HAM v HOLY ROSARY HOSPITAL

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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, 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 M.D., 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. c a s e may be moot a s t o ms. Although t h e 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 rebuilt 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 , Rosebud 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. Trustees. T h i s r e q u e s t was considered by t h e Board of 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 Hospital. 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. t i f f s ' main i s s u e s . 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 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 Burton v. Wilmington Parking criminatory o r wrongful.' 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. 2d 627, 639. 163, 92 S.Ct. 1965, 32 L ed 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. the court said: 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 , "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 res -j u d i c a t a 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 a I1 II 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 , 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 Amendments 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 , supp 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 subsequent 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 subject 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 violate 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 regulations 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: o "(I) N private hospital or health care f a c i l i t y s h a l l 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 hosp 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 personnel,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 / r---rF-rPrrr*rbrrrrd-~---r--r----------- n Chief J u s t i c e Justices. --

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