Title: DeBoer v. Sr. Bridges of Sparks Fam. Hosp.

State: nevada

Issuer: Nevada Supreme Court

Document:

428 Nev., Advance Opinion 38

IN THE SUPREME COURT OF THE STATE OF NEVADA

SUSAN DEBOER, IN HER CAPACITY No. 57107
AS THE LEGAL GUARDIAN OF
GAYLE SAVAGE, AN ADULT WARD,
Appellant,

FILED

AUG 09 2012

Sg

Appeal from a district court order dismissing a tort action.
Second Judicial District Court, Washoe County; Steven P, Elliott, Judge.

vs.
SENIOR BRIDGES OF SPARKS
FAMILY HOSPITAL, INC., D/B/A
NORTHERN NEVADA MEDICAL
CENTER, A DOMESTIC
CORPORATION,

Respondent.

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Bradley Drendel & Jeanney and Joseph S. Bradley, Reno,
for Appellant.

Hall Prangle & Schoonveld, LLC, and ‘Tyler M. Crawford and David P.
Ferrainolo, Las Vegas,
for Respondent.

 

BEFORE CHERRY, C.J., PICKERING and HARDESTY, JJ.
PINT
By the Court, CHERRY, C.J.:

In this appeal, we examine the duty of care owed by a medical
facility when performing nonmedical functions. While we have embraced

12-2502

 
the duty owed by a medical facility towards its patients with respect to
medical treatment, see Wickliffe v. Sunrise Hospital, 101 Nev. 542, 548,
706 P.24 1383, 1388 (1985) (holding “that a hospital is required to employ
that degree of skill and care expected of a reasonably competent hospital
in the same or similar circumstances”), we have not previously addressed
whether a medical facility has a duty of care beyond the duty to provide
competent medical care. We take this opportunity to recognize that when
a medical facility performs a nonmedical function, general negligence
standards apply, such that the medical facility has a duty to exercise
reasonable care to avoid foreseeable harm as a result of its actions,

Here, the complaint alleged that appellant, a cognitively
impaired patient who required a guardian to make medical and financial
decisions for her, was exploited by a third party after a social worker
employed by the respondent medical facility provided the third party with
a preprinted general power-of-attorney form, which the patient
subsequently executed in furtherance of her discharge from the facility,
‘The manner in which the medical facility allegedly effectuated the
discharge of the patient could lead a reasonable jury to find that the
patient's financial injuries were a foreseeable result of the facility's
conduct. Thus, the district court erred when it found that the medical
facility owed the patient no duty beyond the duty to provide competent
medical care and dismissed the complaint for failure to state a claim.

Accordingly, we reverse the order dismissing this action and remand this

case to the district court for further proceedings.

 

 
on

 

FACTS:

Gayle Savaget was admitted to respondent Senior Bridges of
Sparks Family Hospital, Inc., d.b.a, Northern Nevada Medical Center,
after being discovered confused and wandering in a neighbor's backyard.
Senior Bridges, Savage's complaint alleged, is an acute care facility
specializing in the evaluation, treatment, and placement of elderly
patients. Upon entering Senior Bridges, Savage apparently was diagnosed
with mild to moderate dementia as a result of Alzheimer's disease.
Because of Savage's condition, her doctor concluded that she needed a
guardian to make medical and financial decisions for her.

One week after Savage's admission, a Senior Bridges social
worker met with an individual identified as Peggy Violat Six, who offered
to care for Savage upon her discharge from Senior Bridges on the
condition that Savage execute a general power of attorney designating Six
‘as her appointee for financial matters. Thereafter, Savage alleges, the
Senior Bridges social worker provided Savage with a preprinted general
power-of-attorney form, which Savage executed, ostensibly giving Six
power over Savage's personal and financial affairs. A notary public
employed by Senior Bridges purportedly verified Savage's execution and
acknowledgment of the general power-of-attorney form. Savage was
subsequently discharged by Senior Bridges into the care of Six, who

‘The named appellant in this appeal is the Washoe County Public
Guardian, Susan DeBoer, who brought the action in her capacity as
guardian for Gayle Savage. It is unclear from the complaint precisely
when or under what circumstances DeBoer was appointed guardian of
Savage.

 
allegedly proceeded to exploit Savage by misappropriating her money, real
property, and other assets.

