Court Opinion

ID: 9897597
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:18:32.017044+00
Date Added: 2024-06-11T09:15:55.559947
License: Public Domain

08/31/2023
                  IN THE SUPREME COURT OF TENNESSEE
                              AT JACKSON
                                November 9, 2022 Session

      JAMES A. WELCH ET AL. v. OAKTREE HEALTH AND
 REHABILITATION CENTER LLC D/B/A CHRISTIAN CARE CENTERS
                   OF MEMPHIS ET AL.

                   Appeal by Permission from the Court of Appeals
                          Circuit Court for Shelby County
                       No. CT-000544-18 Jerry Stokes, Judge
                      ___________________________________

                             No. W2020-00917-SC-R11-CV
                        ___________________________________

Tennessee’s Durable Power of Attorney for Health Care Act, Tennessee Code Annotated
sections 34-6-201 to -218, includes a provision for limited statutory immunity from civil
liability, under certain conditions, for health care providers who rely in good faith on health
care decisions made by an apparent agent on a principal’s behalf. Id. § -208. Tennessee’s
Health Care Decisions Act, Tennessee Code Annotated sections 68-11-1801 to -1815,
includes a similar provision for limited statutory immunity from civil liability, under
certain conditions, for health care providers who comply in good faith with health care
decisions made by an apparent agent on a principal’s behalf. Id. § -1810. The health care
decision in this case is the execution of an arbitration agreement with admission to a
nursing home. The agreement was signed by an agent under a durable power of attorney
for health care executed several years earlier. After the resident’s death, his estate filed a
wrongful death lawsuit against the nursing home on negligence theories. On appeal from
the trial court’s denial of the defendant nursing home’s motion to compel arbitration, we
hold that the nursing home does not meet the requirements for limited statutory immunity
from civil liability under either the Durable Power of Attorney for Health Care Act or the
Health Care Decisions Act. Consequently, the trial court did not err in considering
evidence on whether the principal had the requisite mental capacity to execute the durable
power of attorney for health care. We overrule the holding on the immunity provision in
the Durable Power of Attorney for Health Care Act, Tennessee Code Annotated section
34-6-208, in Owens v. National Health Corporation, 263 S.W.3d 876, 889 n.4 (Tenn.
2007), to the extent it is inconsistent with this opinion. We affirm the trial court, reverse
the Court of Appeals, and remand to the Court of Appeals.

   Tenn. R. App. P. 11 Appeal by Permission; Judgment of the Court of Appeals
                  Reversed; Remanded to the Court of Appeals
HOLLY KIRBY, J., delivered the opinion of the court, in which ROGER A. PAGE, C.J., and
SHARON G. LEE, JEFFREY S. BIVINS, and SARAH K. CAMPBELL, JJ., joined.

Cameron C. Jehl, Carey L. Acerra, Deena K. Arnold, and Eric H. Espey, Memphis,
Tennessee, and Deborah Truby Riordan, Little Rock, Arkansas, for the appellant, James
A. Welch, Next of Kin and Administrator ad Litem of Estate of David Neil Welch,
deceased, and on behalf of the wrongful death beneficiaries of David Neil Welch.

Craig C. Conley, Quinn N. Carlson, and W. Preston Battle IV, Memphis, Tennessee, and
Christy Tosh Crider, Nashville, Tennessee, for the appellees, Oaktree Health and
Rehabilitation Center, LLC d/b/a Christian Care Center of Memphis, Care Centers
Management Consulting, Inc., and Christian Care Center of Memphis, LLC.

                                       OPINION
                            FACTUAL AND PROCEDURAL HISTORY

       The decedent in this case, David Welch (“David”), was the brother of
Plaintiff/Appellant James Welch (“James”), the administrator of David’s estate.1 David
was diagnosed with Down syndrome shortly after he was born; he could not read and had
difficulty understanding and following instructions. David had no formal education, and
James described him as having “the mind of a two-year-old.”

       In 2012, David needed cataract surgery, and James helped his brother obtain care.
The physician scheduled to perform the surgery required James to get a health care power
of attorney for David. James printed out an online durable power of attorney for health
care (“POA”) form and filled it out, listing James as David’s health care agent and giving
James authority to make David’s health care decisions. At James’s direction, David
“scratched his name” on the signature line on the last page. The POA also had the
signatures of two witnesses who declared under penalty of perjury that the principal, David,
was known to them, signed or acknowledged the document in their presence, and “appears
to be of sound mind and under no duress, fraud or undue influence.”

         James used the POA form for David’s eye surgery and afterward continued to use
it for other health care providers for David. James was never appointed as David’s guardian
or conservator. No physician appointed James as David’s health care agent or surrogate.

       1
          We use first names for David Welch and James Welch to avoid confusion because they share the
same last name. No disrespect is intended.
                                                 -2-
        In November 2016, James sought to admit David to a residential nursing home
facility in Memphis, Tennessee, Defendant/Appellees Oaktree Health and Rehabilitation
Center LLC, d/b/a Christian Care Center of Memphis (“Christian Care”). Christian Care
was aware David had been diagnosed with Down syndrome.

       As part of the admission process, James executed several documents on David’s
behalf. They included an arbitration agreement (“Arbitration Agreement”). It is
undisputed that Christian Care did not require execution of the Arbitration Agreement;
David would still have been admitted to the facility had James declined to sign it. The
Arbitration Agreement lists Christian Care as the “Facility,” David Welch as the
“Resident,” and James Welch as the “Representative.” James signed it and filled out his
“Relationship to Resident” as “Brother [and] POA.” The Arbitration Agreement states it
“waives Resident’s right to a trial in court and a trial by a jury for any future legal claims
resident may have against facility.”

       The Arbitration Agreement required the representative of the resident to provide
Christian Care with a copy of “the document creating the agency or guardianship.” Both
parties agree that James would have shown the POA form to Christian Care in the
admission process.

       David lived at Christian Care for several months. On April 10, 2017, David was
transferred to Saint Francis Hospital. He died four days later, at age 62.

       On February 7, 2018, James, in his capacity as administrator of David’s estate
(“Plaintiff”), sued Christian Care and related entities (collectively, “Defendants”) in the
Circuit Court in Shelby County, Tennessee.2 The complaint alleges health care liability,
ordinary negligence, and wrongful death. It seeks compensatory and punitive damages and
includes a demand for a jury trial.

