This сase concerns the validity of a release from liability for future negligence imposed as a condition for admission to a charitable research hospital. For the reasons we hereinafter specify, we have concluded that an agreement between a hospital and an entering patient affects the public interest and that, in consequence, the exculpatory provision included within it must be invalid under Civil Code section 1668.
Hugo Tunkl brought this action to recоver damages for personal injuries alleged to have resulted from the negligence of two physicians in the employ of the University of California Los Angeles Medical Center, a hospital operated and maintained by the Regents of the University of California as a nonprofit charitable institution. Mr. Tunkl died after suit was brought, and his surviving wife, as executrix, was substituted as plaintiff.
The University of California at Los Angeles Medical Center admitted Tunkl as a patient on June 11, 1956. The Regents maintain the hospitаl for the primary purpose of aiding and developing a program of research and education in the field of medicine; patients are selected and admitted if the study and treatment of their condition would tend to achieve these purposes. Upon his entry to the hospital, Tunkl signed a document setting forth certain “Conditions of Admission.” The crucial condition number six reads as follows: “Release: The hospital is a nonprofit, charitable institution. In consideration of the hоspital and allied services to be rendered and the rates charged therefor, the patient or his legal representative agrees to and hereby releases The Regents of the University of California, and the hospital from any and all liability for the negligent or wrongful acts or omissions of its employees, if the hospital has used due care in selecting its employees.”
Plaintiff stipulated that the hospital had selected its employees with due care. The trial court оrdered that the issue of the validity of the exculpatory clause be first submitted to the jury and that, if the jury found that the provision did not bind plaintiff, a second jury try the issue of alleged malpractice. When, on the preliminary issue, the jury returned a verdict sustaining the validity of the executed release, the *95 court entered judgment in favor of the Regents. 1 Plaintiff appeals from the judgment.
We shall first set out the basis for our prime ruling that the exculpatory provision of the hospital’s contract fell under the proscription of Civil Code section 1668; we then dispose of two answering arguments of defendant.
We begin with the dictate of the relevant Civil Code section 1668. The section states: “All contracts which have for their object, directly or indirectly, to exempt anyone from responsibility for his own fraud, or willful injury to the person or property of another, or violation of law, whether willful or negligent, are against the policy of the law.”
The course of section 1668, however, has been a troubled one. Although, as we shall explain, the decisions uniformly uphold its prоhibitory impact in one circumstance, the courts’ interpretations of it have been diverse. Some of the cases have applied the statute strictly, invalidating any contract for exemption from liability for negligence. The court in
England
v.
Lyon Fireproof Storage Co.
(1928)
In one respect, as we have said, the decisions are uniform. The cases have consistently held that the exculpatory provision may stand only if it does not involve “the public interest.”
6
Interestingly enough, this theory found its first expression in a decision which did not expressly refer to section 1668. In
Stephens
v.
Southern Pac. Co.
(1895)
In applying this approach and in manifesting their reaction as to the effect of the exemptive clause upon the public interest, some later courts enforced, and others invalidated such provisions under section 1668. Thus in
Nichols
v.
Hitchcock Motor Co.
(1937)
In
Barkett
v.
Brucato
(1953)
On the other hand, courts struck down exculpatory clauses аs contrary to public policy in the case of a contract to transmit a telegraph message
(Union Constr. Co.
v.
Western Union Tel. Co.
(1912)
If, then, the exculpatory clause which affects the public interest cannot stand, we must ascertain those factors or characteristics which constitute the public interest. The social forces that have led to such characterization are volatile and dynamic. No definition of the concept of public interest can be contained within the four corners of a formula. The concept, always the subject of great debate, has ranged over the whole course of the common law; rather than attempt to prescribe its nature, we can only designate the situations in which it has been applied. We can determine whether the instant contract does or does not mаnifest the characteristics which have been held to stamp a contract as one affected with a public interest.
In placing particular contracts within or without the category of those affected with a public interest, the courts have revealed a rough outline of that type of transaction in which exculpatory provisions will be held invalid. Thus the attempted but invalid exemption involves a transaction which exhibits some or all of the following characteristics. It concerns a business of a type generally thought suitable for public regulation. 9 The party seeking exculpation is engaged *99 in performing a service of great importance to the public, 10 which is often a matter of practical necessity for some members of the public. 11 The party holds himself out as willing to perform this service for any member of the public who seeks it, or at least for any member coming within certain established standards. 12 As a result of the essential nature of the *100 service, in the economic setting of the transaction, the party invoking exculpation possesses a decisive advantage of bargаining strength against any member of the public who seeks his services. 13 In exercising a superior bargaining power the party confronts the public with a standardized adhesion contract of exculpation, 14 and makes no provision whereby a purchaser may pay additional reasonable fees and obtain protec *101 tion against negligence. 15 Finally, as a result of the transaction, the person or property of the purchaser is placed under the control of the seller, 16 subject to the risk of carelessness by the seller or his agents.
