Case Title: Brandt v. Boston Scientific Corp.

Citation: 

Docket Number: 93982

State: illinois

Court: Illinois Supreme Court

Date: 2003-06-05T00:00:00Z

Document:
Docket No. 93982-Agenda 11-March 2003.
BRENDA BRANDT, Appellant, v. BOSTON SCIENTIFIC 
CORPORATION (Sarah Bush Lincoln Health Center,
Appellee).
Filed June 5, 2003
	JUSTICE GARMAN delivered the opinion of the court:
	Plaintiff, Brenda Brandt, suffered severe complications
following the surgical implantation of a medical device that was
later recalled by the manufacturer for being substandard. Brandt
filed an amended complaint that included a breach of implied
warranty of merchantability claim (810 ILCS 5/2-314 (West
1998)) under the Uniform Commercial Code (UCC) (810 ILCS
5/1-101 et seq. (West 2000)) against her treating hospital,
defendant Sarah Bush Lincoln Health Center (Health Center). The
circuit court of Coles County dismissed the claim, and the
appellate court affirmed (329 Ill. App. 3d 348). We granted
Brandt's petition for leave to appeal (177 Ill. 2d R. 315) to resolve
the question whether Brandt can bring a viable cause of action for
breach of the UCC implied warranty of merchantability against the
Health Center after a defective medical device was surgically
implanted during her medical treatment in that hospital.

BACKGROUND
	Brandt was admitted to the Health Center to receive treatment
for urinary incontinence. While there, a ProteGen Sling (sling) was
surgically implanted on December 23, 1998. A charge for the sling
was included in her bill from the Health Center. In January 1999,
the manufacturer of the sling, Boston Scientific Corporation,
issued a voluntary recall of the product because the product was
causing medical complications in 7% of patients. Brandt suffered
serious complications, including pain, infection, bleeding, and
erosion of vaginal tissue. In response to these complications, the
sling was surgically removed in November 1999.
	Brandt filed a six-count complaint in July 2000, alleging
negligence, strict liability, and breach of warranty against
defendants Boston Scientific Corporation and Sarah Bush Lincoln
Health Center. The Health Center filed a motion to dismiss counts
IV through VI under section 2-615 of the Code of Civil Procedure
(Code) (735 ILCS 5/2-615 (West 1998)) because the Health
Center was not a merchant of medical devices and because the
transaction between Brandt and the Health Center was
predominantly for services instead of goods. Pursuant to section
2-619 of the Code (735 ILCS 5/2-619 (West 1998)), the motion
alleged Brandt failed to comply with the pleading requirements of
section 2-622 of the Code (735 ILCS 5/2-622 (West 1998)).
Section 2-622 requires a plaintiff to attach an affidavit "[i]n any
action, whether in tort, contract or otherwise, in which the plaintiff
seeks damages for injuries or death by reason of medical, hospital,
or other healing art malpractice." 735 ILCS 5/2-622(a) (West
1998). The trial court granted the motion to dismiss without
prejudice for failure to comply with section 2-622.
	Brandt filed a four-count amended complaint in May 2001.
The first three counts again were against Boston Scientific
Corporation and are not part of this appeal. Count IV alleged a
breach of warranty claim against the Health Center; no section
2-622 affidavit was attached. Count IV specifically stated that the
Health Center "was engaged in the sale and distribution of medical
products, including [the] pubovaginal sling." As for the nature of
the transaction, Brandt alleged:
		"Plaintiff, BRENDA BRANDT, purchased a ProteGen
Sling catalog no. 820-121, lot. No. 027101, sold and
distributed by Defendant, SARAH BUSH LINCOLN
HEALTH CENTER, and was implanted with the said
product on or about December 23, 1998, at the SARAH
BUSH LINCOLN HEALTH CENTER in Mattoon,
Illinois."
	The Health Center again filed a motion to dismiss under
sections 2-615 and 2-619 of the Code, citing the same three
arguments it had raised about the original complaint. The trial
court dismissed count IV with prejudice for failure to comply with
the pleading requirements of section 2-622; the court expressed no
opinion regarding the other arguments asserted in the Health
Center's motion.
	The appellate court found that the trial court erred in holding
that count IV alleged a healing art malpractice claim. Thus, section
2-622 did not apply. 329 Ill. App. 3d at 353-54. The appellate
court affirmed the dismissal of count IV, however, because it
found that the transaction between Brandt and the Health Center
was primarily for services rather than goods so that the UCC did
not apply. 329 Ill. App. 3d at 353-54. The appellate court
acknowledged that Garcia v. Edgewater Hospital, 244 Ill. App. 3d
894 (1993), reached the opposite conclusion but expressly
declined to follow Garcia. 329 Ill. App. 3d at 353. The appellate
court concluded that Garcia erroneously relied upon this court's
decision in Cunningham v. MacNeal Memorial Hospital, 47 Ill. 2d 443 (1970), because Cunningham had been entirely overruled by
subsequent legislation and, further, because Cunningham involved
a strict liability claim rather than a UCC claim. 329 Ill. App. 3d at
353.
	Because Brandt prevailed on the section 2-622 issue before
the appellate court, she only raises the arguments from the section
2-615 motion to dismiss before this court. She submits that the
appellate court erred in finding that her transaction with the Health
Center was primarily for services and in asserting that
Cunningham was no longer good law. We now consider the
propriety of the dismissal of the breach of warranty claim against
the Health Center.

