In re Tschumy

• Decision Date: 15 October 2013
• Docket Number: No. A12–2179.,A12–2179.
• Citation: 834 N.W.2d 764
• Parties: In re the GUARDIANSHIP OF Jeffers J. TSCHUMY, Ward.
• Court: Minnesota Court of Appeals

834 N.W.2d 764

In re the GUARDIANSHIP OF Jeffers J. TSCHUMY, Ward.

No. A12–2179.

Court of Appeals of Minnesota.

July 29, 2013.

Review Granted Oct. 15, 2013.

Syllabus by the Court

Unless otherwise limited in the guardianship order, a guardian's power to consent to necessary medical or other professional care for a ward under Minn.Stat. § 524.5–313(c)(4)(2012) includes the power to authorize disconnection of a permanently unconscious ward's life-support systems without seeking an order from the district court.

Lori Swanson, Attorney General, Nathan Brennaman, Mikiesha R. Mayes, Assistant Attorneys General, St. Paul, MN, for amicus curiaeState of Minnesota.

Robert A. McLeod, Karla M. Vehrs, Lindsey Middlecamp, Lindquist & Vennum, L.L.P., and Charles W. Singer, Minneapolis, MN, for appellantJoseph Vogel, guardian and conservator of Jeffers J. Tschumy.

Michael J. Biglow, Law Offices of Michael J. Biglow, Minneapolis, MN, for respondent-wardJeffers J. Tschumy.

Rebecca Egge Moos, Rachel B. Peterson, Charles E. Lundberg, Bassford Remele, P.A., Minneapolis, MN, for respondent Allina Health System.

Diane B. Bratvold, Jennifer A. Lammers, Amie E. Penny Sayler, Briggs & Morgan, P.A., Minneapolis, MN; and Benjamin Peltier, Minnesota Hospital Association, St. Paul, MN; and Teresa Knoedler, Minnesota Medical Association, Minneapolis, MN, for amici curiaeMinnesota Hospital Association and Minnesota Medical Association.

Considered and decided by HUDSON, Presiding Judge; STAUBER, Judge; and TOUSSAINT, Judge.^*

OPINION

HUDSON, Judge.

Appellant guardian challenges the district court's determination that he was required to seek an order from the district court to authorize the discontinuation of a permanently unconscious ward's life-supportsystems.Because the statutory grant of medical-consent power to a guardian, unless otherwise limited by court order, encompasses the authority to discontinue medical treatment for a permanently unconscious ward, we conclude that, if no interested party has objected, a guardian holding that power need not seek an order from the district court before authorizing disconnection of the ward's life-support systems.

FACTS

In April 2008, the district court issued an order placing respondentJeffers J. Tschumy under general guardianship.Tschumy, who resided in a nursing facility, was 53 years old, unmarried, and without children.He suffered from mental health impairments, diabetes, effects from a stroke, and partial paralysis from a spinal infection.An evaluation of his mental ability showed that he functioned within the average to moderately-impaired range and that he would need assistance with his health care, housing, transportation, food, and finances.His behavior at the nursing facility was consistent with this evaluation.The district court found that Tschumy was incapacitated and appointed Tschumy's then-conservator as general guardian.

In 2008 and 2009, Tschumy's condition remained stable.In October 2009, the district court removed the original guardian and appointed appellantJoseph Vogel, a professional guardian, as successor guardian.The successor guardianship order and letters provided that, among other powers, the guardian had the power provided in Minn.Stat. § 524.5–313(c)(4)(2008) to “[g]ive any necessary consent to enable, or to withhold consent for, [Tschumy] to receive necessary medical or other professional care, counsel, treatment, or service.”

On April 15, 2012, while living in a group home, Tschumy suffered respiratory and cardiac arrest after choking on food.Although he survived, he suffered severe and irreversible brain injury and became deeply comatose.Tschumy was placed on a medical ventilator, medication to lessen seizure activity, and intravenous fluids.He also received intravenous nutrition.

Tschumy did not have a health care directive, and the guardian was unable to locate any family members or friends who might have knowledge or information regarding Tschumy's preferences about end-of-life decisions or whether he had ever expressed any religious or moral beliefs regarding those decisions.When the guardian had previously raised this topic with Tschumy, he stated that he did not wish to discuss it.

