Stacy v. Truman Medical Center

• Decision Date: 21 July 1992
• Docket Number: No. 74346,74346
• Parties: Wanda B. STACY, et al., Appellants/Respondents, v. TRUMAN MEDICAL CENTER, et al., Respondents/Appellants.
• Court: Missouri Supreme Court

Page 911

836 S.W.2d 911

Wanda B. STACY, et al., Appellants/Respondents, v. TRUMAN MEDICAL CENTER, et al., Respondents/Appellants.

No. 74346.

Supreme Court of Missouri,

En Banc.

July 21, 1992.

Motion for Clarification Overruled Sept. 22, 1992.^*

Scott Mach, Max Von Erdmannsdorff, Mark C. Kuhls, Michael D. Gibbons, Kansas City, for appellants.

Timothy S. Fretts, R. Douglas Gentile, Mitchell L. Herren, Kansas City, for respondents.

Steven L. Hobson, Kansas City, amicus.

THOMAS, Judge.

This consolidated appeal involves two wrongful death actions that were filed as a result of a fire that occurred in room 327 at Truman Medical Center (TMC) on December 30, 1986. Stephen Stacy and Dale Wheeler were patients in the room and died as a result of the fire. Wanda Stacy, Stephen's mother, and Stephen's three children, Michael, Stephanie and Lindsey, filed a wrongful death suit against TMC and one of its nurses, Michelle Taylor. Thelma Allen, Dale's mother, and Amanda Wheeler, Dale's daughter, brought a similar suit, and the cases were consolidated for discovery and trial. The plaintiffs in both actions below will be referred to collectively as "plaintiffs."

Both the Stacy and Wheeler cases were tried before a jury on negligence theories. The jury returned verdicts in favor of both plaintiffs against defendant TMC but in favor of defendant Michelle Taylor on both claims. The amount of the verdicts accepted by the trial court after all post-trial motions had been ruled were $500,000.00 for the Wheeler plaintiffs and $188,000.00 for the Stacy plaintiffs. The issue of sovereign immunity was not submitted to the jury; the trial court ruled as a matter of law in connection with its rulings on post-trial motions that defendant TMC was a public entity entitled to sovereign immunity. The Missouri Court of Appeals, Western District, reversed on the sovereign immunity issue, finding that TMC was not a public entity. We granted TMC's application for transfer.

I. THE FIRE

The wrongful death actions resulted from a fire in decedents' room at TMC. On the day of the fire, Cheryl Stacy visited her brother, Stephen Stacy. When Cheryl arrived, Stephen, who suffered from head injuries and was not supposed to walk around, was in a chair smoking a cigarette with the permission of one of the nurses. No one told Cheryl not to let Stephen smoke. Because Cheryl did not see an ashtray in the room, she used a juice cup and a plastic soup tray for her ashes. No member of the hospital staff offered to bring them an approved ashtray.

At approximately 5:00 p.m., a nurse came in and restrained Stephen in his chair with ties to prevent him from sliding out of the chair. Before Cheryl left, she lit a cigarette, held it to Stephen's mouth and extinguished it in the soup tray. When Cheryl left, she believed there were one or two cigarette butts in the soup container. Cheryl testified that she did not think she dumped the soup tray into the wastebasket but that she could have. She believed the soup tray was on top of the bedside table when she left.

Shortly after 5:00 p.m., a fire started in a wastebasket in room 327 of TMC. There was no smoke detector in the room. Patient Wheeler was in the bed next to the windows. When Stephanie Schreiner, the nurse in charge, discovered the fire, she did not think Wheeler was in immediate danger. First, she unsuccessfully tried to untie Stacy from his restraints. Then, she attempted to put out the fire by smothering it with a sheet. When her attempts to extinguish the fire failed, she ran to the door of the room and yelled for help, which alerted Nurses Cominos and Rodriguez.

After calling for help, Schreiner resumed her attempts to smother the flames with bed linens. Subsequently, she and others grabbed Stacy by the legs and pulled him and his chair toward the hallway. In the process, Stacy's restraints burned through, and he slid from the chair to the floor. Schreiner and her assistants pulled him the remaining few feet out of the room and into the hallway. Schreiner tried to get back into the room but was prevented by the intense smoke, flames and heat.

After initially entering room 327, both Rodriguez and Cominos returned to the nurse's station to sound alarms and to call security. Neither attempted to remove Wheeler from the room. Both ran directly past a fire extinguisher, but neither grabbed it before returning to the room. After Stacy was removed from the room, Cominos entered the room with a fire extinguisher and tried to rescue Wheeler. Because of the intense smoke and heat, however, she was unable to reach Wheeler.

