Background
Terri Loomis suffered multiple strokes in 2013 and 2016 that left her with severe physical and cognitive impairments, including severely limited communication abilities, blindness in one eye with minimal vision in the other, and difficulty with basic functions. She was admitted to O’Neill Healthcare nursing facility in Middleburg Heights, where she received long-term care.
On March 2, 2021, after returning from hospitalization, Terri was presented with an arbitration agreement, which she signed along with a facility admission agreement. The arbitration agreement was a form document with blanks filled in by facility staff, and no witness was present for Terri’s signature. Nearly three years later, on January 17, 2024, Terri fell at the facility, suffering fractures to her leg and arm. She died one week later.
Jeffrey Loomis, Terri’s husband and administrator of her estate, filed suit against O’Neill Healthcare and its staff for wrongful death, violation of residents’ rights, breach of contract, reckless misconduct, negligent hiring and retention, and conscious pain and suffering. The facility moved to stay proceedings and compel arbitration based on the March 2021 agreement.
The Court’s Holding
The Court of Appeals affirmed the trial court’s decision denying the facility’s motion to compel arbitration and hold that the arbitration agreement was unenforceable. Although the court found that Terri had actually signed the documents—her illegible signatures were attributable to hand tremors resulting from her strokes—this did not render the agreement enforceable.
The court held the agreement was procedurally unconscionable because Terri lacked the ability to comprehend it. The evidence established that Terri could only communicate in short sentences (“I love you,” “hello,” “goodbye”), was blind in one eye with minimal vision in the other, and could not engage in in-depth conversations or read standard-sized print. The facility knew or should have known of these severe impairments and should not have presented the agreement to her.
The agreement was also substantively unconscionable because it violated Ohio’s statutory requirements for medical arbitration agreements under R.C. 2711.23 and 2711.24. The agreement provided only a 21-day cancellation period instead of the required 30 days, did not allow Terri’s spouse or representative to cancel on her behalf, failed to provide two copies as required, and did not clearly disclose that it should not be presented to patients whose condition prevents rational decision-making. Presenting an arbitration agreement to a patient unable to understand its terms supports a finding of substantive unconscionability.
Key Takeaways
- Arbitration agreements in medical contexts must comply with specific Ohio statutory safeguards, including 30-day cancellation rights for patients or their representatives and provision of two copies.
- Healthcare providers cannot present arbitration agreements to patients whose physical or cognitive condition prevents them from making a rational decision whether to agree, even if other medical records suggest the patient is generally “alert and oriented.”
- Procedural unconscionability exists when a weaker party has physical or mental infirmities that the stronger party knew or should have known prevented the weaker party from protecting their interests.
- A trial court’s factual findings regarding a patient’s capacity and ability to comprehend an agreement receive deference on appeal, though the legal question of unconscionability is reviewed de novo.
Why It Matters
This decision provides critical guidance for nursing homes, healthcare facilities, and their counsel regarding the enforceability of arbitration agreements. Facilities cannot use arbitration agreements as a blanket shield against liability by simply having residents sign forms without assessing their actual capacity to understand. The court’s analysis demonstrates that statutory protections for vulnerable patients are not mere formalities—failure to comply with them and to assess capacity can render agreements completely unenforceable, leaving the facility exposed to full litigation in civil court.
The ruling also clarifies that courts will examine the actual circumstances of vulnerable patients, not merely isolated medical records stating alertness. For elderly or infirm residents with communication, cognitive, or vision limitations, healthcare providers must take affirmative steps to ensure informed consent or risk that arbitration agreements will be voided. This case reinforces that arbitration agreements involving medical malpractice claims in institutional care settings face heightened scrutiny when the resident lacks meaningful ability to understand their terms.