Madeline Neumann was 89 when she moved into Joseph L. Morse Geriatric Center in West Palm Beach, Florida. She had watched her husband and two daughters die painfully from cancer, and she did not want to be kept alive pointlessly—so she signed a living will and a health care power of attorney. They didn’t keep the nursing home from having her hospitalized, or the emergency medical personnel from performing a tracheostomy to keep her breathing.

After Ms. Neumann was admitted to the hospital her granddaughter (and health care agent) moved to have the breathing apparatus and all other tubes withdrawn. She was ultimately successful, but Ms. Neumann was kept alive for six days of what her granddaughter insisted was unnecessary suffering. After she was allowed to die, her granddaughter filed suit against the nursing home and its medical director, who had given telephonic instructions that Ms. Neumann be sent to the hospital at the time of her collapse.

A Florida jury decided that the medical director had acted appropriately. He was miles away from the facility when Ms. Neumann collapsed, and his instructions that she be hospitalized for evaluation seemed reasonable to the jurors. The evaluation was especially important because Ms. Neumann had instructed that she was to receive antibiotics for pneumonia and other treatable illnesses; since the doctor did not know if her condition was treatable, her hospitalization was appropriate to find out. The jury ruled in favor of the doctor.

The facility itself, however, did not fare so well. The jury entered a judgment against Morse Geriatric for $150,000 after finding that it had failed to develop a plan for dealing with Ms. Neumann’s inevitable decline and death in the face of her advance directives.

The award in Ms. Neumann’s case is one of a very few against facilities for providing treatment despite the existence of advance directives. In most cases, juries and judges have ruled that a doctor’s (or a facility’s) failure to follow advance directives should not lead to a judgment against them. Health care providers are unlikely to be sanctioned for trying to keep their patients alive; that is often cited as one reason advance directives are too often ignored.

Ms. Neumann’s verdict is important, but its significance is limited. It is only a trial court decision, and subject to the appeals process (where it might be reversed). The $150,000 judgment is substantial, but not large enough to serve as an industry-wide wake-up call, and the physician was exonerated by the jurors. Diligence—by patients and surrogates—remains essential to implementation of advance directives.

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