Norwood Hospital v. Howton

• Decision Date: 14 May 1946
• Docket Number: 6 Div. 250.
• Parties: NORWOOD HOSPITAL, Inc., v. HOWTON.
• Court: Alabama Court of Appeals

26 So.2d 427

32 Ala.App. 375

NORWOOD HOSPITAL, Inc., v. HOWTON.

6 Div. 250.

Alabama Court of Appeals

May 14, 1946

Rehearing Denied June 4, 1946.

Hugh A. Locke and Wade H. Morton, both of Birmingham, for appellant.

Wm. Conway, of Birmingham, for appellee.

CARR Judge.

Under the terms of a written contract entered into between the Norwood Hospital, appellant here, and the DeBardeleben Coal Company, it was agreed, upon certain stated conditions, that the hospital would afford hospitalization to persons, and their families, who were employed by the coal company. Appellee and his family were entitled to the benefits of the written instrument.

The pertinent provisions of the contract, so far as this appeal relates, are:

'No employee or any member of his family shall be admitted to the hospital (other than in accident cases) except upon written request of the doctor regularly employed by the Corporation or the patient's family physician.

'Upon such written request of the attending physician a member or members of the 'STAFF' shall examine all applicants for hospitalization in order to determine whether or not hospitalization is necessary, or whether or not the disease or condition is such as is included or excluded from the hospital under the terms of this contract. In the event it should be excluded from the hospital under the terms of this contract or it is determined that no hospitalization is necessary, the 'STAFF' will advise the employee and/or his family and/or his attending physician the diagnosis and findings revealed by said examination in order that the employee and/or his family may be properly treated by his own physician.'

At the time in question Dr. William J. Lovett was a regularly employed physician of the DeBardeleben Coal Company, and appellee's wife had been brought under his professional care. In the course of his treatment the doctor referred his patient to the appellant's hospital. The direction was in writing as follows:

'Patient:

'Name Mrs. Howard Howton Age 30

'Address Sipsey, Ala.

Date 6/1/44

'Norwood Clinic

'Bham.

'History Recurrent attacks pelvic infection & Ovaritis--Health not good but small part of time--Menses not normal--Norwood 2 years ago.

'Husband employee here & pays you 2.25 fee.

'Yours truly

'Wm J. Lovett.'

Upon arrival at the clinic of the hospital Mrs. Howton was given a physical examination by Dr. M. D. Anderson, one of the staff physicians, and Dr. C. N. Carraway in consultation. The latter was chairman of the board of directors of the institution.

The hospital chart, which indicated the findings of the examination, was:

'Irregular menstruation; right lower quadrant pain; passes only a few drops for last 2 months. Prescription: stilbestrol, milligrams, 5; three times a day.'

Both Dr. Anderson and Dr. Carraway testified that in their opinion the lady did not need or require hospitalization. She was directed by them to follow the prescribed treatment and return in ten or fourteen days. The following letter was sent to Dr. Lovett:

'June 6, 1944

'Wm. J. Lovett, M. D.

'Sipsey, Alabama

'Re Mrs. Howard Howton

'Dear Doctor Lovett:

'This patient was seen in the clinic complaining of irregular menstruation and right lower quadrant pain for the past two months.

'Examination revealed no menstrual abnormalities and the patient will be given a trial test on stilbestrol as an attempt to regulate her menstrual cycle.

'Very truly yours.

'M. N. Anderson, M. D.'

On the occasion of her second visit to the clinic, Mrs. Howton stated to Dr. Anderson that she was not feeling any better, had not shown any progress, and had been having chills and fever. Reflecting her condition upon the second examination, the hospital chart showed:

'No better; having chills and fever; pelvis reveals moderate tenderness in both annexae; no masses; cervix patent but firm, with some evidence of vaginal inflammation. Cystocele and rectocele are prominent. Smear taken.'

In explanation of a part of the chart reading, Dr. Anderson testified:

'A. Well, the bladder has a muscular wall, the same as the rectum, and, due to pressure within the abdomen and from the rectum, and as a rule due to childbirth, these two organs prolapse; so to speak, collapse. It is merely a weakening of the muscles of the pelvic floor, and they bulge down into the vagina. That is a very common condition.

'Q. What did you prescribe that time? A. I think I gave her sulfa, and I also told her that she would have to have that repaired eventually.

