In this wrоngful death and survival action, Appellants, Pruitt Corporation d/b/a UHS-Pruitt Corporation, UHS-Pruitt Holdings, Inc., UHS of South Carolina-East, LLC, United Health Services of South Carolina, Inc., United Clinical Services, Inc., United Rehab, Inc., Rock Hill Healthcare Properties, Inc., and Uni-Health Post Acute Care-Rock Hill, LLC d/b/a UniHealth Post Acute Care-Rock Hill, challenge the circuit court’s order denying their motion to compel arbitration. We affirm.
FACTS/PROCEDURAL HISTORY
On January 11, 2011, Respondent, Mae Ruth Davis Thompson (Daughter), and her brother, Andrew Phillip Davis (Son), had their mother, Eula Mae Davis (Mother), transferred from Piedmont Medical Center to a nearby nursing home fаcility owned or operated by Appellant UniHealth Post Acute Care-Rock Hill (UniHealth). A UniHealth employee presented an Admission Agreement, an Arbitration Agreement (AA), and several other documents to Son for his signature on behalf of Mother, who suffered from dementia. Mother was not present at this time as she was in the process of being transported to UniHealth.
Within five hours of being admitted to UniHealth, Mother died as a result of falling out of a bed with a malfunctioning side rail. Subsequently, Daughter filed a wrongful death and survival action against Appellants. Appellants later filed a motion to dismiss Daughter’s аction and to compel arbitration of Daughter’s claims or, in the alternative, to compel arbitration and stay Daughter’s action.
The circuit court denied the motion to compel on the ground that Son did not have authority to execute the AA on Mother’s
ISSUES ON APPEAL
1. Did the circuit court err in concluding Mother’s estate could not be bound by the AA under the Adult Health Care Consent Act?
2. Did the circuit court err in concluding Mother’s estate could not be bound by the AA under common law agency principles?
3. Did the circuit court err in concluding Mother’s estate could not be bound by the AA under a third-party beneficiary theory?
4. Did the circuit court err in concluding Mother’s estate could not be equitably estopped from refusing to comply with the AA?
STANDARD OF REVIEW
“Determinations of arbitrability are subject to de novo review, but if any evidence reasonably supports the circuit court’s factual findings, this court will not overrule those findings.” Pearson v. Hilton Head Hosp.,
LAW/ANALYSIS
I. Merger
Appellants contend the circuit court erred in concluding Mother’s estate could not be bound by the AA under the Adult Health Care Consent Act (the Act). Appellants argue the AA “merged” with the Admission Agreement, which Son was authorized to execute under the Act, making both agreements one and the same. We disagree.
Initially, we note this issue is not preserved for our review. Appellants did not raise this issue below; rather, Daughter raised the issue during both motions hearings, citing our
Based on the foregoing, Appellants are precluded from arguing the doctrine of merger in this appeal. See Richland Cty. v. Carolina Chloride, Inc.,
The Act confers authority on a health care surrogate to consent on the patient’s behalf “to the provision or withholding of medical care” and to make financial decisions obligating the patient to pay for the medical care provided. Coleman,
Where a patient is unable to consent, decisions concerning his health care may be made by the following persons in the following order of priority:
(1) a guardian appоinted by the [Probate Court], if the decision is within the scope of the guardianship;
(2) an attorney-in-fact appointed by the patient in a durable power of attorney executed pursuant to [section 62-5-501 of the South Carolina Code (2009 & Supp.2015) ], if the decision is within the scope of his authority;
(3) a person given priority to make health care decisions for the patient by another statutory provision;
(4) a spouse of the patient unless the spouse and the patient are separated pursuant to one of the following:
(a) entry of a pendente lite order in a divorce or sеparate maintenance action;
(b) formal signing of a written property or marital settlement agreement;
(c) entry of a permanent order of separate maintenance and support or of a permanent order approving a property or marital settlement agreement between the parties;
(5) a parent or adult child of the patient;
(6) an adult sibling, grandparent, or adult grandchild of the patient;
(7) any other relative by blood or marriage who reasonably is believed by the health care professional to have a close personal relationship with the patient;
(8) a persоn given authority to make health care decisions for the patient by another statutory provision.
