Hospitals Should Replace Bad Healthcare Surrogates (Maya Kowalski)

Many hospitalized patients lack decision-making capacity. So, a surrogate decision maker (agent, guardian, default SDM, parent) must make healthcare decisions on their behalf. Unfortunately, many of these surrogates fail to make decisions consistent with the patient's preferences, goals, values, or best interest. 

When the deviation is wide, hospitals should challenge the surrogate and even move to replace them with another (better) surrogate. That is what Johns Hopkins All Children's Hospital did when Maya Kowalski's mother, Beata, demanded high-dose ketamine treatments. This raised red flags for medical child abuse and prompted the hospital to call the Florida Department of Children.

While JH did everything right, Beata committed suicide after losing custody. A jury awarded over $250 million. But recognizing that JH acted appropriately, an appellate court reversed. This week, the Florida Supreme Court let the reversal stand.