June Miller once told the trust officer at her bank that she loved her son Warren Miller but that she didn’t like him very much. That might have been her motivation for making a number of changes to her estate plan in the last few years of her life. After she died her son sued the bank for letting her make those changes.
When Ms. Miller’s husband (and Warren Miller’s father) died in 1995 he left a trust for Ms. Miller’s benefit. When she died, the trust was to go to their only child, Warren Miller. Ms. Miller had significant assets of her own, and she also established a trust with Key Bank in Ohio. At one point her trust gave Warren the right to approve all investment decisions and trust amendments in the event that Ms. Miller became incapacitated. In 2001, without telling Warren, she changed that provision and deleted his power to review trust activities.
At about the same time Ms. Miller exercised her power to withdraw some of her husband’s trust assets, saying that she intended to benefit her grandchildren at her son’s expense by shifting them to her estate. She also made a series of transfers to a caretaker and family, helping them to buy a home and making outright gifts of about $120,000.
Even as those changes were being undertaken, Ms. Miller was first diagnosed as suffering from mild dementia. When she died in 2002, her son Warren sued the bank, the caretaker and her family members.
Mr. Miller argued that the bank had a duty to watch out for Ms. Miller’s finances and to prevent exploitation. He claimed that the caretaker had in fact exploited his mother. He also insisted that the changes to her trust were made at a time when she was already demented, and that the bank was required to let him review those changes before accepting them.
A trial judge dismissed Mr. Miller’s claims against the bank and the caretaker, and the Ohio Court of Appeals agreed. Whatever duty the bank owed was to Ms. Miller and not to her son, said the appellate judges. Furthermore, the mere diagnosis of dementia was not enough to establish that she could not amend her trust, or make gifts to her caretaker. In fact, the gifts were made not from her trust, but from an account which the bank did not control. Mr. Miller had failed to carry his burden of proof to show that the bank had made any mistake, and the case was properly dismissed.
The appellate court decision also approved dismissal of the claims against Ms. Miller’s caretaker and family members. The judges specifically noted that Mr. Miller didn’t seem to have had any questions about his mother’s competence when she paid off his mortgage, arranged a monthly allowance for him and made other large gifts to him. Miller v. KeyBank National Association, April 6, 2006.
After Paul Carter died at the Imperial of Hazel Crest Nursing Home in Illinois, his widow sued both the facility and the doctor in charge of his care. She claimed that after her husband was discharged from a hospital stay back to the nursing home, his physician failed to prescribe the insulin that Mr. Carter, a diabetic, needed to survive. She settled her lawsuit against the nursing home for $125,000; a jury awarded her $1.3 million against the attending physician.
In a sad irony, Mr. Carter was first admitted to Imperial precisely because his wife believed that it provided better care to bedridden patients than the nursing home and hospital where he had been treated. On his first admission his care was taken over by Dr. Abdol Azaran, the medical director at Imperial.
Mr. Carter had been a diabetic for over forty years, requiring daily injections of insulin. Dr. Azaran entered an order to continue daily insulin; because of Mr. Carter’s dementia, he was unable to participate in that or other treatment decisions.
A few days after his initial admission to Imperial, Mr. Carter was hospitalized for a urinary tract infection. During that stay Dr. Azaran ordered that his daily insulin shots be supplemented with periodic blood glucose checks and, when necessary, injections of a faster-acting insulin.
By the time Mr. Carter was returned to Imperial his daily insulin shots had been abandoned in favor of the regular glucose monitoring. In the course of the readmission, however, Dr. Azaran’s order for fast-acting insulin also got cancelled, so that Mr. Carter received no insulin whatsoever. He also had decubitis ulcers on his tailbone and heel, and he refused to (or could not) eat. Mrs. Carter discovered that the insulin had been stopped when she inquired about his condition.
Dr. Azaran did not return at least three attempts to page him for instructions on Mr. Carter’s care, and he was finally re-hospitalized at the direction of Imperial’s Nursing Director. Doctors at the hospital found that he had suffered a mild heart attack, and treated him for decubitis ulcers, dehydration, pneumonia and infection of both his bladder and his decubitis ulcers. Mr. Carter was discharged back to Imperial a month later, and lived another three months at the facility.
