephenson was “no CPR” and that P had to be called “before patient is intubated.” Dr. Catalano called Alicea requested P's verbal consent for a “surgical” thoracentesis to drain more fluid from Stephenson's lung cavity. Dr. Catalano had not read the Advance Directive or the progress notes in Stephenson's medical chart; he did not tell P that this procedure would require intubation and the use of a ventilator. Dr. Catalano found that much of Stephenson's right lung was necrotic (dead tissue), and he removed two-thirds of the lung. Stephenson was extubated in the recovery room, and P was not told that she had been intubated and put on a ventilator. Two days later, Dr. Catalano decided to have Stephenson intubated and put on a ventilator to prevent her from going into respiratory or cardiac arrest. He decided not to call P. No effort was made to contact P before or after Stephenson was intubated. Ps husband stopped by the Hospital and was surprised to see Stephenson on a ventilator. P consented to another surgical procedure and others recommended by Dr. Catalano and the Hospital staff over the next week, including the placement of a feeding tube, a bronchoscopy to remove pus from Stephenson's airway, and a tracheostomy to provide an alternate airway and to remove secretions. Eventually, P authorized the removal of the ventilator and Stephenson died. P filed a complaint against D and Dr. Catalano, raising claims of breach of agreement, professional and ordinary negligence, medical battery, intentional infliction of emotional distress, and breach of fiduciary duty. P's expert concluded that when Stephenson arrived at D, she already “had an incurable and irreversible condition that was likely to result in her death within a relatively short period of time thereafter,” and that “her condition was such that the likely risk and burdens of any invasive procedures and treatment outweighed any expected benefits.” P's expert stated that D and Dr. Catalano breached the standard of care. Ds filed a motion for summary judgment, contending they were immune from liability. The trial court denied summary judgment. The Court of Appeals affirmed in relevant part.

Issues

Rule of Law

Holding and Decision

Legal Analysis

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