Home Star Bank and Financial Services, etc. v. Emergency Care and Health Organization, Ltd. , 2014 IL 115526 ( 2014 )

2014 IL 115526
IN THE
SUPREME COURT
OF
THE STATE OF ILLINOIS
(Docket No. 115526)
HOME STAR BANK AND FINANCIAL SERVICES, Guardian of the Estate of
Edward Anderson, a Disabled Person, et al., Appellees, v. EMERGENCY CARE
AND HEALTH ORGANIZATION, LTD., et al., Appellants.
Opinion filed March 20, 2014.
JUSTICE THOMAS delivered the judgment of the court, with opinion.
Chief Justice Garman and Justices Freeman, Kilbride, Karmeier, Burke, and Theis
concurred in the judgment and opinion.
OPINION
¶1 Plaintiffs, Darby Thomas and Home Star Bank & Financial Services, as guardian of
the estate of Edward Anderson, a disabled person, filed suit against defendants Michael
T. Murphy, O.D., and his employer, Emergency Care & Health Organization, Ltd.
(ECHO), alleging that Dr. Murphy was negligent in treating Anderson. The circuit
court of Cook County concluded that Dr. Murphy was immune from liability pursuant
to section 25 of the Good Samaritan Act (the Act) (745 ILCS 49/25 (West 2010)) and
granted summary judgment to defendants. Plaintiffs appealed, and the Appellate Court,
First District, reversed and remanded. 2012 IL App (1st) 112321. The court held that
the Act was meant to apply to volunteers, not to those who treat patients within the
scope of their employment and are compensated for doing so. We allowed defendants’
petition for leave to appeal and, for the reasons that follow, we affirm the appellate
court.
¶2 BACKGROUND
¶3 On August 22, 2001, Anderson was admitted to Provena St. Mary’s Hospital
through the emergency room and was later transferred to the intensive care unit.
Anderson was diagnosed with epiglottitis. On August 25, Anderson began having
labored breathing and pain on swallowing. A Code Blue was called at approximately
3:20 a.m. Dr. Murphy, who was working in the emergency room at the time, responded
to the Code Blue and attempted to intubate Anderson. Anderson suffered a severe and
permanent brain injury. Plaintiffs filed a negligence action against Dr. Murphy and
ECHO, alleging that Dr. Murphy’s care and treatment of Anderson were the cause of
Anderson’s injuries.
¶4 Dr. Murphy denied the allegations and moved for summary judgment, asserting
that he was immune from liability for negligence under section 25 of the Act. ECHO
later joined the motion for summary judgment. Section 25 provides as follows:
“Any person licensed under the Medical Practice Act of 1987 or any person
licensed to practice the treatment of human ailments in any other state or
territory of the United States who, in good faith, provides emergency care
without fee to a person, shall not, as a result of his or her acts or omissions,
except willful or wanton misconduct on the part of the person, in providing the
care, be liable for civil damages.” 745 ILCS 49/25 (West 2010).
Dr. Murphy contended that section 25 applied because he provided emergency care to
Anderson, and Anderson was not billed for that care. Although ECHO had billed
Anderson for services its physicians provided him during a previous emergency room
visit on August 22, 2001, it did not bill for Dr. Murphy’s services during the Code Blue.
The hospital billed Anderson for supplies used during the Code Blue, but not for any
physician’s services.
¶5 In their response to the motion for summary judgment, plaintiffs argued that the
Good Samaritan Act was inapplicable because Dr. Murphy was simply doing his job
when he treated Anderson, and he was not providing his services “without fee.” ECHO
was the exclusive provider of emergency room physicians at Provena, and Dr. Murphy
was under contract with ECHO. ECHO paid Dr. Murphy by the hour, and he was not
allowed to bill patients directly. Plaintiffs argued that, just because no discrete bill was
sent for Dr. Murphy’s services, that did not mean that Dr. Murphy was providing his
services “without fee.”
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¶6 The parties submitted various exhibits and discovery depositions in support of their
positions. First, with respect to Dr. Murphy’s job responsibilities, an “independent
contractor agreement” between ECHO and Dr. Murphy provided that Dr. Murphy
would provide emergency medical services in the hospital’s emergency department
and that he would be paid by the hour. The hourly amount would be the sole amount he
would receive for his services. In addition to Dr. Murphy’s responsibilities in the
emergency department, the agreement provided that Dr. Murphy would have the
following “inpatient” responsibilities:
“Physician shall not provide any general or routine care of patients already
hospitalized under the care of another physician.
However, in dire emergencies, i.e., cardiorespiratory (or impending) arrest,
Physician may render service to any patient, as long as there is not an
emergency department patient requiring his/her immediate presence, and only
until the patient[’]s personal physician has assumed ongoing care.”
The agreement further provided that Dr. Murphy would abide by, and render
emergency medical services in accordance with, the bylaws, rules and regulations of
the hospital and departmental policies and procedures, using his professional judgment.
¶7 The “exclusive emergency room services agreement” between ECHO and the
Hospital provided that ECHO would be the exclusive provider of emergency room
physician services at the Hospital. Under the agreement, the “primary obligation of
ECHO’s physicians when in service at HOSPITAL’s emergency room shall be to care
for any and all patients presenting themselves for treatment at the emergency room.”
The agreement made clear that ECHO’s physicians were independent contractors
rather than employees of the hospital, and that they were to provide treatment only until
the patient’s attending physician could be present and assume responsibility. ECHO’s
physicians were required to discharge their duties in accordance with the “Bylaws,
Rules, Regulations, and policies of HOSPITAL and the MEDICAL STAFF Bylaws.”
Further, ECHO would bill patients directly for the services its physicians provided.
¶8 The hospital’s “Clinical Operations/Nursing” policy set forth the procedures for the
“Code Blue and Cardiac Arrest Team.” This policy set forth the Code Blue
responsibilities of the ER physician as follows:
“Responds to all Code Blues in the hospital. Directs Code Blue Team in
CPR, defibrillation and cardioversion and medication therapy. Intubates the
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patient. For DNR patients in Ancillary Departments, assess for Code
continuance.”
