No. 12457
I N THE SUPRENE C U T O THE STATE O M N A A
OR F F OTN
1974
JAMES HAM, MOD, and RICHARD WILLIAM
K A S Y and CLAUDIA ANN KRANSKY,
R NK
husband and w i f e , e t a l . ,
P l a i n t i f f s and A p p e l l a n t s ,
H L ROSARY HOSPITAL, a Montana
OY
Non-profit c o r p o r a t i o n ,
Defendants and Respondents.
Appeal from: D i s t r i c t Court of t h e S i x t e e n t h J u d i c i a l D i s t r i c t ,
Honorable C. B. Sande, Judge p r e s i d i n g .
Counsel of Record:
For A p p e l l a n t s :
Robert La Stephens, Jr., argued, B i l l i n g s , Montana
For Respondents :
Crowley, Kilbourne, Haughey, Hansen and G a l l a g h e r ,
B i l l i n g s , Montana
Stephen H. F o s t e r , argued, B i l l i n g s , Montana
Submitted: November 13, 1974
Decided : -
QFC X 1 1974
F i l e d : i;3f"i" "g 4974
M r . J u s t i c e Wesley C a s t l e s d e l i v e r e d t h e Opinion of t h e Court.
This i s an appeal by t h e p l a i n t i f f s from an o r d e r of t h e
d i s t r i c t c o u r t , County of Custer, g r a n t i n g defendant's motion
f o r summary judgment.
P l a i n t i f f s f i l e d s u i t i n t h e United S t a t e s D i s t r i c t Court,
D i s t r i c t of Montana, on December 1, 1972, seeking an o r d e r
compelling Holy Rosary Hospital-%- t o permit James Ham,
M.D., t o s u r g i c a l l y s t e r i l i z e Claudia Ann Kransky i n t h a t h o s p i t a l
on December 13, 1972, when she was scheduled t o d e l i v e r h e r t h i r d
c h i l d by cesarean s e c t i o n . The complaint a l l e g e d t h e h o s p i t a l ,
i n r e f u s i n g t o permit i t s f a c i l i t i e s t o be used f o r s u r g i c a l
s t e r i l i z a t i o n , was i n f r i n g i n g upon r i g h t s secured t o p l a i n t i f f s
by t h e United S t a t e s Constitution. The c o u r t dismissed t h e case
on December 8 , 1972, f o r want of j u r i s d i c t i o n . A opinion was
n
subsequently issued explaining t h a t t h e c o u r t found no s t a t e
involvement i n t h e h o s p i t a l ' s enforcement of i t s s t e r i l i z a t i o n
r u l e s and t h e r e f o r e t h e c o u r t lacked j u r i s d i c t i o n under 28 U.S.C.
5 1343. N appeal was taken from t h a t decision.
o
P l a i n t i f f s then f i l e d t h e i r complaint i n t h i s a c t i o n on
December 11, 1972, seeking t h e same r e l i e f from t h e d i s t r i c t
court. O December 12, 1972, t h e c o u r t granted a temporary
n
i n j u n c t i o n r e s t r a i n i n g t h e h o s p i t a l from enforcing i t s s t e r i l i z a -
t i o n r u l e s i n s o f a r a s M r s . Kransky was concerned.
T h e r e a f t e r , on December 15, 1972, summary judgment was entered
on t h e m e r i t s i n favor of t h e h o s p i t a l . In the interim, the
s t e r i l i z a t i o n was performed on Claudia Kransky. Although t h e
c a s e may be moot a s t o ms. Kransky, t h e i s s u e s remain w i t h r e s p e c t
t o D r . Ham and members of t h e c l a s s t o which t h e named p l a i n t i f f s
belong.
P l a i n t i f f Claudia Ann Kransky a t a l l times m a t e r i a l t o t h e
i s s u e s was twenty-two years of age and married t o p l a i n t i f f Richard
Kransky. She i s a r e s i d e n t of Miles City, Custer County, Montana,
and a c i t i z e n of t h e United S t a t e s . She had, p r i o r t o t h e i n s t a n t
pregnancy, a medical history of two prior cesarean sections.