Based on Six’s alleged exploitation of Savage, the Washoe
County Public Guardian, in her capacity

 

legal guardian of Savage, filed
a complaint against Senior Bridges for negligence. The complaint asserted

that Senior Bridges breached its duty of care by allowing Savage to a:

 

ign
a general power of attorney in favor of Six, when a reasonable
investigation would have established that Savage lacked the requisite
mental competence to execute a power of attorney or to protect herself
from exploitation,

In response, Senior Bridges filed a motion to dismiss the
complaint under NRCP 12(b)(5) for failure to state a claim upon which

relief can be granted, contending that it did not have a duty to protect

 

Savage from financial exploitation by a third party because, as a medical
facility, its duty was limited to providing Savage with appropriate medical
services and competent medical care. Savage opposed the motion, arguing
that Senior Bridges had a duty to protect her from foreseeable harm of the
type that she suffered. Alternatively, Savage asserted that Senior Bridges
assumed a duty to protect her by facilitating her execution of the power-of-
attorney form.

‘The district court granted Senior Bridges’ motion to dismiss,
finding that Senior Bridges did not owe Savage a duty of care beyond the

duty to provide competent medical care, and asserting that it would be
fundamentally unfair to hold a medical facility liable for damages
resulting from actions that occurred outside the scope of the healthcare-
based relationship. Moreover, the court concluded that the harm of
financial exploitation was not so “necessarily foreseeable” as to warrant

 

 
imposing a duty of care on Senior Bridges in this case. Finally, the court
expressed concern that recognizing a duty to assist patients with financial
planning decisions would require medical facilities to employ financial
planning experts and could potentially open the floodgates of litigation?
‘This appeal followed.

DISCUSSION

This court rigorously reviews de novo a distriet court order
granting an NRCP 12(b\5) motion to dismiss, accepting all of the
plaintiff's factual allegations as true and drawing every reasonable
inference in the plaintiff's favor to determine whether the allegations are
sufficient to state a claim for relief. Sanchez v. Wal-Mart Stores, 125 Nev.
818, 823, 221 P.3d 1276, 1280 (2009); Shoen v, SAC Holding Corp., 122
Nev. 621, 634-35, 137 P.3d 1171, 1180 (2006). A complaint should be
dismissed for failure to state a claim “only if it appears beyond a doubt
that it could prove no set of facts, which, if true, would entitle it to relief.”
Buzz Stew, LLC v, City of N, Las Vogas, 124 Nev. 224, 228, 181 P.3d 670,
672 (2008).

Savage contends that Senior Bridges owed her a duty of care
beyond the duty to provide competent medical care. In particular, she
claims that the social worker employed by the facility failed to exercise
due care when he helped her arrange her financial affairs in furtherance
of her discharge. Senior Bridges acknowledges that it owed Savage a duty

As this opinion addresses the duty of a medical facility to exercise
reasonable care and not a specific duty to assist patients with financial
planning, we disagree with the district court’s concerns that hospitals will
be required to employ financial planners to protect them from actions such
as this one.

 

 
of reasonable care in the treatment of her medical conditions, but argues
that it did not owe Savage a duty to protect her against third-party
financial exploitation

‘The district court, quoting Wickliffe v. Sunrise Hospital, 101
Nev. 542, 548, 706 P.2d 1383, 1888 (1985), found that Senior Bridges was
required to employ “the ‘degree of skill and care expected of a reasonably
competent hospital in the same or similar circumstances” in diagnosing
and treating Savage's cognitive impairments, but had no duty to assist
Savage with financial decisions prior to discharge. In doing so, the district
court narrowly circumscribed the legal duty that Senior Bridges owed to
Savage. The district court effectively furnished Senior Bridges with full
immunity from claims stemming from nonmedical injuries on its premises,
‘This is not sound policy and does not conform to our negligence
Jurisprudence. See generally Moody v, Manny's Auto Repair, 110 Nev.
320, 333, 871 P.2d 935, 943 (1994) (holding, in the context of landowner
liability, that “all persons in this society have an obligation to act

reasonably and . . . should be held to the general duty of reasonable care

5In her briefs filed in this court, Savage only argues under general
negligence principles that Senior Bridges did not act with reasonable care
in facilitating her aftereare plans, Hence, in deciding this appeal, we need
not address whether a medical facility has an affirmative duty to protect
its patients from the harmful acts of third parties. See Sanchez v. Wal-
‘Mart Stores, 125 Nev. 818, 824, 221 P.3d 1276, 1280-81 (2009) (in Nevada,
there is no duty to protect a person from the harmful conduct of a third
party unless “(1) a special relationship exists between the parties or
between the defendant and the identifiable victim, and (2) the harm
created by the defendant's conduct is foreseeable”); see also Sparks v.
Alpha Tau Omega Fraternity, 127 Nev. __, ___, 256 P.3d 238, 244 (2011);
Scialabba v. Brandise Constr, Co,, 112 Nev. 965, 968-69, 921 P.2d 928, 930
(1996).

