No. 12414
I N THE SUPREME COURT O THE STATE OF M N A A
F OTN
1973
BOB E. HULIT, M.D.,
P l a i n t i f f and Respondent,
-vs -
ST. VINCENT'S HOSPITAL, a c o r p o r a t i o n ,
Defendant and A p p e l l a n t ,
and
OB-GYN GROUP O BILLINGS, MONTANA,
F
I n t e r v e n i n g Defendant and Appellant.
Appeal from: D i s t r i c t Court of t h e T h i r t e e n t h J u d i c i a l D i s t r i c t ,
Honorable M , James S o r t e , Judge p r e s i d i n g .
Counsel of Record :
For A p p e l l a n t s :
Crowley, Kilbourne, Haughey, Hanson and Gallagher,
B i l l i n g s , Montana
Bruce R . Toole argued, B i l l i n g s , Montana
S a n d a l l , Moses and Cavan, B i l l i n g s , Montana
John J. Cavan, Jr. argued, B i l l i n g s , Montana
Amicus Curiae
Chadwick @. Smith argued, Helena, Montana
For Respondents:
Ayers and A l t e r o w i t z , Red Lodge, Montana
Michael G. A l t e r o w i t z argued, Red Lodge, Montana
Berger, Anderson, S i n c l a i r and Murphy, B i l l i n g s ,
Montana
Amicus C u r i a e
Paul B a i e r argued, Baton Rouge, Louisiana
Submitted : November 30, 1973
Decided : MAR 2 5 1974
Mr. Justice Wesley Castles delivered the Opinion of the Court.
This is an appeal from a judgment entered by the district
court of the thirteenth judicial district, Yellowstone County,
the Hon. M James Sorte presiding.
. The action was originally
brought by Michael J. Crowley and his wife Michele M. Crowley,
the Husband-Coached Lamaze Childbirth Association, and Robert
E. Hulit, M.D., against St. Vincent's Hospital at Billings,
seeking an injunction against the hospital which would require
it to allow the presence in the delivery room of Mr. Crowley
at the time of the birth of his child and allow Dr. Hulit there-
after to allow other husbands in the delivery room. A temp6ra.r~
restraining order was issued. The Crowley child was born, The
trial court dismissed the Crowleys and the Association as plain-
tiffs at the conclusion of all the evidence, and rendered judg-
ment for Dr. Hulit alone.
The OB-GYN Group, gynecologists of Billings, intervened
as party defendant early in the proceedings and is an appellant
here. Although the OB-GYN Group is not specifically mentioned
in the district court's decree, the decree affects the practicing
obstetricians. On appeal, appearing as amici curiae, are the
Montana Hospital Association and Mr. Paul R. Baier.
Appellant St. inc cent's Hospital states the issue as
being fundamentally whether the court, under all the circumstances,
should intrude itself into the administration of the hospital
on such a decision as to whether to allow fathers in the delivery
room.
The specific issue controlling is the correctness of the
district court's finding that the hospital was arbitrary and
capricious when adopting the rule that fathers would not be
allowed in the delivery room.
A number of other issues are set up and discussed at
length in briefs of the various parties. One of those issues is
whether there is a right to judicial review of a private hospital's
d e c i s i o n making process. W need n o t h e r e d e c i d e t h a t i s s u e ,
e
b u t w i l l assume t h a t such a review i s proper.
Other h i g h l y i n t e r e s t i n g problems a r e d i s c u s s e d and
argued i n t h e b r i e f s concerning d o c t o r - p a t i e n t r e l a t i o n s h i p s .
However, we approach t h i s c a s e w i t h t h e view t h a t l i c e n s e d
h o s p i t a l s have t h e a u t h o r i t y , a c t i n g on t h e a d v i c e o f t h e i r
medical s t a f f s , t o adopt r u l e s of s e l f r e g u l a t i o n governing
t h e h o s p i t a l ' s physicians. Licensed p h y s i c i a n s must l i v e ac-
c o r d i n g t o t h e r u l e s adopted by t h e i r c o l l e a g u e s , even though
t h e p h y s i c i a n h a s d i r e c t i o n over h i s p a t i e n t . Hull v. North
V a l l e y H o s p i t a l , 159 Mont, 375, 498 P.2d 136; S e c t i o n 69-
5217(1), R.C.M. 1947.
