A California Supreme Court majority decision recently determined that an employee of an in-home health care agency who was injured by a patient suffering from Alzheimer's disease may not sue the patient and her husband for battery, negligence, and premises liability (Gregory v. Cott). The employee could only recover from her employer under a workers' compensation claim. Five California Supreme Court justices reached this conclusion and two justices dissented. This comment briefly reviews the legal liability for injuries to caregivers caused by an Alzheimer patient. Individuals confronting the tragedy of Alzheimer's disease should consult experienced medical, financial, social and legal professionals.
The California Supreme Court majority noted that "those hired to manage a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront." Furthermore, since California courts do not impose liability for this type injury in institutional settings, the same rule should apply to in-home care. However, caregivers must be warned of the risks. The injuries in question must come from the symptoms of the disease and not from another unrelated source. The majority opinion urged the legislature to focus on Alzheimer's caregiving.
The majority opinion applied assumption of the risk to this caregiver situation. Prior California decisions have applied assumption of the risk to situations such as firefighters and dog kennel workers since the risk of injury is inherent in the occupation. In like manner, "the risk of violent injury is inherent in the occupation of caring for Alzheimer's patients." The caregiver in this situation, while not a nurse or physician, was specifically employed to provide this care. The patient's husband contracted with the care agency for an aide to help manage his wife's condition.
The majority acknowledged that imposing liability in an in-home setting would encourage the institutionalization of patients with violent tendencies. However, modern public policy encourages home care whenever possible. A variety of California legislative statements support home care for the disabled.
The California Supreme Court dissent stated that while the Alzheimer's patient may be morally blameless, the family decision makers should consider the consequences of care decisions. Employed caregivers should not bear the risk "that a family may guess wrong about the threat that one of its members poses because of Alzheimer's disease." The family controls the home environment and therefore should retain liability. Furthermore, the employee caregiver received little training concerning Alzheimer's disease. Many caregivers receive minimal pay as well or may be categorized as independent contractors without workers' compensation coverage.
This California court decision relates to a long-lasting legal debate concerning whether a mentally incapacitated individual should be held liable for intentional injuries even if unable to comprehend that the actions causing the injury were wrong. The Colorado Supreme Court in a 2000 decision did not impose tort liability on an Alzheimer's patient in a personal care center who struck a caregiver (White v. Muniz). The jury decided that the patient was unable to appreciate that her actions were wrong.
Legal debate exists since an individual may intend to cause the contact but not intend to cause the injury, or not understand that the initial contact was wrong. How much intent and understanding should be proven to impose legal liability? The simplest approach, applied in some jurisdictions, is to only require proof that the individual intended to make the contact. Consequently, there would be automatic liability for all resulting injuries. Should free choice or the lack thereof be relevant in a personal injury situation? A related legal debate, from a public policy viewpoint, is what person or entity should ultimately have to suffer the loss (expense, pain, etc.) that the injury caused? Complicating any intent based doctrine is that it requires a jury to determine what was occurring within an individual's mind.
A Vermont Superior Court in a 2013 sexual harassment case applied the 2000 Colorado Supreme Court decision (Tobin v. Maier). The Vermont court stated that while mental deficiency is not a defense to an intentional tort, it is relevant to the issue of intent to cause the injury. Consequently, the Vermont court allowed the jury to hear testimony that the defendant suffered from Alzheimer's disease.
There has been only limited comprehensive legal attention to tort liability (civil lawsuit injury liability) in the context of Alzheimer's disease. Tort law categorizes injuries as intentional, negligent, or strict liability. Negligence requires proof of unreasonable conduct in the situation in question. Strict liability imposes liability regardless of intent or reasonable care being exercised.
Alzheimer's disease related injuries might result from the actions of the patient, caregiver, or responsible guardian (typically a family member). These injuries might be to the caregiver or the general public. As the California decision illustrates, caregivers typically cannot sue the patient who causes an injury. Clearly a public policy consensus concerning the rights and responsibilities of patients, caregivers, and guardians of those impacted by Alzheimer's disease should be developed in a setting other than a courtroom. The judicial system is not equipped to undertake consensus building and the lengthy deliberation that Alzheimer's deserves. What values does our society wish to apply? What will our society do as the numbers of Alzheimer's patients increase? Thoughtful individuals and groups are already engaged in addressing these and many additional difficult issues. The legal system should act as well.