2015 IL App (1st) 131122
Ill. App. Ct.2015Background
- Koni Johnson presented to Stroger Hospital ER after a fall with back pain, right-leg numbness and progressive inability to walk; she was treated March 4–5, 2007, and discharged after being diagnosed with muscle spasm/back contusion; she was later diagnosed with spinal cord contusion and paralysis.
- Defendants were Drs. Bishof (attending) and Bankoff (resident/chief resident) and Cook County/Stroger Hospital; plaintiff alleged negligence, negligent infliction of emotional distress, and EMTALA violations in a fifth amended complaint.
- Plaintiff’s experts (an ER physician and a neurologist) opined the ER exam and testing were inadequate, an MRI and spine consult were indicated, and failure to immobilize/stabilize and treat (e.g., steroids) violated the standard of care and EMTALA.
- Defendants argued statutory immunity under the Illinois Tort Immunity Act (745 ILCS 10/6-105, 6-106) for failures to examine or to diagnose, and moved for summary judgment; county argued EMTALA did not preempt the Tort Immunity Act or, alternatively, that no EMTALA violation occurred.
- Trial court granted summary judgment to defendants on counts I–V, finding (a) claims rested on misdiagnosis/failure to examine so immunity under §§ 6-105 and 6-106(a) applied to negligence and emotional-distress counts, and (b) EMTALA preempts §§ 6-105/6-106 but plaintiff failed to show a violation (hospital applied its screening uniformly and did not determine an emergency condition existed).
- Plaintiff appealed; the appellate court affirmed in full.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether defendants are immune under §§ 6-105/6-106 for negligence (counts I & III) | Johnson: claims are negligent treatment/omission (failure to treat, consult, stabilize), not mere failure to diagnose; immunity therefore inapplicable under 6-106(b)-(d) | Defs: this is a misdiagnosis/failure-to-examine case; §6-105 and §6-106(a) immunize public entities/employees for failures to examine or to diagnose | Court: Held immunity applies — the gravamen is failure to examine/diagnose; defendants treated the diagnosed condition (muscle spasm) appropriately, so §§6-105 and 6-106(a) bar recovery |
| Whether negligent infliction of emotional distress counts (II & IV) survive despite Tort Immunity Act | Johnson: emotional distress flowed from defendants’ negligent treatment and insulting/demeaning conduct; thus not barred | Defs: the emotional-distress claims mirror the malpractice claims and are therefore immunized under §§6-105/6-106; alternatively, no duty exists to “believe” or be courteous to patients beyond medical standard of care | Court: Held claims mirror malpractice allegations and are barred by §§6-105/6-106; plaintiff showed no separate duty or expert proof that defendants breached a duty by manner of interaction |
| Whether EMTALA (42 U.S.C. §1395dd) claims against county survive (count V) | Johnson: EMTALA preempts the Tort Immunity Act and hospital screening/stabilization were inadequate (MRI/consult/stabilization needed); facts create triable issue whether screening was appropriate and patient was stabilized before discharge | County: EMTALA is preempted by Tort Immunity Act or, if not, no EMTALA violation because hospital followed its screening procedures and EMTALA does not require correct diagnosis; stabilization duty triggers only if hospital determines an emergency condition exists | Court: Held EMTALA preempts conflicting state immunity provisions, but plaintiff failed to raise a genuine factual dispute that Stroger violated EMTALA — hospital applied its screening procedure and determined no emergency condition existed, so stabilization duty was not triggered |
Key Cases Cited
- Michigan Avenue Nat’l Bank v. County of Cook, 191 Ill. 2d 493 (Ill. 2000) (Tort Immunity Act interpretation: §6-105 shields failures to examine; §6-106(a) shields diagnosing or failing to diagnose; limitations in subsections (b)-(d) apply when treatment for a diagnosed condition is negligently prescribed or administered)
- American Nat’l Bank & Trust Co. of Chicago v. County of Cook, 327 Ill. App. 3d 212 (Ill. App. Ct. 2001) (when a condition has been previously diagnosed and treatment prescribed, failures in administering that treatment may fall outside §6-106(a) immunity)
- Baber v. Hospital Corp. of America, 977 F.2d 872 (4th Cir. 1992) (EMTALA requires hospitals to apply an appropriate screening uniformly to similarly situated patients; EMTALA is not a malpractice statute and does not guarantee correct diagnosis)
- Repp v. Anadarko Municipal Hosp., 43 F.3d 519 (10th Cir. 1994) (EMTALA does not impose a national medical standard; compliance is measured by the hospital’s own screening procedures)
- Gatewood v. Washington Healthcare Corp., 933 F.2d 1037 (D.C. Cir. 1991) (EMTALA’s screening requirement judged by hospital’s standard procedure, not by outcome)