Introduction

In Howell v. Spokane Inland Empire Blood Bank et al. (114 Wn. 2d 42, 1990), the Supreme Court of Washington addressed significant legal issues concerning the applicability of statutory amendments to prior actions and the classification of blood transfusions under common law. The case involves Virgil T. Howell, who contracted HIV through a blood transfusion administered during elective knee surgery at Deaconess Medical Center, with the blood provided by Spokane Inland Empire Blood Bank (SIEBB). Howell sought damages based on various legal theories, including strict liability, breach of warranty, and negligence. The central issues revolved around whether the 1985 amendment to RCW 70.54.120 applied retroactively to bar certain claims and whether blood transfusions by hospitals and blood banks should be classified as services or sales for the purposes of liability.

Summary of the Judgment

The Supreme Court of Washington, sitting en banc, reviewed the partial summary judgments granted by the Superior Court of Spokane County, which dismissed several of Howell's claims against SIEBB and Deaconess. The appellate court affirmed most of the lower court's decisions but reversed the dismissal of claims for outrage and negligence per se against Deaconess. Key findings of the Supreme Court included:

• The 1985 amendment to RCW 70.54.120, which extended the blood shield statute to cover HIV/AIDS, does not apply retroactively.
• Blood transfusions by hospitals and blood banks are classified as services under common law, not as sales, thereby excluding them from strict products liability and implied warranty claims.
• Deaconess Medical Center did not have a duty to secure informed consent from Howell for the blood transfusion, as this duty resides with the attending physician.
• The Consumer Protection Act claims were dismissed due to lack of causation.
• The doctrine of res ipsa loquitur did not apply as the hospital did not have exclusive control over the blood transfusion process.

Analysis

Precedents Cited

The court extensively analyzed prior cases and statutory provisions to reach its decision. Notable precedents include:

• FERNDALE v. FRIBERG, 107 Wn.2d 602 (1987): Established that statutory amendments are presumed to be prospective unless there is clear legislative intent for retroactivity.
• PERLMUTTER v. BETH DAVID HOSP., 308 N.Y. 100 (1954): The seminal case differentiating between services and sales in the context of blood transfusions.
• REILLY v. KING CY. CENT. BLOOD BANK, Inc., 6 Wn. App. 172 (1971): Explored whether blood banks should be subject to strict liability as sellers of goods.
• ALEXANDER v. GONSER, 42 Wn. App. 234 (1985): Limited the duty of hospitals to secure informed consent, emphasizing the physician-patient relationship.
• PEDROZA v. BRYANT, 101 Wn.2d 226 (1984): Discussed the doctrine of corporate negligence in the context of hospital duties.

Legal Reasoning

The court's legal reasoning centered on two primary issues: the non-retroactive application of the amended blood shield statute and the classification of blood transfusions as services.

Non-Retroactive Application: The court examined the 1985 amendment to RCW 70.54.120, which extended immunity from strict liability and breach of warranty claims to blood transfusions involving HIV/AIDS. The court determined that, under the presumption of prospective application of statutory amendments, the amendment did not apply retroactively unless Congress explicitly indicated such intent. Legislative history, including floor colloquies, revealed that the legislature intended the amendment to apply prospectively to avoid reopening liability for past transfusions where no screening was available.

Service Classification: The court reinforced the distinction between services and sales, citing Perlmutter and Gile v. Kennewick Pub. Hosp. Dist. These cases establish that blood transfusions are incidental to the primary service of medical treatment and thus classify the transaction as a service rather than a sale of goods. Consequently, strict products liability and implied warranty claims, which apply to sales, were not applicable.

Additionally, the court addressed the duty of hospitals to secure informed consent, aligning with ALEXANDER v. GONSER, and found that this duty primarily resides with the attending physician unless extraordinary circumstances are present.

Impact

The judgment has profound implications for both healthcare providers and legal practitioners:

• Statutory Interpretation: Reinforces the principle that amendments to statutes are generally prospective and require clear legislative intent for retroactive application. This limits the potential for reopening past cases under new legal standards.
• Service vs. Sale Classification: Solidifies the legal stance that medical procedures, including blood transfusions, are services. This classification shields hospitals and blood banks from certain liability claims typically associated with the sale of goods.
• Informed Consent: Clarifies the boundaries of responsibility regarding informed consent, emphasizing the role of individual healthcare providers over institutional obligations, unless specific extraordinary circumstances exist.
• Liability Protections: Enhances the protections available to blood banks and hospitals, encouraging the maintenance of blood supplies without the fear of extensive liability for transfusion-related infections under specific statutory frameworks.

Complex Concepts Simplified

Retroactive vs. Prospective Application of Laws

Retroactive Application: Refers to the enforcement of a law on actions that occurred before the law was enacted. In this case, it would mean applying the 1985 amendment to blood transfusions that happened prior to its passage.

Prospective Application: Means the law applies only to actions that occur after the law has been enacted. The court determined that the blood shield statute amendment was prospective, protecting only future transfusions from strict liability claims.

Service vs. Sale in Legal Terms

Service: An act performed by one party for the benefit of another without the transfer of ownership. Blood transfusions are considered services because they are part of medical treatment.

Sale: A transaction involving the transfer of ownership of goods in exchange for money. The court ruled that since blood transfusions are services, they do not fall under sales, thereby excluding them from certain liability doctrines like strict products liability.

Strict Products Liability

A legal doctrine that holds manufacturers and sellers liable for placing a defective product into the hands of a consumer. It applies strictly, meaning that the plaintiff does not need to prove negligence. However, in this case, because blood transfusions were classified as services, strict products liability did not apply.

Res Ipsa Loquitur

A legal principle that allows a plaintiff to establish a presumption of negligence based on the mere fact that an injury occurred, without direct evidence of the defendant's negligence. The court dismissed this application because the hospital did not have exclusive control over the transfusion process.

Conclusion

The Howell v. Spokane Inland Empire Blood Bank decision serves as a pivotal precedent in Washington state law by delineating the limits of statutory amendments and clarifying the nature of blood transfusions within the legal framework. By affirming the prospective application of the blood shield statute, the court prevented retroactive liability for past blood transfusions, thereby encouraging the availability and distribution of blood products without the looming threat of retrospective lawsuits. Additionally, the classification of blood transfusions as services rather than sales protects healthcare providers from strict liability and implied warranty claims, provided they adhere to the standards of medical care and informed consent as defined by existing laws. This judgment balances the need to protect patients from genuine negligence while also safeguarding the operational aspects of healthcare institutions and blood banks, ensuring that legal principles evolve in a manner consistent with legislative intent and public policy considerations.