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  "id": 1599291,
  "name": "EARLEAN JINKINS, as Adm'r of the Estate of George Jinkins, Deceased, Plaintiff-Appellant, v. EVANGELICAL HOSPITALS CORPORATION, d/b/a EHS Christ Hospital and Medical Center, a/k/a Christ Hospital and Medical Center, et al., Defendants-Appellees",
  "name_abbreviation": "Jinkins v. Evangelical Hospitals Corp.",
  "decision_date": "2002-12-18",
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    "parties": [
      "EARLEAN JINKINS, as Adm\u2019r of the Estate of George Jinkins, Deceased, Plaintiff-Appellant, v. EVANGELICAL HOSPITALS CORPORATION, d/b/a EHS Christ Hospital and Medical Center, a/k/a Christ Hospital and Medical Center, et al., Defendants-Appellees."
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        "text": "JUSTICE WOLFSON\ndelivered the opinion of the court:\nIn 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.\nFACTS\nGeorge Jinkins\u2019 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 facedown 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\u2019s mother, Florine Jinkins, brought him to the emergency room at Christ Hospital and Medical Center (Christ Hospital) at about 7 p.m.\nAt the hospital, George\u2019s 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\u2019s 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, \u201cI just want to go.\u201d According to Dr. Sachs\u2019 notes and hospital records, George had been hearing voices and \u201cseeing colors.\u201d He thought his mother was poisoning his food and people were shooting at him. \u25a0\nLeonard 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 \u201cadministrative,\u201d 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 \u201cmay have been a factor.\u201d Dr. Sachs said he spoke on the telephone to a \u201cDr. Jazed\u201d at Madden regarding George\u2019s condition.\nGeorge 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\u2019s policy not to accept a patient until his blood-alcohol level dropped below .1.\nWhile at Christ Hospital, George was placed in leather restraints, was agitated, and kept screaming, \u201cGet me out of here.\u201d He \u201claughed inappropriately\u201d when blood was drawn from his arm. At 11:40 p.m., he was given 10 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.\nAt 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 Paulette Medlin. It was Dr. Lee\u2019s 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 thought that he had been poisoned. They also were aware that George had been running in front of cars trying to kill himself, but they did not know he was found lying in a puddle of water. They knew of his testing positive for marijuana.\nDuring 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 stat\u00e9d 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.\nBased 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\u2019s strong statement that he did not want to be admitted, his wife\u2019s and mother\u2019s objections to his being admitted, and his \u201csupportive family network.\u201d 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.\nEarlean 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 or the Act) (42 U.S.C. \u00a7 1395dd (1994)), by failing to stabilize the patient before transferring him to Madden.\nDefendants brought a motion for summary judgment, contending that plaintiffs 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\u2019 death and did not violate EMTALA.\nDECISION\nOn appeal, plaintiff contends the trial court erred in granting summary judgment for the defendants because her expert, 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 plaintiffs expert was qualified to testify, we find plaintiff has failed to establish the defendants\u2019 alleged negligent conduct proximately caused her husband\u2019s death.\nA motion for summary judgment should be granted only when \u201cthe 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.\u201d 735 ILCS 5/2 \u2014 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).\nIn 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\u2019 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).\nProximate 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\u2019s acts caused the injury. A defendant\u2019s 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 \u201c \u2018is essentially a question of foreseeability: a negligent act is a proximate cause of an injury if the injury is of a type which a reasonable man would see as a likely result of his conduct.\u2019 \u201d 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\u2019s own negligence. Galman, 188 Ill. 2d at 257.\nThe 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\u2019s testimony as true, the plaintiff fails to establish a factual claim that the defendants\u2019 alleged negligence proximately caused George\u2019s death.\nIn 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\u2019s medical history and inadequately supervised him while at the hospital. Dr. Lahmeyer also testified George was not \u201cmedically stable\u201d at the time of transfer and needed to be observed for a longer period of time. Dr. Lahmeyer said he would have expected the physicians at Madden to admit the patient.\nThe following testimony was elicited during a second deposition of Dr. Lahmeyer on April 6, 2001:\n\u201cQ. Is it your opinion that George needed to be evaluated by a psychiatrist?\nA. At Christ?\nQ. At Christ.