Nancy Frizzell, who was the nursing supervisor at St. Mary’s on the night of
Anderson’s Code Blue, explained in her deposition that, although this document is a
nursing policy, every employee of the hospital was expected to follow it. It was
Frizzell’s experience that when a Code Blue occurs at night, the emergency room
physician normally responds. She said that when a Code Blue was called, the
emergency room doctor would drop what he or she was doing to respond to the code.
Also, even when physicians on the unit responded to a Code Blue, the emergency room
doctor would come when he or she could.
¶9 In his deposition, Dr. Murphy left no doubt that responding to Code Blues was part
of his job:
“Q. Had you responded to any Code Blues at St. Mary’s before this one?
A. Yes.
Q. And was the emergency—was the emergency room physician on duty
the physician who would be expected to respond to a Code Blue?
A. Yes.
Q. Were you the only emergency physician working at that—that night at
the hospital?
A. Yes.
Q. As soon as you were notified of the code, did you go immediately to the
room?
A. I believe so, yes.”
¶ 10 Dr. Joseph Danna, the president and CEO of ECHO, was more equivocal in his
deposition. When asked whether it was part of Dr. Murphy’s job to respond to Code
Blues, Danna said, “no,” and that it “was not an inherent prescribed part of his work, of
his job.” Danna said that, rather, if there were a dire emergency elsewhere in the
hospital, an ECHO physician would respond “in the manner a good samaritan would
respond to that dire emergency.” He assumed that Dr. Murphy responded to the Code
Blue because he was the only person available to respond. Danna was aware that
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ECHO physicians responded to Code Blues at the hospital, but said that he had “no
understanding” that they were “part of the team.” Rather, they were one of many
resources available, and an ECHO physician would typically be the last person that
would respond.
¶ 11 Eunice Rimer was a certified registered nurse anesthetist who responded to
Anderson’s Code Blue. She testified in her deposition that she had worked at the
hospital since 1994 and it was her understanding that the emergency room physician
would respond when Code Blues were called. According to Rimer, the emergency
room physician was “usually there first.”
¶ 12 Anderson’s laryngologist, Kenneth Johnson, testified that he received a call at
home during the early morning of August 25. He was told that Anderson was having
serious respiratory problems and that Dr. Murphy, the emergency room physician, was
attempting an intubation. It was Dr. Johnson’s understanding that an in-house
emergency room physician would respond to Code Blues.
¶ 13 Paula Jacobi, the president and CEO of St. Mary’s, acknowledged in her deposition
that ECHO’s agreement with the hospital did not specifically address whether ECHO
physicians would respond to Code Blues. The nursing department “Code Blue and
Cardiac Arrest Team” policy addressed the responsibility of the emergency room
physician during a Code Blue, but Jacobi did not know if this was addressed in writing
anywhere else. However, Jacobi testified that it had been hospital policy for many
years that the emergency room physician would respond to Code Blues, but she did not
know how that system was set up. Jacobi did not believe that anything specific needed
to be said in the agreement with ECHO because she assumed that the long-standing
practice would continue. If the emergency room physician was already treating a
patient when the Code Blue was called, then the physician would have to exercise his
medical judgment as to who had the more emergent needs.
¶ 14 With regard to billing for Code Blues, Jacobi explained that a Code Blue was a
billable event. The hospital would typically bill for facility charges, and this was done
in Anderson’s case. The hospital billed for the drugs and equipment used on Anderson
during the Code Blue. ECHO was responsible for billing for the services of its
physicians, and Jacobi did not know whether ECHO billed for the services of its
physicians during Code Blues.
¶ 15 Dr. Danna explained that ECHO contracted with a company called Per-Se
Technologies to do its billing. ECHO billed only for services that its physicians
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provided in the emergency department. According to Dr. Danna, ECHO would never
bill when a physician responded to a code outside the emergency department. ECHO
did not bill for the services Dr. Murphy provided to Anderson and had never received
payment for those services. ECHO would also sometimes choose not to bill in a
situation in which a patient was particularly unhappy with emergency department care,
or when the patient simply came in for a recheck or something very minor. In such a
situation, the emergency room physician would have to request that the patient not be
billed.
¶ 16 Heather Cluver, the office manager for ECHO management and consulting,
testified that she was not familiar with how billing would be handled for Code Blues.
However, she testified that sometimes a decision was made not to bill a patient for
services in the emergency department. In such a situation, a request not to bill would
have to come from the physician, and it would go through Dr. Danna. Dr. Danna would
decide whether the patient would be billed.
¶ 17 Richard Mullin, partner/owner of Abrix Emergency Billing Services, LLC,
testified that Abrix provides billing services for physician practices. Abrix handled the
billing for ECHO’s emergency room physicians from 1999 to 2003. ECHO would send
a patient’s chart to Abrix, and then Abrix would bill the insurance company. Mullin
testified that they would get records from ECHO only if a patient was treated in the
emergency room. Abrix no longer had any records for Anderson; they would have
either been destroyed pursuant to a retention policy or turned over to a succeeding
entity. Mullin did not recall any situations in which ECHO sent patient records to Abrix
but then requested that they not bill.
¶ 18 The trial court granted summary judgment to defendants. The court believed that
Illinois law supported defendants’ position. Because ECHO never sent a bill to
Anderson or his insurance carrier, Dr. Murphy was immune from liability under the
Good Samaritan Act. The trial court acknowledged that a federal district court opinion,
Henslee v. Provena Hospitals, 373 F. Supp. 2d 802 (N.D. Ill. 2005), would have
compelled the opposite result. However, the court found that Henslee was out of step
with Illinois law. The trial court gave plaintiffs leave to file an amended complaint
alleging wilful and wanton misconduct. Plaintiffs filed fourth and fifth amended
complaints alleging wilful and wanton misconduct, and later asked the trial court to
make a Rule 304(a) finding with respect to the summary judgment on the negligence
counts. The court granted the motion, finding no just reason to delay appeal or
enforcement of the order.
