## Facts

- Karla H. Miller was admitted to a hospital in premature labor; physicians estimated the fetus at about 23 weeks’ gestation and warned of a low chance of survival and a high likelihood of severe impairments if survival occurred.
- The parents, Karla H. Miller and J. Mark Miller, instructed that “no heroic measures” be used and refused to consent to resuscitation.
- Hospital staff informed the parents of a policy to resuscitate any baby born weighing over 500 grams and sought consent; the father refused.
- The infant, Sidney Ainsley Miller, was born alive at about 23 weeks and 1/7 weeks’ gestation, weighing about 615 grams, and was in distress.
- A neonatologist immediately provided life-sustaining measures (including intubation and ventilation) without parental consent at that moment.
- Sidney survived but developed profound, permanent disabilities.
- The parents sued hospital corporate entities (not the physicians), asserting (1) battery for treatment without consent and (2) negligence based on hospital policies allowing treatment without parental consent.
- A jury returned a verdict for the parents with substantial actual, interest, and exemplary awards; the court of appeals reversed; the Texas Supreme Court granted review.

## Issues

1. Whether parents may recover for medical battery when physicians provide life-saving treatment to a newborn in emergent circumstances without parental consent.
2. Whether parents may recover for negligence based on a hospital’s policies permitting such treatment without parental consent.

## Decision

- The Texas Supreme Court affirmed judgment for the hospital entities.
- The court held that the circumstances at birth fell within an emergency exception to the usual rule requiring parental consent for treatment of a minor.
- Because emergency conditions justified treatment without consent, the parents’ battery claim failed as a matter of law.
- For the same reason, the parents’ negligence claim attacking hospital policies that allowed such emergency treatment also failed as a matter of law.
- The court did not base its holding on a statutory “certifiably terminal” limitation relied on by the court of appeals; it resolved the case on common-law emergency grounds.

## Legal Principles

- As a general rule, treating a child without parental consent can create liability, including battery.
- An emergency exception permits a physician to provide life-sustaining treatment to a newborn without parental consent when:
  - the child’s condition cannot be fully evaluated until birth (making pre-birth treatment directives not fully informed as to the newborn’s actual condition), and
  - immediate post-birth circumstances are emergent such that the child might survive with treatment but likely would die if treatment were delayed to obtain parental consent or a court order.
- This emergency exception operates as a legal justification for treatment without consent and defeats battery claims based solely on lack of consent.
- When emergency treatment without consent is legally justified, a hospital is not liable in negligence merely for maintaining policies (or lacking policies) that permit physicians to act without parental consent in such emergencies.

## Conclusion

The Texas Supreme Court held that emergency resuscitation of a premature newborn at birth, when delay to secure parental consent or judicial authorization would likely be fatal and the newborn’s condition could not be fully assessed before birth, is legally justified and bars both battery and policy-based negligence claims against the hospital entities.


Miller ex rel. Miller v. HCA, Inc., 118 S.W.3d 758 (Tex. 2003)