FOURTH D I VI SI ON

BA RNES, P. J.

, RA Y, and M CM I LLI A N

, JJ.

N O T IC E : M otions for r e c ons i de r a tion m us t be

ph y sic a l ly r e ce iv ed i n our c le r k ’s offic e w ithin te n

da y s of the da te of de c is ion to be de e m ed tim e ly file d.

http://w w w .ga a ppe a ls .us /r ule s /

June 17, 2015



# I n th e Co u r t o f

A p p eals o f

G eo r g ia

A1 5 A0 10 7

. DOCTORS HOSP ITAL OF AUGUSTA, L L C et al

. v

. ALICEA.

B A R N E S , Pres i d i n g J ud g e.

Th i s ap p eal rai s es q ues ti o n s p ert ai n i n g t o t h e i m m unity of h eal t h care pro v i d ers

an d faci li t i es u n d er t he Geo rg ia Ad v an ce Di rect i v e fo r Heal th Care Act

, OCGA § 3 1

-

3 2 -1 et seq

. (“ Ad v an ce Di rect i ve Act ”) an d to t h e law o f i n fo rm ed an d b as ic co n s en t

.

Th e p l ai n t i ff, as ad m i n is t rat o r o f t h e es t at e o f h er g ran d m o t h er, s u ed Do ct ors Ho s p i t al

o f Au g u s t a, LLC an d Dr. Ph i l l i p W i l l i am Cat al an o , al leg i ng t h at t hey i n tu b at ed t h e

p l ai n t i ff’ s g ran d m o t h er an d p l aced h er o n m ech an i cal v en t i lat i on

, wh i ch p ro l o n g ed

h er l i fe wh en s h e was i n a t erm i n al co nd i t i o n an d cau s ed h er u n n eces s ary p ai n an d

s u fferi n g, co nt rary t o t h e g ran d m o t h er’ s ad v an ce d i rect i v e an d t h e s p eci fi c d i rect i on s

o f h er d es i g nat ed h eal t h care ag en t

. Th e p l ai n t i ff as s ert ed cl ai m s fo r, am o n g o t h er

t h i n g s

, m ed i cal m al p ract i ce fo r l ack o f i n fo rm ed co n s en t an d m ed i cal b at t ery fo r l ack

o f b as i c co ns en t

.Th e d efen d an t s m ov ed fo r s u m m ary ju d g m en t

, co nt en d i n g th at t h e

u n co nt ro v ert ed ev i d en ce s h o w ed t h at th ey were i m m u n e fro m l i ab i l i t y fo r i n t u b at i n g

t h e g ran d m o th er o n M arch 7

, 2 0 1 2 b as ed o n OCGA § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ) o f t h e

Ad v an ce Di rect i v e A c t ; t hat t h ey o b t ai ned i n fo rm ed co n sen t fo r a M arch 5

, 2 0 1 2

s u rg i cal p ro ced u re p erfo rm ed o n t h e g ran dm o t h er; an d th at th ey o b t ai n ed b as i c

co n sen t fo r th e M arc h 5 p r o c e d u re an d M arch 7 i n t ub at i o n

. Th e t ri al co u rt d en i ed

s u m m ary ju d g m en t t o t h e d efen d an t s o n t h es e cl ai m s

.

Fo r th e reas o n s d i s cu s s ed b el o w, we affi rm th e t ri a l co u rt ’ s den i al o f t h e

d efen d an t s ’ m o t io n fo r s um m ary ju dg m en t o n t h ei r d efen se o f s tat u t o ry i m m u n i t y an d

o n t h e p l ai n t i ff’ s m ed i cal b a t t e r y c l ai m fo r lack o f b as i c co n s en t t o t h e M arch 7

i n t u b at i o n. Ho w ev er, we rev ers e t h e t ri al co u rt ’ s den i al of su m m ary ju d g m en t t o t h e

d efen d an t s o n t he p l ai n t i ff’ s cl ai m s b as ed o n t h e al l eg ed l ack of bas i c an d i n fo rm ed

co n sen t rel at i n g t o t h e g ran d m o t h er’ s M arch 5 s u rg i cal p ro ced u re.

Su m m ary ju d g m en t i s ap p ro p ri at e o n l y if t h e p l ead i n g s an d ev i d en ce “ s h o w

t h at t h ere i s n o g en u i n e i s s u e as t o an y m at eri al f a c t an d t h at th e m o v i n g p art y i s

en t i t l ed t o a ju dg m en t as a m at ter o f l aw.” OCGA § 9 -1 1 -5 6 (c). W e rev i ew t he d en i al

o f s u m m ary ju dg m en t d e n ov o an d v i ew t he ev i d en ce i n t h e l ig h t m o st fav o rab l e t o

2t h e n o n m o vi n g p art y

. Ho o d v. To d d

, 2 8 7 Ga. 1 64

, 1 6 5 (6 9 5 SE2 d 3 1 ) (2 01 0 ). Gu i d ed

b y t h es e p ri n ci p l es , we t u rn t o t h e reco rd i n t h e p res en t cas e.

S t e p h en so n ’s Ad

va nce Di r ect i ve f

o r Hea l th ca r e. In No v em b er 2 0 09

, Bu ci l l a

C. St ep h en s o n ex ecu t ed an ad v an ce d i rect i v e fo r heal t h ca r e ( t h e “ Ad v an ce

Di rect i ve”). 1 In he r A d

v an ce Di rect i v e, St ep h en s on d es i g n at ed J acq u el i n e Al i cea, h er

g ran d d au g h t er wi t h wh o m s h e li v ed

, as h er h eal th care ag en t i f s h e b ecam e “ i n cap ab l e

o f m ak in g [h er] o wn d eci s i o n s

. ” Sh e g ran t ed Al i cea th e u n l i m i t ed au t h ori t y “ t o m ak e

al l h eal t h -care d eci s i o n s fo r [h er]

, i n cl ud i n g d e c i s i on s t o p ro v i d e, wi t h h o l d

, o r

wi t h d raw art i fi ci al h y d rat io n an d n u t ri t i o n

, an d al l o t h er fo rm s o f h eal t h care t o k eep

[h er] al i v e.” Al icea w as au t h o ri zed t o co n sen t o r r e f u s e co n s en t to an y m ed i cal

t reat m en t o r p r o c e dur e a

nd to d i r e c t t h e wi t h h o l d in g o f card i o pu l m o nary res u s ci t at i o n

(“ CPR”) an d o t h er fo rm s o f h eal t h care.

Ad d it i on al l y

, i n h er Ad v an ce Di rect i v e, St ep h en s on in s t ru ct ed h er h eal t h care

p ro v id ers an d o t h ers i n v o l v ed i n h er care n o t t o p ro l on g h er l ife un d er t he fo l l o wi n g

ci rcu m s t an ces : (1 ) wh en s h e h ad an i n cu rab l e an d i rrev ers i b l e co n d i t i o n t h at wo u ld

res u l t i n h er d eat h wi t h in a rel at i v el y s ho rt p eri o d o f t i m e; (2 ) w h en s h e b ecam e

1 St ep h en s o n ’ s Ad v an ce Di rect i ve v ari ed fro m t h e m od el fo rm s e t out in OCGA

§ 31 -3 2 -4

. Ho wev er, n o n e o f th e p art ies d i s p ut e th at t h e Ad v an ce D i rect i v e was v al id

u n d er Geo rg i a l aw. See OCGA § 3 1 -3 2 -5 (b ).

3u n co ns ci o u s an d

, t o a reas o nab l e d eg ree o f m ed i cal c e r t ai n t y

, wo u l d n o t reg ai n

co n sci o u s n es s ; o r (3 ) wh en th e l i k el y ri s k s an d b u rd en s o f t reat m en t o ut wei g h ed t h e

e x p ect ed b en efi t s

. T h e Ad v an ce Di rect i v e di d n o t s p eci fi cal l y l i st or d efi n e t h e

m ed i cal t ech n o l o gy t h at St ep h en s o n d i d or d i d n o t d es i r e t o b e u s e d as p art o f h er

m ed i cal care. Bu t St ep h en s o n i n fo rm ed h er fam i l y m em b ers t h at s h e d i d no t wan t to

b e k ep t al i v e “ o n an y m ach i n es ” at th e h o s p i t al

, i n cl u d in g a ven t i l at o r, i f h er

co n di t i o n was t erm i n al

.

S t ep hen s o n ’s Ad

mi s s io n t o Do ct o r ’s H o s p i t al

. I n l at e Feb ru ary 2 0 1 2,

St ep h en so n, t h en 9 1 y ears o l d

, d ev el o p ed a p ers i s t en t co u g h

. On th e m o rn i n g o f

M arch 3

, 2 0 1 2

, St ep h en so n awo k e let h arg i c an d “ n ot v ery res p o n si v e,” an d s h e l o s t

co n sci o u s n es s an d b o wel co n t ro l wh en Al i cea w as b at h i n g h er. Al arm ed by

St ep h en so n’ s co n d i t i o n, Al icea an d h er h u s b an d d ro v e St ep h en s o n t o t h e Do ct o r’ s

Ho s pi t al em erg en cy

ro o m

.

Up o n arri val at t h e em erg en cy ro o m

, St ep h en s on was d is o ri en t ed an d u n ab l e

t o co m p let e a s en t en ce b ecau s e o f her s h o rt n es s o f b reat h

. St ep h en s o n w as ex am i n ed

i n t h e em erg en cy ro o m an d s u b s eq u en t l y was ad m i t t ed t o Do ct ors Ho s p i tal aft er h er

b l o o d w o rk an d a ch es t x -ray s h o wed t h at s he was s u fferi n g fro m pn eu m o n ia, s ep s i s

,

an d acu t e ren al fai l u re.

4Al i cea p ro v i ded t h e h os p i t al wi t h a co p y o f St ep h en s o n ’ s Ad v an ce Di rect i v e

an d h er co n t act in fo rm at i o n s o t h at s h e co u l d be co n s u l t ed ab o u t St ep h en s o n ’ s care

i f s h e were away fro m th e h o s p i t al

. Ho s p i t al p o l i cy req ui red t h at u p o n ad m i s s i o n to

t h e h o s p i t al

, a co p y o f a p a t i e n t ’s ad v an ce d i rect i v e b e p l aced i n t h e fro n t o f t h e

m ed i cal reco rd b eh i n d t he ad m i s s i o n t ab t o en s u re t hat i t w as read i l y av ai l ab l e t o al l

p h y s i ci an s an d h o sp i t al s t aff. A co p y o f St ep h en s on ’ s Ad v an ce D i rect i v e was p l aced

i n h er m ed ical reco rd

, b u t n ot b eh i n d t h e ad m i s s i o n t ab wh ere i t co u ld eas i ly b e s een

an d rev i ewed

.