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¶ 19 Plaintiffs appealed, and the Appellate Court, First District, reversed. The appellate
court acknowledged that the rule developed in the Illinois cases was typified by the
second district’s opinion in Estate of Heanue v. Edgcomb, 355 Ill. App. 3d 645 (2005),
where the court held that application of section 25 of the Good Samaritan Act turned on
whether or not the physician had billed for the emergency services. 2012 IL App (1st)
112321, ¶ 30. However, the appellate court determined that this construction was out of
step with what the legislature intended in enacting section 25. The appellate court
agreed with Henslee that the word “fee” in the statute is ambiguous. Id. ¶ 37. It could
refer to patient being billed for a service, but it could also encompass the physician
being paid. Because the statute is ambiguous, the appellate court stated that it needed to
consider other statutory construction aids to determine the legislature’s intent. Id.
¶¶ 36, 41. The appellate court considered the legislative history of section 25, the
statement of legislative policy provided by the legislature in section 2 of the Act, and
the consequences of construing the statute one way or the other. The appellate court
ultimately concluded, as had Henslee, that the purpose of the Act is to promote
volunteerism and that section 25 was never meant to apply to a physician who responds
to an emergency because he or she is paid to do so. Id. ¶ 50. The court remanded to the
trial court to consider Dr. Murphy’s alternative argument that he was entitled to
summary judgment because he had not deviated from the standard of care. Id. ¶ 54.
¶ 20 This court allowed defendants’ petition for leave to appeal. Ill. S. Ct. R. 315 (eff.
Feb. 26, 2010). Additionally, this court allowed the American Association for Justice
to file an amicus curiae brief in support of plaintiffs’ position. The Association
contends that, until the appellate court’s decision in the present case, Illinois’s
construction of its Good Samaritan statute was out of step with the way similar statutes
are construed in other states.
¶ 21 ANALYSIS
¶ 22 This appeal arises from an order granting summary judgment to defendants.
Summary judgment is proper when “the pleadings, depositions, and admissions on file,
together with the affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment as a matter of law.” 735
ILCS 5/2-1005(c) (West 2010). This court reviews summary judgment orders de novo.
Schultz v. Illinois Farmers Insurance Co., 237 Ill. 2d 391, 399-400 (2010).
Additionally, resolving the issue before the court requires us to construe section 25 of
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the Act, and issues of statutory construction are also reviewed de novo. Metropolitan
Life Insurance Co. v. Hamer, 2013 IL 114234, ¶ 18.
¶ 23 Resolving the issue on appeal requires us to consider two different lines of
authority interpreting section 25 of the Act. Defendants contend that the trial court
properly granted them summary judgment under the law as it has always existed in
Illinois. According to defendants, the correct interpretation of section 25 is found in
such cases as Heanue and Neal v. Yang, 352 Ill. App. 3d 820 (2004). Under this
interpretation, the word “fee” in the statute is unambiguous, and a physician is entitled
to claim immunity for negligently performing emergency services so long as he or she
does not bill the patient, and the decision not to bill is made in good faith. By contrast,
plaintiffs contend that the correct interpretation of section 25 is that set forth by the
appellate court below and by the federal district court in Henslee. Under this view,
“fee” is ambiguous and can refer either to a patient being billed or a physician being
paid. Courts adopting this view have looked at other aids for construction to determine
legislative intent, and have concluded that the Act was meant to apply only to those
who volunteer their services.
¶ 24 The issue is thus one of statutory construction, and the principles guiding our
review are familiar. The primary goal of statutory construction, to which all other rules
are subordinate, is to ascertain and give effect to the intention of the legislature.
Jackson v. Board of Election Commissioners, 2012 IL 111928, ¶ 48. The best
indication of legislative intent is the statutory language, which must be given its plain
and ordinary meaning. Metropolitan Life, 2013 IL 114234, ¶ 18. It is improper for a
court to depart from the plain statutory language by reading into the statute exceptions,
limitations, or conditions that conflict with the clearly expressed legislative intent. Id.
Words and phrases should not be viewed in isolation, but should be considered in light
of other relevant provisions of the statute. Midstate Siding & Window Co. v. Rogers,
204 Ill. 2d 314, 320 (2003). Further, each word, clause and sentence of a statute must
be given a reasonable construction, if possible, and should not be rendered superfluous.
Prazen v. Shoop, 2013 IL 115035, ¶ 21. Where statutory language is clear and
unambiguous, it will be given effect without resort to other aids of construction. Kunkel
v. Walton, 179 Ill. 2d 519, 534 (1997). However, if the meaning of an enactment is
unclear from the statutory language itself, the court may look beyond the language
employed and consider the purpose behind the law and the evils the law was designed
to remedy, as well as other sources such as legislative history. Gruszeczka v. Illinois
Workers’ Compensation Comm’n, 2013 IL 114212, ¶ 12. A statute is ambiguous when
it is capable of being understood by reasonably well-informed persons in two or more
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different senses. Id. ¶ 16. In determining legislative intent, we may also consider the
consequences that would result from construing the statute one way or the other, and, in
doing so, we presume that the legislature did not intend absurd, inconvenient, or unjust
consequences. Solon v. Midwest Medical Records Ass’n, 236 Ill. 2d 433, 441 (2010).
¶ 25 The predecessor statute to section 25 was section 2a of the Medical Practice Act.
Ill. Rev. Stat. 1965, ch. 91, ¶ 2a. As originally enacted, the statute had a much narrower
focus:
“Any person licensed pursuant to this Act or any person licensed to practice the
treatment of human ailments in any other state or territory of the United States,
except a person licensed to practice midwifery, who in good faith provides
emergency care without fee at the scene of a motor vehicle accident or in case
of nuclear attack shall not, as a result of his acts or omissions, except wilful or
wanton misconduct on the part of such person, in providing such care, be liable
for civil damages.” Id.
