JUSTICE THEIS delivered the judgment of the court, with
opinion. Chief Justice Karmeier and Justices Thomas and
Garman concurred in the judgment and opinion.
1 The circuit court of Cook County certified the following
question pursuant to Illinois Supreme Court Rule 308 (eff.
Feb. 26, 2010): "Can a hospital be held vicariously
liable under the doctrine of apparent agency set forth in
Gilbert v. Sycamore [Municipal Hospital],
156 Ill.2d 511 (), and its progeny for the acts of the
employees of an unrelated, independent clinic that is not a
party to the present litigation?" The appellate court
answered this question in the affirmative. 2016 IL App (1st)
141585, ¶ 46. For the reasons that follow, we find that
the appellate court answered the question incorrectly.
Accordingly, we reverse the judgment of the appellate court
and remand this cause to the circuit court for further
proceedings consistent with this opinion.
3 On November 15, 2005, plaintiff Christina Yarbrough went to
the Erie Family Health Center (Erie) located at 1701 West
Superior Avenue in Chicago after searching online for a
clinic that would administer a pregnancy test without
requiring her to have insurance coverage.
4 Erie does not require medical insurance. Erie is a
"Federally Qualified Health Center" (FQHC) that
comprises several clinics in the Chicago area. FQHCs are
"community-based and patient-directed organizations that
serve populations with limited access to health care. These
include low income populations, the uninsured, those with
limited English proficiency, *** individuals and families
experiencing homelessness, and those living in public
housing." (Internal quotation marks omitted.) Lyndsay
Gunkel, Federally Qualified Health Centers: The Next Step
in Cost-Effective Health Care, 20 Annals Health L.
Advance Directive 31, 33 (2010); see also 42 U.S.C. §
254b (2012). FQHCs rely heavily on federal grants and
Medicaid cost-based reimbursement to operate and provide the
communities that they serve with primary and preventative
care regardless of a patient's ability to pay. Gunkel,
supra, at 32-33; see also 42 U.S.C. § 254b
5 Erie was originally founded as a project between
Northwestern Memorial Hospital (NMH) and "Erie
Neighborhood House" in 1957. NMH provides financial
support, technological assistance, and strategic support. A
representative of NMH may serve on Erie's board if
requested by Erie's board chairperson. Erie-employed
physicians seeking privileges to practice at NMH are required
to apply for them, as would any physician.
6 At the time Yarbrough went to Erie in November 2005, she
did not have a relationship with an obstetrician-gynecologist
(OB-GYN) or a family physician. After receiving a positive
pregnancy result during her initial visit, Yarbrough spoke
with a staff member at Erie. She asked the unnamed staff
person where she would deliver her baby. Yarbrough was
informed that she would have her ultrasounds done at
Northwestern Medicine Prentice Women's Hospital and would
most likely deliver her baby at NMH. During this same visit,
Yarbrough received informational materials regarding tours of
NMH's birthing/delivery area, having the installation of
an infant car seat inspected at NMH, and attending birthing
classes at NMH. Based upon this information, Yarbrough
believed that Erie and NMH were one and the same entity,
particularly because she was told that she would give birth
7 On November 30, 2005, Yarbrough began to experience vaginal
bleeding and went to the emergency room at Advocate Illinois
Masonic Medical Center (Advocate). She obtained an abdominal
ultrasound there and was allegedly advised by a physician at
Advocate that she had a bicornuate uterus.
8 On December 2, 2005, Yarbrough met at Erie with Betsy
McKelvey, a certified nurse midwife, and Dr. Raymond Suarez,
an OB-GYN. Both McKelvey and Dr. Suarez were employees of
Erie. She underwent another abdominal ultrasound that day.
Yarbrough was purportedly told that she did not have a
bicornuate uterus but instead was diagnosed with a shortened
9 On February 21, 2006, Erie referred Yarbrough to NMH for a
20-week ultrasound. This second ultrasound was interpreted by
Dr. William Grobman, who is employed by Northwestern Medical
Faculty Foundation (NMFF).
