Wentzel v. Montgomery General Hosp., Inc.

• Decision Date: 20 July 1982
• Docket Number: No. 74,74
• Citation: 447 A.2d 1244,293 Md. 685
• Parties: Nancy M. WENTZEL et al. v. MONTGOMERY GENERAL HOSPITAL, INC. et al.
• Court: Maryland Court of Appeals

Page 685

293 Md. 685

447 A.2d 1244

Nancy M. WENTZEL et al. v. MONTGOMERY GENERAL HOSPITAL, INC. et al.

No. 74.

Court of Appeals of Maryland.

July 20, 1982.

Thomas L. Beight, Gaithersburg, for appellants.

M. Michael Cramer, Rockville (Benjamin A. Klopman, Rockville, on the brief), for appellee, the minor child.

Joseph V. Truhe, Jr., Rockville (Miller, Miller & Canby, Chartered, Rockville, on the brief), for appellee, Montgomery General Hosp., Inc. Argued before MURPHY, C. J., and SMITH, DIGGES, ^* ELDRIDGE, COLE, DAVIDSON and RODOWSKY, JJ.

MURPHY, Chief Judge.

This case presents the question whether a trial court of general jurisdiction is empowered to grant a guardian's petition to sterilize an incompetent minor through the performance of a subtotal hysterectomy.

I

The child who is the subject of this litigation, Sonya Star Flanary, is a severely retarded 13-year-old with an I.Q. of about 25 to 30 (the equivalent of a mental age of 1 to 2 years), blind and with pronounced neurological problems. Sonya was born a normal child. At the age of 5 months, she was severely injured in an automobile accident, suffering brain and other physical damage. After an initial paralysis, Sonya's physical condition greatly improved but her mental development was seriously retarded. Unable to cope with the event, Sonya's mother took her to live with her grandmother, Nancy Wentzel, who is now 61 years old. Sonya, her two sisters, and Gail Sheppard, Sonya's aunt, have been living with Mrs. Wentzel since shortly after the accident. This case began when Mrs. Wentzel and Gail Sheppard, who together provide Sonya's principal care, sought the performance of a hysterectomy upon Sonya, which would terminate her menstrual cycle and result in her sterilization. The medical staff of Montgomery General Hospital refused to perform the operation without a court order authorizing the procedure. Consequently, Mrs. Wentzel and Ms. Sheppard filed a petition in the Circuit Court for Montgomery County, seeking appointment as Sonya's guardians with authority to consent to the proposed surgical procedure. The petition recited that Sonya "is currently in need of additional medical care (hysterectomy) and that the medical staff and petitioners request an Order of Court approving said medical procedure for therapeutic reasons."

Pursuant to Maryland Rule R76, the court appointed an attorney to represent Sonya and conducted an evidentiary hearing. The evidence disclosed that Sonya regularly attended a special school, although missing many sessions because of illness. It was established that Sonya had reached puberty and was experiencing pain connected with menstruation. It was shown that Sonya could not care for her most basic hygienic needs, that she would not wear sanitary napkins and was irritable and disoriented during the menstruation process. There was evidence showing that the guardianship petition was motivated by a sincere desire to free Sonya of the pain and other consequences suffered by her during menstruation and because of genuine concern that Sonya was an easy subject for rape and resulting pregnancy. Sonya's mother testified in support of the guardianship petition, stating that sterilization was in Sonya's best interest.

The petitioners produced testimony of a child psychiatrist who, although he had never treated Sonya and had only seen her twice, said that a subtotal hysterectomy would be in Sonya's best interest. The psychiatrist was unable to say, however, that such a procedure was necessary for Sonya's physical or mental health. On cross-examination, the witness admitted that Sonya would not be in any medical danger if the operation were not performed, and he also agreed that some pain and irritation connected with the menstrual cycle is normal. The psychiatrist agreed that no life threatening consequences would occur if Sonya were to have offspring and further that Sonya was perfectly capable of having a normal baby. The evidence disclosed that there was no reasonable expectation that Sonya's mental condition would improve.

It was argued that Maryland Code (1974, 1981 Cum.Supp.), § 13-708 of the Estates and Trusts Article empowered the court to grant the guardianship petition and to authorize the guardians to consent to the operation. Section 13-708, insofar as pertinent, provides:

"(a) The court may grant to a guardian of a person only those powers necessary to provide for the demonstrated need of the disabled person.

"(b) Subject to subsection (a) of this section, the rights, duties, and powers which the court may order include, but are not limited to:

(1) The same rights, powers, and duties that a parent has with respect to an unemancipated minor child ...;

(2) ...