S.C.Code Ann. § 44-66-S0(A) (2002).
In Coleman, our supreme court held an arbitration agreement signed by the surrogate in that case was separate from the agreement to admit the patient to a health care facility and “concerned neither health care nor payment, but instead provided an optional method for dispute resolution between [the facility] and [the patient or her surrogate] should issues arise in the future.”
Here, in its order denying Appellants’ motion to compel arbitration, the circuit court stated,
The manifest purpose of the Act is to enable contracting parties in a healthcare situation to enter into a binding agreement when express authority has not been conferred upon an agent for that purpose. It further eliminates the need to deal with questions of apparent agency or authority in order to make such a contract binding.
However, the Act does not confer such authority with respect to an Arbitration Agreement[ ] such as thе one in issue in this case. See Coleman v. Mariner Health Care, Inc., Supreme Court, Opinion No. 27362 [407 S.C. 346 ,755 S.E.2d 450 ], filed March 12, 2014. As the ArbitrationAgreement does not deal with healthcare decisions, the provisions of the Act do not apply to establish the necessary principal-agent relationship. Id.
(emphasis added). We agree with the circuit court’s analysis.
Like the arbitration agreement in Coleman, the AA signed by Son in the present case was separate from the Admission Agreement. Therefore, any authority Son had to sign the AA on Mother’s behalf could not come from the Act. See id. at 353-54,
Appellants argue the terms of the Admission Agreement indicate it either incorporated, or merged with, the AA and thus, Son’s authority to execute the Admission Agreement covered the terms of the AA as well. We disagree.
After holding the Act did not authorize the surrogate to sign an arbitration agreement on the patient’s behalf, the court in Coleman addressed the health care facility’s alternative argument that the surrogate was equitably estоpped to deny the arbitration agreement’s enforceability because that agreement merged with the admission agreement:
The general rule is that, in the absence of anything indicating a contrary intention, where instruments are executed at the same time, by the same parties, for the same purpose, and in the course of the same transaction, the courts will consider and construe the documents together. The theory is that the instruments are effectively one instrument or contract.
Here, as in Coleman, the AA contained language that provided it could be disclaimed within thirty days, yet the Admission Agreement did not include such a provision. Appellants argue the Admission Agreement could have been “disclaimed” at any time by Mother leaving the facility and thus, the right to disclaim the AA does not show the parties intended for the AA to be separate from the Admission Agreement. This is not a valid comparison. Because there are no provisions in the Admission Agreement allowing Mother to disclaim it, leaving the facility would be the only way she could “disclaim” the agreement, whereas the AA allows the patient to disclaim the AA unconditionally. Therefore, Mother’s right to disclaim the AA without having to terminate her residency at the facility indicates the parties’ intent to keep the AA separate from the Admission Agreement. This is consistent with the AA’s statement that its execution was not a condition precedent for being admitted to the nursing home: “The signing of this Agreement is not a precondition to admission, expedited admission, or the furnishing of services to the Patient/Resident by the Healthcare Center[.]” This demonstrates the parties’ intent that the two agreements retain their separate identities.
Appellants also argue the Admission Agreement incorporates by reference all exhibits to the agreement and the AA is one of the exhibits. However, the Admission Agreement is ambiguous on this point because (1) it does not define the term “exhibit” or cross-reference any specific exhibits and (2) the AA does not include any labels or other language indicating it serves as an exhibit or addendum to the Admission Agreement.
Based on the foregoing, we affirm the circuit court’s conclusion that the particular AA in the present сase did not require the type of decision for which the Act confers authority on a surrogate, i.e., health care or payment for health care.
II. Common Law Agency
Appellants maintain the circuit court erred in concluding no common law agency relationship existed between Son and Mother when Son executed the AA. Appellants argue Son had apparent authority to execute the AA on Mother’s behalf. We disagree.
