The a gr ee m ent a t i s s ue i n B uracz yns ki w as bet w een a ph ysi ci an and pat i ent

. L i ke here , t he agre em ent w as 1
p re se n te d to th e p a tien t at th e ti m e o f tre a tm e n t o n a “ ta k e it o r l e a v e it” b a sis

. A l s o a s t he ca s e i s he r e, ha d t he pat i ent
re fu se d to sig n th e a g re e m e n t, th e p h y sic ia n w o u ld n o t h a v e re n d e re d m e d ic a l ca re
.



### IN THE COURT OF APP EALS OF TENNESS EE

AT NAS HVILLE June 5, 200 7 S es sio n BRID GETT HILL, ET A L 

### . v. NHC H EALTH CARE/NASH VIL LE, LL C, ET AL 

### . Appeal from the Circuit Court for D avidson County No. 03C2808 Walte r Kurtz , Judge

No. M2005- 01818-COA-R3-CV - Filed April 30, 2008

F R ANK G. C LE MENT , J R ., J., concur ring.
I conc ur fully with the determination th at t h ea rbitration provision is unconscionable and thus unenfor cea

ble. My conc urre nce is ba sed on t he combined e ffe ct of the f ollowing facts, which I find dispositi ve of the issue of unconsc ionability. One, the agr eeme nt affor ded the n u rsing home an unfair a dvantage in the ar b itration proce ss by requiring Ms. Hill to remit potentially exorbitant arbitration fees in advance of any p ro ce ed i n g s she commenc ed. Two, Ms. Hill was under a compellingtime cons t ra i n t t o execute the a dmissions ag ree ment due to the fa ct she neede d immediate nursinghome ca re. Three , the ag ree ment did not a ffor d her theop tio n to su bs e qu e ntl y revokethe ar

bitration provision. Although arbi t ration agreeme nts betwee n residents and nursing homes arepermitted, see Owens v. Nat’l He alth Corp. et al , No. M2005-01272-SC-R11-CV, 2007 WL 3284669, ___ S.W.3d ___ (Tenn. N ov. 8, 2007), our c ourt s h ave refuse d to enforc e ar bitration provisions when the agre ement requires the resident or patient t o choose betwee n a waiver of her right to go to court or fore going health ca

re se rvice s if the agr eeme nt affor ds the health care provider an unfair a dvantage in the arb itr a tio n p ro c e ss. See B uraczynsk i v. Eyring , 919 S.W.2d 314, 321 (Tenn. 1996)

. 1
The NH C agre ement at issue require d that Ms. Hill advanc e the cost of all arbitration fees should she commencean ar bitration proce eding to resolve essentially any dispute with NHC. The rec ord re veals the c ost to arbitrate pur suant t o t he protoc ol specified in the a gree ment could be a s hig h a s $ 18 ,0 00 . T hu s, Ms. Hi ll w ou ld h a ve be e n r e qu ir e d to adv ance as mu c h a s $ 18 ,0 00 to commencethe ar

bitration proce ss. If she w ereunable to a dvance the arbitration f ees, she would have to a band on he r l e ga l r e me die s. Suc h an o ne ro us re qu ir e me nt i s sh oc kin g, e sp e c ia lly in c on tr a st t o themin us c ulesu m Ms . H ill wo uldbe re qu ir e d to a dv a nc e to c omm e nc e a c ivi l a c tio n f

or thesa me relief

.In Phi l pot , t he r evoc at i on provi s i on w as ava i l abl e t o t he r es i dent of t he nur s i ng hom e f or a pe r i od of t en days 2 fr o m th e sig n in g o f th e a g re e m e n t. P h ilp o t, 2007 W L 4340874, a t * 2.

N H C ’ s us e of bo l d a nd enl ar ged f on t t o di r ect t he r es i dent ’ s at t ent i on t o t he f act t he agre em ent cont ai ned an 3

ar bi t r at i on pr ovi s i on w as done i n a f as hi on ve r y si m i l ar t o tha t a ppr oved by t he Supr em e Cour t i n O wens , 2 0 0 7 WL 3284669 at *2,