The statute underwent various amendments, and the legislature gradually broadened its
scope. First, the legislature removed the words “motor vehicle,” thus broadening the
statute to apply at the scene of any accident. Pub. Act 76-1205 (eff. Sept. 11, 1969)
(amending Ill. Rev. Stat. 1967, ch. 91, ¶ 21). The legislature later removed the phrase
“victim of an accident at the scene of an accident or in case of nuclear attack” and
simply replaced it with “person.” See Pub. Act 78-385 (eff. Aug. 23, 1973) (amending
Ill. Rev. Stat. 1971, ch. 91, ¶ 2a). At the same time, the legislature added in the
requirement that, for the statute to apply, the physician must not have “prior notice of
the illness or injury.” Id. In 1996, the legislature enacted the Good Samaritan Act, and
the exemption that was originally provided for in section 2a of the Medical Practice Act
became section 25 of the Good Samaritan Act. See 745 ILCS 49/25 (West 1996).
Finally, the statute was amended in 1998 to eliminate the requirement that the
physician must not have had prior notice of the injury. 1 Pub. Act 90-742, § 40 (eff.
Aug. 13, 1998). Thus, as currently enacted, the statute provides immunity when a
physician in good faith renders emergency care without fee. However, there is now a
division in the case law over what it means to render care “without fee.”
1
At oral argument, defense counsel treated the "without prior notice" requirement that previously
existed as synonymous with a requirement that the physician must not have had a preexisting duty to act.
These are clearly not the same thing, as the facts of this case demonstrate. Dr. Murray did not have prior
notice of Anderson’s emergency, but he had a duty to respond to such emergencies. See also Neal, 352
Ill. App. 3d at 830 (finding physician had preexisting duty to respond to the emergency but no prior
notice of the emergency).
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¶ 26 This court has not previously spoken on the scope of section 25. The appellate
court, however, has considered several section 25 cases. In Johnson v. Matviuw, 176
Ill. App. 3d 907 (1988), the court held that a physician who responded to a Code Blue at
a nurse’s request could claim immunity under the Act because the patient had not been
billed for the physician’s services. The court found that the record was unclear as to
whether or not the physician had a preexisting duty to respond, but found this fact to be
irrelevant. The court also did not consider it relevant that the emergency took place in a
hospital setting. Rather, the court held that all that mattered for application of the
statute was that the physician had responded to an emergency of which he or she had no
prior notice and had not charged a fee. Johnson, 176 Ill. App. 3d at 916-18. Subsequent
decisions would continue to apply the Act to physicians who responded to emergencies
in hospitals or medical centers. See, e.g., Neal, 352 Ill. App. 3d 820 (anaesthesiologist
immune for alleged negligence during emergency delivery when she had no prior
notice and did not charge a fee; court holds it irrelevant that she had a preexisting duty
to treat plaintiff under her employment contract with hospital); Blanchard v. Murray,
331 Ill. App. 3d 961 (2002) (reversing summary judgment on basis that physician had
prior notice of the emergency before going to hospital, but concluding that the statute
otherwise would have provided immunity because no fee was charged); Rivera v.
Arana, 322 Ill. App. 3d 641 (2001) (Act applied to physician who rendered emergency
care in a medical center because no bill was sent for the services); Roberts v. Myers,
210 Ill. App. 3d 408 (1991) (physician who was not patient’s regular doctor immune
from negligence claim involving emergency prenatal care and delivery because he had
no prior notice of the illness or injury, responded to an emergency, and did not receive
a fee for his services).
¶ 27 Originally, the courts were not willing to look into the reasons why a fee was not
charged. For instance, in Villamil v. Benages, 257 Ill. App. 3d 81 (1993), a physician
who was at the hospital delivered a baby in an emergency situation when the patient’s
regular obstetrician did not respond to the call. Id. at 85. The patient sued the physician
for malpractice, alleging that his negligence in the delivery had caused the baby’s
death. The plaintiff testified that she had received a cover letter requesting her public
aid card so that public aid could be billed for the delivery. Id. at 89. However, neither
public aid nor the plaintiff was ever actually billed for the delivery. Thus, the court held
that the physician was immune. The court considered the request for the plaintiff’s
public aid number to be irrelevant because, even if it showed an intent to bill, the
controlling fact was that no bill was ever sent. Id. at 92.
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¶ 28 Later, in Heanue, the appellate court would hold, for the first time, that the decision
not to bill must be made in good faith for the Act to apply. In Heanue, the patient
underwent an elective IJ dialysis catheter insertion and was then taken to the recovery
room at Swedish American Hospital. Dr. Mark Whitman performed the procedure. A
nurse later observed that the medication was not working and attempted to page Dr.
Whitman. She could not get in touch with him, and Rockford Surgical Service sent Dr.
Edgcomb, who was a partner of Dr. Whitman’s. Dr. Edgcomb took over the patient’s
treatment. The plaintiffs brought a negligence action against Dr. Edgcomb, and he
moved to dismiss, asserting immunity under the Act. The trial court granted the
defendant’s motion. Heanue, 355 Ill. App. 3d at 646-47.
¶ 29 On appeal, the court first held that the existence of a preexisting duty to treat the
patient was not fatal to a physician’s claim of immunity under the Act. Id. at 648.
However, the court held that a preexisting duty could be relevant to whether a decision
not to bill was in good faith. Id. at 650. The court rejected the plaintiffs’ argument that
Dr. Edgcomb could not seek immunity under the Act because he received an economic
benefit from his relationship with Rockford Surgical. Rather, the court held that the
word “fee” in the Act has a set, narrow meaning: “a fee is generated by and tied to the
service performed.” Id. at 649. Thus, because the patient was not billed for Dr.