Following consultations with her attending physician, Dr. Ham,
it was determined by plaintiffs that Mrs. Kransky should have a
tubal ligation performed contemporaneously with her third scheduled
cesarean section. For a number of personal reasons Mr. and Mrs.
Kransky determined they did not desire additional childreo. The
sole purpose of the proposed tubal ligation was contraception.
Excepting the customary and usual residual effects of three cesarean
sections and the desire to avoid future pregnancies, Mrs. Kransky
had no medical indication for permanent sterilization.
Defendant Holy Rosary Hospital is a nonprofit Montana corporation.
The members and corporate board of the corporation are members of
the congregation of Presentation Sisters of Aberdeen. Presentation
Sisters of Aberdeen is a religious congregation of sisters organized
pursuant to authorization of the Roman Catholic Church. The
corporate board, however, has delegated primary responsibility for
control and administration of Holy Rosary Hospital to a board of
trustees comprised of seven members of the Presentation Sisters of
Aberdeen and four lay members. The hospital's physical facilities
at Miles City are owned by defendant Holy Rosary Hospital.
Originally established in 1906, Holy Rosary Hospital was re-
built in 1950. The total cost of the physical facilities at that
time was $1,560,500, of which approximately $77,600 was voluntarily
contributed by individual citizens of the community following an
appeal to the public at large.. In 1958, Holy Rosary Hospital
received the benefit of approximately $70,000 voluntarily contributed
by citizens of the community following an appeal to the public for
funds to assist in operating the hospital. Except for these two
fund drives the hospital has made no appeal to the public for
voluntary contributions. It does receive unsolicited memorials and
contributions from time to time of approximately $2,000 per year.
Members of the Presentation Sisters have contributed services valued
in excess of $796,000 to the operation of the hospital since its
inception. A t no time has t h e h o s p i t a l r e c e i v e d any funds under
t h e Hill-Burton Act (42 U.S.C. $291 e t seq.) o r any o t h e r g r a n t s
from c i t y o r county governments, t h e s t a t e o f Montana, o r t h e
United S t a t e s government f o r c o n s t r u c t i o n of p h y s i c a l f a c i l i t i e s ,
purchase of equipment, o r o p e r a t i o n of t h e h o s p i t a l .
Holy Rosary H o s p i t a l s e r v e s an a r e a i n s o u t h e a s t e r n Montana
i n c l u d i n g t h e c o u n t i e s of G a r f i e l d , F a l l o n , Carter, P r a i r i e , Rose-
bud and C u s t e r . It i s t h e o n l y h o s p i t a l i n Miles C i t y and h a s
f a c i l i t i e s f o r c e s a r e a n s e c t i o n s and postpartum c a r e . With t h e
same a r e a , t h e r e a r e a l s o h o s p i t a l s l o c a t e d a t Jordan, Ekalaka,
Baker, F o r s y t h , and Glendive. Of t h e s e h o s p i t a l s , only t h o s e i n
Forsyth and Glendive have f a c i l i t i e s f o r performing c e s a r e a n
s e c t i o n s and postpartum c a r e . Forsyth i s 46 m i l e s and Glendive
i s 76 m i l e s d i s t a n t from Miles City. P l a i n t i f f James Ham i s
admitted t o f u l l s t a f f p r i v i l e g e s t o p r a c t i c e i n and u s e t h e
h o s p i t a l i n Forsyth.
Tuba1 l i g a t i o n i s a medically accepted s u r g i c a l procedure f o r
female s t e r i l i z a t i o n . It has n o t been performed a t Holy Rosary
H o s p i t a l because o f t h e i n t e r p r e t a t i o n placed upon t h e p u b l i c a t i o n
" ~ t h i c a land R e l i g i o u s D i r e c t i v e s f o r C a t h o l i c ~ o s p i t a l s "which
i s i n c o r p o r a t e d by r e f e r e n c e i n t h e bylaws o f t h e medical s t a f f
o f Holy Rosary H o s p i t a l . Holy Rosary H o s p i t a l had n o t adopted
any g u i d e l i n e s f o r s t e r i l i z a t i o n procedures except a s provided by
t h e E t h i c a l and R e l i g i o u s D i r e c t i v e s f o r C a t h o l i c H o s p i t a l s , n o r
has t h e defendant c r e a t e d a s t e r i l i z a t i o n committee t o review r e -
quests f o r s t e r i l i z a t i o n .
