delivered the opinion of the court:
Plaintiff, Jeannie Childs, as independent administrator of the estate of Dorothy Jones, deceased, filed a multiple-count complaint against various entities and individuals, including Pinnacle Health Care, LLC (Pinnacle), and registered nurse Carolyn English. Prior to her death, Jones was a resident at Pinnacle’s nursing home in Waukegan, Illinois, where English was the director of nursing. The trial court dismissed with prejudice counts XXIII, XXIV¡ and XXV of plaintiffs complaint, all of which were directed against English. The court reasoned that plaintiff’s allegations were limited to English’s role as the director of nursing for Pinnacle; that, although titled otherwise, the three counts were premised on the Nursing Home Care Act (210 ILCS 45/1 — 101 et seq. (West 2008)); and that only licensees and owners of nursing homes can be held liable pursuant to the Nursing Home Care Act (see 210 ILCS 45/3 — 601 (West 2008)). In this appeal brought pursuant to Supreme Court Rule 304(a) (210 Ill. 2d R. 304(a)), plaintiff asserts that the counts against English were improperly dismissed, because they stated causes of action for professional negligence pursuant to section 2 — 622 of the Code of Civil Procedure (Code) (735 ILCS 5/2 — 622 (West 2008)), commonly referred to as the Healing Arts Malpractice Act. Alternatively, plaintiff asserts that the trial court abused its discretion in dismissing with prejudice the three counts against English. For the reasons that follow, we reverse the judgment of the trial court and remand the matter for further proceedings.
I. BACKGROUND
According to plaintiffs complaint, Jones was born on October 26, 1947. As a result of multiple sclerosis, Jones was rendered nonambulatory, and she became a resident of Pinnacle’s long-term care facility in Waukegan, Illinois, on July 26, 2002. When Jones began residing at Pinnacle’s facility, she had no skin impairment. However, skin assessments administered by Pinnacle personnel between January 20, 2005, and October 4, 2006, categorized Jones to be at high risk for developing pressure sores. During Jones’s residency at Pinnacle’s facility, she developed 16 pressure sores, including seven stage IV decubitus ulcers, one stage III decubitus pressure sore, one stage II decubitus pressure sore, and one pressure sore that was categorized as “unstageable.” By October 4, 2006, the pressure ulcers had become infected and progressed to more serious stages, including bleeding from a sacral decubitus ulcer, necessitating Jones’s transfer from Pinnacle’s facility to Victory Memorial Hospital. Upon her admission, the hospital documented Jones’s injuries to include: (1) a sacral pressure ulcer so large, deep, and infected that liquid stool was seeping out of her vagina; (2) a scalp pressure ulcer that appeared to reach down to the skull; (3) a left leg pressure ulcer that exposed Jones’s tendons; and (4) pressure ulcers on Jones’s ears, which exposed cartilage. Moreover, prior to Jones’s transfer from Pinnacle’s facility on October 4, 2006, she had developed multiple severe urinary tract infections, symptoms of recurrent infection with yellow-green sputum production, and severe respiratory problems. Jones died from respiratory failure on October 6, 2006.
On August 3, 2007, plaintiff (Jones’s daughter) was appointed the independent administrator of Jones’s estate. On February 11, 2008, plaintiff filed the complaint at issue. As noted above, three counts were directed against English. Those counts were styled as “Medical Malpractice” (count XXIII), “Wrongful Death” (count XXIV), and “Funeral and Burial Expenses” (count XXV). Count XXIII was brought by plaintiff under the provisions of the Illinois survival statute (755 ILCS 5/27 — 6 (West 2008)), while counts XXIV and XXV were premised upon provisions of the Wrongful Death Act (740 ILCS 180/1 et seq. (West 2008)).
