Review of Bohn v. Providence Health Services Lawsuit

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The Alaska Supreme Court recently interpreted a portion of the Alaska Healthcare Decision Act under Bohn v. Providence Health Services – Washington. While this is the first time the Court has interpreted the HCDA, its decision focused on a single provision of the statute, AS 13.52.080(a)(3). This provision grants immunity to health care providers declining to comply with a person’s health care decision so long as the provider “acts in good faith and in accordance with generally accepted health care standards” and so long as the refusal to comply is “based on a good faith belief that the person then lacked authority” to make health care decisions.

While the Court denied Providence summary judgment, it did not decide the case in Bohn’s favor. Instead, it remanded to the trial court, noting “Providence may nonetheless succeed on the merits if it can show that it declined to follow Bohn’s parents’ instructions only in statutorily permitted contexts.” For example, if Providence can show that—pursuant to other provisions of HCDA—it declined to follow Bohn’s parents’ instructions after observing that Bohn’s parents were not abiding by Bohn’s wishes, values, and best interest, or that those instructions required medically ineffective health care, it may still survive against Bohn’s causes of action “without recourse to the immunity provisions.”

The Alaska Supreme Court feels that the HCDA demonstrates a clear legislative directive that the decision-making of patients and surrogates must be carefully considered by health care providers. A provider who proceeds with treatment contrary to the directives of these decision-makers must do so very carefully. Furthermore, a provider should review the HCDA’s provisions and enact policies consistent with its requirements.

Best Practice Recommendations

The Bohn decision focuses on a conflict between surrogate decision-makers and the patient’s treating physicians. In such circumstances, providers should carefully and repeatedly document their reasons for disregarding specific directives from either a patient or a surrogate decision-maker. While the Bohn decision makes it clear that providers are only immune from potential liability in very narrow circumstances, providers can comply with the HCDA, and lessen potential liability, by considering other aspects of the HCDA when deciding whether to obey the decisions of a patient or surrogate. For example, the HCDA specifically allows a provider to refuse to comply with instructions when the provider believes the surrogate is not “abiding by the wishes, values, and best interest of the patient,” AS 13.52.030(h), or if a patient or surrogate decision would require medically ineffective care or care “contrary to generally accepted health care standards,” AS 13.52.060.