delivered the opinion of the court:
Plaintiff Jesse Nosbaum, a minor, appeals from the circuit court’s granting of defendants’ motions to dismiss her complaint. In that four-count complaint, Jesse, her mother, Monica Harding (Monica), and her mother’s husband, Scott Harding (Scott), alleged medical malpractice and negligent misrepresentation against defendants Susan Martini, Advocate Medical Group (Advocate), and Lutheran General Hospital (Lutheran General). Counts I and II of the complaint are for medical malpractice, and counts III and IV are for negligent misrepresentation. The circuit court granted the defendants’ motions to dismiss under section 2 — 619 of the Illinois Code of Civil Procedure (735 ILCS 5/2 — 619 (West 1992)). Jesse argues the court erred in finding defendants immune from liability under the Abused and Neglected Child Reporting Act (the Act) (325 ILCS 5/9 (West Supp. 1999)) and in ruling that her complaint did not sufficiently allege liability under an apparent agency theory. Therefore, Jesse contends her medical malpractice claims should not have been dismissed. For the reasons set forth below, we reverse in part, vacate in part and remand for further proceedings.
BACKGROUND FACTS
The defendants moved for dismissal under sections 2 — 615 and 2 — 619 of the Code of Civil Procedure (735 ILCS 5/2 — 615, 2 — 619 (West 1992)). In support, they submitted affidavits of Dr. Martini and Lutheran General social worker Kim Seltzer, and a supplemental affidavit of Kim Seltzer. Also attached to their motions to dismiss were Kim Seltzer’s written report to the Illinois Department of Children and Family Services (DCFS), Laurence Nosbaum’s (Laurence) petition for change of residential custody (filed July 29, 1996) and his affidavit in support, and Laurence’s amended petition for change of residential custody (filed October 16, 1996). In response, the plaintiffs submitted an affidavit of Monica Harding. Also attached to the plaintiffs’ response to the motions to dismiss were Laurence’s petition for temporary change of residential custody (filed July 29, 1996), Dr. Martini’s report of her examination of Jesse, and Dr. Martini’s (April 3, 1997) letter to Laurence’s attorney, Denis J. McKeown. The following facts are undisputed.
Jesse is the daughter of Laurence and Monica, who were husband and wife at the
Dr. Martini was a member of the CPS team, but she was an employee of Advocate, an independent entity that had its offices on the premises of Lutheran General. According to Dr. Martini, Laurence informed her that Jesse said she “played doctor” with her stepfather (Scott). Laurence also said he had noticed Jesse placing objects in and around her genital area and rubbing water close to her vagina and saying “it felt good.” Jesse also placed crayons in her three-year-old cousin’s vagina while staying at her paternal aunt’s house. In addition, she became agitated when it was time to leave her father’s house and return to her mother’s house. Jesse said she wished her mother would die so she could live with her father.
Dr. Martini examined Jesse for physical signs of sexual abuse and completed a report called a “Child Protective Services Team Evaluation.” Using a device called a colposcope, Dr. Martini concluded that the diameter of Jesse’s transhymenal opening was 20 or 21 millimeters, which she termed “abnormal.” In both her report and her subsequent affidavit, Dr. Martini said such an opening might indicate sexual abuse or it might result from “digital manipulation” by the child herself. Dr. Martini wrote in her report that she “Suggested to father [Laurence] to report [the] case to DCFS” but that “he did not want to.” She also wrote that the case was “not reported yet” to DCFS and that Kim Seltzer, a Lutheran General social worker, was “to call DCFS to see if they think [a] report needs to be filed.”
Ms. Seltzer also spoke with Laurence on July 12, 1996. Three days later (July 15), she made an oral report to DCFS “[b]ased on Jesse’s history given by Mr. Nosbaum.” In her subsequent written report to DCFS, submitted on July 22, Ms. Seltzer listed (as evidence of previous suspected abuse) both Laurence’s “concerns about Jesse’s statements & behavior” and an “[a]bnormal medical exam.” Both Ms. Seltzer and Dr. Martini assert in their affidavits that regardless of the results of Dr. Martini’s examination, the history reported to them by Laurence meant a report had to be filed with DCFS.
