Alexander v. Scripps Memorial Hospital La Jolla (Apr. 16, 2018, D071001) __ Cal.App.5th __ [2018 WL 1790545], certified for partial publication May 11, 2018
Elizabeth Alexander, a 70-year-old woman suffering from terminal pancreatic cancer, died four days after she was transferred from a skilled nursing facility to Scripps Memorial Hospital. Elizabeth had an advance health care directive stating she wanted all measures taken to prolong her life. Her doctors at Scripps believed certain advanced life support measures would be medically ineffective and harmful. They involved Scripps’s Appropriate Care Committee—a team of physicians who provide recommendations and ethical guidance—which discussed the tension between Elizabeth’s health care directive and her treating physicians’ views. After reviewing Elizabeth’s records and observing her condition, the Committee recommended against advanced life support measures and informed Elizabeth’s son, Christopher, that Scripps’s doctors could not embark on ineffective care. Christopher requested that Elizabeth be transferred to another facility, but she died before her scheduled transfer. Elizabeth’s estate and children later sued Scripps and numerous providers (including members of the Committee) for negligence (of several varieties) and elder abuse, alleging they failed to provide the life-sustaining treatment requested in her advanced health care directive. The trial court entered judgment for defendants after sustaining demurrers and granting summary judgments. Plaintiffs appealed.
The Court of Appeal affirmed; three aspects of its decision merit attention. First, the court held that disagreements between physicians and patients (or their family members) about the type of care provided do not give rise to elder abuse claims. Second, the court held that members of the Committee lacked a physician-patient relationship, meaning they owed no duty of care to Elizabeth. Third, recognizing the valuable role that ethics committees play in patient care, the court interpreted provisions of the Health Care Decisions Law (Prob. Code, §§ 4735, 4740) to confer immunity on institutions that act in good faith and in accordance with generally accepted health care standards in declining to comply with an individual health care directive that would require medically ineffective care. The Court of Appeal also explained that hospitals are not health care providers within the meaning of the Health Care Decisions Law; they are institutions and the law distinguishes providers from institutions.
Prepared by H. Thomas Watson and Peder K. Batalden, Horvitz & Levy, LLP
California Society for Healthcare Attorneys
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