New Jersey Court Rules That Hospital Must Resume Life Support For Patient In Vegetative State

A Union County judge has ordered life support resumed for a patient who has been in a vegetative state for 14 months, restraining a hospital from taking it upon itself to discontinue or suspend treatment, and rejecting arguments that public health considerations take precedence over the patient’s family’s wishes.

Ruben Betancourt has been unconscious since suffering complications in an operation at Trinitas Regional Medical Hospital to remove a malignant thymus gland. The hospital maintained he does not respond to pain or move his extremities and only makes reflexive eye movements, and that continuing treatment is inhumane and contrary to standards of care. Betancourt’s family members, however, insisted he is responsive to stimuli. They say he recoils when approached by medical providers and opens his eyes or turns his head when he hears certain voices. In fact, notations on his chart by medical staff state that he has been observed to be “awake.”

On March 4th, Superior Court Judge John Malone ruled that life-support decisions should be made not by caregivers or courts but in accordance with a patient’s rights as expressed by a surrogate decision-maker.

The decision is important because the judge refused to adopt a novel position advanced by the hospital: that its doctors should not be forced to provide medical treatment that they believe is inhumane and contrary to standards of care. The hospital, relying in part on the out-of-state decision in Causey v. St. Francis Medical Center, 719 So. 2d 1072 (LA. App. 2d.Cir. 1998), argued there is a public interest in letting physicians provide what they consider quality care — including “promoting dignity where death is inevitable and elevating the quality of life over longevity.” The hospital also cited Couch v. Visiting Home Care Service, 329 N.J. Super. 47 (App. Div. 2000), in which a New Jersey court said a home nursing care agency need not continue to treat a patient in a deteriorating condition that made it unsafe for him to live at home.

Judge Malone instead followed the New Jersey Supreme Court’s ruling in matter-of-jobes, 108 N.J. 394 (1987), which held the trial court’s role is not to decide on the removal of medical treatment but to respect the patient’s right to self-determination. Where the patient is unable to enunciate his wishes, the “substituted judgment” doctrine first enunciated in in_re_quinlan, 70 N.J. 10 (1976), requires the court to defer to a surrogate decision-maker. Judge Malone appointed Betancourt’s daughter, who wishes to continue life support, as his guardian.

A significant fact that I did not get from the N.J.L.J. article about the case is that defendant Trinitas Regional Medical Center was accused by the plaintiff’s family of medical malpractice in causing the plaintiff, Ruben Betancourt, to develop anoxic encephalopathy after surgery for a malignant thymoma. The surgery was performed at Trinitas. Subsequently, Trinitas sought to discontinue life support. Although not relevant in deciding the issues that Judge Malone confronted in the case, this fact seems to be significant background information in understanding the decision.

The next question is, of course, one of cost. Who do you think will pay for the hospital life support?  If Mr. Betancourt has assets and more than one child, can the other children sue the daughter for continuing life support and “wasting” their potential inheritances on fruitless [according to the hospital] medical care?  If, on the other hand, Mr. Betancourt has no assets, can Medicaid refuse to pay on grounds that the care is not medically necessary?

Judge Malone’s decision is attached here – betancourt_v_trinitas_3-4_2_.Thanks to Thaddeus Mason Pope, Esq. at Medical Futility for posting a copy of the opinion.

UPDATED ON AUGUST 13, 2010: Trinitas Hospital filed an appeal from Judge Malone’s Order.  Unfortunately, Ruben Betancourt died soon after the appeal was filed, on May 29, 2009. Although plaintiff filed a motion to dismiss the appeal as moot, the Appellate Division reserved decision on the motion pending consideration of the merits of the appeal. The appeals court recognized that the issues raised by the parties were significant.  After reviewing the factual record and hearing the arguments of counsel, the Appellate Court issued its decision and Order on August 13, 2010. The Court dismiss the appeal, holding that “both the lack of an adequate factual record as well as the limited, but unique, factual context presented” warranted dismissal of the appeal as moot.  The decision and Order of the Superior Court, Appellate Division is annexed hereto – Betancourt v. Trinitas Hospital