10 On April 8, 2006, Yarbrough delivered her daughter, Hayley
Joe Goodpaster, prematurely by emergency caesarean section at
NMH. Dr. Suarez purportedly told Yarbrough that she did, in
fact, have a bicornuate uterus and an "incompetent
11 On December 28, 2009, Yarbrough and David Goodpaster, on
behalf of their daughter Hayley, filed a two-count complaint
against NMH and NMFF. Count I of the complaint alleged
medical negligence by Dr. Grobman, as an actual or apparent
agent of NMFF, in relation to his interpretation of the
ultrasound on February 21, 2006. In count II, as subsequently
amended on August 22, 2013, plaintiffs alleged that
Erie's employees were the actual or apparent agents of
12 They alleged that the medical staff who treated Yarbrough
at Erie had negligently failed to identify and address issues
surrounding her shortened cervix and bicornuate uterus,
causing her to deliver her daughter prematurely at 26
weeks' gestation. Plaintiffs further alleged that
Yarbrough was never told that the healthcare workers at Erie
were not employees of NMH. Plaintiffs alleged that based on
Yarbrough's knowledge of NMH's reputation and the
information provided to her by Erie, she believed that if she
received prenatal care from Erie, she would be receiving
treatment from NMH health care workers.
13 NMH moved for partial summary judgment on the amended
complaint as to all agency claims arising out of treatment
that Yarbrough received by Erie employees. NMH asserted that
it did not hold Erie out as its agent. Similarly, Erie and
its employees did not hold themselves out as agents of NMH.
NMH maintained that Erie was an independent, federally funded
community health center and that the staff at Erie who
treated Yarbrough on-site at Erie were working strictly
within the scope of their employment with Erie.
14 The trial court denied NMH's motion for partial
summary judgment. After NMH orally moved to certify a
question under Rule 308, the trial court ordered the parties
to draft a proposed certified question, which they
subsequently filed, respectively, with the court. Thereafter,
the trial court entered an order certifying the above-quoted
question, which the court drafted.
15 The appellate court initially denied NMH's application
for leave to appeal. We denied NMH's petition for leave
to appeal but entered a supervisory order directing the
appellate court to vacate its order and to consider the
question certified by the circuit court. Yarbrough v.
Northwestern Memorial Hospital, No. 118149 (Ill. Nov.
26, 2014) (supervisory order).
16 The appellate court in its subsequent opinion answered the
certified question in the affirmative. 2016 IL App (1st)
141585, ¶ 46. The appellate court rejected NMH's
argument that Gilbert is inapplicable in this case
because the alleged negligent conduct did not occur at the
hospital. Id. ¶¶ 36, 46. The appellate
court held that nothing in Gilbert limits a
plaintiff from recovering against a hospital "
'merely because the negligent conduct of the physician
did not occur in the emergency room or some other area within
the four walls of the hospital.' " Id.
¶ 40 (quoting Malanowski v. Jabamoni, 293
Ill.App.3d 720, 727 (1997)). The appellate court also held
that a plaintiff is not required to name the individual
physician or his or her employer as a defendant in order to
hold the hospital vicariously liable as the principal.
Id. ¶¶ 43-44, 46.
17 This court allowed NMH's petition for leave to appeal.
Ill. S.Ct. R. 315 (eff. Mar. 15, 2016). In addition, we
allowed the Illinois Association of Defense Trial Counsel to
file an amicus curiae brief in support of NMH. We
also allowed the University of Chicago Medical Center, Rush
University Medical Center, Advocate Health Care, Northshore
University Health System, Presence Health and Trinity Health
to file a joint amicus curiae brief in support of
NMH. We further allowed the Illinois Trial Lawyers
Association to file an amicus curiae brief in
support of plaintiffs. Ill. S.Ct. R. 345 (eff. Sept. 20,
19 The certified question asks:
"Can a hospital be held vicariously liable under the
doctrine of apparent agency set forth in Gilbert v.
Sycamore [Municipal Hospital], 156 Ill.2d 511
(), and its progeny for the acts of the employees of an
unrelated, independent clinic that is not a party to the
20 NMH asserts that the appellate court erred in answering
this question in the affirmative. NMH contends that the
doctrine of apparent authority, as set forth in
Gilbert and subsequent cases, is inapplicable, as a
matter of law, because the treatment at issue occurred at
Erie and not at a hospital or hospital facility owned by NMH.