        In response, the Defendants filed a motion to compel arbitration based on the
Arbitration Agreement. The trial court let the parties engage in discovery related to
arbitration.3

        2
          The complaint lists James as the Plaintiff “et al.” presumably because he sued in his capacity as
administrator of David’s estate and on behalf of beneficiaries. In this opinion, however, we refer to Plaintiff
in the singular.
        3
         Under Tennessee statutes, if a party files a motion to compel arbitration and it is opposed, the trial
court proceeds immediately to determine whether the motion should be granted:

        On application of a party showing an agreement described in § 29-5-302, and the opposing
        party’s refusal to arbitrate, the court shall order the parties to proceed with arbitration, but
        if the opposing party denies the existence of the agreement to arbitrate, the court shall
                                                       -3-
       In response to the motion to compel arbitration, Plaintiff asserted that James had no
authority to sign the Arbitration Agreement because David did not have the mental capacity
to appoint an agent when David executed the POA. In support, Plaintiff submitted David’s
medical records, as well as an expert affidavit and deposition testimony.4

       In reply, Defendants argued that the trial court could not look beyond the face of the
POA to consider evidence of David’s mental capacity. They based this argument on
Tennessee Code Annotated section 34-6-208, the immunity provision in Tennessee’s
Durable Power of Attorney for Health Care Act, as well as a footnote in this Court’s
opinion in Owens v. National Health Corporation, 263 S.W.3d 876 (Tenn. 2007).5 In the
alternative, Defendants argued that the evidence on David’s lack of mental capacity was
not clear and convincing.

       The trial court entered an order stating that it would consider evidence on whether
David had the mental capacity to execute the POA. After doing so, it entered a second
order denying the motion to compel arbitration. The trial court found by clear and
convincing evidence that David lacked the requisite mental capacity to execute the POA.
As a result, the POA was invalid, and James did not have authority to execute the
Arbitration Agreement on David’s behalf.

      Defendants appealed to the Court of Appeals.6 On appeal, they raised two issues:
(1) whether the trial court erred in looking beyond the face of the POA to determine

        proceed summarily to the determination of the issue so raised and shall order arbitration if
        found for the moving party; otherwise, the application shall be denied.

Tenn. Code Ann. § 29-5-303(a) (2012).
        4
           Plaintiff submitted an affidavit and deposition testimony from A. Jefferson Lesesne, M.D., a
licensed physician in the State of Georgia with training and knowledge in the provision of long-term care,
as well as treatment of patients with Down syndrome and other cognitive impairments. Dr. Lesesne
reviewed the medical records, depositions, and other documentation related to David in preparation for his
testimony. In the alternative, Plaintiff argued that the Arbitration Agreement was unconscionable. The
trial court did not address unconscionability, and it is not at issue in this appeal.
        5
          As explained more fully below, the plaintiff in Owens questioned whether the principal was
competent to execute a power of attorney granting authority to an agent. In response to a petition to rehear,
the Owens Court stated that, on remand, “[d]iscovery should not be permitted . . . concerning the validity
of the power of attorney or the circumstances surrounding its execution.” 263 S.W.3d at 889 n.4 (citing
Tenn. Code Ann. § 34-6-208 (2021)).
        6
          Under Tennessee statutes, Defendants had a right to immediately appeal the trial court’s denial of
the motion to compel arbitration: “An appeal may be taken from: (1) An order denying an application to
compel arbitration made under § 29-5-303 . . . .” Tenn. Code Ann. § 29-5-319(a).

                                                    -4-
whether David had the mental capacity to execute it; and (2) whether the trial court erred
in finding clear and convincing evidence that David lacked the requisite mental capacity
when he signed the POA.

       The Court of Appeals reversed the trial court on the first issue. Welch v. Oaktree
Health & Rehab. Ctr. LLC., No. W2020-00917-COA-R3-CV, 2022 WL 589926 (Tenn. Ct.
App. Feb. 28, 2022), perm. app. granted (Tenn. Aug. 4, 2022). As a threshold
determination, the intermediate appellate court concluded that the POA was not governed
by the Durable Power of Attorney for Health Care Act, Tennessee Code Annotated sections
34-6-201 to -218 (2021), as contended by Defendants. Id. at *7–8. Instead, the court
concluded that the POA was governed by Tennessee Code Annotated section 68-11-1810,
the immunity provision in the Health Care Decisions Act. Id. (citing Tenn. Code Ann. §§
68-11-1801 to -1815 (2013)).

        On the merits, based on section 68-11-1810, the appellate court held that the trial
court erred by considering evidence on whether David had the mental capacity to sign the
POA. Id. at *12. It found that the footnote in Owens governed, even though Owens applied
the immunity provision in the Durable Power of Attorney for Health Care Act, not the
Health Care Decisions Act. Id. (citing Owens, 233 S.W.3d at 889 n.4, 891). It said: “[W]e
believe that the Tennessee Supreme Court’s application of Tennessee Code Annotated
section 34-6-208 in Owens requires the same result with respect to section 68-11-1810 in
this case, involving a power of attorney for health care and the newer [Health Care
Decisions Act].”7 Id. at *10. It found that this holding pretermitted the issue of whether
there was clear and convincing evidence that David lacked the required mental capacity to
execute the POA, and it remanded the case to the trial court to consider Plaintiff’s argument
that the Arbitration Agreement is unconscionable. Id. at *12.

       Plaintiff then sought permission to appeal to this Court, arguing that the Court of
Appeals erred in holding that the trial court could not consider evidence that David lacked
the required mental capacity to execute the POA. We granted permission to appeal.

                                             ANALYSIS

       In this appeal, we determine whether the immunity provisions in Tennessee statutes
governing health care decisions apply to arbitration agreements executed with admission
to a health care facility. We first consider a preliminary matter and then the merits of the
parties’ arguments.

       7
          The Court of Appeals added, “It is not for this Court to say whether the statute was properly
applied in Owens” because it was bound to follow decisions by the Tennessee Supreme Court. Welch, 2022
WL 589926, at *12.
                                                  -5-
                                           I.      Preliminary

       As a preliminary matter, we address the Court of Appeals’ choice to decide the case
based on a statute other than the statute the parties cited to the trial court and argued on
appeal, without giving the parties an opportunity to address the question of which statute
is operative.

