County of Riverside v. Loma Linda University

• Decision Date: 22 April 1981
• Citation: 118 Cal.App.3d 300,173 Cal.Rptr. 371
• Court: California Court of Appeals Court of Appeals
• Parties: COUNTY OF RIVERSIDE, etc., Plaintiff and Respondent, v. LOMA LINDA UNIVERSITY, Defendant and Appellant. Civ. 21401.

Page 371

173 Cal.Rptr. 371

118 Cal.App.3d 300

COUNTY OF RIVERSIDE, etc., Plaintiff and Respondent, v. LOMA LINDA UNIVERSITY, Defendant and Appellant.

Civ. 21401.

Court of Appeal, Fourth District, Division 2, California.

April 22, 1981.

Robert J. Pickell & Associates and Karl J. Knudson, Riverside, for defendant and appellant

Baltaxe, Rutkin & Juarez, George Baltaxe and George A. Juarez, Beverly Hills, for plaintiff and respondent.

OPINION

TAMURA, Associate Justice.

This is an action by the County of Riverside (county) against Loma Linda University (university) for indemnification for the monetary value of a settlement of a medical malpractice action against the county for injuries sustained by a child during birth at the Riverside County General Hospital (county hospital). The county's claim for indemnity is grounded on an affiliation of the university's medical school with the county hospital.

Following a jury trial, a verdict was returned in favor of the county on two independent theories: (1) The university and the county were joint venturers in providing the medical care and treatment giving rise to the malpractice action and (2) the two entities were joint tortfeasors with fault apportioned equally. Based upon the jury's findings, judgment was entered in favor of the county and against the university for one-half of the monetary value of the consideration paid for the settlement of the medical malpractice action. The university appeals from the judgment. ¹

The university seeks reversal on several grounds but the primary thrust of its appeal is that the finding that the two entities were joint venturers lacks evidentiary support.

Viewing the evidence most favorably to the party prevailing below, as we are required to do by long-settled rules on appeal (Aceves v. Regal Pale Brewing Co., 24 Cal.3d 502, 507, 156 Cal.Rptr. 41, 595 P.2d 619, Nestle v. City of Santa Monica, 6 Cal.3d 920, 925, 101 Cal.Rptr. 568, 496 P.2d 480), the pertinent facts (subject to amplification in our discussion of the specific contentions) may be summarized as follows:

The Medical Malpractice Action

Mrs. Clow was admitted to the county hospital on October 22, 1967, and her child was delivered at 8:15 the following morning. The attending doctors were Bertus L. Brown, a second-year resident, and his supervisor, E. A. Pachten, a third-year resident. A Riverside obstetrician in private practice who was chief of staff of the obstetrics-gynecology department of the hospital was on back-up call. Mrs. Clow underwent a difficult delivery marked by a protracted second-stage labor. Pelvimetry examination indicated the baby was in a breach position. About 15 minutes before delivery, a substantial drop in the fetal heart tone was noted. Dr. Brown attempted a forceps delivery, but was unsuccessful. He called for Dr. Pachten who ultimately delivered the baby using forceps. The child developed cerebral palsy and in 1972 he filed a medical malpractice action through his guardian ad litem against the county. The university was not named as a defendant.

The malpractice action was settled through an agreement between the plaintiffs and Pacific Indemnity, referred to in the agreement as the county's "primary insurer." The settlement was structured to provide for payment of a stipulated sum forthwith and for the establishment of a trust sufficient in amount to generate an agreed upon annual income for the benefit of the child through January 1, 2044. Following the settlement, the county instituted the instant action for indemnity against the university.

The Affiliation Agreement

In 1963 the university entered into an "AFFILIATION AGREEMENT" with the county whereby the university agreed to furnish the teaching services of the faculty members of its medical school to the county hospital. It was agreed that the faculty members would, under the direction of the county hospital administrator and its chief of professional services, instruct and train interns and resident physicians at the county hospital and, concurrently with the teaching services, render medical care and services "as designated by the Hospital Administrator and Chief of Professional Services." Such care and services were to include "both direct care of patients and the supervision of medical care rendered by resident physicians and interns of the Hospital."