(3) The duty to provide for care, comfort, and maintenance, including social, recreational, and friendship requirements, and, if appropriate, for training and education of the disabled person;

(4) ...

(5) ...

(6) If a guardian of the estate has been appointed, the duty to control the custody and care of the disabled person, ...;

(7) ...

(8) The power to give necessary consent or approval for medical or other professional care, counsel, treatment, or service, except that the court must authorize any medical procedure that involves a substantial risk to life."

The trial judge (Bell, J.) found from the evidence that Sonya was totally lacking in capacity to consent to the operation; that "Sonya cannot care for herself, let alone a baby"; and that "Sonya's menstruation further burdens an already over-burdened family." The court noted the sincerity of the family's belief that the operation was in Sonya's best interest, and it also recognized the possibility that Sonya could become pregnant if sexually abused. The court observed that the psychiatrist did not testify that the operation was necessary for Sonya's medical health or that refusal to authorize it would cause such a mental hardship as would justify the surgery for therapeutic reasons. The court concluded that § 13-708 of the Estates and Trusts Article "could not be interpreted to provide a hysterectomy in a case such as Sonya's." It noted that "the alternative to the hysterectomy is not life threatening." The court said:

"In the absence of such statutory authority and guide lines, this Court cannot find that it has the authority to grant the relief sought."

The court appointed the petitioners as co-guardians of the person and property of Sonya but denied permission to consent to the hysterectomy. The guardians appealed to the Court of Special Appeals. We granted certiorari prior to decision by the intermediate appellate court to consider the profound issues raised in the case.

II

The guardians claim that the lower court erroneously denied the petition on the ground that it was not empowered, absent express statutory authorization, to order sterilization unless for therapeutic reasons. They maintain that under § 13-708 of the Estates and Trusts Article the court, upon a showing of "demonstrated need," is authorized to approve the sterilization of a minor incompetent for nontherapeutic reasons. The guardians suggest that they have a duty under the statute to plan for the preservation and maintenance of the future well-being of their ward. The evidence in this case, they argue, substantiates the existence of a demonstrated need for the operation because Sonya is mentally and physically unable to care for her own physical needs due to her severe state of mental retardation. It is additionally argued that the medical evidence supports the conclusion that Sonya's sterilization "will preclude future negative trauma both physically and mentally, given the severity of Sonya's mental retardation and her low functioning levels and eliminate the possibility of pregnancy."

The guardians contend that Code (1980 Repl.Vol.) § 1-501 of the Courts and Judicial Proceedings Article confers upon a circuit court full equity powers in civil cases--powers which are not limited by the provisions of § 13-708 of the Estates and Trusts Article. Sterilization would be in Sonya's best interests, the guardians say, because Sonya is unable to communicate effectively with others; to understand or handle her own bodily functions; to know the difference between sexes, much less the needs of a potential child; and to understand the menstrual cycle or pregnancy. Moreover, the guardians point out that they are presently 61 and 33 years old, respectively, and that Sonya's life expectancy far exceeds their own. In these circumstances, it is contended that it is in the best interests of Sonya and those who assume responsibility for her care, both in the present and in the future, that Sonya be sterilized. The guardians maintain that acting under the parens patriae doctrine, equity courts have traditionally exercised their powers in the best interests of incompetent minors, and that accordingly the lower court should have granted their petition in order to preserve Sonya's physical and mental well-being. It is emphasized that should Sonya have a child, both she and the child will become wards of the State, if her family cannot care for both. It is argued that this will place a financial burden on the State, and it therefore has a compelling interest justifying granting the guardians' petition authorizing the giving of consent to Sonya's sterilization.

III

A number of jurisdictions hold that in the absence of express legislative authorization, courts are totally devoid of subject matter jurisdiction to consider petitions seeking sterilization of incompetent minors. See, e.g., Hudson v. Hudson, 373 So.2d 310 (Ala.1979); Guardianship of Tulley, 83 Cal.App.3d 698, 146 Cal.Rptr. 266 (1978), cert. denied, 440 U.S. 967, 99 S.Ct. 1519, 59 L.Ed.2d 783 (1979); Matter of S. C. E., 378 A.2d 144 (Del.Ch.1977); A. L. v. G. R. H., 163 Ind.App. 636, 325 N.E.2d 501 (1975); Holmes v. Powers, 439 S.W.2d 579 (Ky.1968); In Interest of M. K. R., ...