Stockwell v. State
| Decision Date | 23 June 2017 |
| Docket Number | No. 115,897,115,897 |
| Parties | Garen W. STOCKWELL, Appellant, v. STATE of Kansas, Appellee. |
| Court | Kansas Court of Appeals |
Gerald E. Wells, of Jerry Wells Attorney-at-Law, of Lawrence, for appellant.
Kimberly M.J. Lynch, senior litigation counsel, Kansas Department for Aging and Disability Services, for appellee.
Before Leben, P.J., Powell and Schroeder, JJ.
Since 1997, Garen Stockwell has lived at Larned State Hospital, though not by choice: He was involuntarily committed to the hospital's Sexual Predator Treatment Program because of the substantial risk that he would reoffend if left at large. Although he can't leave the state-hospital grounds, he retains most of his civil rights because he has been placed in custody in a civil proceeding, not sent to prison for a crime.
When Stockwell sought to exercise one of those civil rights—the right to refuse medical treatment—hospital staff said he had no right to enter an advance directive like a do-not-resuscitate order, and Stockwell filed suit. Under court order, hospital staff then gave him a form he could fill out to request that he not be resuscitated if he stopped breathing or his heart stopped beating as well as a living-will form. Hospital staff put the completed forms in Stockwell's medical file but told him that under the hospital's policies, it would not honor his requests unless and until two physicians had determined that he was terminally ill. Since Stockwell has no terminal illness, he concluded that hospital staff were violating his rights and sought further relief from the district court.
A person like Stockwell, who has been involuntarily confined by the State, can file a habeas-corpus petition under K.S.A. 2016 Supp. 60–1501 to challenge the conditions of his confinement. To obtain relief, he must show either (1) shocking or intolerable conduct in his treatment or (2) continuing mistreatment of a constitutional nature. See Merryfield v. State , 44 Kan.App.2d 817, Syl. ¶ 1, 241 P.3d 573 (2010). Stockwell claims continuing mistreatment of a constitutional nature in the denial of his constitutional right to control the medical treatment he receives. The district court concluded that the hospital's policies didn't violate Stockwell's rights, and Stockwell has appealed to our court.
When the district court denies a habeas petition under K.S.A. 2016 Supp. 60–1501 after hearing evidence from both sides, as it did here, we first review the district court's factual findings to be sure that they are supported by substantial evidence and are sufficient to support the court's legal conclusions. Rice v. State , 278 Kan. 309, 320, 95 P.3d 994 (2004) ; Hooks v. State , 51 Kan.App.2d 527, 530, 349 P.3d 476 (2015). We then review the district court's legal conclusions independently, without any required deference to the district court. Rice , 278 Kan. at 320, 95 P.3d 994. Whether Stockwell's constitutional rights have been violated is a legal matter, so we review it independently. See In re Habeas Corpus Application of Pierpoint , 271 Kan. 620, 627, 24 P.3d 128 (2001).
The facts are relatively straightforward and not in dispute. Following an initial court ruling, Stockwell filled out two forms and submitted them to the hospital. One was a do-not-resuscitate (DNR) request; the other was a living will. The hospital placed them in Stockwell's medical file but also advised him that these directives are only honored if certain conditions set out in written policies are met.
Under those policies, for his DNR request to be honored, two physicians must first determine either (1) that he has a terminal condition and that CPR, ventilation, intubation, defibrillation
, or a combination of those steps would only forestall death temporarily or (2) that he has an illness "for which further treatment ... would not likely prolong the life of the patient other than by artificial means ...." In either situation, he must have some condition that would be expected to end his life; no such condition has been diagnosed in Stockwell. Similarly, for his living will to be honored, "two physicians must agree that death will occur whether or not the medical procedure or intervention is done." In other words, the living will is honored only if Stockwell has a terminal illness.
That presents no problem with respect to the living will Stockwell has signed—by its own terms, it takes effect only if he "should have an incurable injury, disease, or illness certified to be a terminal condition by two (2) physicians who have personally examined me ...." But there's a real dispute about the effect of Stockwell's DNR request. He wants the hospital to honor it whether or not he has a terminal illness; should his heart stop beating or he stop breathing, he wants no action taken to revive him. Under the hospital's written policies, though, it doesn't enter an actual DNR order (which it calls a directive) unless the person has both a terminal illness (confirmed by two physicians) and a DNR request.