By l e t t e r d a t e d J u l y 11, 1972, Mrs. Kransky r e q u e s t e d permission
from t h e h o s p i t a l f o r t h e s t e r i l i z a t i o n procedure a t t h e time of t h e
cesarean section. T h i s r e q u e s t was considered by t h e Board of
Trustees. The a d m i n i s t r a t o r o f t h e h o s p i t a l r e p l i e d by l e t t e r d a t e d
September 15, 1972, e x p l a i n i n g t h a t s t e r i l i z a t i o n was p r o h i b i t e d by
t h e E t h i c a l and R e l i g i o u s D i r e c t i v e s f o r C a t h o l i c H o s p i t a l s . Holy
Rosary H o s p i t a l has expressed no o t h e r r e a s o n s f o r denying t h e tuba1
ligation. There a r e no formal a p p e a l procedures from d e c i s i o n s
o f t h e Board of T r u s t e e s r e l a t i n g t o a p p l i c a t i o n s f o r s t e r i l i z a -
tion.
P l a i n t i f f , James Ham, M.D., i s a physician specializing i n
o b s t e t r i c s and gynecology i n Miles C i t y . Outside of t h e B i l l i n g s
a r e a , D r . Ham i s t h e o n l y OB-Gyn s p e c i a l i s t i n t h e e a s t e r n Montana
area. A s a c o n d i t i o n t o admission t o s t a f f p r i v i l e g e s , D r . Ham
h a s consented t o , a n d agreed t o be bound by, t h e medical s t a f f
bylaws of Holy Rosary H o s p i t a l . Holy Rosary H o s p i t a l r e q u i r e s i t s
medical s t a f f t o a b i d e by t h e medical s t a f f bylaws, t h e p r i n c i p l e s
of medical e t h i c s of t h e American Medical A s s o c i a t i o n , and t h e
E t h i c a l and R e l i g i o u s D i r e c t i v e s f o r C a t h o l i c H o s p i t a l s i n s o f a r
a s t h e y r e l a t e t o a p h y s i c i a n ' s s e r v i c e s w i t h i n Holy Rosary Hos-
pital.
Holy Rosary H o s p i t a l i s s u b j e c t t o s t a t e r e g u l a t i o n and c o n t r o l
i n accordance w i t h T i t l e 69, Chapters 52 and 53, Revised Codes of
Montana, 1947, and i s l i c e n s e d a n n u a l l y by t h e s t a t e of Montana upon
proper a p p l i c a t i o n by t h e h o s p i t a l . In addition, the hospital
i s s u b j e c t t o t h e r e g u l a t i o n s f o r h o s p i t a l s and r e l a t e d i n s t i t u t i o n s
pzomulgat,ed by t h e Montana Department o f Health and Environmental
Sciences. The h o s p i t a l h a s had t h e b e n e f i t o f g e n e r a l exemptions
from t a x a t i o n a s provided by s e c t i o n s 84-202 and 84-1501, R.C.M.
1947, f o r n o n p r o f i t c o r p o r a t i o n s organized f o r c h a r i t a b l e , s c i e n t i f i c ,
r e l i g i o u s o r e d u c a t i o n a l purposes. The h o s p i t a l has a l s o been
p a i d w i t h p u b l i c funds f o r s e r v i c e s rendered t o e l i g i b l e p a t i e n t s
under s t a t e and f e d e r a l w e l f a r e , medicare and medicaid programs.