\nA. It\u2019s my opinion that a psychiatrist should have been consulted, you know, should have been called. ***\nQ. So you think a reasonably well-qualified emergency room physician, under these circumstances, was required to have contacted, minimally, a psychiatry resident or at least a psychiatry attending at Christ Hospital?\nA. Well, that\u2019s commenting on the procedures of ER docs, which is really not my expertise, and I don\u2019t know their guidance. You know, I read a little bit in their depositions about their training and so forth. I think I stated last time that I don\u2019t want to comment about, you know, specifically the standard of care for ER doctors. I can say what I would do; you know, if I had been a psychiatrist and being called, I can say a lot of things that I would be very alarmed about, but, you know, they have separate training, they have separate attendings. I\u2019d rather not get into that.\nQ. Okay. As a psychiatrist in looking at this case in its entirety, is it your opinion that Mr. Jinkins should have been evaluated by a psychiatrist?\nA. Yes.\nQ. And is it your opinion, then, a reasonably well-qualified psychiatrist would have recommended admission to a hospital to evaluate and treat the psychosis?\nA. Yes.\u201d\nAll that Dr. Lahmeyer\u2019s testimony establishes is that, in his opinion, the defendants breached their standard of care. Nowhere in his testimony does he make a causal connection between the conduct of the physicians at Christ Hospital and George Jinkins\u2019 subsequent suicide. Moreover, it is apparent from the record that the physicians at Christ Hospital expected George to be admitted to Madden and did not foresee his release from the Madden facility. In his deposition on October 30, 1998, Dr. Sachs testified as follows:\n\u201cQ. Did you consider the possibility \u2014 when you were talking to George and his family, did you consider the possibility that the patient might wind up at home within the next 12 hours?\nA. No. I did not think that would happen.\nQ. And why didn\u2019t you think that would happen?\nA. Because he had demonstrated suicidal behavior over the course of three weeks, consistent attempts to kill himself over the course of three weeks, and had made comments like, I just want to go. Patients like that, we don\u2019t discharge home. ***\nQ. Did you learn that he was \u2014 when you learned that he had killed himself, did you learn that he had killed him \u2014 he was not under institutional care when he killed himself? Or did you make that inference?\nA. Well, I made that inference.\nQ. Was that a surprise to you that he was not under institutional care\u2014\nA. Yes.\nQ. \u2014 within just 12 hours after seeing him?\nA. Yes, it was a surprise to me.\nQ. Was it a surprise to you because George needed to be admitted to a hospital?\nA. It was a surprise to me because George needed supervised psychiatric care.\nQ. And it was a surprise to you that he didn\u2019t get it?\nA. Yes.\u201d\nThe plaintiff is unable to establish the defendants\u2019 conduct was the proximate cause of George\u2019s death, because the defendants could not reasonably have foreseen that he would be released from Madden and commit suicide. The release of George from Madden was a sufficient intervening act to break the causal connection between the defendants\u2019 conduct and George\u2019s death. There is no liability for a party\u2019s negligent act unless the negligent act was the proximate cause of the injury suffered. Madden v. Kuehn, 56 Ill. App. 3d 997, 1000, 372 N.E.2d 1131 (1978). It is not conceivable that the defendants could be held responsible for George\u2019s death where they transferred the patient to Madden and informed the Madden staff of the patient\u2019s history. See Madden, 56 Ill. App. 3d at 1000 (in medical malpractice case for death of an inmate, sheriff was not liable for proximately causing decedent\u2019s death when he turned decedent over to the Department of Corrections and informed Department of his condition).\nPlaintiff contends George would not have died if the defendants had kept him at Christ Hospital and had not transferred him to Madden. This is essentially a \u201cbut for\u201d argument reaching only to the issue of cause in fact and not legal cause. The plaintiff fails to show the defendants reasonably might have anticipated that Madden would release George as a probable result of their negligent acts.\nBecause the plaintiff fails to offer any factual allegations that, if true, would establish proximate cause, we find the trial court properly granted summary judgment. The element of proximate cause is ordinarily a question of fact for the jury; however, summary judgment is appropriate where the facts are undisputed and there is no difference in the judgment of reasonable men as to the inferences to be drawn. Williams v. University of Chicago Hospitals, 179 Ill. 2d 80, 88-89, 688 N.E.2d 130 (1997); McCoy v. McCoy, 227 Ill. App. 3d 244, 248, 591 N.E.2d 124 (1992). Although it appears the trial court granted summary judgment on bases other than proximate cause, we may affirm on any basis appearing in the record. Material Service Corp. v. Department of Revenue, 98 Ill. 2d 382, 387, 457 N.E.2d 9 (1983).\nThe plaintiff also contends Christ Hospital violated EMTALA (42 U.S.C. \u00a7 1395dd (1994)) by transferring George to Madden without first stabilizing his condition. EMTALA is a limited \u201canti-dumping\u201d statute, not a federal malpractice statute. Bryan v. Rectors & Visitors of the University of Virginia, 95 F.3d 349, 351 (4th Cir. 1996). Its \u201ccore purpose is to get patients into the system who might otherwise go untreated and be left without a remedy because traditional medical malpractice law affords no claim for failure to treat.