ANALYSIS
	A section 2-615 motion to dismiss presents a question of law,
which is reviewed de novo. Oliveira v. Amoco Oil Co., 201 Ill. 2d 134, 147-48 (2002). In reviewing a motion to dismiss under
section 2-615, we accept as true all well-pleaded facts and
reasonable inferences therefrom. Jackson v. South Holland Dodge,
Inc., 197 Ill. 2d 39, 44 (2001). We determine whether plaintiff
asserts a cause of action upon which relief may be granted after
considering all allegations in a light most favorable to plaintiff.
Jackson, 197 Ill. 2d  at 45.
	Article 2 of the UCC imposes the implied warranty of
merchantability. 810 ILCS 5/2-314 (West 2000). To succeed on
a claim of breach of implied warranty of merchantability, a
plaintiff must allege and prove: (1) a sale of goods (2) by a
merchant of those goods, and (3) the goods were not of
merchantable quality. 810 ILCS 5/2-314(1) (West 2000); see
Garcia, 244 Ill. App. 3d at 902; Malawy v. Richards
Manufacturing Co., 150 Ill. App. 3d 549, 558 (1986). Unless
excluded or modified, this warranty is implied in every sale under
these conditions. 810 ILCS 5/2-314(1) (West 2000).
	Article 2 applies to "transactions in goods." 810 ILCS
5/2-102 (West 2000). The UCC defines goods as "all things,
including specially manufactured goods, which are movable at the
time of identification to the contract for sale." 810 ILCS
5/2-105(1) (West 2000). Where there is a mixed contract for
goods and services, there is a "transaction in goods" only if the
contract is predominantly for goods and incidentally for services.
Belleville Toyota, Inc. v. Toyota Motor Sales, U.S.A., Inc., 199 Ill. 2d 325, 352-53 (2002). This analysis is known as the
"predominant purpose" test.
	The parties here do not dispute that the sling implanted in
Brandt satisfies the UCC definition of goods. The parties do
dispute, however, whether the exchange between Brandt and the
Health Center constituted a transaction in goods; the Health Center
argues that it primarily provided medical services rather than
goods to Brandt.
	In addition, an implied warranty of merchantability applies
only to a merchant of goods of the kind involved in the contract.
"Merchant" is defined in the UCC as:
		"a person who deals in goods of the kind or otherwise by
his occupation holds himself out as having knowledge or
skill peculiar to the practices or goods involved in the
transaction or to whom such knowledge or skill may be
attributed by his employment of an agent or broker or
other intermediary who by his occupation holds himself
out as having such knowledge or skill." 810 ILCS
5/2-104(1) (West 2000).
Section 2-314 provides, "a warranty that the goods shall be
merchantable is implied in a contract for their sale if the seller is
a merchant with respect to goods of that kind." (Emphasis added.)
810 ILCS 5/2-314(1) (West 2000). UCC comments explain that
this language in section 2-314 requires a merchant to have
professional status as to a particular kind of goods, which is
narrower than the general definition of merchant found in section
2-104. 810 ILCS Ann. 5/2-104, Uniform Commercial Code
Comment 2, at 70-71 (Smith-Hurd 1992); Siemen v. Alden, 34 Ill.
App. 3d 961, 964 (1975). The Health Center disputes that it is a
merchant of medical devices.
	Finally, a plaintiff must show that the goods in question were
not of merchantable quality. Merchantable means of a quality
commensurate with that generally accepted within the trade under
the description of the goods in the contract. 810 ILCS Ann.
5/2-314, Uniform Commercial Code Comment 2, at 186 (Smith-Hurd 1992). There is little dispute in this case that the sling was
not merchantable. In its notice of voluntary recall of the sling, the
manufacturer conceded as much by explaining, "we cannot assure
ourselves that the overall experience with ProteGen meets our
standards for product performance."
	We must determine whether, accepting the truth of the
complaint allegations and reasonable inferences, Brandt has stated
a cause of action upon which relief may be granted. Jackson, 197 Ill. 2d  at 44-45. The complaint alleged: (1) Brandt purchased the
sling from the Health Center; (2) the sling was implanted in her
body at the Health Center; and (3) the Health Center was engaged
in the sale of medical products, including slings. Thus, we must
determine whether these allegations assert that the transaction
between Brandt and the Health Center was predominantly for
goods, and if so, that the Health Center can be considered a
merchant of slings.
	As an initial matter, we address Brandt's contention that such
an evaluation is not properly made upon review of a motion to