I n t h e i r argument and b r i e f , p l a i n t i f f s have r a i s e d a number
of f e d e r a l c o n s t i t u t i o n a l i s s u e s . However, a s a c o n d i t i o n precedent
t o t h e c o n s i d e r a t i o n of t h o s e i s s u e s , t h i s Court must f i r s t f i n d
t h a t t h e a c t i o n s of t h e h o s p i t a l i n v o l v e s t a t e a c t i o n p r o h i b i t e d by t h e
federal constitution. W hold, a s did the f e d e r a l d i s t r i c t court,
e
t h a t t h e a c t i o n s of defendant Holy Rosary H o s p i t a l a r e merely
p r i v a t e conduct, n o t s t a t e a c t i o n , and a r e t h u s n o t p r o s c r i b e d by
the Constitution. Finding no s t a t e a c t i o n , we do n o t r e a c h p l a i n -
t i f f s ' main i s s u e s . In addition, t h i s action, a s t o the constitu-
t i o n a l i s s u e s , i s b a r r e d by t h e a p p l i c a t i o n of t h e d o c t r i n e o f -
res
judicata. P l a i n t i f f s a l s o claim t h a t t h e h o s p i t a l ' s a c t i o n s
v i o l a t e s e c t i o n 69-5217(1), R.C.M. 1947. W hold t h e r e has been
e
no v i o l a t i o n of t h a t s t a t u t e .
In support of t h e i r a l l e g a t i o n t h a t s t a t e a c t i o n i s involved
i n Holy Rosary ~ o s p i t a l ' sdecision t o f o r b i d t h e use of i t s
f a c i l i t i e s f o r voluntary s t e r i l i z a t i o n , p l a i n t i f f s p r e s e n t s e v e r a l
f a c t s which they claim lead t o t h a t conclusion: (1) t h e h o s p i t a l ' s
use of "public" funds derived from i t s public appeals f o r c o n t r i -
b u t i o n s ; (2) t h e h o s p i t a l ' s submission t o r e g u l a t i o n s prescribed
pursuant t o t h e s t a t e ' s p a r t i c i p a t i o n i n o t h e r Hill-Burton p r o j e c t s ;
(3) t h e h o s p i t a l ' s monopoly p o s i t i o n i n t h e Miles C i t y a r e a ; (4)
t h e h o s p i t a l ' s s u b j e c t i o n t o s t a t e l i c e n s i n g and r e g u l a t i o n ; (5)
t h e operation of a h o s p i t a l i s per s e a public function; and (6)
t h e h o s p i t a l ' s p r e f e r r e d p o s i t i o n under s t a t e law due t o i t s t a x
exemption s t a t u s . W f i n d none of t h e s e f a c t s , e i t h e r i n d i v i d u a l l y
e
o r taken t o g e t h e r , t o be s u f f i c i e n t t o warrant a f i n d i n g t h a t t h e
a c t i o n s of Holy Rosary H o s p i t a l , a p r i v a t e c o r p o r a t i o n , c o n s t i t u t e
s t a t e action subject t o constitutional limitations. Since t h e
p a r t i e s and t h e i s s u e s were t h e same, we adopt and quote from t h e
unreported opinion of Judge Russell E. Smith, dated December 20,
1972, C i v i l No. United S t a t e s D i s t r i c t Court f o r t h e D i s t r i c t
of Montana, B i l l i n g s Division:
"It i s n o t disputed t h a t t h e 1 4 t h amendment ' e r e c t s
no s h i e l d a g a i n s t merely p r i v a t e conduct however d i s -
criminatory o r wrongful.' Burton v. Wilmington Parking
Authority, 365 U.S. 715 (196Q; Moose Lodge No. 107 v.
I r v i s , 407 U.S. 163 (1972). Holy Rosary Hospital i s a
p r i v a t e yerson and u n l e s s t h e s t a t e has ' s i g n i f i c a n t l y
involved i t s e l f with t h e claimed d i s c r i m i n a t i o n t h e r e i s
n o t s t a t e a c t i o n and t h e c o u r t has no j u r i s d i c t i o n . Moose
Lodge No. 107 v. I r v i s , supra.
