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A Jehovah’s Witness who received a blood transfusion at a Florida hospital after he allegedly refused it on religious grounds is suing the hospital, accusing it of battery and falsification of medical records. The suit was filed in Palm Beach Circuit Court in January by Julio Cordero, 29, who was injured in an auto accident in May 2000 and operated on at Delray Medical Center in Delray Beach, where the transfusion was given. The hospital is owned by national hospital chain Tenet Healthcare Corp. Claims based on provision of medical services without proper informed consent typically are framed as medical malpractice. A battery claim, however, could sidestep Florida’s new statutory cap on noneconomic damages in malpractice actions. The suit cites no specific injury to Cordero other than “trespass against his body.” “The battery charge is based on my client’s total lack of consent,” said Cordero’s attorney, George Bender, a partner at Bender Bender & Chandler in Coral Gables, Fla. “He is extremely devout. It is his deep and firm belief that transfusion is unacceptable for religious reasons.” Bender declined to discuss the suit in greater detail, citing his client’s privacy concerns. Courts in Florida and other states repeatedly have upheld the First Amendment right of adult Jehovah’s Witnesses to refuse transfusion, even in life-threatening situations. But Cordero’s suit may be the first case brought by an adult Jehovah’s Witness alleging that a transfusion was given without the Witness’ knowledge, experts say. Delray Medical Center spokeswoman Pat McCarthy declined to discuss Cordero’s suit, saying it was against hospital policy to discuss pending litigation. Harry Anderson, spokesman for Santa Barbara, Calif.-based Tenet, said patient confidentiality prevented him from discussing the case. The lawsuit comes at a sensitive time due to well-publicized problems at Tenet. In June, longtime chief executive Jeffrey Barbakow resigned after the Internal Revenue Service ruled that the company owed the government $269 million in back taxes and interest. In August, the company paid $54 million to settle a Medicare fraud case for hundreds of unnecessary heart surgeries at a California hospital. EMERGENCY TREATMENT The accident leading to Cordero’s hospitalization occurred in May 2000. According to Bender, Cordero and his mother were driving on I-95 one night when their car broke down. Cordero was standing in front of the car on the roadside when another vehicle spun out of control and collided with it, injuring Cordero. Emergency medical personnel transported Cordero to Delray Medical Center, a 372-bed hospital in west Delray Beach, Fla., where he was found to have two broken legs. According to the lawsuit, Cordero was continuously awake and alert until he was anesthetized for an emergency operation. He repeatedly instructed paramedics and hospital personnel not to give him a blood transfusion under any circumstances. Medical records in the court file show that Cordero received maximum test scores for alertness and responsiveness at six different times before he went into surgery that night, and that he signed a consent form for anesthesia services. Hospital records include a consent form for Cordero’s blood transfusion, signed at 9:45 p.m., just before he went into surgery. The signature, however, is that of a witness; a notation reads “verbal consent.” But according to his complaint, “Julio Cordero never gave such verbal consent. … The falsified record is an attempt by Delray Medical Center to conceal their transfusion.” Cordero then underwent emergency surgery. According to medical records, 250 milliliters of blood, or about one cup, was administered to Cordero during the operation. According to his complaint, two days after the operation, doctors at the hospital told Cordero that further blood transfusions were advisable, but he refused. He then was transferred to Jackson Memorial Hospital in Miami, where he was treated at the Center for Bloodless Medicine and Surgery. OLD TESTAMENT PROHIBITION The Jehovah’s Witnesses are best known to the public for their neatly dressed acolytes distributing The Watchtower magazine door-to-door. The group grew from a late 19th century Pennsylvania Bible study circle to a worldwide Christian sect claiming more than 6 million followers. Representatives at the Jehovah’s Witnesses world headquarters in Brooklyn declined to be interviewed for this article. In a faxed statement, the group said “Christians are commanded to ‘abstain from … blood.’ “ Stephen J. Stein, a University of Indiana professor of religious studies, said the Jehovah’s Witnesses — who call themselves a group rather than a church — have interpreted the Old Testament prohibition against the eating of blood as a prohibition against medical transfusion. The Witnesses believe that their sole allegiance is to Jehovah, the Old Testament name for God. As a result, they decline to salute the national flag or to serve in the military. Such beliefs and practices led to persecution of Witnesses both in the United States and Nazi Germany in the 1930s and 1940s. A number of historians have compared the Witnesses’ legal battles in the United States to those of black civil rights groups. The Witnesses’ legal efforts to protect their members’ constitutional rights produced 23 U.S. Supreme Court decisions between 1938 and 1946. “This is a group that has experienced considerable difficulty for its beliefs, even gone to prison,” Stein said. Jehovah’s Witnesses who stray from doctrine are subject to a form of shunning called “disfellowship.” Stein said the combination of these nonmainstream beliefs and their door-to-door proselytizing has made the Witnesses “among the most despised religious groups in America. Undeservedly so — they tend to be model citizens.” The group’s prohibition against blood transfusion became known to the wider public in the 1940s, when the medical technique first became widely used among civilian populations. Decades later, due to the efforts of the Witnesses, hospitals around the country started bloodless surgery units, said Dr. Jeffrey Carson, medical director of the Center for Innovations in Bloodless Surgery and Medicine at Robert Wood Johnson University Hospital in New Brunswick, N.J. “There was resistance at first in the medical community,” he said. “But concern about AIDS in the mid-’80s and a chronic shortage of blood supplies gave the movement an appeal beyond the Witnesses.” Studies have shown that patients who refuse transfusions often gain significant medical benefits, Carson said. But beyond that, he said, “physicians have to respect the wishes of patients, even in critical situations.” Florida courts have held that “any competent adult has the right to refuse any kind of treatment,” said Mary Crossley, a law professor at Florida State University who is an expert on health law. But Crossley said the courts have overridden First Amendment claims in cases in which Witnesses, as well as Christian Scientists, have refused to consent to blood transfusions or other medical treatment for their children. “Typically the courts will intervene if the child’s life is at stake or there is a threat of significant, long-term injury.” Lawsuits based on failure to obtain informed consent before providing treatment usually are framed as medical malpractice claims, Crossley said. But “historically,” she said, battery is the original form of complaint for civil cases of that type. “If the allegations are accurate, [Cordero's] case looks strong,” she said. But she added, framing the complaint as battery may not avoid the new medical malpractice statute’s caps on noneconomic damages. “The question is how the court construes it,” she said. “This is a brand new statute and there’s no experience with it.” Crossley said the court could see that the defendant is a medical provider and decide that “the substance of the claim” is medical malpractice and that the caps apply. But in her opinion, that would be wrong. “Lawsuits alleging absence of informed consent are generally treated as medical malpractice claims,” she said. “But there is an exception for allegations that medical providers acted despite patients’ instructions to the contrary. That should be seen as battery.”

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