Opinion ID: 2364737
Heading Depth: 2
Heading Rank: 4

Heading: Hospitals are Governmental

Text: The alleged negligence in this case arose from the provision of medical services in a city hospital. The operation of a hospital by a city has traditionally been held to be governmental. See, e.g., Schroeder v. City of St. Louis, 228 S.W.2d 677 (Mo.1950); Zummo v. Kansas City, 285 Mo. 222, 225 S.W. 934. That a hospital is governmental has been so well settled that in recent cases no detailed explanation has been necessary and the bare citation of authority has been sufficient support for the proposition. See, e.g., New Liberty Hospital District, 687 S.W.2d at 486. The plaintiffs do not offer any arguments sufficient to change this conclusion. The plaintiffs argue that the operation of this particular hospital is a proprietary function of the City. They offer to show that the hospital has a substantial advertising budget designed to attract private patients, that the hospital has a surplus of revenue over expenses, and that the hospital has assets of $133 million compared to liabilities of only $9 million. Essentially, the plaintiffs argue that the Board competes with private hospitals and makes money doing it. The plaintiffs' point about competition is well-taken, but not dispositive. It may not be entirely fair for the City to compete with private companies in providing health services. However, the City also provides police protection in competition with private security companies. Further, laying out, building, and maintaining city streets are proprietary functions, but ones in which cities have no competition. Mere competition with private enterprise is insufficient to divest an activity of its governmental character. Nor does the absence of competition prevent a city's actions from being proprietary. The plaintiffs' arguments regarding the revenues and assets of the hospital are less persuasive. In the past, we have noted that a patient paying for services in a hospital does not change the governmental character of the hospital. See New Liberty Hospital District, 687 S.W.2d at 186 ( citing Schroeder, 228 S.W.2d at 678). In 1954, the people of North Kansas City voted on the measure to impose the hospital tax under section 96.150. In 1958, after another vote to authorize a bond, the hospital finally began operation. The plaintiffs do not claim or offer to prove that the hospital was formed with the intention of making money. Rather, they assert that there has been a surplus of revenue over expenses in fiscal years ending in 1989 and 1990. The fact that a city hospital brings in more than it spends in a given fiscal period does not strip it of its governmental character. In examining the question of whether an activity is governmental or proprietary, the nature of the particular defendant's conduct is often less important than the generic nature of the activity. Rather than examining the motives of the city employees who were performing the function, the analysis focuses on the motives of the legislature that conferred the power upon all municipalities. Why the City is operating this hospital now is less relevant than why the state allows cities of the third class the power to operate hospitals and why cities would want to have hospitals at all. Even if the sole motivation of the city government were profit, the hospital would still be governmental. The status of a function of a city does not vary from day to day with the whims of the particular people elected or appointed to municipal offices. The generic fact that cities begin hospitals to provide health care to the people and the historic fact that Chapter 96 is an effort to allow cities to provide health care amply support the conclusion that the operation of a city hospital is a governmental function.