16 Cal.App.5th 87
Cal. Ct. App.2017Background
- Decedent Anthony Carter (78) was admitted to St. Mary Medical Center confused and with limited capacity; he designated Maxine Stewart (a registered nurse) as his durable health care power of attorney.
- Treating clinicians recommended a permanent pacemaker for observed long cardiac pauses; Stewart objected, requested a second opinion, and suggested sleep apnea as an alternative explanation.
- St. Mary’s risk management/ethics process convened an ethics committee, concluded the power of attorney was valid but voided Stewart as designee, and the hospital proceeded to allow the pacemaker implantation without notifying Stewart; surgery later preceded cardiac arrest and eventual death.
- Stewart sued for elder abuse under the Elder Abuse and Dependent Adult Civil Protection Act, fraudulent concealment, medical battery, medical negligence, and related claims; St. Mary moved for summary adjudication and prevailed on elder abuse, fraudulent concealment, and medical battery claims.
- The Court of Appeal granted Stewart’s petition for writ of mandate, concluding the trial court erred in summarily adjudicating those three causes of action because triable issues of material fact existed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether hospital conduct could constitute "neglect" under the Elder Abuse Act | Stewart: authorizing surgery over POA’s objection and excluding her from the ethics process deprived Carter of medical decision autonomy and was custodial neglect potentially rising to recklessness | St. Mary: ethics/administrative review of a POA is non-custodial/administrative and, at most, medical malpractice; hospital owed no custodial duty for that act | Reversed — triable issues exist; hospital-patient relationship and deprivation of autonomy can support neglect under the Act, including reckless conduct; jury must decide extent of custody/role |
| Whether St. Mary had a duty and intent to support fraudulent concealment claim | Stewart: hospital knew of Stewart’s objections, scheduled/authorized surgery, and deliberately failed to inform her — meets duty/intent under LiMandri tests | St. Mary: no fiduciary duty to patient (relying on Moore), so no duty to disclose; any omission was not fraudulent | Reversed — fiduciary duty not required; triable issues exist on exclusive knowledge, active concealment, and intent to conceal |
| Whether medical battery claim can proceed against hospital that did not physically perform surgery | Stewart: hospital’s role in authorizing the surgery, risk management/ethics "green light," and prompting physicians to sign consent implicated the hospital in the unconsented touching | St. Mary: surgeon (independent contractor) performed surgery; hospital did not physically touch or perform the operation, so no battery | Reversed — factual questions exist about the hospital’s involvement and whether it was sufficiently connected to an unconsented medical touching; jury to decide |
| Whether the challenged claims were at most medical malpractice/informed-consent negligence | St. Mary: Cobbs and related authority limit nonconsent claims to negligence/informed-consent theory; hospital characterized plaintiff’s evidence as malpractice | Stewart: conduct here was authorization of surgery over objection and concealment — implicates autonomy and custodial-protection statutes, not only malpractice | Court: Autonomy is fundamental; facts alleged could support elder-abuse and concealment claims beyond ordinary malpractice; triable issues preclude summary adjudication |
Key Cases Cited
- Winn v. Pioneer Medical Group, Inc., 63 Cal.4th 148 (2016) (defines custodial relationship and scope of "neglect" under the Elder Abuse Act)
- Covenant Care, Inc. v. Superior Court, 32 Cal.4th 771 (2004) (distinguishes neglect under the Act from professional medical malpractice)
- Thor v. Superior Court, 5 Cal.4th 725 (1993) (patient autonomy and right to refuse medical treatment are fundamental)
- Moore v. Regents of University of California, 51 Cal.3d 120 (1990) (limits fiduciary-duty findings in physician–hospital contexts; hospital liability differs from treating physician)
- Cobbs v. Grant, 8 Cal.3d 229 (1972) (informed consent framework distinguishing negligence-based disclosure claims from battery)
- Delaney v. Baker, 20 Cal.4th 23 (1999) (recklessness standard for enhanced remedies under the Elder Abuse Act)