St, inc cent's H o s p i t a l , h e r e i n a f t e r c a l l e d H o s p i t a l , i s
o p e r a t e d by t h e S i s t e r s o f C h a r i t y of Leavenworth. The day t o
day o p e r a t i o n i s d e l e g a t e d t o t h e a d m i n i s t r a t o r . The H o s p i t a l
h a s 207 beds, 140 d o c t o r s on t h e medical s t a f f , and about 565
employees. For a long p e r i o d of time t h e H o s p i t a l o p e r a t e d
under a r u l e which prevented f a t h e r s b e i n g i n t h e d e l i v e r y room.
Respondent, D r . H u l i t , concluded t h a t he should be a l -
lowed t o b r i n g husband's of h i s p a t i e n t s i n t o t h e d e l i v e r y room
t o p a r t i c i p a t e i n what i s r e f e r r e d t o as t h e Lamaze o r psychopro-
p h y l a c t i c method of c h i l d b i r t h . To achieve h i s ends, D r . H u l i t
p e t i t i o n e d t h e H o s p i t a l , through i t s v a r i o u s committees, t o adopt
a new r u l e . The m a t t e r was heard and debated a t l e n g t h . The
r u l e was adopted f o r a s h o r t p e r i o d time and t h e n r e s c i n d e d ,
whereupon D r . H u l i t brought s u i t .
The H o s p i t a l i s organized around committees and departments.
One department i s O b s t e t r i c s and Gynecology, o t h e r s a r e I n t e r n a l
Medicine, Surgery, General P r a c t i c e and P e d i a t r i c s . The g e n e r a l
s t a f f i s composed of a l l t h e d o c t o r s a u t h o r i z e d t o p r a c t i c e
medicine t h e r e . The b u s i n e s s of t h e g e n e r a l s t a f f i s conducted
through an e x e c u t i v e committee. The e x e c u t i v e committee i s e l e c t e d ,
one from each department, and t h r e e a r e appointed by t h e S i s t e r s
of C h a r i t y . Various committees recommend t o t h e e x e c u t i v e committee,
which submits their recommendations to the administrator. The
administrator is in turn, for our purposes here, responsible to
the Board of Directors of the Sisters of Charity. A subsequent
change occurred, but it is not of importance here.
The matter of fathers in the delivery room was first presented
to the OB-GYN Group by Dr. Hulit August 6, 1968. In September 1968,
Sister Barbara from St. Vincent's Hospital conducted a survey of
other hospitals operated by Sisters of Charity of Leavenworth.
The matter was considered by the OB-GYN Group again on October 22,
1968. It was considered by the executive committee on September
22, 1969, at which time a thorough discussion was conducted and
the rule affirmed that no father be allowed in the delivery room.
On October 27, 1969, Dr. Hulit made a complete presentation of his
proposal to the executive committee. The executive committee then
reversed its earlier position and resolved that fathers should
be allowed in the delivery room.
The matter was next brought up at the regular staff meeting
on December 8, 1969. The general staff thought the committee had
acted improperly in overruling the position of the OE-GYN Group,
Another meeting was held on December 22, 1969, at which both
members of the executive committee and the OB-GYN Group were present.
Final action was not taken at this meeting, and the matter was
again thoroughly discussed at the executive meeting January 26,
1970. At this meeting the executive committee reversed its
earlier position and adopted the rule that fathers would not be
allowed in the delivery room.
Particularly, the doctors at this time were concerned
about the possibility of malpractice suits arising out of this
practice. Although Dr. Hulit was not present at all meetings,
he was given ample opportunity to explain his position and the
practice he wished to follow. Another meeting occurred on April
22, 1970, at which time Dr. Hulit again asked and was allowed
to present his position. Additional meetings ensued, and in
particular at the meeting of July 27, 1970, there was extended
discussion as to the merits and objections to the system. Finally,
the matter was last aired at a special meeting September 3, 1970,
and the previous action excluding fathers from the delivery room
was affirmed. The issue had been thoroughly considered and oppor-
tunity afforded Dr. Hulit and the OB-GYN Group to present their
sides.
Sister Alice Marie, the administrator of St. inc cent's
Hospital, being of the opinion that this was to a significant extent
a medical question, accepted the position taken by the executive
committee, both on the occasion when it allowed fathers in the
delivery room and when it subsequently reversed its stand.
