Arbitration Agreements Are Not “Health-Care Decisions”: The Kentucky Supreme Court Narrows KRS 311.631 Spousal Authority

Introduction

In Lexington Alzheimer’s Investors, LLC d/b/a The Lantern at Morning Pointe Alzheimer’s Center of Excellence v. Sandra Norris, the Kentucky Supreme Court confronted a first-impression question: May a spouse, acting under KRS 311.631(1)(c) of the Living Will Directive Act, bind an incapacitated patient to a mandatory arbitration agreement as a condition of admission to a personal-care facility? The Court answered “No,” holding that such an act is not a “health-care decision” within the meaning of KRS 311.621(8).

The dispute arose after Sandra Norris, conservator and spouse of Alzheimer’s patient Rayford Charles Norris, signed a four-page “Mandatory Arbitration Agreement” demanded by The Lantern as a prerequisite to residency. After Rayford’s death and the filing of negligence and wrongful-death claims, the facility moved to compel arbitration. Both the Fayette Circuit Court and the Court of Appeals refused, and the Supreme Court has now affirmed, establishing a limiting precedent on spousal authority under the Living Will Directive Act.

Summary of the Judgment

Delivering the opinion of the Court, Chief Justice Lambert held:

KRS 311.631 empowers a spouse to make only those “health-care decisions” expressly defined in KRS 311.621(8): “consenting to, or withdrawing consent for, any medical procedure, treatment, or intervention.”
Signing a mandatory arbitration agreement for admission to a care facility does not fall within that definition; it is neither a medical procedure, treatment, nor intervention.
The arbitration contract was therefore void ab initio for lack of authority, and the trial court correctly denied the motion to compel arbitration.
This construction does not offend the Federal Arbitration Act (FAA) or Kindred Nursing Centers Ltd. P’ship v. Clark, 581 U.S. 246 (2017), because the ruling rests on a generally applicable contract principle—absence of agency authority—rather than on hostility to arbitration.

Analysis

Precedents Cited and Their Influence

Ping v. Beverly Enterprises, Inc., 376 S.W.3d 581 (Ky. 2012)
Established that an attorney-in-fact acting under a durable power of attorney can execute a mandatory arbitration clause as a health-care decision if admission hinges on it, but cannot sign an optional clause.
LP Louisville East, LLC v. Patton, 651 S.W.3d 759 (Ky. 2020)
Confirmed Ping; a broad grant of authority “necessary to provide for the principal’s health” suffices where arbitration is compulsory for admission.
Jackson v. Legacy Health Services, Inc., 640 S.W.3d 728 (Ky. 2022)
Applied Ping/Patton to guardianships; a guardian may agree to compulsory arbitration only if it’s necessary to secure care.
Kindred Nursing Centers Ltd. P’ship v. Clark, 581 U.S. 246 (2017)
Struck down Kentucky’s “clear-statement rule,” holding state law may not single out arbitration agreements for special obstacles.

The Lantern relied heavily on Ping, Patton, and Jackson, arguing that because arbitration was a condition of admission, Sandra’s signature qualified as a health-care choice. The Court distinguished those cases on a pivotal fact: each involved an affirmative legal instrument (durable power of attorney or guardianship order) in which the principal or a court had already conferred broad agency powers. By contrast, Sandra relied solely on KRS 311.631—an automatic statutory hierarchy that is much narrower in scope.

Legal Reasoning

Statutory Text Controls. The Court began with the plain language of KRS 311.621(8): a health-care decision is limited to consenting or withdrawing consent for “any medical procedure, treatment, or intervention.” Arbitration is a contractual forum selection device; it does not affect the nature or delivery of medical care.
No Agency Authority, No Contract. Contract law requires an agent to possess actual or apparent authority. Because KRS 311.631 confers only narrow medical-consent powers, Sandra’s signature could not bind Rayford to arbitration, rendering the agreement unenforceable ab initio.
FAA and Clark Distinguished. The ruling does not single out arbitration for disfavorable treatment: any contract outside the scope of the statutorily defined agency would be void. Therefore, federal pre-emption concerns are inapposite.
Procedural Deficiencies. Even if arbitration were a health-care decision, KRS 311.631 requires a physician’s finding of incapacity and notation in medical records—facts not established in the record.

Impact of the Judgment

This decision creates a clear boundary in Kentucky law:

Spouses (and others in the KRS 311.631 priority list) cannot use that statute to execute arbitration clauses or other non-medical contracts for an incapacitated patient.
Long-term-care facilities and hospitals must now seek separate formal authority—e.g., a durable power of attorney, guardianship order, or direct patient consent—to enforce arbitration agreements.
The ruling reinforces the principle that statutory surrogacy mechanisms are strictly construed, guarding incapacitated persons’ contractual rights.
Litigation over personal-care-facility negligence in Kentucky may increase, as facilities can no longer rely on spousal signatures alone to funnel disputes into arbitration.
Practitioners drafting admission packages must adjust their risk-management strategies, perhaps encouraging prospective residents to execute comprehensive health-care powers of attorney before incapacity.

Complex Concepts Simplified

Health-Care Decision – Under KRS 311.621(8), it is limited to saying “Yes” or “No” to a medical procedure, treatment, or intervention. Anything outside that narrow realm—finances, contracts, lawsuits—does not qualify.
Agency Authority – A person (agent) can bind another (principal) to a contract only if the principal (or the law) has granted power to do so. No authority = no contract.
Mandatory vs. Voluntary Arbitration – If a facility makes arbitration a condition of admission, agreeing to it may be considered “necessary” within a broad agency grant (as in Patton), but necessity alone does not expand a narrow statutory grant like KRS 311.631.
Federal Arbitration Act (FAA) – A federal law requiring courts to treat arbitration contracts just like any other contract—no special hostility, no special favoritism.

Conclusion

The Kentucky Supreme Court’s decision in Lexington Alzheimer’s Investors v. Norris decisively limits the reach of KRS 311.631. A spouse’s statutory authority to make medical decisions for an incapacitated partner does not include the power to waive the partner’s constitutional right to a jury trial through arbitration. By drawing a bright textual line, the Court protects incapacitated individuals from unintended forfeiture of legal rights and provides clear guidance to health-care providers, attorneys, and families alike. Future disputes over arbitration in the health-care context must now grapple with this precedent, ensuring that only properly authorized agents—or the patients themselves—may channel claims away from the courts.