The jury awarded $55,000 for actual medical expenses, $385,000 for aggravation of existing medical conditions and $1,060,000 for pain and suffering against Dr. Azaran, and he appealed. The Illinois Court of Appeals upheld the judgment; the evidence supported the jury’s award and it did not “exceed the limits of fair and reasonable compensation.” Dr. Azaran’s novel argument that Mr. Carter “would have paid for a bed to sleep in at the nursing home” did not mean his estate could not recover all the costs of medical care. Carter v. Azaran, July 22, 2002.
Late-life marriages, of course, are usually unions of love—even when entered into by widows and widowers with families from earlier marriages. The strains on family relationships can be severe, but love can conquer all. Sometimes, though, late marriages can be the product of manipulation and overreaching by one of the spouses. While there is little empirical data to indicate any change, it seems increasingly common that mildly (or even severely) demented seniors are drawn into marriages with (often younger) caretakers, opportunists or even, sometimes, well-meaning but self-interested acquaintances. A recent Illinois case explored the aftermath of such a relationship.
John R. Lundahl and Elizabeth Gabel were married in Florida in August, 1988. By 1989, Mr. Lundahl had become so incapacitated that a guardian had been appointed to make both personal and financial decisions for him. His guardian sued to have the marriage annulled, arguing that Mr. Lundahl had actually been incapacitated at the time of the marriage, even though no court order had been entered to that effect.
After a year of negotiations Ms. Gabel agreed that the marriage could be annulled, but on the condition that Mr. Lundahl’s guardian pay her $1,700 per month for the rest of her life. Payments began in July of that year.
After Mr. Lundahl died in June, 2000, the question arose whether his probate estate was liable for continued payments for the rest of Ms. Gabel’s life. She argued that the agreement clearly required lifetime payments, and that it was akin to the property settlement agreement that might have been entered had the couple gotten a divorce. The probate court agreed and ordered that the payments continue.
The Illinois Court of Appeals disagreed. Annulment of the marriage, said the appellate court, was a judicial declaration that the marriage never existed, not that a valid marriage was ended. Since no marriage ever existed the settlement agreement should be judged according to general contract principles rather than the standards applied in divorce cases. Even if marital settlement agreement principles were applied the payments should end, the court decided.
Public policy considerations, said the judges, required that any intention to extend liability after the death of one party to a contract should be clearly expressed in the contract itself. Although this agreement was to continue for the rest of Ms. Gabel’s “natural life,” it was silent about what would happen on the death of Mr. Lundahl, the other party to the agreement. In the absence of clear language, Mr. Lundahl’s estate was not liable, and the payments to Ms. Gable ended on his death. Estate of Lundahl, July 16, 2002.
Two years before Erwin W. Schlueter died in 1997 at age 85, he had completed his estate planning. He had signed a will, a durable power of attorney for financial matters and a durable power of attorney for health care. When his relatives contested the validity of the will, they pointed to the powers of attorney as evidence that Mr. Schlueter knew he was already incompetent to make his own financial decisions.
Mr. Schlueter and his wife Frieda had watched neighbor Chris Bowers grow up, and they were particularly fond of him. In 1994, Mr. Schlueter even named the youngster as alternate agent in his power of attorney, to take effect if Frieda should die before him. Mr. Bowers was only seventeen years old at the time.
There was no doubt that Mr. Schlueter suffered from dementia at the time he executed his powers of attorney and (later) his will. His relatives asserted that the mere fact of the dementia diagnosis should be evidence of incapacity, and that they should be permitted to make the case for invalidating his will to a jury. In addition, they argued, when Mr. Schlueter signed the immediately effective power of attorney he tacitly admitted his own incapacity even before the will was signed.
Mr. Schlueter’s doctor and the witnesses to the will all agreed that he was confused, and that his short-term memory was poor. Mr. Bowers argued that the mere fact of a dementia diagnosis was not enough to get the case before a jury, and that the family had to show more specific evidence of lack of capacity.
Mr. Schlueter’s relatives pointed to the will itself. It identified his mother as his mother-in-law, and vice versa. It also described him as the “testatrix,” which would have made Mr. Schlueter a female. In response, Mr. Bowers submitted the affidavit of the secretary who prepared the wills for the Schlueters; she explained that she had prepared Mrs. Schlueter’s will first, and then switched names to make the identical will for Mr. Schlueter, and that the failure to switch “mother” and “mother-in-law” and to change “testatrix” to “testator” were her mistakes, not Mr. Schlueter’s.
