Case Name: In re Matter of Patricia DUBREUIL
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1992-07-08
Citations: 603 So. 2d 538
Docket Number: No. 90-1295
Parties: In re Matter of Patricia DUBREUIL.
Judges: DELL, J., concurs.
Reporter: Southern Reporter, Second Series
Volume: 603
Pages: 538–548

Head Matter:
In re Matter of Patricia DUBREUIL.
No. 90-1295.
District Court of Appeal of Florida, Fourth District.
July 8, 1992.
Lonworth Butler, Jr., Fort Lauderdale, for appellant-Patricia Dubreuil.
Clarke Walden, Hollywood, for appellee-South Broward Hospital District.

Opinion:
STONE, Judge.
We affirm a trial court order authorizing a hospital and attending physicians to perform blood transfusions on the appellant, Patricia Dubreuil, notwithstanding that appellant, a Jehovah's Witness, refused such transfusions. It is undisputed that the transfusions were required in order to save her life. The appellant claims that the order violates her rights of privacy and religious freedom.
The appellant was admitted to Memorial Hospital late on a Thursday evening. She was in an advanced state of pregnancy and ready for immediate delivery. Her condition required that the delivery be done by cesarean section. She did not have a private physician. Although Mrs. Dubreuil signed routine admission forms authorizing the infusion of blood, she informed the doctor that she objected to the transfusions, rejecting her earlier signed consent. The appellant's mother, also a member of Jehovah's Witnesses, was present and supported her decision.
The cesarean section was performed and a healthy baby was born. However, the appellant suffers from a severe blood condition which prevents her blood from clotting properly. Due to uncontrolled bleeding, she lost large quantities of blood. As a result, transfusions became necessary to save her life.
The appellant and her husband, Luc Du-breuil, were separated and did not live together. Mr. Dubreuil is the natural father of their four minor children, ages 12, 6, 4 and the newborn child, only hours old at the time of the events in question. He did not accompany her to the hospital. The hospital contacted the local police who located him. Mr. Dubreuil, who is not a member of the Jehovah's Witnesses, signed consent forms for blood transfusions. Acting on that consent, the hospital performed a blood transfusion upon Mrs. Dubreuil prior to the court hearing. Also, Mrs. Du-breuil's two brothers came to the hospital and expressed their belief that a blood transfusion should be performed. Shortly thereafter, the appellant's spiritual adviser came to the hospital and emphasized that injecting blood into her body was objectionable.
The hospital then petitioned the circuit court for an emergency declaratory judgment to determine its authority to administer additional blood to appellant. The emergency hearing was conducted at approximately 3:00 p.m. Friday. Mrs. Du-breuil's attorney and the hospital district's counsel were present. There was not enough time to appoint a guardian ad litem for appellant or the children, or to secure sworn testimony. The matter was submitted to the trial court on stipulated facts. During the course of the hearing, counsel for the hospital district received a phone call and the court was advised that the appellant, who had been unconscious, regained consciousness for a time and had again stated that she did not consent to receiving blood. At another point in the hearing, the court spoke with her physicians by a conference call.
The court was willing to hold a hearing at the hospital, but all parties and the court determined that such an adjournment would serve no purpose because Mrs. Du-breuil, but for the above limited communication, was in an unconscious state during most of the day and remained at that time unconscious. No evidence was submitted to the court concerning the fate of the four children in the event of the mother's death.
The court issued an order authorizing the hospital to administer transfusions as deemed necessary by Mrs. Dubreuil's attending physicians. As a result of the court's order, blood was immediately transfused into Mrs. Dubreuil and she survived. Her survival did away with any urgency in issuing this opinion, but does not mean that this case is moot, because the circumstances are capable of repetition, and should therefore not evade review. See Wons v. Public Health Trust of Dade County, 500 So.2d 679 (Fla. 3d DCA 1987), decision approved by 541 So.2d 96 (Fla.1989).
The trial court recognized that the controlling authority governing the issues in this case is Public Health Trust of Dade County v. Wons, 541 So.2d 96 (Fla.1989), the leading case in Florida regarding blood transfusions in the face of religious objection.
In Wons, the supreme court approved the trial court's refusal to order a blood transfusion where it was shown that the mother, by refusing the transfusion, was not abandoning her minor children. However, as the trial court here recognized, the supreme court in Wons also determined that each case of this nature requires individual attention. Here, the trial court concluded that the circumstances of this case substantially differed from those in Wons, as here Mrs. Dubreuil was separated from her husband and no testimony was presented regarding who would care for the four minor children in the event of her death. Therefore, in the absence of some suggestion or showing as to the availability of proper care for the minor children, the court held that the state's interests in the preservation of innocent third parties, Mrs. Dubreuil's four minor children, outweighed the wishes of Mrs. Dubreuil.
We see no reason to re-address in this opinion those matters covered by the supreme court and the Third District in their respective Wons opinions. However, we agree with the conclusion of the trial court that the factual support for those opinions relies upon the evidence and findings that the surviving Wons children, both teenagers, would be cared for by their father and the balance of the surviving family. We note that Justice Ehrlich's concurring opinion in Wons further emphasizes that in Wons there was no abandonment of the children, thereby negating any claim of an overriding state interest with respect to protecting the surviving children.