21 Rule 308(a) provides for interlocutory appeals of nonfinal
orders that present "a question of law as to which there
is substantial ground for difference of opinion." Ill.
S.Ct. R. 308(a) (eff. Feb. 26, 2010). When the trial court
finds that an answer to that question "may materially
advance the ultimate termination of the litigation, "
the court must identify the question in writing, and the
appellate court may allow an appeal. Id.
"Because an interlocutory appeal under Rule 308
necessarily involves a question of law, our review of the
appellate court's decision in such an appeal is de
novo." In re Marriage of Mathis, 2012 IL
113496, ¶ 19.
22 This court first applied the apparent authority doctrine
in a medical malpractice context in Gilbert. There,
we addressed whether a hospital may be held vicariously
liable for the negligence of a physician who is not an
employee of the hospital but, rather, an independent
contractor. Gilbert, 156 Ill.2d at 514. The
physician who treated the plaintiff's decedent in the
hospital's emergency room was a staff physician
practicing through an independent professional association.
Id. at 515-16. The hospital did not advise emergency
room patients that the physicians were independent
contractors and not hospital employees. Id. at 516.
The hospital argued that it could not be held vicariously
liable for a physician's negligence where the physician
was neither an employee nor agent of the hospital.
Id. at 517. The appellate court agreed. Id.
23 In rejecting appellate court decisions that had refused to
impose vicarious liability upon a hospital based upon an
agency relationship unless the physician was an actual agent
of the hospital, we held those decisions overlooked two
realities of modern hospital care. Id. at 519-20.
First, those appellate court decisions overlooked the
"business of a modern hospital." Id. at
520. We recognized:
" '[H]ospitals increasingly hold themselves out to
the public in expensive advertising campaigns as offering and
rendering quality health services. One need only pick up a
daily newspaper to see full and half page advertisements
extolling the medical virtues of an individual hospital and
the quality health care that the hospital is prepared to
deliver in any number of medical areas. Modern hospitals have
spent billions of dollars marketing themselves, nurturing the
image with the consuming public that they are full-care
modern health facilities. All of these expenditures have but
one purpose: to persuade those in need of medical services to
obtain those services at a specific hospital. In essence,
hospitals have become big business, competing with each other
for health care dollars.' " Id. (quoting
Kashishian v. Port, 481 N.W.2d 277, 282 (Wis.
24 The second reality of modern hospital care discussed by
this court in Gilbert involved the "reasonable
expectations of the public." Id. at 521. We
" '[G]enerally people who seek medical help through
the emergency room facilities of modern-day hospitals are
unaware of the status of the various professionals working
there. Absent a situation where the patient is directed by
his own physician or where the patient makes an independent
selection as to which physicians he will use while there, it
is the reputation of the hospital itself upon which he would
rely. Also, unless the patient is in some manner put on
notice of the independent status of the professionals with
whom [he] might be expected to come into contact, it would be
natural for him to assume that these people are employees of
the hospital.' " Id. (quoting Arthur v.
St. Peters Hospital, 405 A.2d 443, 447 (N.J.Super. Ct.
Law Div. 1979)).
25 This court also emphasized that " '[s]uch
appearances speak much louder than the words of whatever
private contractual arrangements the physicians and the
hospital may have entered into, unbeknownst to the public, in
an attempt to insulate the hospital from liability for the
negligence, if any, of the physicians.' "
Id. (quoting Brown v. Coastal Emergency
Services, Inc., 354 S.E.2d 632, 637 (Ga.Ct.App. 1987)).
26 After considering these realities of modern hospital care,
we held that a patient who is unaware that the person
providing treatment is not the employee or agent of the
hospital has the right to look to the hospital in seeking
compensation for any negligence in providing emergency room
care. Id. at 522. We stressed that liability
attaches to the hospital in such cases only where the
treating physician is the apparent or ostensible agent of the
hospital. If a ...