Al i cea ’s Co m mu n i ca t i o n s to t he P h ys i ci a n s. On t he m o r n i n g fo l l o wi n g

St ep h en so n’ s ad m i s s i o n, Al i cea was at h o m e p rep ari n g t o ret u rn t o t h e h o s p i t al wh en

s h e recei ved a p ho n e cal l fro m Dr. Cat al an o , a t ho raci c an d card i o v as cu l ar s u rg eo n

wi t h s taff p ri v i l eg es at Do ct o rs Ho s p i t al

. Dr. Cat al an o i n fo rm ed Al i cea t h at

St ep h en so n w as b ei n g m o v ed to t h e i n ten s i v e care u n i t (“ ICU”) wh ere h e wo u l d b e

t reat i n g h er an d t hat h e p l an n ed t o p erfo rm a co m p u t ed t o m o grap h y

(“ CT”) s can to

b et t er as s es s h er co n d i t io n. Du ri n g t h e p h on e cal l

, Al i cea t o l d Dr. Cat al an o ab o ut

St ep h en so n’ s Ad v an ce Di rect i v e an d s p eci fi cal l y i ns t ru ct ed t h at n o CPR s h o u l d ev er

b e ad m i ni s t ered an d “ n o h ero i c m eas u res ” em p l o y ed

.

5Th e CT s can p erfo rm ed o n M arch 4 s h o wed t h at t h e p neu m o ni a was cau s i n g

a b u i l d-u p o f fl u i d aro u n d St ep h en s o n ’ s l u n g t h at was d i s p laci n g h er h eart

. Aro u n d

2 : 3 0 p

. m

. t h at s am e d ay

, Al i cea recei v ed a p h o n e cal l fro m Dr. Carm el Jo s ep h

, a n

ICU p h y s i ci an

, w h o wan t ed t o p erfo rm a t h o racen tes i s

, a t h erap eu ti c p ro ced u re t h at

i n v o l v ed i n s ert i n g a t u b e i n t o St ep h en s o n ’ s ch es t t o drai n t h e fl ui d aro u nd th e l u n g.

Al i cea co n s en t ed t o t h e t h o racen t es i s d u ri n g t he p h o n e cal l

.

R e p eat i n g wh at s h e t o l d Dr. Cat al an o earl i er t hat d ay

, Al i cea i n fo rm ed D r

.

J o s ep h d u ri n g t h ei r p h on e cal l t h at al t h o u g h sh e was co n s en t i n g t o t h e t h o racen t es i s

,

St ep h en so n wan t ed n o “ h ero i c m eas ures ” t o p ro l o n g h er l i fe an d t h at t here was t o b e

n o CPR b ecau s e s h e feared t h a t S t ep h en s o n wo ul d b e i n ju red d uri n g ch es t

co m p res s i o n s

. Al i cea al s o s p ec i f i c a l l y d irect ed D r. Jo s ep h th at n o i n t u b at i o n b e

p erfo rm ed o r m ech an i cal v en t i l at i on b e u s ed o n St ep h en s on wi t h o u t fi rs t cal l i n g h er

f o r p erm i s si o n. 2 Un d er ho s p i t al p o l i cy

, an y di s cu s s i on s b et ween a p h y s i ci an an d

fam i l y m em

b ers reg ard in g an ad v an ce d i rect iv e were t o b e d o cu m en t e d i n t h e

p ro g res s n o t es o n t h e p at i en t ’ s m e d i c a l ch art

. Pu rs u an t t o t h at p o l i cy

, Dr. J o s ep h

2 In t u b at i on in vo l v es p as s i n g a p l as t i c t u be t h ro u g h t h e m o u t h o f t h e p at i en t

d o wn i n t o h er ai rway

. Th e p l as t i c t u b e i s t h en co nn ect ed t o a v en t i lat o r t h at co n t ro l s

t h e p at i en t ’ s b reat h in g

.

6m ad e t wo n o t at i o ns i n h i s M arch 4 pro g res s no t e t h at St ep hen s o n was “ no CPR” an d

t h at Al i cea was t o b e cal l ed “ b efo re p at i en t i s i n tu b at ed .”

Aft er h i s p h o ne cal l wi t h A lic e a

, D r. J o sep h p erfo rm ed th e t h o racen t es i s

, wh i ch

rev eal ed p o ck et s o f p us wi t h i n St ep h en s o n’ s ch es t cav i t y o u t s i d e o f h er l u n g s

.

Co n cer n e d t h at St ep h en s on faced an i m m i nen t ri s k of d eat h fro m o v erwh el m i n g

i n fect i o n i n h er ch es t cav i t y

, t he p h y s i ci an s i n v ol v ed i n St ep h en s o n ’ s care ag reed t h at

Dr. Cat al an o w o ul d co ns u lt wi t h St ep h en s o n ’ s fam i l y ab o u t perfo rm i n g an ad d i t i o n al

s u rg i cal p ro ced u re t o d rai n t h e p u s

.

Th e M a rch 5 S u rg i ca l Pr o ced

u r e. On t h e m o rn i n g o f M arch 5

, Al i cea recei v ed

a tel ep h o ne cal l fro m Dr. Cat al an o

, wh o as k ed fo r h er co n sen t to p erfo rm t h e s u rg i cal

p ro ced ure t o d rai n m o re fl ui d fro m St ep hen s o n ’ s lu n g cav i t y

. He to l d A l i cea h e wo u ld

i n s ert a t ub e fo r d rai n ag e an d t h at St ep h en s o n wo u l d b e un d er g en eral an es t h es i a fo r

t h e p ro ced u re. Dr. Cat al an o h ad n o t rev i ewed t h e p ro g res s n ot es i n th e m ed i cal ch art

an d d i d no t i n fo rm A l i cea t h at t h e p ro ced u re wo ul d req u i re i n tu bat i o n. U n aware t h at

St ep h en so n wo ul d b e i n t u b at ed , Al i cea co n s en t ed t o t h e p ro ced u re.

Dr. Cat al an o p erfo rm ed t h e s urg i cal p ro ced u re l at er th at d ay . He cl ean ed o ut

t h e i n fect ed area o f St ep hen s o n ’ s ch es t cav i t y an d rem o v ed po rt i o n s o f t h e l u n g u p o n

d i s co v eri n g t h at t he t i s s u e was n ecro t i c. On ce t h e p ro ced u re was co m p l et ed

,

7St ep h en so n w as ex t u bat ed (i .e., t h e t u b e i n s ert ed i n t o h er ai rway was rem o ved ) an d

t ak en o ff t h e v en t il at o r.

Th e Ma r ch 7 In t ub a t i o n

. Fo l l o w i ng t he M arch 5 su rg i cal p ro ced u re,

St ep h en so n’ s co n d i t i o n co n t i nu ed t o d et eri o rat e, an d by ap p ro x i m at el y 4 : 0 0 a.m

. o n

M arch 7

, s h e was u n ab le to res p o n d t o q u es t io n s fro m th e ICU n u rs es an d “ was

b eg in n i n g t o g o i nt o res p i rat o ry fai l u re.” Des p i t e t he n o tat i o n i n t he p ro g res s n o t es

t h at t h ere was to b e n o CPR or i n t u b at i o n wi t h o u t cal li n g Al i cea, t h e n u rs es d i d n ot

co n tact Al i cea, w h o h ad g on e h o m e fo r t h e n i g h t

. In s t ead

, on e o f t h e n u rs es cal l ed Dr.

Cat al an o at h o m e aro u n d 4 : 0 0 a.m

. an d as k ed h i m to g iv e an o rd er fo r St ep h en s o n to

b e i n t ub at ed

. Al t h o ug h Al i cea had t o l d Dr. Cat al an o o n M arch 4 th at St ep h en s o n h ad

an Ad v an ce D i rect i v e an d h e k n ew t h at Al i cea was th e des i g nat ed h eal t h care ag en t

,

Dr. Cat al an o h ad n o t rev iewed t h e Ad van ce D i rect i v e si n ce t h at t i m e an d d i d n ot

co n tact Al icea u p o n recei v i n g t h e p h o n e cal l fr o m t he ICU n u rs e. Fu rt h erm o re,

al t h o u g h h o s p it al p o l icy was t o d o cu m en t co n v ers at i o n s reg ard in g an ad v a n c e

d i rect i v e i n t h e p r o g r e s s n ot es

, Dr. Cat al an o had n o t rev i ewed t h e p ro g res s n o t es

reg ard i n g St ep h en s o n’ s care.

W i t h o u t co n tact i n g A li cea fo r p erm i s s i o n

, Dr. Cat al an o g av e t h e o rd er to

i n t u b at e St ep h en s o n

. Bas ed o n Dr. Cat al an o ’ s ord er, Dr. Tro y Co o n

, t h e o n -d u t y

8p h y s i ci an i n t h e em erg en cy ro o m

, cam e t o t h e ICU an d i n t u bat ed St ep h en s o n aro u n d

4 : 5 0 a.m

.

Lat er t h at m o rn i n g, Al i cea’ s h u s b an d v i s i t ed St ep h en s o n i n t h e ICU an d was

s u r p ri s ed t o fi n d h er i n t u b at ed an d o n a v en ti l at or. Aft er h er h u s ban d cal l ed an d

i n fo rm ed h er o f t h e i n t ub at i o n, Al i cea ret u rn ed t o t h e h o sp i t al

. Al i cea s p o k e wi t h t h e

ICU n urs es an d as k ed t h em t o l o cat e t h e ho s pi t al ’ s co py o f S t e p h e n s o n ’ s Ad v an ce

Di rect i ve. Th e nu rs es i ni t i al l y co ul d n o t fi nd t h e h os p i tal ’ s co py bu t u l t i m at el y

l o cat ed i t i n St ep h en s o n ’ s m ed i cal ch art at t h e IC U m a i n d es k

. W h en Al i cea

d em an d ed to k n o w wh y St ep h en s o n h ad b een i n t u b at ed wi t h o u t cal l i n g h er fi rs t fo r

p erm i s s i o n

, t h e nu rs es as k ed Dr. M i ch ael Beh n i a, t h e at t en d i n g p u l m on o l o g i s t wh o

was m an ag i n g St ep h en s o n’ s o veral l care i n t h e ICU, t o s p eak wi t h Al i cea ab o u t t h e

s i tu at i o n

.

Dr. Beh ni a ad v i s ed Al icea o f t h e ci rcu m s tan ces o f th e earl y m o rn i n g i n t u b at i o n

an d o f St ep h en s o n ’ s co n d i t i o n an d t reat m en t o p t i o n s. He i n fo rm ed Al i cea t h at s h e

co u ld au t h o ri ze an ex t u b at i o n an d t h e rem o v al o f t he v en t il at or, an d t h at t o d o s o

wo u l d cau s e St ep h en s on t o s u ffo cat e. Al i cea was fu rt h er ad vi s ed t h at

, al t ern at i v el y

,

s h e co u l d au th o ri ze t h e m ed ical t eam t o co n t i n u e t o t reat St ep h en s o n, i n cl u d i n g a

9s eco n d s urg ical p ro ced ure b y Dr. Cat al an o to cl ean o u t m o re p u s fro m t h e ch es t

cav i t y

.

