Velez v. Bethune

Decision Date05 December 1995
Docket NumberNo. A95A1552,A95A1552
PartiesVELEZ v. BETHUNE et al.
CourtGeorgia Court of Appeals

Wrongful death. Clayton State Court. Before Judge Carbo.

Sullivan, Hall, Booth & Smith, John E. Hall, Jr., T. Andrew Graham, Atlanta, for appellant.

George H. Connell, Jr., Atlanta, for appellees.

McMURRAY, Presiding Judge.

Plaintiff Sherry S. Bethune, individually, as mother of Mary Elizabeth Bethune, a deceased minor, and as temporary administratrix of the child's estate, brought this intentional tort 1 action against defendant Francisco J. Velez, M.D., and others, seeking to recover for the alleged wrongful death of the nine-day-old infant. Mary Elizabeth Bethune was born prematurely "on the side of the expressway ..." on November 20, 1991, after a gestation period of approximately 24 weeks, and was immediately taken to Southern Regional Medical Center. Defendant first saw the infant on November 28, 1991. Due to severe prematurity, the infant "was unstable with a chest [X]-ray that shows evidence of interstitial pulmonary emphysema, and ... metabolic acidosis." According to the amended complaint, on November 29, 1991, Dr. Velez unlawfully, intentionally, and without justification, abandoned his patient, the infant Mary Elizabeth Bethune, by causing the "termination[, deescalation,] and discontinuance of cardio pulmonary resuscitation, life support measures and medical treatment for her," without the consent and approval of the infant's parents, and without their knowledge.

Dr. Velez denied the material allegations, although he subsequently deposed that he "ordered discontinuation of an on-going resuscitation." After a period of discovery, defendant moved for summary judgment on the grounds that he had obtained the consent of the parents to stop treatment and that the child was already "clinically dead" by the time he disconnected ongoing life support measures. In support of the contention that he obtained the consent of the parents, defendant relied on his progress notes made by him on November 29, 1991, which recite, in part: "After discussing condition with parents and agreement with them we decided that it was in the best interest of this patient to stop any further resuscitative effort." This meant that Dr. Velez "stopped the infusion of Dopamine, and we stopped mechanical ventilation."

Plaintiff opposed the motion with the affidavit of the infant's father, Clayton E. Bethune, who deposed that he "never discussed with [defendant] any efforts by him to stop resuscitation efforts for my daughter[; and further that he had] never given permission to [defendant] to stop resuscitation efforts on Mary Elizabeth Bethune." The affidavit of Delaine Brown, plaintiff's cousin, contradicts defendant's contention that he spoke with plaintiff and obtained her permission to stop resuscitative efforts on November 29, 1991. "In the presence of [plaintiff], I observed Mary Elizabeth Bethune on November 29, 1991. When I first saw Mary Elizabeth Bethune, she was [already] dead, was not clothed in any way and was not attached to any life support systems." Also, medical records indicate that the infant still had a heartbeat at 8:30 a.m., i.e., although, in the death certificate he signed, Dr. Velez had pronounced the infant dead at 7:50 a.m. Defendant also testified variously that the infant was in the process of dying at 7:50 a.m., which necessarily "means that the baby is still alive[.]"

The trial court denied defendant's motion for summary judgment but certified its order denying reconsideration for immediate review. Defendant's application for interlocutory appeal was granted and a timely notice of appeal was filed. Held:

1. In four related enumerations, defendant enumerates the denial of his motion for summary judgment. He argues first that the act of removing infant Bethune from life support is not a tort for which plaintiff can recover. We disagree.

The allegations were sufficient to state a wrongful death claim on the basis that the infant's death resulted either from defendant's reckless disregard of the consequences, or his heedless indifference to the rights and safety of others. When coupled with a reasonable foresight that injury would probably result, this constitutes that criminal negligence equivalent to an intentional tort. Hamilton v. Powell, Goldstein, etc., 252 Ga. 149, 150, 311 S.E.2d 818. See also Bowers v. State, 177 Ga.App. 36, 38, 338 S.E.2d 457. In the case sub judice, Dr. Velez had no right to decide, unilaterally, to discontinue medical treatment even if, as the record in this case reflects, the child was terminally ill and in the process of dying. That decision must be made with the consent of the parents. See In re Jane Doe, 262 Ga. 389, 391(2), 393(2)(c), 418 S.E.2d 3.

