DENISE BASS, Individually and as Independent Administrator of the Estate of Donail Weems, Deceased, Plaintiff-Appellee, v. COOK COUNTY HOSPITAL, d/b/a Provident Hospital, Defendant (University of Chicago Hospital, Defendant-Appellant).
Docket No. 1-14-2665
Appellate Court of Illinois, First District, Sixth Division
March 20, 2015
2015 IL App (1st) 142665
Illinois Official Reports; Appeal from the Circuit Court of Cook County. No. 08-L-14343; the Hon. Moira S. Johnson, Judge, presiding.
Mark M. Brennan, Blair R. Kipnis, and Anthony J. Longo, all of Cassiday Schade LLP, of Chicago, for appellant.
Ryan E. Yagoda and Constance M. Dukes, both of Kralovec, Jambois & Schwartz, of Chicago, for appellee.
PRESIDING JUSTICE HOFFMAN delivered the judgment of the court, with opinion.
Justices Hall and Rochford concurred in the judgment and opinion.
¶ 1 The plaintiff, Denise Bass, individually and as independent administrator of the estate of Donail Weems, deceased,1 filed a medical malpractice action against the defendants, Cook County Hospital, d/b/a Provident Hospital (Provident), and the University of Chicago Hospital (UCH), alleging that 11-year-old Donail received negligent emergency medical treatment on September 3, 2006. UCH filed a motion for summary judgment, pursuant to section 2-1005 of the Code of Civil Procedure (Code) (
“Whether a defendant hospital is immune from vicarious liability under the Emergency Medical Services Systems Act for the allegedly negligent medical services rendered by its certified flight physician after he arrives at the transferring hospital, assumes care, and transports the patient to another hospital.”
¶ 2 UCH timely filed an application for leave to appeal under Rule 308, which we granted on September 24, 2014. For the reasons that follow, we answer the certified question in the affirmative.
¶ 3 For purposes of context, we briefly discuss the general provisions of the Act. The Act has been described as a “comprehensive, omnibus source of rules governing the planning, delivery, evaluation, and regulation of emergency medical services.” Abruzzo v. City of Park Ridge, 231 Ill. 2d 324, 341 (2008). The purpose of the Act is to provide “minimum standards for the statewide delivery of emergency services, recognizing that “diversities exist between different areas of the State, based on geography, location of health care facilities, availability of personnel, and financial resources.”
¶ 4 In order to fulfill the stated purpose, the Act provides that the Department of Public Health (Department) shall designate emergency medical services (EMS) regions (
¶ 6 In this case, UCH served as one of four designated resource hospitals in Chicago, and Provident was a participating hospital within UCH‘s EMS System plan. UCH‘s Aeromedical Network (UCAN) participates in the EMS System plan as UCH‘s medical transport service for prehospital and interhospital transfers of patients to and between hospitals. See
¶ 7 The undisputed facts establish that Donail began to have breathing difficulties on the evening of September 2, 2006. Pursuant to a previous diagnosis of asthma in 2003, Bass and Donail were instructed to use an albuterol inhaler and nebulizer to treat Donail‘s symptoms as needed. On that night, after Donail‘s albuterol inhaler and nebulizer treatments failed to help him, Bass called an ambulance. Donail was taken to Provident Hospital, where he was treated in the emergency room by Dr. Linda Lynch and resident physician, Dr. Michael Hohlastos. At approximately 6:45 a.m. on the morning of September 3, 2006, Donail was intubated and connected to a mechanical ventilator, and his physicians determined that he needed to be transferred to the nearest hospital with a pediatric intensive care unit (PICU).
¶ 8 At approximately 7:20 a.m. on that morning, Dr. Hohlastos contacted Provident‘s resource hospital, UCH, to request an emergency transport for Donail to UCH‘s PICU. Dr. Norma Lopez-Molina, a UCH PICU physician, received the call from Dr. Hohlastos and contacted UCAN to request the emergency transfer. Dr. Blumen, in his capacity as acting EMS medical director, authorized the transfer and directed Dr. Nicholas Strane, a UCH emergency room resident physician and UCAN certified flight physician, to assist in the transport. Dr. Strane was also authorized under the EMS System plan as an “Emergency Communications Physician.”
¶ 9 After receiving Dr. Blumen‘s order, Dr. Strane and certified flight registered nurse Therese Campbell2 rode in the UCAN-ambulance to pick up Donail at Provident. They arrived at approximately 8:27 a.m. Dr. Strane assessed Donail‘s condition, determining that he was in respiratory distress, extremely tachycardic, sedated, intubated, and unresponsive. The EMS team took Donail off the mechanical ventilator and placed him on a manual bag ventilator. Donail was transferred onto a gurney and into the ambulance. The ambulance left Provident at 8:48 a.m., with Dr. Strane and nurse Campbell taking turns operating Donail‘s manual bag ventilator.
