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M.A.K. v. Rush-Presbyterian-St.-Luke's Medical Center

December 20, 2001


The opinion of the court was delivered by: Justice Garman.


Docket No. 90527-Agenda 28-May 2001.

Plaintiff, M.A.K., filed a complaint in the circuit court of Will County against defendants, Rush-Presbyterian-St. Luke's Medical Center (Rush) and Royal Maccabees Life Insurance Company (Royal), alleging that Rush had improperly released certain medical records to Royal, pursuant to a written consent signed by plaintiff. The circuit court granted judgment on the pleadings to Rush. Thereafter, plaintiff voluntarily dismissed his action as to Royal and appealed the circuit court's order. The appellate court reversed and remanded (316 Ill. App. 3d 156). We granted Rush's petition for leave to appeal (177 Ill. 2d R. 315) and we now reverse the judgment of the appellate court.


In count I of his second amended complaint, plaintiff alleged that Rush had breached the physician-patient relationship by releasing his records without first advising plaintiff of its intention to do so and obtaining his approval. In count II, for invasion of privacy, plaintiff alleged that Rush had wrongfully released his medical records without his prior authorization or consultation. Count III alleged negligent infliction of emotional distress.

The allegations of the complaint show that on January 13, 1995, plaintiff was admitted to Rush's Behavioral Health Center-Du Page (Behavioral Health Center) for alcohol dependence. He was discharged on March 2, 1995. In October 1994, plaintiff had applied to Royal for a disability income insurance policy. Royal issued the policy. While receiving treatment at Rush, plaintiff contacted his insurance agent about filing a claim for benefits under the policy. After receiving a claim form from Royal, plaintiff notified Royal in February 1995 that he would not be filing a claim. In April 1995, Rush received from Royal a written consent signed by plaintiff, dated October 12, 1994, to release plaintiff's medical and non-medical information to Royal. The records that Rush released to Royal included plaintiff's records of alcohol- dependence treatment. After receiving plaintiff's medical records from Rush, Royal cancelled plaintiff's disability policy.

The written consent signed by plaintiff was entitled "AUTHORIZATION AND ACKNOWLEDGEMENT" (hereafter authorization) and stated in pertinent part as follows:

"I AUTHORIZE any physician, medical practitioner, hospital, clinic, health care facility, [or] other medical or medically related facility[ ] *** having information available as to diagnosis, treatment and prognosis with respect to any physical or mental condition and/or treatment of me *** and any other non- medical information of me *** to give to Royal *** any and all such information.

I UNDERSTAND the purpose of this authorization is to allow Royal *** to determine eligibility for life or health insurance or a claim for benefits under a life or health policy. ***

I UNDERSTAND THAT my *** medical records may be protected by certain Federal Regulations, especially as they apply to any drug or alcohol abuse data. I understand that I *** may revoke this authorization at any time as it pertains to any such drug or alcohol abuse data by written notification ***.

*** I AGREE this Authorization shall be valid for two and one half years from [October 12, 1994]."

In the circuit court, Rush filed a motion for judgment on the pleadings (735 ILCS 5/2-615(e) (West 1998)), arguing that plaintiff's executed authorization expressly permitted Rush to release his medical and non-medical records to Royal and was therefore facially valid. Plaintiff argued that the authorization was not a valid waiver of his right to confidentiality of his medical records that were not in existence at the time he signed the authorization and that Rush should have notified plaintiff that Royal had submitted a request for his medical records. Plaintiff also filed a reply to Rush's reply brief in support of its motion for judgment on the pleadings in which plaintiff included an affidavit of his attorney, who stated that, during a meeting with Paul Feldman, the medical director of the Behavioral Health Center, Feldman admitted that plaintiff's records should not have been released to Royal. On December 11, 1997, the circuit court granted Rush's motion.

The issue addressed by the appellate court was whether the authorization complied with the requirement of section 2.31(a)(1) of the Confidentiality of Alcohol and Drug Abuse Patient Records regulations (hereafter regulation). Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. §2.31(a)(1) (2000). The regulation requires that a written consent for release of alcohol and drug treatment records give the "specific name or general designation" of the person or program authorized to make the disclosure of such records. In reversing the circuit court, the appellate court relied upon the "plain language" of the authorization and concluded that the term "general designation" required something more specific than the phrase "any physician, medical practitioner, hospital, clinic, health care facility or other medical or medically related facility." The court described the language of the authorization as "at best imprecise and far too generic to be considered a general designation as that term is commonly understood and as is required by the regulations." 316 Ill. App. 3d at 160.


