Title: HUTCHINS v BLOOD SERVICES OF MONTA

State: montana

Issuer: Montana Supreme Court

Document:

No. 12239 I N THE S U P R E M E COURT O F THE STATE O F MONTANA C H A R L E S A. HUTCHINS, Plaintiff and Respondent, BLOOD SERVICES O F M O N T A N A , an Arizona corporation, and BILLINGS D E A C O N E S S HOSPITAL, a Montana corporation, Defendants and Appellants. Appeal from: District Court of the Thirteenth Judicial District, Honorable Robert H. Wilson, Judge presiding. Counsel of Record: For Appellants : Moulton, Bellingham, Lango and Mather, Billings, Montana. W. H. Bellingham argued, Billings, Montana. Lewis and Roca , Phoenix, Arizona. Douglas L. I r i s h argued, Phoenix, Arizona. For Respondent: Scott, Scott and Baugh, Billings, Montana. Jeffrey 3. Scott argued, Omaha, Nebraska. G. Todd Baugh appeared, Billings, Montana. Submitted: January 22, 1973 Decided : FEB I 4 1973 Filed : FEB 1 4 19-73 X r . J u s t i c e Wesley Castles delivered the Opinion of the Court. This i s an appeal from a judgment based on a jury v e r d i c t returned October 22, 1971, i n Yellowstone County, i n favor of p l a i n t i f f Charles A. Hutchins and against defendant Blood Services of Montana. Hutchins claimed Blood Services negligently caused him t o contact serum h e p a t i t i s , The t r i a l court denied defendant's motion f o r directed v e r d i c t a t the close of p l a i n t i f f ' s case and again a t the close of a l l the evidence. The t r i a l court a l s o denied defendant's combined motion f o r judgment notwithstanding the verdict and f o r new t r i a l . This appeal i s from the judgment a s well a s the denial of motions f o r a directed v e r d i c t , f o r judgment notwithstanding the verdict,and f o r a new t r i a l . P l a i n t i f f Charles A, Hutchins, 56 years of age, underwent abdominal surgery i n September 1966. During the course of t h a t surgery he received two u n i t s of whole blood which was supplied by Blood Services of Montana. Defendant i s an Arizona corporation authorized t o do business i n the s t a t e of Montana under the name Blood Services of fjontana. Blood Services i s a nonprofit medically-sponsored community blood banking system which maintains 27 f a c i l i t i e s serving about 850 hospitals i n 18 s t a t e s . It provides nearly 275,000 u n i t s of blood f o r transfusions annually. I n Montana, a s elsewhere, Blood Services u t i l i z e s a v a r i e t y of methods t o persuade people t o become blood donors, i n order t o obtain and maintain a constant supply of blood t o f u l f i l l i t s commitments t o the communities it serves. It i n v i t e s friends and r e l a t i v e s of patients who have received transfusions t o replace blood used and thereby obtain a c r e d i t on the p a t i e n t ' s h o s p i t a l b i l l . Blood Services w i l l arrange f o r the issuance of an insurance policy t o a blood donor t o insure him and h i s family against t h e i r potential blood needs f o r one year i n exchange f o r a single donation. It w i l l a l s o make a donation i n the donor's name t o a charity of the donor's choice, i f the donor so wishes. When an individual presents himself a s a prospective donor a t Blood Services a determination i s made, depending on the needs of the community, if Blood Services will accept the service of such volunteer, if he is acceptable as a donor. In order to assure itself of a supply of volunteers, Blood Services compen- sates them for their availability and willingness to serve either by the insurance plan, offered to all donors, or a charitable donation, or a direct payment in the amount of $5. Blood Services' procedures for gathering, testing, pro- cessing and distributing blood are established in three sets of regulations: ( 1 ) Federal regulations issued by the United States Public Health Service, National Institutes of Health, Division of Biologic Standards, by which it is regularly inspected; ( 2 ) the accreditation standards of the American Association of Blood Banks, by which it is accredited and regularly inspected; and ( 3 ) its own internal Medical-Technical Procedures Manual, prepared by Dr. John B. Alsever, Blood Services' Vice-President for Medical Affairs, which manual meets or exceeds all requirements of the Public Health Service and the American Association of Blood Banks. Here, there was no contention that any regulation or procedure was violated by Blood Services. On September 22, 1966, donor Sharon Holm, a 19 year old resident of Butte, felt and appeared to be in good health, She had never previously donated blood. At Blood Servicesf Butte facility where she donated, Sharon and her blood were