The supreme court in Wons recognized that the right to refuse medical treatment must be analyzed in terms of the principles enunciated in Satz v. Perlmutter, 379 So.2d 359 (Fla.1980), affirming and adopting the reasoning of this court in 362 So.2d 160 (Fla. 4th DCA 1978). Perlmut-ter recognized that a right to refuse life saving treatment will be overridden by a compelling state interest. The protection of innocent third parties is one such interest. Id. Here, those innocents are the children. See also St. Mary's Hosp. v. Ramsey, 465 So.2d 666 (Fla. 4th DCA 1985).
In this case, the essential issue to be resolved by the trial court was whether the possible "abandonment" of the Dubreuils' children was an overriding state interest. Unfortunately, in this case, unlike Wons, no reliable evidence was available to assist the trial court in making this determination. No testimony was presented, and no suggestion was made to the court, as to who would care for Mrs. Dubreuil's four minor children in the event of her death, except that it was a known fact that Mr. and Mrs. Dubreuil were separated to the point where he did not accompany her to the hospital. There was no evidence that either Mr. Dubreuil or Mrs. Dubreuil's family was able, capable, or suitable to care for the older child, let alone the young ones and the infant.
The trial court found that, "in the absence of some suggestion or showing as to the availability of proper care and custody of the four minor children[ ] in the event of the death of Patricia Dubreuil[,] this court believes that the demands of the state (and society) outweigh the wishes of Patricia Dubreuil[,] and that every medical effort should be made to prolong her life...."
Although the supreme court in Wons indicated that the burden is on the hospital to demonstrate abandonment, the court did not specifically address the dilemma, inherent in most such cases, that the "state" is not a party. This increases the heavy burden upon the court. We do not interpret Wons as placing an insurmountable or unreasonable burden of proof in the way of the court's responsibility to exercise its discretion, particularly given the emergency circumstances and the need for an immediate decision. Here, the trial court was presented with limited information, and the judge did not have the benefit of taking evidence from the patient or the estranged father and family with respect to the overriding issue of abandonment and the prospects of care for the children in the event that the mother's decision should be honored. Nevertheless, we can discern no reason to conclude that the hospital has not met its burden. We see no basis to hold that in the absence of first hand evidence to the contrary there is some presumption against a finding of abandonment. If anything, the presumption here should be to the contrary, given the ages of the children and the preexisting custody conditions. Additionally, it should be recognized that in many instances, the hospital's agents will understandably be primarily interested in protecting the hospital's interests, and may not represent all of the factors recognized in Wons.
Here, nothing at all is known about the father or his ability to care for the children. The record only shows that the Dubreuils were separated, the children were in their mother's care and custody, the father did not accompany the mother to the hospital and he was contacted, apparently not at her request, only after the emergency arose. There is also evidence that the wife has a family but, similarly, the record is blank as to their ability or willingness to help out. The simple fact is that the trial court had no indication at the time of the crucial decision concerning what would happen to the children if their mother died.
We must assume that the emphasis placed by the supreme court in Wons on the facts of the case concerning the family support was significant to the outcome. There is no other explanation for the supreme court's treatment of those facts. We cannot say that the trial court abused its discretion in concluding on this record that there was an overriding interest in the state as parens patriae that out-balances the mother's free exercise and privacy right to reject the transfusion.
We additionally note that the trial court's order also mentions, in distinguishing Wons, that in this case the husband was not a member of Jehovah's Witnesses and did not support his wife's decision to refuse a blood transfusion. In so commenting the trial court was cognizant that both the appellate court and the supreme court in Wons had considered relevant the evidence of the husband's support for his wife's decision. However, we do not construe this comment by the trial court as indicating that the court believed that Mrs. Dubreuil's constitutional right to refuse treatment was in any way dependent upon the consent of her husband. Obviously a spouse's concurrence in such a decision is irrelevant to the exercise of a first amendment or privacy right, taken alone. Rath er, it is relevant only for the purpose of considering whether alternative care for the surviving children is available, in weighing the overriding interest of the state, and in determining whether or not the spouse's decision to refuse the transfusion constitutes an abandonment. That being the case, there is no reason to address the issue further. We also note that the issue in this case did not involve the additional considerations that are present where it is necessary to perform a blood transfusion in order to save the life of a fetus as well as the mother.
We conclude that since there was no showing that the children of tender years would be protected in the event of their parent's death, the trial court did not abuse its discretion.
AFFIRMED.
DELL, J., concurs.
WARNER, J., dissents with opinion.
. Wons stated that four established factors to be considered in determining whether a compelling state interest overrides the right to refuse medical treatment are (1) the preservation of life, (2) the protection of innocent third parties, (3) the prevention of suicide, and (4) the maintenance of the ethical integrity of the medical profession. Wons, 541 So.2d at 97.