Leach v. Akron General Medical Center

• Decision Date: 18 December 1980
• Citation: 68 Ohio Misc. 1,426 N.E.2d 809,22 O.O.3d 49
• Parties: , 22 O.O.3d 49 LEACH, Guardian, v. AKRON GENERAL MEDICAL CENTER et al.
• Court: Ohio Court of Common Pleas

Page 1

68 Ohio Misc. 1

426 N.E.2d 809, 22 O.O.3d 49

LEACH, Guardian, v. AKRON GENERAL MEDICAL CENTER et al.

Court of Common Pleas of Ohio, Summit County, Probate Division.

Dec. 18, 1980.

William L. Curtice, Akron, for plaintiff

Elizabeth A. Reilly, Akron, guardian ad litem, pro se.

Buckingham, Doolittle & Burroughs Co., L.P.A., Akron, and Gary A. Banas, Canton, for defendants.

Stephan M. Gabalac, Pros. Atty., and Timothy M. Hartman, Asst. Pros. Atty., for intervening defendant.

SPICER, Judge.

Edna Marie Leach is a seventy-year-old housewife and the mother of two children, Roy A. Leach and Mary E. Hoyt. Neither child resides with his parents. Roy lives in Akron and Mary in Phoenix, Arizona. Mrs. Leach has a number of brothers and sisters. Gifford Leach, her husband, is a retired laborer from B. F. Goodrich Company. Edna and Gifford reside in a modest home which they own as tenants in common. Mrs. Leach has no valuable assets other than three small insurance policies and two bank accounts. If Mrs. Leach were to die, Mr. Leach would be the beneficiary of the insurance proceeds, and the children would share the accounts. Most of all hospital and medical costs are covered by either Medicare or Goodrich.

Mrs. Leach was an energetic woman who enjoyed good health until two years ago. At that time, she developed a problem in her lower back, which became a marked weakness of most of the muscles of her lower extremities. This condition caused her to walk in a bent-over position. On June 11, 1980, she entered a hospital and her condition was diagnosed as amyotrophic lateral sclerosis, a progressively deteriorating, disabling disease of the nervous system.

Mrs. Leach was informed by her treating physician, Dr. Howard Shapiro, of the disease and that it would be terminal within three to five years. He further informed her she would be incapacitated. Mrs. Leach's condition deteriorated and she was admitted to Akron General Medical Center on July 27, 1980, in a stuporous condition with difficulty in breathing. After some improvement in the early hours of July 29th, Edna suffered a cardiac arrest. Cardio-pulmonary resuscitation was administered and Mrs. Leach's heartbeat was quickly restored. She was then placed on a life support system.

The life support system consists of a respirator, a nasogastric tube, and a catheter. The respirator is for breathing and enters the body through a tube inserted in an incision in the trachea. The nasogastric tube is for feeding and consists of a tube entering the nose and extending into the stomach. The catheter is for bladder elimination. Mrs. Leach has been on that system for just over four months. During that four-month period she has not responded or shown any recognition of attempts to communicate with her. She does not move her extremities. She cannot breathe on her own. She does react to deep pain by grimacing. Her eyes react to light stimuli. There is eye movement. However, the eye movement is not associated with cognitive recognition. EEG scans have shown very low brain activity. Her state of being is described as semi-comatose, or chronic vegetative. ¹ Attempts have been made to wean her from the respirator with no success. Mrs. Leach's present condition is the result of amyotrophic lateral sclerosis, or cardiac arrest, or some combination thereof.

Mrs. Leach's condition is a continuing anxiety to her family. In addition, it constitutes an expense approximating $500 a day to her insurance company. Mr. Leach, observing his wife's condition, contacted Dr. Shapiro and requested that the use of the respirator be terminated. On October 13, 1980, Dr. Shapiro responded with a letter stating her condition to be "hopeless" and "her ultimate demise is only a matter of time," but he refused to end her life support. Dr. Shapiro further indicated that life support could only be terminated by court order.

