No Real Winners in Caregiver Injury Case

     SAN FRANCISCO (CN) - Alzheimer's patients and their families cannot be held liable for injuries caused to in-home caregivers, a divided California Supreme Court held Monday.
     Carolyn Gregory sued Lorraine Cott, an Alzheimer's patient, and her husband Bernard after being cut with a kitchen knife while trying to restrain Lorraine. A trial court dismissed Gregory's negligence, premises liability and battery claims before trial, and a divided Court of Appeals agreed that her claims were barred by the assumption of risk doctrine typically applied to caregivers in institutional settings.
     Writing for the majority, Justice Carol Corrigan noted that California and other states have long held that Alzheimer's patients are not responsible for injuries they cause in institutional settings like hospitals and rest homes. The same rule should apply to Gregory's case, since she was also hired by the agency the Cotts contracted with to manage a potentially hazardous situation, Corrigan said.
     "This conclusion is consistent with the strong public policy against confining the disabled in institutions," Corrigan wrote. "If liability were imposed for caregiver injuries in private homes, but not in hospitals or nursing homes, the incentive for families to institutionalize Alzheimer's sufferers would increase. Our holding does not preclude liability in situations where caregivers are not warned of a known risk, where defendants otherwise increase the level of risk beyond that inherent in providing care, or where the cause of injury is unrelated to the symptoms of the disease."
     Corrigan urged lawmakers to focus on training and enhanced insurance benefits for caregivers of Alzheimer's patients, noting that better workers' compensation benefits should compensate injured caregivers instead of personal injury lawsuits.
     In a sharply worded dissent, Justice Laurence Rubin - temporarily assigned to the state's highest court from the Second Appellate District - agreed Lorraine was not liable for Gregory's injuries. But her husband bears some responsibility as Lorraine's competent decisionmaker, Rubin said.
     "I believe tort law should align incentives with the consequences of the decisions one makes," Rubin wrote. "Thus, when a family considers the suitability of in-home care for a member suffering from Alzheimer's disease, the law should encourage family members like Bernard Cott to weigh the benefits of in-home care against the costs it may impose on others."
     He added: "Because family members retain control, family members should likewise retain liability. But the court's decision today weakens the link between control and accountability by relieving the family from needing to be concerned about dangers to the in-home caregiver so long as those dangers arise from the family member's Alzheimer's disease."
     Rubin also noted that Gregory's lack of training by the agency the Cotts hired raised questions of whether she actually knew what risks she was assuming that that should have been fleshed out at trial.
     "In deposition, Gregory answered the question 'Were you trained in how to deal with a client suffering from Alzheimer's' with her reply 'Very much so.' But her declaration, which fleshes out her answer, suggests that her 'very much so' was in fact very little," Rubin wrote. "Her training consisted of 'watching a video and visiting a nursing home with Alzheimer's patients.' She had never worked in a nursing home or hospital. She did not have certification as a nurse or nurse's aide and, having worked only in single-family homes, had never worked under the direct supervision of a registered nurse or health care professional. The lack of supervision from a registered nurse or medical professional continued while she worked for the Cotts."
     Rubin also called on the Legislature to "turn their attention to the problems associated with caring for Alzheimer's patients."
     "Whatever the solutions to those problems, I do not believe they should be at the expense of in-home caregivers who risk a physical injury by working on the front line, typically for low pay and few benefits," he concluded.