       On appeal to the Court of Appeals, the Defendant’s argument was based on
Tennessee Code Annotated section 34-6-208, the immunity provision in the Durable Power
of Attorney for Health Care Act, as well as the footnote in Owens citing that same statute.
Neither party asked the Court of Appeals to consider the counterpart immunity provision
in the Health Care Decisions Act.8

        Nevertheless, without raising the question to the parties or asking for supplemental
briefs, the Court of Appeals decided the appeal based on the Health Care Decisions Act,
not the Durable Power of Attorney for Health Care Act. Welch, 2022 WL 589926, at *7.
It commented that both immunity provisions had substantially similar language and would
yield the same result. Id. at *10 (citing Tenn. Code Ann. §§ 34-6-208, 68-11-1810).

        On appeal to this Court, Plaintiff argues that the Court of Appeals exceeded its scope
of review by reversing the trial court’s decision based on the immunity provision in the
Health Care Decisions Act instead of the statute briefed by the parties, citing the discussion
of the role of appellate courts in State v. Bristol, 654 S.W.3d 917 (Tenn. 2022). Defendants
agree that the Court of Appeals made its decision based on the Health Care Decisions Act
without giving the parties an opportunity to address the question of which Act applies, but
say this was a proper exercise of the Court of Appeals’ discretion, and the result the
appellate court reached would be correct under either Act.

       In Bristol, the intermediate appellate court granted relief on an unpreserved and
unpresented issue without giving the parties notice and an opportunity to be heard on that
issue. Id. at 923. On appeal, this Court acknowledged that, in limited circumstances,
appellate courts have discretion to consider unpresented or unpreserved issues. Id. at 926.
On the whole, however, Bristol emphasized the many reasons why such discretion should
be exercised “sparingly.” Id. at 927 (citations omitted).

        8
          The only mention of any provision in the Health Care Decisions Act in the Defendant’s brief to
the intermediate appellate court was in support of its alternate argument that the evidence did not clearly
and convincingly establish that David lacked the capacity to execute the POA. See Br. of Defendants-
Appellees at 19, Welch v. Oaktree Health & Rehab. Ctr. LLC, No. W2020-00917-COA-R3-CV, 2022 WL
589926 (Tenn. Ct. App. Feb. 28, 2022) (No. CT-000544-18).
                                                   -6-
      Regardless, Bristol stressed that when an appellate court exercises its discretion to
consider an issue not properly presented, “it must give the parties ‘fair notice and an
opportunity to be heard.’” Id. (citations omitted). The Court explained:

               The requirement that an appellate court give parties notice and an
       opportunity to be heard is especially important when, as here, an appellate
       court undertakes to review an issue that was neither preserved below nor
       presented on appeal. Reviewing an unpreserved and unpresented issue
       presents an especially strong risk of unfairness and prejudice, since the party
       who stands to lose on that issue would have no inkling that the issue was in
       play and therefore no reason to develop a record on the issue, research it, or
       address it in its briefs. Such review also presents a serious risk of error by
       depriving the court of the adversarial presentation that is central to the
       truthfinding function of our judicial system. Affording the parties notice that
       the appellate court intends to address an issue and an opportunity to be heard
       on that matter helps mitigate those risks and protect the weighty interests that
       the party-presentation principle and preservation requirements are designed
       to foster.

Id.

        In this case, the Defendant argued that the trial court erred in looking beyond the
four corners of the POA to determine whether David Welch was competent to execute it.
Its argument was based entirely on Owens and Tennessee Code Annotated section 34-6-
208(a), the immunity provision in the Durable Power of Attorney for Health Care Act cited
in Owens. Instead of considering that statute, the Court of Appeals chose to interpret a
different statute, Tennessee Code Annotated section 68-11-1810(a)(1), the immunity
provision in the Health Care Decisions Act. By happenstance, as discussed below, we have
an unusual situation where two similar statutes are potentially applicable, so the appellate
court was still looking at the overall question of whether the trial court was precluded by
statute from considering evidence on David’s mental capacity. But that question hinges on
statutory interpretation, and the Court of Appeals decided the case by interpreting an
entirely different statute. Welch, 2022 WL 589926, at *7.

       Certainly, the parties’ failure to argue that the Health Care Decisions Act is the
operative statute did not bind the appellate court; it could fairly question whether it should
consider the Health Care Decisions Act instead of the Durable Power of Attorney for
Health Care Act. Bristol, 654 S.W.3d at 925 (explaining that an appellate court is “not
precluded from supplementing the contentions of counsel through [its] own deliberation
and research”) (citation omitted); see also Kamen v. Kemper Fin. Servs., Inc., 500 U.S. 90,
99 (1991) (explaining that “[w]hen an issue . . . is properly before the court, the court is
not limited to the particular legal theories advanced by the parties, but rather retains the
                                             -7-
independent power to identify and apply the proper construction of governing law”). If an
appellate court comes to believe after oral argument that the parties have focused on the
wrong statute, it can and should take steps to apply the correct law.

        But, barring unusual circumstances, those steps should normally include efforts to
allow the parties to weigh in. We stop short of saying the Court of Appeals was required
to ask the parties to address whether it should construe the immunity provision in the Health
Care Decisions Act instead of the Durable Power of Attorney for Health Care Act. But
doing so clearly would have been best practice. As in Bristol, the parties in this case had
“no inkling” that another statute “was in play and therefore no reason to . . . research it[]
or address it in [their] briefs.” 654 S.W.3d at 927. They were put in the position of having
to address the question either “for the first time in a petition for rehearing after the court
has already ruled” or in a further appeal. Id. at 928. The record here indicates no reason
why the appellate court could not have at least ordered supplemental briefing on the
question of which statute applies.

       Now the question of the Health Care Decisions Act has been teed up, and the parties
have had an opportunity to address it in their briefs and in oral argument. Before this Court,
both take the position that the result should be the same regardless of which Act applies.
Plaintiff argues that the trial court had authority under either Act to consider evidence on
whether David lacked the requisite mental capacity to execute the POA, so we should
reverse the holding of the Court of Appeals. Defendants argue that the immunity
provisions in both Acts prohibit the trial court from considering evidence of David’s
competence, so we should affirm the holding of the Court of Appeals.

        We will address the immunity provisions in both Acts in our analysis of whether the
trial court was precluded from considering evidence of David’s mental capacity.

                                             -8-
                II.     Overview of Normal Procedure Absent Immunity

       As our Court of Appeals has observed, “An arbitration agreement is, of course, a
contract.” Elite Emergency Servs., LLC v. Stat Sols., LLC, No. M2008-02793-COA-R3-
CV, 2010 WL 845392, at *7 (Tenn. Ct. App. Mar. 10, 2010). Arbitration “is a consensual
proceeding in which the parties select decision-makers of their own choice and then
voluntarily submit their disagreements to those decision-makers for resolution in lieu of
adjudicating the dispute in court.” Id. at *8 (citations omitted).