Al i cea s h owed t h e Ad v an ce Di rect i v e t o Dr. Beh n i a an d t o ld h i m t h at t h e

h o s p it al had fai l ed t o fo l l o w St ep h en s o n ’ s wi s h es b y i n t u b at i n g her an d p l aci n g h er

o n a v en t i l at o r, b u t t h at “ s i n ce th ey p u t h er o n i t

, t h ey h ad t o t ak e care of her.” Al i cea

d rew a d i s t i n ct i o n b et ween n ev er p l aci n g St ep h en so n o n a v en ti l at o r an d “ l et [t i n g ]

n at u re t ak e i t s c o u rs e,” an d t ak i n g t h e affi rm at i v e st ep o f rem o v i ng h er fro m t h e

v en ti l at o r n o w t h at sh e was al read y on i t. Acco rd i n g t o Al i cea, sh e n o w “ h ad t o m ak e

t h e d eci s i o n t h at [s h e] was n’ t s u p p os ed to h av e t o m ak e.” Decl i n i n g t o h av e

St ep h en so n ex t ub at ed a n d t h e v en t i l at o r rem o v ed at t hat p oi n t

, Al i cea ch o s e to

co n ti n u e t reat m en t f

o r S t e p hen s o n an d co ns en ted t o t h e s eco nd s u rg ery b y Dr.

Cat al an o , wh i ch h e p erfo rm ed o n M arch 8

.

S t ep hen s o n ’s Su b s eq u en t Med i ca l Pr oced u r es

. A s St ep h en s o n’ s co n d i t i o n

co n ti n u e d t o d et eri o rat e aft er t h e M arch 8 s u rg ery

, a n um b er o f ad d i t i o n al m ed i cal

p ro ced ures an d i n terv en t i o ns were p erfo rm ed o n t h e ad v i ce o f St ep h en s o n ’ s

p h y s i ci an s an d wi t h A l i cea’ s co n s en t

, i n cl u d i n g t h e p l acem en t o f a feed i n g t u b e, a

b ro n ch o s co p y t o rem ov e p u s fro m t h e ai rway

, an d a t rach eo st om y t o p ro v i d e an

ai rway an d rem o v e l u n g s ecret i o n s

. St ep h en s o n rem ai n ed i n t h e ICU u n t i l M arch 1 4,

10wh en Al i cea an d t he at t en di ng p h y si ci an s au th o ri zed t he rem o v al o f St ep h en s o n fro m

t h e v en t il at o r, t h e en try o f a “ Do No t Res us ci t at e” o rd er, an d t h e p ro v i s io n o f co m fo rt

m eas u res o n l y

fro m t h at p o i n t fo rward

. St ep h en so n d i ed o n M arch 1 7

.

Pr o ced u r al Ba ckg r o u nd

. On M ay 1 4

, 2 0 1 3

, Al i cea, as t he ad m i n is t rat o r o f t h e

es t at e o f St ep h en s o n

, fi l ed h er co m p lai n t fo r d am ag es ag ai n s t Dr. Cat al an o an d

Do ct o rs Ho s p i t al (co l lect i v el y

, th e “ Defen d an t s ”), al l eg i n g cl ai m s o f b reach o f

ag reem en t

, p ro fes si o n a l an d o rd i n ary n eg l i gen ce, m ed i cal b at tery

, i nt en t i o n al

i n fl i ct i o n o f em o t i o n al d i s t res s

, an d b reach o f fi d u ci ary d u t y fo r i n ju ri es al l eg ed l y

ari s in g o u t of t h e care an d t reat m en t o f St ep hen s o n at D o ct ors Ho s pi t al

. 3 Th e

co m p l ai n t al l eg ed t h a t D r. Cat al an o an d t h e n urs es an d o t h er m ed i cal pers o n n el

a s s o c i at ed wi t h D oct o rs Ho s pi t al h ad cau s ed St ep h en s o n p ai n, s u fferi n g

, an d

em ot i o n al d i st res s b y s u b

ject i n g h er t o u n n eces s ary m ed i cal pro ced u res

, s peci fi cal l y

i n t u b at i o n an d p l acem en t o n a v en t i l at o r o n M ar c h 5 an d M arch 7

, wh en s h e was

t erm i n al l y i l l

, i n v i o l at i o n o f h er Ad van ce Di rect i ve an d t he i n s t ru ct i o n s o f Al i cea as

3 Th e co m

p l a i n t a l s o n am ed Dr. Co o n an d h i s em p l o y er, CSRA Em erg en cy

Ph y s i ci an s

, P.C., as d efen d an t s . Th e t ri al co u rt g ran t ed s u m m ary ju d g m en t i n fav o r

o f Dr. Co o n an d h i s em

p l o y er o n al l o f Al i cea’ s cl ai m s

. A l icea h as n o t ap p eal ed t h at

ru l i n g.

11h er d es i g n at ed h eal t h care ag en t

. Th e co m p l ai n t s o u g ht co m

p en s at ory an d p u n i t i v e

d am ag es , t o get h er wi t h at t o rn ey fees an d t h e ex p en s es o f l i t i g at i o n

.

Al i cea rel i ed u p o n an ex p ert o n g ero nt o l o g y

, geri at ri cs

, an d p al l i at i v e care 4 to

s u p p ort h er cl ai m s. 5 Th e ex p ert o p i n ed t h at wh en St ep hen s on arri v ed at t h e

em erg en cy ro om on M arch 4

, “ s h e h ad an i n cu rab l e an d i rrev ers i bl e c o n d i t i o n t h at

was l ik el y to res u l t i n h e r d e a t h wi t h in a rel at iv el y s ho rt p eri od o f t i m e t h ereaft er.”

Co n s eq u en t l y

, t h e ex pert o p i ned t h at t h e Defen dan ts were req u ir e d under t h e s t an d ard

o f care t o refrai n fro m t ak i n g s t ep s to p ro l o n g St ep h en s o n’ s l i fe i n acco rd an ce wi th

4 Gero n t o l o g y i s “ [t ] h e s ci en t i fi c st u d y o f t h e b io lo g ical

, p s y ch o l o gi cal

, an d

s o ci o l o g i cal p hen o m en a t h at are as s o ci at ed w i t h o l d ag e an d ag i n g .” T h e Am eri can

Heri t ag e M ed i cal Di ct i o n a r y. ( 2 0 0 7 )

. R e t r i e v e d M a y 2 2, 2 01 5 fro m

h t t p : / /m ed ical -d i ct i on ary .t h efreed i ct i o nary .co m / g ero n t o l og y

. Geri at ri cs i s “ [t ] h e

b ran ch of m e d i ci n e t h at d eal s wi t h t h e d i ag n o s i s an d t reat m en t of d i s eas es an d

p r o b l e m s s p e c i f

i c t o o l d a g e

. ” I d

. R e t r i e v e d M a y 2 2 2 0 1 5 f r o m

h t t p : // m ed i cal -d ict i o n ary .t h efreed i ct i o n ary .co m /Geri at ri cs

. Pal l i at iv e care refers to

t reat m en t s ai m ed at “ [r] el i e v i n g o r s o o t h i n g t h e s y m pt o m s o f a d i seas e o r d i s o rd er

w i t h o u t e f

f e c t i n g a c u r e

. I d

. R e t r i e v e d M a y 2 2

, 2 0 1 5 f r o m

h t t p : // m ed i cal -d ict i o n ary .t h efreed i ct i o n ary .co m /p al li at iv e.

5 Th e Defen d an t s as s ert t h at Al i cea’ s ex p ert was n ot q u al i fi ed to t es t i fy u n d er

OCGA § 2 4 -7 -7 0 2. Th e reco rd refl ect s t hat aft er t h e tri al co u rt en t ered it s s u m m ary

ju d g m en t o rd er, t h e Defen d an t s rai sed t h e q u al i fi cat i o n is s u e i n a m o ti o n t o s t ri k e t h e

a ffi d av i t an d o p i n i on s o f Al icea’ s ex p ert

, b u t th e t ri al co u rt h as n o t ru led o n t h a t

m o ti o n an d t h u s i t rem ai n s p en di n g b el o w. Gi v en t h is reco rd

, t h e qu al i fi cat i o n i s s u e

i s n ot ri p e fo r o u r rev i ew an d wi l l n o t b e ad d res sed on a pp eal

. See Demp s ey v.

Gwi nn et t Ho s

p

. Sys tem

, 3 3 0 Ga. Ap p

. 4 6 9, 47 4 (1 ) (b ) (7 65 SE2 d 5 2 5) (2 0 1 4 ); Ren z

v. No r t hs i d

e Ho s p

. , 2 8 5 Ga. Ap p . 8 8 2 , 8 8 4 (1 ) (6 4 8 SE2 d 1 8 6) (2 00 7 ).

12h er Ad van ce D i rect iv e an d th e i n s t r u ct i o n s o f h er des i g n at ed h eal t h care ag en t

,

Al i cea. Acco rd i ng t o t h e ex p ert

, Dr. Cat al an o b reach ed th e st an d ard o f care b y fai l i n g

t o rev i ew St ep h en s o n ’ s Ad v an ce Di rect iv e an d t h e p ro g res s note s in h er m ed i cal ch art

t o d et erm i n e i f Al i cea had g i v en an y d i rect i o n s fo r St ep h en s o n ’ s care; b y fai l i n g t o

o b t ai n b as i c an d i n fo rm ed co n s en t fro m Al i cea b efo re t h e M arch 5 su rg i cal p ro ced u re

i n v o l v i n g in t u b at i o n ; an d b y fai l i n g t o o b tai n bas i c co n s en t fro m Al i cea b e f o r e t h e

M arch 7 i n t u b at i o n

. Th e ex p ert fu rt h er o p in ed t h at th e n u rs es em p l o y ed b y Do ct o rs

Ho s p i t al h ad v i o l at ed t h e s t an d ard o f care b y fai l i ng t o co nt act Al icea b efo re t h e

M arch 7 i n t u b at i o n an d fai li n g t o cal l Dr. Cat al an o’ s at t en t i o n t o St ep h en s o n ’ s

Ad v an ce Di rect iv e an d t h e n o tat i o n i n t h e p ro g res s n ot es reg ard i n g i nt ub at i o n

.

Al i cea l at er t es t i fi ed i n her d ep o s it i o n t h a t s h e w o u l d n o t h av e co n s en t ed to

St ep h e n s o n’ s March 5 su rg i cal p ro ced u re i f s h e h ad b een t o l d i t wo u l d i n v o l v e

i n t u b at i o n, an d w o u l d no t h av e co n s en t ed t o t h e M arch 7 i n t u b at i o n i f s he h ad b een

cal l ed b efo re i t o ccu rred

. Acco rd i n g t o A l i cea, i f s he h ad b een t o l d on March 5 t h at

t h e p ro p o s ed p ro ced u re i n vo l v ed i nt u b at io n, s h e wo u l d h av e au t h ori zed o n l y l e s s

i n v as i v e p ro ced u res s u ch as a t h o racen t es i s , an d i f s h e h ad b een cal l ed o n M arch 7,

s h e w o u l d h av e au t h o ri zed o n l y co m fo rt m eas u res fro m t h at po i n t fo rward rat h er t h an

i n t u b at i o n.