¶ 11 On December 30, 2008, Bass filed a medical malpractice action against Provident. On June 18, 2012, she filed an amended complaint adding UCH as a defendant, alleging, in relevant part, that UCH was vicariously liable for Dr. Strane‘s negligence in failing to: manage and treat Donail‘s abnormally high pCO2 levels prior to his transfer; perform aggressive asthma management and treatment prior to his transfer; address Donail‘s worsening respiratory failure prior to his transfer; recognize the improper paralytics administered in the emergency room prior to transfer; and provide proper ventilator management prior to and during the transfer.
¶ 12 After extensive discovery, UCH moved for summary judgment on May 5, 2014, arguing that the civil immunity provided by section 3.150 of the Act (
¶ 13 As noted, this appeal comes to us in the form of a certified question pursuant to Rule 308, and the resolution of that question requires us to interpret section 3.150 of the Act. The fundamental principle of statutory construction is to ascertain and give effect to the legislature‘s intent. Illinois Department of Financial & Professional Regulation v. Rodriguez, 2012 IL 113706, ¶ 13. The language of the statute is the most reliable indicator of the legislature‘s objectives in enacting a particular law, and we give statutory language its plain and ordinary meaning. Id. Where the language of a statute is clear and unambiguous, we must apply it without resort to further aids of statutory construction. Id. Moreover, “[w]e must not depart from the plain language of the Act by reading into it exceptions, limitations, or conditions that conflict with the express legislative intent.” Town & Country Utilities, Inc. v. Illinois Pollution Control Board, 225 Ill. 2d 103, 117 (2007). Finally, “words and phrases should not be construed in isolation, but must be interpreted in light of other relevant provisions of the statute.” Id. Questions of law, such as those involving statutory construction, are reviewed de novo. O‘Casek v. Children‘s Home & Aid Society of Illinois, 229 Ill. 2d 421, 440 (2008).
¶ 14 UCH contends that the treatment rendered by Dr. Strane falls under the immunity provisions provided by section 3.150(a) of the Act, which states:
“(a) Any person, agency or governmental body certified, licensed or authorized pursuant to this Act or rules thereunder, who in good faith provides emergency or non-emergency medical services during a Department approved training course, in the normal course of conducting their duties, or in an emergency, shall not be civilly liable as a result of their acts or omissions in providing such services unless such acts or omissions, including the bypassing of nearby hospitals or medical facilities in
accordance with the protocols developed pursuant to this Act, constitute willful and wanton misconduct.”
210 ILCS 50/3.150(a) (West 2012) .
¶ 15 According to UCH, Dr. Strane fits each requirement for immunity under section 3.150(a), including that he: (1) is a person licensed or authorized pursuant to the Act or rules thereunder; and (2) provided emergency medical services (3) in the normal course of conducting his duties. Because Dr. Strane is immune under this section of the Act, UCH maintains it is also immune as his employer under the doctrine of respondeat superior. Bass counter-argues that the Act was not intended to provide civil immunity for all emergency physicians, but only to the types of EMS personnel clearly defined within it.
¶ 16 We agree with Bass that the Act defines and sets forth the licensing requirements for various types of EMS personnel. See
¶ 17 Section 3.150(a) does not limit its protection only to those “licensed” pursuant to the Act as it states that “[a]ny person *** certified, licensed or authorized pursuant to this Act or rules thereunder *** shall not be civilly liable as a result of [his] acts or omissions in providing” emergency services in the normal course of conducting his duties. (Emphasis added.)
¶ 18 It is not disputed that Dr. Beck had designated Dr. Blumen to act as EMS medical director and that, on September 3, 2006, Dr. Blumen granted the request of a participant hospital to provide an emergency interhospital transport for Donail, pursuant to the regional EMS System plan. As part of the responsibilities of a resource hospital and EMS medical director, UCH and Dr. Blumen were required to:
“Utilize levels of personnel required by the Department to provide emergency care to the sick and injured at the scene of an emergency, during transport to a hospital or during inter-hospital transport and within the hospital emergency department until the responsibility for the care of the patient is assumed by the medical personnel of a hospital emergency department or other facility within the hospital to which the patient is first delivered by System personnel.”
210 ILCS 50/3.35(n) (West 2012) .
¶ 19 Specifically, for critical care transports, the Act states:
“When medically indicated for a patient, as determined by a physician licensed to practice medicine in all of its branches, an advanced practice nurse, or a physician‘s assistant, in compliance with subsections (b) and (c) of Section 3.155 of this Act, critical care transport may be provided by:
(1) Department-approved critical care transport providers, not owned or operated by a hospital, utilizing EMT-paramedics with additional training, nurses, or other qualified health professionals; or
(2) Hospitals, when utilizing any vehicle service provider or any hospital-owned or operated vehicle service provider.”