       In Tennessee, arbitration agreements are generally enforceable unless there are
grounds to revoke the agreement. Id. (citations omitted). The Court of Appeals has
outlined the normal procedure at the trial court level when a motion to compel arbitration
is opposed on the ground that the arbitration agreement is unenforceable:

      When one of the parties to the arbitration agreement opposes a motion to
      compel arbitration, the trial court must decide certain gateway matters, such
      as whether the parties have a valid arbitration agreement at all. Similar to a
      motion for summary judgment, resolving these gateway issues frequently
      requires the consideration of matters outside of the pleadings. However, a
      motion to compel arbitration differs from either a motion to dismiss or a
      motion for summary judgment, because the trial court must go on to
      determine whether the arbitration agreement is in fact enforceable before the
      motion to compel arbitration can be decided. . . .

             In considering opposition to a motion to compel arbitration, a court
      must distinguish between those arguments attacking the agreement which
      can be resolved solely as a matter of law and those arguments which require
      resolution of factual issues. While the former category mirrors a case in
      which a court is called upon to interpret contractual language and apply it to
      uncontested facts, the latter requires the trial court to receive evidence and
      resolve the relevant disagreements before deciding the motion.

      ***
             The trial court’s role, then, is not just to determine if there is an issue
      regarding enforceability. It must also determine if the agreement is in fact
      enforceable. . . . [I]f the party challenging the arbitration agreement
      interposes such defenses as . . . lack of authority, it is up to the trial court to
      resolve such issues and make a clear ruling as to whether or not the agreement
      is enforceable. Therefore, the trial court must proceed expeditiously to an
      evidentiary hearing when it faces disputed issues of fact that are material to
                                             -9-
        a party’s motion to compel arbitration; it may not decline to resolve the
        question until trial of the underlying case.

Id. (cleaned up) (citations omitted).9

        Here, the trial court below followed this normal procedure and determined that the
Arbitration Agreement was unenforceable because James did not have authority to execute
it on David’s behalf. “An agent has the power to make contracts that are binding on a
principal . . . when the agent has actual authority, express or implied.” 12 Williston on
Contracts § 35:11 (4th ed.). James’s authority to execute the Arbitration Agreement here
derives from the POA David signed, appointing James as his agent. Execution of a power
of attorney “creates a principal-agent relationship.”10 Tenn. Farmers Life Reassurance Co.
v. Rose, 239 S.W.3d 743, 749 (Tenn. 2007) (citing Rawlings v. John Hancock Mut. Life
Ins. Co., 78 S.W.3d 291, 296–97 n.1 (Tenn. Ct. App. 2001)).

        A “principal’s capacity is requisite to a relationship of agency.” Restatement (Third)
Of Agency § 3.04 cmt. b (2006). “[T]o have an agency relationship under a power of
attorney, the principal must have the capacity to contract.” Rawlings, 78 S.W.3d at 296 n.1
(citing Testa v. Roberts, 542 N.E.2d 654, 658 (Ohio Ct. App. 1988); In re Thames, 544
S.W.2d 854, 856–57 (S.C. Ct. App. 2001)). Whether a “party whose act is called in
question” has the requisite mental capacity is a “question of fact” to be determined from
evidence. Nashville, C. & St. L.R. Co. v. Brundige, 84 S.W. 805, 805 (Tenn. 1905). Here,
after an evidentiary hearing, the trial court determined that David did not have the required
mental capacity to designate James as his agent.

        Thus, the trial court below followed the normal procedure when a motion to compel
arbitration is opposed on the basis that the arbitration agreement is unenforceable because
the agent who executed it was without authority to do so.

                                 III.    Background on Two Statutes

        9
          Generally, “the issue of whether a valid agreement to arbitrate exists should be decided by the
courts before submitting the remainder of the claim to arbitration.” Berent v. CMH Homes, Inc., 466 S.W.3d
740, 746 n.1 (Tenn. 2015) (citing Taylor v. Butler, 142 S.W.3d 277, 283–84 (Tenn. 2004)).
        10
           The common law of agency “attributes the legal consequences of one person's action to another
person.” Barbee v. Kindred Healthcare Operating, Inc., No. W2007-00517-COA-R3-CV, 2008 WL
4615858, at *6 (Tenn. Ct. App. Oct. 20, 2008) (quoting Restatement (Third) of Agency ch. 2, Introductory
Note (2006)). “Agency is the fiduciary relationship that arises when one person (a ‘principal’) manifests
assent to another person (an ‘agent’) that the agent shall act on the principal’s behalf and subject to the
principal’s control, and the agent manifests assent or otherwise consents so to act.” Restatement (Third) Of
Agency, supra, § 1.01. “Relationships of agency are among the larger family of relationships in which one
person acts to further the interests of another and is subject to fiduciary obligations.” Id. § 1.01 cmt. g.
                                                     - 10 -
       As background, it is helpful to explain briefly how Tennessee came to have two
alternative statutes that potentially apply to durable powers of attorney for health care such
as the POA here.

       Before 1990, it was unclear whether a durable power of attorney “could be used to
authorize a proxy decision-maker for an incompetent patient.” Charles M. Key & Gary D.
Miller, The Tennessee Health Care Decisions Act A Major Advance in the Law of Critical
Care Decision Making, Tenn. B.J., Aug. 2004, at 25, 26. In 1990, Tennessee’s legislature
adopted the Durable Power of Attorney for Health Care Act, which authorized the use of
durable powers of attorney for health care and set out requirements for them. Id.; see Tenn.
Code Ann. §§ 34-6-201 to -218 (“Durable Power of Attorney for Health Care Act”). This
allowed for the written appointment of an agent to make health care decisions for a
principal if the principal became unable to do so.11 Key & Miller, supra, at 27.

       Despite enactment of the Durable Power of Attorney for Health Care Act,
difficulties remained in securing valid, executed advance directives. Id. at 28. In 2004,
with intent “to simplify formal requirements” for such directives, Tennessee’s legislature
adopted the Tennessee Health Care Decisions Act. Id.; see Tenn. Code Ann. §§ 68-11-
1801 to -1815 (“Health Care Decisions Act”).