 

 

 
when another is injured”). Immunity from liability cannot be enjoyed
simply due to one’s legal status. Wright v. Schum, 105 Nev. 611, 613-14,
781 P.2d 1142, 1143 (1989). Thus, a healtheare-based corporation's status
as a medical facility cannot shield it from other forms of tort liability when.
it acts outside of the scope of medicine. Instead, we establish that medical
facilities should be required to conform to normal standards of
reasonableness under general principles of tort law when performing
nonmedical functions, Courts in other jurisdictions, including
Connecticut, Louisiana, Michigan, New York, and Tennessee, have
developed a similar standard, Seo, e.g, Gold v. Greenwich Hosp. Ass'n,
811 A.2d 1266, 1270 (Conn, 2002) (claim was not characterized under
ordinary negligence principles because it involved medical diagnosis and
judgment); Coleman_v. Deno, 813 So. 24 303, 315 (La, 2002) (aims
against a healthcare facility not arising in medical malpractice are
governed by general tort law); Dorris v, Detroit Osteopathic Hosp,, 594
N.W.2d 455, 465 (Mich. 1999) (ordinary negligence claims “raise issues

that are within the common knowledge and experience of the jury,”

 

whereas medical malpractice claims “raise questions involving medical
judgment”); Weiner v, Lenox Hill Hospital, 673 N.E.2d 914, 916 (N.Y.
1996) (‘{W]hen ‘the gravamen of the complaint is not negligence in

furnishing medical treatment to a patient, but the hospital's failure in

fulfilling a different duty,’ the claim sounds in negligence.” (quoting Bleiler
v. Bodnar, 479 N.E.2d 230, 235 (N.Y. 1985))); Estate of French v, Stratford
House, 333 S.W.3d 546, 556 (Tenn. 2011) (claims sound in ordinary
negligence when the act or omission complained of requires no specialized
medical skills)

 

 
Aside from the wide range of medical services healtheare-
based facilities provide, they also offer diverse nonmedical services to the
public, including, but not limited to, aftercare planning with social
workers.4 Although such services do not fall within the scope of the duty
owed by a medical facility towards its patients as contemplated in
Wickliffe, medical facilities across this state nonetheless “““must exercise
reasonable care not to subject others to an unreasonable risk of harm”
when acting in roles unrelated to the practice of medicine, Wright, 105
Nev. at 614, 781 P.2d at 1143 (quoting Turpel v. Sayles, 101 Nev. 35, 38,
692 P.2d 1290, 1292 (1985) (quoting Sargent v. Ross, 308 A.2d 528, 634
(NH, 1973))). A social worker helping a patient to establish financial
arrangements in effectuating the patient's discharge cannot be regarded
as a medical function, Cf, Brown v, United Blood Services, 109 Nev. 758,
766, 858 P.2d 391, 396 (1998) (rejecting the proposition that a blood bank
supplying blood from a donor infected with HIV should be held to an
ordinary nogligence standard). Savage's complaint was grounded in
ordinary negligence, as it was not related to medical diagnosis, judgment,
or treatment. As such, the district court erred in branding Savage's

complaint as a medical malpractice claim.s Therefore, the question in this

“The statutes pertaining to the regulation of social workers are
found in NRS Chapter 641B.

The district court essentially applied a medical malpractice
standard. To prevail on a medical malpractice action, the plaintiff must
demonstrate: “(1) that the doctor's conduct departed from the accepted
standard of medical care or practice; (2) that the doctor's conduct was both
the actual and proximate cause of the plaintiff's injury; and (8) that the
plaintiff suffered damages.” Prabhu v, Levine, 112 Nev. 138, 1543, 930
P.2d 103, 107 (1996).

 

 
case is not whether Senior Bridges is liable to Savage as a medical facility,
as the district court suggests, but rather, whether it is liable to Savage
under a general negligence theory.