___ S. W

. 3d ___. I n O wens a n d h e re , th e r e sid e n t sig n e d im m e d ia te ly b e lo w th e s e c tio n to e x p re ssly
a c k n o w le d g e th a t t h e a rb itra ti o n p r o v isio n w a s p u rp o se fu lly d isc lo se d p rio r to th e re sid e n t ex e c u tin g th e a g re e m e n t. I n f ac t , M s
. H i l l , he r da ught er a nd he r s on (who w as her a t t or ney- i n- f ac t ) a l l t hr ee s i gned t o a cknowl edge t he f ac t t he
a rb itra tio n p ro v isio n w a s e x p re ssly d isc lo se d to th e m
. -2- The other significan t circumstance is that the a gree ment was signed by Ms. Hill under compelling time constraints, and it did not aff ord her the right to revoke the ar bitration provisions within a rea sonable pe riod of time, as is the case in m any nursing home a dmission agreeme nts. As 2 the Cou rt ex p lained in Buraczynsk i , our courts are r eluctant to enf orcean ar

bitration agre ement betwee n a patient and a health careprovider if the agre ement has the combined eff ect of requiring the pati en t “to choose betwee n fore ver w aiving the right to a trial by jury or f oregoing ne cessa

ry medical tre atment,” and it affor ds the health car e provider “an unequal a dvantage in the arbitration proce ss itself.” Buraczynsk i , 919 S.W.2d at 321. Although the revoc ation of such an agre ement by a r esident following admission to a nursing fac ility m ay be pr oblematic, see Philpot v. T ennesse e He alth Mgmt., Inc., No. M2006-01278-COAR3-CV, 2007 WL 4340874, at * 8 (Tenn. Ct. App. De c. 12, 2007) pe rm. app. filed ( Tenn. Feb. 11, 2008), the inclusion of a r easona ble re vocation provision in an adhe sion contrac t is indi cative of the rea so n ableness of the agr eeme nt. Buraczynsk i , 919 S.W.2d at 320 (noting that the patient ha d not immediately relinquished acc ess to the courts, “but could revoke the agre ements for an y reason within thirty days of its exe cution and re gain that right”)

. This court re ache d the same c onclusion in Philpot , which hinged on the validity o f a nur sing home admission agree ment, holding the revoc ation provision in the arbitration and waiver of jury trial a gree ment enfor cea ble base d upon a substantially sim ilar ar

bitration provision to that at issue in Buraczynsk i

. For the rea sons stated above , I concur with the determination that the ar bitration provision is unconscionable and thus unenforc eable

. I, howe ver, r espec tfully d i sagre e with the empha sis placed on c ertain other fa cts. For e xampl e , I do not pla c e a ny sig nif ic a nc e on thefa c t th e nu rs i n g h o m e di d n o t p ro v i d e “a t h o ro u gh expl an ati o n ” o f

th e nu an c e s o f

th e ar b it r ati o np r o v is io n s b e c a

u s e n o e xp la

n ati o nw a s r e quested. Moreove r, I

do not place a

ny signific ance on the fa ct the agree ment “c o n t ai n ed no explanation of binding a rbitration, nor a

ny languag e that wo u l d en courag e the patient to ask questions about the proce ss.”
As our c ourt s hav e no ted in r e c e nt o pin ion s, the nurs ingho me ha d a n a ff ir mativ e duty

to disclose the fa ct the agree ment contained ma ndatory arbitration pr ovisions. I

submit NHC fulfilled that duty by emphasizing the a

rb i t ra t i o n p rovi sion prominently in bold font set out in block para g raph f

orm as fo llo ws : 3-3-

By agree ing to arbitration of all disp utes, b oth parties are waivi ng a jury trial forallc ont r ac t, to r t, st at ut or y, r e gul at or y, and o th e r c lai m s.

. . . . I a m in t ot al a gr e e m e ntwith th e ar bit r at ion pr oc e dur e s de sc r ibe d ab ov e in Section H, inclu din g the use wh ere appl icable of the AAA Defined “Con sume rRelate d D is pu t e s . ” Th e pr o v is io ns o f t hi s Se c t io n I I ha v e be e n r e v ie we d w ith
m e pr io r t o m ys ig na t ur e be lo w. Ms. Hill, her son (who ser ved as he r attorne y -i n -f

ac t), and he r daughter a ll three sig ned immediately

below the a

rbitration sec tion to acknowledg e t h ey were aw are that arbitration was require d. Thus, there can be no dispute that they wer e aw are the agree ment contained a n arbitration provision.

Ialso place no signific ance on the fa ct the nursinghome did not pr ovide a copy of all re levant
arb itr atio n r

ule s and the fa c t it did no t pr ov ide int e rn e t a c c e ss s o M s. Hi ll, he r s on or da ughte r c ou ld study the ar bitration ru l es and procedure s incorporated in the agree ment prior to sig ning the ag ree ment. As with any contra ct, if an uninformed party chooses to ente r into an agree ment without sufficie nt knowledg e of all terms and conditions of t he agr eeme nt, that party is g ener ally bound by the agree ment as written, r eg ardle ss of the par ty ’s level of

understandingof all its provisions.
The for eg oing dif

fer ence s notwithst an ding, I fully concur with the determination that the arbitration provision is unconsciona ble and thus unenf

orce able.

___________________________________ FRANK G. CLEMENT, JR., JUDGE