'1
Under c o n t r o l l i n g d e c i s i o n s (Moose Lodge No. 107
v. I r v i s , supra) t h e c o u r t i s r e q u i r e d t o s i f t t h e f a c t s
and weigh t h e circumstances t o determine whether i n a
given c a s e t h e r e i s a non-obvious involvement of t h e s t a t e
i n p r i v a t e conduct. ***
"As I independently weigh. and s i f t t h e f a c t s and c i r -
cumstances h e r e I am unable t o conclude t h a t t h e r e i s any
s i g n i f i c a n t r e l a t i o n s h i p between t h e s t a t e and t h e a c t i o n
h e r e sought t o be enjoined. It does n o t appear t h a t
t h e t a x b e n e f i t s o r t h e s t a t e patronage enjoyed by Holy
Rosary Hospital a r e dependent upon t h e enforcement of a
s t e r i l i z a t i o n policy. Were t h a t s o , a d i f f e r e n t problem
would be presented, b u t t h e r e c e i p t of t a x b e n e f i t s alone
i s n o t s u f f i c i e n t t o make t h e a c t i o n of t h e b e n e f i c i a r y
t h e a c t i o n of t h e s t a t e . Browns v. M i t c h e l l , 409 F.2d 593
(10th C i r . 1969); Blackburn v. Fisk University, 443 F.2d 121
(6th C i r . 1971). The S t a t e of Montana has n o t by s t a t u t e
o r r e g u l a t i o n attempted t o p r o h i b i t o r r e g u l a t e operations
r e s u l t i n g i n t h e s t e r i l i t y of noncustodial males and females.
"It i s urged t h a t Holy Rosary Hospital has assumed a
public function and may n o t i n t h e e x e r c i s e of such function
r e s t r i c t t h e fundamental r i g h t s of c i t i z e n s . The c a s e s i n
support of t h i s p r o p o s i t i o n a r e analyzed i n t h e c a s e of Powe
v. Miles, 407 F,2d 73 (2d C i r . 1968) and t h e r u l e s t a t e d i n
them was held t o be i n a p p l i c a b l e t o p r i v a t e schools i n c o r -
porated under s t a t e law, r e g u l a t e d by s t a t e law, and aided
t o some e x t e n t by s t a t e funds. What i s s a i d i n Powe v. Miles,
supra, with r e s p e c t t o p r i v a t e schools i s e q u a l l y a p p l i c a b l e
t o p r i v a t e h o s p i t a l s . I n f a c t , s t a t e supported and managed
education i n America a t a l l l e v e l s f o r many years has been
a more common t h i n g than s t a t e supported and managed h o s p i t a l s .
"The f a c t t h a t Holy Rosary Hospital has a p r a c t i c a l , b u t
n o t s t a t e - e n f o r c e d , monopoly i n o b s t e t r i c a l s e r v i c e s i n
Miles C i t y does not make i t s a c t i o n s t a t e a c t i o n . Martin v.
P a c i f i c Northwest B e l l Telephone Company, 441 F.2d 1116 (9th
C i r . 1971). "
W e w i l l d i s c u s s b r i e f l y two of t h e f a c t u a l b a s e s , n o t discussed
i n Judge Smith's opinion, which p l a i n t i f f s h e r e urge r e q u i r e t h e
conclusion t h a t t h e h o s p i t a l ' s d e c i s i o n t o f o r b i d t h e use of i t s
f a c i l i t i e s f o r voluntary s t e r i l i z a t i o n c o n s t i t u t e s s t a t e a c t i o n .
P l a i n t i f f s ' contention t h a t t h e h o s p i t a l ' s use of "public funds"
derived from i t s public appeals f o r c o n t r i b u t i o n s c o n s t i t u t e s s t a t e
a c t i o n i s without m e r i t , The f a c t t h a t t h e appeal was t o t h e public
a t l a r g e i s immaterial t o a f i n d i n g t h a t t h e power of t h e s t a t e i s
involved i n t h e operation of t h e h o s p i t a l . A t no time have funds
derived from t h e s t a t e been used i n a l e g a l sense i n t h e operation
of Holy Rosary Hospital.
