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DraftOpinion -- Draft  =Y(Xdd=:%\  `$Times NewRoman(2$ !    8z ?=dXXd8     & A`ArialTTltt8Italic 12ptItalics Courier 12pt type[2H  9`(.Courier NewItalicTT[[2H  9`(.Courier NewItalicTT[7|A`$ArialTTR& 8BibliogrphyBibliography0....fE2Doc InitInitialize Document Style%( )    (&'(($0 ($0 0 (($0 0 0    A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)jD4Tech InitInitialize Technical Style( + ( CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1x?u2PleadingHeader for numbered pleading paper 3(2$ !    8z ?=dXXd8     % [  `*Times New RomanTT 2Home PtrSets codes for printing opinions on Sperry Laser X   C"3 HA`$ArialTTCXXXO1<6X9`("Courier NewTTO#12Xd#<6X9`("Courier NewTTH  9`(.Courier NewItalicTT  ./ ʣ/z3|x(#$  0   Level 1 Level 2 Level 3 Level 4 Level 5(2$ !    8z ?=dXXd8     2J+M 0_level1  X 2( ` hp x 223  ..  5+ ` hp x 5  2G+M 0_level2   /%` ` hp x /23  ..  5+ ` hp x 5  2D+M 0_level3   ," hp x ,23  ..  5+ ` hp x 5  2A+M 0_level4  ` ) hp x )23  ..  5+ ` hp x 5  2>+M 0_level5   &hhp x &23  ..  5+ ` hp x 5  2;+M 0_level6   #p x #23  ..  5+ ` hp x 5  28+M 0_level7  h  p x 23  ..  5+ ` hp x 5  25+M 0_level8   pp x 23  ..  5+ ` hp x 5  22+M 0_level9    x 23  ..  5+ ` hp x 5  2JM 0_levsl1  X 2( ` hp x 223  Ԁ  5+ ` hp x 5  2GM 0_levsl2   /%` ` hp x /23  Ԁ  5+ ` hp x 5  2DM 0_levsl3   ," hp x ,23  Ԁ  5+ ` hp x 5  2AM 0_levsl4  ` ) hp x )23  Ԁ  5+ ` hp x 5  2>M 0_levsl5   &hhp x &23  Ԁ  5+ ` hp x 5  2;M 0_levsl6   #p x #23  Ԁ  5+ ` hp x 5  28M 0_levsl7  h  p x 23  Ԁ  5+ ` hp x 5  25M 0_levsl8   pp x 23  Ԁ  5+ ` hp x 5  22M 0_levsl9    x 23  Ԁ  5+ ` hp x 5  2JM 0_levnl1  X 2( ` hp x 223   5+ ` hp x 5  2GM 0_levnl2   /%` ` hp x /23   5+ ` hp x 5  2DM 0_levnl3   ," hp x ,23   5+ ` hp x 5  2AM 0_levnl4  ` ) hp x )23   5+ ` hp x 5  2>M 0_levnl5   &hhp x &23   5+ ` hp x 5  2;M 0_levnl6   #p x #23   5+ ` hp x 5  28M 0_levnl7  h  p x 23   5+ ` hp x 5  25M 0_levnl8   pp x 23   5+ ` hp x 5  22M 0_levnl9    x 23   5+ ` hp x 5  0.Normal<:Definition T<AA:Definition L , 5+ ` hp x 5  5+ ` hp x 586Definition(''&H1      XXX(&H2  XXX(&H3  XXX(&H4 XXX XXX(&H5  XXX(&H6  XXX20Address8MM6Blockquote , , 5+ ` hp x 5   5+ ` hp x 5,*CITE,dl*CODEK<6X9`(Courier NewKXXXS`\  `&Times New RomanS42Emphasis64Hyperlink    <:FollowedHype    4go2Keyboard K<6X9`(Courier NewK XXXS`\  `&Times New RomanS<:Preformatted/%  ,Kk %#/K<6X9`(Courier NewKXXXS`\  `&Times New RomanS/%  ,Kk %#/<:zBottom of 7\(X7  ?%2A`Arial?7](X7  XXXS`\  `&Times New RomanS<:zTop of For7(X7  ?%2A`Arial?7](X7  XXXS`\  `&Times New RomanS[)2dxd0KS.SampleK<6X9`(Courier NewKS`\  `&Times New RomanS0.Strong 8dl6TypewriterK<6X9`(Courier NewKXXXS`\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB  ($gh]A<< c(O$G:\APPS\COREL_~1\OPINION1.WPTG:\APPS\Corel_template\Opinion1.wpt<6X9`(Courier New%2A`Arial<  9Z+ Courier New   U$ 5XX    1    _ActofJune14,1989,71stLeg.,R.S.,ch.678,1,1989,Tex.Gen.Laws2982(formerlyTex.Health&  SafetyCode672.002.021),amended&renumberedbyActofJune18,1999,76thLeg.,R.S.,ch.450,1.02  .03,1999Tex.Gen.Laws2836(currentversionatTex.Health&SafetyCode166.001.166). U$ 5XX    2    _36S.W.3d187,195.  U$ 5XX    3    _Cruzexrel.Cruzv.PasoDelNorteHealthFound.,44S.W.3d622,642n.16(Tex.App.-ElPaso2001,  pet.denied). U$ 5XX    4    _Id. U$ 5XX    5    _36_ԀS.W.3dat193. U$ 5XX    6    _Id. U$ 5XX    7    _Id.at19394;seeTex.Health&SafetyCode166.051. U$ 5XX    8    _36_ԀS.W.3dat195. U$ 5XX    9    _Id. U$ 5XX    10    _Id. U$ 5XX    11    _Id. U$ 5XX    12    _Id.__ U$ 5XX    13    _Id.at196. U$ 5XX    14    _Id.at197. U$ 5XX    15    _Id. U$ 5XX    16    _Id. U$ 5XX    17    _Id. U$ 5XX    18    _Id.at199. U$ 5XX    19    _SeePrincev.Massachusetts,321U.S.158,166(1944). U$ 5XX    20    _Parhamv.J.R.,442U.S.584,602(1979)(citationsomitted). U$ 5XX    21    _Tex.Fam.Code151.001(a)(6). U$ 5XX    22    _36S.W.3dat191;seeCruzanv.Director,Mo.DeptofHealth,497U.S.261,270(1990). U$ 5XX    23    _Bowenv.Am.Hosp.Assn,476U.S.610,627n.13(1986)(citationomitted). U$ 5XX    24    _Id. U$ 5XX    25    _Tex.Fam.Code151.001(d)(1)._  U$ 5XX    26    _See,e.g.,O.G.v.Baum,790S.W.2d839,84041(Tex.App.!Houston[1stDist.]1990,orig.  proceeding);Mitchellv.Davis,205S.W.2d812,81315(Tex.Civ.App.!Dallas1947,writrefd). U$ 5XX    27    _SeeWilsonv.Scott,412S.W.2d299,301(Tex.1967). R U$ 5XX    28    _Gravisv.Physicians&SurgeonsHosp.,427S.W.2d310,311(Tex.1968);seeMossv.Rishworth,222  S.W.225,22627(Tex.CommnApp.1920,judgmtapproved). U$ 5XX    29    _Gravis,427S.W.2dat311. U$ 5XX    30    _222S.W.at226. U$ 5XX    31    _Id. U$ 5XX    32    _Seeid. U$ 5XX    33    _Tex.Fam.Code32.001. U$ 5XX    34    _Tex.Health&SafetyCode773.008(3). U$ 5XX    35    _Tex.Rev.Civ.Stat.art.4590i,6.07(a)(2). U$ 