Johnson v. Kindred Healthcare, Inc.

• Decision Date: 13 January 2014
• Docket Number: SJC–11335.
• Court: United States State Supreme Judicial Court of Massachusetts Supreme Court
• Parties: Barbara JOHNSON & another,co-administratrices, v. KINDRED HEALTHCARE, INC., & others.

466 Mass. 779

2 N.E.3d 849

Barbara JOHNSON & another,¹co-administratrices,²

v.KINDRED HEALTHCARE, INC., & others.³

SJC–11335.

Supreme Judicial Court of Massachusetts, Plymouth.

Submitted Sept. 4, 2013.

Decided Jan. 13, 2014.

John Vail, of the District of Columbia (David J. Hoey with him) for the plaintiffs.

Christopher R. Lavoie, Boston, for the defendants.

Kelly Bagby, of the District of Columbia, & Rebecca J. Benson, Boston, & Debra Silberstein, Andover, for National Academy of Elder Law Attorneys (Massachusetts Chapter) & another, amici curiae, submitted a brief.

Present: IRELAND, C.J., SPINA, CORDY, BOTSFORD, GANTS, DUFFLY, & LENK, JJ.

DUFFLY, J.

This case presents the question whether a health care agent's agreement with a health care facility to arbitrate disputes arising from the principal's stay at that facility constitutes a “health care decision” binding on the principal pursuant to G.L. c. 201D, § 5.⁴

The plaintiffs, administrators of the estate of Dalton Johnson, filed a complaint in the Superior Court against a national operator of nursing and rehabilitation centers, one of its subsidiary nursing homes, and the operator of that nursing home, alleging, inter alia, negligence and seeking damages under the wrongful death statute, G.L. c. 229, § 2, as a result of the defendants' care of Dalton ⁵ while he was a resident at the nursing home.⁶

On May 24, 2007, Dalton executed a health care proxy pursuant to the Massachusetts health care proxy statute, G.L. c. 201D, §§ 1–17 (health care proxy statute). In it, he authorized his wife, Barbara Johnson, “as my Health Care Agent to make any and all health care decisions for me, except to the extent that I state otherwise.” Dalton was admitted to the nursing facility operated by Braintree Nursing, LLC, doing business as Braintree Manor Rehabilitation and Nursing Center (Braintree Nursing), in September, 2007. On August 6, 2008, Barbara, in her capacity as health care agent, signed an agreement with Braintree Nursing “to submit any disputes that may arise between [Dalton and the nursing home defendants] for resolution by mediation, and if mediation is unsuccessful, then by arbitration” (arbitration agreement). ⁷ In March, 2009, while a resident of the nursing facility, Dalton suffered burns and was transported to a hospital where, on July 27, 2009, he died.

After the plaintiffs filed their complaint, the nursing home defendants sought to enforce the arbitration agreement. Contending that the agreement to arbitrate disputes arising out of Dalton's stay at the nursing facility was not a “health care decision” under the terms of Dalton's health care proxy and the health care proxy statute, the plaintiffs argued that Barbara, as Dalton's health care agent, did not have the authority to execute the arbitration agreement on his behalf. A judge of the Superior Court concluded that the arbitration agreement was “an agreement affecting the responsibilities of the health care facility toward the patient,” and therefore that Barbara's decision to enter into such an agreement was a health care decision that bound Dalton. The judge ordered that the proceedings be stayed pending the conclusion of mediation and arbitration, and denied the plaintiffs' request for reconsideration. The plaintiffs thereafter filed a petition under G.L. c. 231, § 118, seeking leave to pursue an interlocutory appeal. A single justice of the Appeals Court allowed the petition, and we transferred the case to this court on our own motion.

We conclude that a health care agent's decision to enter into an arbitration agreement is not a health care decision as that term is defined and used in the health care proxy statute and, therefore, that an agreement to arbitrate all claims arising out of a principal's stay in a nursing facility does not bind the principal where the agreement was entered into solely by a health care agent under the authority of a health care proxy.

Discussion. Adjudication of a motion to compel arbitration, including a challenge to the validity of the arbitration agreement, is governed by G.L. c. 251, § 2 ( a ). If there is a dispute as to a material fact, “the judge conducts an expedited evidentiary hearing”; where, as here, “there is not such a dispute, the judge resolves the issue as a matter of law.” McInnes v. LPL Fin., LLC, 466 Mass. 256, 261, 994 N.E.2d 790 (2013). We review matters of law de novo. See Deutsche Bank Nat'l Ass'n v. First Am. Title Ins. Co., 465 Mass. 741, 744, 991 N.E.2d 638 (2013).