The Wyoming Supreme Court reviewed the affidavits submitted and decided that there was insufficient evidence of incapacity to even submit the matter to a jury. The mistakes in the will, said the court, “demonstrate clerical carelessness rather than incapacity,” and the mere diagnosis of dementia did not preclude a finding that Mr. Schlueter had sufficient capacity to sign his will. Finally, granting a power of attorney, even an immediately effective power, can not be construed as an admission of incapacity. Estate of Schlueter, January 11, 2000.
Homer Cone suffered from dementia. As a result, he was placed in a nursing home in Missouri, run by national nursing home chain Beverly Enterprises. Apparently because of his confusion, he wandered out of the nursing home one winter day, got lost and died of hypothermia.
Mr. Cone’s daughter, Barbara C. Ragle, brought an action in Missouri Federal Court against Beverly Enterprises for its alleged negligence in allowing Mr. Cone’s death. The jury in the case found that Beverly Enterprises had been negligent, but that the damages for Mr. Cone’s wrongful death should be set at $100. Furthermore, ruled the jury, Mr. Cone was himself at fault, and his failure was responsible for 99% of the loss (his own death). Consequently, the jury awarded Ms. Ragle $1 for her father’s death.
Although the notion of finding a nursing home resident liable for his own confusion may at first seem completely out of line, there was evidence of Mr. Cone’s contribution to his own dilemma. Mr. Cone and his wife Ethel (who lived with him in the nursing home) deliberately removed a security bracelet that was designed to alert nursing staff of any attempt to leave the facility.
Ms. Ragle appealed to the Eight Circuit Court of Appeals, arguing that the amount of the judgment was grossly inadequate. She also argued that the jury should not have been permitted to find her father partially at fault for his own death.
Ms. Ragle first argued that the total damages of $100 were woefully inadequate. Her argument was based on the testimony of the investigating police officer responding to the emergency call on the morning of Mr. Cone’s death, coupled with the language of Mr. Cone’s death certificate (which starkly described his death as resulting from the fact that he “wandered out of nursing home in cold weather”). That, ruled the judges, was insufficient to show that the jury’s small damage award was “against the weight of the evidence”—the standard which Ms. Ragle was required to meet before a new trial could be ordered on damages.
Ms. Ragle also asked the judges to rule that a demented nursing home patient could never be responsible for his own injury or death, since he could not understand the nature or consequence of his acts. The court disagreed, however, observing that “mental infirmities exist in infinite degrees and with infinite levels and varieties of behavioral impairment.” Because of the variability of a demented patient’s level of understanding, the question of comparative fault should be left to the jury’s decision, and the Court of Appeals let stand the $1 award of damages against Beverly Enterprises. Ragle v. Beverly Enterprises, November 5, 1999.
Sidney Head lived in Georgia with his wife, Martha. He had married Martha late in life, after the death of his first wife; he had four grown children from his first marriage.
Col. Head’s ability to care for himself began to slip and, a few months after his eighty-fourth birthday, Martha sought appointment as his guardian and conservator and placed him in a Georgia adult care facility.
Over several visits, Col. Head’s children became alarmed that the care he received in the Georgia care home was inadequate. They complained that his confusion worsened due to a lack of appropriate programs for demented patients, that his personal dignity was not respected, and that he was inappropriately medicated (primarily with Haldol) during his stay.
Sometime prior to Col. Head’s placement in the Georgia care home, and before the guardianship and conservatorship was initiated, he had executed a durable medical power of attorney naming one of his sons as agent. After reading Georgia law as permitting a health care agent to act even after the appointment of a guardian, his son took steps to secure the treatment and care he believed his father desperately needed.
First, Col. Head’s son transferred his father to a clinic in the Chicago area which specialized in the treatment of Alzheimer’s patients by injection of testosterone, pituitary growth hormone and placental gonadotropin. After a brief stay at that facility, Col. Head was transferred to a Tucson-area nursing home, where the hormone treatments were continued.
After Col. Head’s arrival in Tucson, several of his children sought appointment as temporary guardian. They alleged that, despite Martha’s appointment as guardian in Georgia, she had not acted in his best interests, and that an emergency existed requiring their appointment, to assure the nursing home that he would not be removed and to authorize the continuation of his treatment program.