All three counts stated that English, a registered nurse, was, “[a]t various times relevant,” Pinnacle’s director of nursing. Plaintiff asserted that on or prior to October 4, 2006, and at all times relevant, English knew or should have known that Jones was at a high risk for skin breakdown, pressure sores and infections therefrom, urinary tract infections, and respiratory problems. Plaintiff alleged that English “had a duty to provide nursing and nursing home services consistent with the standard of care for like institutions and medical treatment providers when treating residents and patients similar to [Jones].” Paragraph 16 of each count alleged that English breached her duty and was negligent in that she committed one or more of the following acts or omissions:
“a. failed to hire qualified and experienced nursing staff to provide appropriate care and treatment to DOROTHY JONES during her residency pursuant to the state and federal regulations governing nursing home residents;
b. failed to ensure that the medical and nursing services provided to DOROTHY JONES met the applicable regulations, policies, procedures and standards for overall quality of care;
c. failed to ensure the safety and welfare of DOROTHY JONES pursuant to the state and federal regulations governing nursing home residents;
d. failed to evaluate, monitor and supervise the overall quality of healthcare being provided by the attending physician, nursing staff and other medical personnel pursuant to the state and federal regulations governing nursing home residents;
e. failed to demonstrate a personal effort to improve the overall quality of care being provided to DOROTHY JONES by the medical and nursing staff during her residency;
f. failed to ensure that the nursing staff implemented a care plan that addressed the specific measures necessary to treat a highly complex, total-care resident like DOROTHY JONES;
g. failed to ensure that the medical and nursing staff provided adequate monitoring and care to prevent the development and worsening of numerous infected decubitus ulcers, pursuant to the state and federal regulations governing nursing home residents;
h. failed to ensure that the nursing staff appropriately assessed, monitored and consistently documented the status of DOROTHY JONES’ skin, wounds and clinical condition during her residency pursuant to the state and federal regulations governing nursing home residents;
i. failed to monitor and timely obtain treatment orders for infections pursuant to the state and federal regulations governing nursing home residents;
j. failed to recommend that the appropriate medical consultants were consulted when DOROTHY JONES’ pressure sores continued to worsen;
k. failed to ensure that DOROTHY JONES’ skin remained free of pressure sores throughout her residency as it was upon her admission to PINNACLE HEALTHCARE, pursuant to the state and federal regulations governing nursing home residents;
l. failed to ensure that the nursing staff notified the physician and family members of other significant changes in DOROTHY JONES’ clinical condition throughout her residency;
m. failed to ensure that the nursing staff followed physician orders and administered medications and treatments as ordered pursuant to state and federal regulations governing nursing home residents;
n. failed to ensure that the nursing staff was providing appropriate care to DOROTHY JONES’ PEG tube stoma site in order to prevent infections;
o. failed to ensure that the nursing staff kept the head of the bed at an appropriate level in order to prevent aspiration pneumonia and other respiratory problems;
p. failed to ensure that DOROTHY JONES was properly medicated for pain pursuant to the state and federal regulations governing nursing home residents;
q. failed to evaluate and address the continued appropriateness of DOROTHY JONES’ medical regime during her residency and change the plan of care as needed; [and]
r. failed to ensure that the nursing staff followed proper nursing policy and procedures for performing gastrostomy feedings.”
The counts further alleged that as a direct and proximate result of one or more of the foregoing acts or omissions of English, Jones suffered injuries of a personal and pecuniary nature, including, but not limited to, pain and suffering, disability and disfigurement, and medical and related expenses.
Attached to plaintiffs complaint were various certificates for “an Action in Medical Malpractice Pursuant to 735 ILCS 5/2 — 622.” See 735 ILCS 5/2 — 622 (West 2008). Relevant here is a certificate signed by Patricia Bawcum, a licensed registered nurse. Bawcum opined that there existed a meritorious basis for filing an action against English. Regarding the specific acts or omissions allegedly committed by English, Bawcum set forth allegations of negligence essentially identical to those in paragraph 16 of counts XXIII, XXIV and XXV of plaintiffs complaint. Bawcum concluded her certificate with the following statement:
“In summary, Carolyn English, R.N., Director of Nursing repeatedly fell below the standard of care individually and through their [sic] nursing staffs treatment of DOROTHY JONES in terms of managing her overall clinical condition and skin and wound care. As a result, she developed respiratory failure and numerous horrendous infected pressure ulcers, which caused her disfigurement and extreme pain and suffering and ultimately caused or contributed to cause her death.”