On July 29, 1996, Laurence filed simultaneous petitions for change of residential custody and for temporary change of residential custody, asking that custody of Jesse be transferred to him. The petitions were filed with the circuit court of the nineteenth judicial circuit in Lake County, Illinois. In his petition for change of residential custody, Laurence listed several grounds, including Monica’s removal of Jesse from the Chicago area to an “isolated environment” in southern Illinois, Jesse’s comment that “she plays doctor with an adult in Southern Illinois,” and Jesse’s masturbation and apparent “preoccupation with sexual matters.” He also noted that Dr. Martini had examined Jesse and found “an abnormal opening of the vaginal area *** that can be consistent in sexual abuse cases,” and he attached a copy of Dr. Martini’s report. In addition, Laurence noted that Lutheran General had reported the case to DCFS “as suspected child abuse.” On August 19, 1996, the court ordered temporary custody of Jesse transferred from Monica to Laurence for 90 days. The court extended that custody arrangement on the following November 8, noting that Jesse could stay with Monica for the Thanksgiving holiday but that her husband, Scott, could not be left alone with Jesse. In January 1997, the court denied Laurence’s petition for a further extension of the temporary custody
In a letter dated April 3, 1997, Dr. Martini wrote to Laurence’s attorney, Denis J. McKeown, informing him that the initial transhymenal diameter was incorrect and that she had amended Jesse’s medical record to reflect the correct diameter of four millimeters, which she said was “in the normal range.” Dr. Martini said the error resulted from “confusion of one of the magnifying powers used on the colposcope.” In August 1997, following a trial on Laurence’s petition for change of custody, the court terminated the joint custody arrangement and awarded sole custody of Jesse to Monica.
Eight months later (April 28, 1998), Jesse, Monica and Scott filed the instant complaint, alleging medical malpractice (counts I and II) and negligent misrepresentation (counts III and IV) against Dr. Martini, Advocate, and Lutheran General. Counts I and III seek damages for Jesse for the mental anguish and loss of companionship of her mother and stepfather that she suffered when she was temporarily removed from her mother’s care. Counts II and IV seek similar damages plus attorney fees for Monica and Scott. In the instant appeal, only Jesse is contesting the dismissal of the complaint, and she is appealing only the dismissal of her medical malpractice claims (not her negligent misrepresentation claims).
On January 7, 1999, the trial court dismissed the complaint under section 2 — 619, holding that “Dr. Martini and the hospital meet the statutory definition of those afforded immunity under the [Abused and Neglected Child Reporting] Act as they were involved in the creation of the report [to DCFS] by providing information to Ms. Seltzer.” The court also held that the plaintiffs failed to show the defendants acted in bad faith and that the statute thus “operates to immunize the defendants.” In addition, because the complaint did not allege that the plaintiff, Jesse, acted in reliance on the defendants’ conduct, the court held that it failed to state a claim against Lutheran General for the apparent agency of Dr. Martini. A motion to reconsider was denied on March 10, 1999. This appeal followed.
ANALYSIS
I. Standard.of Review
In a section 2 — 619 motion, all well-pleaded allegations in support of the claim are taken as true and all reasonable inferences are drawn in the plaintiffs favor. Calloway v. Kinkelaar,
A section 2 — 619 motion to dismiss falls between “the completely legal bases of section 2 — 615 and the completely factual bases of section 2 — 1005.” Barber-Colman,
Appellate review of a dismissal under section 2 — 619 is de novo. Kedzie,
II. Immunity Under the Abused and Neglected Child Reporting Act
Section 4 of the Abused and Neglected Child Reporting Act (the Act) provides:
“Any physician *** having reasonable cause to believe a child known to them in their professional or official capacity may be an abused child or a neglected child shall immediately report or cause a report to be made to the Department. Whenever such person is required to report under this Act in his capacity as a member of the staff of a medical or other public or private institution, school, facility or agency, he shall make report immediately to the Department in accordance with the provisions of this Act ***.” 325 ILCS 5/4 (West Supp. 1999).
Section 7 of the Act provides:
“All reports of suspected child abuse or neglect made under this Act shall be made immediately by telephone to the central register *** or in person or by telephone through the nearest Department office.” 325 ILCS 5/7 (West Supp. 1999).
Section 9 of the Act provides:
“Any person, institution or agency, under this Act, participating in good faith in the making of a report or referral, or in the investigation of such a report or referral *** shall have immunity from any liability, civil, criminal or that otherwise might result by reason of such actions. For the purpose of any proceedings, civil or criminal, the good faith of any persons required to report or refer, or permitted to report, cases of suspected child abuse or neglect or permitted to refer individuals under this Act or required to disclose information concerning reports of child abuse and neglect *** shall be presumed.” 325 ILCS 5/9 (West Supp. 1999).
Jesse argues that because immunity under the Act applies only to liability resulting from participating in the making of a report, as set forth in section 9, defendant Dr. Martini is not protected by that immunity since she did not prepare any report to DCFS. She further contends that since neither Dr. Martini nor anyone else made an immediate report to DCFS, Dr. Martini had no reasonable cause to believe abuse had occurred and thus chose not to make a report. Jesse also argues that failure to make an immediate report, as required under sections 4 and 7, is in itself sufficient under the Act to preclude the extension of immunity.