Martha Head, for her part, objected to the Arizona courts assuming jurisdiction of the matter. She argued that the Georgia guardianship gave her authority to make medical decisions for her husband, and that any objections to her decisions should be dealt with in those Georgia proceedings. She sought dismissal of the Tucson petition and a return to the Georgia courts for resolution of the dispute.
While proceedings were pending in Arizona, both parties continued to press their respective positions in the Georgia court. Martha Head secured an order directing that she could “exercise the powers” of Col. Head with respect to the power of attorney (in other words, revoke or restrict the appointment of Col. Head’s son as agent). The children, meanwhile, secured a Georgia court order compelling Martha Head (as conservator) to pay for the expensive hormone treatment program. Each party appealed the rulings in favor of the other.
Finally, Arizona’s court ruled on the question of jurisdiction. In a short ruling, Pima County Superior Court Judge William Sherrill (in one of his last rulings as chief Probate Judge for the Tucson area) ruled that “[b]ecause Mr. Head has a guardian and conservator appointed in the State of Georgia who is able to act on behalf of Mr. Head, this court finds no emergency necessitating its exercise of jurisdiction.” Furthermore, Judge Sherrill found that to relitigate any of the issues currently in controversy in Georgia “would be disrespectful to a competent court of a sister state.” In Re: Sidney A. Head, Sr., January 10, 1997.
Col. Head’s case was returned to Georgia for further resolution, even though he remains (for the moment, at least) in Arizona. While it may not be the final answer, it suggests that another state’s guardianship order will be respected in Arizona.
With nursing home costs approaching $40,000 per year for most residents, the government’s Medicaid program has for decades been the “safety net” for families with long-term care needs. In recent years, escalating Medicaid costs and increases in the portion of national nursing home bill paid by the program have resulted in Congressional efforts to reduce Medicaid eligibility and coverage. Prudent elders should be considering other ways to ensure that nursing home stays can be paid for if needed.
A relative handful of individuals have long-term care available from religious or service group affiliations. Another small portion of the population can rely on government programs other than Medicaid, but for most elders the only alternatives are to accumulate substantial personal wealth (a common goal, though sometimes difficult to realize) or purchase long-term care insurance (LTCI).
A recent review of LTCI purchasing strategies by Elder Law Forum (a newsletter published by Legal Counsel for the Elderly, Inc., and sponsored by AARP) points out some of the considerations for typical buyers. The review makes several points for the “typical” LTCI buyer:
About half of 65-year-old women and a third of the men will spend some time in a nursing home.
Most nursing home stays will be short, with the median length of institutionalization being slightly less than one year.
LTCI premiums currently average about $1,000 per year for 60-year-olds, and rise to $1,500 for 65-year-olds and $2,000 for 70-year-olds.
If you (or a relative or client) are concerned about long-term care costs, some pertinent questions to consider include:
When should you buy? The average age of new policyholders is currently 67. Many employers now offer group plans, and a few younger people may buy policies. But for most people, waiting until age 60 to make the purchase is probably reasonable.
Should both a husband and wife buy policies? In many cases, one spouse or the other may be uninsurable due to illness or age. The “well” spouse should particularly consider LTCI, since she (most commonly) is likely to survive the “ill” spouse, and therefore have no spouse to care for her. Of course, this is another way of saying that the well spouse is likely to spend some considerable time providing care for the ill, uninsurable spouse, as well.
Does family history matter? If a potential LTCI buyer has a family history of strokes, high blood pressure, dementia, Parkinson’s or other conditions likely to require long-term care, insurance is more strongly indicated. Such persons should make the initial purchase at younger ages, since the onset of disability will usually make them uninsurable.
Does net worth make a difference? Couples with a net worth of less than $100,000 (not counting the family home), and individuals worth less than $50,000, may not need to consider LTCI, since (current) Medicaid rules will permit them to receive government assistance within a year or two of nursing home admission. Prospective LTCI buyers with large estates may not need the insurance, particularly if their estates generate $40,000 in annual income over and above their (or their spouse’s) other living expenses. In other words, LTCI is primarily of interest to the middle-class elderly.
How important are individual policy provisions? Very. Some policies provide excellent coverage for home health care, while others do not; a policy without home care provisions might unnecessarily force the owner into an institution.
A checklist for comparison shoppers can help frame some of the issues. For a helpful checklist, contact FLEMING & CURTI at the fax, e-mail or street address below.