       The Health Care Decisions Act outlines how a competent adult may execute a
written “advance directive”12 for health care that authorizes an “agent”13 to make health

        11
             “Durable power of attorney” is defined by statute as:

        a power of attorney by which a principal designates another as the principal’s attorney in
        fact in writing and the writing contains the words ‘This power of attorney shall not be
        affected by subsequent disability or incapacity of the principal,’ or ‘This power of attorney
        shall become effective upon the disability or incapacity of the principal,’ or similar words
        showing the intent of the principal that the authority conferred shall be exercisable,
        notwithstanding the principal’s subsequent disability or incapacity.

        Tenn. Code Ann. § 34-6-102. The Durable Power of Attorney for Health Care Act defines a
“durable power of attorney for health care” as “a durable power of attorney to the extent that it authorizes
an attorney in fact to make health care decisions for the principal.” Tenn. Code Ann. § 34-6-201(1).
        12
           The Health Care Decisions Act defines “advance directive” as “an individual instruction or a
written statement relating to the subsequent provision of health care for the individual, including, but not
limited to . . . a durable power of attorney for health care.” Tenn. Code Ann. § 68-11-1802(a)(1) (2013).
        13
           The Health Care Decisions Act defines “agent” as “an individual designated in an advance
directive for health care to make a health care decision for the individual granting the power.” Tenn. Code
Ann. § 68-11-1802(a)(2).
                                                    - 11 -
care decisions should the adult lose the capacity to do so. See Tenn. Code Ann. § 68-11-
1803(b). A durable power of attorney for health care is considered a type of advance
directive. Id. § -1802(a)(1). The Health Care Decisions Act includes a simplified
definition of “power of attorney for health care” as “the designation of an agent to make
health care decisions for the individual granting the power.” Id. § -1802(a)(14).14

        The Health Care Decisions Act also created alternatives to written powers of
attorney for health care, less formal methods for proxy decision-making. A competent
adult may—orally or in writing—designate someone “to act as surrogate by personally
informing the supervising health care provider.” Id. § -1806(a). For a patient who lacks
capacity and has no agent or surrogate, the Act gives directions for health care providers
to identify a surrogate to make health care decisions on the patient’s behalf. Id. § -1806(c).
It also addresses situations where no surrogate is available. See id. § -1806(c)(5). Overall,
the Act provides “comprehensive, common sense method[s] for making health care
decisions” for patients who cannot act on their own behalf. Barbee, 2008 WL 4615858, at
*11.

       Notably, the Health Care Decisions Act did not repeal existing statutes on durable
powers of attorney for health care, including the Durable Power of Attorney for Health
Care Act.15 Instead, the Health Care Decisions Act provides that “durable powers of
attorney for health care executed prior to July 1, 2004 will be governed by the old law, as
will instruments executed on or after July 1, 2004 that ‘evidence an intent’ to be governed

        14
           “[T]here are no statutorily prescribed forms, no ‘magic language’ requirements for the body of
the instrument, and no requirements for legalistic warnings.” Key & Miller, supra, at 28.
        15
           Initial drafts of the Health Care Decisions Act “provided for the repeal of the old . . . durable
health care power of attorney laws with grand-fathering provisions . . .; however, following an expression
of a concern by some members of the bar that such repeal would create confusion, the statute was redrafted
to leave the old laws in place.” Key & Miller, supra, at 28 n.22.
                                                   - 12 -
by the old law.” Key & Miller, supra, at 28 n.22. Thus, both Acts remain in effect under
redundant savings provisions. See Tenn. Code Ann. §§ 34-6-217;16 68-11-1803(j).17

       The parties’ arguments to the trial court were based on the immunity provision in
the Durable Power of Attorney for Health Care Act, and this statute was applied in the
footnote passage in Owens v. National Health Corporation on which the Defendants rely.
263 S.W.3d at 889 n.4. For those reasons, we first consider the immunity provision in the
Durable Power of Attorney for Health Care Act, then its application in Owens. After that
we consider the immunity provision in the Health Care Decisions Act, which was applied
by the Court of Appeals.

                            a. Durable Power of Attorney for Health Care Act

          The immunity provision in the Durable Power of Attorney for Health Care Act
states:

          Subject to any limitations stated in the durable power of attorney for health
          care, and, subject to subsection (b) and §§ 34-6-210 -- 34-6-212, a health
          care provider is not subject to criminal prosecution, civil liability or
          professional disciplinary action except to the same extent as would be the

          16
            The Durable Power of Attorney for Health Care Act provides:
          (a) A durable power of attorney for health care entered into before July 1, 2004, under this
          part shall be given effect and interpreted in accord with this part.

          (b) A durable power of attorney for health care entered into on or after July 1, 2004, that
          evidences an intent that it is entered into under this part shall be given effect and interpreted
          in accord with this part.

          (c) A durable power of attorney for health care entered into on or after July 1, 2004, that
          does not evidence an intent that it is entered into under this part may, if it complies with
          the Tennessee Health Care Decisions Act, compiled in title 68, chapter 11, part 18, be given
          effect as an advance directive under that act.

Tenn. Code Ann. § 34-6-217.
          17
               The Health Care Decisions Act provides:

          Any living will, durable power of attorney for health care, or other instrument signed by
          the individual, complying with the terms of title 32, chapter 11, and a durable power of
          attorney for health care complying with the terms of title 34, chapter 6, part 2, shall be
          given effect and interpreted in accord with those respective acts. Any advance directive
          that does not evidence an intent to be given effect under those acts, but that complies with
          this part may be treated as an advance directive under this part.

Tenn. Code Ann. § 68-11-1803(j).
                                                       - 13 -
       case if the principal, having had the capacity to give informed consent, had
       made the health care decision on the principal’s own behalf under like
       circumstances, if the health care provider relies on a health care decision and
       both of the following requirements are satisfied:

       (1) The decision is made by an attorney in fact who the health care provider
       believes in good faith is authorized under this part to make the decision; and

       (2) The health care provider believes in good faith that the decision is not
       inconsistent with the desires of the principal as expressed in the durable
       power of attorney for health care or otherwise made known to the health care
       provider, and, if the decision is to withhold or withdraw health care necessary
       to keep the principal alive, the health care provider has made a good faith
       effort to determine the desires of the principal to the extent that the principal
       is able to convey those desires to the health care provider and the results of
       the effort are made a part of the principal’s medical records.

Tenn. Code Ann. § 34-6-208(a).