I. Standard of Review

Judgment on the pleadings is proper only where no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Chicago Title & Trust Co. v. Steinitz, 288 Ill. App. 3d 926, 934 (1997). In ruling on a motion for judgment on the pleadings, only those facts apparent from the face of the pleadings, matters subject to judicial notice, and judicial admissions in the record may be considered. All well-pleaded facts and all reasonable inferences from those facts are taken as true. Mt. Zion State Bank & Trust v. Consolidated Communications, Inc., 169 Ill. 2d 110, 115 (1995). Our review is de novo. Board of Trustees of the University of Illinois v. City of Chicago, 317 Ill. App. 3d 569, 571 (2000).

II. Compliance With the Regulation

The regulation implements section 523 of the Public Health Service Act (Public Health Act) (42 U.S.C. §290dd-2 (1994)). That section mandates the confidentiality of alcohol and drug abuse patient records and prescribes the conditions and manner of release of such records. It states in pertinent part as follows:

"(a) Requirement

Records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance abuse education, prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly assisted by any department or agency of the United States shall, except as provided in subsection (e) of this section, be confidential and be disclosed only for the purposes and under the circumstances expressly authorized under subsection (b) of this section.

(b) Permitted disclosure

(1) Consent

The content of any record referred to in subsection (a) of this section may be disclosed in accordance with the prior written consent of the patient with respect to whom such record is maintained, but only to such extent, under such circumstances, and for such purposes as may be allowed under regulations prescribed pursuant to subsection (g) of this section." 42 U.S.C. §§290dd-2(a), (b) (1994).

Subsection (g) grants authority to the Department of Health and Human Services (Department) to promulgate regulations to implement the purposes of the law. 42 U.S.C. §290dd-2(g) (1994). The regulation sets forth the requirements of a written consent authorizing disclosure of a patient's alcohol or drug abuse treatment records. That section provides in pertinent part:

"(a) Required elements. A written consent to a disclosure under these regulations must include:

(1) The specific name or general designation of the program or person permitted to make the disclosure.

(2) The name or title of the individual or the name of the organization to which disclosure is to be made.

(3) The name of the patient.

(4) The purpose of the disclosure.

(5) How much and what kind of information is to be disclosed.

(6) The signature of the patient ***.

(7) The date on which the consent is signed.

(8) A statement that the consent is subject to revocation at any time except to the extent that the program or person which is to make the disclosure has already acted in reliance on it. ***

(9) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must insure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given." 42 C.F.R. §2.31(a) (2000).

Familiar principles of statutory construction apply to the interpretation of regulations of an administrative agency. See Tivoli Enterprises, Inc. v. Zehnder, 297 Ill. App. 3d 125, 132 (1998). The primary rule of statutory construction is to give effect to the intent of the legislature. Paris v. Feder, 179 Ill. 2d 173, 177 (1997). The best evidence of legislative intent is the language used in the statute itself and that language must be given its plain and ordinary meaning. Paris, 179 Ill. 2d at 177. The statute should be construed as a whole and, if possible, in a manner such that no term is rendered meaningless or superfluous. Texaco-Cities Service Pipeline Co. v. McGaw, 182 Ill. 2d 262, 270 (1998). Where the meaning of a statute is unclear from a reading of its language, courts may look beyond the language of the statute and consider the purpose of the law, the evils it was intended to remedy, and the legislative history behind it. In re B.C., 176 Ill. 2d 536, 542-43 (1997).

The phrase "general designation" is not defined in the regulation. The word "general" means "involving, applicable to, or affecting the whole," "involving, relating to, or applicable to every member of a class, kind, or group," and "concerned or dealing with universal rather than particular aspects". Merriam Webster's Collegiate Dictionary 484 (10th ed. 1996). "[D]resignation" is defined as "the act of indicating or identifying," and "a distinguishing name, sign, or title." Merriam Webster's Collegiate Dictionary 313 (10th ed. 1996).

Rush argues that the phrase "general designation" is properly construed to mean "a broad and comprehensive classification of the programs and persons permitted to make disclosure" of the patient's confidential records. Since the terms "physician, medical practitioner, hospital, clinic, health care facility, and other medical or medically related facility" constitute such a classification, their use in the authorization complied with the regulation. Plaintiff, on the other hand, argues that the phrase requires the authorization to contain a reference to records of treatment in an alcohol abuse program.

As the appellate court recognized, this is an issue of first impression. We have been unable to locate any case that has addressed the question before us.

On its face, the phrase "general designation" appears to be vague. The word "general" refers to a broad classification. The word "designation" refers to either the act of identifying or a distinguishing name or title. It is unclear how to reconcile these words. We will therefore look beyond the language ...

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