13Dr. Cat al an o co n ced ed i n h i s dep o si t io n t h at h e k n e w t h at A l i cea was

St ep h en so n’ s h eal t h care ag en t u n d er th e Ad v an ce Di rect i v e b u t d i d n o t co n t act h er

b efo re t he M arch 7 i nt u b a t i o n

. N o r h ad h e rev i ewed t h e A d v an ce Di rect i ve o r t h e

M arch 4 pro g res s n o t e co n t ai ni n g Al i cea’ s d i rect i o n t h at n o i nt u b at i o n o ccu r wi t h o ut

cal l in g h er fi rs t

. D r

. C a t al an o t es t ifi ed t hat b ecau s e t h e fam il y h ad au t h o ri zed t h e

M arch 5 s u rg i cal p ro ced u re o n St ep h en s o n t h at h ad in v o l v ed g en eral an es th es i a, an d

“ o b v i o u s l y [h e] had t o i n t ub at e h er t o d o [t h at ] s u rg ery ,” h e h ad b el i ev ed t h ere wo u ld

b e n o o b j e c t i o n t o t h e M arch 7 i n t u bat i o n

. Lat er i n h i s d ep o si t i o n

, D r. Cat al an o

t es t i fi ed th at h e h ad d eci d ed i t wo u l d b e b et t er t o o rd er t he i n t u b at i o n o n M arch 7 an d

t h en co n s u l t t h e fam i l y l a t e r ab o u t wh et h er t h ey wan t ed t o rem o v e t h e v en t i l at o r:

“ [W ] h en t hi s h ap p en ed I real l y d i d n ’ t g o i n to an y o f t h e co d e / n o co d e / d o n ot

i n t u b at e/ res u s c i t a t e

. Sav e t h e pat i en t ’ s l ife fi rs t an d t h en we’ l l do wh at ev er i t t ak es

t o m ak e t h e fam i l y an d t he p at i en t wh at ev er, bu t we can ’ t u nd o deat h

. So t h at ’ s wh at

I was t h i n k i n g .”

Fo l l owi n g d is co v ery, t h e Defen d an ts m o v ed fo r s u m m ary ju d g m en t

. Th e

Defen d an t s co nt en d ed t h at t h ey were s hi el ded fro m

l iab i l i t y fo r an y cl ai m s rel at i n g

t o t h e M arch 7 i n t u b at i o n u n d er t h e i m m u n i t y pro v i s i on s o f OCGA § 3 1 -3 2-1 0 (a) (2 )

14an d (3 ), an d t h at an y cl ai m s fo r l ack o f b as i c an d i n fo rm ed co ns en t fo r t h e M arch 5

s u rg i cal p ro ced u re an d t he M arch 7 i n t u bat i o n fai l ed as a m at t er o f l aw.

Aft er co n d u ct i n g a heari ng

, t h e t ri al co u rt g ran t ed i n p art an d den i ed i n p art t h e

Defen d an t s ’ m o t i o n fo r s u m m ary ju d g m en t

. Sp eci fi cal l y

, t h e t ri al co u rt g ran t ed

s u m m ary ju d g m e n t t o t h e Defen d an t s wi t h res p ect t o an y in fo rm ed co n s en t cl ai m

b as ed on t h e M arch 7 i n t u b at i o n

, fi nd i ng as a m at t er o f l aw t hat i n tu b at i o n was n ot

a m ed i cal p ro ced u re t h at req u ired i n fo rm ed co n sen t u n d er Geo rg i a l aw as set fo rt h in

OCGA § 3 1 -9 -6 .1 (a). 6 Th e t ri al co u rt d en ied th e D ef e n d a n t s ’ m ot i o n fo r s u m

m ary

ju d g m en t as t o al l rem ai n i n g cl ai m s an d i s s u es

, i n cl u di n g wh et h er t h e Defen d an t s

were en t it l ed t o i m

m u n i t y fo r t h e M arch 7 i n t u b a t i o n u n d e r OCGA § 3 1 -3 2 -1 0 (a),

wh et h er t h ere was b as i c an d i n f o rm ed co n s en t fo r t h e M arch 5 s u rg i cal p ro ced u re,

an d wh et h er t h ere was b as i c co n s en t fo r t h e M arch 7 i n t u b at i o n

.

In co n j u n c t i o n wi t h i t s s u m

m ary ju dg m en t o rd er, th e tri al co u rt g ran t ed a

cert ifi cat i o n o f im

m ed i at e rev i ew. Th e Defen dan t s fi l ed an ap p li ca t i o n fo r

i n t erl o cu t o ry

ap p eal , wh i ch we g ran t ed . Th i s ap peal fo l l owed

.

6 Al i cea h as n o t fi led a cro s s -ap p eal ch al l en g i ng t h e t ri a l c o urt ’ s g ran t o f

s u m m ary ju d g m en t t o t h e Defen d an ts on th e i n fo rm ed co n s en t cl ai m p ert ai n i n g t o t h e

M arch 7 i n t u b at io n

.

151

. Th e Defen d an t s co n t en d t h at t he t ri al co u rt erred i n d en y i n g t h ei r m o t i o n fo r

s u m m ary ju d g m en t o n Al i cea’ s cl ai m s p ert ai n i n g t o t h e M arch 7 i n t u b at i o n b ecau s e

t h e u n co n t ro v ert ed ev i d en ce s h o w e d t h at t h ey were en t i t l ed t o i m m u n i ty u n d er

OCGA § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ). Im m un i t y un d e r t h e s t at u t e i s an affi rm at i v e

d efen s e, an d th u s th e Defen d an t s h ad t h e b u rd en o f p ro v i n g t h at t h ey were i m m u n e

fro m l i ab i l i t y

. See Hea t h v. Emo r y Un i v. Ho s

p

. , 2 08 Ga. A p p

. 6 29

, 6 3 1 (2 ) (4 3 1 SE2 d

4 2 7 ) (1 9 93 ) (d efen d an t s h ad b u rd en o f pro v i ng affi rm at i v e d efen s e o f st at u t o ry

i m m u ni t y fo r g o o d fai t h co m

p l ian ce wi t h p ro ced u res fo r h o l d in g a p at i en t i n a m en t al

h eal t h faci l i t y af

t e r t h e pat i en t h as req u es t ed di s ch arg e). W e co n cl u d e t h at t h e t ri al

co u rt p ro p erl y d en i ed s u m m ary ju d g m en t t o t he Defen d an t s o n t he i m m u n i t y q u es t i o n

b ecau s e g en u i n e i s s u es o f m at eri al fact ex i st reg ard i n g w h et h er th e Defen d an t s m ad e

a g o o d fai t h effo rt t o rel y o n t h e di rect i on s an d d eci si o n s o f A l i c e a

, St ep h en s o n ’ s

h eal t h care ag e n t u n d e r h er Ad v an ce D i rect i v e, in carry i n g ou t t he M arch 7

i n t u b at i o n.

Th e Ad v an ce Di rect i ve Act i s co d i fi ed at OCGA § § 3 1 -3 2-1 t h ro u g h 3 1 -3 2 -1 4.

I n a d o p t in g t h e cu rren t v ers i o n o f th e Act

, t h e Gen eral As s em b l y no t ed t h at i t “ h a s

l o n g reco g n i zed t h e ri g h t of t h e i n d i v i d u al t o co n t ro l al l as p ect s o f h i s o r her p ers o n al

care an d m ed i cal t reat m en t

, i ncl u d i n g t h e ri g h t to i ns i s t up o n m ed ical t reat m en t

,

16d ecl i ne m ed i cal t reat m en t, o r d i rect t h at m ed i cal t reat m en t b e wi th d rawn

, ” an d t h at

“ the c le a r e x p res si o n o f an i n d i v i d u al ’ s d eci s i o n s reg ard i ng h eal t h care, wh ethe r m a de

b y t he i n d i v i du al o r an ag en t ap p o i n t ed b y t h e i n d i vi d u al

, i s o f cri ti cal i m p o rt an ce n ot

o n l y t o ci t i zen s b ut al s o t o t h e h eal t h care an d l eg al co m m un i t i es

, th i rd p art i es

, an d

fam i l i es .” Ga. L. 2 0 0 7

, p .1 3 3 , § 1 (a), (d ).

Am o n g ot h er t h i n g s

, t he Ad v an ce Di rect iv e Act au t h o ri zes an ad ul t o f s o u n d

m i n d (t he “ d ecl aran t ”) t o ex ecu t e a d ocu m en t des i g n at i ng a h eal t h care ag en t t o m ak e

d eci s i o n s o n h i s o r h er b eh al f w h en t h e “ d ecl aran t i s un ab le o r ch o o s es n o t t o m ak e

h eal t h care d eci s i o n s fo r h i m sel f o r h ers el f.” OCGA § § 3 1 -3 2 -2 (3 ), (6 ); 3 1 -3 2 -5 (a)

(1 ). Th e h eal t h care ag en t m ay co n s en t t o o r refu s e an y m ed i cal care o r t reat m en t fo r

t h e d ecl aran t, i ncl u d i ng an y s u rg i cal o r l i fe-s u s t ai n i n g p ro ced u res

. OCGA § 3 1 -3 2 -7

(e) (1 ). Th e ag en t m

u s t ex erci s e h i s o r h er p o wers “ co n s i s t en t w i t h t h e in t en t i o n s an d

d es i res o f t he d ecl aran t ” if k n o wn

, b u t i f t he d ecl aran t ’ s wi sh es are u n cl ear, th e ag en t

m u st “ act i n t h e d ecl aran t ’ s b es t i n t eres t co n s i deri n g t h e b en efi t s

, b u rd en s, an d ri s k s

o f t h e d ecl aran t ’ s ci rcu m s t an ces an d t reat m en t o pt i o n s

. ” OCGA § 3 1 -3 2 -7 (b ).