5XX    36    _Cf.Canterbury_Ԁv.Spence,464F.2d772,78889(D.C.Cir.1972). U$ 5XX    37    _Restatement(Second)ofTorts892D(b)(1979). U$ 5XX    38    _Cf.Canterbury,464F.2dat788. U$ 5XX    39    _678S.W.2d918,925(Tex.1984). U$ 5XX    40    _36_ԀS.W.3dat198. + U$ 5XX    41    _SeeLoneStarPartnersv.NationsBankCorp.,893S.W.2d593,598_99(Tex.App."Texarkana1994,  writdenied). `  U$ 5XX    42    _42U.S.C.5101etseq.;45C.F.R.1340.1etseq. U$ 5XX    43    _42U.S.C.5106a(b)(2)(B)_(footnoteomitted)._  U$ 5XX    44    _See,e.g.,Tex.Fam.Code261.101,261.103;d C 40Tex.Admin.Code700.504. Ul$==Xdd=    XnXXX    47    _Tex.Fam.Code261.001(4)(B)(ii). U$ 5XX    45    _36S.W.3dat19697. U$ 5XX    46    _Tex.Health&SafetyCode166.051.  HCAParham J.R.parenspatriae A]sjudgmtRishworth S.W.Krusenha[ve !    8d?=dd8     _  RdXX@ INTHESUPREMECOURTOFTEXAS   #XX Rd#    K\(X. &K@%No.-  010079-  Ԉ V N     K](Xj b((K-  @SidneyAinsleyMiller,byandThroughHernextFriendKarlaH.Miller,andKarla V N @O O H.MillerandJ.MarkMiller,Individually-  Ԉ B : -  @)v.  @KKHca,Inc.,HcahospitalCorporationofAmerica,HospitalCorporationofAmerica   @ andColumbia/HcaHealthcareCorporation-  Ԉ     K\(X K@44OnPetitionforReviewfromthe   @# # CourtofAppealsforthe-  Fourteenth-  ԀDistrictofTexas     K](X ((K @ArguedonApril3,2002     JusticeEnochdeliveredtheopinionoftheCourt.    JusticeONeillandJusticeSmithdidnotparticipateinthedecision. vn   ThenarrowquestionwemustdecideiswhetherTexaslawrecognizesaclaimbyparentsfor :2 eitherbatteryornegligencebecausetheirprematureinfant,bornalivebutindistressatonlytwenty   threeweeksofgestation,wasprovidedresuscitativemedicaltreatmentbyphysiciansatahospital   withoutparentalconsent.Thecourtofappeals,withonejusticedissenting,heldthatneitherclaim " couldbemaintainedasamatteroflawbecauseparentshavenorighttorefuseurgentlyneededlife $ sustainingmedicaltreatmentfortheirchildunlessthechildsconditionis certifiablyterminal r&j! undertheNaturalDeathAct f#  1      ׀(nowtheAdvanceDirectivesAct). f#  2      ׀Andhereitisundisputedthatthe J(B!# Millersnewborninfantwasnot certifiablyterminal.    Althoughweagreewiththecourtofappealsjudgment,ourreasoningdifferssomewhat.  First,thereisnodisputeintheevidencethattheMillersprematureinfantcouldnotbefully   evaluatedformedicaltreatmentuntilbirth.Asaresult,anydecisionsconcerningtreatmentforthe   Millerschildwouldnotbefullyinformeddecisionsuntilbirth.Second,theevidencefurther h` establishedthatoncetheinfantwasborn,thephysicianattendingthebirthwasfacedwithemergent @8  circumstances"i.e.,thechildmightsurvivewithtreatmentbutwouldlikelydieiftreatmentwas   notprovidedbeforeeitherparentalconsentoracourtorderoverridingthewithholdingofsuch   consentcouldbeobtained.    Weholdthatcircumstancesliketheseprovideanexceptiontothegeneralruleimposing  liabilityonaphysicianfortreatingachildwithoutconsent.ThatexceptioneliminatestheMillers xp claimforbattery.WefurtherconcludethattheMillersnegligenceclaim"premisednotonany PH physiciansnegligenceintreatingtheinfantbutonthehospitalspolicies,orlackthereof,permitting (  aphysiciantotreattheirinfantwithoutparentalconsent"failsasamatteroflawforthesame  reasons.Weaccordinglyaffirmthecourtofappealsjudgment.   @& I.Facts  "   TheunfortunatecircumstancesofthiscasebeganinAugust1990,whenapproximatelyfour $  monthsbeforeherduedate,KarlaMillerwasadmittedtoWomansHospitalofTexas(the `&X"  Hospital)inprematurelabor.AnultrasoundrevealedthatKarlasfetusweighedabout629grams 8(0!$ or11/4poundsandhadagestationalageofapproximatelytwentythreeweeks.Becauseofthe *#& fetussprematurity,Karlasphysiciansbeganadministeringadrugdesignedtostoplabor. +$(   KarlasphysicianssubsequentlydiscoveredthatKarlahadaninfectionthatcouldendanger  herlifeandrequirethemtoinducedelivery.Dr.MarkJacobs,Karlasobstetrician,andDr.Donald  Kelley,aneonatologistattheHospital,informedKarlaandherhusband,MarkMiller,thatifthey   hadtoinducedelivery,theinfanthadlittlechanceofbeingbornalive.Thephysiciansalsoinformed   theMillersthatiftheinfantwasbornalive,itwouldmostprobablysuffersevereimpairments, h` includingcerebralpalsy,brainhemorrhaging,blindness,lungdisease,pulmonaryinfections,and @8  mentalretardation.Marktestifiedattrialthatthephysicianstoldhimtheyhadneverhadsucha   prematureinfantliveandthatanythingtheydidtosustaintheinfantslifewouldbeguesswork.     