Mr. Leach sought legal counsel. On the basis of Mrs. Leach's incompetency, Mr. Leach, by this court, was appointed her legal guardian. Mr. Leach and Mrs. Leach's two children then instituted this action for an order to discontinue life supports of Edna Marie Leach. Pursuant to that request, this court, after having appointed Elizabeth A. Reilly as guardian ad litem, ordered the matter set for evidentiary hearing. On November 4 and 5, 1980, an evidentiary hearing was held. Additional evidence was taken on December 2, 1980. A total of 17 witnesses testified. Much of the testimony was directed towards two areas: Mrs. Leach's desires in reference to being "That's the one thing that terrifies me. I don't want to be put on life support systems. I don't want to live if I have to be a vegetable."

placed on a life support system, and the prognosis for Mrs. Leach's survival. Mr. Leach, Helen Carr, a friend, Mrs. Carpenter, a sister, Patsy Novoselich, a friend, Avis Joseph, a cousin, and Annaleisa Manning, a cousin, all testified as to numerous conversations concerning life support systems. In each of those conversations, Mrs. Leach expressed a desire, if ill, not to be placed on a life support system. The last of those conversations took place in Mrs. Leach's bedroom only two days prior to her entering the hospital. Mrs. Carr recalled one conversation in which Mrs. Leach said:

Robert Crawford, Mrs. Leach's pastor, testified that while he had not discussed life supports with her, he did say that nothing in the family's request "violates the tenets of her faith or of my church."

As to the prognosis of Mrs. Leach's future health, three neurologists testified: Dr. Howard Shapiro, Dr. Harvey Friedman and Dr. Richard J. Lederman. Dr. Shapiro was called by the guardian and Doctors Friedman and Lederman by the guardian ad litem. Each doctor is a specialist in treating the nervous system and brain diseases such as amyotrophic lateral sclerosis, and each has conducted a physical examination of Mrs. Leach. All three agreed that Mrs. Leach was not dead under any accepted medical standard. All three agreed that she suffered from amyotrophic lateral sclerosis, which is terminal, and that there is no known treatment for such a disease. All agreed that she suffered brain damage. Doctors Friedman and Lederman stated she has suffered irreversible brain damage. Dr. Friedman said:

"I think, unequivocally, she has suffered irreversible brain damage."

Dr. Lederman said:

"In my opinion, there can be no question that she has suffered extensive central nervous system or brain damage. By all the criteria that we have gathered over the years, this level of functioning would be considered almost certainly irreversible in its major degree."

When asked whether Mrs. Leach was cognitive, all agreed she was not, and that it was unlikely that she would ever "Well, there is, of course, no no one could ever say that it can't happen. However, I am unfamiliar with a single case in the medical literature of this degree of disfunction with this cause, and I am emphasizing that in a patient of this age."

regain consciousness. Dr. Lederman and Dr. Friedman stated that it was "highly" unlikely. Dr. Lederman stated:

All agreed that if taken off the respirator, she would die within minutes or hours, and continuing her on it served no medical goal other than sustaining her respiration. Finally, all agreed there is no known treatment to help Mrs. Leach.

FINDINGS OF FACT

From the testimony and exhibits presented, this court specifically finds the following:

(1) that Edna Marie Leach is suffering from amyotrophic lateral sclerosis, a terminal illness of the nervous system;

(2) that she has suffered irreversible brain damage;

(3) that she is in a permanent, chronic, vegetative state;

(4) that she is not now cognitive and, within a reasonable medical certainty, it is highly unlikely and remote that her cognitive powers will be restored;

(5) that there is no known treatment that can be administered with any expected success;

(6) that Edna Marie Leach, in her present physical condition, if competent, would elect not to be placed on or continued on life supports; and

(7) that Gifford Leach, Roy Leach, and Mary Hoyt's sole motive for bringing this action is to end their wife and mother's present vegetative condition.

CONCLUSIONS OF LAW

THE PROBLEM

When an individual is suffering from an incurable, terminal disease and is in a permanent vegetative state with no hope of regaining cognitive or sapient powers, may this court grant an order for discontinuation of a respirator sustaining what minimal life that remains? That, simply stated, is the problem and question this court must answer. This, of course, is a court of law, and it must be guided by the law of its jurisdiction.

However, Ohio has no law or precedent dealing with a matter similar to the one now faced by this court. There is no case law or statutory law within the court's jurisdiction to When does death occur when the heart ceases or brain function ends? While it is an interesting and important problem, it is one that does not appear to be answered in Ohio. ² That is not the problem this court faces. The problem that this court faces does grow out of the same genesis, i. e., life support systems. In this case, Edna Marie Leach's brain is not dead. Edna Marie Leach's brain is functioning. It is functioning at the lowest possible level. While she cannot be classified as dead, she can be classified as being very near death, and that is the crux of the problem.

directly guide it in answering the questions and problems placed before it. Case law that does pertain can be found outside the state of Ohio. Even there, only a few states have ruled on the question. The reason for the lack of law in the area of life supports is the newness of their success and the importance to society of the questions and answers posed by their use. Not many years ago, questions dealing with death or the point of death were not as complex. Death occurred when the lungs ceased and the...