W h en t h e d es i g n at ed ag en t n o t i fi es a h ea l t h care p ro v i d er o f a d eci s i o n

reg ard i n g t h e d ecl a r a n t ’s m e d i cal care o r t reat m en t

, t h e p ro v id er m u s t ab i d e b y t h e

ag en t’ s deci s io n

, “ su b

ject t o t h e h eal t h care p ro v i d er’ s ri g h t t o ad m i n i s t er t reat m en t

17fo r t he d ecl aran t ’ s co m fo rt an d al l ev i at io n o f pai n .” OCGA § 3 1 -3 2 -8 (2 ). H o wev er,

OCGA § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ) o f t h e Ad v an c e Di rect i v e Act affo rd s h eal t h care

p ro v id ers an d faci l it i es 7 i m m u n i t y fro m l iab i l i t y fo r t h e refu sal o r fai l u re t o co m p l y

w i t h a h eal t h care ag en t ’ s d eci s i o n

, s o l on g as cert ai n co n d i t i o n s are m et

. 8

Sp eci fi cal l y , OCGA § 3 1 -3 2 -1 0 (a) p ro v i d es i n p art :

(a) Each h eal t h care p ro v i d er, h eal t h care faci li t y

, an d an y o th er p ers o n

wh o a ct s i n g o o d f

a it h r el i a n ce o n a n

y d i rect i o n o r deci s i o n by th e

7 It i s un d i s p u t ed t h at as a l i cen s ed h o s p i tal es t ab l is h ed u n d er t h e l aws o f

Geo rg i a, Do ct ors Ho s p i t al s at i s fi ed t h e st at ut o ry d efi n it i o n o f a “ h eal t h care faci l i t y ”

u n d er t h e Ad v an ce D irect i v e A ct

. See OCGA § 3 1 -3 2 -2 (7 ). It i s l ik ewi s e u n d i s p u t ed

t h at as a l i cen s ed at ten d i n g p h y s i ci an p erm i t t ed b y l aw to ad m i n i s ter h eal t h care, Dr.

Cat al an o m et t he Ad v an ce Di rect i v e Act ’ s d efi n i ti o n o f a “ heal t h care p ro v i d er.” See

OCGA § 3 1 -3 2 -2 (8 ).

8 OCGA § 3 1 -3 2-1 0 (b ) p ro v i d es i m m u ni t y fro m ci v i l l i ab i l i t y

“ fo r fai l i n g o r

refu si n g i n g oo d fai th t o effect u at e t h e d ecl a r a n t ’s di rect i o n s reg ard i n g t h e

wi t h h o l d i n g o r wi t h d rawal o f l i fe-s u s t ai n i n g p ro ced u res o r t h e wi t h h o l d i n g o r

wi t h d rawal o f t h e p ro v i s i o n o f n o u ri s h m en t o r h y d rat i o n .” (Em p h as i s su p pl i ed .) Th e

Defen d an t s di d no t rel y u p o n t h i s p ro v i s i o n i n t h e t ri al co u rt as a b as is fo r i m m u n i t y

,

an d we wi l l n o t co n si d er i t fo r t h e fi rs t t im e o n ap p eal

. See W el l o n s, In c. v.

La n g b o a r d

, In c.

, 3 1 5 Ga. Ap p

. 1 8 3

, 1 8 6 (1 ) (7 26 SE2 d 6 7 3) ( 2 0 1 2 ) (“ Ap p el l at e

co u rt s do n o t co n s i d er wh et h er s u m m ary ju d g m en t s ho u ld h a v e b een g ran t ed fo r a

reas on no t rai s ed bel o w becau s e, i f t h ey d i d

, i t wo u l d b e co n t rary t o t h e l i n e o f cas es

h o l d i n g t h a t a p a rt y m

u st s t an d o r fal l u p o n t h e p o s i t i o n t ak en i n t h e t ri al co u rt .”)

(ci t at i o n an d p u nct u at io n o m i t ted ).

18h ea l th ca r e a g en t s h al l b e p ro t ect ed an d rel eas ed t o t he s am e ex t en t as

t h o u g h s u ch p ers o n h ad i n t eract ed d i rect l y wi th t h e d ecl aran t as a fu l l y

co m p et en t p ers o n

. W it h o u t l i m i t i n g t h e g en eral i t y o f t h e fo reg o i n g, th e

fo l l o wi ng s p eci fi c p ro v i s i o n s s h al l al s o g o v ern

, p ro t ect

, an d v al i dat e th e

act s o f t h e heal t h care ag en t an d each s u ch heal t h care pro v i der, h eal t h

care faci l i t y

, an d an y o th er p ers on a ct i n g i n go o d f a i th r el i a n ce o n s u ch

d i r ect i on o r d

eci s i o n :

(1 ) No s uch h eal t h care p ro v i d er, h eal t h care faci l i t y

, o r p ers o n sh al l be

s u b ject t o ci v i l o r cri m i n al l i ab i l i t y o r d i s ci pl i n e fo r u n p ro fes s i o nal

co n d u ct s ol el y fo r co m

pl y i n g wi th an y d i rect i o n o r deci s i o n b y th e

h eal th care ag en t , ev en i f d eat h o r i n ju ry t o t h e d ecl aran t en s u es ;

(2 ) No s u ch h eal t h care p ro v i d er, h eal t h care faci li t y

, or p ers o n sh al l be

s u b ject t o ci v i l o r cri m i n al l i ab i l i t y o r d i s ci pl i n e fo r u n p ro fes s i o nal

co n d u ct s ol el y fo r fai l u re t o c o m p l y wi t h an y d i rect i o n o r d eci si o n b y

t h e h e al t h care ag en t

, as l o n g as s uch h eal t h care pro v i d er, h eal t h care

faci l it y

, o r p ers o n p ro m

p t l y i n fo rm s th e h eal t h care ag en t o f s u ch h eal t h

care p ro v i d er’ s, h eal t h care faci l i t y ’ s

, o r p ers o n ’ s refu s al o r fai l u re t o

co m p ly wi t h s uch d i rect i o n o r d eci s i o n b y t he h eal t h care ag en t

. T he

h eal th care ag en t s h al l t hen b e res p o n s i b l e fo r arran g i n g th e d ecl aran t ’ s

t ran s fer t o an o t h er heal th care p ro v i d e r

. A h e al t h care p ro v i d er wh o i s

u n wi l l in g t o co m

p l y wi t h t h e h eal t h care ag en t ’ s d eci s i o n s h al l co nt i n ue

t o p ro v i d e reas o n ab ly n eces s ary co n s u l t at i o n a nd care i n co n n ect i o n

wi t h t he p en d in g t ran s fer;

19(3 ) If th e act i o n s o f a h eal t h care p ro v i d er, heal t h care faci l it y

, or p ers o n

wh o fai l s t o co m

pl y w i th an y d i rect i o n or d eci s io n b y th e h eal th care

ag en t are s u b s t an t i al l y i n acco rd wi t h reas o n ab l e m ed i cal s t an d ard s at

t h e t i m e o f referen ce an d t h e pro v i der co o p erat es in th e t ran s fer o f th e

d ecl aran t p u rs u an t t o p arag rap h (2 ) o f Co d e Sect i o n 3 1 -3 2 -8 ,[ 9 ] th e

h eal th care p ro v i der, h eal t h care faci l i t y

, or pers o n s h al l n ot b e s u b ject

t o ci v i l o r cri m i n al li ab i l i t y or d i s ci p l i n e fo r u n p ro fes s i o n al co n d u ct fo r

fai l u re t o co m

pl y wi th t h e ad v an ce d i rect iv e fo r h eal th care . . . .

(Em p h as i s s u p p li ed .)

Th e im m u n i t y q u es t i o n rai s ed i n t h i s cas e cen t ers o n t h e Defen dan t s ’ “ fai l u re

t o co m pl y ” wi t h A l i c e a ’s di rect i o n to co n t act h er an d o b tai n p erm i s s i o n b efo re

9 OCGA § 3 1 -3 2-8 (2 ) p ro v i d es :

A h eal t h care d eci s io n m ad e b y a h eal t h care ag en t i n acco rd an ce wi t h

t h e t erm s of an ad van ce d i rect i ve fo r h eal t h care s h al l b e co m p l i ed w i t h

b y ev ery heal t h care p ro v i d er t o wh o m t h e d e c i s i o n i s co m m u ni cat ed

,

s u b ject t o t h e h eal th care p ro v i d er’ s ri g h t t o ad m i ni s t er t reat m en t fo r th e

d ecl aran t ’ s co m fo rt o r al l ev i at io n o f p ai n ; pro v i ded

, h o wev er, t h at if th e

h eal th care pro vi d er is u n wi l l i n g t o co m p l y w i t h t he h eal t h care ag en t ’ s

d eci si o n

, t h e h eal t h care p ro vi d er s h al l p ro m p t l y i n fo rm t he heal t h care

ag en t wh o sh al l t h e n b e res p o n s i b l e fo r arran gi n g fo r th e d ecl aran t ’ s

t ran s fer t o an o t h er heal th care p ro v i d er. A h eal t h c a r e p ro v i d er wh o i s

u n wi l l in g t o co m

p l y w it h t h e h eal t h care ag en t’ s d eci s io n s h al l p ro v id e

reas o n ab l y n eces s ary co n s u l tat i on an d care i n co n nect i o n wi t h th e

p en d i n g t ran s fer.

20i n t u b at i n g S t ep hen s o n an d p l aci n g h er o n a ven ti l at o r o n M arch 7

. 1 0 By i t s p l ai n

l an g u ag e, OCGA § 3 1-3 2-1 0 (a) (2 ) an d (3 ) affo rd i m m u n i t y t o a heal t h care p ro v i d er

o r faci l i t y t h at fai l s to co m p l y wi t h a d i rect i o n o f t h e h eal th care ag en t i f: t h e p ro v i d er

o r f a c i l i t y p ro m

p t l y in fo rm ed t h e ag en t of t h e fai l u re t o co m p l y w i t h th e ag en t ’ s

d i rect i o n ; t h e act i o n s o f th e h eal t h care p ro v id er o r faci l i t y t h at fai l ed t o co m p l y wi th

t h e ag en t ’ s d i rect i o n w ere “ s u b st an t i al l y i n acco rd wi t h reas o nab l e m ed i cal st an d ard s

at t he t i m e o f referen ce”; an d t h e p ro v i d er or faci l i t y co o p erat ed i n t he t ran s fer o f t h e

d ecl aran t at t h e b eh es t o f t h e ag en t an d p ro v i ded reas o nab l y n eces s ary co n su l t at i o n

an d care o f t h e d ecl aran t i n co n n ect wi th t h e p en di n g t ran sfer.

In ad d i t i o n t o t h es e el em en t s , Al icea arg u es t hat wh en t h e s tat u te i s read as a

wh o l e, i m m u n it y fo r th e fai l u re t o co m p ly w i t h a h eal t h care ag en t ’ s d i rect io n u n d er

OCGA § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ) req u i res a s h o w i ng t h at t h e h eal t h care p ro v i d er o r

faci li t y was act i n g i n g o o d fai t h rel i an ce o n t h e d i rect i o n s an d d eci s i o n s of t h e ag en t

.

In co nt ras t

, t h e D efen d an t s s u g g es t t h at go o d fai t h rel i an ce, referen ced i n t h e

i n t ro du ct o ry cl au s e of t h e s t at u t e, i s n ot an el em en t o f pro v i ng i m m u ni t y f o r a

1 0 Becau se t h e D efen d an t s n ev er arg u ed i n t h e t ri al co u rt t h at t h ey were en t i t l ed

t o i m m u n i t y fo r t he M a r c h 5 s urg i cal p ro ced u re, we w i l l n o t co ns i d er t h at i s s u e o n

ap p eal

. See W

el l o n s , In c. , 3 1 5 Ga. Ap p . at 1 8 6 (1 ). W e al s o n o t e t h at th i s cas e d o es

n o t i n v o l v e a “ refu s al ” b y a h eal t h care pr o v i d e r t o fo l l o w a h eal t h care ag en t ’ s

d i rect i o n fo r rel i g i o u s o r p h i lo so p h i cal reas o n s

.

