Appeal from the Circuit Court of Cook County. Honorable Martin S. Agran, Judge Presiding.
The opinion of the court was delivered by: Justice Wolfson
In this medical negligence case, personnel at the defendant hospital transferred the patient to a State medical facility, where he was examined and released. One hour later, he committed suicide. The question is whether the defendant hospital and its personnel can be held liable for that suicide. The trial judge granted summary judgment on behalf of the defendants. We affirm the trial court.
George Jinkins' friend, Lorenzo Norwood, testified in a deposition that for several months before the suicide, George had begun drinking heavily. He was wearing dirty clothes, giving away money and possessions, and jumping in front of cars. George had separated from his wife, Earlean, who was living elsewhere with their children. On June 20, 1996, Maurice Abernathy, another friend, found George lying face-down in a puddle of muddy water. He was bleeding and his pants were pulled down. After they brought him home, George jumped in front of another car. Norwood, Abernathy, and George's mother, Florine Jinkins, brought him to the emergency room at Christ Hospital and Medical Center (Christ Hospital) at about 7 p.m.
At the hospital, George's blood alcohol level was .203, and he tested positive for marijuana. Dr. Daniel Sachs diagnosed George with acute psychosis, suicidal behavior, and alcohol intoxication. A petition for involuntary admission was prepared and signed by George's mother. In a certificate attached to the petition, Dr. Sachs said, in his opinion, George was mentally ill and because of his illness was reasonably expected to inflict serious physical harm on himself or another in the near future. He based that opinion partially on statements by family members that George repeatedly tried to kill himself by walking into the street in front of cars and told them, "I just want to go." According to Dr. Sachs' notes and hospital records, George had been hearing voices and "seeing colors." He thought his mother was poisoning his food and people were shooting at him.
Leonard Kemp, a social worker at Christ Hospital, informed Dr. Sachs of the decision to transfer George to Madden Mental Health Center (Madden), a state facility. Dr. Sachs stated in his deposition that this decision was "administrative," and he was not involved in the decision. He told Kemp he thought George should either be involuntarily transferred or involuntarily evaluated by a psychiatrist. The plaintiff contends George was transferred to Madden because he did not have health insurance. Dr. Sachs stated he did not know the reason for transfer, but insurance "may have been a factor." Dr. Sachs said he spoke on the telephone to a "Dr. Jazed" *fn1 at Madden regarding George's condition.
George was not transferred immediately because his alcohol level upon arrival at Christ Hospital was too high. A psychiatrist at Madden testified it was the facility's policy not to accept a patient until his blood alcohol level dropped below .1.
While at Christ Hospital, George was placed in leather restraints, was agitated, and kept screaming, "Get me out of here." He "laughed inappropriately" when blood was drawn from his arm. At 11:40 p.m., he was given ten milligrams of Haldol, a medication used to calm combative patients. At 2:50 a.m., he ran out of the emergency room during a trip to the restroom. He was found in a parking lot a half-hour later and brought back to the hospital.
At 5:50 a.m., George was transported to Madden by ambulance and arrived at 7:30 a.m. The record shows he was interviewed and evaluated by both Dr. Lee and Medlin. It was Dr. Lee's decision as an intake psychiatrist whether or not to admit a patient involuntarily. George was accompanied by his mother, Florine, and his wife, Earlean. Dr. Lee and Medlin reviewed records from Christ Hospital stating George had been hearing noises and voices, thought he was being shot at, thought birds were talking to him, and that he had been poisoned. They also were aware that George had been running in front of cars trying to kill himself, but did not know he was found lying in a puddle of water. They knew of his testing positive for marijuana.
During the interview, George was calm and coherent and displayed no paranoid symptoms. He denied all of the behaviors listed in the Christ Hospital records, and denied being suicidal or depressed. He denied any past psychiatric history or past suicide attempts. He said he did not want to be admitted to Madden. Earlean and Florine both stated he did not need to be admitted to Madden. Earlean stated she did not witness any suicidal behavior by George and did not think he was suicidal. She said she and George had been separated for a few days, but were now back together.