330 N. Granada Avenue, Tucson, Arizona 85701
520-622-0400 / FAX: 520-203-0240
Elma Mason, a 77-year-old Massachusetts woman, suffered from congestive heart failure, anemia, diabetes, pulmonary hypertension and mild dementia. She was being treated in Massachusetts General Hospital, and her treatment team agreed that she should not be treated aggressively in the event of cardiopulmonary arrest.
Ms. Mason’s son Joseph was actively involved in his mother’s care. In fact, in the view of the hospital, he was too actively involved. Hospital personnel complained that Joseph had disrupted the hospital’s schedule, abused the staff and repeatedly claimed that the staff had neglected and mistreated his mother. The hospital sought to have a disinterested person appointed as guardian for Ms. Mason.
After the appointment of the hospital’s nominee on a temporary basis, the new guardian consented to entry of a “do not resuscitate” order for Ms. Mason. Joseph appealed the guardian’s decision, and produced three different documents, apparently signed by Ms. Mason, naming Joseph as the person to make medical (as well as financial) decisions for her. Joseph argued that the temporary guardian should have no power to make medical decisions in the face of the medical powers of attorney.
The Massachusetts Court of Appeals agreed that the guardian could be permitted to place the “do not resuscitate” order. The court specifically found that the evidence showed Joseph was “incapable of making health care determinations based upon a true assessment of Elma’s best interests.” Even assuming that the health care powers of attorney were valid, the temporary guardian’s decisions would stand. In Re Guardianship of Mason, September 17, 1996.
The Mason case illustrates a common potential for conflict. With the growing prevalence of advance directives generally, and durable health care powers of attorney in particular, what should health care providers do when family members and agents do not appear to be acting in the “best interests” (a phrase admittedly open to interpretation) of the patient? More importantly, what should they do when the family member or agent is making decisions different from those directed in the living will or other advance directive?
Arizona law is very clear. Health care providers are required to comply with the stated wishes of patients (as set out, for instance, in living wills). Surrogates (including both agents and family members) are also required to follow the patient’s wishes. Where surrogates choose not to follow the instructions of the patient, there is provision for a relatively simple and speedy court proceeding to determine the patient’s wishes and direct the surrogate to act accordingly.
Are health care providers required to take every such concern (or dispute) to court? No, but providers should be aware of their ultimate duty to carry out the patient’s wishes regarding treatment. If family members persist in their refusal to act according to an advance directive after counseling, negotiation, involvement of ethics committees and good medicine and social work practice, legal action may be required.
Ms. Mason’s case implies a subtly different question. What should the health care provider do when there is not clear direction from the patient, but the surrogate is acting inappropriately? Of course, disruption and abuse may be in the eyes of the beholder, and health care providers should be slow to try to overrule family wishes. But when there is no clear expression of the patient’s wishes, the treatment team must look to the patient’s “best interests.” If family members are acting contrary to that principle, once again court action may be the only option.
Arizona law on the duties of health care providers to follow surrogates’ instructions can be found at Arizona Revised Statutes ’36-3204.
The common usage of “dementia” usually refers to loss of intellectual functioning or diminished mental capacity. Frequently, the term is used to describe any of a wide variety of illnesses or conditions, without distinguishing among the possible causes.
In a similar way, “Alzheimer’s” is commonly used to describe almost all demented individuals, regardless of the actual reason for the diminution of capacity. It is commonly understood that Alzheimer’s Disease is a diagnosis of exclusion; other than autopsy, it is usually impossible to definitively diagnosis Alzheimer’s, and the diagnosis is reached by excluding all other possible diseases.
For many purposes, the difference between a diagnosis of Alzheimer’s and, for example, vascular dementia is unimportant. Most dementias are irreversible, and there is little evidence to suggest that the progress of many dementing illnesses can be slowed. Still, it is both important and interesting to know what different illnesses might cause dementia, and the relative frequency of each.
In their 1992 book “Dementia: A Clinical Approach,” medical researchers Jeffrey L. Cummings and D. Frank Benson survey the existing literature about dementia. Among demented patients, the frequency of each cause varies according to the researcher. Cummings and Benson caution that the estimates of Alzheimer’s disease, in particular, are almost certainly overstated, but the research suggests the following frequencies:
Alzheimer’s Disease–25-50%
Vascular (multi-infarct) Dementia–10-25%
Depression and other psychiatric disorders–10-20%
Alcoholic Dementia–2-12%
Other causes, each accounting for between one or two percent and ten percent of all dementias, include metabolic conditions, infections, toxic conditions, Huntington’s and Parkinson’s diseases and other, less frequent causes.