P l a i n t i f f s ' contention t h a t t h e h o s p i t a l ' s s u b j e c t i o n t o s t a t e
l i c e n s i n g and r e g u l a t i o n c o n s t i t u t e s s t a t e a c t i o n was answered i n
Moose Lodge No. 107 v. I r v i s , 407 U.S. 163, 92 S.Ct. 1965, 32 L ed
2d 627, 639. There, t h e United S t a t e s Supreme Court held t h a t t h e
mere l i c e n s i n g of Moose Lodge t o s e r v e l i q u o r by t h e Pennsylvania
Liquor Control Board d i d n o t amount t o such s t a t e involvement with
t h e c l u b ' s a c t i v i t i e s a s t o make i t s discriminatory p r a c t i c e s f o r -
bidden by t h e Fourteenth Amendment. With r e s p e c t t o s t a t e r e g u l a t i o n ,
the court said:
"However d e t a i l e d t h i s type of r e g u l a t i o n may
be i n some p a r t i c u l a r s , i t cannot be s a i d t o i n any
way f o s t e r o r encourage r a c i a l d i s c r i m i n a t i o n . Nor
can i t be s a i d t o make t h e S t a t e i n any r e a l i s t i c
sense a p a r t n e r o r even a j o i n t v e n t u r e r i n t h e c l u b ' s
e n t e r p r i s e . II
In t h e i n s t a n t c a s e , t h e r e g u l a t i o n of k o s p i t a l s prescribed
pursuant t o Chapters 52 and 53, T i t l e 69, R.C.M. 1947, cannot be
s a i d t o i n any way f o s t e r o r encourage a decision by t h e h o s p i t a l
on t h e s u b j e c t of s t e r i l i z a t i o n . A t most, s e c t i o n 69-5223, R.C.M.
1947, s e t f o r t h l a t e r i n t h i s opinion, merely l e t s t h e d e c i s i o n
r e s t with t h e h o s p i t a l , f r e e from any s t a t e coercion e i t h e r way.
Neither can i t be s a i d t h a t these r e g u l a t i o n s i n any r e a l i s t i c
sense make t h e s t a t e of Montana a p a r t n e r o r j o i n t venturer i n t h e
h o s p i t a l ' s d e c i s i o n t o f o r b i d voluntary s t e r i l i z a t i o n s w i t h i n t h e
w a l l s of i t s f a c i l i t y .
W now consider t h e i s s u e of whether t h e argument of p l a i n t i f f s ,
e
t h a t the hospital i s violating p l a i n t i f f s ' federal constitutional
r i g h t s by r e f u s i n g t o permit s t e r i l i z a t i o n o p e r a t i o n s , must be
r e j e c t e d because t h e o r d e r dismissing t h e f e d e r a l c o u r t a c t i o n i s
-j u d i c a t a
res on t h a t i s s u e . I n 28 U.S.C. J 1343, Congress granted
t h e f e d e r a l d i s t r i c t c o u r t s j u r i s d i c t i o n t o enforce t h e Fourteenth
Amendment. The j u r i s d i c t i o n conferred by t h a t s e c t i o n i s r e s t r i c t e d
t o c a s e s where t h e defendant has a c t e d "under c o l o r of any S t a t e law,
s t a t u t e , ordinance, r e g u l a t i o n , custom o r usage." Whether t h e r e
i s "color of S t a t e lawff f o r purposes of 5 1343 and whether t h e r e i s
II
a s i g n i f i c a n t involvement of t h e s t a t e i n p r i v a t e conduct", i . e ,
I1
s t a t e action", f o r Fourteenth Amendment purposes a r e i d e n t i c a l
questions. See: Moose Lodge v . I r v i s , supra; United S t a t e s v.
Wiseman, 445 F.2d 792 (2d C i r . 1971); Hall v. Garson, 430 F.2d 430,
439 (5th C i r . 1970).
Attempting t o invoke j u r i s d i c t i o n under 28 U. S.C. § 1343
p l a i n t i f f s a l l e g e d i n t h e i r f e d e r a l c o u r t complaint t h a t t h e h o s p i t a l ,
a c t i n g under c o l o r of s t a t e law, was i n f r i n g i n g upon r i g h t s secured
tothem by t h e United S t a t e s C o n s t i t u t i o n , Based upon s t i p u l a t e d
f a c t s v i r t u a l l y i d e n t i c a l t o those i n t h e i n s t a n t c a s e , Judge Smith
dismissed t h e c a s e f o r l a c k of j u r i s d i c t i o n , holding, c o n t r a r y
t o t h e a l l e g a t i o n s of t h e complaint, t h a t t h e h o s p i t a l was n o t a c t i n g
under c o l o r of s t a t e law.