2. Next, defendant contends that the denial of summary judgment was erroneous because the infant Bethune was clinically dead. We do not agree that the absence of legal injury to the tragically premature infant nor the absence of proximate cause has been established beyond question. The evidence is in conflict as to whether the defendant physician, Francisco J. Velez, M.D., reasonably believed that he acted with the informed consent of the parents when he intentionally discontinued resuscitative efforts and intentionally removed life support mechanisms. See In re Jane Doe, 262 Ga. 389, 391(2), 393(2)(c), 418 S.E.2d 3, supra. The evidence is also in conflict as to whether the infant was clinically dead at the time. Although the trier of fact could conclude that Dr. Velez was entirely justified in his actions, within the meaning of OCGA § 51-11-1, the question of reasonableness remains for the jury to determine under all the attendant circumstances, including the credibility of the witnesses. The case law regarding the negligent failure to diagnose a terminal disease is simply inapposite to the deliberate acts of withholding or deescalating medical assistance, and the dissents err in relying thereon. Furthermore, the imminence and inevitability of death for this nine-day-old infant go only to the quantum of damages and do not vitiate the doctor's initial dereliction, if the jury finds one. See, e.g., In re Jane Doe, 262 Ga. 389, 391(2), fn. 4, 418 S.E.2d 3, supra. It is our view that, the trial court correctly denied defendant's motion for summary judgment in this instance.

3. Defendant's two remaining enumerations have been considered and are found to be without merit.

Judgment affirmed.

POPE, P.J., and JOHNSON, BLACKBURN and RUFFIN, JJ., concur.

BEASLEY, C.J., and BLACKBURN, J., concur specially.

BIRDSONG, P.J., and ANDREWS and SMITH, JJ., dissent.

BEASLEY, Chief Judge, concurring specially.

I agree with the majority because Dr. Velez had no right to discontinue treatment without the parents' consent. The obligation is enunciated by the Georgia Supreme Court in In re L.H.R., 253 Ga. 439, 321 S.E.2d 716 (1984), which recognized a duty. Following that decision, the legislature delineated certain rights and obligations with respect to the question of cardiopulmonary resuscitation, in OCGA § 31-39-1 et seq. See In re Jane Doe, 262 Ga. 389, 391(2), 418 S.E.2d 3 (1992).

Since the constitutional right to refuse belonged to the child, and had to be exercised by her surrogates (her parents) following the diagnosis and prognosis not only of the attending physician but also that of another, disinterested, physician, OCGA § 31-39-2, discontinuance without consent could be either an intentional or a negligent act, depending on the facts found by the jury. In either event, it would be an "unlawful violation of a private legal right," OCGA § 51-1-1. The law always seeks to give a remedy if a legal right has been violated. See Ga. Law of Damages (4th ed.), §§ 1-1, 1-4. If the failure to get consent carries no legal liability, then the protective scheme created in In re L.H.R., supra at 446, 321 S.E.2d 716, and refined by the statute is unenforceable.

The fact that there may be little or no actual damages does not govern whether there is a compensable tort. Nominal damages would be sufficient. See measure of damages, OCGA § 51-12-4. Bradley v. Godwin, 152 Ga.App. 782, 784(3), 264 S.E.2d 262 (1979).

In my opinion, the wrongful death statute includes the wrongful hastening of death, and there is some evidence that the infant's earlier death was caused by Dr. Velez. The record does not preclude a finding that his actions caused the death to be sooner rather than later, and that before he took these actions he did not get the consent of the surrogates of the person whose life was thereby terminated.

BLACKBURN, Judge, concurring specially.

I agree with the majority; I write separately to specifically address Dowling v. Lopez, 211 Ga.App. 578, 579, 440 S.E.2d 205 (1993) cited by Judge Andrews' dissent. Although I agree with Judge McMurray that Dowling is factually distinguishable from the present case, I am compelled to raise the same concern here that I raised in my dissent in Dowling.

Judge Andrews would find that because Dr. Velez, at most, only shortened the life of a terminally ill child, no damages for the wrongful death of the child are available to the plaintiffs. It is undisputed in this case that the immediate cause of the child's death was the actions of Dr. Velez. The child was connected to a mechanical ventilator that Dr. Velez caused to be turned off. While it may well be true that the child would probably have ultimately succumbed to her illness, which had been diagnosed as terminal, no one can state with certainty that death would have in fact resulted from her condition. In any event, a jury would be authorized to find that the child would have lived longer but for the actions of Dr. Velez and that the immediate cause of the child's death was the intentional wrongful act of Dr. Velez. As the majority found, the child's condition and life...

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