Aftertheirdiscussion,Drs.JacobsandKelleyaskedtheMillerstodecidewhetherphysicians  shouldtreattheinfantuponbirthiftheywereforcedtoinducedelivery.Atapproximatelynoonthat  day,theMillersinformedDrs.JacobandKelleythattheywantednoheroicmeasuresperformedon xp theinfantandtheywantednaturetotakeitscourse.Marktestifiedthatheunderstoodheroic PH measurestomeanperformingresuscitation,chestmassage,andusinglifesupportmachines.Dr. (  KelleyrecordedtheMillersrequestinKarlasmedicalnotes,andDr.Jacobsinformedthemedical  staffattheHospitalthatnoneonatologistwouldbeneededatdelivery.MarkthenlefttheHospital   tomakefuneralarrangementsfortheinfant. "   Inthemeantime,thenursingstaffinformedotherHospitalpersonnelofDr.Jacobs $  instructionthatnoneonatologistwouldbepresentinthedeliveryroomwhentheMillersinfantwas `&X" born.AnafternoonofmeetingsinvolvingHospitaladministratorsandphysiciansfollowed.Between 8(0!$ approximately4:00p.m.and4:30p.mthatday,AnnaSummerfield,thedirectoroftheHospitals *#& neonatalintensivecareunit,andseveralphysicians,includingDr.Jacobs,metwithMarkuponhis +$( returntotheHospitaltofurtherdiscussthesituation.MarktestifiedthatMs.Summerfield  announcedatthemeetingthattheHospitalhadapolicyrequiringresuscitationofanybabywhowas  bornweighingover500grams.AlthoughMs.Summerfieldagreedthatshesaidthat,theonly   writtenHospitalpolicyproduceddescribedtheNaturalDeathActanddidnotmentionresuscitating   infantsover500grams. h`   Moreover,thephysiciansatthemeetingtestifiedthattheyandHospitaladministratorsagreed @8  onlythataneonatologistwouldbepresenttoevaluatetheMillersinfantatbirthanddecidewhether   toresuscitatebasedontheinfantsconditionatthattime.AsDr.Jacobstestified:   8  [W]hatwefinallydecidedthateveryonewantedtodowastonotmakethecallprior  tothetimeweactuallysawthebaby.Deliverthebaby,becauseyouseetherewas  this[question]isthebabyreally23weeks,oristhebabyfurtheralong,howbigis  thebaby,whatarewedealingwith.Wedecidedtolettheneonatologistmakethe  callbylookingdirectlyatthebabyatbirth.xp   Anotherphysicianwhoattendedthemeetingagreed,testifyingthattodenyanyattemptsat PH resuscitationwithoutseeingtheinfantsconditionwouldbeinappropriateandbelowthestandard (  ofcare.    AlthoughDr.EduardoOtero,theneonatologistpresentinthedeliveryroomwhenSidneywas   born,didnotattendthatmeeting,heconfirmedthatheneededtoactuallyseeSidneybeforedeciding " whattreatment,ifany,wouldbeappropriate: $  8  Q.0`   Canyou...tellusfromaworstcasescenariotoabestcasescenario,what `&X" typeofpossibilitiesyouveseeninyourownpersonalpractice?L'D #` `  8  A.0`   Well,theworstcasescenariois...thebabycomesoutanditsdead,ithas $)"% noheartrate....Oryouhavebabiesthatactuallygothrougharockystart *#& thencruisethroughtherestandgohome.Andtheymayhavesmall *#' handicapsortheymayhavesomeproblemsbut"learningdisabilitiesor +$( somethinglikethat,butingeneral,allbabiesarenormalchildrenorfairly  normalchildren.` `  8  Q.0`   Andisthereanywaythatyoucouldhavemadeaprediction,atthetimeof   Sidneysbirth,whereshewouldfallinthatrangeofdifferentoptions? ` `    A.0 ` No,sir. ` (#` (# 8  Q.0`   Isthereanywaythatyoucanmakethatdecision,astowhetherthenewborn h` infantwillbeviableornotinacasesuchasSidneys,beforethetimeof TL  delivery,anassessmentatthetimeofdelivery?@8 ` `    A.0 ` No. ` (#` (#   Marktestifiedthat,afterthemeeting,Hospitaladministratorsaskedhimtosignaconsent   formallowingresuscitationaccordingtotheHospitalsplan,butherefused.Markfurthertestified  thatwhenheaskedhowhecouldpreventresuscitation,Hospitaladministratorstoldhimthathe  coulddosobyremovingKarlafromtheHospital,whichwasnotaviableoptiongivenhercondition. xp Dr.JacobsthennotedinKarlasmedicalchartsthataplanforevaluatingtheinfantuponherbirth PH wasdiscussedatthatafternoonmeeting. (    Thatevening,Karlasconditionworsenedandheramnioticsacbroke.Dr.Jacobsdetermined  thathewouldhavetoaugmentlaborsothattheinfantwouldbedeliveredbeforefurther   complicationstoKarlashealthdeveloped.Dr.Jacobsaccordinglystoppedadministeringthedrug " toKarlathatwasdesignedtostoplabor,substitutinginsteadadrugdesignedtoaugmentlabor.At $  11:30p.m.thatnight,Karladeliveredaprematurefemaleinfantweighing615grams,whichthe `&X" MillersnamedSidney.Sidneysactualgestationalagewastwentythreeandoneseventhweeks. 8(0!$ Andshewasbornalive. *#&   Dr.OteronotedthatSidneyhadaheartbeat,albeitataratebelowthatnormallyfoundin +$( fulltermbabies.HefurthernotedthatSidney,althoughblueincolorandlimp,gaspedforair,  spontaneouslycried,andgrimaced.Dr.OteroalsonotedthatSidneydisplayednodysmorphic  featuresotherthanbeingpremature.Heimmediately baggedand intubatedSidneytooxygenate   herblood;hethenplacedheronventilation.Heexplainedwhy:   8  Becausethisbabyisaliveandthisisababythathasareasonablechanceofliving. h` Andagain,thisisababythatisnotnecessarilygoingtohaveproblemslateron. TL  Therearebabiesthatsurviveatthisgestationalagethat"withthisbirthweight,that @8  laterongoonanddowell.,$    NeitherKarlanorMarkobjectedatthetimetothetreatmentprovided.     