English filed her answer to plaintiffs complaint on June 4, 2008. 1
On February 10, 2009, English moved the trial court to dismiss with prejudice counts XXIII, XXIV and XXV of plaintiffs complaint (see 735 ILCS 5/2 — 619 (West 2008)) or in the alternative to enter judgment on the pleadings (see 735 ILCS 5/2 — 615(e) (West 2008)). In her motion, English argued that despite their headings, counts XXIII, XXIV and XXV of plaintiffs complaint did not allege any “independent acts of negligence” against her. Rather, English argued, the counts consisted of “allegations of statutory violations pursuant to the Illinois Nursing Home Care Act *** and the Illinois Department of Public Health regulations, 77 Ill. Admin. Code, Part 300 et seq.” English argued that liability for violations of the Nursing Home Care Act can be imposed only upon the owner or licensee of a nursing home. See 210 ILCS 45/3 — 601 (West 2008); Wills v. De Kalb Area Retirement Center,
On March 17, 2009, the trial court entered an order granting English’s motion and ordered counts XXIII, XXIV, and XXV of plaintiff’s complaint dismissed with prejudice. 2 The order further pronounced that there was “no just reason to delay the filing of an appeal pursuant to [Supreme Court Rule] 308(a) [155 Ill. 2d R. 308(a)].” On April 7, 2009, the trial court, on English’s motion, entered a corrected order nunc pro tunc to refer in the March 17, 2009, order to Supreme Court Rule 304(a) (210 Ill. 2d R. 304(a)) rather than to Rule 308(a).
On April 13, 2009, plaintiff filed a motion to reconsider the trial court’s March 17, 2009, order. In her motion, plaintiff reiterated her position that the counts against English were premised on section 2 — 622 of the Code (735 ILCS 5/2 — 622 (West 2008)) and supported by a certificate for a meritorious claim in medical malpractice. Plaintiff asked the trial court to reevaluate the actual allegations made against English, particularly in relation to the supreme court’s ruling in Eads v. Heritage Enterprises, Inc.,
On April 21, 2009, plaintiff filed a motion for leave to file her first amended complaint. In her motion, plaintiff noted that a motion to reconsider the trial court’s order granting English’s motion to dismiss the counts against her was currently pending. Nevertheless, plaintiff sought leave to amend the allegations against English as well as to amend allegations made against a different defendant who had filed a motion to strike portions of plaintiffs complaint against her. The copy of plaintiffs motion in the record is not accompanied by a proposed first amended complaint.
On May 20, 2009, the trial court entered an order denying plaintiff’s motion to reconsider the March 17, 2009, order, “for the reasons stated in open court on the record.” On the same day, the court granted plaintiff leave to file an amended complaint against the remaining defendants on or before May 29, 2009. In addition, the court found that pursuant to Rule 304(a) (210 Ill. 2d R. 304(a)), there was no just reason for delaying either enforcement or appeal of the court’s March 17, 2009, order or the court’s denial of the motion to reconsider same.
