Wons v. Public Health Trust of Dade County

• Decision Date: 06 January 1987
• Docket Number: No. 86-985,86-985
• Citation: 12 Fla. L. Weekly 192,500 So.2d 679
• Parties: 12 Fla. L. Weekly 192 Norma WONS, Appellant, v. The PUBLIC HEALTH TRUST OF DADE COUNTY, Florida, Appellee.
• Court: Florida District Court of Appeals

Page 679

500 So.2d 679

12 Fla. L. Weekly 192

Norma WONS, Appellant, v. The PUBLIC HEALTH TRUST OF DADE COUNTY, Florida, Appellee.

No. 86-985.

District Court of Appeal of Florida,

Third District.

Jan. 6, 1987.

Kelner & Kelner and John Kelner, for appellant.

Robert A. Ginsburg, Co. Atty., and Aurora Ares, Asst. Co. Atty., for appellee.

Before SCHWARTZ, C.J., and HUBBART and BASKIN, JJ.

HUBBART, Judge.

This is an appeal by a hospital patient from a final order authorizing a public hospital to administer involuntary blood transfusions to the said patient over the latter's religious objections. As in St. Mary's Hospital v. Ramsey, 465 So.2d 666 (Fla. 4th DCA 1985), we are confronted with the question of whether a competent adult has a lawful right to refuse a blood transfusion without which she may very well die. Because the state has no compelling interest under the circumstances of this case sufficient to override the patient's constitutional right (a) to practice her religion according to her conscience, and (b) to lead her private life free from unreasonable governmental inference, we reverse the order under review. We further certify that our decision herein passes upon a question, stated above, which is of "great public importance," so as to permit further review of this case by the Florida Supreme Court under Article V, Section 3(b)(4) of the Florida Constitution.

I

The facts of this case are these. On Sunday April 13, 1986, the Public Health Trust of Dade County, Florida, an agency and instrumentality of Dade County, Florida, which owns and operates Jackson Memorial Hospital [hereinafter "the Hospital"], filed an emergency petition with the Circuit Court for the Eleventh Judicial Circuit of Florida. In the petition, the Hospital sought (1) a court order authorizing its medical staff to administer allegedly lifesaving blood transfusions to Mrs. Norma Wons [hereinafter "Mrs. Wons"], an adult patient at the hospital, who for religious reasons had refused such transfusions, and (2) a court order appointing a guardian ad litem to advise the court on the issue presented on behalf of the patient. Circuit Judge Edmund Newbold, the emergency circuit judge on duty below, immediately appointed Mr. John Kelner, an attorney, to represent Mrs. Wons, and at 2:00 P.M. that day, April 13, 1986, conducted an emergency evidentiary hearing in chambers. Four witnesses testified at the hearing: Dr. Joseph M. Cevetta, the attending physician of the Hospital's intensive care unit; Henrich Wons, Mrs. Wons' husband; and Alberto and Nefdali Guadalupe, Mrs. Wons' two brothers. Also Henrich Wons, Jr., Mr. and Mrs. Wons' fourteen-year-old son appeared at the hearing, identified himself to the court, said he had a twelve-year-old brother, but did not testify under oath.

Based on the testimony adduced at the hearing, Judge Newbold made certain findings of fact in the order under review, to wit:

"1. That Norma Wons, a 38 year old woman, is a patient at Jackson Memorial Hospital in need of medical treatment and procedures including blood transfusions.

2. That Norma Wons and her family was informed as to the nature of and the necessity for emergency medical treatment and procedures, including blood transfusions.

3. That Norma Wons is a member of the Jehovah's Witness faith and has refused consent to the blood transfusion on the basis of her religious belief.

4. That Norma Wons was competent at the time she refused consent to the blood transfusion.

5. That the testimony heard by this Court shows that Norma Wons is suffering from dysfunctional uterine bleeding and that delay in initiating a blood transfusion would threaten her life and that a blood transfusion would save her life.

6. That Norma Wons, a housewife, and her husband Henrich Wons, a carpenter, have two minor children ages twelve and fourteen, whose physical residence is with their parents and who are being reared by them."

