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06/16/87 In Re Estate of Anthony Wade

June 16, 1987

IN RE ESTATE OF ANTHONY WADE, A DISABLED PERSON (MATTIE


APPELLATE COURT OF ILLINOIS, FIRST DISTRICT, SECOND DIVISION

Wade, as Guardian, Plaintiff-Appellee, v.

Rehabilitation Institute of Chicago, Defendant-Appellant)

510 N.E.2d 99, 156 Ill. App. 3d 844, 109 Ill. Dec. 478 1987.IL.827

Appeal from the Circuit Court of Cook County; the Hon. Lester D. Foreman and the Hon. Michael F. Czaja, Judges, presiding.

APPELLATE Judges:

JUSTICE BILANDIC delivered the opinion of the court. SCARIANO, P.J., and HARTMAN, J., concur.

DECISION OF THE COURT DELIVERED BY THE HONORABLE JUDGE BILANDIC

Defendant, Rehabilitation Institute of Chicago (the hospital), asserted a lien against certain settlement proceeds received by plaintiff, estate of Anthony Wade (the plaintiff). The circuit court of Cook County, Law Division, disallowed a portion of the lien covering private duty nursing services. The Probate Division of the circuit court adopted the findings of the Law Division. The hospital appeals both orders. These cases have been consolidated on appeal.

Anthony Wade suffered injuries due to "perioperative complications" in April 1984. As a result of those injuries, he was declared a disabled person and his mother, Mattie Wade, was appointed his guardian. The trial court approved a settlement of the estate's subsequent malpractice cause of action against certain defendants not involved in this appeal. After appropriate fees were awarded, the estate received $2,966,667 in settlement of its claim.

Anthony Wade was a patient at the hospital from January 10, 1985, through September 9, 1985. Plaintiff's total bill was $259,823.45.

From July 9, 1985, to September 9, 1985, when plaintiff was discharged from the hospital, he was not eligible for public aid because he was no longer indigent due to the settlement of his claim. The portion of the bill covering this period is not in dispute.

During the initial period of his hospitalization, from January 10, 1985, to July 8, 1985, plaintiff was eligible for public aid. The hospital sent invoices for general hospital care to the Illinois Department of Public Aid for payment. The invoices listed the private duty nursing services as non-covered services payable by the patient. The hospital made no claim for reimbursement for the private duty nursing services but noted the amount and stated that those services were not a covered charge under IDPA regulations. IDPA paid the hospital's charges and settled its lien with the estate.

At issue in this case is the balance of the hospital's lien for $53,818.50 covering the private duty nursing services from January 10, 1985, through July 8, 1985. Neither the reasonableness nor the necessity of the private duty nursing services is contested. Rather, the plaintiff contests the hospital lien on the basis that it is barred under the Public Aid Code. (Ill. Rev. Stat. 1985, ch. 23, par. 11-13.) After a hearing, the trial court found that, notwithstanding the fact that the hospital was not a contract vendor of private duty nursing services, it was incumbent upon the hospital to apply to have that service become a compensable service under a hospital regulation. Based upon this finding, the court entered an order disallowing the portion of the hospital's lien at issue and subsequently denied its motion to vacate. The Probate Division adopted the findings of the Law Division. These consolidated appeals followed. I

The gravamen of plaintiff's argument is that the settlement of the IDPA's lien completely discharged his ...


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