During the hearing on the motion to reconsider, the court stated that it was denying the motion to reconsider because “there still aren’t any facts that change the landscape in that everything that nurse English is alleged to have done she did as the director of nursing, not as the nurse for the patient.” The court further articulated that “[tjhat’s the distinction that I draw, and I agree with the defense that that is the distinction that the statute draws and no matter how this is pled, when it comes to the end of the day, this is a nursing care act case as far as nurse English because she is only involved because she is the director or nursing.” Plaintiffs attorney indicated that he intended to file an amended complaint that would “probably include a cause of action against nurse English alleging things that, [he] believe[s], could be alleged.” The court responded that counsel could not file a complaint against English. The court explained that in order to file an amended complaint including allegations directed against English, plaintiff would have had to “allege either a change in the law or new facts that the court was not aware of” when the original complaint was filed. The court found that plaintiffs motion to reconsider “did not allege new facts which would change the role of nurse English.” As such, the court stated that plaintiff was “barred” from filing a complaint against English in this case.
Thereafter, plaintiff filed a notice of appeal from the trial court’s March 17, 2009, order and the May 20, 2009, denial of the motion to reconsider the March 17, 2009, order. The notice of appeal is file stamped June 16, 2009. Plaintiff also filed on June 16, 2009, a motion for leave to file a first amended complaint. Attached to plaintiffs motion were two documents. The first document, captioned a “Previously Proposed” first amended complaint, included three counts directed against English. The second document, captioned simply “Plaintiffs First Amended Complaint at Law,” did not contain any allegations against English. On June 16, 2009, the trial court granted plaintiffs motion for leave to file her first amended complaint instanter. That same day, plaintiff filed in the trial court a first amended complaint that omitted the allegations against English. On plaintiffs motion, we stayed the proceedings in the trial court pending the outcome of this appeal. See 210 Ill. 2d R. 305(b).
II. ANALYSIS
Prior to addressing the merits of plaintiffs appeal, we address English’s claim that plaintiff has forfeited any objection to the trial court order granting her motion to dismiss counts XXIII, XXiy and XXV of the original complaint by filing a first amended complaint. In Foxcroft Townhome Owners Ass’n v. Hoffman Rosner Corp.,
“In particular is the interest in the efficient and orderly administration of justice. It is expected that a cause will proceed to trial on the claims as set forth in the final amended complaint.
This procedure ensures that the trial judge will be aware of the points in issue, and can properly rule on objections at trial. To allow a party to also introduce allegations related in earlier pleadings would result in confusion and impose an unnecessary burden upon the trial judge. No interest would be served by requiring the judge to speculate as to which legal theories or claims a party intends to advance during trial.
The complaint notifies the defendant of the alleged causes of action and theories of recovery. When a complaint is amended, without reference to the earlier allegations, it is expected that these allegations are no longer at issue. Defendants would be disadvantaged by a rule which would, in effect, permit a plaintiff to proceed to trial on different issues contained in separate complaints. In contrast, we perceive no undue burden in requiring a party to incorporate in its final pleading all allegations which it desires to preserve for trial or review.” Foxcroft,96 Ill. 2d at 154 .
To avoid the consequences of the Foxcroft rule, a party wishing to preserve a challenge to an order dismissing fewer than all of the counts in his complaint has several options. For instance, he or she can elect to stand on the dismissed counts and argue the matter at the appellate level. Du Page Aviation Corp., Flight Services, Inc. v. Du Page Airport Authority,
At the outset, we point out that the proceedings in the trial court have been stayed. Therefore, the policy considerations referenced by the supreme court in Foxcroft (see