Sidneyinitiallyrespondedwelltothetreatment,asreflectedbyherApgarscores.AnApgar   scorerecordsfivedifferentcomponentsofanewborninfant:respiratoryeffort,heartrate,reflex  activity,color,andmuscletone. f#  3      ׀Eachcomponentgetsascoreofzero,one,ortwo,withascoreof  tworepresentingthebestcondition. f#  4      ׀SidneystotalApgarscoreimprovedfromathreeatone d\ minuteafterbirthtoasixatfiveminutesafterbirth.Butatsomepointduringthefirstfewdaysafter <4 birth,Sidneysufferedabrainhemorrhage"acomplicationnotuncommonininfantsbornso   prematurely.    TherewasconflictingtestimonyaboutwhetherSidneyshemorrhageoccurredbecauseofthe ! treatmentprovidedorinspiteofit.Regardlessofthecause,aspredictedbyKarlasphysicians,the # hemorrhagecausedSidneytosufferseverephysicalandmentalimpairments.Atthetimeoftrial, t%l! Sidneywassevenyearsoldandcouldnotwalk,talk,feedherself,orsituponherown.The L'D # evidencedemonstratedthatSidneywaslegallyblind,sufferedfromseverementalretardation,  cerebralpalsy,seizures,andspasticquadriparesisinherlimbs.Shecouldnotbetoilettrainedand  requiredashuntinherbraintodrainfluidsthataccumulatethereandneededcaretwentyfourhours   aday.Theevidencefurtherdemonstratedthathercircumstanceswillnotchange.      TheMillerssuedHCA,Inc.,HCAHospitalCorporationofAmerica,HospitalCorporation h` ofAmerica,andColumbia/HCAHealthcareCorporation(collectively, HCA),andtheHospital, @8  asubsidiaryofHCA.Theydidnotsueanyphysicians,includingDr.Otero,thephysician_who_   actuallytreatedSidney.Instead,theMillersassertedbatteryandnegligenceclaimsonlyagainst   HCAandtheHospital.    TheMillersclaimsstemmedfromtheirallegationsthatdespitetheirinstructionstothe  contrary,theHospitalnotonlyresuscitatedSidneybutperformedexperimentalproceduresand xp administeredexperimentaldrugs,withoutwhich,inallreasonablemedicalprobability,Sidneywould PH nothavesurvived.TheMillersalsoallegedthattheHospitalsactsand/oromissionswere (  performedwithHCAsfullknowledgeandconsent.AlthoughtheMillersdidnotsueDr.Otero,  theyallegedthatheandotherHospitalpersonnelweretheHospitalsapparentorostensibleagents.     TheMillersallegedthattheHospital,HCA,Inc.,andHospitalCorporationofAmericawere " alteregosoforbusinessconduitscreatedandmaintainedforimpermissiblepurposesbyHCA $  HospitalCorporationofAmerica.TheMillersfurtherallegedthattheHospital,HCA,Inc.,and `&X" HospitalCorporationofAmericaintegratedtheirresourcestoachieveacommonbusinessenterprise. 8(0!$ Thus,theMillersassertedthattheHCAdefendantswerejointlyandseverallyliable.Thetrialcourt *#& grantedHCAsmotionforaseparatetrialfromtheHospitalandthen,attheMillersrequest,tried +$( theMillersclaimsagainstHCAfirst.    ThoughtheHospitalwasnotapartyatthetrialagainstHCA,thetrialcourtsubmitted  questionstothejuryabouttheHospitalsconduct.ThejuryfoundthattheHospital,withoutthe   consentofKarlaorMarkMiller,performedresuscitativetreatmentonSidney.Thejuryalsofound   thattheHospitalsandHCAsnegligence proximatelycausedtheoccurrenceinquestion.Thejury h` concludedthatHCAandtheHospitalweregrosslynegligentandthattheHospitalactedwithmalice. @8  ThejuryalsodeterminedthatDr.OteroactedastheHospitalsagentinresuscitatingSidneyandthat   HCAwasresponsiblefortheHospitalsconductunderalteregoandsinglebusinessenterprise   theories.ThetrialcourtrenderedjudgmentjointlyandseverallyagainsttheHCAdefendantsonthe  jurysverdictof$29,400,000inactualdamagesformedicalexpenses,$17,503,066inprejudgment  interest,and$13,500,000inexemplarydamages. xp    HCAappealed.Thecourtofappeals,withonejusticedissenting,reversedandrendered PH judgmentthattheMillerstakenothing.ThecourtconcludedthattheTexasLegislatureallowed (  parentstowithholdmedicaltreatment,urgentlyneededornot,forachildwhosemedicalcondition  iscertifiablyterminalundertheNaturalDeathAct. f#  5      ׀ButthecourtheldthattheLegislaturehadnot   extendedthatrighttoparentsofchildrenwithnonterminalimpairments,deformities,ordisabilities, " regardlessoftheirseverity.T f#  6      ׀ $     ThecourtacknowledgedthattheNaturalDeathActdidnot impairorsupersedeanylegal `&X" rightapersonmayhavetowithholdorwithdrawlife-sustainingtreatmentinalawfulmanner. f#  7      ׀But   thecourtnotedthatthepartieshadnotcited,andthecourtdidnotfind,anyauthorityallowinga  parenttowithholdurgentlyneededlifesustainingmedicaltreatmentfromanonterminallyillchild.   