dismiss because we have only the amended complaint and billing
statements to consider. Illinois courts on several occasions have
evaluated whether a contract involved a transaction in goods or
services upon review of dismissal of a UCC claim. Pitler v.
Michael Reese Hospital, 92 Ill. App. 3d 739, 742-43 (1980)
(hospital delivery of radiation treatment was predominantly for
services, so the breach of warranty claim was properly dismissed);
see also Zielinski v. Miller, 277 Ill. App. 3d 735, 741 (1995)
(masonry subcontract was primarily for services, so dismissal
under the UCC statute of limitations was inappropriate); Tivoli
Enterprises, Inc. v. Brunswick Bowling & Billiards Corp., 269 Ill.
App. 3d 638, 645-47 (1995) (bowling lane construction contract
was predominantly for goods, so dismissal under the UCC statute
of limitations was proper); Bob Neiner Farms, Inc. v. Hendrix, 141
Ill. App. 3d 499, 501-03 (1986) (building construction contract
was primarily for goods, so claim properly was dismissed under
UCC statute of limitations); Nitrin, Inc. v. Bethlehem Steel Corp.,
35 Ill. App. 3d 577, 594-95 (1976) (breach of implied warranty of
merchantability claim properly stricken by trial court because
construction contract was predominantly for services). We agree
that the predominant purpose test can be applied at this stage of
the proceedings.
	In addition, even what ordinarily may be a question of fact
becomes a question of law if the factual circumstances are
undisputed and no reasonable difference of opinion could arise
about the inferences that can be made from those facts. See Ceres
Illinois, Inc. v. Illinois Scrap Processing, Inc., 114 Ill. 2d 133, 142
(1986); Zale Construction Co. v. Hoffman, 145 Ill. App. 3d 235,
242 (1986). The parties do not dispute that Brandt purchased a
sling from the Health Center, which was implanted in her body at
the Health Center. It is reasonable to infer that Brandt had a
medical condition, which was diagnosed and treated through a
surgical procedure at the Health Center. According to the billing
statement, the hospital clearly provided medical facilities and
treatment necessary to enable the implantation of the sling. The
purchase of the sling was not an isolated transaction; it is not
reasonable to infer that Brandt simply went to the hospital, bought
the sling, and left. There is no reasonable dispute about the facts
of this case.
	Plaintiff asserts that the amended complaint does not allege
that the surgeon acted as an employee or agent of the hospital
when performing the implantation surgery and that we should not
presume as much. Defendant does not dispute the status of the
surgeon. The status of the surgeon is not determinative, and we
proceed on the assumption that the surgeon was not in any way
affiliated with the Health Center because the pleadings do not
address the surgeon's status.
	Thus, we can analyze, as a matter of law, whether the
hospital's sale of the sling and facilitation of its surgical
implantation was a transaction in goods under the UCC. There is
little Illinois case law evaluating the nature of such a hospital-patient transaction, and other jurisdictions are divided on this issue
(1 J. White & R. Summers, Uniform Commercial Code §9-2, at
436 (3d ed. 1988); Annotation, L. Sharp, Liability of Hospital or
Medical Practitioner Under Doctrine of Strict Liability in Tort, or
Breach of Warranty, for Harm Caused by Drug, Medical
Instrument, or Similar Device Used in Treating Patient, 65
A.L.R.5th 357 (1999)).
	We evaluated a transaction between a hospital and patient in
Cunningham. Both Brandt and the Garcia court rely heavily on
Cunningham in support of the position that a hospital's provision
of a medical device is a sale of goods to which UCC implied
warranties apply. In Cunningham, however, the plaintiff brought
a strict liability claim rather than a UCC claim against a hospital
after she contracted hepatitis from a contaminated blood
transfusion she received there. Cunningham, 47 Ill. 2d  at 445. The
defendant, relying on Perlmutter v. Beth David Hospital, 308 N.Y. 100, 123 N.E.2d 792 (1954), argued that a blood transfusion is a
service rather than a sale of a product so that strict liability could
not attach. Cunningham, 47 Ill. 2d  at 448-49. In Perlmutter, the
Court of Appeals of New York held that the plaintiff could not
bring an implied warranty of merchantability claim because a
blood transfusion was a service rather than a sale of goods under
the New York sales act. Perlmutter, 308 N.Y.  at 104, 108, 123 N.E.2d  at 796, 800. We rejected the Perlmutter reasoning.