To establish apparent authority, the proponent must show (1) “the purported principal consciously or impliedly represented another to be his аgent;” (2) the proponent relied on the representation; and (3) “there was a change of position to the [proponent’s] detriment.” Froneberger v. Smith,
Apparent authority to do an act is created as to a third person by written or spoken words or any other conduct of the principal which, reasonably interpreted, causes the third person to believe the principal consents to have the act done on his behalf by the person purporting to act for him.
Id. (emphasis added) (quoting Frasier v. Palmetto Homes of Florence, Inc.,
Here, Appellants assert Mother “allowed, passively or otherwise, [Son] to not only sign her into [UniHealth], but also to handle multiple other financial affairs for her.” While the evidence indicates Son handled Mother’s finances in the years leading up to her admission to UniHealth, the evidence also indicates Mother had dementia prior to being admitted to UniHealth. Therefore, her incapacity prevented her from “consciously or impliedly” representing another to be her agent. See id. at 47,
Further, the authority conveyed by a principal to an agent to handle finances or make health care decisions does not encompass executing an agreement to resolve legal claims by arbitration, thereby waiving the principal’s right of access to the courts and to a jury trial. See Dickerson v. Longoria,
Based on the foregoing, the evidence does not show that Son had either actual or apparent authority to execute the AA on Mother’s behalf. Thereforе, the circuit court properly concluded Son did not have the authority to bind Mother to the AA. See Pearson,
III. Third-Party Beneficiary
Appellants contend the circuit court erred in concluding that Mother’s estate was not bound by the AA under a third-party beneficiary theory. Appellants maintain Mother was a third-party beneficiary of the AA as executed by Son in either his representative or individual capacity and Mother’s third-party beneficiary status made the AA binding оn her estate. We disagree.
As to thе AA between Appellants and Son in his individual capacity, “a third-party beneficiary to an arbitration agreement cannot be required to arbitrate a claim unless the third party is attempting to enforce the contract containing the arbitration agreement.” Id. Here, Daughter is not attempting to enforce the AA on behalf of Mother’s estate. Rather, she has asserted tort claims against Appellants arising out of the patient-provider relationship created by the separate Admission Agreement. Further, Mother’s diminished mental capacity prevented her from assenting to thе AA’s terms. Therefore, her estate cannot be bound by the AA. See Drury v. Assisted Living Concepts, Inc.,
Appellants also assert that even if Mother was not a third-party beneficiary of the AA, it is still binding on Mother’s estate because “the claims of the other beneficiaries of the Estate are inextricably intertwined with [Son’s] claims and the members of the group share a close relationship.” Appellants cite Long v. Silver,
IV. Equitable Estoppel
Finally, Appellants assert the circuit court should have concluded that Mother’s estate was equitably estopped from refusing to comply with the AA. Appellants argue Mother benefited from the AA because she was admitted to Uni-Health, received medical care, and became capable of enforcing the AA. We disagree.
Initially, we note the recent conflict between the United States Supreme Court and our state courts concerning the applicаtion of state law in determining whether a non-signatory is bound by an arbitration agreement. Compare Arthur Andersen LLP v. Carlisle,
Nonetheless, the doctrine of equitable estoppel does not apply to Mother’s estate under either South Carolina law or federal substantive law concerning arbitrability. We first examine the doctrine as it has been developed under fеderal substantive law:
In the arbitration context, the doctrine recognizes that a party may be estopped from asserting that the lack of his signature on a written contract precludes enforcement of the contract’s arbitration clause when he has consistently maintained that other provisions of the same contract should be enforced to benefit him.
Pearson,
Notably, in those opinions addressing equitable estoppel in the arbitration context, the nonsignatory’s contractual benefit is not typically an alleged benefit of arbitration such as “avoiding the expense and delay of extended court proceedings” or being “capable of enforcing the [AA],” as touted by Appellants in the present case — rather, the contractual benefit typically arises from another provision of the same contract that includes the arbitration prоvision. See Pearson,
Here, the AA is not incorporated into the Admission Agreement; therefore, Appellants’ assertion that Mother received benefits under the Admission Agreement, i.e., being admitted to the facility and receiving medical care, is of no moment. The two agreements are independent of one another, as reflected in the language of the AA indicating its execution is not a condition for being admitted to thе nursing home. Further, any possible benefit emanating from the AA alone is offset by the AA’s requirement that Mother waive her right to access to the courts and her right to a jury trial. Therefore, equitable estoppel under federal substantive law has no application to the present case.