Thus,thecourtconcludedthat,totheextentaninfantsconditionisnotcertifiedasterminal,ahealth   careproviderisundernodutytofollowaparentsinstructiontowithholdurgentlyneededlife h` sustainingmedicaltreatment.T f#  8      ׀ @8    Thecourtnotedthatwhennonurgentlyneededornonlifesustainingmedicaltreatmentis   proposedforachild,acourtorderisneededtooverrideaparentsrefusaltoconsenttothetreatment   becauseadeterminationofsuchissuesasthechildssafety,welfare,andbestinterestcanvaryunder  differingcircumstancesandalternatives. f#  9      ׀Butthecourtheldthatwhentheneedforlifesustaining  medicaltreatmentisorbecomesurgentwhileanonterminallyillchildisunderahealthcare xp providerscare,andwhenthechildsparentsrefuseconsenttotreatment,acourtorderis PH unnecessarytooverridethatrefusal.l f#  10      ׀Accordingtothecourt,nolegalorfactualissueexiststo (  decideaboutprovidingsuchtreatmentbecauseacourtcannotdecidebetweenimpairedlifeversus  nolifeatall. f#  11           Giventhisbackdrop,thecourtconcludedthattheMillershadnorighttodenythemedical " treatmentgiventoSidneyandthatnocourtorderwasnecessarytoovercometheirrefusalto  consent. f#  12      ׀Thus,thecourtsustainedHCAscontentionsthatitdidnotowetheMillersatortduty  to:(a)refrainfromresuscitatingSidney;(b)havenopolicyrequiringresuscitationofpatientslike   Sidneywithoutconsent;and(c)havepoliciesprohibitingresuscitationofpatientslikeSidney   withoutconsent.T f#  13      ׀ h`   ThedissentingjusticedisagreedthatnocourtorderwasnecessarytooverridetheMillers @8  refusaltoconsent. f#  14      ׀Accordingtothedissent,acourtmustdecidethemostimportantissue:What   isinthebestinterestofthechild?l f#  15      ׀Thedissentconcludedthatacourtdecisioninfavorof   resuscitationwouldaffordthephysicianandtheHospitaltheconsentnecessarytotreatSidney. f#  16      ׀  ThedissentfurtherconcludedthattheNaturalDeathActwasnotmandatoryandtheMillerswere  notrequiredtoseekadirectiveundertheAct. f#  17      ׀Thedissentwouldhaveaffirmedthetrialcourts xp judgment.  f#  18      ׀ PH   WegrantedtheMillerspetitionforreviewtoconsiderthisimportantanddifficultmatter. (  Inadditiontobriefingfromtheparties,wereceivedseveralamicibriefs,somesupportingthe  MillerspositionandsomesupportingHCAsposition.  @$ II.Analysis     Thiscaserequiresustodeterminetherespectiverolesthatparentsandhealthcareproviders   playindecidingwhethertotreataninfantwhoisbornalivebutindistressandissoprematurethat,   despiteadvancementsinneonatalintensivecare,hasalargelyuncertainprognosis.Althoughthe h` partieshavecitednumerousconstitutionalprovisions,statutes,andcases,weconcludethatneither @8  theTexasLegislaturenorourcaselawhasaddressedthisspecificsituation.Weaccordinglybegin   ouranalysisbyfocusingonwhattheexistingcaselawandstatutesdoaddress.     Generallyspeaking,thecustody,care,andnurtureofaninfantresidesinthefirstinstance  withtheparents. f#  19      ׀AstheUnitedStatesSupremeCourthasacknowledged,parentsarepresumed  tobetheappropriatedecisionmakersfortheirinfants: xp 8  OurjurisprudencehistoricallyhasreflectedWesterncivilizationconceptsofthe PH familyasaunitwithbroadparentalauthorityoverminorchildren.Ourcaseshave <4 consistentlyfollowedthatcourse;ourconstitutionalsystemlongagorejectedany (  notionthatachildis themerecreatureoftheStateand,onthecontrary,asserted   thatparentsgenerally havetheright,coupledwiththehighduty,torecognizeand  prepare[theirchildren]foradditionalobligations....Surely,thisincludesa high  dutytorecognizesymptomsofillnessandtoseekandfollowmedicaladvice.The   lawsconceptofthefamilyrestsonapresumptionthatparentspossesswhatachild ! lacksinmaturity,experience,andcapacityforjudgmentrequiredformakinglifes " difficultdecisions.Moreimportant,historicallyithasrecognizedthatnaturalbonds # ofaffectionleadparentstoactinthebestinterestsoftheirchildren.T f#  20      $    Ѐ TheTexasLegislaturehaslikewiserecognizedthatparentsarepresumedtobeappropriatedecision `&X" makers,givingparentstherighttoconsenttotheirinfantsmedicalcareandsurgicaltreatment. f#  21      ׀   Alogicalcorollaryofthatright,asthecourtofappealshererecognized,isthatparentshavetheright  nottoconsenttocertainmedicalcarefortheirinfant,i.e.,parentshavetherighttorefusecertain   medicalcare.T f#  22      ׀     Ofcourse,thisbroadgrantofparentaldecisionmakingauthorityisnotwithoutlimits.The h` Statesroleasparenspatriaepermitsittointercedeinparentaldecisionmakingundercertain @8  circumstances.AstheUnitedStatesSupremeCourthasnoted:   8  [A]spersonsunabletoprotectthemselves,infantsfallundertheparenspatriaepower   ofthestate.Intheexerciseofthisauthority,thestatenotonlypunishesparents   whoseconducthasamountedtoabuseorneglectoftheirchildrenbutmayalso  superveneparentaldecisionsbeforetheybecomeoperativetoensurethatthechoices  madearenotsodetrimentaltoachild'sinterestsastoamounttoneglectandabuse. f#  23      ׀      ButtheSupremeCourthasalsopointedout: xp  8  [A]slongasparentschoosefromprofessionallyacceptedtreatmentoptionsthe PH choiceisrarelyreviewedincourtandevenlessfrequentlysupervened.Thecourts <4 haveexercisedtheirauthoritytoappointaguardianforachildwhentheparentsare (  notcapableofparticipatinginthedecisionmakingorwhentheyhavemadedecisions   thatevidencesubstantiallackofconcernforthechild'sinterests.l f#  24      ׀     TheTexasLegislaturehasacknowledgedthelimitationsonparentaldecisionmaking.For    