The fact that it was Kim Seltzer and not Dr. Martini who made the report to DCFS does not determine the entitlement of Dr. Martini to immunity. Although there are no cases in Illinois construing the relevant portion of section 9, the statute’s explicit
With respect to Jesse’s contention that Dr. Martini had no reasonable cause to believe abuse had occurred and thus chose not to make a report, we agree with the defendants that the contention is not supported by the record. In her evaluation of Jesse, Dr. Martini wrote that the “abnormal transhymenal diameter” she observed “can be seen in sexual abuse.” She also noted that she suggested to Laurence that he report the case and that Kim Seltzer was to call DCFS to see if a report needed to be filed. In her affidavit, Dr. Martini said “[t]he history of statements and observations given by Mr. Nosbaum gave rise to a reasonable suspicion of child abuse.”
In addition, though the Act does require that a report be made “immediately,” it imposes no time restriction more specific than that. The record shows that Kim Seltzer made an oral report to DCFS on July 15, 1996, just three days after her interview with Laurence. Moreover, while there are no Illinois cases on point, one of the cases cited by plaintiff (and discussed below) looks at a timeliness argument similar to the one Jesse makes. In Wilkinson v. Balsam,
Jesse next argues that statutory immunity does not apply because her suit arose not from the report to DCFS but from Dr. Martini’s negligent examination.
It is apparent that the damages sought here stem from the temporary removal of Jesse from the primary care of her mother (in the custodial hearing before the domestic relations judge in Lake County). That removal resulted from Laurence’s petition for change of residential custody. In that petition he listed several grounds, including that Jesse was examined by Dr. Martini, who found “an abnormal opening of the vaginal area *** that can be consistent in sexual abuse cases.” Laurence stated in his petition that he was attaching a copy of Dr. Martini’s report. The record does not make clear the precise reasons why the court granted temporary custody of Jesse to Laurence. However, the emphasis given Dr. Martini’s examination in that petition supports an inference that it may have been the dominant basis for the decision. As the defendants correctly note, Laurence’s petition also lists Lutheran General’s report to DCFS, but there is no indication he attached a copy of it as he did with Dr. Martini’s report.
This case therefore raises the apparently novel issue of whether (for purposes of immunity under the Act) a child abuse report should be viewed separately from the examination that preceded it. Both sides here appear to agree there would be no immunity for a doctor who negligently caused harm independent of a DCFS report simply because there was a tangential link to such a report. For example,
This case of course presents a different situation from the hypothetical missed-cancer diagnosis. Here there is no physical harm alleged as a result of Dr. Martini’s misdiagnosis. In addition, the defendants contend the measurement of Jesse’s transhymenal diameter was “an integral part of the evaluation of possible abuse” and thus cannot be considered apart from the abuse report. Even so, a physician has an independent duty to report the results of her findings to her patient, and that duty exists wholly separate and apart from any duty imposed by the Act. Goldberg v. Ruskin,
We are not unmindful of the important policy reason underlying the Act’s immunity: granting such immunity for liability arising from the reporting of child abuse helps encourage such reporting. However, in the instant case it is clear that no liability should or will flow from any damages caused by the report to DCFS (for which immunity is granted), and there is no reason to extend that immunity to cover the doctor’s independent obligation to her own patient where the failure to do so causes damage independent of the DCFS report.
The question of whether statutory immunity applies to liability arising from a medical examination that precedes a child abuse report has not been directly addressed in any previous Illinois decisions. However, that issue has been looked at in other jurisdictions. In Comstock v. Walsh,
That issue was reached in Wilkinson v. Balsam,
The decision in Pryweller v. Cohen,
In Pryweller, unlike the instant case, the main defendant, Gabriella Cohen, was a child care worker, not a physician. Pryweller,
While the case of Poulos v. Lane,
In Poulos, the defendant physician reported to DCFS that a child she examined for possible sexual abuse had tested positive for gonorrhea of the throat. Poulos,
Thus in Poulos, as in Pryweller, no contention was raised as to a doctor’s liability for an independent breach of duty to a patient in rendering a proper diagnosis. The central issue raised is whether the doctor acted in good faith and thus came within the statute’s immunity. In this case, we reached the question head-on as to whether liability resulting from the independent negligence of a doctor comes within the umbrella of the immunity provision simply because the result of that malpractice also became a predicate of a DCFS report that followed. We submit that under these circumstances, if it can be shown that the damages claimed resulted directly from the misdiagnosis and not from the DCFS report itself, there is no reason to extend to that independent malpractice the protection of the statute’s immunity provision.
III. Apparent Agency
Jesse also contends the trial court erred in finding that Dr. Martini was not an apparent agent of Lutheran General. Under Illinois law, a hospital can be held vicariously liable under an apparent agency theory if the plaintiff can show:
“ ‘(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude that the individual who was alleged to be negligent was an employee or agent of the hospital; (2) where the acts of the agent create the appearance of authority, the plaintiff must also prove that the hospital had knowledge of and acquiesced in them; and (3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care and prudence.’ ” Gilbert v. Sycamore Municipal Hospital,156 Ill. 2d 511 , 525,622 N.E.2d 788 , 795 (1993), quoting Pamperin v. Trinity Memorial Hospital,144 Wis. 2d 188 , 208, 423 N.W2d 848, 856 (1988).