screened, tested and processed by Blood Servicesf personnel in accordance with all of its standard testing and screening procedures. Sharon gave no history or indication from which it might be inferred she could be a hepatitis carrier. She was paid $5 by Blood Services for her donation of blood. Sharon ~olm's blood was transfused to plaintiff Hutchins on September 29, 1966, while he was under- going abdominal surgery. About three weeks after Hutchins re- ceived the blood, Sharon Holm, having been ill for a few days, was diagnosed as having hepatitis. ~utchins' doctors in Billings were immediately notified but it was too late and Hutchins also became ill with hepatitis. Blood Services r a i s e s several issues on appeal. W e w i l l deal primarily with the question of whether p l a i n t i f f by s u f f i c i e n t evidence adequately established negligence, so a s t o c r e a t e a jury question. P l a i n t i f f attempted t o prove Blood Services was negligent on accepted b ood i n t h a t i t did not use a laboratory t e s t known a s the SGQT t e s t / and i n the handling of the paid donor, since paid donors allegedly have a much higher r a t e of h e p a t i t i s than volunteer donors. W e have reviewed the evidence i n the l i g h t most favorable t o the p l a i n t i f f and find p l a i n t i f f did not e s t a b l i s h any case of negli- gence against Blood Services. P l a i n t i f f Hutchins asserted t h a t Blood Services by its negligence caused him t o contact serum h e p a t i t i s . He proffered two a c t s of negligence on Blood Services' part. I n a negligence action it is encumbent upon the p l a i n t i f f t o prove, among other elements, a duty owing from defendant t o p l a i n t i f f and a breach of t h a t duty. See: Pickett v. Kyger, 151 Mont. 87, 439 P,2d 57. W e f i r s t consider the allegation t h a t Blood Services did n o t use the S G O T test. S G O T i s a laboratory t e s t developed and used f o r many years i n following the c l i n i c a l course of persons who a r e known t o be ill. I n general, it measures the l e v e l of a c e r t a i n enzyme i n the blood. Cells damaged by trauma o r disease r e l e a s e t h i s enzyme i n the blood. Hence, an increased S G O T l e v e l may indicate there a r e damaged or diseased c e l l s somewhere i n the body, It was Blood Services' f a i l u r e t o use the SGQT t e s t t h a t was charged a s negligence. I n 1966, when t h e incident i n t h i s case occurred, not a single blood bank i n the nation had ever used the t e s t t o screen blood donors, In other words, the standard of care established throughout the nation was not t o use the S G O T t e s t . This same standard of care was established f o r Butte and Billings, Montana. P l a i n t i f f produced one witness, D r . J. Garrott Allen, a professor of surgery a t Stanford University and a practicing surgeon. D r . Allen i s a recognized expert i n the f i e l d of what we w i l l generally c a l l blood. Over Blood Services' objection, D r . Allen was allowed t o express h i s opinion t h a t i f the S G O T test had been given t o Sharon Holm a t the time of the taking of h e r blood, i t "probably" would have given a positive reaction. However, D r , Allen t e s t i f i e d t h a t no blood bank i n the United S t a t e s , including h i s own h o s p i t a l ' s blood bank i n California, had ever used the S G O T test t o screen donors. D r . Allen then, a s w e l l a s a l l other witnesses, established a standard of care a s regards the SGOT t e s t , a s a standard of not using the SGOT test. Neither D r . Allen nor any other witness expressed the opinion: (a) t h a t a blood bank's decision not t o use the S G O T t e s t was a deviation from, o r contrary t o , the ap- proved custom o r practice i n any other blood bank, o r (b) t h a t the conclusion of the e n t i r e blood banking community not t o perform t h i s test deviated from what anyone would consider reasonable o r prudent practice. D r . Allen did say he personally would l i k e it done on blood he receives. But, one person's preference does not e s t a b l i s h a standard of care. This was the only evidence offered by p l a i n t i f f . However, i n order t o prove a case of actionable negligence, p l a i n t i f f must do more than have an expert witness t e s t i f y t h a t he would like t o have the t e s t used. P l a i n t i f f had t o e s t a b l i s h , by com- petent medical evidence, e i t h e r t h a t Blood Services did something blood bankers of ordinary care, s k i l l and diligence would not have done under similar conditions, or it omitted t o do something they would have done