According to the affidavit of mailing and proof of service accompanying plaintiffs filing, her notice of appeal was deposited in the United States mail on June 12, 2009. See 155 Ill. 2d R. 373; 145 Ill. 2d R. 12(b)(3). The notice of appeal was file stamped by the clerk of the circuit court on June 16, 2009. Since the notice of appeal reached the circuit court clerk prior to its due date, we consider the date of filing to be the date that it was received by the clerk as evidenced by the file stamp. 155 Ill. 2d R. 373. In this case, plaintiff’s first amended complaint also bears a file stamp date of June 16, 2009, and the file-stamp legend does not indicate a time of filing. Nevertheless, we point out that the notice of appeal appears in the record prior to the amended complaint. Moreover, before plaintiff could file her first amended complaint, she was required to obtain an order from the trial court granting her permission to file the pleading. Under these circumstances, we conclude that plaintiff perfected the appeal from the trial court order dismissing the counts against English before plaintiff filed her first amended complaint. As a result, plaintiff has not forfeited consideration of the issue presented in this appeal. See Brown Leasing, Inc.,
Given the foregoing sequence of events, we believe that an opposite conclusion would lead to anomalous results. Consider, for instance, if each event in the sequence had occurred just one week later. That is, plaintiff deposited her notice of appeal in the United States mail on June 19, 2009. The circuit clerk received the document and file stamped it on June 23, 2009. Also on June 23, 2009, plaintiff was granted leave to file her first amended complaint instanter and did so. Under this scenario, the notice of appeal would still be timely. However, because it would have been received by the clerk of the court after the date it was due, the time of mailing would have been deemed to be the time of filing (155 Ill. 2d R. 373; Standard Mutual Insurance Co.,
In any event, the record also suggests that the Foxcroft rule does not apply for a second reason — that is, plaintiff preserved the counts against English when she filed her first amended complaint. In her motion for leave to file the first amended complaint, plaintiff noted that her original complaint was “a matter of record and [was] incorporated herein by reference as though fully set forth.” Plaintiff further noted that her request for leave to file an amended complaint including allegations against English was denied. Nevertheless, plaintiff attached as an exhibit a “previously proposed” first amended complaint containing the allegations she wished to make against English in addition to a copy of the first amended complaint omitting the same allegations. These actions indicate that plaintiff did not intend to abandon or withdraw the allegations against English. See Foxcroft,
Finally, we find that English’s reliance on Boatmen’s National Bank of Belleville v. Direct Lines, Inc.,
In her motion to dismiss the counts against her, English did not specify upon which subparagraph of section 2 — 619 of the Code (735 ILCS 5/2 — 619 (West 2008)) the motion was premised. However, it appears to be based upon section 2 — 619(a)(9) (735 ILCS 5/2 — 619(a)(9) (West 2008)). That provision permits involuntary dismissal where the claim asserted against the defendant is barred by some affirmative matter avoiding the legal effect of or defeating the claim. Van Meter v. Darien Park District,
Plaintiff contends that the trial court erred in dismissing the three counts directed against English. According to plaintiff, while liability under the Nursing Home Care Act may be limited to owners and licensees of nursing homes (see 210 ILCS 45/3 — 601 (West 2008); Wills,
The Nursing Home Care Act is “a comprehensive statute which established standards for the treatment and care of nursing home residents; created minimum occupational requirements for nurses aides; and expanded the power of the Illinois Department of Public Health to enforce the provisions of the [Nursing Home Care] Act.” Harris v. Manor Healthcare Corp.,
“It is important to note *** that while claims under the Nursing Home Care Act may sometimes involve a resident’s medical care, they do not directly implicate the individual health-care providers. A failure to provide adequate medical care that ‘results in physical or mental injury to a resident, or in the deterioration of a resident’s physical or mental condition’ constitutes neglect (210 ILCS 45/1— 117 (West 2000)) and is prohibited by the [Nursing Home Care] Act (210 ILCS 45/2 — 107 (West 2000)). The only defendants liable for damages, costs, and attorney fees under the [Nursing Home Care] Act, however, are the owners and licensees of the nursing home. See 210 ILCS 45/3 — 601, 3 — 602 (West 2000). Nothing in the Nursing Home Care Act requires owners or licensees to be medical professionals themselves, and nothing in the [Nursing Home Care] Act authorizes nursing home residents to recover damages for medical malpractice from the individuals who actually provided the care. Suits against those individuals must be asserted independently of the Nursing Home Care Act.” (Emphasis added.) Eads,204 Ill. 2d at 108-09 .