Wheeler died in the room from smoke inhalation. Stacy survived for several weeks, then died as a result of complications from infections secondary to burns.

TMC's policy on December 30, 1986, in case of fire, provided for the removal of patients from the room and out of immediate danger first. In its fire training programs, TMC used the acronym of "RACE" to supply a chronology of steps to take in case of a fire. The "R" meant to rescue or remove the patient first. "A" meant that an alarm should be sounded second. "C" meant that the fire should be contained third, and "E" meant that the fourth order of priority was to extinguish the fire. TMC also had a training movie depicting a trash can fire started by smoking that showed how to pull a patient out of bed by the sheets and drag the patient across the floor at the first recognition of a fire.

TMC's written smoking policy at the time of the fire stated: "No smoking shall be permitted in the Truman Medical Center Health Care Facility except those areas specifically designated and posted as smoking areas...." Room 327 was not posted as a designated smoking area on the date of the fire. The smoking policy further stated: "In the event violations of this policy are observed, the person violating the policy must be requested to discontinue such violation. This shall be the responsibility of all employees and particularly supervisory and security employees." Nurse Cominos admitted violating this portion of the smoking policy on the date of the fire by observing smoking and the use of a juice cup for an ashtray in room 327. She also admitted that she was a supervisory employee on the date of the fire.

II. STRUCTURE OF TRUMAN

In considering the trial court's ruling that TMC is a public entity under the sovereign immunity statute, this Court must decide whether TMC is simply a not-for-profit corporation (of which there are thousands in Missouri and which, as such, do not necessarily qualify for sovereign immunity) or whether it is enough like a governmental entity that it is entitled to the benefits of sovereign immunity. In fact, TMC is a hybrid entity and is not clearly one or the other. This requires us to examine tediously the organization and operation of TMC and compare it with other hybrid institutions that have qualified for sovereign immunity.

Prior to 1962, Kansas City (the City) owned and operated a hospital called Kansas City General Hospital. In 1962, Kansas City General Hospital and Medical Center (KCGHMC), the predecessor of TMC, was formed as a not-for-profit corporation pursuant to Chapter 355, RSMo Supp. 1953. KCGHMC's Articles of Incorporation specifically stated that KCGHMC was formed for charitable and scientific purposes, including providing hospital, medical and dental services to the indigent, and any related educational programs. The incorporation was an attempt by the City to access additional federal funds and private grants not available to the hospital as a department of the City, to alleviate political interference and to reduce administrative problems in the daily operation of the hospital. Truman Medical Center, Inc. v. N.L.R.B., 641 F.2d 570 (8th Cir.1981).

In May of 1970, KCGHMC entered into a Cooperation Agreement, authorized by section 70.220, RSMo 1959, with the City, the Board of Trustees of the Jackson County Public Hospital, and Jackson County (the County) to construct and operate a new hospital. The agreement recognized a need for a facility in the County dedicated to the care of the indigent citizens of the County and City. The parties to the agreement proposed that the City purchase land for the new hospital and convey the land to the County. The County agreed to issue bonds to raise $13,000,000.00 to build and equip the new hospital. Upon completion, KCGHMC was to operate the new hospital, and the City was to provide funds for the provision of services to the indigent citizens of both the County and the City. The City and County were to set guidelines for the admission of patients.

A year later, in November of 1971, the parties entered into another Cooperation Agreement, which also included the Curators of the University of Missouri. This agreement provided for a new facility for the University of Missouri, Kansas City School of Medicine. As in the first agreement, the parties agreed that the County would hold title to all of the land and would design and construct the new hospital. The agreement contemplated that both facilities would be used by KCGHMC and the School of Medicine.

Both facilities were completed in 1976. In November of 1976, KCGHMC, which continued as a not-for-profit corporation, changed its name to Truman Medical Center, Inc. The medical center and medical school complex became known as Truman Medical Center-West.

The Cooperation Agreements require TMC to provide services for the indigent of the City and County, up to the amount of money made available from the City and County for that purpose. TMC receives funds from the State, private organizations and foundations, the County, the City, and its patients. TMC also has its own self-insurance trust and collects medical care charges from insurance providers and self-paid patients as long as TMC can meet its contractual obligations to the City and County to serve the indigent.

TMC is operated by a self-governing Board of...