Storar, Matter of
| Decision Date | 10 November 1980 |
| Citation | 433 N.Y.S.2d 388,106 Misc.2d 880 |
| Parties | In the Matter of the Application for Order Authorizing Medical Procedures (Blood Transfusions, etc.) On John STORAR, a resident at Newark Developmental Center. |
| Court | New York Supreme Court |
In Mtr. of Eichner (Fox), 102 Misc.2d 184, 423 N.Y.S.2d 580, affd. 73 A.D.2d 431, 426 N.Y.S.2d 517, it was established that the court has the power, upon request of a duly appointed committee, to order termination of extraordinary life-sustaining treatments being administered to a person whose affliction has rendered him permanently comatose and, therefore, unable to make an intelligent and articulate choice with respect to continuation of the treatments. The present case presents a novel and slightly more complicated question equally without precedent in New York, i. e., whether a committee for someone dying of bladder cancer who has been incompetent since birth due to mental retardation may compel by court order the termination of repeated blood transfusions which are being administered for the sole purpose of extending his life.
The case comes before the court by an application brought by the Newark Developmental Center, an institution operated by the Office of Mental Retardation and Developmental Disabilities, (hereinafter "the Center") pursuant to Section 15.03(b)(4) of the Mental Hygiene Law and 14 NYCRR § 27.9(b), its corresponding regulation, for an order directing continuation of the periodic blood transfusions currently being administered to John Storar, a lifelong resident of the Center, to replace the blood loss due to bleeding from his bladder through his urinary tract because of bladder cancer.
By cross-motion, Mrs. Dorothy Storar, the incompetent's 77 year old widowed mother, seeks an order terminating the transfusions. At the hearing held before me, she moved to be appointed committee of the person and property of her son. All necessary parties being present and having no objection, her application was granted.
Although Mtr. of Eichner (Fox), (supra), dealt with a patient in a permanent vegetative coma, I find that it provided for the court's authority to grant relief in this situation as well and that the procedures required by the Second Department in that case are also applicable to this case. Accordingly, by my order, the District Attorney of Wayne County where the Center is located was made a party to this proceeding. In addition, on July 9, 1980, Arlene A. Hughes, the Deputy Director and Counsel of the Mental Health Information Service, was appointed Guardian ad litem of Storar (see, Matter of Strauss, 56 A.D.2d 570, 391 N.E.2d 168).
Storar is and always has been profoundly mentally retarded. His IQ has been assessed at between 10 and 20, with a corresponding mental age of between 11/2 and 2. He is able to recognize some people and understand some verbal communication. At one time he had some vocabulary, but no longer does and for some time has been able to express himself only by grunts and growls. He is unable to adhere to daily routines and requires constant supervision.
Storar's condition was first diagnosed in July, 1979 when, after a series of tests and x-rays, a finding of invasive, transitional carcinoma (cancer) of the bladder was made. On March 17, 1980, after radiation therapy and other treatments had been tried, Storar's condition was diagnosed as terminal and incurable.
The cancer has since metastasized to Storar's lungs and the medical testimony indicates probable metastasis to his liver and brain as well. Neither radical surgery, chemotherapy nor radiation are indicated as viable courses of treatment. Moreover, the bleeding of the lesions cannot be controlled by cauterization. Fulguration has been attempted on several occasions without success. There is, unfortunately, no known mode of treatment for Storar except to make him as comfortable as possible.
On May 13, 1980, Storar's attending physicians ordered blood transfusions for the first time. The bleeding, caused by the bladder cancer, had by this time become so severe that Storar was losing massive quantities of blood. At the time of the hearing the transfusions were being administered on the average of once every eight days.
When the transfusions first started, Storar did not require restraint. However, on July 25, 1980, Storar had to be physically restrained during administration of the transfusion and thereafter, on August 18, he had to have his arm tied down to prevent him from pulling out the needle.
The transfusions, which are performed by inserting a needle in Storar's arm, normally consist of two units of blood, which is the rough equivalent of one-fifth of the total amount of blood in Storar's system. Each transfusion takes approximately three to four hours to administer if both units are given at the same time. On some occasions, Storar has been given one unit in the evening and the second the following morning. The transfusions are painful, but not excessively so. However, because of Storar's mounting apprehension and manifest dislike of this procedure, a nurse has been giving him a shot approximately one hour before the transfusion to settle him down.
Although he is still ambulatory and can feed himself, Storar's physical condition has steadily deteriorated. In March, 1979, he weighed 150 pounds. In August, 1980 his weight was down to 108 pounds. He is pale, has diminished appetite and is subject to frequent attacks of nausea and emesis (vomiting). He naps frequently and spends most of his time in his room, either in bed or on the commode. Sometimes, infrequently, he sits in a chair. In contrast to his behavior prior to the commencement of the transfusions, Storar now very seldom ventures outside his room. On those occasions, perhaps once or twice a week, he sits in a chair in an outside room for a maximum of two hours. He is occasionally capable of running for a short distance and each morning after breakfast walks to a shower in the hall, but sometimes has to lean on someone because of his weakness. Even after blood transfusions he remains weak.
In addition, and as a direct result of the transfusions, there is frequent clotting in Storar's urine which makes urination quite painful. The clots increase in both size and number and he bleeds extensively after a transfusion. Each time he goes to the bathroom, the blood and clotting are present. He becomes very upset when he urinates blood, particularly because it seems that he has made a primitive connection between the blood going in and the blood coming out.
There is no question but that Storar's illness causes him intense pain and discomfort. The physicians at the hearing were in agreement that cancer of the bladder is extremely painful. One physician described it as a ...
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