North Kansas City Memorial Hospital v. Wiley, 23785

• Decision Date: 07 December 1964
• Docket Number: No. 23785,23785
• Citation: 385 S.W.2d 218
• Parties: NORTH KANSAS CITY MEMORIAL HOSPITAL, Respondent, v. Bertha Mae WILEY, Administratrix, Estate of William A. Wiley, Deceased, Respondent, and Group Hospital Service, Inc., Appellant.
• Court: Missouri Court of Appeals

Page 218

385 S.W.2d 218

NORTH KANSAS CITY MEMORIAL HOSPITAL, Respondent, v. Bertha Mae WILEY, Administratrix, Estate of William A.

Wiley, Deceased, Respondent,

and

Group Hospital Service, Inc., Appellant.

No. 23785.

Kansas City Court of Appeals, Missouri.

Dec. 7, 1964.

Harry L. Thomas, Max O. Bagby, Kansas City, for appellant.

James P. Aylward, William B. Teasdale, James P. Aylward, Jr., Kansas City, for respondent.

HUNTER, Judge.

This is a suit by plaintiff-respondent, North Kansas City Memorial Hospital in the sum of $1,091.81 against defendant, William A. Wiley, for services rendered him while he was a patient at the hospital. ¹ In turn, Wiley added as defendant (appellant) Group Hospital Service, Inc., by reason of its assumption of a certain hospitalization contract originally issued by Health Service, a corporation, earlier a party but later dismissed from this action. The jury, as directed by the court, found for plaintiff hospital and against defendant Wiley in the sum of $1,081.30, and found for defendant Wiley on his cross claim against defendant Group Hospital Service, Inc., in the sum of $669.50. Group Hospital Service, Inc., hereinafter referred to as Blue Cross, has appealed from the cross claim judgment against it.

The Blue Cross policy is of the usual type and provides certain benefits, payments and services for hospitalization of the subscriber 'except as limited in Article IV or excluded in Article V.' Article V contains the following exception from the general benefits provided: 'Article V--Benefits Not Provided. Benefits shall not be provided for: * * * (b) Hospitalization for any occupational condition, ailment, or injury arising out of and in the course of employment, or which is furnished to a Subscriber under the laws of the United States or any state of political subdivision thereof.' (Italics ours.) Blue Cross denies liability for Wiley's hospital expenses on the ground that these expenses were occasioned by an injury he received arising out of and in the course of his employment and these were exempted from policy coverage under Article V thereof.

On June 4, 1958, Wiley in the course of his employment suffered an unusual and abnormal strain to his low back. This back condition seemed to worsen. On July 5, 1958, he was hospitalized for that injury in North Kansas City Memorial Hospital and remained there continuously as a patient from July 5, 1958, until August 21 1958, when he was discharged therefrom. The admitting diagnosis was probable disc, lumbar and hernia; and the final diagnosis was herniated lumbo sacral disc, congenital bladder, neck contracture, prostatitis and cystitis.

At the trial on June 25, 1962, none of the attending physicians or other doctors were called as witnesses. Rather, the evidence touching the issue of the allocation of Wiley's hospital expenses consisted of the hospital reports and the testimony of the hospital administrator.

According to the hospital records, 'patient admitted for back pain, with radiation down into legs'. The next day, July 6, he was experiencing trouble passing urine. A portion of that day's hospital report read 'seen in consulation by Dr. Charles Vilmer and Dr. Revis Lewis for back symptons and by Dr. Andrews for urinary obstruction and infection.' On July 10, his temperature rose to 102 degrees with a diagnosis of urinary infection. On July 12th a thrombosed painful hemorrhoids condition was diagnosed and a two times normal size prostate was noted. On July 14th, the hospital records reported, 'Problem at present is whether care of prostate and diagnostic tests should precede any definite surgical therapy of disc, and if so, whether either or both full under compensation.' On July 15th, the hospital report stated, 'Complaining of soreness over the hypogastric region. Catheterized 1270 cc. obtained. Bladder spasm during catheterization. Rectum still reveals hemorrhoids. Prostate enlarged. Dr. Andrews to see and go ahead with GU workup and therapy. Treatment for disc will be deferred during this.'

The above is but partly illustrative of the contents of some sixty-seven pages of hospital reports concerning Wiley, his complaints, medical examinations, medical diagnosis and medical treatments, including therapy, x-rays, medicines and injections, between July 5 and August 21, 1958, while a patient there.