'Q. That she would eventually have to have that repaired? A. That is right.

'Q. You mean that falling? A. That is right.

'Q. Is their anything acute about that--A. (Interposing) No, sir.

'Q. That calls for immediate operation? A. No, sir.

'Q. What is the best practice of physicians with reference to that trouble? A. It is usually done after the childbearing period.'

Again Dr. Anderson entertained the view that Mrs. Howton's condition was such that hospitalization was not necessary, and again she was advised to follow the treatment and was also told if she did not show improvement to return to the hospital at a later date.

Appellee's wife did not return to appellant's clinic, but instead employed the professional services of Dr. Harold Langdon who was in no way connected with the DeBardeleben Coal Company.

Dr. Langdon testified that when he saw Mrs. Howton she was complaining of severe abdominal pains and intense nausea and in his professional judgment she should go to a hospital. He so advised her, and she was forthwith carried to the Birmingham Baptist Hospital. For the first week or ten days she did not respond satisfactorily to the treatment and persisted in having pain in her lower abdominal region and also suffered from nausea. The doctor, according to his testimony, suspected that the patient had a mild inflammation or infection of the uterus which could not be detected from her blood count. She was scheduled for a curettement of the uterus, and during the process of the curettement a hemorrhage developed which could not be checked by packing. It became necessary, in the opinion of the surgeon, to remove the uterus to assure safety to the life of the patient.

Mrs. Howton remained in the hospital all together about twenty days. At the trial of the instant case she testified in part: 'I have been feeling fine. It has not hurt a bit after the operation.'

We should not overlook to note the dates of the various occurrences in question. The first visit to the Norwood Hospital was on June 1, 1944; the second, June 19th following; and the admittance to the Baptist Hospital was on June 22, 1944. The trial in the lower court began on April 3, 1945.

Suit was brought by appellee for damages which in his complaint he claims he suffered because of a breach of the contract referred to above. According to his contention appellant refused to his wife the benefits of hospitalization, to which, under the terms of the agreement, he was justly entitled.

It is urged that the evidence does not sustain the necessary proof that there was a demand for performance on the part of appellee or his wife or a refusal to perform on the part of the appellant.

Under the terms of the contract this is a condition precedent to a right of action for its breach. 17 C.J.S., Contracts, § 590, subsec. b(3), p. 1232; 12 Am.Jur., Sec. 296, p. 849; Ingram et al. v. Bussey, 133 Ala. 539, 31 So. 967.

We entertain the view, however, that under the evidence in this case it became a question for the jury to determine whether or not these essential requisites were established. The jury was privileged, and it was its duty, to consider all the facts and circumstances disclosed by the evidence in its effort to find whether or not there was a demand for performance and a refusal thereof. This inquiry would include a consideration of the conduct of the parties involved. It cannot be successfully contended that a formal demand or refusal was required. If it was made known to the hospital authorities that hospitalization was expected, and the course of action of the authorities was such that the jury could reasonably infer that hospitalization was denied, these essential conditions would have been met. 17 C.J.S., Contracts, § 479, p. 984; Hafner Mfg. Co.

v. Lieber Lumber & Shingle Co. et al., 127 La. 348, 53 So. 646; Ingram et al. v. Bussey, supra; Alabama Trunk & Luggage Co. v. Hauer, 214 Ala. 473, 108 So. 339.

In further support of our view we find in Mrs. Howton's testimony the following:

'Q. Did you ask to be admitted to the hospital at that time; that is, on the 19th of June? A. Yes, sir, I did.'

The position is also taken in oral argument and brief of counsel that, since the contract in question provides by its terms that the hospital staff shall determine whether or not hospitalization is necessary or required, appellee is precluded from inquiring into the good faith of the decision so made and is compelled to accept this judgment as final and conclusive of the right to claim a breach of the contract to furnish hospitalization.

It is, of course, the duty of the courts to adhere to the expressed stipulations of a written agreement and not change by implication the manifest intention of the contracting parties. 'The presumption is, that, having expressed some, they have expressed all the conditions by which they intend to be bound.' Blackman v. Dowling, 63 Ala. 304.

This responsibility of the court must, however, yield to a reasonable construction of all contracts in an effort to secure and safeguard the real intention of the parties in the light of their mutual understandings and the objects and rights intended to be accomplished and protected....