        The Defendants argue that this immunity provision alters the normal procedure at
the trial court level when a party challenges a motion to compel arbitration by interposing
a defense such as lack of authority. Under section 34-6-208(a), Defendants argue, if a
health care provider relies in good faith on a facially valid durable power of attorney for
health care used for an arbitration agreement, the trial court is statutorily precluded from
looking beyond the face of the POA to consider evidence of the principal’s mental capacity.
Here, Defendants stress, James presented Christian Care with a “fully executed 2012
Health Care Power of Attorney, which bore the signatures of two witnesses who swore
under penalty of perjury that they knew David, that he signed the document in their
presence, and that he ‘appear[ed] to be of sound mind and under no duress, fraud or undue
influence.’” Under these circumstances, they emphasize, the health care provider had
ample reason to “believe[] in good faith” that James was authorized to sign the Arbitration
Agreement. See Tenn. Code Ann. § 34-6-208(a)(1).

        This issue requires us to construe section 34-6-208(a). In doing so, we are mindful
that “[t]he text of the statute is of primary importance, and the words must be given their
natural and ordinary meaning in the context in which they appear and in light of the
statute’s general purpose.” Coffee Cnty. Bd. of Educ. v. City of Tullahoma, 574 S.W.3d
832, 839 (Tenn. 2019) (quoting Mills v. Fulmarque, Inc., 360 S.W.3d 362, 368 (Tenn.
2012)). We consider “the language of the statute, its subject matter, the object and reach
of the statute, the wrong or evil which it seeks to remedy or prevent, and the purpose sought
to be accomplished in its enactment.” Spires v. Simpson, 539 S.W.3d 134, 143 (Tenn.
2017) (quoting State v. Collins, 166 S.W.3d 721, 726 (Tenn. 2005)). Our construction
                                             - 14 -
must be reasonable in light of the statute’s purposes and objectives. Beard v. Branson, 528
S.W.3d 487, 496 (Tenn. 2017) (citing Scott v. Ashland Healthcare Ctr., Inc., 49 S.W.3d
281, 286 (Tenn. 2001)).

        Subject to limitations not applicable here, section 34-6-208 offers limited protection
to health care providers who rely on health care decisions by a principal’s attorney-in-fact.
Such health care providers are “not subject to . . . civil liability . . . except to the same
extent as would be the case if the principal, having had the capacity to give informed
consent, had made the health care decision on the principal’s own behalf under like
circumstances . . . .” Tenn. Code Ann. § 34-6-208(a). Thus, if the statutory requirements
are met, such health care providers are immune from civil liability except to the extent they
would be liable had the principal made the health care decision. A grant of immunity from
civil liability is clearly in derogation of the common law. As such, we must construe the
statute strictly and confine it to its “express terms.” Lawson v. Hawkins Cnty., 661 S.W.3d
54, 59 (Tenn. 2023) (“Statutes ‘in derogation of the common law,’ moreover, must be
‘strictly construed and confined to their express terms.’”) (quoting Moreno v. City of
Clarksville, 479 S.W.3d 795, 809 (Tenn. 2015))).

        The grant of immunity from civil liability in section 34-6-208(a) has conditions.
Health care providers are not subject to civil liability “if the health care provider relies on
a health care decision and both of the” good faith requirements quoted above “are
satisfied.” Tenn. Code Ann. § 34-6-208(a) (emphasis added). This language indicates all
of the requirements for the grant of immunity must be met in order for health care providers
to get statutory immunity.

        Defendants argue in their briefs that the two good faith requirements are met here:
Christian Care believed in good faith that James was authorized to execute the Arbitration
Agreement on David’s behalf, and they believed in good faith that this decision was not
inconsistent with David’s desires. See id. § -208(a)(1)–(2). They note that, under Owens,
a durable power of attorney for health care provides authority for agents to execute
arbitration agreements as part of admission to a health care facility. 263 S.W.3d at 885.
Ergo, they contend, the decision to enter into an arbitration agreement in connection with
admission to Christian Care is considered a “health care decision” under section 34-6-
208(a).

        For purposes of this appeal, we assume all of this to be true. Defendants fail to
explain, however, how they “relied” on James’s decision to execute the Arbitration
Agreement. Section 34-6-208(a) states that health care providers are “not subject to . . .
civil liability . . . if the health care provider relies on a health care decision,” here, the
decision to sign the Arbitration Agreement. Tenn. Code Ann. § 34-6-208(a) (emphasis
added); see Reliance, Black’s Law Dictionary (11th ed. 2019) (“Dependence or trust by a
person, esp. when combined with action based on that dependence or trust. — rely, vb.”).
                                             - 15 -
Here, it is undisputed that David’s admission to Christian Care was not conditioned on
execution of the Arbitration Agreement; Christian Care would have admitted David even
if James had refused to sign the arbitration materials in the general admission documents.

       This stands in contrast with many other types of health care decisions. We find an
example in the text of section 34-6-208: A “decision is to withhold or withdraw health care
necessary to keep the principal alive.” Tenn. Code Ann. § 34-6-208(a)(2). Had James,
acting as David’s agent, decided to withhold life-saving health care for David, one can
readily see how Christian Care could have withheld care for David in good faith reliance
on James’s decision. In this case, however, Defendants did not depend or rely in any way
on the Arbitration Agreement; they did not act or refrain from acting based on it.

        In addition, the text of section 34-6-208 contemplates that the civil liability from
which the provider gets immunity is related to or arises out of the health care decision. It
states: “[A] health care provider is not subject to . . . civil liability . . . except to the same
extent as would be the case if the principal . . . had made the health care decision . . . under
like circumstances . . . .” Id. § -208(a). Again, using the example in the text of section 34-
6-208(a)(2) of a decision to withhold life-saving health care, had James decided to withhold
such care, Christian Care would have civil liability only to the extent as would be the case
had David made that same decision “under like circumstances.” Id.

       Here, the complaint seeks damages based on wrongful death, negligence, and health
care liability theories. None of the claims arise out of James’s decision to execute the
Arbitration Agreement. This Court has said, “Arbitration agreements do not limit liability,
but instead designate a forum that is alternative to and independent of the judicial forum.”
Harvey ex rel. Gladden v. Cumberland Tr. & Inv. Co., 532 S.W.3d 243, 264 (Tenn. 2017)
(quoting Buraczynski v. Eyring, 919 S.W.2d 314, 319 (Tenn. 1996)).