under similar circumstances. Here, it was established t h a t no one i n the blood banking business used the S G O T t e s t t o screen blood donors. Neither the government's reg- ulatifig agency, the blood bankers' accrediting association, the American Medical Association, nor anyone e l s e i n authority had ever asked blood bankers t o use the S G O T t e s t i n screening donors. It was established t h a t Blood Services' decision was not t o use the S G O T t e s t . But the testimony of a professor a t a medical school t h a t he would l i k e t o have the t e s t done on the blood he uses, does not e s t a b l i s h a case of negligence. This Court s t a t e d i n Mang v. Eliasson, 153 Mont. 431, 435, 458 P.2d 777: "An additional t e s t of actionable negligence i s not what might have prevented a p a r t i c u l a r accident, but what reasonably prudent men would have done i n the discharge of t h e i r duties under the circumstances a s they existed a t the time of the accident, Milasevich v. Fox Western Montana Theatre Corp., 118 Mont, 265, 272, 165 P.2d 195." Here then, we must look t o what actually happened and what a reasonably prudent blood bank would have done i n the same s i t u a t i o n , Using t h a t t e s t , and considering the circumstances a s they were i n 1966, it was not negligence f o r Blood Services not t o use the S G O T t e s t , it acted a s a reasonably prudent blood bank. The uncontradicted circumstances a t the time were: (a) no blook bank i n the United States was using the S G O T t e s t a s a routine screening t e s t ; (b) n e i t h e r federal regulations nor the accrediting standards of the American Association of Blood Banks required o r had ever required the use of the S G O T t e s t on prospective donors; (c) neither the Public Health Service, the American Association of Blood Banks of the American Medical Association Committee on Transplantation and Transfusion had ever recommended the use of S G O T t e s t i n g ; and (d) although some w r i t e r s had suggested investigating the usefulness of SGOT f o r blood donors, those F J ~ O were recognized a s a u t h o r i t i e s i n blood banking had concluded it was not a useful or meaningful t e s t f o r purposes of screening blood donors. N o witness, not even D r . Allen, ex- pressed the opinion t h a t Blood Services' decision f a i l e d t o comply with any standard of practice o r recognized degree of care anywhere other than i n D r . Allen's private preferences. This Court said "'Nor does the f a c t t h a t other physicians might have adopted other methods necessarily render the attending physician l i a b l e , nor show negligence or want of s k i l l o r care. I f the method adopted I - 1 . - 4h + : has s u b s t a n t i a l medical support, it i s suf- f i c i e n t . : ' : * * And, where there i s a difference of opinion among p r a c t i c a l and s k i l l f u l surgeons a s t o the practice t o be pursued i n c e r t a i n cases, a physician may exercise h i s own b e s t judgment, employing the methods h i s experience may have shown t o be b e s t , and mere e r r o r of judgment w i l l not make him l i a b l e i n damages, i n the absence of a showing of want of care and s k i l l . "' That standard i s c l e a r l y applicable here. There was no evidence introduced t o show t h a t Blood Services f a i l e d t o use care and s k i l l , and it was established i t s practice was t h e same as a l l other blood banks. The public i n t e r e s t requires blood banks t o be v i g i l a n t but t h i s consideration would not j u s t i f y the lowering the standard proof i n cases of t h i s kind, f o r i n doing so the public i n t e r e s t would be ill served. I f those who supply the very f l u i d of l i f e were required, without the s l i g h t e s t evidence of deviation from approved medical practice, ips0 facto t o pay damages any time a person whose l i f e they save suffers an untoward r e s u l t , such a charitable nonprofit e n t e r p r i s e would be hazardous and self-defeating. W e do not find from the evidence t h a t Blood Services was negligent i n not using the S G O T t e s t . The second alleged negligent a c t was t h a t since Blood Services was using paid donors, it was negligent in not taking the necessary steps t o make sure t h e blood from i t s paid donors was not infected. P l a i n t i f f ' s theory wa,s t h a t i n accepting blood from Sharon Holm, a paid donor, the r i s k she would be carrying h e p a t i t i s was eleven times higher than a volunteer donor. Since t h i s i s a higher r i s k of h e p a t i t i s , p l a i n t i f f maintains Blood Services should