Does the hospital's policy violate Stockwell's constitutional rights? In the Cruzan case, the United States Supreme Court declared that every "competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment." Cruzan v. Director, Missouri Dept. of Health , 497 U.S. 261, 278, 110 S.Ct. 2841, 111 L.Ed. 2d 224 (1990) ; see Washington v. Glucksberg , 521 U.S. 702, 720, 117 S.Ct. 2258, 138 L.Ed. 2d 772 (1997) (); Conservatorship of Wendland , 26 Cal.4th 519, 533, 110 Cal.Rptr.2d 412, 28 P.3d 151 (2001) (); Thor v. Superior Court , 5 Cal.4th 725, 744, 21 Cal.Rptr.2d 357, 855 P.2d 375 (1993) (); In re Guardianship of Browning , 568 So.2d 4, 10 (Fla. 1990) (). Both prison inmates and those civilly committed under the Sexually Violent Predator Act maintain this right even though their liberty has been significantly limited in other ways. See Turner v. Safley , 482 U.S. 78, 89–91, 107 S.Ct. 2254, 96 L.Ed. 2d 64 (1987) ; Merryfield v. Kansas Dept. of Aging & Disability Services , No. 111,204, 2015 WL 326652, at *6 (Kan. App.) (unpublished opinion), rev. denied 302 Kan. 1010, ––– P.3d –––– (2015). And though he is confined due to the likelihood he might reoffend and is subject to treatment for any underlying condition that leads to criminal sexual offenses, Stockwell has not been determined mentally incompetent. So Stockwell's right to refuse unwanted medical treatment is well-established and constitutional in nature.
The district court found no violation of this right, in part because a person living in the City of Larned or elsewhere—not in custody at the state hospital—wouldn't be able to ensure that everyone would follow his or her DNR request, either. For example, a person who has a written DNR request might well collapse on the street, where a passerby might administer CPR or call an ambulance. As the district court noted,
While that's true, there's a key difference between Stockwell and the ordinary person on the street: Stockwell is in state custody.
If Stockwell has a right to refuse unwanted medical treatment—and he does—then the State surely must use reasonable efforts to accommodate his exercise of that right as a person in state custody. While the hospital made some effort to accommodate Stockwell's exercise of that right by placing his DNR request in his medical file, the accommodation was made largely ineffective by the hospital's policy that a DNR order won't be issued except in cases of terminal illness confirmed by two physicians. Although a person on the street may not be able to ensure that his or her DNR request is honored in the case of sudden cardiac arrest
or respiratory failure, Stockwell isn't a person on the street. He's a person in state custody, so the State must bear some responsibility for ensuring that his constitutional right to refuse unwanted medical treatment is protected.
In response to Stockwell's exercise of his constitutional right through his DNR request, the State has not shown that accommodating that request will have any detrimental effect, that its failure to accommodate the request furthers some significant governmental interest, or that any other factor is present here that might allow the government to override this exercise of a person's constitutional rights. See Chubb v. Sullivan , 50 Kan.App.2d 419, 440–44, 330 P.3d 423, rev. denied 300 Kan. 1103, ––– P.3d –––– (2014). Understandably, the State also did not argue that it would face potential legal liability for following Stockwell's DNR request: Kansas law gives health-care providers immunity when they in good faith honor a DNR request. See K.S.A. 65–4944. We therefore hold that the hospital must use reasonable efforts to inform its staff of Stockwell's DNR request and to have its staff act in accordance with his DNR request should a situation covered by it arise.
We limit our holding to a requirement that the hospital use reasonable efforts; it is not our place to micromanage the Larned State Hospital. The district court will retain jurisdiction to enforce its judgment should a dispute arise as to whether the hospital undertakes reasonable efforts.
Before we close our opinion, we must make four brief points in response to our colleague's dissenting opinion:
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