A

These findings, we think, are based on substantial competent evidence. The testimony below plainly reveals that on Sunday April 13, 1986, Mrs. Wons was admitted to Jackson Memorial Hospital for a condition known as dysfunctional uterine bleeding. Dr. Joseph Cevetta, Director of the Intensive Care Unit at the hospital, examined Mrs. Wons, diagnosed her condition, and determined that she had lost over 90% of her available red blood cells. Mrs. Wons was suffering from extreme blood loss from her uterus, although the bleeding itself had stopped. Her bone marrow was producing red blood cells, but, in Dr. Cevetta's opinion, not in sufficient amount to replace those which she had already lost. In his view, Mrs. Wons was "absolutely at the edge, and at any instant or within hours she could die from lack of oxygen delivering capacity due to loss of red blood cells." (R. 17). He further stated that in the eighteen years he had been in charge of the Intensive Care Unit, he had "never taken care of a patient with a level as low as her hematocrit is at this point," (R. 17) that "[e]xperimentally in primates once a hematocrit falls below 10 percent, the oxygen delivery is insufficient, and once it falls below five percent death occurs," (R. 17-18) that Mrs. Wons' hematocrit level was at 3.5% and without an immediate blood transfusion "she will die." (R. 18).

Dr. Cevetta informed Mrs. Wons, a practicing Jehovah's Witness, of the seriousness of her medical condition and asked for permission to give her a blood transfusion. Although Mrs. Wons was drowsy and tired due to severe anemia, she was, in Dr. Cevetta's opinion, mentally competent to make a decision on this matter. Mrs. Wons' decision was "[n]o, I refuse based on my religious beliefs, the law of Jehovah, which says you will not accept a blood transfusion;" moreover, she added, "I will pull through." (R. 18) In Dr. Cevetta's opinion, Mrs. Wons wanted to live, which was a source of some concern to him, as he felt that she was hoping for an unwarranted miracle, rather than being resigned to die based on her religious convictions. "I think that she is denying the likelihood that she is at very serious risk of dying today" (R. 19), he said, and added "she is trusting that she will somehow miraculously pull through...." (R. 23).

Mr. Henrich Wons, Mrs. Wons' husband, testified that he fully supported his wife's decision to refuse a blood transfusion. He stated that he, too, was a practicing Jehovah's Witness and if the decision were his, he would refuse a blood transfusion on his wife's behalf. He is a carpenter and an independent distributor of "natural products" (R. 25). In this capacity, he is the sole financial support for his family which consists of his wife and two minor children, ages twelve and fourteen. Mrs. Wons, it appears, had been in bed the past few weeks and during that time, her mother, a sixty-two-year-old woman in good health, had been caring for the children while Mr. Wons was at work. He testified that if his wife were to die, Mrs. Wons' mother and two brothers had agreed that they would assist in taking care of the children.

Alberto and Nefdali Guadalupe, Mrs. Wons' two brothers, were also fully supportive, in their testimony, of their sister's refusal to accept a blood transfusion. They too are practicing Jehovah's Witnesses and regard such transfusions to be a serious sin. Alberto Guadalupe stated:

"I have known my sister for many years when I lived in Pennsylvania, also in the State of Florida since 1972 when I moved here. She had this disease for a while, a long time ever since she had the second kid, and I have seen my sister pull through; and also she was hospitalized before, and the doctor didn't want to take any responsibility, and she was released from the hospital, but up to this point they didn't take it to court.

The idea to say she will definitely die, that's just his opinion. There's no guarantee in there, you know. If she dies, she will die because that's her right as a patient, her right as a citizen of this country, and also her conviction of her belief of the Holy Scriptures as a principle.

We talk about principles. There's a lot of principles. Even in our coins it says 'In God we trust.' Sometimes we put that trust aside. Now, we trust more in God. We are not asking for miracles. We are not going to say she's going to pull through.

Right away you say okay, take her out of the hospital, but she might make it, you see. She might. She might not. But it's her decision.

We personally as brothers, you know, me and my brother, we will not give any blood transfusions to her or any members of our family. We are convinced of that. Whatever decision is to be made she has to make the final decision. She made it in front of me, my wife, and in front of him. Strictly she said no blood transfusion. She will refuse until death if she has to."

Nefdali Guadalupe added:

"I sort of bring out the same point of view as my brother. I had the privilege to talk with the doctor earlier, and he gave me an idea of the critical point that she's at, but like I feel, and I know people feel--the body itself, the human body is a fantastic organism that even today scientists feel, are amazed at how it counteracts problems. She might be having an emergency, like she may come off it, but there's a slight margin. I cannot thoroughly agree with the doctor when he says she's going to definitely pass away. I'll not say that.

Adding reinforcement to what my brother said, through faith, it's based on facts that we know the Supreme Being, of God and heaven on earth, he created life, and one way or another the circumstances are there, and we are just putting things in his hands, and see what may become of this situation.

At this point we would like the Court to respect our opinion and, of course, strong belief that even if she did pass away we still have the day of resurrection, which we believe greatly also. Thank you."

B

At the conclusion of the testimony below, counsel for the Hospital urged ...