Conservatorship of Torres, Matter of

• Decision Date: 02 November 1984
• Docket Number: No. C1-84-761,C1-84-761
• Citation: 357 N.W.2d 332
• Parties: In the Matter of the CONSERVATORSHIP OF Rudolfo TORRES, Conservatee.
• Court: Minnesota Supreme Court

Page 332

357 N.W.2d 332

In the Matter of the CONSERVATORSHIP OF Rudolfo TORRES Conservatee.

No. C1-84-761.

Supreme Court of Minnesota.

Nov. 2, 1984.

Syllabus by the Court

1. The probate courts of Minnesota, by reason of both constitutional and statutory authority, have the power to order the termination of life support systems.

2. The order of termination in this case was not clearly erroneous.

Timothy W. Regan, Minneapolis, for appellant.

Marilyn Maloney, Minneapolis, for Hennepin County.

Joseph Beaton, Minneapolis, for conservator.

John R. Kenefick, St. Paul, amicus curiae for Minnesota Soc. of Hosp.

David Feinwachs, John Kingrey, Minneapolis, amicus curiae for Minnesota Hosp. Assoc.

Kathy Meyerle, Minneapolis, amicus curiae for Minnesota Medical Assoc.

Heard, considered and decided by the court en banc.

TODD, Justice.

Rudolfo Torres has been comatose and dependent on life support systems since July 14, 1983. A conservator was appointed for Mr. Torres and on March 9, 1984, a hearing was held before the Hennepin County Probate Court to determine the appropriate level of medical care for Mr. Torres. Mr. Torres' interests were represented in that proceeding by his conservator and by court-appointed counsel. All attorneys involved have performed in the finest traditions of the legal profession in adversely presenting the issues to the probate court and this court. After hearing the arguments of counsel and considering the medical evidence, the probate court authorized the conservator to order removal of Mr. Torres' respirator. That decision was appealed by Mr. Torres' court-appointed counsel. We affirm.

On June 2, 1983, Mr. Torres, age 57, was injured in a two-story fall at his residence. He was admitted to the Hennepin County Medical Center with extensive chest and head injuries. He was treated for those injuries and by July 14, 1983, he was able to follow simple commands, make one-word responses, and walk with assistance.

On July 14, 1983, Mr. Torres was found in the early hours of the morning with a "posey" around his neck, in a state of complete cardiopulmonary arrest. A "posey" is a restraining device which straps a patient into a hospital bed to keep the patient from falling out. The posey had been attached to a stationary, rather than a movable part of the bed, and had strangled Mr. Torres when the back part of the bed came forward.

Mr. Torres was resuscitated but was found on examination to have severe anoxic encephalopathy; that is, he had suffered massive and irreversible brain damage due to a lack of oxygen. Mr. Torres was then placed on a respirator, on which he has remained dependent. At the March 6, 1984 hearing before Judge Melvin J. Peterson of the Hennepin County Probate Court, counsel for Mr. Torres and the Hennepin County Medical Center stipulated that Mr. Torres has a potential cause of action based on negligence against the Hennepin County Medical Center.

Mr. Torres is comatose. He is not, however, "brain dead" under the traditional definition (i.e. a cessation of all brain functions) because laboratory studies show a "poor but definite cerebral [blood] flow" and "very rudimentary evidence of low medullary brain stem function."

In his order of April 6, 1984, Judge Peterson found that:

Aside from spontaneous twitching of his tongue and intermittent twitching of his left thumb, [Mr. Torres displays] no motor movement, either spontaneously or in response to central or acral pain. He appears to have no reflexes, no toe signs, no corneal response, nor other indication of motor response. After these several months have passed, there is no evidence of cortical functions and only very rudimentary evidence of low medullary brain stem function. Some respiratory efforts and the twitching are noted. The medical evidence indicates within a reasonable medical certainty that Rudolfo Torres has sustained massive irreversible cerebral cortical and brain stem damage and has no reasonable chance of any recovery. That he will not recover as a mentating human being and will not recover consciousness nor regain an ability to communicate or respond or regain any ability to use any of his extremities. The medical evidence submitted supports the proposition that the maintenance of the breathing functions through the use of a respirator should be discontinued. The foregoing conclusions are supported by the medical opinion of Dr. Steven Lebow, who was appointed as an independent medical examiner by the Court. The patient will continue indefinitely to be unresponsive and in a vegetative state until he dies. The prognosis for his recovery is nil. The patient is therefore totally incompetent and cannot participate in any degree or manner whatsoever in any decision-making process.