Edgcomb’s services, his treatment of her was without fee. However, the court held that
previous Illinois decisions had failed to recognize that the term “good faith” in the
statute modifies both “provides emergency care” and “without fee.” Id. at 650. Thus, a
physician who did not bill a patient simply to obtain immunity under the Act would not
be acting in good faith. The court explained that it is at this part of the analysis that the
preexisting duty issue might be relevant: if a physician has a preexisting duty to treat,
and he or she ordinarily would bill for such services, then an inference may arise that
the decision not to bill was not in good faith. Id. at 650-51. The court held that, on the
record before it, there was an inference that the decision to bill might not have been in
good faith, because the patient was billed for treatment prior to and following the
emergency on the same day. Thus, the court reversed and remanded for a determination
of whether defendant’s decision to charge a fee was in good faith. Id. at 651.
¶ 30 Thus, the law in Illinois at the time the Federal District Court issued its opinion in
Henslee was that a physician would be immune under the Act if he or she, in good faith,
provided emergency treatment and did not bill the plaintiff for his or her services. A
preexisting duty to treat the plaintiff would not prevent application of the Act, and it did
not matter if the physician received any sort of economic benefit or compensation for
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his time, assuming that he or she did not did not specifically bill the patient for the
treatment he or she provided.
¶ 31 In Henslee, the court surveyed Illinois law and concluded that the Illinois decisions
had strayed far from what the legislature intended in enacting the Good Samaritan Act.
In that case, Dr. Drubka worked at Provena Immediate Care Center. He was employed
and compensated by Midwest Emergency Associates (MEA), which had a contract
with Provena St. Joseph’s Hospital to provide physicians for the Care Center and the
emergency room. Dr. Drubka was paid on a per diem basis. He did not account for his
time other than signing in an out of the care center, and he did not bill patients directly.
MEA also did not bill patients directly, but rather billed the hospital for their
physicians’ time. Provena was responsible for billing patients seen at the Care Center.
Dr. Drubka was sued for his alleged negligent treatment of a patient who had a peanut
allergy and had experienced an anaphylactic reaction from eating Chinese food. The
patient was never billed for Dr. Drubka’s treatment at the Care Center, although she
was billed for care she received after being transferred to Provena St. Joseph Hospital.
Although the patient was never billed for Dr. Drubka’s treatment, Dr. Drubka was paid
for working at the Care Center on the date in question. Henslee, 373 F. Supp. 2d at
804-05.
¶ 32 The plaintiffs brought suit in federal district court, because their suit included a
claim that the defendants had violated the Emergency Medical Treatment and Labor
Act (42 U.S.C. §§ 1395 et seq.). Henslee, 373 F. Supp. 2d at 805. Dr. Drubka moved
for summary judgment on the state law negligence claim, arguing that he was immune
under section 25 because the patient had not been billed for his treatment. The court
denied the motion. The court noted that, as the Illinois Supreme Court had never
interpreted section 25, its task was to resolve the state law question as it thought that
this court would. Id. at 807 (citing United States v. Navistar International
Transportation Corp., 152 F.3d 702, 713 (7th Cir. 1998)). The court ultimately
concluded that this court would not follow the Illinois Appellate Court’s construction
of the statute.
¶ 33 The court began by noting the narrow focus of the statute when it was originally
enacted. As the court explained, the Act was originally designed to “encourage
physicians fearful of malpractice suits to stop and render aid to those injured in
automobile accidents.” Henslee, 373 F. Supp. 2d at 807. The court further noted that
the legislature had included a statement of legislative purpose in the statute that showed
that the intent of the Act was to encourage people to volunteer their time and talents to
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help others (see 745 ILCS 49/2 (West 2010)) and that the available legislative history
also showed that the legislature’s intent was to promote volunteerism. Henslee, 373 F.
Supp. 2d at 808. The court then reviewed the Illinois Appellate Court cases construing
section 25 and determined that, despite the legislature’s clear intent in enacting the
statute, the Illinois courts had used the statute almost exclusively to immunize doctors
who provide emergency care in hospitals. Id. at 808-09.
¶ 34 Henslee determined that the Illinois appellate cases had gone astray in determining
that the phrase “without fee” in the statute was clear and unambiguous. Because the
courts in those cases saw no ambiguity in the statute, they did not consider any
statutory construction aids. Id. at 812. Although the term is undefined in the statute, the
Illinois courts had determined that the word “fee” “means only a situation where a
patient is billed for the specific services the doctor provides.” Id. at 809. The court
noted that the definition of “fee” is simply a “ ‘charge for labor or services, esp.
professional services.’ ” Id. at 812 (quoting Black’s Law Dictionary 629 (7th ed.
1999)). The court found that the Illinois appellate court decisions had too narrowly
considered only one side of a typical fee situation—the client being billed. However,
the court found that a typical fee transaction implicitly includes two steps: a party being
billed and a professional being paid. Henslee found that the term “fee” is broad enough
to include either a doctor being paid for his services or a client paying a bill for the
services. The court noted that, under this definition, a “fee” would exist when “a doctor
is paid for the emergency services he renders.” Id.
¶ 35 Because it found the phrase “without fee” ambiguous, the court found it necessary
to consider other statutory construction aids to determine the legislature’s intent. Once
it did so, the court found it clear that a broader definition of “fee” than that adopted by
the Illinois appellate court would better effectuate the legislature’s intent. The court
found it beyond dispute that the legislature’s intent was to encourage and promote
volunteerism, and a doctor who is paid for his services is not acting as a volunteer. The
appellate court’s interpretation would thwart this clear legislative intent. Id. at 812-13.
The court thus determined that Dr. Drubka could not claim immunity under the Act
because he was paid for his time at the Care Center and simply responded to the
emergency as part of his job. The court also determined that a broader definition of the
word “fee” was necessary in light of modern billing practices: “because most doctors
are no longer compensated directly by their patients, and thus it is difficult to link a
charge for services and the eventual payment, a definition of ‘fee’ should include both
the doctor’s compensation and the patient’s eventual payment.” Id. at 814.