Clearly, Alzheimer’s Disease is the most common dementing condition, but other causes collectively account for more dementia. The very fact that Alzheimer’s is a diagnosis of exclusion operates to inflate its reported frequency, since unidentified dementias will usually be lumped into that category.
Cummings and Benson also report several studies about the frequency of dementia in various groups. Among those 65 or over, approximately 6% can be expected to suffer from severe dementia, and another 10% to 15% evidence mild to moderate impairment.
The frequency of dementia, not surprisingly, increases with age. The percentage of demented individuals can be expected to double for each five-year increment in age, so that about 20% of those over age 75 will show severe symptoms of dementia.
Dementia should be expected to appear more frequently in more restrictive medical facilities, and that expectation is borne out by the research. About 54% of state hospital patients demonstrate severe dementia, while 30% of nursing home residents and 15% of retirement community residents are severely demented. Mild dementia (or worse) can be expected in 94% of state hospital patients, 87% of nursing home residents and 80% of retirement community residents.
What do these figures mean for the treatment or care of demented patients? The high frequency of dementia other than Alzheimer’s Disease suggests the importance of differential diagnosis of dementing illnesses. While most dementia is irreversible, some (such as metabolic conditions and infection) may be treated, and the progress of others (notably vascular dementia) may be slowed by drug therapy and/or diet. And diagnosis and treatment regimens become more important with age and type of treatment facility.
Roland Monicken resided in the St. Croix Health Care Center, a Wisconsin nursing home. Mr. Monicken suffered from dementia, and had a history of combativeness and disorientation. On one occasion, head nurse Sheri Gould found Mr. Monicken in another resident’s room and attempted to return him to his own room. Unfortunately, Mr. Monicken resisted Ms. Gould’s attempts and apparently struck her or pushed her down, injuring her.
Ms. Gould brought an action against Mr. Monicken and his wife. Mr. Monicken’s homeowner’s insurance company defended, arguing that he could not be held liable for his actions because of his dementia.
After the evidence had been presented to the jury, the trial judge instructed jurors to ignore Mr. Monicken’s mental condition in determining whether he should be held liable. The jury subsequently awarded Ms. Gould damages against Mr. Monicken’s insurance company.
The Wisconsin Supreme Court disagreed with the trial judge’s view of the law. The Supreme Court noted the long-standing rule used by the trial court; since at least 1616, most English (and, subsequently, American) courts have agreed that mental disability is no defense to a personal injury action. The reasons for holding disabled individuals liable for their actions include:
As between two “innocent” persons (the mentally disabled person and the injured person), it is better to charge damages to the person who caused the injury.
If disabled individuals are held liable, family members will exercise more caution to restrain them and monitor their behavior.
Permitting defendants in civil actions to, in effect, plead “insanity” would encourage them to feign illness to avoid liability.
Despite three centuries of precedent, the Wisconsin Supreme Court decided that the rationale for imposing liability did not apply to Mr. Monicken. Analyzing the three principles as they applied to Ms. Gould’s injury, the Court noted:
Ms. Gould was not the kind of “innocent” victim imagined by previous cases. She worked in a facility devoted to treating disabled individuals, and was well aware of the risks associated with the care, specifically, of Mr. Monicken. Placing the duty of care on Mr. Monicken was, therefore, too great a burden, since his disability was the precise reason for his institutionalization.
Mr. Monicken’s family could not be expected to do more to contain his violence. In fact, placement in Ms. Gould’s care was precisely the sort of precautionary measure they should be encouraged to take.
While the Court was concerned about malingering defendants, it seems unlikely that Mr. Monicken would be willing to pretend dementia for years in order to avoid civil liability.
As a result, Ms. Gould’s lawsuit against Mr. Monicken was thrown out. Wisconsin’s Supreme Court has carved out a narrow exception to the rules governing liability, but one which could have widespread effect in nursing and similar facilities. Gould v. American Family Mutual Insurance Co., January 30, 1996.
While Arizona has not expressly adopted the new Wisconsin approach to liability in nursing homes, the logic seems compelling. A similar result might well be expected if and when Arizona’s courts are asked to address the question.