have taken necessary steps t o determine i f the blood was infected. This theory i s based on studies of the types of people who exchange blood f o r money. It was D r . Allen who had made part of the studies and made the observation during t r i a l t h a t the r i s k when dealing with paid donors was much higher than when dealing with volunteers. D r . Allen gave a two-fold b a s i s upon which h i s opinion was based: (a) h i s own studies at the I l l i n o i s S t a t e Penitentiary, which showed prisoners i n s t a t e p e n i t e n t i a r i e s carry a high h e p a t i t i s r i s k , and (b) studies of others which show t h a t drug addicts, d e r e l i c t s and skid-row bums a l l carry a high r i s k of h e p a t i t i s . Even accepting everything p l a i n t i f f o f f e r s a s t r u e , t h a t s t i l l does not show Blood Services was negligent when dealing with Sharon Holm. The uncontroverted evidence was t h a t Sharon did not f a l l i n t o the category of a dangerous donor such a s prison inmates, bums, o r addicts; she did not l i v e i n a slum o r skid-row d i s t r i c t ; Blood Services does not accept, paid o r n o t , the type of donor i n the category D r . Allen and others found t o be dangerous; and Blood Services f a c i l i t i e s were not located i n a slum o r skid-row d i s t r i c t . The evidence of D r . Allen on the r i s k of using paid donors was not applicable t o the s i t u a t i o n of Sharon Holm. There was no evidence t o bring Sharon Holm within the c i r c l e of those personsvhoseblood i s more l i k e l y t o contain h e p a t i t i s than blood of the general population. It may be t h a t prisoners, bums, and addicts who s e l l t h e i r blood a r e high r i s k donors, but it does not follow t h a t everyone who s e l l s h i s blood i s a high r i s k donor. It i s not negligence t o o f f e r t o buy blood, when a blood bank finds t h a t i s the only way i t can meet i t s obligations. Since the only two a c t s of negligence r e l i e d upon by p l a i n t i f f f a W t o e s t a b l i s h negligence, the case was improperly submitted t o the jury. Therefore, we order the judgment of the d i s t r i c t court reversed and the cause dismissed. ~ s s d i a t e J u s t i c e .............................. Associate Justices. M r . J u s t i c e Frank I. Haswell took no part i n t h i s Opinion. M r . J u s t i c e John Conway Harrison concurring i n part and dissenting i n part: I concur with the majority on i s s u e one, t h a t the case should be reversed, but I would r e t u r n the case f o r a new t r i a l . I do not agree with the majority on issue two a s t o paid blood donors. The f a c t s , a s I understand them, concerning Sharon Holm would have made her a high r i s k donor. These f a c t s brought out during t r i a l need not be s t a t e d , but they did indicate t h a t i f defendant had made any inquiries she might not have been a l - lowed t o s e l l her blood. Numerous cases have a r i s e n i n recent years where e i t h e r hospitals have been sued or a private blood bank, a s here, f o r imperfect blood. Hoffman v. Misericordia Hospital of Philadelphia, 439 Pa. 501, 267 A.2d 867, and cases c i t e d therein. Some of these cases speak of an action i n implied warranty ex contractue, and hold such an action cannot l i e because the furnishing of blood i s not a sale. One court held t h a t a d i s t i n c t i o n might possibly be drawn between a hospital t h a t furnished medical services, and a blood bank which collected the blood and supplied i t t o the hospital. Koenig v. Milwaukee Blood Center, Inc., 23 Wis.2d 324, 127 N.W.2d 50. I believe there i s a d i s t i n c t i o n between a s u i t against a blood bank a s opposed t o a hospital. 103 U.Pa,L.R.ev. 833; Gottsdanker v. Cutter Laboratories, 182 CalaApp,2d 602, 6 Cal. Rptr. 320, 79 ALR2d 290. I think a s a matter of public policy t h a t we should I 1 depart from the s a l e v , service" category and examine the issue here a s one primarily involving the question of implied warranty. Here, expressions of sound policy preferences a r e more i n harmony with the doctrine, which I f e e l should control. See Prosser, S t r i c t L i a b i l i t y t o the Consumer, 69 Yale Law Journal 1099, 1124, A hospital suppling whole blood t o a patient may be merely per- forming service incident t o the overall medical a t t e n t i o n being furnished, such theory of "service" should not be extended t o t h e private blood bank which c o l l e c t s and d i s t r i b u t e s the blood. I would adopt the implied warranty theory a s i t applies t o the case before us. Associate J u s t i c e J