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¶ 36 Finally, the court determined that public policy considerations supported a broader
meaning of the word “fee.” The court was concerned that physicians could engineer
immunity by declining to bill for the specific service provided. The court noted that
Heanue had addressed this problem by determining that the decision not to bill had to
be made in good faith and not for the purpose of avoiding liability. However, the court
did not consider that solution adequate to protect patients: “shifting the burden onto the
plaintiff to prove the reasons why a hospital did or did not bill for specific services
creates an unnecessary level of complex proof.” Id. The court was also concerned that
the appellate court’s one-sided definition of “fee” could set up an inequitable situation
where the Act would apply differently to those without means. A person who had
private insurance and was billed for a doctor’s emergency treatment would be able to
sue the doctor for negligent care. If the same doctor treated a poor person without
insurance, the same doctor could be shielded from his negligence. Id. at 814-15.
¶ 37 A later federal district court opinion, Rodas v. SwedishAmerican Health System
Corp., 594 F. Supp. 2d 1033 (N.D. Ill. 2009), would disagree with Henslee. Rodas
concluded that, if asked to resolve the issue, this court would follow the long line of
Illinois appellate court cases rather than rejecting them. Id. at 1041. Thus, Rodas
granted summary judgment to two physicians, Dr. Seidlin and Dr. Soleanicov, who had
provided emergency care to the patient during a delivery. Summary judgment was
proper because “neither doctor billed plaintiff for their services rendered or received an
economic benefit that was derived directly from the services performed.” Id.
¶ 38 The Seventh Circuit, however, reversed the summary judgments for both doctors.
Rodas v. Seidlin, 656 F.3d 610 (7th Cir. 2011). The court concluded that, based on the
facts before it, it was not required to resolve the conflict between Heanue and Henslee
over whether receiving compensation for medical services was itself sufficient to put
one outside the reach of the Good Samaritan statute. Id. at 628 n.4. The court believed
that the defendants were reading Heanue too narrowly, and it determined that even
Heanue would have mandated that the summary judgments be reversed. Id. at 626-28.
With respect to Dr. Seidlin, the court concluded that material questions of fact existed
as to whether the decision not to bill was made in good faith. Id. at 629. With respect to
Dr. Soleanicov, the court fou nd it irrelevant that the patient was not directly billed for
her services. Dr. Soleanicov was paid a salary by University of Illinois College of
Medicine at Rockford (UIC). The patient had been receiving her prenatal care from
Crusader Central Clinic Association. Id. at 612. Crusader Clinic had an Agreement for
Professional Services with UIC whereby UIC obstetricians and gynecologists would
provide back-up professional services to Crusader Clinic patients who were admitted
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for treatment at local hospitals. Under the agreement, Crusader Clinic would pay UIC a
fixed amount each year, and Crusader Clinic reserved the right to bill its patients after
receiving documentation of services rendered from the UIC physician. Id. at 613;
Rodas, 594 F. Supp. 2d at 1036. In this case, Dr. Soleanicov had submitted
documentation to Crusader Clinic of the services she had provided to the patient.
Rodas, 656 F.3d at 613. Crusader Clinic ultimately billed Medicaid for the delivery.
Medicaid wrote off part of the amount and paid Crusader Clinic the remaining balance.
Rodas, 594 F. Supp. 2d at 1037. The plaintiff was never billed directly from UIC or any
of the physicians. Id. Seidlin and Soleanicov were paid their normal salary for the date
in question, and neither received any additional compensation from the amount billed
to Medicaid. Id. at 1037-38. Because Soleanicov submitted a billing form to Crusader
Clinic, there was “no serious question that she charged a fee for her emergency
services.” Rodas, 656 F.3d at 629. The court elaborated:
“We see no evidence that the legislature, with its use of the unassuming word
‘fee’ intended anything to turn on how a fee is processed or the compensation
structures of the physicians who provide treatment. For good reason. The
moment the General Assembly makes the coverage of the Good Samaritan Act
turn on the business model used to collect physicians’ fees is the moment every
medical practice restructures so that every doctor can be a good Samaritan. That
outcome would do nothing to advance the enacted purpose of the Good
Samaritan Act, which is to promote volunteerism and shield from liability ‘the
generous and compassionate acts’ of Illinois citizens. 745 ILCS 49/2.” Id. at
628.
¶ 39 Having considered all of the above authority, we must agree with Henslee that the
term “fee” is ambiguous. We agree with that court that previous Illinois appellate court
cases simply assumed that the term was unambiguous and gave it its narrowest possible
definition. This resulted in a line of cases that thwarted unmistakably obvious
legislative intent. As Henslee correctly pointed out, the term “fee” is broad enough to
include both a patient being billed and a doctor being paid. The term “fee” is variously
defined as “compensation often in the form of a fixed charge for professional service”
(emphasis added) (Webster’s Third New International Dictionary 833 (2002)); “[a]
charge for labor or services, esp. professional services” (Black’s Law Dictionary 647
(8th ed. 2004)); “[a] recompense for an official or professional service or a charge or
emolument or compensation for a particular act or service. A fixed charge or perquisite
charged as recompense for labor; reward, compensation, or wage given to a person for
performance of services or something done or to be done” (emphasis added) (Black’s
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Law Dictionary 553 (5th ed. 1979)); “payment asked or given for professional
services” (emphasis added) (Webster’s New World Dictionary 512 (2d coll. ed. 1986));
“a charge or payment for services” (emphasis added) (The Random House Dictionary
of the English Language 521 (1983)). One can find dictionary definitions to support
either the definition adopted by the previous appellate court decisions or by Henslee
and the appellate court below. The existence of these different dictionary definitions,
each which would make sense in the statute, indicates that the term is ambiguous. See
Landis v. Marc Realty, L.L.C., 235 Ill. 2d 1, 11 (2009). The term is clearly capable of
being understood by reasonable persons in more than one way.