       Indeed, the Arbitration Agreement itself says it does not alter Christian Care’s
duties: “[T]his Arbitration Agreement does not change the Facility’s duty to use reasonable
care in caring for residents and does not limit liability for any breach of that duty, but
merely shifts certain disputes between the parties to a different forum . . . .” It says that
the potential damages are unaffected by using arbitration as the forum: “The parties agree
that damages awarded, if any, in an arbitration conducted pursuant to this Arbitration
Agreement shall be determined in accordance with the provisions of the state or federal
law applicable to a comparable civil action, including any prerequisites to, credit against,
or limitations on, such damages.”
       Moreover, the Durable Power of Attorney for Health Care Act only provides
immunity from “criminal prosecution, civil liability or professional disciplinary action.”
Tenn. Code Ann. § 34-6-208(a). The Defendants invoke the immunity provision to
forestall inquiry into David’s capacity and ensure arbitration of the parties’ dispute. But

                                              - 16 -
the statute offers protection from liability or prosecution—not from litigating in a particular
forum.

       Thus, considering the plain language of section 34-6-208(a), Defendants do not
meet the requirements in the Durable Power of Attorney for Health Care Act that must be
met in order for health care providers to get statutory immunity.

                                             b. Owens footnote

       In support of their argument that they are entitled to statutory immunity, Defendants
rely on language in a footnote to this Court’s past decision in Owens v. National Health
Corporation, in which the Court cited and applied section 34-6-208, the immunity
provision in the Durable Power of Attorney for Health Care Act. See Owens, 263 S.W.3d
at 889 n.4 (citing Tenn. Code Ann. § 34-6-208).

        In Owens, an agent acting under a durable power of attorney for health care signed
an arbitration agreement as a precondition for admission of the principal to a nursing home.
Id. at 880–81. The primary issue on appeal was “whether a durable power of attorney for
health care authorized the attorney-in-fact to enter into an arbitration agreement as part of
a contract admitting the principal to a nursing home and thereby to waive the principal’s
right to trial by jury.” Id. at 879. Owens answered that question in the affirmative, holding
that an agent by dint of a power of attorney for health care had authority to enter into an
arbitration agreement with a healthcare facility and waive the principal’s right to a trial by
jury. Id. On November 8, 2007, the Owens Court issued an opinion to that effect and
remanded the case to the trial court for further proceedings. Id. at 879, 889.18

     Three months later, in response to the defendants’ petition to rehear, the Owens Court
entered an order granting the petition in part and denying it in part. Id. at 890–91. The
order stated:
              In their petition, the appellees allege that the Court improperly
       allowed discovery as to the principal’s competence to sign the power of
       attorney.

        18
             The Owens Court stated:

        We are unable to resolve the question of whether the arbitration agreement is
        unconscionable due to the limited nature of the factual record. We therefore conclude that
        the case should be remanded to the trial court for further proceedings on that issue. The
        trial court, in its discretion, may allow the parties to conduct discovery.

Id. at 889 (citing Berger v. Cantor Fitzgerald Sec., 942 F. Supp. 963, 966 (S.D.N.Y. 1996)).
                                                    - 17 -
               Upon due consideration, the Court concludes that appellees’ petition
        to rehear is well-taken as to this issue and should therefore be granted. The
        petition to rehear is denied as to the remainder of the issues.

               It appearing to the Court from appellees’ Petition to Rehear and
        appellant’s response that footnote four of its Opinion filed November 8,
        2007, should be modified . . . .

Id. at 891. The Court then modified footnote four of the opinion to read:

        The plaintiff also questions whether King was incompetent to sign the
        nursing-home agreement when Daniel executed the contract pursuant to the
        power of attorney. The plaintiff asserts that the trial court should have
        permitted discovery regarding the circumstances surrounding the execution
        of both the nursing-home contract and the power of attorney, which was
        executed only twenty-one days later. We agree that discovery concerning
        whether King was incompetent to sign the nursing-home agreement should
        be permitted on remand. Discovery should not be permitted, however,
        concerning the validity of the power of attorney or the circumstances
        surrounding its execution. See Tenn. Code Ann. § 34-6-208 (providing
        immunity to health care providers who rely on decisions “made by an
        attorney in fact who the health care provider believes in good faith is
        authorized” to make health care decisions).

Id. at 889 n.4 (emphasis added).

       Based on the language in footnote four as modified, the Defendants correctly argue,
and the Court of Appeals correctly noted, that Owens prohibited the trial court from
allowing discovery on the validity of the durable power of attorney for health care or the
circumstances surrounding its execution. In doing so, the Court cited the immunity
provision in the Durable Power of Attorney for Health Care Act. Id. (citing Tenn. Code
Ann. § 34-6-208). Defendants argue that Owens was correct and should apply here.19
       We cannot consider the Owens Court’s reasoning on section 34-6-208(a) because
the opinion gives us none. We must, however, consider any factual distinctions from this
case. For example, in Owens, unlike this case, execution of the arbitration agreement was
required as a precondition of admission to the facility. Id. at 887. So it is possible the

        19
           Plaintiff argues that the language in footnote four of Owens was dicta. It was not. The Court of
Appeals in this case correctly noted that “[d]ictum has been described as ‘a remark or opinion uttered by
the way’ that ‘has no bearing on the direct route or decision of the case but is made as an aside.’” Welch,
2022 WL 589926, at *5 (quoting Staten v. State, 232 S.W.2d 18, 19 (Tenn. 1950)). Here, the language at
issue in footnote four of Owens was affirmative directive to the trial court on what it could not do on remand,
so it was not an “aside.”
                                                     - 18 -
Court found that the defendants in Owens “relied” on the agent’s decision to agree to
arbitration, within the meaning of section 34-6-208(a). Tenn. Code Ann. § 34-6-208(a)
(providing immunity “if the health care provider relies on a health care decision” (emphasis
added)).

       However, as to whether the civil liability in Owens from which the provider sought
immunity was related to or arose out of the health care decision, we see no difference
between Owens and this case. Id. In Owens, the complaint asserted claims “for negligence;
gross negligence; willful, wanton, reckless, malicious and/or intentional conduct; medical
malpractice; and violations of the Tennessee Adult Protection Act.” Owens, 263 S.W.3d
at 881. None of these claims seem related to the arbitration agreement. And again, this
Court has said that arbitration agreements do not affect liability, they only designate an
alternative forum. Harvey, 532 S.W.3d at 264. The parts of the arbitration agreement
quoted in Owens do not say otherwise, but the opinion does not reproduce the entire
agreement. 263 S.W.3d at 880–81.