On April 23, 2012, respondent Allina Health System, d/b/a Abbott Northwestern Hospital, where Tschumy was hospitalized, filed a motion to clarify and, if necessary, to amend the successor letters of general guardianship to specifically authorize the guardian to direct removal of Tschumy's life-support systems.In support of the motion, an Allina physician alleged that Tschumy suffered from medical conditions that had brought him close to the end of his life; that further medical intervention would be futile and, in fact, harmful; and that, in line with good medical practice and ethical obligations, the life-support systems should be removed.A hospital ethics-committee consultation determined that no benefit could be achieved with further intensive treatment.The guardian agreed, but took the position that Allina's motion was unnecessary because the 2009 successor guardianship order and letters already authorized him to direct removal of Tschumy's life-support systems.

After an initial hearing, the district court issued orders appointing an attorney to represent Tschumy and identifying the issues posed as (1) whether the medical power granted to a professional guardian permits the guardian to consent to life-support removal without court review or approval and (2) if court approval is necessary, whether Tschumy's life-support systems should be removed.At a second hearing, Tschumy's counsel indicated that he had reviewed Tschumy's medical records and an ethics-committee recommendation, had spoken to medical staff and the guardian, and visited Tschumy, who was unable to respond.Tschumy's counsel argued that, based on this information, including information on Tschumy's personal likes and dislikes, if Tschumy were able to communicate, he would wish to have life support removed and be allowed to die naturally.Counsel for Allina concurred, but also argued that, if there were disagreements about decisionmaking for a ward, an evidentiary hearing was required under the Minnesota Supreme Court's decision in In re Guardianship of Torres,357 N.W.2d 332(Minn.1984).

Vogel, as guardian, testified that he had attempted to discuss advanced directives with Tschumy before the injury, but Tschumy refused to do so.Vogel testified that he believed he had successor authority to authorize the withdrawal of life support, based on the court's 2009 order and guardianship letters, which gave him the power to make necessary medical decisions, which included declining medical treatment, if appropriate.¹He expressed his opinion that Tschumy would not wish to remain in this ongoing medical state and that it would be in his best interests to have life-support systems terminated, even if that termination would result in death.He testified that he formed this opinion based on conversations with Tschumy's doctor and his own observations over the last two and one-half years.

Another professional guardian testified that, absent a health care directive or other evidence, guardians have the right to make end-of-life decisions within the designated medical-consent power.On questioning by the district court, he agreed that some guardians may not be as careful as he in making those decisions and that there are a variety of reasonable views and opinions on end-of-life decisions.He testified that if he knew that a person or family believed that life was sacred and should be sustained as long as possible, even if medically futile, he would seek a decision from the court.He stated that he had proceeded in this manner on a few occasions when the family wanted to continue with life-support systems to keep the ward alive, but the hospital declined continued treatment.

Vogel's counsel argued that Vogel had authority to discontinue life-support systems, based on the general medical-consent power in Minn.Stat. § 525.5–313(c)(4)(i) and on the guardianship order, which specifically included consent to withdraw medical care.He argued that any limitation on a guardian's authority should be restricted to situations in which a controversy existed.Tschumy's counsel expressed concern about the lack of uniformity among guardians in carrying out a person's wishes, and argued that a guardian's decision to end a life was as important as other decisions for which the guardianship statutes expressly require a court order.

The district court issued an initial order in May 2012 authorizing Allina and Vogel to discontinue Tschumy's life-support systems, concluding that it was in his best interests to be taken off of life support and allowed to die.Tschumy died shortly thereafter.Five months later, the district court issued a second order, concluding that, although Minn.Stat. § 524.5–313(2012) grants broad power to guardians to consent to medical treatment on behalf of wards, it does not specifically grant guardians the power to terminate life support, and that, absent a valid health care directive, guardians must seek authorization from the district court to terminate life support.The guardian appealed the second order to this court.This court issued an order concluding that the appeal is timely, the guardian has standing to appeal, and the appeal is not moot because the issue presented is capable of repetition, yet likely to evade review, and involves an important public issue of statewide significance.The supreme court denied Vogel's petition for accelerated review.

ISSUE

Did the district court err by concluding that a guardian who has the statutory power to consent to a ward's necessary medical treatment must seek a separate order from the district court to authorize the disconnection of the life-support systems of a permanently unconscious ward, even if no interested person has objected?

ANALYSIS

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