example,theLegislaturehasprovidedintheFamilyCodethattherightsanddutiesofparentsare " subjecttomodificationbycourtorder. f#  25      ׀AndTexascourtshaverecognizedtheirauthoritytoenter   orders,underappropriatecircumstances,appointingatemporarymanagingconservatorwhomay  consenttomedicaltreatmentrefusedbyachildsparents.T f#  26      ׀     Withrespecttoconsent,therequirementthatpermissionbeobtainedbeforeproviding   medicaltreatmentisbasedonthepatientsrighttoreceiveinformationadequateforhimorherto h` exerciseaninformeddecisiontoacceptorrefusethetreatment. f#  27      ׀Thus,thegeneralruleinTexasis @8  thataphysicianwhoprovidestreatmentwithoutconsentcommitsabattery.0 f#  28      ׀Butthereare   exceptions.Forexample,inGravisv.Physicians&SurgeonsHospital,thisCourtacknowledged   that consentwillbeimpliedwherethepatientisunconsciousorotherwiseunabletogiveexpress  consentandanimmediateoperationisnecessarytopreservelifeorhealth. f#  29      ׀    InMossv.Rishworth,thecourtheldthataphysiciancommitsa legalwrongbyoperating xp onaminorwithoutparentalconsentwhenthereis anabsolutenecessityforapromptoperation,but PH notemergentinthesensethatdeathwouldlikelyresultimmediatelyuponthefailuretoperformit.  f#  30      ׀ (  ButthecourtinMossexpresslynotedthat it[was]notcontended[there]thatanyrealdangerwould  haveresultedtothechildhadtimebeentakentoconsulttheparentwithreferencetotheoperation. f#  31        Mossthereforeimplicitlyacknowledgesthataphysiciandoesnotcommitalegalwrongbyoperating  onaminorwithoutconsentwhentheoperationisperformedunderemergentcircumstances"i.e.,   whendeathislikelytoresultimmediatelyuponthefailuretoperformit.T f#  32      ׀     Mossguidesushere.Weholdthataphysician,whoisconfrontedwithemergent h` circumstancesandprovideslifesustainingtreatmenttoaminorchild,isnotliablefornotfirst @8  obtainingconsentfromtheparents.TheMillerscitetoTexasFamilyCodesection32.001, f#  33      ׀Texas   Health&SafetyCodesection773.008,l f#  34      ׀andTexasRevisedCivilStatutesarticle4590i,section   6.07(a)(2), f#  35      ׀asillustratingthatimpliedconsentdoesnotarisefromanemergencycontextwhena  healthcareproviderhasactualnoticeoflackofconsent.Becausethesestatutesapplywhenaparent  isnotpresenttoconsent,theMillerssuggestthatthismustmeanthatemergencyservicescannotbe xp providedwhentheparentsrefuseconsent.Butthatisnotso. PH   Providingtreatmenttoachildunderemergentcircumstancesdoesnotimplyconsentto (  treatmentdespiteactualnoticeofrefusaltoconsent.Rather,itisanexceptiontothegeneralrulethat  aphysiciancommitsabatterybyprovidingmedicaltreatmentwithoutconsent.Assuch,the   exceptionisnarrowlycircumscribedandarisesonlyinemergentcircumstanceswhenthereisnotime " toconsulttheparentsorseekcourtinterventioniftheparentswithholdconsentbeforedeathislikely  toresulttothechild.Thoughinsituationsofthischaracter,thephysicianshouldattempttosecure  parentalconsentifpossible,thephysicianwillnotbeliableunderabatteryornegligencetheory   solelyforproceedingwiththetreatmentabsentconsent. f#  36      ׀     WerecognizethattheRestatement(Second)ofTorts892Dprovidesthatanindividualis h` notliableforprovidingemergencytreatmentwithoutconsentifthatindividualhasnoreasonto @8  believethattheother,ifheorshehadtheopportunitytoconsent,woulddecline.T f#  37      ׀Butthat   requirementisinapplicableherebecause,aswehavediscussed,theemergentcircumstances   exceptiondoesnotimplyconsent.    Further,theemergentcircumstancesexceptionacknowledgesthattheharmfromfailingto  treatoutweighsanyharmthreatenedbytheproposedtreatment, f#  38      ׀becausetheharmfromfailingto xp providelifesustainingtreatmentunderemergentcircumstancesisdeath.Andasweacknowledged PH inNelsonv.Krusen,albeitinthedifferentcontextofawrongfullifeclaim,itisimpossibleforthe (  courtstocalculatetherelativebenefitsofanimpairedlifeversusnolifeatall.l f#  39      ׀    Followingtheseguidingprinciples,wenowdeterminewhethertheMillerscanmaintaintheir   batteryandnegligenceclaimsagainstHCA.ThejuryfoundthattheHospital,throughDr.Otero, " treatedSidneywithouttheMillersconsent.Thepartiesdonotchallengethatfinding.Thus,we $  onlyaddresswhethertheHospitalwasrequiredtoseekcourtinterventiontooverturnthelackof  parentalconsent!whichitundisputedlydidnotdo!beforeDr.OterocouldtreatSidneywithout  committingabattery.     