Quackenbush, Matter of

• Decision Date: 13 January 1978
• Citation: 156 N.J.Super. 282,383 A.2d 785
• Parties: In the Matter of Robert QUACKENBUSH, an alleged incompetent.
• Court: New Jersey County Court. New Jersey County Court — Probate Division

Page 282

156 N.J.Super. 282

383 A.2d 785

In the Matter of Robert QUACKENBUSH, an alleged incompetent.

Morris County Court, Probate Division, New Jersey.

Jan. 13, 1978.

Clifford W. Starrett, Morristown, for Morristown Memorial hospital.

Martin Newmark, Morristown, appointed as guardian ad litem on behalf of Robert Quackenbush.

MUIR, A. J. S. C.

Morristown Memorial Hospital petitions for the appointment of a guardian for Robert Quackenbush, an alleged mental incompetent and patient at the hospital, to authorize the guardian to consent to an operation to amputate the legs of Quackenbush and to consent to other medical treatment necessary due to gangrenous conditions in both his legs.

The verified complaint asserts an advanced gangrenous condition in both legs and the incompetence of the patient to give his consent for the treatment. A treating physician's affidavit indicates extensive gangrene in both legs, the likelihood of one foot falling off and the probability of death within three weeks unless amputation and treatment occur.

Based on the complaint and the supporting affidavit, an order to show cause issued directing Quackenbush to show cause why the relief sought should not be granted. In absence of any next of kin being noted in the complaint and based on the allegation of mental incompetency, Martin Newmark, an attorney, was appointed guardian ad litem for Quackenbush.

An answer was filed on behalf of Quackenbush asserting his mental competency, his right of self-determination and seeking dismissal of the hospital's complaint.

An affidavit was filed by Martin Newmark setting forth that he had spoken with Quackenbush, that the latter was reasonably responsive to the attorney's questions, that he was aware of his condition and that he expressed "in no uncertain terms he had a right not to have the surgery performed against his will." Newmark indicated that Quackenbush is lucid and aware of the consequences of his position and the alternatives available to him.

A plenary hearing was commenced within 24 hours of the issuance of the order to show cause.

The facts elicited at the hearing indicate that Robert Quackenbush is 72 years old and has lived as a semi-recluse for the last ten years in a trailer in Chester, New Jersey. He is divorced, has no children, his parents and siblings are deceased and he is unable to provide any significant information concerning relatives except for a Mrs. Kagan, an 83-year-old cousin with whom he lived in the trailer. The cousin is presently in a nursing care facility.

A local rescue squad brought Quackenbush to the hospital emergency room at the request of his neighbors. He refused treatment and was rambunctious and belligerent. Because of the refusal to accept treatment, hospital officials attempted to send him home, but all available agencies for transportation refused to transport him. Finally, he was admitted at the direction of Dr. Ames Filippone, who became his treating physician.

Dr. Filippone, mainly through other sources, but with some information from the patient, learned that Quackenbush was hospitalized about two months prior to his admission. At that time he was diagnosed as suffering from arteriosclerosis in the legs and advised to have an operation, but he refused and left the hospital. Aside from that hospitalization and medical attention, he shunned medical treatment for the prior 40 years. Dr. Filippone described him as a conscientious objector to medical therapy.

A medical examination by Dr. Filippone indicates that Quackenbush has gangrene in both legs. On his left leg the skin is black from the knee down, is partially mummified and the foot is dangling, about to fall off. On the left leg, there is an open sore, which is draining fluid and in which the tibia (shinbone) and tendons are exposed. His right leg is in a similar condition except that the black skin and mummified condition extend from midcalf down.

Neither leg has a normal pulse behind the knee or ankle, indicating total absence of blood flow. The blood is being seeded with bacteria from inflamed areas adjoining the gangrene. Cultures of the blood indicate the presence of gas-forming bacteria. Such bacteria can lead to gas gangrene, a more fulminating type infection than gangrene. The existence of bacteria multiplying in the blood is described as septicemia.

The diagnosis is that the gangrene is caused by arteriosclerosis (a thickening and hardening of arteries and other vessels leading to acute diminishment of blood flow) inducing high fever, dehydration and profound anemia (number of red blood cells being less than normal). At the time of admission to the hospital Quackenbush had a 102o fever and an abnormally high pulse rate.

After commencement of treatment, which consisted of bandaging and heavy doses of two antibiotics, penicillin and gentamicin, the patient's temperature and pulse rate gradually became normal. Dr. Filippone described the doses of antibiotics as heroic measures, meaning quantities in highly unusual amounts. He indicated concentrated use of gentamicin could cause kidney failure.

Realizing his patient's aversion to an operation, Dr. Filppone discussed with Quackenbush carefully over a period of days the nature and extent of the illness, the nature and extent of the surgery, the risks involved in the operation and the risks involved if there is no operation. On January 5 Quackenbush signed a form consenting to the operation but later that day withdrew the consent.

Dr. Filippone's prognosis is that Mr. Quackenbush must have the operation or he will die within about three weeks. The antibiotics can control the infection only if the source of the infection is removed through amputation. If the source of the infection is not removed, the formation of bacteria in the blood will build to the point where abscesses will occur on the legs, lungs, brain and other places. Fever will develop, become uncontrollable and ultimately lead to a comatose condition. The abscesses and fever will eventually result in death.

Death may be averted if the operation is performed. The operation will consist of removal of both legs just above the knee at the very least, and possibly removal of both legs entirely. Whether both legs must be removed entirely cannot be decided until the operation is underway. The probability of recovery from the amputation is good and the risks involved are limited.

The extent of the amputation will dictate whether Quackenbush will be confined to a wheelchair for the rest of his life or be a candidate for rehabilitation. If the amputations are of the entire legs, wheelchair confinement is the only alternative. If the amputations are restricted, leaving portions of the legs, he may be fitted with artificial legs for use in moving about. In either event, he will need nursing care which the hospital cannot provide.

A social worker from the hospital indicates it could take up to six months to place Mr. Quackenbush in a nursing home after the operation. She was unable to state with any certainty that the nursing home of placement would have rehabilitation facilities. She did say it was unlikely that Quackenbush could get into a complete rehabilitation facility due to his age and the fact that such a facility is normally for temporary treatment, not permanent, care.

The testimony concerning Quackenbush's mental condition was elicited from two psychiatrists. The first, appearing for the hospital, was Dr....