Cunningham, 47 Ill. 2d  at 450. We instead found that the blood
transfusion transaction was a sale of a product, and the complaint
sufficiently alleged a strict liability claim. Cunningham, 47 Ill. 2d 
at 447, 450, 457.
	In response to our holding in Cunningham, the General
Assembly enacted the Blood and Organ Transaction Liability Act
(Act). See Pub. Act 77-184, eff. July 2, 1971 (adding Ill. Rev.
Stat. 1971, ch. 91, pars. 181 through 183, now codified at 745
ILCS 40/1 et seq. (West 2000)). Under this statute, no warranty or
strict liability claims can be brought regarding the "procuring,
furnishing, donating, processing, distributing or using" human
blood products or tissue "for the purpose of injecting, transfusing
or transplanting" them into the human body. 745 ILCS 40/2 (West
2000). Our appellate court is split in its interpretation of the effect
of this legislation. The appellate opinion in this case concluded
that the legislature entirely overruled our holding in Cunningham
through the Act (329 Ill. App. 3d at 353), while Garcia found that
the legislature foreclosed claims concerning human blood products
and tissue but not claims involving drugs, surgical instruments,
and other articles usable in the human body (Garcia, 244 Ill. App.
3d at 900, citing Hill v. Jackson Park Hospital, 39 Ill. App. 3d
223, 226 (1976)). We note that we applied the rationale of
Cunningham to the dispensing of birth-control pills subsequently
to the enactment of the Act. Berry v. G.D. Searle & Co., 56 Ill. 2d 548, 554-55 (1974). In addition, the language of the Act very
clearly expresses an intent to address only human blood products
and tissue. 745 ILCS 40/2 (West 2000). Thus, we find that the Act
overruled Cunningham only as to human blood products and
tissue.
	Nonetheless, Cunningham, a strict liability case, has limited
relevance to the present UCC warranty case. Courts in strict
liability cases must find that the defendant sold a product rather
than services before imposing liability. Restatement (Second) of
Torts §402A, at 347 (1965); Dubin v. Michael Reese Hospital &
Medical Center, 83 Ill. 2d 277, 279 (1980). In contrast, under
article 2 of the UCC, the transaction between the plaintiff and the
defendant must have been predominantly for goods rather than
services. Belleville Toyota, 199 Ill. 2d  at 352-53. Thus, in
Cunningham, we were undeterred by the fact that the provision of
blood was "an ancillary part of the services rendered to that
patient" before holding that the blood was a product sold so that
the complaint validly alleged a strict liability claim. (Emphasis
added.) Cunningham, 47 Ill. 2d  at 447, 449-50, 457. Thus, the
appellate court in Garcia incorrectly concluded that Cunningham
dictated that the predominant purpose test was inapplicable to
breach of warranty claims involving transactions between
hospitals and patients. Garcia, 244 Ill. App. 3d at 900.
	We also note that the 1970 Cunningham case predated
application of the predominant purpose test to UCC claims in
Illinois. This court did not explicitly endorse application of the
predominant purpose test to determine whether there is a
transaction in goods under article 2 of the UCC until 2002.
Belleville Toyota, 199 Ill. 2d  at 352-53. The earliest cases applying
the test in the lower Illinois courts began to appear in the mid-1970s. See, e.g., Executive Centers of America, Inc. v. Bannon, 62
Ill. App. 3d 738, 742 (1978) (contract was predominantly for the
employment services of plaintiff golf professional and only
incidentally for the purchase of goods, 20 golf carts); J&R Electric
Division of J.O. Mory Stores, Inc. v. Skoog Construction Co., 38
Ill. App. 3d 747, 748, 751 (1976) (subcontract to purchase and
install exterior unit electrical switchgear was primarily for
services).
	We now apply the predominant purpose test to the facts of
this case. Plaintiff's transaction with the Health Center is a mixed
contract because the hospital provided both medical services, such
as an operating room, and goods, such as the sling, to facilitate
treatment of plaintiff's medical condition. Under the predominant
purpose test, article 2, and its implied warranties, applies only if
a mixed contract is predominantly for goods and only incidentally
for services. Belleville Toyota, 199 Ill. 2d  at 352-53. When
evaluating the predominant nature of contracts, Illinois courts have
considered contract language in addition to assessing the
proportion of goods and services in the contract. See, e.g., Tivoli
Enterprises, 269 Ill. App. 3d at 646-47 (construction contract).