Appellant Blue Cross' first contention is that the trial court erred in permitting Witness Rich, the hospital administrator, over objection, to testify from an examination of the hospital records that charges in the amount of $453.72 were applicable to back injury and that charges in the amount of $669.50 were not for the treatment of Wiley's back and spine injury but were for other injury or illness, namely, the genito-urinary system. It is Blue Cross' position that Witness Rich, who was not a medical doctor but rather whose only possible relevant experience was as hospital administrator with several years experience in managing the hospital's drug store, was not and could not be qualified as a medical expert and that only a medical doctor would be qualified to make the judgments and render the opinions to which Witness Rich testified. Witness Rich based his expert testimony on his interpretation of the medical records of the North Kansas City Memorial Hospital concerning Wiley. Rich testified, 'It (hospital record) tells in essence what has happened to him (Wiley) during the time that he was in the hospital. It is made by doctors, laboratory technicians, nurses, all of those who work at the hospital and have authority to enter on this the results of their work on Mr. Wiley.'

The general definition of an expert witness is one who by reason of education or specialized experience possesses superior knowledge respecting a subject about which persons having no particular training are incapable of forming an accurate opinion or of deducing correct conclusions. Giambelluca v. Missouri Pacific Railroad Company, Mo.Sup., 320 S.W.2d 457, 463; Gaddy v. Skelly Oil Co., Mo.Sup., 259 S.W.2d 844; McAnany v. Henrici, 238 Mo. 103, 141 S.W. 633.

Where the subject is a medical one such as the cause or effect of disease or injury on the human system, which is not a subject of common knowledge, the proof must be by a witness or witnesses possessing special knowledge and skill in the science of medicine. This is especially so where the case presents issues involving pathology of disease and subjective effects of injury through trauma. See, 46 C.J.S. Insurance Sec. 1357(c), pages 537-538; Ryan v. Sheffield Car & Equipment Co., Mo.App., 24 S.W.2d 166. This is in accordance with the general rule that except to the extent the physical condition of a person is open to ordinary observation by persons of common experience, opinion evidence concerning the diagnosis, causes and effect of diseases, ailments and kindred matters of medical practice is limited to the opinions of experts in the technical field involved--that is, of physicians. 20 Am.Jur., Evidence, Section 862, page 722; Carlsburg v. Wesley Hospital, 182 Kan. 634, 323 P.2d 638.

In deciding whether the use of certain drugs was for Wiley's back injury or for his genito-urinary system and unrelated to the back injury Rich stated, 'Its an impression, an impression or a judgment that we (Rich) obtain from running a drug store. I run a drug store. * * * I have some knowledge of the drugs that are used.' As to the allocation of the daily charge for hospital room and board Rich stated, '* * * when did the room and board charge become applicable to the back injury and when did it become applicable to the genito-urinary system. Now, we can tell the infection from the nursing notes as to the elevation in temperature and we can tell it from the remarks the physician makes in his daily progress notes, and we can tell another thing about what kind of medicines the physician was ordering. By putting these three together I have made a judgment as to at what day the room and board, as an example, would appear to become applicable to genito-urinary problems these other things not being present, and the progress notes indicating the physician's concern and treatment for the back, then the room and board in that, on that particular day or series of days would become applicable to the back injury.' * * * 'I assigned his charges to the back when actually he had an in-dwelling Foley catheter for his genito-urinary problems, but it was according to the doctors' progress notes and nursing notes, the medications he was on, it was of minor significance as compared to the other, and this bounced back and forth.' * * * 'I'm sure that every day that Mr. Wiley was in the hospital he was being treated to some degree for his back injury, whether it was just lying on bed boards or whether it was pelvic traction, whatever it might be, I'm sure that there was some element of treatment for his back. At the same time there was elements on almost every day of the treatments of this genito-urinary----.'

There was no allocation or designation in the mentioned hospital records or the resultant billings as to what expenses were for the back jury and its effects as contrasted with the genito-urinary system ills. Witness Rich alone made these allocations of various hospital charges by indulging in medical judgments and medical opinions and in some instances, speculation, based on the sixty-seven pages of hospital reports of the doctor, nurses and other hospital personnel concerning Wiley. We are...