In accordance with the foregoing authority, we must determine whether the counts against English state claims for healing art malpractice independent of the Nursing Home Care Act. In conducting this inquiry, we note that it is the nature of the complaint that defines a cause of action, not the label assigned to it by the plaintiff (Chatham Surgicore, Ltd. v. Health Care Service Corp.,
A plaintiff seeking recovery for healing art malpractice must allege facts that establish the existence of a standard of care by which to measure the defendant’s conduct, a negligent breach of that standard of care by the defendant, and an injury to the plaintiff proximately caused by the defendant’s breach. Cummings v. Jha,
The trial court dismissed the counts against English on the basis that “everything that nurse English is alleged to have done she did as the director of nursing, not as the nurse for the patient.” The court further opined that “no matter how this is pled, when it comes to the end of the day, this is a nursing care act case as far as Nurse English because she is only involved because she is the director of nursing.” We disagree. Assessing the allegations in plaintiffs complaint in the light most favorable to her, as we are required to do (Van Meter,
Plaintiffs complaint listed 18 separate negligent acts or omissions by English involving medical judgment. Among the allegations against her, English is alleged to have failed to: (1) ensure adequate monitoring by the nursing staff to prevent the development and worsening of numerous infected decubitus ulcers; (2) monitor and timely obtain treatment orders for infection; (3) recommend that the appropriate medical consultants be consulted when Jones’s pressure sores continued to worsen; (4) ensure that Jones’s skin remained free of pressure sores throughout her residency; (5) ensure that the nursing staff notified the physician and family members of the significant changes to Jones during her residency at Pinnacle; (6) ensure that Jones was properly medicated; and (7) evaluate and address the continued appropriateness of Jones’s medical regime during her residency. Given the breadth of the term “healing art malpractice,” as well as the fact that the allegations in plaintiff’s complaint involve aspects of medical judgment, we conclude that the trial court erred in dismissing the counts against English.
Moreover, we do not agree that these allegations attack English’s conduct solely in her capacity as the director of nursing. Plaintiff alleged that English “had a duty to provide nursing and nursing home services consistent with the standard of care for like institutions and medical treatment providers when treating residents and patients similar to [Jones].” (Emphases added.) Further, as noted in the foregoing paragraph, some of the allegations against English relate to the direct care of Jones. Thus, as plaintiff asserts, the allegations establish aspects of English’s alleged negligent acts or omissions falling within the realm of her professional nursing responsibilities, both in her identified capacity as director of nursing and based upon her own individual nursing duties in the care of Jones. The fact that English was the director of nursing during Jones’s residency or that the setting of the alleged negligent conduct occurred in a nursing home does not automatically transform this case into one under the Nursing Home Care Act. As noted above, this is not a case merely involving ordinary negligence, such as a fall by a resident of a nursing home. See Eads,
In sum, we conclude that the counts against English include allegations of negligent acts or omissions involving medical judgment. As such, the trial court erred in granting English’s motion to dismiss the counts against her. Given our disposition, we need not address plaintiff’s alternate claim that the trial court erred in not allowing her leave to file an amended complaint to more fully address the court’s concerns about counts XXIII, XXIX and XXX
III. CONCLUSION
For the reasons set forth above, we conclude that the allegations directed against English sound in “healing art malpractice,” falling within the realm of her professional nursing responsibilities, both in her identified capacity as director of nursing and based upon her own nursing duties in the care of Jones, and are independent of and not proscribed by the Nursing Home Care Act. Accordingly, we reverse the judgment of the circuit court of Lake County and remand this cause to the circuit court for further proceedings.
Reversed and remanded.
HUTCHINSON and BURKE, JJ., concur.
Notes
According to English’s brief, she denied all material allegations of the counts against her. However, because two pages of English’s answer are missing from the record, we cannot verify this claim.
The March 17, 2009, order does not explain the court’s reasoning. Moreover, the record does not contain a transcript for the proceedings, if any, on March 17, 2009.