	In this case, Brandt's bill from the Health Center reflects that
of the $11,174.50 total charge for her surgery, a charge of
$1,659.50, or 14.9%, was for the sling and its surgical kit; a charge
of $5,428.50, or 48.6%, was for all movable goods, including
pharmaceuticals, medical supplies, and sterile supplies. The
remainder of the charges were for various services, including the
hospital and operating rooms and various kinds of medical testing
and treatment. A charge for the implantation of the sling by the
surgeon was not included in the bill. A majority of the charges,
51.4%, were for services rather than goods. Only a small fraction
of the total charge was for the sling, the goods at issue in this case.
In addition, the bill listed itemized charges under the heading
"service description."
	There is, however, more to the predominant purpose test than
making a simple comparison of money paid for goods and services
within a transaction. We must consider the predominate nature of
the transaction as a whole. As can be reasonably inferred from the
amended complaint, Brandt went to the Health Center for medical
treatment for her urinary incontinence, rather than merely to buy
a sling as one buys goods from a store. Treatment for her condition
involved implantation of the sling. While Brandt clearly purchased
these goods from the Health Center, the sling was only potentially
useful after its surgical implantation. Even assuming the surgeon
was a private physician not affiliated with the Health Center, the
Health Center provided services before, during, and after surgery
to facilitate implantation of the sling. These services, the medical
treatment, were the primary purpose of the transaction between
Brandt and the Health Center, and the purchase of sling was
incidental to the treatment.
	This analysis also has been adopted by the Georgia Court of
Appeals when similarly applying a predominant purpose test to
determine whether the UCC applies in a breach of warranty claim
against a hospital:
			"In this case, McCombs did not go to Southern
Regional to purchase a cervical plate but to have her
spinal problem surgically repaired. Southern Regional
furnished its facility for use by her surgeon, and it
supplied the requisite underlying support services,
including recovery room, laboratory, pharmacy support,
and nursing care, to help facilitate the surgery and her
recovery from it. 
			Thus, the transaction at issue was one involving
'services and labor with an incidental furnishing of
equipment and materials.' [Citation.]" (Emphasis added.)
McCombs v. Southern Regional Medical Center, Inc., 233
Ga. App. 676, 677, 504 S.E.2d 747, 749 (1998).
	In fact, the conclusion that the Health Center predominantly
provided services in this case is in accord with the national trend
on this issue. A majority of foreign jurisdictions hold that a
hospital's provision of a defective surgical device is primarily a
transaction for services rather than goods so that no implied
warranty of merchantability claim is available. See McCombs, 233
Ga. App. at 677, 504 S.E.2d  at 749; In re Breast Implant Product
Liability Litigation, 331 S.C. 540, 553, 503 S.E.2d 445, 452
(1998); Easterly v. HSP of Texas, Inc., 772 S.W.2d 211, 214 (Tex.
Ct. App. 1989); Hector v. Cedars-Sinai Medical Center, 180 Cal. App. 3d 493, 508 n.3, 225 Cal. Rptr. 595, 602 n.3 (1986); Redwine
v. Baptist General Convention, 681 P.2d 1121, 1124 (Okla. Ct.
App. 1982); Cutler v. General Electric Co., 4 U.C.C. Rep. Serv.
300 (N.Y. Sup. 1967); contra Skelton v. Druid City Hospital
Board, 459 So. 2d 818, 821-23 (Ala. 1984); Perfetti v. McGhan
Medical, 99 N.M. 645, 653, 662 P.2d 646, 654 (App. 1983).
	Holding hospitals liable for breach of warranty is not the only
legal remedy available to Brandt. She can seek recovery from the
manufacturer of the sling. See Immergluck v. Ridgeview House,
Inc., 53 Ill. App. 3d 472, 476 (1977). In fact, counts I through III
of Brandt's amended complaint are directed toward the
manufacturer. She also could bring a cause of action against the
hospital under a negligence theory. Cafazzo, 542 Pa. at 535, 668 A.2d  at 525. Foreclosing a breach of warranty claim under these
circumstances does not preclude recovery for Brandt.

CONCLUSION
	Because we find that the transaction between Brandt and the
Health Center was predominantly a transaction for services, article
2 of the UCC does not apply. Given this holding, we need not
evaluate whether the Health Center is a merchant of medical
devices. Count IV was properly dismissed from Brandt's amended
complaint.
	The judgment of the appellate court is affirmed.
Affirmed.