P l a i n t i f f s i n t h e i r b r i e f here r e t u r n t o t h e same i s s u e s
involved i n t h e f e d e r a l c o u r t case and argue a t l e n g t h t h a t t h e
h o s p i t a l ' s s t e r i l i z a t i o n p r o h i b i t i o n i n f r i n g e s upon r i g h t s secured
t o them by t h e F i r s t , F i f t h , Eighth, Ninth and Fourteenth Amend-
ments t o t h e United S t a t e s Constitution. Since t h e s e Amendments
r e s t r i c t only s t a t e a c t i o n and n o t purely p r i v a t e a c t i o n , t h i s
argument again r a i s e s t h e i s s u e of whether o r not t h e s t a t e i s
" s i g n i f i c a n t l y involved" i n t h e h o s p i t a l ' s p r o h i b i t i o n a g a i n s t
sterilization. Judge Smith r u l e d a g a i n s t p l a i n t i f f s on t h i s pre-
c i s e i s s u e and h i s r u l i n g i s conclusive here.
The general r u l e r e s p e c t i n g t h e conclusive e f f e c t of a
d i s m i s s a l f o r l a c k of j u r i s d i c t i o n on grounds m a t e r i a l t o t h e
m e r i t s of t h e cause 9s s t a t e d i n t h e Annotation, 49 A.LR2d 1036,
1068 (1956):
"In some s i t u a t i o n s a d e c i s i o n on t h e j u r i s d i c t i o n of
a c o u r t may depend upon questions of f a c t which a r e a l s o
m a t e r i a l i n determining t h e m e r i t s of t h e cause of a c t i o n .
The weight of t h e c a s e s , expressly o r by i n f e r e n c e , sup-
p o r t s t h e r u l e t h a t where a question of f a c t m a t e r i a l t o
t h e merits has been decided by and i s e s s e n t i a l t o a
judgment f o r defendant based on l a c k of j u r i s d i c t i o n , such
determination i s conclusive upon t h e p a r t i e s i n a subse-
quent a c t i o n e i t h e r f o r the same o r a d i f f e r e n t cause of
action. It
The a p p l i c a b i l i t y of t h i s r u l e i n t h e i n s t a n t c a s e cannot be
questioned. S i g n i f i c a n t s t a t e involvement i n t h e h o s p i t a l ' s
s t e r i l i z a t i o n r u l e s i s e s s e n t i a l n o t only t o t h e f e d e r a l c o u r t ' s
j u r i s d i c t i o n but a l s o t o t h e merits of t h e claim t h a t t h e h o s p i t a l
i s denying p l a i n t i f f s t h e i r c o n s t i t u t i o n a l r i g h t s .
The p a r t i e s h e r e a r e t h e same as w e r e before t h e federal
c o u r t ; t h e s u b j e c t matter i s t h e same a s was before t h e f e d e r a l
c o u r t ; t h e i s s u e of s t a t e a c t i o n i s t h e same and r e l a t e s t o t h e
same s u b j e c t matter; and, t h e c a p a c i t i e s of t h e p a r t i e s a r e t h e
same. Consequently, Judge smith's f i n d i n g t h a t t h e r e i s no s t a t e
participation in the hospital's rules against sterilization is
conclusive, and precluded a ruling here that such rules are sub-
ject to Fourteenth Amendment restrictions. Smith v. County of
Musselshell, 155 Mont. 376, 378, 472 P.2d 878, 879.
Plaintiffs claim that the hospital's sterilization rules vio-
late section 69-5217, R.C.M. 1947. That statute provides in
pertinent part:
" 1 No person who operates a facility may discriminate
()
among the patients of licensed physicians. The free and
confidential professional relationship between licensed
physician and patient shall continue and remain unaffected.
Physicians shall continue to have direction over their
patients. f I
The actions of Holy Rosary Hospital did not violate section
69-5217. There is no discrimination among patients. All patients
are alike subject to the hospital's rule prohibiting sterilizations to
be performed within the hospital. As a private hospital, which
voluntarily initiated and voluntarily provides these hospital
factilities, Holy Rosary Hospital has a legal right to prescribe
the terms upon which it furnishes its services to the public so
long as it does not discriminate against some patients in providing
those services. The confidential relationship between physician
and patient is unaffected. The relationship which these rules
affect is that between the hospital and the physkian or the
hospital and the patient. The free and confidential relationship
between patient and physician was never intruded upon by Holy
Rosary Hospital. Plaintiffs were at all times free to choose
another facility, albeit inconvenient, for the tuba1 ligation.