        In short, with no reasoning to go on, the holding in footnote four of Owens on section
34-6-208 seems subject to question and should not be read as a blanket interpretation of
that statute. It is not binding in this case. We overrule the holding in footnote four of
Owens to the extent it is inconsistent with the above analysis of whether the Defendants
met the conditions for statutory immunity in section 34-6-208(a).

                                  c. Health Care Decisions Act

      The immunity provision in the Health Care Decisions Act, section 68-11-
1810(a)(1), was applied by the Court of Appeals to reverse the decision of the trial court.
Welch, 2022 WL 589926, at *10. That statute states:

       (a) A health care provider or institution acting in good faith and in accordance
       with generally accepted health care standards applicable to the health care
       provider or institution is not subject to civil or criminal liability or to
       discipline for unprofessional conduct for:

       (1) Complying with a health care decision of a person apparently having
       authority to make a health care decision for a patient, including a decision to
       withhold or withdraw health care . . . .

Tenn. Code Ann. § 68-11-1810(a)(1).

      Section 68-11-1810(a)(1) is simpler than the immunity provision in the Durable
Power of Attorney for Health Care Act, but it is similar. As Defendants point out, it broadly

                                            - 19 -
offers statutory immunity from civil liability to health care providers who act in “good
faith.” The language in section 68-11-1810(a)(1) differs somewhat though.

        In particular, while the Durable Power of Attorney for Health Care Act offers
statutory immunity to a health care provider who “relies on a health care decision” by an
agent, id. § 34-6-208(a), the Health Care Decisions Act provides a health care provider
immunity from civil liability for “[c]omplying with a health care decision of a person
apparently having authority to make a health care decision for a patient.” Id. § 68-11-
1810(a)(1) (emphasis added). To comply means “[t]o do what is required or requested; to
conform, submit, or adapt to (a command, demand, requirement, etc.).” Comply, Black’s
Law Dictionary (11th ed. 2019). The immunity in this statute applies to civil liability “for”
complying with the apparent agent’s health care decision for the patient. Tenn. Code Ann.
§ 68-11-1810(a)(1). This statutory language directly links the civil liability to the
provider’s compliance with the agent’s health care decision. It makes it clear that, to have
the statutory immunity offered in section 68-11-1810(a)(1), the civil liability of the health
care provider must arise out of its compliance with the agent’s health care decision.

       As with the Durable Power of Attorney for Health Care Act, the text of section 68-
11-1810(a)(1) offers an example of the type of health care decision to which the immunity
could apply: “a decision to withhold or withdraw health care.” Id. Thus, if a person with
apparent authority as an agent decided on a patient’s behalf to withhold health care, and a
health care provider, acting in good faith, complied with that health care decision, the
health care provider could benefit from the immunity offered in section 68-11-1810(a)(1).

        Defendants in this case do not meet the requirements for the statutory immunity
offered in section 68-11-1810(a)(1). Defendants did not “comply” with the agent’s
decision here.20 And again, the Plaintiff’s complaint seeks damages based on wrongful
death, negligence, and health care liability theories. The Defendants’ potential civil
liability does not arise out of James’s decision to execute the Arbitration Agreement.
        Moreover, similar to the Durable Power of Attorney for Health Care Act, the Health
Care Decisions Act provides immunity only from “civil or criminal liability or to discipline
for unprofessional conduct.” Id. § -1810(a). The Defendants invoke the immunity
provision in hopes of requiring arbitration of the parties’ dispute, but the statute does not
offer protection from litigating in a particular forum.

       Thus, considering the plain language of section 68-11-1810(a)(1), Defendants do
not meet the requirements in the Health Care Decisions Act that must be met in order for
health care providers to get statutory immunity.

       20
        We again assume for purposes of this appeal that James’s decision to execute the Arbitration
Agreement is a “health care decision” under the Health Care Decisions Act.

                                               - 20 -
        In sum, Defendants do not meet the requirements for statutory immunity from civil
liability in either the Durable Power of Attorney for Health Care Act or the Health Care
Decisions Act. See Tenn. Code Ann. §§ 34-6-208(a), 68-11-1810(a)(1). The holding in
footnote four of Owens on section 34-6-208(a) does not control this case, and we overrule
it to the extent it is inconsistent with the analysis in this opinion on whether the Defendants
met the requirements for statutory immunity in section 34-6-208(a). Owens, 263 S.W.3d
at 889 n.4 (“Discovery should not be permitted, however, concerning the validity of the
power of attorney or the circumstances surrounding its execution.” (citing Tenn. Code Ann.
§ 34-6-208)). We reverse the decision of the Court of Appeals and affirm the trial court’s
decision to consider evidence on the circumstances surrounding execution of the durable
power of attorney for health care and whether the principal lacked the requisite mental
capacity to sign it.21

       Because the Court of Appeals ruled for the Defendants on statutory immunity, that
holding pretermitted Defendants’ second issue of whether the trial court erred in finding
there was clear and convincing evidence that David lacked the requisite mental capacity
when he signed the power of attorney for health care. We remand the case to the Court of
Appeals for consideration of that issue and any other issues raised on appeal not
pretermitted by our holding in this opinion.

        21
           Plaintiff also raised the issue of whether the Court of Appeals’ determination that the trial court
erred in looking into the validity of the durable power of attorney for health care improperly favors nursing
home arbitration agreements over other contracts, contrary to the requirements of 9 U.S.C.A. § 2 and AT&T
Mobility LLC v. Concepcion, 563 U.S. 333 (2011) and Tennessee contract law. Our holding pretermits this
issue.
                                                     - 21 -
                                        CONCLUSION

        For the foregoing reasons, we reverse the Court of Appeals’ ruling that the trial court
in this case erred in considering evidence on the circumstances surrounding execution of
the durable power of attorney for health care and whether the principal lacked the requisite
mental capacity to sign the document. We remand back to the Court of Appeals for
consideration of whether the trial court erred in finding clear and convincing evidence that
David lacked the requisite mental capacity when he signed the durable power of attorney
for health care, and any other issues raised on appeal not pretermitted by our holding in
this opinion. Costs of this appeal are taxed to the appellees, Oaktree Health and
Rehabilitation Center, LLC d/b/a Christian Care Center of Memphis, Care Centers
Management Consulting, Inc., and Christian Care Center of Memphis, LLC, for which
execution may issue if necessary.

                                                _________________________________
                                                 HOLLY KIRBY, JUSTICE

                                             - 22 -