210 ILCS 50/3.10(f-5) (West 2012) .
¶ 20 In reading sections 3.35(n) and 3.10(f-5), it is clear that the Act contemplated that medical personnel with expertise beyond the scope of that of emergency medical technicians (EMT) and paramedics, including physicians, will be called upon when executing EMS System plans for transporting critically ill patients, such as Donail. As further evidence thereof, Dr. Strane was trained in the EMS System plan and authorized to participate as an ECP and in transports of critically ill patients. We agree with UCH that, when Dr. Blumen assigned Dr. Strane to assist in Donail‘s transport, he did so using the authorities proscribed to him by the Act. Thus, Dr. Strane was also “authorized” under the Act to participate in the emergency transport of Donail.
¶ 21 In so holding, we reject Bass‘s argument that section 3.155 supports her position that the Act did not intend to provide immunity to emergency physicians. Section 3.155 states:
“(a) Authority and responsibility for the EMS System shall be vested in the EMS Resource Hospital, through the EMS Medical Director or his designee.
(b) For an inter-hospital emergency or non-emergency medical transport, in which the physician from the sending hospital provides the EMS personnel with written medical orders, such written medical orders cannot exceed the scope of care which the EMS personnel are authorized to render pursuant to this Act.
(c) For an inter-hospital emergency or non-emergency medical transport of a patient who requires medical care beyond the scope of care which the EMS personnel are authorized to render pursuant to this Act, a qualified physician, nurse, perfusionist, or respiratory therapist familiar with the scope of care needed must accompany the patient and the transferring hospital and physician shall assume medical responsibility for that portion of the medical care.” (Emphases added.)
210 ILCS 50/3.155 (West 2012) .
¶ 22 Reading this provision along with section 3.10(f-5), it is clear that, when medical care exceeding the scope of a paramedic‘s duties is necessary for an interhospital emergency transfer, a physician or other medical professional is required to assist. Further, the transferring hospital assumes medical responsibility for the patient during that transport. While this section makes it clear that the transferring hospital will assume medical responsibility for that portion of the patient‘s care, it is silent as to the legal liability for that medical care. We do not read a limitation in section 3.155 which is not present.
¶ 23 Our conclusion is supported by our supreme court‘s decision in Wilkins v. Williams, 2013 IL 114310, ¶ 20. In Wilkins, the supreme court determined that the Act provided immunity to an ambulance driver for a third-party negligence claim, noting that the plain language of the
¶ 24 Bass also argues that sections 3.150(c) (
¶ 25 It is a general rule of construction that where a statute can be reasonably interpreted so as to give effect to all its provisions, a court will not adopt a strained reading which renders one part superfluous. Panarese v. Hosty, 104 Ill. App. 3d 627, 628-29 (1982). Our interpretation of section 3.150(a) as applying to Dr. Strane does not render section 3.150(c) or section 3.150(g) superfluous. Section 3.150(c) simply states that civil immunity afforded to situations involving volunteer medical personnel is derived through the Good Samaritan Act. In this case, it is undisputed that all medical personnel involved were acting within the scope of their employment. Further, while section 3.150(a) provides for civil immunity for those providing emergency medical services to “[a]ny person,” section 3.150(g) provides immunity, not limited to medical services, for “damages in any civil action” for EMS Medical Directors exercising, in good faith, “his responsibilities under [the] Act.” (Emphasis added.)