21p ro v id er o r faci l i t y ’ s fai l u re to co m p l y wi t h an ag en t ’ s d i rect i o n u nd er O CGA § 3 1

-

3 2 -1 0 (a) (2 ) an d (3 ). W e ag ree wi t h Al i cea t h at g o o d fai t h rel i an ce m us t b e tak en i n to

acco u n t as p art o f t he i m

m u n i t y an al y si s

.

St at u t o ry co n s t ru ct i o n i s a q u es t io n o f l aw, an d o u r rev i ew i s d e n o v o

. Hi l l v.

Fi r s t At l a n t i c Ba n k

, 3 2 3 Ga. Ap p

. 7 3 1

, 7 3 2 (7 4 7 SE2 d 8 9 2) (2 0 1 3 ). “ I n c o n s t ru i n g

a l eg i s lat i v e act

, a co urt m u s t fi rs t l o o k t o t h e l it eral m ean i ng o f t h e act

. If t h e

l an g u ag e i s p l ai n an d d o es n o t l ead t o an y ab s u rd o r i m pract icab l e co n seq u en ces

, t h e

co u rt s im p l y co ns t ru es i t acco rd i ng t o i t s t erm s an d co n d u ct s n o fu rt her in q u i ry .”

(P u n ct u at i o n an d fo o t n o t e om it t ed .) S a va n n ah Cemet er

y G r o u p v. DePu e-W

i l b er t

Va u lt Co

. , 3 0 7 Ga. Ap p

. 2 0 6

, 2 0 7 (1 ) (7 04 SE2 d 85 8 ) (2 0 1 0 ). Fu rt h erm o re, “ in

co n st ru i n g l an g u ag e i n an y o n e p art o f a st at ut e, a co u rt s h o u l d c o n s i d e r th e en t i re

s ch em e o f t h e s tat u t e an d at t em p t t o g at h er t h e l eg is lat i v e i n t en t fro m t h e s t at u t e as

a wh o l e.” (Ci tat i o n an d p u nct u at i o n o m i t t ed .) W a l ker Co u n t y v. Tr i -S ta t e Cr ema t o r

y

,

2 9 2 Ga. Ap p

. 4 1 1, 4 1 4 -4 1 5 (1 ) (6 6 4 SE 2 d 7 8 8 ) (2 0 0 8 ). Di fferen t s u b s ect i o n s o f a

s t at u te s h o u l d b e r e a d i n p ari m at eri a, an d we m us t s t ri v e t o “ reco n ci l e t h em

, i f

p o s s i b l e, s o t h at t hey m ay b e read as co n s i s t en t an d h arm o ni o u s wi t h o n e an o t h er.”

(Pu n ct u at i on an d fo o tn o t e o m i tt ed .) Ci t y o f La Gr a ng e v. Ga

. Pu bl i c S vc. Co mm.

, 2 9 6

Ga. Ap p . 6 1 5 , 6 2 1 (2 ) (6 7 5 SE2 d 5 2 5 ) (2 0 0 9 )

.

22Ap p ly i n g t h es e p ri n ci p l es i n th e p res en t cas e, we co ncl u d e t hat t h e i m m u n i t y

affo rd ed b y O C G A § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ) ap p l i es on l y wh ere t he h eal t h care

p r o v i d e r o r faci l i t y was m ak i n g a g o o d fai t h effo rt t o rel y o n t h e d eci s i o n s a n d

d i rect i o n s o f th e h eal t h care ag en t wh en treat i n g th e d ecl aran t

, b u t nev ert h el es s fai l ed

t o co m p l y wi t h a d i rect i o n o f t h e ag en t

. Th e fi rs t s en t en ce of t h e i n tro d u ct o ry cl au s e

o f OCGA § 3 1 -3 2 -1 0 (a) refers t o h eal t h care p ro vi d ers an d faci l i t i es t h at act “ i n g o o d

fai t h rel i an ce o n an y

d i rect io n o r d eci s io n b y t h e h eal t h care ag en t ,” an d t h e s eco n d

s en t en ce s t at es th at “ wi t h o ut l im i t i n g t h e g en eral i t y o f t h e fo reg o i ng

, th e fo l l o wi n g

s p eci fi c p ro v i si o n s sh al l al s o g o v ern

, p ro t ect

, an d v al i d at e t h e act s o f t h e h eal t h care

ag en t an d each s u ch heal t h care p ro v i der, h e a l t h care faci l i ty

, an d an y o t h er p ers o n

a ct i n g i n g o o d fa i t h r el i a n ce o n s u ch d i r ect i o n o r d eci s i o n

. ” (Em

ph as i s s u p p l i ed .)

OCGA § 3 1 -3 2 -1 0 (a)

. Th e s eco n d s en t en ce o f th e in t ro d u ct ory cl au se t h en en d s wi th

a co l o n fo l lo wed b y s ev eral s u b s ect i o n s

, i n cl ud i n g su b s ect io n s (a) (2 ) an d (3 ), wh i ch

ad d res s fai l u res t o co m

p l y w i t h a h eal t h care ag en t ’ s d i rect io n o r d eci s i o n

. I n t u rn

,

OCGA § 3 1 -3 2 -1 0 (a) (2 ) b eg in s wi t h t h e wo rd s “ no s u ch h eal t h care p ro v id er, h eal th

care faci l i t y

, o r p ers o n

, ” li nk i n g t h e s ub s ect i on t o t h e in t ro d u ct o ry cl au s e, an d OCGA

§ 3 1-3 2-1 0 (a) (3 ) fu rt h er el ab o rat es o n th e co n di t i o n s u n der wh i ch i m m u n it y can b e

o b t ai n ed fo r fai l in g t o co m pl y wi t h an ag en t ’ s d irect i o n o r d eci si o n

.

23Tak en t o g et h er, t h e l an g u ag e, g ram m ar, an d st ru ct ure o f O CGA § 3 1-3 2 -1 0 (a)

refl ect t h at t h e req u i rem en t of “ go o d fai t h rel i an ce” o n a h eal th care ag en t’ s d i rect i o n

o r d eci s i o n referen ced i n t h e i n t ro d u ct o ry cl au s e wa s i n t en d ed to ap p l y t o t h e

s u b s ect i o n s th at fo l lo w i t

, i n cl u d i n g s u b s ect i o ns (a) (2 ) an d (3 ) p ert ai n i n g to a fai l u re

t o co m p l y wi th an ag en t ’ s d i rect i on o r deci s i o n. To reco n ci l e an d h arm o n i ze t h e

i n t ro du ct o ry cl au se wi t h th es e s u bs ect i o ns an d g i v e effec t t o a l l t h e st at u t o ry

l an g u ag e, we co n s t ru e th e i m m u n i t y affo rd ed b y OCGA § 3 1 -3 2 -1 0 (a) (2 ) an d (3 ) to

ari s e o n l y wh ere t h e heal t h care p ro v i d er o r faci l i ty m ad e a g o o d fai t h effo rt t o rel y

o n t h e d irect i o n s an d d eci s i on s o f t h e h ea l t h c a r e a g en t i n t h e m ed i cal care an d

t r eat m en t of t h e d ecl aran t t hat h as b een cal l ed i nt o qu es t i o n. By co n s t ru i n g t h e

i n t r o d u c t o r y cl au s e an d s ub s ect i o n s i n th i s m an n er, we av o i d an y ap p aren t i n t ern al

co n fl i ct i n t h e s t at u t e an d ren d er t h e p ro v i si on s co n s i s t en t an d h arm o ni ou s wi t h o n e

an o th er, as we are ch arg ed t o do

. Fo r d Mo t o r Co

. v. Ca r ter , 2 3 9 Ga. 6 57 , 6 6 1 (2 3 8

SE2 d 3 6 1) (1 9 7 7).

Acco rd i ng l y

, t h e Defen d an t s

, t o p ro v e t h at t h e y were en t i t l ed t o i m m u n i t y

u n d er OCGA § 31 -3 2 -1 0 (a) (2 ) an d (3 ) as a m at ter o f l aw, h ad t o es t ab l i s h t h at t h e

u n co nt ro v ert ed ev i d en ce o f reco rd s h o wed t h at t h ey were m ak i n g a g o o d fai t h effo rt

t o rel y on t h e d i rect io ns an d d eci s i o n s o f t h e h eal th care ag en t

, Al i cea, wh en

24St ep h en so n was i n t u b at ed i n t h e ICU o n M arch 7

. “ G o o d fai th ” h as b een d efi n ed as

“ a s t at e o f m i n d i nd icat i n g h on es t y an d l awf u l n es s o f p u rp os e; b el i ef t h at o n e’ s

c o n d u c t is n o t u n co n s ci o n ab l e o r t h at k no wn ci rcu m s t an ces d o n o t req u i re fu rt h e r

i n v es t i g at i o n .” (Pu n ct u at i on

, an d fo o t n o t e o m it t ed .) O ’Her o n v. Bl a ney

, 2 7 6 Ga. 8 7 1,

8 7 3 (1 ) (5 8 3 SE2 d 8 3 4 ) (2 0 03 ). See An d er s o n v. Li tt l e & Da ven

po r t Fu n er a l Ho me

,

2 4 2 Ga. 7 5 1, 7 53 (1 ) (2 5 1 SE2 d 2 50 ) (1 9 7 8). “ Ord i n ari l y

, g o o d fai t h i s a q u es t i o n fo r

t h e ju ry bas ed on a co n s i d erat i o n o f t h e fact s an d ci rcu m s t an ces o f th e cas e.” Pu r cel l

v. Br ees e

, 2 5 0 Ga. Ap p

. 4 7 2

, 4 7 6 ( 4 ) (5 5 2 SE2 d 8 6 5 ) (2 0 0 1 ). See Ho d g es v.

Y ou ma n s , 1 2 9 Ga. Ap p . 4 8 1

, 4 8 3 (3 ) (2 0 0 SE2 d 1 5 7 ) (1 9 7 3 ).

As prev i ou s ly d i s cu s s ed

, Dr. Cat al an o t es t i fi ed i n hi s d ep os i t i o n t h at h e h ad

b el i ev ed h e was carry i n g o u t t h e fam i l y ’ s wi s h es i n o rd eri n g t h e M arch 7 i n t u b at i o n

b ecau s e in h i s “ fram ewo rk o f t h i n k i n g ” A l i c e a h ad au t h o ri zed hi m t o p erfo rm t h e

M arch 5 su rg i cal p ro ced u re i n v o l v i n g g en eral an es t h es ia th at req u i red i nt u b at i o n

. Dr.

Cat al an o ’ s t es t i m o ny wo u l d s u p p o rt a fi n d in g b y a ju r y t h a t h e was m ak i n g a g o o d

fai t h effo rt t o rel y o n th e d i rect io n s an d d eci s i o n s o f Al i cea w h e n h e o r d ered

St ep h en so n’ s i n t u bat i o n

.