The last sentence of section 69-5217, R.C.M. 1947, heretofore
quoted, does appear to create some difficulty however. The sentence
is ambiguous in that it may mean either (1) the physician has
exclusive direction over his patient to the extent that he can
totally disregard reasonable rules and regulations of a private
hospital, or it may mean ( ) that the physician has exclusive
2
direction over his patient subject to reasonable rules and regula-
tions of a private hospital. Although not enacted when this
s u i t commenced, t h e l e g i s l a t u r e has subsequently enacted a s t a t u t e
which c l a r i f i e s t h i s ambiguity with r e s p e c t t o t h e i s s u e a t hand.
Section 69-5223, which became e f f e c t i v e March 31, 1974, provides
i n part:
"(I) N private hospital or health care f a c i l i t y s h a l l
o
be required c o n t r a r y t o t h e r e l i g i o u s o r moral t e n e t s o r t h e
s t a t e d r e l i g i o u s b e l i e f s o r moral convictions of such hos-
p i t a l o r f a c i l i t y a s s t a t e d by i t s governing body o r board
t o admit any person f o r t h e purpose of s t e r i l i z a t i o n o r t o
permit t h e u s e of i t s f a c i l i t i e s f o r such purpose. Such
r e f u s a l s h a l l n o t g i v e r i s e t o l i a b i l i t y of such h o s p i t a l
o r h e a l t h c a r e f a c i l i t y , o r any personnel o r agent o r
governing board t h e r e o f , t o any person f o r damages a l l e g e d l y
a r i s i n g from such r e f u s a l , nor be t h e b a s i s f o r any d i s -
criminatory, d i s c i p l i n a r y , o r o t h e r recriminatory a c t i o n
a g a i n s t such h o s p i t a l o r h e a l t h c a r e f a c i l i t y , o r any per-
sonnel,agent, o r governing board thereof."
Although t h e c o n s t i t u t i o n a l i t y of s e c t i o n 69-5223 was
questioned by p l a i n t i f f s i n o r a l argument, we need not decide t h a t
i s s u e a t t h e present time. W merely use s e c t i o n 69-5223 a s
e
persuasive a u t h o r i t y , bearing on t h e l e g i s l a t i v e i n t e n t i n enacting
s e c t i o n 69-5217, f o r t h e purpose of r e s o l v i n g t h e ambiguity i n h e r e n t
i n t h e l a s t sentence of s e c t i o n 69-5217, R.C.M. 1947. Viewing t h e
two s e c t i o n s t o g e t h e r , t h e r e s o l u t i o n of t h e ambiguity i s r e a d i l y
apparent. With r e s p e c t t o t h e i s s u e of voluntary s t e r i l i z a t i o n , t h e
physician has exclusive d i r e c t i o n over h i s p a t i e n t s u b j e c t t o r u l e s
and r e g u l a t i o n s based upon r e l i g i o u s o r moral t e n e t s .
It i s c l e a r t h e h o s p i t a l ' s r u l e s r e s p e c t i n g s t e r i l i z a t i o n
v i o l a t e n e i t h e r t h e United S t a t e s C o n s t i t u t i o n nor t h e laws of t h e
s t a t e of Montana. The f i n d i n g of no " s t a t e a c t i o n " by t h e f e d e r a l
d i s t r i c t c o u r t i s -j u d i c a t a i n t h i s a c t i o n .
res The d i s t r i c t c o u r t
t h e r e f o r e properly r e f u s e d t o i s s u e a permanent i n j u n c t i o n r e -
s t r a i n i n g Holy Rosary Hospital from enforcing i t s r u l e s p r o h i b i t i n g
sterilizationd.Mn t h e h o s p i t a l by g r a n t i n g summary judgment i n
favor of t h e h o s p i t a l .
The judgment i s a £ firmed.
Justice. 0
W concur:
e
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Chief J u s t i c e
n
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Justices.