Guardianship of Myers, In re
| Decision Date | 26 February 1993 |
| Docket Number | No. G,G |
| Citation | 610 N.E.2d 663,62 Ohio Misc.2d 763 |
| Parties | In re GUARDIANSHIP OF MYERS. * 92-12-049. |
| Court | Ohio Court of Common Pleas |
Kaufmann & Kaufmann and George R. Wertz, Akron, for petitioner Timothy Myers.
Western Reserve Legal Services of Ravenna and Carol J. Crimi, Ravenna, Western Reserve Legal Services of Akron and Ann Snyder, Akron, for petitioner Robin Myers.
Willis & Linnen and Mark C. Willis, Akron, for Penny Myers.
Barbara J. Patterson, guardian.
Lynn Slaby, Pros. Atty., and Patricia A. Cosgrove, Asst. Pros. Atty., Kevin C. O'Neil and Jennifer A. Uebele, Akron, for Edwin Shaw Hosp.
On the night of October 25, 1992, Carla Myers, the minor incompetent ward herein, was involved in an automobile collision when the limousine she was riding in was struck in the passenger side by another automobile.
As a result of this collision, Carla suffered multiple injuries, including severe head injury. Records indicate that Carla lost consciousness during the collision, and arrived at Akron General Medical Center without regaining consciousness. Preliminary diagnosis indicated that Carla was in a comatose state due to the severe head injury.
Carla was transferred to Edwin Shaw Hospital for terminal care on November 24, 1992.
Carla had been receiving artificially administered nutrition and hydration from the beginning of her hospitalization. On November 30, 1992, after discussion with Dr. Michael Maggio, Carla's doctor, Timothy Myers, Carla's father, requested that the hydration and nutrition be removed. This was accomplished on December 2, 1992. On December 7, 1992, in response to objections raised by Robin Myers, Carla's mother, nutrition and hydration were again given to Carla through the use of a nasogastric tube.
A conflict had arisen between the natural parents of Carla Myers concerning continued artificially administered nutrition and hydration to Carla to sustain her existence. Both parents made independent application to this court for appointment as guardian for their daughter, Carla Myers.
On Wednesday, December 30, 1992, a hearing was held at which time this court, with agreement of Timothy Myers, Carla's father, Robin Myers, Carla's mother, and Penny Myers, Carla's stepmother, appointed Barbara Patterson, an attorney and former nurse with extensive experience in the field of emergency medical treatment, as Carla's legal guardian for the purpose of making recommendations to this court concerning all future medical decisions for Carla.
On January 15, 1993, attorney Patterson submitted a written report containing her recommendations. Subsequently, on January 20, 1993, at 10:00 a.m., a hearing was conducted to determine if this court should approve the report and recommendation of the guardian. In attendance at the hearing were Tim Myers, with counsel; Robin Myers, with counsel; and Penny Myers, with counsel. Also in attendance were Lynn Slaby, Summit County Prosecutor, and Edwin Shaw Hospital through legal counsel.
Testimony was taken in support of the guardian's report from Dr. Jon L. Weingart. Dr. Weingart, a neurologist, testified that he examined Carla Myers personally and reviewed her medical records. In response to Guardian's Exhibit 2-A, Weingart testified that a CAT scan of Carla's head showed a large subdural hematoma with an inordinate swelling of the left side of the brain which caused damage to the right side of the brain through restricted vessels, and that the injury had necessitated the removal of the left temporal portion of Carla's brain. Additionally, he stated that Carla was completely unresponsive to all levels of painful stimuli, and that all tests indicated no cortical function and only limited brain stem function in Carla. Dr. Weingart stated that, in his professional opinion and to a reasonable degree of medical certainty, Carla was in a persistent vegetative state. He stated, in response to questions from the court, that Carla's prognosis was very poor and that there was no chance for any meaningful recovery. He stated that Carla's future physical state would deteriorate, that the left arm would probably become hypertonic, and that the right arm and legs would probably remain in their present, flaccid state, with decreased muscle tone. He stated that Carla's bones would become more brittle, and atrophy would continue to occur. Carla would also sustain more skin breakdown and bed sores. Additionally, he stated that Carla's remaining brain tissue would deteriorate. In response to further questioning, Dr. Weingart stated that, due to Carla's youth and general good health prior to the accident, she could exist in this deteriorating state for years, and that the eventual cause of her death would most likely be infection brought on by her continued physical deterioration and increased immunity to antibiotics. Dr. Weingart also stated that his review and examinations of Carla showed no change in her condition from October 25 to date, and that, in his professional medical opinion, the present course of treatment, including nutrition and hydration, was only prolonging her death, not providing any meaningful comfort or care.