\u201d Bryan, 95 F.3d at 351. The Act requires a hospital to provide limited stabilizing treatment to, or an appropriate transfer of, any patient who arrives with an emergency medical condition. 42 U.S.C. \u00a7 1395dd(b)(l) (1994). The hospital must stabilize the patient before transfer. 42 U.S.C. \u00a7 1395dd(c) (1994). To \u201cstabilize\u201d means \u201cto provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result or occur during the transfer of the individual from a facility.\u201d 42 U.S.C. \u00a7 1395dd(e)(3)(A) (1994).\nIn the instant case, the plaintiff fails to present any evidence the hospital violated the requirements of EMTALA by failing to stabilize the patient before transfer within the meaning of the Act. The following testimony was elicited during Dr. Lahmeyer\u2019s deposition on April 6, 2001:\n\u201cQ. What was George\u2019s condition at the time of his discharge from Christ?\nA. George\u2019s condition was that he was still acutely psychotic, he was in restraints, he had received 10 milligrams of Haldol, he was in, you know, a little bit more serious denial about his mental illness. He was denying, you know, all kinds of psychotic symptoms, because he basically just wanted out of there. And he had just tried to run away at 3:30 a.m., so he was acutely psychotic and probably trying to run away to kill himself.\nQ. And do you have any information about George\u2019s condition during the period of transport from Christ to Madden?\nA. My understanding from everything I\u2019ve read is that he was fine.\nQ. Had his condition changed at all from the time of discharge from Christ up to the time he arrived at Madden? Was he still acutely psychotic and in denial?\nA. Yeah.\nQ. And when he arrived at Madden, his condition was the same?\nA. As when he left?\nQ. When he left Christ.\nA. Yeah, he may have \u2014 I don\u2019t know. He was out of restraints there, and I don\u2019t know when his wife actually arrived. I think she arrived in the middle of the night at Christ, but I remember from [Dr. Choong Lee\u2019s] deposition they were on the sofa, hugging. So, you know, he probably felt a little calmer with his wife being there. I saw the comment that he, you know, appeared calm on the sofa.\nQ. You mentioned the Haldol\u2014\nA. But basically, to answer your question, the psychosis hadn\u2019t changed.\u201d\nBased on Dr. Lahmeyer\u2019s testimony, the plaintiff has not offered any evidence that George\u2019s condition deteriorated as a result of his transfer to Madden. According to the testimony, George was in the same or better condition upon arriving at Madden than when he left Christ Hospital. In her reply brief, the plaintiff contends deterioration of George\u2019s condition is shown by the fact that \u201c[w]ithin four hours of being sent away by the Defendant, Jinkins had a self inflicted bullet wound to his head which caused his death.\u201d Plaintiffs contention misconstrues the purpose of the Act. The Act does not require a hospital to completely alleviate a patient\u2019s emergency condition; all that is required is to refrain from transferring a patient until he is \u201cstable.\u201d Brooker v. Desert Hospital Corp., 947 F.2d 412, 415 (9th Cir. 1991). It is clear from the record that defendant acted reasonably in stabilizing George within the meaning of the Act before his transfer.\nWe also find summary judgment was appropriate because plaintiff is unable to prove proximate cause with regard to her EMTALA claim. EMTALA allows plaintiffs to recover any damages they are entitled to under state law as a result of a hospital\u2019s failure to comply with the Act. 42 U.S.C. \u00a7 1395dd(2)(A) (1994). A plaintiff is required to show the patient\u2019s injury was proximately caused by the defendant\u2019s violation of EMTALA. See Tolton v. American Biodyne, Inc., 48 F.3d 937, 944 (6th Cir. 1995). Here, the plaintiff is unable to establish the requisite causal connection between the hospital\u2019s conduct and the patient\u2019s death. Summary judgment is appropriate on the EMTALA claim.\nCONCLUSION\nWe affirm the decision of the trial court.\nAffirmed.\nSOUTH, P.J., and HALL, J., concur.\nAccording to both parties, the name of the physician at Madden was Dr. Javed. Dr. Javed was not present when the patient was examined at Madden.\nThe plaintiff also brought suit against two Madden employees, Dr. Choong Lee and Paulette Medlin, for releasing George from Madden. That case is being decided in a separate appeal, Jinkins v. Lee, 337 Ill. App. 3d 403 (2003).",
        "type": "majority",
        "author": "JUSTICE WOLFSON"
      }
    ],
    "attorneys": [
      "Marvin A. Brustin and Milo W. Lundblad, both of Marvin A. Brustin, Ltd., of Chicago, for appellant.",
      "Meyer, Kreuzer, Esp & Cores, of Wheaton, for appellees."
    ],
    "corrections": "",
    "head_matter": "EARLEAN JINKINS, as Adm\u2019r of the Estate of George Jinkins, Deceased, Plaintiff-Appellant, v. EVANGELICAL HOSPITALS CORPORATION, d/b/a EHS Christ Hospital and Medical Center, a/k/a Christ Hospital and Medical Center, et al., Defendants-Appellees.\nFirst District (3rd Division)\nNo. 1\u201401\u20144210\nOpinion filed December 18, 2002.\nMarvin A. Brustin and Milo W. Lundblad, both of Marvin A. Brustin, Ltd., of Chicago, for appellant.\nMeyer, Kreuzer, Esp & Cores, of Wheaton, for appellees."
  },
  "file_name": "0377-01",
  "first_page_order": 395,
  "last_page_order": 404
}