Court involvement in the case of Rudolfo Torres began with the appointment of attorney at law Timothy Regan to represent Mr. Torres in a conservatorship proceeding initiated by the Hennepin County Medical Center. On October 5, 1983, Judge Peterson appointed Michael J. O'Loughlin conservator of the person and estate of Mr. Torres. Neither the conservator nor the attorney appointed to represent Mr. Torres was authorized by the court to bring suit on behalf of Mr. Torres. The conservator was granted the power "to petition the court for approval to discontinue treatment or withhold treatment, if deemed by the conservator to be in the conservatee's best interests." The court also extended the appointment of Mr. Regan, permitting him to represent Mr. Torres in later proceedings.

At a prehearing conference on January 6, 1984, Mr. Torres' conservator requested a full evidentiary hearing be held to determine the appropriate level of medical care for Mr. Torres. The hearing requested was held on the motion of the Hennepin County Attorney on March 9, 1984. Present at that hearing were Mr. Regan, the court-appointed counsel for Mr. Torres; Marilyn Maloney and George Elwell, Assistant Hennepin County Attorneys, appearing on behalf of the Hennepin County Medical Center; Michael J. O'Loughlin, the conservator of Mr. Torres; and Joseph G. Beaton, Jr., counsel for the conservator.

Four witnesses testified at the hearing.

Mr. O'Loughlin, the conservator, urged the court to permit removal of Mr. Torres' respirator. His recommendation was based partly on his perception of what Mr. Torres would want and partly on the prognosis of Dr. Steven S. Lebow, the neurologist he had hired to examine Mr. Torres.

David Torres, Rudolfo's first cousin, testified that he had seen Rudolfo "at least once a week" since 1972 and based on his knowledge of his cousin's beliefs, he believed Rudolfo would want to have the respirator removed. David Torres also stated that he had no intent in pursuing any claim he might have as Rudolfo's cousin against Hennepin County.

James Garrity, Rudolfo Torres' best friend, testified as to Mr. Torres' unwillingness to wear a pacemaker and his belief that Mr. Torres would want to have the respirator removed.

Dr. Ronald E. Cranford, a nationally respected neurologist, gave testimony on Mr. Torres' medical condition. He stated that Mr. Torres has no chance of regaining consciousness.

Dr. Cranford was questioned about his work on the David Mack case. ¹ Officer Mack regained consciousness despite Dr. Cranford's prognosis that he would not. Dr. Cranford explained that Mack's "recovery" was highly unusual and that Mr. Torres is "more severely and extensively brain damaged" than David Mack.

After noting some of the differences in the two cases, Dr. Cranford was asked to predict the consequences of removing Mr. Torres' respirator. He replied:

That's hard to know for sure. We think he probably can't sustain respirations for any variable period of time, but we can't say with any degree of certainty. He could die within a few minutes; he may continue for hours or days, probably not weeks.

Dr. Cranford also testified that he did not believe Mr. Torres should be "weaned" from the respirator despite the suggestion that "weaning" be tried. He recommended that the respirator be removed.

The testimony of Dr. Cranford does not differ in any significant way from the deposition testimony of Dr. Lebow, the neurologist hired by the conservator to examine Mr. Torres. Dr. Lebow believes Mr. Torres will die if the respirator is removed and that it should be removed because Mr. Torres has "no chance of recovering as a mentating human being."

The record also includes the reports of three area Biomedical Ethics Committees which outline the procedures they would use to determine the appropriate treatment for someone in Mr. Torres' condition. ² These reports support the recommendation of Drs. Cranford and Lebow that Mr. Torres' respirator be removed.

The only known living relatives of Rudolfo Torres are his cousin, David Torres, who testified at the hearing, and Rudolfo's aunt, Louise Valdez Torres. Ms. Torres, age 78, raised Rudolfo from infancy and resides in Corpus Christi, Texas. Ms. Torres was informed of the proceedings, but was unable to attend because of her advanced age and poor health. Ms. Torres did send a letter indicating her awareness of Mr. Torres' condition and her belief that he "would not wish to be sustained by mechanical devices." This letter was never received into evidence. Judge Peterson, however, took notice of it as part of the file from previous hearings.

On April 6, 1984, Judge Peterson issued an order granting the conservator authority to have Mr. Torres removed from the respirator even though it may result in his death. Judge Peterson further ordered that Mr. Torres be cared for in a manner maintaining human dignity until natural death.

Mr. Regan, attorney for Mr. Torres, appealed Judge Peterson's order to the Court of Appeals. This court granted a petition for accelerated review. Judge Peterson's order has been stayed during the pendency of this appeal.

The issues presented are:

1. Does the court have the...