Counsel for Tim Myers, the natural father of Carla Myers, called Dr. Michael Maggio to testify. Dr. Maggio, a doctor of internal medicine, stated that he had observed and examined Carla on the average of three times per week since her admission. Dr. Maggio responded to the same questions concerning Carla's prognosis in the same general fashion as Dr. Weingart. He stated that, in his professional opinion and to a reasonable degree of medical certainty, Carla was in a persistent vegetative state. He stated that no cognitive function could reasonably be expected from Carla in the future. Dr. Maggio stated that sustaining Carla in her present state would require insertion of a gastrostomy tube for feeding through the stomach wall. He also stated that, if removal of hydration and nutrition was approved, Carla's death would occur in approximately two to three weeks, but that he would recommend continued pain medication and local moisture application during this process. He stated, also, that no indication of pain or discomfort was noted in Carla during the six days in December 1992, when hydration and nutrition had been removed. He stated that, in his professional opinion, these procedures should be stopped.
In addition to Dr. Weingart and Dr. Maggio, a second neurologist, Dr. G. Dean Timmons, examined Carla at the request of Carla's guardian. His report was introduced into evidence as Guardian's Exhibit No. 7. His examination and report confirmed the same prognosis and diagnosis as Dr. Weingart and Dr. Maggio. "It is certainly this examiner's impression that this child was in a chronic vegetative state * * *."
The court also took testimony from all other interested parties, specifically, Tim Myers, the natural father; Robin Myers, the natural mother; and Penny Myers, the former stepmother. In response to questions posed by the court, all named individuals stated that they were fully aware of the results if Carla was removed from hydration and nutrition, and that they were in support of removal of the procedures named. In addition, Tim Myers and Penny Myers testified that, on several occasions prior to the accident, Carla had stated that "she wouldn't want to go through life like that." These statements were purportedly made by Carla subsequent to separate incidents, specifically, after watching a movie concerning removal of life support systems, and again upon visiting a relative in the hospital who was on life support systems due to severe brain injury.
Upon inquiry of this court, Summit County Prosecutor Lynn Slaby stated that neither the state nor the county would find any criminal liability if removal of the hydration and nutrition was accomplished.
Considering that there is no controverting evidence and that the evidence in support is straightforward and lacking in ambiguity, this court must find that there is clear and convincing evidence that the ward, Carla Myers, is in a persistent vegetative, or permanently unconscious, state, and that, with a reasonable degree of medical certainty, she will not recover from that condition. 1
It is the further finding of this court that the medical procedure or treatment of providing Carla with nutrition and hydration through a nasogastric tube is the principal reason for her remaining in a vegetative state or alive. Without that treatment, Carla will die within a short period of time.
The guardian, Barbara Patterson, has recommended to this court that the nasogastric tube be removed and Carla be allowed to die. The guardian maintains that the medical treatment in question serves no purpose other than to delay the dying process of the ward.
A decision to remove life supports in circumstances such as Carla's, which will result in death, is not a routine decision for a guardian, or a court under whose authority a guardian operates. It is a decision that should be approached with caution and reflection. It is a decision that must meet the standards and procedures embodied in the law, that is, the law pertaining to removal of life-sustaining treatment and to guardianships. Therefore, a review of that law and application to the case at hand are necessary before this court may approve of the guardian's treatment decision.
The law pertaining to removal of life-sustaining treatment from individuals in a persistent vegetative, or permanently unconscious, state is relatively undeveloped due to the newness and advancement of life-sustaining procedures. The 1976 New Jersey case of Karen Ann Quinlan (In re Quinlan [1976], 70 N.J. 10, 355 A.2d 647) was the first in a long series of cases dealing with removal of life supports. Like Quinlan, removal of a respirator was the life-sustaining...
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