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Temesvary v. Houdex

November 24, 1998


The opinion of the court was delivered by: Justice Rathje


Appeal from the Circuit Court of Du Page County.

No. 95--L--1568

Honorable Paul Noland, Judge, Presiding.

In this appeal, we are asked to decide if a trial court may determine the reasonableness of a physician's charges prior to adjudicating the physician's lien under the Physicians Lien Act (the Act) (770 ILCS 80/0.01 et seq. (West 1996)). We answer the question in the affirmative but reverse and remand on other grounds.

The plaintiff, Doris Temesvary, filed a personal injury lawsuit against the defendant, Diane Houdek. On November 10, 1997, the plaintiff filed a petition to adjudicate liens, alleging a settlement of the above suit and that the only outstanding lien was the bill of Dr. A. G. Phillips, in the amount of $8,140 for nuclear medicine studies performed on the plaintiff. The petition further alleged that Dr. Phillips's charges were "in excess of the normal and customary costs for such services in the medical community" and were therefore "unreasonable." Dr. Phillips filed a response, and the matter was set for hearing on December 23, 1997.

Prior to the commencement of the hearing, Dr. Phillips disputed the authority of the trial court to refuse to enforce the amount of his lien when the lien was not in excess of one-third of the amount of the settlement. See 770 ILCS 80/1 (West 1996). The trial court rejected that argument, relying on the "reasonable charges" language of the Act (770 ILCS 80/1 (West 1996)).

Dr. Phillips, whose office is in Naperville, testified that he specializes but is not board certified in nuclear medicine. He provides nuclear medicine imaging services, mostly to patients who have been injured in accidents and who are referred to him by other healthcare providers. He is not associated with any hospital or group practice. When a patient is referred to him, he takes a history, explains what tests will be performed, and how much it will cost. He has the patient sign forms indicating that the patient has had a complete explanation of the procedure. The doctor then administers a radioactive isotope; after a waiting period, the nuclear medicine studies are performed. Imaging is done with a gamma system, which provides images of the target organ system; the modalities used with the system are planar, digital, and SPECT. After the processing and interpretation, a report is sent to the referring physician. In setting his fees, Dr. Phillips takes into consideration his overhead, which includes the cost of his equipment, maintenance expenses, and office costs.

Dr. Phillips testified further that the plaintiff was referred to him by another physician. Upon meeting with the plaintiff, Dr. Phillips explained the procedures and the costs involved for each type of study he would perform. The plaintiff signed a request and consent for a nuclear medicine study. She also signed a fee and price disclosure, which stated that she understood that the price for the nuclear studies would range from $1,500 to $9,500 and that the price was higher than what was charged at local hospitals.

Dr. Phillips further testified that the plaintiff was at his office from 9:30 a.m. to 3 p.m for the performance of the nuclear studies. She was the only patient seen that day. After the studies were performed, the doctor processed the work, interpreted the results, and dictated the report. All together, he spent approximately eight hours on the plaintiff's case performing the above tasks. He believed that his charges were reasonable.

Dr. Phillips further testified that nuclear medicine studies can be performed at hospitals where the charges are considerably less. His practice differs from that of a hospital in that, in addition to providing services to the patients, he is responsible for all of the equipment and maintenance costs and for running the business and collecting payments. In a hospital, a technician actually performs the nuclear studies, not a physician. The SPECT system costs between $300,000 and $700,000.

On cross-examination, Dr. Phillips disputed that the same tests he performed would cost between $900 and $2,500 at a hospital. He believed that his charges are reasonable and that other physicians would agree with that assessment if they did the same work. He denied telling the plaintiff that she did not need to be concerned with the bill.

Dr. Charles Martinez, board certified in internal and nuclear medicine and director of nuclear medicine at Lutheran General Hospital, testified for the plaintiff as an expert witness as to the usual and customary charges for nuclear medicine in the greater Chicagoland area. At the hospital, the charges are determined by the cost of the material, the technologist's pay, and the cost of the overhead of the area in which they worked. The trial court overruled Dr. Phillips's objection to Dr. Martinez's rendering an opinion as to whether Dr. Phillips's charges were reasonable.

After reviewing Dr. Phillips's charges, Dr. Martinez opined that the charges were not reasonable based upon his knowledge of what area hospitals and several imaging centers charge. According to Dr. Martinez, the charge for most of their complete scans, including the professional component, would be around $1,000. If the highest amount for the "technical professional ...

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