In order to prevail on a traditional negligence theory, a
plaintiff must establish that (1) the defendant owed the plaintiff a duty of
care, (2) the defendant breached that duty, (3) the breach was the legal
cause of the plaintiff's injuries, and (4) the plaintiff suffered damage:
Klasch v. Walgreen Co,, 127 Nev. _, _, 264 P.3d 1155, 1158 (2011); see
Driscoll_v. Erroguible, 87 Nev. 97, 101, 482 P.2d 291, 294 (1971)

 

(Negligence is failure to exercise that degree of care in a given situation
which a reasonable man under similar circumstances would exercise.”)
‘This appeal concerns only the first of these four elements—the existence of
a duty of care. As discussed herein, under general negligence standards,
medical facilities have a duty to exercise reasonable care to avoid
foreseeable harm when they furnish nonmedical services. See Wright, 105
Nev. at 614, 781 P.2d at 1143, The district court erred when it determined
as a matter of law, based on the pleadings alone, that Senior Bridges’
actions breached its duty of reasonable care. See Butler v. Bayer, 123
Nev. 450, 464, 168 P.3d 1055, 1065 (2007) (“Because the question of
whether reasonable care was exercised almost always involves factual
inquiries, it is a matter that must generally be decided by a jury.”).
Accepting the allegations of the complaint as true and drawing
inferences in favor of Savage, Sanchez v. Wal-Mart Stores, 125 Nev. 818,
823, 221 P.3d 1276, 1280 (2009), we conclude that the manner in which
Senior Bridges effectuated Savage's discharge could lead a reasonable jury

to find that her financial injuries were a foreseeable result of the facility's

conduct. Because Senior Bridges specializes in elder care, a jury could

 

 
on ae

 

reasonably determine that the facility should be particularly aware of
concerns related to financial abuse of older, cognitively impaired patients,
See Jane A. Black, Note, The Not-So-Golden Years: Power of Attorney,
Elder Abuse, and Why Our Laws Are Failing a Vulnerable Population, 82
St. John’s L, Rev. 289, 291 (2008) (stating that “[fJinancial exploitation of
the elderly is the third most common category—and fastest growing
form—of elder abuse”); Dana Shilling, Legal Issues of Dependent and
Incapacitated People { 7.7, at 7-21 (2007) (recognizing that financial
exploitation of the elderly by trustees and guardians is a significant
problem); see generally NRS 200.5091-.50995 (defining and establishing
punishments for crimes related to abuse, neglect, exploitation, and

jolation of elderly and otherwise vulnerable individuals), Moreover, a
jury could reasonably find that Senior Bridges was on notice that Savage
was especially vulnerable to financial exploitation due to the fact that a
Senior Bridges doctor had determined that Savage's dementia rendered
her unable to make financial decisions for herself. See Matthew A.
Christiansen, Unconscionable: Financial Exploitation of Elderly Persons
With Dementia, 9 Marg. Elder's Advisor 383, 415 (2008) (stating that
“{flinancial exploitation of elderly persons with dementia is particularly
troublesome”). A jury could further find that someone in Savage's
psychological condition may lack the cognitive ability to manage his or her
own financial affairs, including important monetary decisions surrounding
the activation of the power of attorney. Sce Julia Calvo Bueno, Reforming
Durable Power of Attorney Statutes to Combat Financial Exploitation of
the Elderly, 16 NAELA Q. 20, 20 (2003) (noting that studies have
suggested a significant rate of occurrence of financial abuse through
powers of attorney); Carla Spivack, Why the Testamentary Doctrine of

10

 
 

Undue Influence Should Be Abolished, 58 U. Kan. L. Rev. 245, 298 (2010)
(citing one study estimating that 40 percent of elder abuse cases involve
financial exploitation). In accordance with the standard negligence
framework, we conclude that Senior Bridges may have breached its duty
of care to Savage by not acting reasonably in facilitating the power-of-
attorney forms in furtherance of discharging her from its medical facility.
Accordingly, dismissal of this action for failure to state a claim was
improper.
CONCLUSION

‘The allegations in Savage's complaint, taken as true, establish

 

a viable claim for relief. Consequently, we conclude that the district court

erred in dismissing the complaint. Potential factual issues exist as to

  

whether Senior Bridges acted negligently in overseeing Savage's release
from its medical facility. Therefore, we reverse the district court's order
dismissing the action against Senior Bridges and remand this case to the

district court for further proceedings consistent with this opinion.

 

We concur:

Parris J.
Pickering J

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