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When Does an Advance Directive for Healthcare Take Effect?

An advance directive provides your physician and other healthcare providers with instructions regarding your care in the event you are no longer able to make your wishes known. An advance directive also enables you to appoint an agent to make healthcare decisions on your behalf. It’s important you provide clear instructions to your agent so that he or she does not act in a manner contrary to your wishes.

Even healthcare providers can misunderstand the scope of an advance directive. A recent California Court of Appeals decision addressed such a case. Please note, this case is discussed here for informational purposes only.

Goldman v. Sunbridge Healthcare, LLC
Edward Goldman signed an advance directive while receiving medical care at a Veterans Administration hospital. Shortly thereafter, Goldman was transferred to a skilled nursing facility. While under the facility’s care, Goldman suffered multiple falls, one of which fractured his hip and required surgery. Goldman was then transferred to a second nursing facility. He continued to experience complications related to his hip and died in August 2010.

Goldman’s widow, Judy, filed a wrongful death lawsuit against both nursing homes, Carmichael Care and Rosewood Terrace, acting on behalf of her late husband. She also sued both facilities individually, alleging “negligent infliction of emotional distress.” The nursing homes asked the court to require Goldman submit to binding arbitration instead.

Healthcare facilities typically require patients to sign arbitration agreements upon admission. Such agreements are legally binding in California. But the party seeking to compel arbitration must prove to the court that a valid agreement exists.

Judy Goldman did sign arbitration agreements with both nursing facilities when her husband was admitted. But did she have the authority to do so? Carmichael Care and Rosewood Terrace pointed to Edward Goldman’s VA advance directive, which named his wife as his agent. But that directive only applied if and when Edward Goldman lacked the capacity to make his own decisions. Neither nursing facility presented any evidence proving Edward Goldman was incompetent at the time of his admission, according to the trial court. Therefore, the advance directive was not in effect and Judy Goldman could not legally bind her husband to any arbitration agreement.

The court of appeals agreed with the trial judge
. It noted that under California law, a person’s lack of capacity required “a determination by a primary physician,” unless his advance directive specified another standard. No such determination was ever made regarding Edward Goldman.

Carmichael Care argued that in the alternative, Judy Goldman could sign an arbitration agreement on her husband’s behalf simply because she was his wife. The court of appeals disagreed. Spouses are considered fiduciaries of one another in the context of family law. But that doesn’t apply to an agency relationship like an advance directive (or a power of attorney). Edward Goldman’s advance directive reserved healthcare decisions to himself unless he was declared incompetent. The appeals court said one could not infer a grant of power to Judy Goldman that contradicted Edward Goldman’s express wishes.

Making Your Own Wishes Clear
This case illustrates the importance of not just making an advance directive, but clearly communicating to healthcare providers the exact scope and authority of any agent named under such a directive. When important decisions have to be made regarding your healthcare, there should be no confusion. To speak with a San Diego estate planning attorney about advance directives or any other matter, contact the Law Office of Scott C. Soady today.

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