While obviously no public policy opposes private, voluntary transactions in which one party, for a consideration, agrees to shoulder a risk which the law would otherwise have placed upon the other party, the above circumstances pose a different situation. In this situation the releasing party does not really acquiesce voluntarily in the contractual shifting of the risk, nor can we be reasonably certain that he receives an adequate consideration for the transfer. Since the service is one which each member of the public, presently or potentially, may find essential to him, he faces, despite his economic inability to do so, the prospect of a compulsory assumption of the risk of another’s negligence. The public policy of this state has been, in substance, to posit the risk of negligence upon the actor; in instances in which this poliсy has been abandoned, it has generally been to allow or require that the risk shift to another party better or equally able to bear it, not to shift the risk to the weak bargainer.
In the light of the decisions, we think that the hospital-patient contract clearly falls within the category of agreements affecting the public interest. To meet that test, the agreement need only fulfill some of the characteristics above outlined; here, the relationship fulfills all of them. Thus the contract of exculpation involves an institution suitable for, and a subject of, public regulation. (See Health & Saf. Code, §§ 1400-1421, 32000-32508.) 17 That the services of the hospital to those members of the public who are in special need of the particular skill of its staff and facilities constitute a practical and crucial necessity is hardly open to question.
*102 The hospital, likewise, holds itself out as willing to perform its services for those members of the public who qualify for its research and training facilities. Whilе it is true that the hospital is selective as to the patients it will accept, such selectivity does not negate its public aspect or the public interest in it. The hospital is selective only in the sense that it accepts from the public at large certain types of eases which qualify for the research and training in which it specializes. But the hospital does hold itself out to the public as an institution which performs such services for those members of the public who can quаlify for them. 18
In insisting that the patient accept the provision of waiver in the contract, the hospital certainly exercises a decisive advantage in bargaining. The would-be patient is in no position to reject the proffered agreement, to bargain with the hospital, or in lieu of agreement to find another hospital. The admission room of a hospital contains no bargaining table where, as in a private business transaction, the parties can debate the terms of their contract. As a result, we cannot but conclude that the instant agreement manifested the characteristics of the so-called adhesion contract. Finally, when the patient signed the contract, he completely placed himself in the control of the hospital; he subjected himself to the risk of its carelessness.
In brief, the patient here sought the services which the hospital offered to a selective portion of the public; the patient, as the price of admission and as a result of his inferior bargaining position, accepted a clause in a contract of adhesion waiving the hospital’s negligence; the patient thereby subjected himself to control of the hospital and the possible infliction of the negligence which he had thus been compelled to waive. The hospital, under such circumstances, occupied a status different than a mere private party; its contract with the patient affected the public interest. We see no cogent current reason for according to the patron of the inn a greater protection than the patient of the hospital; we cannot hold the innkeeper’s performance affords a greater public service than that of the hospital.
We turn to a consideration of the two arguments urged by *103 defendant to save the exemptive clause. Defendant first contends that while the public interest may possibly invalidate the exculpatory provision as to the paying pаtient, it certainly cannot do so as to the charitable one. Defendant secondly argues that even if the hospital cannot obtain exemption as to its “own” negligence it should be in a position to do so as to that of its employees. We have found neither proposition persuasive.
As to the first, we see no distinction in the hospital’s duty of due care between the paying and nonpaying patient. (But see Rest., Contracts, § 575(1) (b).) The duty, emanating not merely from contract but also tort, imports no discrimination based upon economic status. (See
Malloy
v.
Fong
(1951)
Defendant’s second attempted distinction, the differentiation between its own and vicarious liability, strikes a similar discordant note. In form defendant is a corporation. In everything it does, including the selеction of its employees, it necessarily acts through agents. A legion of decisions involving contracts between common carriers and their customers, public utilities and their customers, bailees and bailors, and the like, have drawn no distinction between the corporation’s “own” liability and vicarious liability resulting from negligence of agents. We see no reason to initiate so far-reaching a distinction now. If, as defendant argues, a right of action against the negligent agent is in fact a sufficient remedy, then defendant by paying a judgment against it may be subrogated to the right of the patient against the negligent agent, and thus may exercise that remedy.