Based on these interviews, Dr. Lee and Medlin released George and referred him for outpatient treatment for alcohol abuse. George refused the referral. Dr. Lee diagnosed George with alcohol-related disorder NOS (not otherwise specified), and alcohol abuse. In his deposition, Dr. Lee stated he did not believe George was suicidal, but there was a low risk of suicide. His decision to release George was based on George's strong statement that he did not want to be admitted, his wife's and mother's objections to his being admitted, and his "supportive family network." George was released from Madden at approximately 9:50 a.m. on June 21, 1996. Within an hour of arriving home, George shot himself in the head and later died of his injuries.
Earlean brought an action against Christ Hospital and its employees for providing negligent treatment. She also alleged Christ Hospital violated the Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.S.C. § 1395dd (1994), by failing to stabilize the patient before transferring him to Madden. *fn2
Defendants brought a motion for summary judgment, contending that plaintiff's expert witness was not competent to establish the applicable standard of care because he was not licensed in the same profession as the defendants. Defendants also contended their actions were not a proximate cause of Jinkins' death and did not violate EMTALA.
On appeal, plaintiff contends the trial court erred in granting summary judgment for the defendants because her expert, Dr. Henry Lahmeyer, M.D., established the applicable standard of care for the defendants. She seeks to use the deposition testimony of Dr. Lahmeyer to establish the standard of care. Regardless of whether plaintiff's expert was qualified to testify, we find plaintiff has failed to establish the defendants' alleged negligent conduct proximately caused her husband's death.
A motion for summary judgment should be granted only 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 2000); Petrovich v. Share Health Plan of Illinois, Inc., 188 Ill. 2d 17, 30-31, 719 N.E.2d 756 (1999). We conduct a de novo review of a grant of summary judgment. Morris v. Margulis, 197 Ill. 2d 28, 35, 754 N.E.2d 314 (2001).
In a negligence medical malpractice action, the plaintiff has the burden of proving the following elements: (1) the proper standard of care for the defendant physicians; (2) an unskilled or negligent failure to comply with the appropriate standard; and (3) a resulting injury proximately caused by the physicians' failure of skill or care. Purtill v. Hess, 111 Ill. 2d 229, 241-42, 489 N.E.2d 867 (1986). Expert medical testimony generally must be used to establish the three elements. Addison v. Whittenberg, 124 Ill. 2d 287, 297, 529 N.E.2d 552 (1988).
Proximate cause is composed of two separate elements: cause in fact and legal cause. First Springfield Bank & Trust v. Galman, 188 Ill. 2d 252, 257-58, 720 N.E.2d 1068 (1999), citing Lee v. Chicago Transit Authority, 152 Ill. 2d 432, 455, 605 N.E.2d 493 (1992). To establish cause in fact, there must be a reasonable certainty that a defendant's acts caused the injury. A defendant's conduct is the cause in fact of the injury if the conduct was a material element and a substantial factor in bringing about the injury. Lee, 152 Ill. 2d at 455. Legal cause "'is essentially a question of foreseeability: a negligent act is a proximate cause of an injury if the injury is of the type which a reasonable man would see as a likely result of his conduct.'" Lee, 152 Ill. 2d at 456, quoting Masotti v. Console, 195 Ill. App. 3d 838, 845, 552 N.E.2d 1292 (1990). Where there is an intervening act by a third person, the test we apply is whether the first wrongdoer reasonably might have anticipated the intervening cause as a natural and probable result of the first party's own negligence. Galman, 188 Ill. 2d at 257.
The parties dispute whether Dr. Lahmeyer is competent to testify to the standard of care for the defendants. We will assume he is competent and all of the deposition testimony is admissible. Even accepting all of Dr. Lahmeyer's testimony as true, the plaintiff fails to establish a factual claim that the defendants' alleged negligence proximately caused George's death.
In his deposition taken on February 19, 1999, Dr. Lahmeyer testified, in his opinion, the emergency department staff or social work staff did not adequately obtain George's medical history and inadequately supervised him while at the hospital. Dr. Lahmeyer also testified George was not "medically stable" at the time of transfer and needed to be observed for a longer period ...