The agreement authorized the university's medical school to make recommendations concerning the selection of professional employees of the hospital and membership on the voluntary professional staff but reserved the ultimate power of appointment to the county. In addition, there was a general provision declaring that the affiliation agreement was not to be deemed a relinquishment to the university of any of the county's statutory powers, express or implied, over the administration of the hospital. That provision reads:

"It is mutually agreed that by the terms of this agreement the County has not granted or delegated any of its powers statutory, implied, administrative, medical or otherwise to the University or School, and that the teaching program, the treatment of the Hospital patients, medical research, the use of the clinical equipment, the hiring, acceptance, and assignments of personnel will all be and remain within the jurisdiction of the County and exercised through the office of the Administrator and the Chief of Professional Services; further that this contract in no way constitutes a delegation of the County's power to determine the admissibility and eligibility of patients for care either as out-patients or in-patients in the Hospital; and further that this agreement in no way confers upon the University or the School, the right to possess, to use, or to control any County property."

The agreement contained the following hold harmless provision: "It is mutually agreed that the University, School, doctors, and medical students are independent contractors and shall be responsible for the manner in which they perform the services required of them under the terms of this agreement. The University agrees to hold the County and its Hospital harmless against any and all suits and/or claims or liability for damage arising from any activity of the University or School personnel in the Hospital under the provisions of this agreement."

The Joint Residency Program

Soon after execution of the affiliation agreement and in furtherance of its objectives, Dr. William G. Slate, professor and chairman of the medical school's department of obstetrics-gynecology and Dr. William W. Brown, chief of obstetrics-gynecology services at the county hospital, made application to the American Medical Association for certification of a joint residency program in obstetrics-gynecology for the Loma Linda Hospital and the county hospital. Dr. Slate was designated the director of the program.

Under the joint residency program, residents served their three years of specialized training in obstetrics and gynecology at the Loma Linda Hospital and the county hospital on a six-month rotation basis. They signed two contracts of employment, one with Loma Linda and one with county; while serving at the county hospital, they were paid by the county and while serving at Loma Linda they were paid by the university. The physicians attending Mrs. Clow in October 1967 were residents in the joint program and each had signed separate contracts with the university and the county.

The residency program included structured teaching conferences in various aspects of the speciality (conducted at the county hospital and at the medical school) and clinical experience. According to Dr. Slate, he was in charge of the residents' clinical training but he gave Dr. Brown (chief of the county's obstetrics-gynecology services) "considerable latitude and responsibility" in the operation of the clinical program at the county hospital. Dr. Slate testified that he "worked with him (Dr. Brown) in establishing policies and procedures" but he had the "power of veto." The clinical training at the county hospital was conducted under progressive supervision depending upon the complexity of the procedure involved. Simple procedures were performed by an intern supervised by a resident. More complex procedures were performed by a resident with advanced training supervised by an attending physician or a medical school faculty member.

In furtherance of the goals of the affiliation agreement, medical school faculty members were granted staff privileges at the county hospital and most of the staff doctors at the county hospital were accorded faculty status with the medical school.

The Verdict and Judgment

The jury returned a special verdict in which it responded to numerous questions submitted to it. The jury found, inter alia: There was a joint venture between the university and the county; the residents attending Mrs. Clow were acting in the course and scope of their authority as agents of the joint venture; the negligence of the residents was a proximate cause of the injury to the child; the university and the county were joint tortfeasors with 50 percent fault attributable to each; the county was not actively negligent; the monetary value of the settlement of the medical malpractice action was $944,109; and the settlement was made in good faith.

The judge ruled that the jury's findings precluded the county from recovering under the indemnity clause of the affiliation agreement. He determined that the jury finding that the county was not actively negligent was irreconcilable with the finding that the residents were acting as agents of the county (as well as the university). ² The judge decided, however, that under the jury's findings, the county was entitled to be indemnified to the extent of 50 percent of the loss either on the theory that the university and the county were joint venturers or on the theory the county and university were concurrent tortfeasors with fault...