¶ 26 Moreover, we find that existing cases, although not directly on point with the facts of this case, have determined that physicians providing services within the scope of the Act enjoy immunity. For instance, in Washington v. City of Evanston, 336 Ill. App. 3d 117, 119 (2002), the plaintiff sued St. Francis Hospital and Dr. Therese Kloempken after the doctor provided verbal instructions to paramedics responding to her emergency breech-baby delivery. The attending emergency room physician, Dr. Hector Aguilera, asked Dr. Kloempken, an obstetrical resident at the hospital, to assist in directing the paramedics on what to do. Id. The trial court granted summary judgment in favor of the defendants on the basis that they were immune under the Act. Id. at 121. The appellate court determined that Dr. Kloempken was not immune under section 3.150(a) of the Act because: she was not an emergency room physician; she was unfamiliar with EMS protocols; and she had not been approved by the EMS director to participate in the EMS System plan of St. Francis Hospital, the resource hospital for its region. Id. at 122-23. However, the appellate court determined that Dr. Kloempken was nonetheless immune pursuant to section 3.150(b) of the Act, because at Dr. Aguilera‘s request, she supervised the paramedics. Id. at 123. The court noted that it was “uncontested that the paramedics were certified pursuant to the Act and that delivery of a baby [was] within the scope of emergency medical services contemplated by the Act.” Id. Thus, the court determined that there was “no question that Dr. Kloempken was engaged in ‘supervision’ of ‘emergency medical services personnel certified, licensed or authorized pursuant to [the] Act’ and [that] her alleged misconduct occurred ‘in connection with activities within the scope of [the] Act.’ ” Id. (quoting
¶ 27 Bass argues that Dr. Strane was an “ER doctor providing care to Donail during a hospital to hospital transfer” and that he “was acting within his training as an emergency room physician.” (Emphasis in original.) Bass contends that the Act provides immunity to physicians only when supervising or instructing EMTs or paramedics, such as Dr. Kloempken was doing in Washington. However, we read neither the plain language of the Act nor the holding in Washington to contain such limitation. Wilkins, 2013 IL 114310, ¶¶ 20, 22. Applying the logic in Washington to the facts of this case leads to our outcome; that is, the immunity provided in section 3.150(a) applies to the services Dr. Strane delivered during Donail‘s emergency interhospital transport. Unlike Dr. Kloempken in Washington, Dr. Strane is an emergency physician who was familiar with and trained under the EMS System plan. Specifically, he was trained and certified in the plan protocols and authorized to participate as an ECP and flight physician. Furthermore, Dr. Strane was directed by Dr. Blumen, the acting EMS medical director, to assist in Donail‘s emergency transport, a medical service undisputedly contemplated by the Act. It then follows that, because Dr. Strane is immune, UCH is also immune from the plaintiff‘s claims based on vicarious liability. Vancura v. Katris, 238 Ill. 2d 352, 375 (2010). We therefore answer the certified question in the affirmative.
¶ 28 For the sake of completeness, we note that Washington similarly supports UCH‘s alternate argument that it is immune under section 3.150(b). That section states:
“(b) No person, including any private or governmental organization or institution that administers, sponsors, authorizes, supports, finances, educates or supervises the functions of emergency medical services personnel certified, licensed or authorized pursuant to this Act, including persons participating in a Department approved training program, shall be liable for any civil damages for any act or omission in connection with administration, sponsorship, authorization, support, finance, education or supervision of such emergency medical services personnel, where the act or omission occurs in connection with activities within the scope of this Act, unless the act or omission was the result of willful and wanton misconduct.”
210 ILCS 50/3.150(b) (West 2012) .
¶ 29 In Washington, the court determined that St. Francis Hospital was immune from civil liability for Dr. Kloempken‘s role supervising paramedics on the telephone regarding a breech-baby delivery. Washington, 336 Ill. App. 3d at 129. The court determined that St. Francis, as its region‘s resource hospital, had to coordinate, monitor and supervise its EMS System. Id. Dr. Aguilera, in his capacity as the EMS Medical Director designee, chose to utilize Dr. Kloempken in the EMS System plan, despite her unfamiliarity with it, because of her obstetrical training and the nature of the plaintiff‘s emergency. Id. at 129-30.
¶ 30 Likewise, UCH, as the region‘s resource hospital, “administers *** or supervises the functions of emergency medical services personnel certified, licensed or authorized pursuant to [the] Act.”
“[The Act] expressly states that the intent of this legislation is to provide Illinois a system for emergency medical services by establishing a central authority to coordinate and integrate the planning, evaluation, and regulation of prehospital emergency medical services systems. With that general purpose in mind, we are persuaded that by enactment of the immunity provision, the legislature intended to encourage emergency response by trained medical personnel without risk of malpractice liability for every bad outcome or unfortunate occurrence. Emergency situations are often fraught with tension, confusion, and, as here, difficult physical locations for giving medical care. Emergency personnel must not be afraid to do whatever they can under less than ideal circumstances.” Gleason v. Village of Peoria Heights, 207 Ill. App. 3d 185, 188-89 (1990) (in context of EMTs’ response to victim of diving accident at beach which resulted in quadriplegia despite efforts to stabilize spine at the scene and during transport to hospital).
¶ 32 For similar reasons, we believe the Act‘s immunity provision intended to cover those medical personnel attending to an emergency interhospital transport like Donail‘s. The various provisions of the Act make it clear that EMS medical directors are authorized to engage qualified medical personnel, including physicians, when an emergency situation necessitates medical services exceeding the skill of EMTs or paramedics and that such personnel must not be afraid to participate under the less-than-ideal conditions which exist during a frantic ambulance transport. An opposite outcome would serve to discourage EMS medical directors from utilizing medical personnel with advanced training during such emergencies and nonemergency transports, which would defeat the very purpose behind the Act and its immunity provision.
¶ 33 Based on the foregoing reasons, we answer the certified question in the affirmative and remand the cause to the circuit court for further proceedings consistent with this opinion.
¶ 34 Certified question answered; cause remanded.