## Facts

- Bucilla C. Stephenson executed an advance directive naming her granddaughter, Jacqueline Alicea, as health-care agent with authority to make all health-care decisions if Stephenson became incapacitated and expressing a desire not to have life prolonged by artificial means.
- In March 2012, Stephenson (age 91) was admitted to Doctors Hospital of Augusta with serious conditions including pneumonia, sepsis, and renal failure.
- Alicea provided the hospital a copy of the advance directive and contact information; hospital policy required the directive to be placed in the front of the chart, and the chart included a note to consult Alicea before intubation.
- On March 5, a physician sought Alicea’s consent for a procedure; Alicea consented but later contended she was not informed it would involve temporary intubation.
- On March 7, Dr. Phillip William Catalano ordered Stephenson to be intubated and placed on mechanical ventilation without calling Alicea beforehand.
- After discovering Stephenson on a ventilator, Alicea objected that the intervention conflicted with the directive and her authority; later she authorized additional procedures and ultimately approved withdrawal of ventilation; Stephenson died days after ventilator removal.
- Alicea, as administratrix, sued the hospital and Dr. Catalano alleging, among other claims, medical battery (lack of basic consent) and medical malpractice, and defendants asserted statutory immunity under the Georgia Advance Directive for Health Care Act.

## Issues

1. Whether health-care providers were entitled to summary judgment based on immunity under OCGA § 31-32-10(a)(2) and (3) for intubation and mechanical ventilation allegedly performed contrary to the advance directive and the agent’s directions.
2. Whether disputed facts existed as to “good faith” reliance on, or compliance with/declining to comply with, the health-care agent’s decision within the meaning of OCGA § 31-32-10(a)(2) and (3).

## Decision

- The Georgia Supreme Court affirmed the Court of Appeals on the question reviewed, holding defendants were not entitled to summary judgment on statutory immunity for the March 7 intubation.
- The Court held the record allowed a jury to find defendants did not act in good faith reliance on a health-care agent’s decision and did not satisfy the statutory conditions for immunity.
- The Court applied the summary-judgment standard, concluding genuine disputes of material fact existed regarding defendants’ knowledge of the directive, the agent’s directions, and whether defendants acted in good faith as required by the Act.

## Legal Principles

- Immunity under OCGA § 31-32-10(a)(2) and (3) is conditional and depends on a provider’s good-faith reliance on a person believed to be the health-care agent and on complying with or properly declining to comply with the agent’s health-care decision.
- The Advance Directive for Health Care Act is structured to keep health-care decisions, as much as possible, with the patient and the chosen agent rather than with providers.
- Where evidence permits a finding that providers proceeded with life-sustaining treatment without consulting the designated agent despite the opportunity and instructions to do so, “good faith” and thus statutory immunity generally present jury questions.
- If a provider is unwilling to follow an agent’s decision, immunity is not established by simply disregarding the decision; the Act contemplates refusal accompanied by appropriate steps such as arranging transfer of care.

## Conclusion

The Georgia Supreme Court held that statutory immunity under the Advance Directive for Health Care Act was not established on summary judgment because the evidence could support a finding that the hospital and physician intubated the patient without consulting the designated health-care agent and without acting in good faith as required by OCGA § 31-32-10(a)(2) and (3).


Doctors Hosp. of Augusta, LLC v. Alicea, 299 Ga. 315, 788 S.E.2d 392 (2016)