*104 In substance defendant here asks us to modify our decision in Malloy, which removed the charitable immunity; defendant urges that otherwise the funds of the research hospital may be deflected from the real objective of the extension of medical knowledge to the payment of claims for alleged negligence. Since а research hospital necessarily entails surgery and treatment in which fixed standards of care may not yet be evolved, defendant says the hospital should in this situation be excused from such care. But the answer lies in the fact that possible plaintiffs must prove negligence; the standards of care will themselves reflect the research nature of the treatment; the hospital will not become an insurer or guarantor of the patient’s recovery. To exempt the hospital completely from any standard of due care is to grant it immunity by the side-door method of a contractual clause exacted of the patient. We cannot reconcile that technique with the teaching of Malloy.
We must note, finally, that the integrated and specialized society of today, structured upon mutual dependency, cannot rigidly narrow the concept of the public interest. Prom the observance of simple standards of due care in the driving of a car to the performance of the high standards of hospital practice, the individual citizen must be completely dependent upon the responsibility of others. The fabric of this pattern is so closely woven that the snarling of a single thread affects the whole. We cannot lightly accept a sought immunity from careless failure to provide the hospital service upon which many must depend. Even if the hospital’s doors are open only to those in a specialized category, the hospital сannot claim isolated immunity in the interdependent community of our time. It, too, is part of the social fabric, and prearranged exculpation from its negligence must partly rend the pattern and necessarily affect the public interest.
The judgment is reversed.
Gibson, C. J., Traynor, J., Schauer, J., Me Comb, J., Peters, J., and Peek, J., concurred.
Notes
Plaintiff at the time of signing the release was in great pain, under sedation, and probably unable to read. At trial plaintiff contended that the release was invalid, asserting that a release does not bind the releasor if at the time of its execution he suffered from so weak a mental condition that he was unable to comprehend the effect of his act
(Perkins
v.
Sunset Tel. & Tel. Co.
(1909)
Accord,
Hiroshima
v.
Bank of Italy
(1926)
To the same effect:
Werner
v.
Knoll
(1948)
See
Butt
v.
Bertola
(1952)
Barkett
v.
Brucato
(1953)
The view that the exculpatory contract is valid only if the public interest is not involved represents the majority holding in the United States. Only New Hampshire, in definite opposition to "public interest” test, categorically refuses to enforce exculpatory provisions. The cases аre collected in an extensive annotation in
See also
Hischemoeller
v.
National Ice etc. Storage Co.
(1956)
Exculpatory clauses were regarded as invalid, although without reference to the public interest doctrine, in
Franklin
v.
Southern Pac. Co.
(1928)
“Though the standard followed does not always clearly appear, a distinction seems to be made between those contracts which modify the responsibilities normally attaching to a relationshiр which has been regarded in other connections as a fit subject for special regulatory treatment and those which affect a relationship not generally subjected to particularized control.” (11 So.Cal.L.Rev. 296, 297 (1938); see also Note (1948)
In
Munn
v.
Illinois
(1877) 94 TJ.S. 113 [
See
New York C. Railroad Co.
v.
Lockwood
(1873)
See
Bisso
v.
Inland Waterways Corp.
(1955)
See Burdick,
The Origin of the Peculiar Duties of Public Service Companies
(1911), 11 Colum.L.Rev. 514, 616, 743;
Lombard
v.
Louisiana, supra,
fn. 10. There is a close historical relationship between the duty of cоmmon carriers, public warehousemen, innkeepers, etc. to give reasonable service to all persons who apply, and the refusal of courts to permit such businesses to obtain exemption from liability for negligence. See generally Arterburn,
supra,
fn. 10. This relationship has led occasional courts and writers to assert that exculpatory contracts are invalid only if the seller has a duty of public service. 28 Brooklyn L.Rev. 357, 359 (1962); see
Ciofalo
v.
Vic Tanney Gyms, Inc.
(1961)
Prosser, Torts (2d ed. 1955) p. 306: “The courts have refused to uphold such agreements . . . where one party is at such obvious disadvantage in bargaining power that the effect of the contract is to put him at the mercy of the other’s negligence.” Note (1948)
See
Simmons
v.
Columbus Venetian Stevens Buildings, Inc.
(1958)
See 6A Corbin, Contracts (1962) §1472 at p. 595; Note (1948)
See
Franklin
v.
Southern Pac. Co.
(1928)
‘ [P]roviding hospital facilities to those legally entitled thereto is a proper exercise of the police power of the county ... as it tends to promote the public health and general welfare of the citizens of the county.
’ ’ (Goodall
v.
Brite
(1936)
See
Wilmington General Hospital
v.
Manlove
(1961)