¶ 40 Thus, we find it necessary to turn to other statutory construction aids to determine
the legislature’s intent in enacting the statute. First, we note that the legislature chose
the title “Good Samaritan Act” for the statute. While a statute’s title cannot be used to
limit the plain meaning of statutory text, it can provide guidance in resolving statutory
ambiguities. Alvarez v. Pappas, 229 Ill. 2d 217, 230-31 (2008). As Webster’s explains,
the term “Good Samaritan” derives from the biblical parable found at Luke 10:30-37,
and refers to “one who compassionately renders personal assistance to the
unfortunate.” Webster’s Third New International Dictionary 979 (2002); see also The
Random House Dictionary of the English Language 609 (1983) (defining “good
Samaritan” as “a person who gratuitously gives help or sympathy to those in distress”
(emphasis added)). Moreover, a “good Samaritan law” has a commonly understood
meaning in the law. See Black’s Law Dictionary 715 (8th ed. 2004) (explaining that a
“good-samaritan law” is a “statute that exempts from liability a person (such as an
off-duty physician) who voluntarily renders aid to another in imminent danger but
negligently causes injury while rendering the aid” (emphases added)).
¶ 41 Second, the legislature left no doubt that it intended the commonly understood
meaning of “good Samaritan law” when it enacted the “Good Samaritan Act.” In the
Act, the legislature codified a statement of legislative purpose to make its intentions
clear:
Ҥ 2. Legislative purpose. The General Assembly has established numerous
protections for the generous and compassionate acts of its citizens who
volunteer their time and talents to help others. These protections or good
samaritan provisions have been codified in many Acts of the Illinois Compiled
Statutes. This Act recodifies existing good samaritan provisions. Further,
without limitation the provisions of this Act shall be liberally construed to
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encourage persons to volunteer their time and talents.” (Emphases added.) 745
ILCS 49/2 (West 2010).
¶ 42 Third, during the legislative debates on the various amendments to the statute, the
legislators who spoke out about the statute’s purpose clearly indicated that its purpose
is to promote volunteerism. In the legislative debates on Public Act 78-385 (eff. Aug.
28, 1973), which added the “prior notice” requirement to the statute, Senator Schaffer
explained:
“This bill only gives a doctor a safeguard that [sic] if he comes upon an
emergency situation if one of us falls down the stairs and rolls to the foot of the
stairs here and a doctor treats us, and this is on the spot, not in his doctor’s office
or in the hospital on the operating table, that he has a little protection that if we
have bad effects because he wasn’t able to do the things he might do in a
hospital, he would be somewhat protected.” (Emphasis added.) 78th Ill. Gen.
Assem., Senate Proceedings, May 22, 1973, at 49-50 (statements of Senator
Schaffer).
¶ 43 When the legislature enacted Public Act 90-742, which removed the “prior notice”
requirement, Representative Lang asked Representative Winters whether it was his
position that “ ‘the passage of th[e] [Act] would encourage good samaritans to do the
right thing on the streets of Illinois, I suppose, without fear of repercussions in a court
of law.’ ” Representative Winters responded, “ ‘[t]hat is exactly the point of the Bill.
To make it patently obvious to anyone that this state does encourage voluntary action
that professionals who do that kind of action, will not have repercussions against them
for their voluntary action.’ ” (Emphases added.) 89th Ill. Gen. Assem., House
Proceedings, Mar. 25, 1996, at 100 (statements of Representatives Lang and Winters).
¶ 44 This same exchange between Representatives Lang and Winters also shows that the
legislature intended a broad and flexible definition of the word “fee”:
“Lang: ‘Just to clarify this. It only covers services that are rendered without
compensation. Is this correct?’
***
Winters: ‘That is correct. If a person is serving under … you know, for pay
in his line of duty, this Good Samaritan Bill would not affect that. He would still
be liable for lawsuits. It’s only where there is no compensation.’ ” (Emphases
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added.) 89th Ill. Gen. Assem., House Proceedings, Mar. 25, 1996, at 100-01
(statements of Representatives Lang and Winters).
¶ 45 Fourth, as persuasively argued by the California Appellate Court in Colby v.
Schwartz, 144 Cal. Rptr. 624 (Cal. Ct. App. 1978), physicians who respond to
emergencies because they are paid to do so do not need the incentive to act that is at the
very heart of Good Samaritan statutes. In that case, several physicians responded to an
emergency in a hospital because they were serving on the hospital’s emergency call
surgical panel. Id. at 626. When they were sued for negligence, they claimed immunity
under California’s Good Samaritan statutes, which were similar to the Illinois statute,
but did not say anything about compensation. The court explained that the purpose of
Good Samaritan statutes is to encourage people to act when they otherwise have no
duty to do so:
“Sections 2144 and 2144.5 were enacted to aid the class of individuals
though requiring immediate medical care were not receiving it. Typically, it
was the roadside accident victim who, as a result of the strictures of the
common law malpractice doctrines, was left uncared for. However, hospital
patients, such as the decedent have historically enjoyed the benefits of full
medical attention. There is no need for special legislation to encourage
physicians to treat this class of individuals.
On the other side of the doctor-patient equation, sections 2144 and 2144.5
were not directed towards the class of physicians of which defendants are
members. Physicians, like defendants, who treat patients requiring immediate
medical care as part of their normal course of practice do not need the added
inducement that immunity from civil liability would provide. Moreover,
excusing such physicians of their negligence could have the adverse effect of
lowering the quality of their medical care without justification. And further, to
extend immunity to such physicians would deny an overly broad spectrum of
malpractice victims of their legal remedies.” Id. at 628; see also Clayton v.
Kelly, 357 S.E.2d 865, 868 (Ga. App. 1987) (explaining that, if a doctor
responds to an emergency because his employment requires him to do so, then
he does not need a special inducement to offer aid).
¶ 46 Fifth, Colby also recognized that immunity is important in this volunteer setting
because the physician will likely be acting without the necessary equipment and
facilities, and might be acting outside of his area of expertise:
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“These sections were directed towards physicians who, by chance and on an
irregular basis, come upon or are called to render emergency medical care.
