CHA News Article

Court of Appeal Grants CHA Request for Published Opinion
Court ruled in favor of hospital, physicians in wrongful death suit

The California Court of Appeal last week granted CHA’s request to publish its opinion in Alexander v. Scripps Memorial Hospital La Jolla et al. CHA requested that the court publish the decision because of the important legal issues it addresses, and because having it published allows attorneys in future cases to rely on it.

In the case, a patient with incurable stage four pancreatic cancer was transferred to a hospital from a skilled-nursing facility (SNF) for evaluation. The transferring physician did not believe she would return to the SNF, as he believed her death was imminent. The patient had completed an advance directive and a Physician Orders for Life Sustaining Treatment (POLST) form electing to have all measures taken to prolong her life, including full resuscitation if necessary. All physicians caring for the patient agreed that cardiac compression would be futile and cause harm and suffering. The family said they understood her condition was terminal, but still wanted full resuscitation.

The physicians consulted the hospital’s Appropriate Care Committee, which met at the patient’s bedside, reviewed her medical records and spoke with her physicians. The committee explained to the family that doctors could not embark on ineffective care. The patient died three days after admission, having received palliative care and pain control, but without receiving cardiac compression. She died about an hour before she was scheduled to be transferred to another facility that the family believed would comply with its directions. The family sued, alleging 16 different causes of action, including malpractice, wrongful death, elder abuse, misrepresentation, infliction of emotional distress and violations of state law regarding advance directives.

The trial court found in favor of the hospital and physicians, and awarded them more than $160,000 to cover their costs of defending the case. The family appealed. The appellate court agreed with the trial court, and made several important rulings:

  1. Physicians serving on the Appropriate Care Committee do not have a physician-patient relationship with the patient sufficient to impose upon them the associated duty of care. The court held that these committees serve a valuable and difficult role in patient care, and imposing liability on their members would discourage physicians from participating.
  2. A health care provider is not required to comply with every technical documentation requirement of the Health Care Decisions Law in order to enjoy immunity, if the provider acts in good faith in accordance with generally accepted health care standards.
  3. Neither the hospital nor every physician treating a patient is considered a “supervising health care provider” under Probate Code Section 4731 and, therefore, are not required to request a copy of an advance directive and document its existence.
  4. A physician’s failure to request a copy of an advance directive is not actionable unless it is intentional and causes injury to the patient.