TheMillersacknowledgethatnumerousphysiciansattrialagreedthat,absentanemergency   situation,thepropercourseofactioniscourtinterventionwhenhealthcareprovidersdisagreewith h` parentsrefusaltoconsenttoachildstreatment.AndtheMillerscontendthat,asamatteroflaw, @8  noemergencyexistedthatwouldexcusetheHospitalstreatmentofSidneywithouttheirconsent   oracourtorderoverridingtheirrefusaltoconsent.TheMillerspointoutthatbeforeSidneysbirth,   Drs.JacobsandKelleydiscussedwiththemthepossibilitythatSidneymightsufferfromthe  numerousphysicalandmentalinfirmitiesthatdid,infact,afflicther.Andsomeelevenhoursbefore  Sidneysbirth,theMillersindicatedthattheydidnotwantanyheroicmeasuresperformedon xp Sidney.TheMillersnotethatthesefactorspromptedthedissentingjusticeinthecourtofappeals PH toconcludethat [a]nytimeagroupofdoctorsandahospitaladministrationha[ve]theluxuryof (  multiplemeetingstochangetheoriginaldoctorsmedicalopinions,withouttakingamoreobvious  courseofaction,thereisnomedicalemergency. f#  40      ׀     Weagreethataphysiciancannotcreateemergentcircumstancesfromhisorherowndelay " orinactionandescapeliabilityforproceedingwithoutconsent.ButtheMillersreasoningfailsto $  recognizethat,inthiscase,theevidenceestablishedthatSidneycouldonlybeproperlyevaluated `&X" whenshewasborn.AnydecisiontheMillersmadebeforeSidneysbirthconcerninghertreatment 8(0!$ atorafterherbirthwouldnecessarilybebasedonspeculation.Therefore,werejecttheMillers  argumentthatadecisioncouldadequatelybemadeprebirththatdenyingallpostbirthresuscitative  treatmentwouldbeinSidneysbestinterest.Suchadecisioncouldnotcontrolwhetherthe   circumstancesfacingDr.Oterowereemergentbecauseitwouldnothavebeenafullyinformedone   accordingtotheevidenceinthiscase. h`   TheMillerspointoutthatphysiciansroutinelyaskparentstomakeprebirthtreatment @8  choicesfortheirinfantsincludingwhethertoacceptorrefuseinuteromedicaltreatmentandto   continueorterminateapregnancy.Whilethatmaybeentirelytrue,theevidencehereestablished   thatthetimeforevaluatingSidneywaswhenshewasborn.Theevidencefurtherreflectedthat  Sidneywasbornalivebutindistress.Atthattime,Dr.Oterohadtomakeasplitseconddecision  onwhethertoprovidelifesustainingtreatment.WhiletheMillerswerebothpresentinthedelivery xp room,therewassimplynotimetoobtaintheirconsenttotreatmentortoinstitutelegalproceedings PH tochallengetheirwithholdingofconsent,hadtheMillersdoneso,withoutjeopardizingSidneys (  life.Thus,althoughHCAneverrequestedajuryinstruction,norchallengedtheabsenceofajury  instruction,onwhetherDr.OterotreatedSidneyunderemergentcircumstances,theevidence   conclusivelyestablishedthatDr.Oterowasfacedwithemergentcircumstanceswhenhetreated " Sidney.ThosecircumstancesresultedfromnotbeingabletoevaluateSidneyuntilshewasborn,not $  becauseofanydelayorinactionbyHCA,theHospital,orDr.Otero.AsHCAsexperttestified: `&X" 8  Ithinktheimportantthingtorealizehereisthephysicianshaveanobligationboth 8(0!$ forassessmentandtreatment,andthephysiciansfulfilledthatobligationinthiscase $)"% byattendingthedelivery,makingimmediateassessmentanddeterminingthatthe *#& childwasviable.Thatsanimportantdiagnosisthatthephysicians"twophysicians *#' feltthatSidneyhadtheabilitytoliveoutsidethewomb.Havingdoneso,itis +$( importantthatlifesustainingtreatmentbegivenonanemergentbasiswherethatis  essentialtothemaintenanceoflife,andthatiswhatwasdonehere.Itwouldbe  impropernottoorderthatcarein[an]emergent...situation.     WeacknowledgethatcertainphysiciansinthiscaseinitiallyaskedtheMillerstodecide   whetherSidneyshouldberesuscitatedsomeelevenhoursbeforeherbirth.Andcertainphysicians   andHospitaladministratorsaskedtheMillerstoconsenttothesubsequentplandevelopedtohave h` aneonatologistpresentatSidneysdeliverytoevaluateandpossiblytreather.Weagreethat, @8  wheneverpossible,obtainingconsentinwritingtoevaluateaprematureinfantatbirthandtorender   anywarrantedmedicaltreatmentisthebestcourseofaction.Andphysiciansandhospitalsshould   alwaysstrivetodoso.Butifsuchconsentisnotforthcoming,orisaffirmativelydenied,wedecline  toimposeliabilityonaphysiciansolelyforprovidinglifesustainingtreatmentunderemergent  circumstancestoanewborninfantwithoutthatconsent. xp   TheMillerscontendthattheyofferedtestimonyfromDr.OterothatSidneymighthave PH survivedwithouttreatment.ButwedonotreadDr.Oterostestimonyassayingthat.Atonepoint, (  Dr.OterotestifiedthattherewasnodoubtthatSidneywouldhavediedbutforhistreatmentofher.  Hethentestifiedthatprematureinfants,likeSidney,mightnotdieimmediatelywithouttreatment   butarestillalivewithintwoorthreehoursgaspingforbreathorcryingandthenarerushedtohim " fortreatment.Therefore,contrarytotheMillersassertion,Dr.OterodidnottestifythatSidney $  mightwellhavesurvivedwithoutanytreatmentatall. `&X"   Moreover,therewastestimonythatthesoonertreatmentwasprovided,thebetterchance 8(0!$ Sidneyhadforsurvivalwithoutbraindamageor,atleast,withoutfurtherbraindamage.Thus,the *#& evidenceestablishedthat,atSidneysbirth,Dr.Oterowasfacedwithemergentcircumstancesin +$( decidingwhethertotreatSidneyinanattempttopreventherotherwiselikelydeath.    TherewastestimonythatDr.OterosresuscitativetreatmentcausedSidneysmentaland  physicalinfirmities.Buttherewasalsotestimonythatitdidnotand,infact,theoxygenprovided   duringthefirstdaysofSidneyslifepreventedherfromsufferingevenfurtherbraindamage.   