DOCTORS HOSPITAL OF AUGUSTA, LLC Et Al. v. ALICEA
332 Ga. App. 529
Ga. Ct. App.2015Background
- 91-year-old Bucilla Stephenson executed a valid advance directive naming granddaughter Jacqueline Alicea as health-care agent, directing no life-prolonging measures in specified terminal circumstances and telling family she did not want to be kept "on any machines" (including a ventilator).
- Stephenson was admitted with pneumonia, sepsis, and acute renal failure; a copy of the advance directive was placed in her chart but not in the admission tab as hospital policy required.
- Alicea told treating physicians she did not want "heroic measures," no CPR, and specifically instructed that no intubation occur without calling her; a March 4 progress note reflected "no CPR" and "call before intubate."
- Dr. Catalano performed a March 5 surgical procedure under general anesthesia (intubation occurred intraoperatively and patient was extubated after the procedure). Alicea consented to the surgery but was not told it would require intubation.
- On March 7, Stephenson deteriorated; ICU staff called Dr. Catalano, he ordered intubation without contacting Alicea or reviewing the advance directive or progress notes, and the patient was intubated. Alicea later consented to continued care but did not authorize the March 7 intubation.
- Alicea (as administrator) sued hospital and Dr. Catalano for claims including lack of informed consent (March 5), medical battery (March 7), and sought damages; defendants moved for summary judgment arguing statutory immunity under OCGA § 31-32-10(a)(2)-(3) and lack of legal basis for consent/battery claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether defendants are entitled to statutory immunity under OCGA § 31-32-10(a)(2)-(3) for failing to comply with agent's direction (March 7 intubation) | Alicea: Defendants did not act in good faith reliance and failed to promptly inform or seek her consent before intubation | Defendants: Immunity applies; their actions were reasonable and in accord with medical standards | Denied as to summary judgment: genuine factual dispute whether defendants made a good-faith effort to rely on agent; immunity not resolved on summary judgment |
| Whether intubation required informed consent under OCGA § 31-9-6.1(a) (as a "surgical procedure") | Alicea: Intubation associated with March 7 care implicated informed consent/injury | Defendants: Intubation is not a procedure requiring statutory informed consent; trial court granted summary judgment for March 7 informed-consent claim (no cross-appeal) | Trial court's grant on March 7 informed-consent claim stands (not challenged) |
| Whether March 5 surgery (general anesthesia/intubation) gave rise to informed-consent claim (OCGA § 31-9-6.1) | Alicea: She was not informed that intubation would be used and was not given required disclosures | Defendants: Even if disclosure was incomplete, Alicea must show injury proximately caused by the procedure | Reversed denial of summary judgment for defendants: Alicea produced no evidence of injury proximately caused by the March 5 procedure, so informed-consent claim fails as a matter of law |
| Whether March 7 intubation constituted medical battery (lack of basic consent) and March 5 surgery constituted battery | Alicea: March 7 intubation performed despite an express restriction in chart; March 5 consent did not include intubation so battery claim exists | Defendants: March 5 consent was basic consent for the surgery; March 7 was emergent or justified | Mixed: Summary judgment reversed for battery claim as to March 5 (no battery; issue is informed consent) but affirmed as to denial for March 7 battery — jury question whether battery occurred because staff ignored agent's specific limitation and could have contacted agent |
Key Cases Cited
- Hood v. Todd, 287 Ga. 164 (Ga. 2010) (standard of review for summary judgment appeals)
- Heath v. Emory Univ. Hosp., 208 Ga. App. 629 (Ga. Ct. App. 1993) (burden on defendant to prove statutory immunity affirmative defense)
- Purcell v. Breese, 250 Ga. App. 472 (Ga. Ct. App. 2001) (good faith ordinarily jury question)
- O'Heron v. Blaney, 276 Ga. 871 (Ga. 2003) (definition of good faith)
- Blotner v. Doreika, 285 Ga. 481 (Ga. 2009) (Georgia does not recognize common-law informed-consent duty; statutory scheme governs)
- Roberts v. Connell, 312 Ga. App. 515 (Ga. Ct. App. 2011) (OCGA § 31-9-6.1 requirements for informed consent)
- Paden v. Rudd, 294 Ga. App. 603 (Ga. Ct. App. 2008) (distinguishing basic consent/battery from informed-consent claims)