Under South Carolina law, the elements of equitable estoppel as to the party to be estopped are
(1) conduct which amounts to a false representation or concealment of material facts, or, at least, which is calculated to convey the impression that the facts are otherwise than, and inconsistent with, those which the party subsequently attempts to assert; (2) intention, or at least expectation, that such conduct shall be acted upon by the other party; and (3) knowledge, actual or constructive, of the real facts. As related to the party claiming the estoppel, they are: (1) lack of knowledge and of the means of knowledge of the truth as to the facts in question; (2) reliance upon the conduct of the party estopped; and (3) action based thereon of such a character as to change his position prejudicially.
Boyd v. BellSouth Tel. Tel. Co.,
Here, Mother had demеntia prior to being admitted to UniHealth. Therefore, her incapacity prevented her from forming the intent or having the requisite knowledge to mislead Appellants or to assent to the AA’s terms. In their brief, Appellants side-step this inconvenient fact by substituting both Daughter, in her individual capacity, and Son for Mother in the estoppel analysis:
[Son] represented in the contract itself that he was authorized to sign it.... [Daughter] was present while the agreements were signed and made no effort to repudiate [Son’s] representations that he was authorized to sign the agreements on [Mother’s] behalf----Now, however, [Daughter] seeks to repudiate these agreements on the basis that [Son] was not authorized to sign them on [Mother’s] behalf. [Daughter] should be estopped from taking this contrary position. Additionally, ... the very last sentence of the [AA] notes that in signing the [AA], the Patient/Resident Representative binds both the Patient/Resident and the Patient/Resident Representative. [Son], [Daughter], and the Estate should be estopped from denying that [Son] had the authority to sign the [AA], or that they are bound by it....
This argument necessarily implies that Daughter, in her individual capacity, or Son may serve as the legal equivalent of Mother’s estate. However, at least one jurisdiction has rejected this type of premise. In Dickerson, the Maryland Court of Appeals addressed an argument identical to Appellants’ estoppel argument in the present case:
Respondent is attempting to use equitable estoppel against [the patient’s] [e]state based on actions that [patient’s companion] took in her individual capacity. The fact that [the patient’s companion] is now the personal representative for [the patient’s] [e]state is of no moment; we will not hold this circumstance against [the patient’s] [e]state. Simply put, [the patient’s] [e]state is the plaintiff in this case, and Rеspondent has alleged no conduct on the part of [the patient’s] [e]state, or by [the patient’s companion] in her capacity as Personal Representative of [the patient’s] [ejstate, that has affected Respondent’s position. This, too, is a necessary element of an equitable estoppel defense.
The Dickerson court also addressed the facility owner’s argument that the doctrine of unclean hands should apply to the patient’s estate beсause the patient’s companion was an heir to the estate:
Respondent notes that [the patient’s companion] is ‘the heir of [the patient’s] [e]state,’ suggesting that we should apply the doctrine of unclean hands because [the patient’s companion] may benefit if the [e]state’s claims against Respondent are successful. We decline to do so. First, as we have explained, we will not hold against the Estate acts that [the patient’s companion] may have performed in her individual capacity. Second, the [e]state may well have other beneficiaries or creditors. We will not hold [the patient’s companion’s] individual acts against these other entities for the same reasons.
Id. at 744 n. 23 (emphases added). Likewise, Appellants in the present case may not hold Mother’s estate responsible for any possible misrepresentations Son or Daughter may have made in their individual capacities. Therefore, the circuit court properly rejected Appellants’ equitable estoppel theory.
CONCLUSION
Accordingly, the circuit court’s denial of Appellants’ motion to compel arbitration is
AFFIRMED.
Notes
. In fact, the front page of the AA is labeled "Arbitration Agreement,” indicating the parties’ intent for it to stand by itself as an independent contract.