The plaintiffs argue that the health care proxy statute solely concerns decisions about a patient's treatment by health care professionals and, because the statute does not authorize a health care agent to make decisions about dispute resolution on the principal's behalf, the order compelling arbitration must be vacated. The nursing home defendants contend that health care decisions should be defined broadly to include decisions that “pertain[ ] to or [are] associated with the health care which is to be provided to the individual resident” or “arise out of and ... are connected to” such health care. They claim that, therefore, a health care agent may decide not only whether to admit the principal to a health care facility, but also whether to enter into an agreement to arbitrate claims arising from the principal's treatment while a resident of the facility.⁸

a. Statutory framework. As set forth in G.L. c. 201D, § 2, “[e]very competent adult shall have the right to appoint a health care agent by executing a health care proxy.” This statutory right reflects the doctrine of informed consent, which promotes an individual's “strong interest in being free from nonconsensual invasion of his bodily integrity” and protects his “human dignity and self-determination.”Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 739, 370 N.E.2d 417 (1977). See Cohen v. Bolduc, 435 Mass. 608, 617, 760 N.E.2d 714 (2002) (purpose of health care proxy statute is “to support and enhance patient autonomy”). In the case of an incompetent person, who has “the same panoply of rights and choices” as a competent person, those rights may be asserted by an authorized representative. See Superintendent of Belchertown State Sch. v. Saikewicz, supra at 746, 370 N.E.2d 417. The health care proxy statute enables an individual to designate in advance a person he or she trusts to provide such informed consent when the individual is no longer able to do so. An agent granted the authority to make health care decisions on behalf of an individual lacking capacity must do so “from the principal's perspective,” in accordance with the principal's wishes, if known, or best interests, if not. Cohen v. Bolduc, supra at 618, 760 N.E.2d 714.

The manner in which the health care proxy is to be executed and the scope of authority of the health care agent are governed by G.L. c. 201D, §§ 1–17. The health care proxy statute authorizes a health care agent “to make any and all health care decisions on the principal's behalf that the principal could make, including decisions about life-sustaining treatment, subject, however, to any express limitations in the health care proxy.” G.L. c. 201D, § 5. In making these decisions, the agent must assess the principal's wishes, including “the principal's religious and moral beliefs.” Id. An agent will be removed if “not reasonably available, willing and competent to fulfill his or her obligations.” G.L. c. 201D, § 17.

Echoing the language of the health care proxy statute, Dalton's health care proxy authorized his agent “to make any and all health care decisions for me, except to the extent that I state otherwise.” Whether Barbara had authority to execute the arbitration agreement as Dalton's health care agent thus turns on the meaning of the phrase “health care decisions.”

b. Meaning of “health care decision.” “The object of all statutory construction is to ascertain the true intent of the Legislature from the words used.” Sullivan v. Chief Justice for Admin. & Mgt. of the Trial Court, 448 Mass. 15, 24, 858 N.E.2d 699 (2006), quoting Champigny v. Commonwealth, 422 Mass. 249, 251, 661 N.E.2d 931 (1996). We interpret a statute according to “all its words construed by the ordinary and approved usage of the language, considered in connection with the cause of its enactment, the mischief or imperfection to be remedied and the main object to be accomplished, to the end that the purpose of its framers may be effectuated.” Board of Educ. v. Assessor of Worcester, 368 Mass. 511, 513, 333 N.E.2d 450 (1975), quoting Industrial Fin. Corp. v. State Tax Comm'n, 367 Mass. 360, 364, 326 N.E.2d 1 (1975). “Significantly, a statute must be interpreted ‘as a whole’; it is improper to confine interpretation to the single section to be construed.” Commonwealth v. Keefner, 461 Mass. 507, 511, 961 N.E.2d 1083 (2012), quoting Wolfe v. Gormally, 440 Mass. 699, 704, 802 N.E.2d 64 (2004).

We begin with the plain language of the statute. The health care proxy statute defines “[h]ealth care” as “any treatment, service or procedure to diagnose or treat the physical or mental condition of a patient,” and “[h]ealth care decision” as “a decision which is made in accordance with the requirements of this chapter, is consistent with any limitations in the health care proxy, and is consistent with responsible medical practice.” G.L. c. 201D, § 1. Taken together, these definitions appear on their face to limit “health care decisions” to those that directly involve the provision of responsible medical services, procedures, or treatment of the principal's physical or mental condition.⁹

This reading of “health care decisions” gains support from language elsewhere in the statute. In particular, G.L. c. 201D, § 5, which delineates the scope of a health care agent's authority, provides that the agent has a right to all “medical information” necessary for an informed health care decision and, further, that the...