AlthoughthejuryfoundthattheHCAsandtheHospitalsnegligencecausedthe occurrencein h` question,itisunclearwhatwasmeantbythe occurrenceinquestion. @8    IfthatphrasereferstoSidneysmentalandphysicalinfirmities,theMillersneversuedDr.   Oterooranyotherphysician.AndtherewasnoallegationthattheynegligentlytreatedSidney,   whichcausedherinfirmities.Instead,theMillersonlynegligenceclaimwasthatHCAandthe  Hospitalhadpolicies,orlackedpolicies,andtookactionsthatallowedSidneytobetreatedwithout  theirconsent.Thus,theirnegligenceclaimisbasedonthelackofconsentbeforetreatment,justlike xp theirbatteryclaim. PH   IfthephrasereferstoDr.OteroresuscitatingSidneyagainsttheMillerswishes,itwasnot (  HCAsortheHospitalspolicies,orlackthereof,thatpermittedDr.OterototreatSidneywithout  consent.Rather,itwastheemergentcircumstancesthatcausedthattohappen.BecauseDr.Otero   treatedSidneyunderemergentcircumstances,hedidnotcommitabattery.AndbecauseDr.Otero " didnotcommitabattery,HCAisnotliablederivatively. f#  41      ׀NorwastheHospitalnegligentfor $  allowingDr.OterototreatSidneyunderthecircumstanceswithouttheMillersconsent. `&X"   TheMillersraiseadditionalargumentsthatweneednotaddress,givenourholdingonthe 8(0!$ emergentcircumstancesexception.Similarly,HCAraisesseveralargumentsaboutwhyitcannot  beheldliablefortheMillersbatteryandnegligenceclaims.Althoughwedonotneedtoaddress  thoseargumentstoresolvethiscase,wedoaddresstwomattersthatthecourtofappealsdiscussed.     HCAarguesthatthefederal BabyDoeregulations f#  42      ׀arepartofTexaslawandforbidany   denialofmedicalcarebasedonqualityoflifeconsiderations.WhilewedonotdisagreewithHCAs h` assertionasageneralproposition,HCAcites42U.S.C.5106a(b)(2)(B)assupportforits @8  contentionthattheBabyDoeregulationswere scrupulouslyfollowedinthiscaseand faithful   adherencetothepublicpolicyestablishedbytheregulationsshouldnotbethwartedthroughcivil   liabilityindamages....But42U.S.C.5106a(b)(2)(B)providesthatafederallyfundedstate  mustimplement proceduresforrespondingtothereportingofmedicalneglectwhichinclude:  8  authority,underStatelaw,fortheStatechildprotectiveservicessystemtopursueany xp legalremedies,includingtheauthoritytoinitiatelegalproceedingsinacourtof d\ competentjurisdiction,asmaybenecessarytopreventthewithholdingofmedically PH indicatedtreatmentfromdisabledinfantswithlifethreateningconditions.T f#  43      ׀<4   Assumingthatthisprovisionapplieshere,itstatesthatTexasmustprovideamechanismbywhich   thechildprotectiveservicessystemcaninitiatelegalproceedingstopreventthewithholdingof  medicaltreatmentfrominfants.AndtheFamilyCodeandTexasAdministrativeCodecontainsuch ! provisions. f#  44      ׀ #   ButitisundisputedthatneithertheHospitalnorHCAinitiatedorrequestedchildprotective t%l! servicestoinitiatelegalproceedingstooverridetheMillers withholdingofmedicaltreatmentby  refusingtoconsenttoSidneystreatment.Thus,thefederalfundingregulationsappearto  contemplatelegalproceedingstooverridethelackofparentalconsent,andtheydonotanswerthe   questionofwhetherDr.Oterocommittedabatterybyprovidingtreatmentwithoutdoingso.   Further,weagreewiththecourtofappealsconclusionthatthedispositionofthatissue isgoverned h` bystatelawratherthanfederalfundingauthorities. f#  45       @8    HCAalsoargues,andthecourtofappealsagreed,thatparentscanwithhold urgentlyneeded   lifesustainingmedicaltreatmentfortheirchildonlywhentherequirementsoftheNaturalDeath   Actaresatisfied!i.e.,onlywhenthechildiscertifiablyterminal.ButtheActexpresslystatesthat  itdoesnotimpairorsupersedeanylegalrightapersonmayhavetowithholdorwithdrawlife  sustainingtreatmentinalawfulmanner.T f#  46      ׀Inanyevent,weneednotdecidethisissue.TheMillers xp assertedbatteryandnegligenceclaimsbasedonDr.OterotreatingSidneywithouttheirconsent.As PH wehavediscussed,whenemergentcircumstancesexist,aphysiciancannotbeheldliableunder (  eitherbatteryornegligencetheoriessolelyforprovidinglifesustainingmedicaltreatmenttoaminor  childwithoutparentalconsent.    @MM" III.Conclusion  "   Dr.OteroprovidedlifesustainingtreatmenttoSidneyunderemergentcircumstancesasa $  matteroflaw.Thosecircumstancesprovideanexceptiontothegeneralruleimposingliabilityon `&X" aphysicianforprovidingtreatmenttoaminorchildwithoutfirstobtainingparentalconsent. 8(0!$ Therefore,Dr.Oterodidnotcommitabattery.AndHCAcannotbeheldliablefortheMillers  &  batteryandnegligenceclaims.Wearenotpresentedwithanddonotdecidethequestionofwhether  therulewehaveannouncedappliestoadults.Weaffirmthecourtofappealsjudgment.   AZ6)dEA      `     h     CraigT.Enoch 6.     `     h     Justice "     `     h     OPINIONDELIVERED:September30,2003'