In determining whether the Hospital was arbitrary and
capricious in following the recommendation of the executive committee,
one must consider the factors which the administrator had to take
into account and weigh. Sister Alice ~arie's objectives as an
administrator are set forth in her testimony, wherein she points out
that it is her responsibility to deliver service to thousands of
people at the least possible cost; that she is the coordinator of
the activities of the board of trustees, the medical staff, and
the administrative staff. That it is her responsibility to see
that policies are carried out and to do so she must have harmony
with all the personnel involved, which in turn places a strong
motive upon her to follow decisions made through the normal deci-
sion making process. There are hundreds of policies in existence,
most in writing, and it is clear that the administrator cannot
perform by overruling the actions of the staff, except in the most
special situations.
On the specific issue here, Sister Alice Marie pointed
out some of her reasons. There was not any one item that caused
her to make the final decision, but these were considered: in-
creased possibility of infection; concern about malpractice suits;
inadequate physical facilities which do not allow room for fathers
to change their clothes without possible bothering of the doctors;
increased costs; which though they may not be great have to be
taken into account, such as additional nursing time, providing
gowns, masks, booties, etc.; greater tension in the delivery room
caused by the presence of the father which might cause some of the
nurses to not perform as well; lack of privacy to other women
getting ready to deliver; the strict policy concerning visitors
in surgical areas favored by the state board of health; and the
furtherance of harmony between physicians so that there would
always be cover should Dr. Hulit be absent.
In reading the entire transcript, it is apparent that with
respect to most of these concerns there was in fact two sides.
But, we find the concerns of the administrator were reasonable
concerns to be taken into account.
Respondent argues at length that the other side of the coin
would show the administrator's concerns to be unwarranted and
not proven. Further, the district court found to the contrary and
that the trier of the facts should not be overturned unless there
was no credible evidence to sustain it,
But, what did the tria.1 court hold? Having assumed here
that the trial court could review the decision of the hospital,
this question is pertinent. The trial court found, in a conclusion
of law, that:
"I. The decision of St. inc cent's Hospital in
disallowing the practice of the Lamaze or psycho-
prophylactic method including having Lamaze-trained
fathers in the delivery room with the attending
plaintiff physician's consent is arbitrary and capri-
cious because there are no medical or scientific facts
to support the decision."
This conclusion of arbitrary and capricious action is simply not
supported by the record. A proper statement of a court's function
in this area is found in Sosa v. Board of Managers of Val Verde
Memorial Hospital, (5th Cir. 1971), 437 F.2d 173, 177:
"The court is charged with the narrow responsi-
bility of assuring that the qualifications imposed
by the Board are reasonably related to the opera-
tion of the hospital and fairly administered. In
short, so long as [hospital actions] are administered
with fairness, geared by a rationale compatible with
hospital responsibility, and unencumbered with irrelevant
considerations, a court should not interfere. Courts
must not attempt to take on the escutcheon of Caduceus. 11
Our f u n c t i o n then i s twofold. F i r s t , t o determine whether
due p r o c e s s was accorded. From our r e c i t a t i o n h e r e t o f o r e , i t i s
c l e a r t h a t i t has been. Second, t o determine whether t h e r e was
an a r b i t r a r y and c a p r i c i o u s d e c i s i o n made by t h e H o s p i t a l adminis-
trator. That a c o n s c i e n t i o u s judgment w a s made i s c l e a r - - j u s t t h e
o p p o s i t e of a n a r b i t r a r y and c a p r i c i o u s one. Unquestionably
t h e judgment i s a d e b a t a b l e one, as w i t n e s s t h e e x p e r t medical
judgments involved here. Respondent s t a t e s i n h i s b r i e f t h a t t h e
OB-GYN Group of d o c t o r s had "closed minds" and would n o t l i s t e n
t o reason. When one o p i n i o n does n o t a g r e e w i t h a n o t h e r , a
"closed mind" i s n o t t h e answer.
Here, competent medical opinionswere expressed. Those
competent medical o p i n i o n s a r e s u f f i c i e n t evidence t o uphold t h e
f i n d i n g s and d e c i s i o n of t h e H o s p i t a l and t h a t d e c i s i o n was n o t ,
a s t h e t r i a l c o u r t found, a r b i t r a r y and c a p r i c i o u s .
Accordingly, we hold t h e d i s t r i c t c o u r t ' s judgment be
r e v e r s e d and t h e i n j u n c t i o n s e t a s i d e . W answer o u r o r i g i n a l
e
q u e s t i o n - - t h e t r i a l c o u r t should n o t have i n t r u d e d i t s e l f i n t o
t h e a d m i n i s t r a t i o n of t h e H o s p i t a l where t h e H o s p i t a l had a c t e d
i n good f a i t h on competent medical advice.
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T-7T
Justlce-
Justices.