On t h e o t her han d

, Dr. Cat al an o l at er t es t i fi ed i n h is dep o s i t i o n t h at h e “ d i d n ’ t

g o i n t o an y o f t h e co d e/ n o co d e / d o n o t i n t ub at e/ res u sci t at e” in d eci d in g t o i n t u b at e

25St ep h en so n o n March 7 b ecau s e h e h ad d eci ded t o p lace h er o n v en t i l at i on fi rs t an d

t h en gi v e t h e fam i l y t h e ch oi ce wh et h er t o rem ov e h er fro m i t

. Ad d i t i o n al l y

, t h ere was

ev i d en ce t h at Al i cea h ad s p eci fi cal l y t o l d Dr. Cat al a n o t h at St ep hen s on h ad an

Ad v an ce Di rect i v e an d t hat Al i cea d i d n o t w an t CPR o r “ h ero i c m eas u res ” p erfo rm ed

o n St ep h en s on

. D es pi t e t hes e co m m u n icat i o n s

, Dr. Cat al an o ch o se n ot t o read t h e

Ad v an ce Di rect i v e o r t o co n t act Al i cea b efo re o rd eri ng th e i n t u b at io n

, ev en t h o u g h

u p t o 5 0 m i n u t es p as s ed b et w een wh en h e was cal led b y t h e ICU nu rs es an d wh en t h e

i n t u b at i o n was p erfo rm ed

. Dr. Cat al an o al s o ch o s e n o t t o rev i ew t h e p ro gres s n o t es

i n St ep hen so n ’ s m ed i cal ch art

, wh i ch wo u l d h av e al ert ed h i m t o Al i cea’ s ex p res s

d i rect i o n t h at n o in t u b at i on o ccu r w ithout he r perm i s s i o n

, ev en t h o u gh h o s pi t al p o l i cy

refl ect ed t h at an y co m

m u n i cat i o n s b et ween a p h y s ici an an d fam i l y m em b ers

reg ard i n g an ad v an ce d i rect i v e wo u l d b e d o c u m en t ed t h ere, an d Dr. Cat al an o

co n ced ed t h at h e h ad s een an d rev i ewed t h e h o s p it al ’ s p o li ci es p ert ai n i n g t o ad v an ce

d i rect i v es

.

Th i s co m b in ed ev id en ce, wh en v i ewed i n t h e l i g h t m o s t fav o rab l e t o Al i cea as

t h e n on -m o v i n g part y

, creat es a g en u i n e i s s u e o f m at eri al fact as t o wh et h er Dr.

Cat al an o m ad e a g o o d fai t h effo rt t o rel y o n t h e d i rect i o ns an d d eci si on s o f Al i cea

wh en h e o rd ered t h e M arch 7 i n t u b at i o n

. S e e Pu r c el l

, 2 5 0 Ga. Ap p. at 4 7 7 (4 )

26(g en u i n e i s s u es o f m at eri al fact p recl ud ed s u m m ary ju d g m e n t o n qu es t i o n o f

p h y s i ci an ’ s g o o d fai t h u n d er d i fferen t i m m u n i t y s t at u t e, wh ere t h ere was ev i d en ce

t h at

, am o n g t h i n g s, t h e p h y si ci an fai l ed t o cal l t h e p at i en t ’ s p aren ts o r rev iew n o t es

i n t h e p at i en t ’ s fi l e m ad e b y an o t h er p h y s i ci an t h at w o u l d h a v e al ert ed h i m t o t h e

p at i en t ’ s n eed fo r fu rt h er t reat m e n t )

. T h e t ri al co urt t h u s co m m it ted n o erro r in

d en y i n g s u m

m ary ju dg m en t t o Dr. Cat al an o o n h i s i m m un i t y d efen s e u n d er OCGA

§ 3 1-3 2-1 0 (a) (2 ) an d (3 ).

W e reach t h e s am e res u l t wi th res p ect t o Do ct o rs H o s p i tal

, wh i ch fai l ed to

p o i n t t o an y ev i d en ce refl ect i n g t h a t t h e n urs es em p lo y ed at t he h o s p i t al wh o were

i n v o l v ed i n t h e M arch 7 i n t ub at i o n o f St ep h en s o n m ad e a go o d fai t h effo rt t o rel y o n

t h e d i rect i o n s an d d eci s io n s o f Al i cea as t h e d es i g n at ed h eal t h care ag en t

. Becau s e

Do ct o rs Ho s p i tal h ad t h e b urd en o f p r o o f o n th i s is s u e, s ee Hea t h

, 20 8 Ga. Ap p

. at

6 3 1 (2 ), th e l ack o f ev i d e n c e i n t h e reco rd reg ard i n g t he g o o d fai t h rel i an ce o f i t s

n u rs es p recl u ded t h e gran t o f s u m m ary ju d g m en t i n i ts fav or o n t h e i s s u e of i m m u n i t y

u n d er OCGA § 31 -3 2 -1 0 (a) (2 ) an d (3 ), as t h e t ri al co u rt p ro p erl y co n cl u d ed

. 1 1

1 1 Becau s e t here are g en u i n e i s s u es o f m at eri al fact reg ard in g wh et h er th ere was

a go o d fai t h effo rt b y t h e Defen d an t s t o rel y o n t h e d i rect io n s an d d eci s i o n s o f Al i cea

i n carry in g ou t t h e March 7 i n t u b at i o n

, we n eed n o t ad d res s wh et her th e o t h er

s t at u to ry co nd it i o n s fo r i m m u n i t y wer e m e t i n t hi s cas e. See g en eral ly Lo wr y v.

Co ch r a n

, 3 0 5 Ga. Ap p

. 2 4 0

, 2 4 1 (6 9 9 SE2 d 3 2 5 ) (2 01 0 ) (“ W e wi l l affi rm a t ri al

272

. Th e Defen d an t s al s o co n t en d t h at t h e t ri al co u rt erred i n d en y i n g t h ei r

m o ti o n fo r s u m

m ary ju d g m en t o n Al i ce a ’s m ed i cal m al pract ice cl ai m fo r l ack o f

i n fo rm ed co n s en t b as ed o n t h e M arch 5 s u rg i cal p ro ced u re p erfo rm ed o n St ep h en so n

t h at i nv o l v ed i n t ub at i o n

. Acco rd i n g t o t he Defen d an t s

, Al i cea fai l ed t o co m e fo rward

wi t h an y ev i d en ce s h o w i n g t h at St ep h en s o n was i nju red b y t he M arch 5 p ro ced u re,

an d t h u s can n o t s u cceed o n h er i n fo rm ed co n s en t cl ai m as a m at t er of l aw. W e ag ree.

“ Geo rg i a d oes n o t reco g n i ze a co m m o n l aw du t y to i n fo rm p at ien t s o f t h e

m at eri al ri s k s o f a p ro p o s ed t reat m en t o r p ro ced ure[.] ” B lo t n er v. Do r ei ka , 2 8 5 Ga.

4 8 1 (6 78 SE2 d 8 0 ) (2 0 0 9 ). Ho wev er, b y s t at ut e,

an y p ers on w h o u n d erg o es an y s u rg i cal p ro ced u re u n d e r gen eral

an es th es i a

. . . m

u s t co n s en t t o s u ch p ro ced ure an d s h al l b e i nfo rm ed o f

t h e d i ag n o s i s

, n at u re, an d p u rp o s e o f t h e su rg i cal o r d i ag n o s t i c

p ro ced u re, m at eri al ri sk s o f t h e p ro ced u re, l i k el i h o o d o f s ucces s

, th e

p ract i cal al t ern at i v e s t o t h e p ro ced u re, an d t h e p ro g n o s i s i f th e

p ro ced u re i s reject ed

.

(Ci t at i o n an d p u n ct uat i o n o m it t ed .) Ro ber t s v. Co n n el l

, 3 1 2 G a. A p p

. 51 5

, 5 1 8 (2 )

(7 1 8 SE2 d 8 6 2 ) (2 0 1 1 ). See OCGA § 3 1-9 -6 .1 (a). To b ri ng a n a c t i o n fo r m ed i cal

co u rt ’ s d en i al o f a m ot i o n fo r s u m m ary ju d gm en t i f i t i s ri g h t fo r an y reas o n .”).

28m al p ract i ce p rem i s ed u p o n t h e fai l u re t o o b tai n i n fo rm ed co n sen t fo r a p ro ced u re in

acco rd an ce wi t h OCGA § 3 1 -9 -6 .1 (a), t h e p l ai n t iff m u st p res en t ev id en ce s h o wi n g

t h at “ t h e p at i en t s u ffered an i n ju ry wh i ch was p ro x i m at el y cau s ed b y t h e s u rg i cal o r

d i ag n o s ti c p ro ced u re.” OCGA § 3 1 -9 -6 .1 (d ) (1 ).

In t h e p res en t cas e, t h e M arch 5 s u rg i cal p ro ced u re i nv o l v ed gen eral an es t h es i a

an d t hu s t ri g g ered a d u t y to i n fo rm Al i cea, as St ep hen s o n ’ s h eal t h care ag en t

, o f t h e

m at eri al ri s k s as so ci at ed wi t h t h e p ro ced u re an d t h e o t her i n fo rm at i o n req u ired t o b e

d i s cl os ed u n der OCGA § 3 1 -9 -6 .1 (a). Al i cea cl ai m s t h at i n fo rm ed co n s en t was n ot

p ro p erl y o b t ai n ed fro m

h er fo r t h e M arch 5 su rg i cal p ro ced u re b ecau se sh e was n ot

t o l d th at St ep h en s o n wo u l d b e i n t ub at ed an d was n o t fu l l y i n fo rm ed o f t h e n at u re,

p u rp os e, p ro g no s i s

, al t ern at i ves

, an d ad v is ab i l i ty o f t h e p ro p os ed p ro ced u re. Sh e

s eek s co m

p en s at o ry an d p u n i t i v e d am ag es bas ed on t hi s al leg ed lack o f i n fo rm ed

co n sen t

.

Al i cea, ho weve r

, ha s f

a i led t o co m e fo rward w i t h an y ev i d en ce t h at St ep h en so n

s u ffered an i n

j u ry t h at was p ro x i m at el y cau sed b y t h e M arch 5 s u rg i cal p ro ced u re.

