334 P.3d 194
Ariz. Ct. App.2014Background
- Julio Preciado, a vulnerable adult after a stroke causing dysphagia and aspiration risk, was admitted to Carondelet St. Mary’s Hospital; hospital placed and administered PEG-tube feedings.
- After a February 2010 admission for fall-related complaints, St. Mary’s administered tube feeding; staff observed high residuals, abdominal distention, increased respiratory rate, and lung crackles; Preciado later suffered respiratory distress and died.
- Equihua, personal representative, sued St. Mary’s (and others) asserting APSA abuse (negligent tube-feeding) and wrongful death; St. Mary’s moved for summary judgment.
- Trial court granted summary judgment for St. Mary’s, concluding APSA did not cover the alleged negligence and dismissed the wrongful death claim as dependent on the APSA ruling.
- On appeal, the court reviewed de novo whether the APSA applied to the alleged negligent act (tube feeding) and whether wrongful death could proceed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does the APSA cover alleged negligent tube-feeding? | Equihua: negligent tube-feeding arose from caregiver-recipient relationship and is the exact service provided due to incapacity. | St. Mary’s: tube-feeding was incidental to acute-care admission and not subject to APSA. | Court: APSA applies — McGill factors met for tube-feeding tied to incapacity. |
| Are acute-care hospitals categorically exempt from APSA liability? | Equihua: APSA applies whenever an enterprise undertakes responsibility for safety/wellbeing. | St. Mary’s: acute-care status precludes APSA exposure for services tied to the admission reason. | Court: No categorical exemption; acute-care hospitals can be liable under APSA (following Estate of Wyatt). |
| Can a single negligent act give rise to an APSA claim? | Equihua: single act may qualify; McGill and McGill’s interpretation do not require multiple acts. | St. Mary’s: Wyatt suggests single acts should not trigger APSA. | Court: Single act can support APSA; Wyatt did not hold otherwise and Supreme Court precedent allows single-act claims. |
| Can wrongful death be predicated on an APSA-based malpractice theory? | Equihua: wrongful death may follow APSA-based medical negligence; she also filed a separate wrongful death claim. | St. Mary’s: Winn limits loss-of-life damages in APSA; wrongful death must be based on MMA and APSA cannot serve as basis. | Court: Trial court erred — wrongful death claim may proceed; Winn requires a separate wrongful death action for loss-of-life damages but does not bar wrongful death predicated on APSA-based negligence; MMA issues may be addressed below. |
Key Cases Cited
- Estate of McGill ex rel. McGill v. Albrecht, 203 Ariz. 525, 57 P.3d 384 (Ariz. 2002) (sets four-part test for APSA negligent-abuse claims)
- In re Estate of Wyatt, 232 Ariz. 506, 307 P.3d 73 (App. 2013) (acute-care hospitals are not categorically exempt from APSA liability)
- In re Estate of Winn, 225 Ariz. 275, 237 P.3d 628 (App. 2010) (APSA may include pre-death pain and suffering but loss-of-life damages require a wrongful death action)
- Cornerstone Hosp. of Se. Ariz., L.L.C. v. Marner, 231 Ariz. 67, 290 P.3d 460 (App. 2012) (statutory expert witness requirements for MMA claims apply to APSA claims alleging medical negligence)