In her complaint, Jesse alleges it was reasonable for Laurence to conclude Dr. Martini (an employee of Advocate) was an employee of Lutheran General. She also alleges that Lutheran General “had knowledge of and acquiesced in the acts of Dr. Martini” and that Laurence justifiably relied on Lutheran General’s conduct “in referring him to its Child Protective Services Team” (of which Dr. Martini was a member). Jesse thus contends her complaint meets the reliance requirements for an apparent-agency claim as set out in Gilbert.
Lutheran General notes that Laurence is not the plaintiff in the instant suit, and thus contends Jesse did not allege that it was the plaintiff who relied on the conduct of the hospital or its agent, as is required under Gilbert. Lutheran General also argues that because Laurence is neither the plaintiff nor a party, any claims Jesse makes as to his state of mind are hearsay and improper. Finally, according to Lutheran General, Jesse’s complaint alleges Laurence acted on the results of Dr. Martini’s examination, not on his conclusion that there was an agency relationship between Dr. Martini and Lutheran General, as required in an apparent agency claim.
Jesse first argues that, for purposes of the reliance element in Gilbert, it makes no difference whether Laurence was the plaintiff or even a party to the suit. She contends it is enough that he is her father and that his reliance was a factor in the decision he made on her behalf. Jesse cites Chicago Title & Trust Co. v. Sisters of St. Mary,
Lutheran General contends Chicago Title is inapplicable because, unlike Laurence, the father there was a plaintiff joined in the action and thus met the reliance element (while Laurence did not). We consider that to be a distinction without a difference since under Chicago Title the father’s reliance was attributed not only to the father but also to the minor son, who was also a plaintiff in the action. The central facts appear to be that there was reliance by those responsible for the infant’s care. Otherwise, no infant could ever hope to avail himself of apparent agency since he would be incapable of his own evaluation and reliance.
That rationale is specifically borne out in the case of Monti v. Silver Cross Hospital,
The same reasoning applies to the instant case. If because of her minority Jesse was incapable of relying on Lutheran General, then the reliance of a person responsible for her care (in this case her father) established an “implied reliance” on Jesse’s part. Just as in Monti, it does not matter that the person who relied was neither a plaintiff nor a party to the suit. Further, Monti’s reasoning would appear to apply even more strongly where, as here, the person who relied was the plaintiffs parent, not a person unrelated to her.
The defendants’ other two arguments, that the pleadings are insufficient to establish reliance because of hearsay and that reliance is insufficiently developed in the pleadings, do not detain us long. Though Laurence is not a party to the suit, he may still testify at trial, and then his statements would not be hearsay. Nothing prevents plaintiffs here from alleging in their pleading that Laurence relied on Lutheran General’s conduct. What is important at this stage of the proceeding is that Jesse’s complaint sufficiently alleged a claim of apparent agency. That is not to be confused with proof of that claim, established not through hearsay but through
We therefore reject the trial judge’s conclusion that apparent agency was not established by the pleadings.
CONCLUSION
Accordingly, we reverse the trial court’s determination with respect to the issue of apparent agency, and we vacate and remand to the trial court the immunity issue for clarification and reevaluation. If it is determined that the damages claimed flow independently from defendant Martini’s misdiagnosis and not from the incorporation of that misdiagnosis into the DCFS report, then the trial court’s dismissal of this action shall stand as reversed as well as vacated. If on the other hand the court determines that the damages resulted from the DCFS report and not solely from the independent negligence of the doctor, then the trial court’s dismissal of this action shall be reinstated. Since there was no jury demand by the plaintiff in this case, the court is free to weigh the evidence. See section 2 — 619(c) discussed above. However, while no evidentiary hearing apparently was requested and none given, we would urge that there be such an evidentiary hearing on remand. See 4 R. Michael, Illinois Practice § 41.8, at 336 (1989):
“In determining [a section 2 — 619] motion on the merits *** the trial court may not simply resolve the motion on the bases of the affidavits and similar material submitted in the initial stage of the hearing on the motion. Rather an evidentiary hearing must be held, and the unresolved issue or issues of fact must be determined on the basis of a preponderance of the evidence.”
Reversed in part, vacated in part and remanded for further proceedings.
McNULTY and McBRIDE, JJ., concur.
Notes
In the instant case, the defendants made a jury demand, but there is no indication the plaintiffs made one.
The court also noted that the plaintiffs husband was “present during much of the day” and that he also “relied upon the hospital to provide the *** services she required.” Monti,