Th ere i s n o t h i n g i n t h e reco rd t o s u g g es t t h a t t h e in t u bat i o n an d v en t il at i o n o f

St ep h en so n d uri n g t h e pro ced u re i n ju red h er i n an y m an n er, an d St ep h en s o n was

ex t u b at ed an d t h e v en ti l at o r wa s rem ov ed wh en t h e p ro ced u re was co m p l et ed

. No r

29i s t h ere an y ev i d en ce t h at St ep h en s o n ex p eri en ced an y ad v ers e s i d e eff ect s o r

co m p l icat i o n s a r i s i ng fro m t h e p ro ced u re, t h at h er co n d i t i o n wo rs en ed fro m t h e

p ro ced ure, o r t h at s h e ex p eri en ced an y p ai n, s u fferi ng

, o r m en tal d i s t res s as a res u l t

o f t he pro ced ure ap art fro m wh at s h e was al read y ex p eri en ci ng as a res u l t o f h er

s ev ere i l l n es s

. Acco rd i n gl y

, we co n cl u d e t h at Al ic e a f a i l e d

, as a m at t er o f l aw, to

s at i s fy t h e s t at u to ry req u i rem en t o f s ho wi ng an i n j u ry p ro x i m at el y res u l t i n g fro m t h e

al l eg ed l ack o f in fo rm ed co n s en t

. See OCGA § 3 1-9 -6 .1 (d ) ( 1 ). It fo l l o ws t h at t h e

t ri al co u rt erred i n d en y i n g s u m m ary j u d gm en t t o t h e Defen d an ts o n Al i cea’ s

i n fo rm ed co n s en t cl ai m

p red icat ed o n t h e M arch 5 s urg i cal p ro ced u re.

3

. Las t l y

, t h e Defen d an t s co n t en d t h at t h e t ri al co u rt erred i n d en y i n g t h ei r

m o ti o n fo r s um m ary ju d g m en t o n Al i cea’ s m ed i cal b at tery cl ai m

. W e ag ree wi t h t h e

Defen d an t s wi t h res p ect t o t h e M arch 5 s u rg ical p ro ced u re, b u t n o t wi t h res p ect t o t h e

M arch 7 i n t u b at io n

.

It is wel l -es t a b l i s hed t h at a co m p et en t ad u l t p at i en t h as t h e ri g h t to refu s e

m ed i cal an d s urg i cal t reat m en t

. See OCGA § 3 1 -9 -7 ; S t at e v. McAf ee

, 2 5 9 Ga. 5 7 9,

5 8 0 (1 ) (3 8 5 SE2 d 6 51 ) (1 9 89 ). If a h eal t h care ag en t h as b een d es i g n at ed fo r t h e

p a ti en t i n acco rd an ce wi th t h e Ad v an ce Di rect i v e Act

, t h e ag en t m ay ex erci s e t h e

p at i en t ’ s ri g ht t o refu s e s u ch t reat m en t . OCGA § 3 l -3 2 -5 (a) (1 ); 3 1 -3 2 -7 (e) (1 ).

30In ad d i t io n t o t h e l eg al p ri n ci p l e o f “ i n fo rm ed co n s en t ” p rev i o u s l y d i s cu s s ed

i n Di v i si o n 2

, co n s en t t o m ed i cal t reat m en t en co m p as s es th e pri n ci p l e of “ b as i c

co n sen t .” Pa d

en v. Ru d d

, 2 94 Ga. Ap p

. 6 03

, 6 0 5 (2 ) (6 6 9 SE2 d 5 4 8 ) (2 0 0 8 ). “ W i th

res p ect t o b as i c co n s en t

, a m ed i cal t o u ch i n g wi t h o u t co n s en t co n s t i t u t es t h e

i n t en t i o n al t o rt o f b a t t ery fo r wh i ch an act i on wi l l l i e.” (Pu n ct u at io n an d fo o t n o t e

o m it t ed .) Id . See P r i nce v. Es p o s i t o

, 2 7 8 Ga. Ap p

. 3 1 0

, 3 1 1 (1 ) (a) (6 2 8 SE2 d 6 0 1 )

(2 0 0 6). Co n t i n u ed t reat m en t o f a p at i en t aft er co n s en t has b een wi t h drawn al s o wi l l

g i v e ri s e t o a m ed i cal b at t ery cl ai m

. Jo i n e r v

. L e e

, 1 9 7 G a. Ap p

. 7 5 4, 7 56 (1 ) (3 9 9

SE2 d 5 1 6) (1 9 9 0 ). “ Act u al p h y s i cal i nju ry i s n o t req u i red to s u pp o rt a cl ai m fo r

b at t ery

, wh i ch i s an i n t en ti o n al t o rt .” (Ci t at i o n an d p u n ct u at i on o m i t t ed .) La ws o n v.

Bl o o ds wo r t h , 3 1 3 Ga. Ap p. 6 1 6 , 6 1 9 (7 2 2 SE2 d 3 5 8 ) (2 0 1 2 ).

Here, t h e u n co n t ro vert ed e v i d e n c e o f reco rd refl ect s t h at t h ere w as b as i c

co n sen t fo r th e M arch 5 su rg i cal p ro ced ure. Al i cea co n s en t ed t o Dr. Cat al an o

co n du ct in g a su rg i cal p ro ced ure u nd er g en eral an es t hes i a t o d rai n m o r e f l u i d fro m

St ep h en so n’ s l u ng cav i t y o n t h at d at e. An d wh i l e A l i cea al leg es th at Dr. Cat al an o d id

n o t fu l l y d i s cl o s e t o her t h e n a t u re o f t h e p ro ced u re (i ncl u d in g th at i t wo u l d en t ai l

i n t u b at i o n), t he l i k el i h oo d o f s u cces s, an d t h e p ract i cal al t ern at i v es t o t h e p ro ced u re,

31t h o s e al l eg at io ns refl ect an in fo rm ed co n s en t

, n o t a b at t ery

, cl ai m

. 1 2 See OCGA § 3 1

-

9 -6 .1 (a). Becau se t h e “ p u rp o rt ed fai l u re to ob t ai n

. . . i n fo rm ed co n sen t do es n o t g i v e

ri se t o a cl ai m o f b at t ery ,” Pa d e n

, 2 9 4 Ga. Ap p

. at 6 0 5 (2 ), th e t ri al co u rt erred in

d en y i n g s u m

m ary ju d g m en t t o th e Defen dan t s o n Al i cea’ s bat t ery cl ai m b as ed o n t h e

M arch 5 s u rg i cal p ro ced u re.

W e reach a d ifferen t r e s u l t wi t h res p ect t o t h e M arch 7 i nt u b at i on

. Al i cea

s p eci fi cal l y

d i rect ed Dr. J os ep h t h at n o i n t u bat i on of St ep h en s o n was t o o ccu r u n t i l

s h e had b een cal l ed an d h ad g i v en co n s en t

, an d Dr. J o s ep h p l aced t h i s i n fo rm at i o n

i n h is M arch 4 p ro g res s no t e i n t h e m ed i cal ch art

. Bas ed o n t h i s ev i d en ce, a ju ry

co u ld fi n d th at t h e Defen d an t s had n o t i ce o f t h i s s p eci fi c l i m i t at io n o n St ep h en s o n ’ s

m ed i cal care an d t reat m en t an d t h u s w e r e u n der an ob l ig at i o n t o ab i d e b y i t

. See

OCGA § 3 1 -3 2 -8 (2 ). Co m p are Ro b er t

s v. Jo n es

, 2 22 Ga. Ap p

. 5 4 8

, 5 4 9 (2 ) (4 7 5

S E2 d 1 9 3 ) (1 9 9 6 ) (p h y si ci an co u l d n o t b e h el d li ab l e fo r b at t ery

, w h ere m ed i cal

p ro ced ure l i m i t at i on co n t ai n ed i n ad v anc e dir e c tive w a s ne it h er p l aced i n t he p at i en t ’ s

m ed i ca l c h a r t n o r t o l d t o t h e p h y s i ci an ). Nev ert hel es s

, Dr. Cat al an o an d t h e ICU

n u rs es d i d n ot co n t act Al i cea to o b t ai n her co n s en t befo re t h e M a r c h 7 i n t u b at i o n.

1 2 As n o ted i n Di v i s i o n 2

, Al i cea’ s i n fo rm e d co n sen t cl ai m p red i cat ed o n t h e

M arch 5 s u rg i cal p ro ced u re fai l s fo r l ack o f ev i den ce o f an y i n ju ry

.

32Fu rt h erm o r e

, g i v en t hat t h ere w as ev i d en ce t h at ap p ro x i m at el y 5 0 m i n u t es el ap s ed

b et ween t h e t i m e Dr. C a t a l an o was cal led an d t h e in t u b at io n was p erfo rm ed

, a ju ry

co u ld fi nd t h at t he si t u at i o n was n ot so em erg en t t h at co n s en t co u l d no t h av e b een

o b t ai n ed fro m A l i cea b y cal l i n g h er at h o m e b efo re p erfo rm i n g th e i n t ub at i o n

. Un d er

t h es e ci rcu m s t an ces

, a ju ry m u s t res o l v e wh et h er t h e Defen d an t s co m m i tt ed m ed i cal

b at t ery b y p erfo rm i n g t h e M arch 7 i n tu b at i o n

, an d th e t ri al co u rt co m m i t t ed n o erro r

i n d en y i n g t h e Defen d an t s ’ m o t i o n fo r s u m m ary ju d g m en t o n t hi s cl ai m

. 1 3

In s u m m ary

, we affi rm th e t ri al c o u r t ’s d e n i al o f t he Defen d an t s ’ m ot i o n fo r

s u m m ary ju d g m en t o n t h ei r i m

m u n i t y d efen s e p red i cat ed o n OCGA § 3 1 -3 2 -1 0 (a)

(2 ) an d (3 ) an d o n Al icea’s m e di cal b at t ery cl ai m p red i cat ed o n t he M arch 7

i n t u b at i o n. W e rev ers e th e t ri al co u rt ’ s d en i al o f t h e Defen d an t s ’ m o t i o n fo r s u m m ary

ju d g m en t o n Al i cea’ s m ed i cal m al p ract i ce cl ai m fo r l ack o f i n fo rm ed co n s en t an d o n

h er m ed ical b at t ery cl ai m p red i cat ed o n t h e M arch 5 s urg i cal p ro ced u re.

Ju d g men t a f f i r med i n pa r t ; r ever

s ed i n p a rt

. Ra

y a n d McMi l l i a n

, JJ., co n cu r

.

1 3 Th e Defen d an t s ’ rel i an ce o n Pr u et t e v. Un g a rino

, 3 2 6 Ga. Ap p. 5 84

, 5 9 0 -5 9 2

(3 ) (7 5 7 SE2 d 19 9 ) (2 0 1 4 ) (p h y s i cal preced en t o n l y ) i s m i sp l aced

. Pr u et t e ad d res s ed

,

am on g o t h er t h i n g s

, wh et h er cert ai n ex p ert t es t i m o n y reg ard i n g wh at th e d efen d an t

p h y s i ci an s h ou l d hav e to l d th e p at i en t ’ s fam i l y wen t to t h e i s s u e o f i n fo rm ed co n s en t

o r bas i c co n s en t an d wh et h er it s h o u l d h av e been ex cl u d ed fro m t ri al

. In co n t ras t

, t h e

i s su e i n t h e p res en t cas e i s t h e m o re g en eral o n e wh et h er t h ere was an y ev i d en ce t o

s u p p ort a b at tery cl ai m

fo r l ack o f b as i c co n s en t t o t h e M arch 7 i n t u b at io n

.

33