Often, under these circumstances, the medical needs of the individual would
not be matched by the expertise of the physician and facilities could be severely
limited. The general practitioner might well find himself treating an individual
for needs outside his training or the specialist forced to practice in an unrelated
speciality. However, in the instant case, defendants in performing the
exploratory surgical procedure were practicing within their area of expertise
and with all of the benefits of full hospital facilities. It is therefore not
unreasonable to hold them to the level of skill and training required under such
circumstances.” Colby, 144 Cal. Rptr. at 628.
¶ 47 Sixth, in determining legislative intent, we will consider the consequences of
construing the statute one way or another, and we will presume that the legislature did
not presume absurd, unjust, or inconvenient results. Solon, 236 Ill. 2d at 441. Here,
those considerations clearly support a broad, flexible reading of the word “fee.” As
detailed above, the broader definition of “fee” first adopted by the Henslee court will
effectuate the legislature’s clear intent. Under this definition, volunteerism is
promoted. By contrast, the narrow definition previously adopted by the appellate court
thwarts legislative intent. Rather than promoting volunteerism, that interpretation
simply promotes immunity for doctors who do not bill. But the appellate court has
never explained why the legislature would intend such a thing, and has never attempted
to justify its interpretation from a policy standpoint. In fact, the appellate court has
previously acknowledged that its interpretation of section 25 is contrary to the
statement of legislative purpose. See, e.g., Neal, 352 Ill. App. 3d at 826. This was a
result of the appellate court assuming that the statute is clear and unambiguous. See id.
¶ 48 Another consequence of employing the narrow interpretation of “fee” is that an
unfair system could emerge in which the wealthy had a greater access to justice than the
poor. As the appellate court noted below:
“Heanue’s one-sided definition of ‘fee’ could result in a disparity of legal
remedies between the affluent and the less-privileged. See Ben Bridges,
Comments, Curb Your Immunity: The Improper Expansion of Good Samaritan
Protection in Illinois, 34 S. Ill. U. L.J. 373, 391 (2010). If a hospital physician
paid by the hour negligently provided emergency care to an affluent patient and
the patient or the patient’s insurer was billed for that care, the doctor would not
be immune under the Act. Bridges, supra, at 391. If the same doctor provided
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negligent emergency care to an indigent uninsured patient and the hospital did
not bill the patient because it would not be able to collect payment, the doctor
would be immune under the Act. Bridges, supra, at 391. The affluent patient
would be able to file a negligence action against the physician and the indigent
patient would not. Bridges, supra, at 391. The physician could arguably provide
substandard care to all poor, uninsured patients because those patients would
have no legal recourse against him. Bridges, supra, at 391. The legislature
cannot have intended such a result.” 2012 IL App (1st) 112321, ¶ 47.
¶ 49 And finally, as Henslee pointed out, giving “fee” its narrowest possible definition
makes the statute difficult to apply, given the modern realities of billing for medical
services:
“[B]illing for medical services is no longer a simple transaction between two
parties. Before the days of private health insurance, physician’s groups, and
Medicaid, doctors used to bill patients directly for their services; in return, the
patient would pay the doctor directly. Charging for medical services is no
longer so simple. For example, in this case, Dr. Drubka worked for MEA,
which had a contract with Provena Saint Joseph’s Hospital to provide
physicians for both the hospital emergency room and the Care Center. The
doctors never billed the patients directly; neither, for that matter, did MEA.
Instead, the hospital billing department was the unit responsible for charging
Johnson for Dr. Drubka’s services. Had the hospital billed Johnson for Dr.
Drubka’s services, it would have had to send a bill to Johnson specifying the
doctor’s individual services and then most likely attempt to collect money from
Johnson’s insurance carriers. Paying Dr. Drubka a per diem fee for his services
was a system most likely constructed by the hospital to deal with the realities of
the new generation of health care in this country.” Henslee, 373 F. Supp. 2d at
813-14.
Henslee thus concluded that “fee” should be given a broader reading than that
previously adopted by the Illinois appellate court, because “it is difficult to link a
charge for services and the eventual payment.” Id. at 814.
¶ 50 Considering all of the above, we agree with the appellate court below that “fee”
must be given a broader definition than that employed by the earlier appellate court
decisions. The phrase “without fee” is ambiguous, and giving it a construction that
includes a doctor’s compensation will ensure that the legislature’s intent is effectuated
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rather than thwarted. We agree with the appellate court’s conclusion that Dr. Murphy
did not provide his services to Anderson “without fee.” He was fully compensated for
his time that day, and it is clear that he responded to the emergency not because he was
volunteering to help but because it was his job to do so. Dr. Murphy testified that it was
his responsibility to respond to Code Blues. Moreover, it is clear from both the
agreement that ECHO had with the hospital and the agreement that ECHO had with Dr.
Murphy that ECHO physicians were required to comply with hospital policies, and the
hospital’s written policy made clear that emergency room physicians were to respond
to Code Blues. The agreement between Dr. Murphy and ECHO also specifically
addresses physicians responding to emergencies outside the emergency room. In his
brief before this court, Dr. Murphy made a very short argument that he was a volunteer.
However, at oral argument his attorney conceded that Dr. Murphy was not a volunteer
in this situation and that he could not ignore a Code Blue if he was available. The
evidence marshaled for and against the summary judgment motion supports no
conclusion other than that Dr. Murphy responded to the Code Blue because it was his
job to do so. The legislature never intended that Good Samaritan immunity would be
available in this situation.
¶ 51 CONCLUSION
¶ 52 We thus conclude that Dr. Murphy did not provide his services “without fee,” and
he may not claim immunity under the Good Samaritan Act. We therefore affirm the
decision of the appellate court, which reversed the summary judgment in favor of Dr.
Murphy and remanded for a determination of Dr. Murphy’s alternative argument in
support of summary judgment.
¶ 53 Affirmed.
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