Case Title: Eads v. Heritage Enterprises, Inc.

Citation: 

Docket Number: 92691

State: illinois

Court: Illinois Supreme Court

Date: 2003-02-21T00:00:00Z

Document:
Docket No. 92691-Agenda 27-September 2002.
BETTY LOU EADS, Appellee, v. HERITAGE ENTERPRISES, 
 								INC., et al., Appellants.
Opinion filed February 21, 2003.
	JUSTICE RARICK delivered the opinion of the court:
	The sole issue in this case is whether a plaintiff asserting a
private right of action under the Nursing Home Care Act (210
ILCS 45/1-101 et seq. (West 2000)) must attach to her complaint
the certificate of merit and supporting report required by section
2-622 of the Code of Civil Procedure (735 ILCS 5/2-622 (West
2000)), popularly known as the Healing Arts Malpractice Act. On
a permissive interlocutory appeal brought pursuant to Supreme
Court Rule 308 (155 Ill. 2d R. 308), the appellate court answered
this question in the negative, holding that section 2-622 is
inapplicable to claims arising under the Nursing Home Care Act.
325 Ill. App. 3d 129. One justice dissented. We granted leave to
appeal from the appellate court's judgment (177 Ill. 2d R. 315) and
now affirm.
	The litigation which gave rise to this appeal commenced when
plaintiff, Betty Lou Eads, brought an action in the circuit court of
Sangamon County to recover damages for personal injuries she
sustained in a fall at Memorial ContinuCare (ContinuCare), a for-profit, extended-term nursing facility located in Springfield,
Illinois. Named as defendants were ContinuCare's three owners,
Heritage Enterprises, Inc.; Rutledge Joint Ventures, L.L.C.; and
Memorial Health Ventures.
	Plaintiff's complaint, as amended, alleged that she resided at
ContinuCare for approximately one week in July of 1998. Plaintiff
had gone to the facility following her release from Memorial
Medical Center, where she had been hospitalized for transient
ischemic attacks. At the time she arrived at ContinuCare, plaintiff
was weak, unsteady, and suffering from confusion. She
subsequently became feverish, which caused additional confusion,
hallucinations, weakness, unsteadiness, and an inability to
comprehend instructions given to her by the facility's staff.
	Plaintiff's amended complaint alleged that defendants, as the
owners and operators of ContinuCare, by and through their staff,
agents or employees, were aware that she was suffering from the
foregoing problems. The complaint further alleged that defendants
were aware that plaintiff repeatedly got out of bed without
assistance to go to the bathroom. On one such trip, she fell. The
fall caused her to fracture her hip and produced severe bruises on
her head and body.
	Plaintiff sought to impose liability on defendants for her
injuries pursuant to the Nursing Home Care Act (210 ILCS
45/1-101 et seq. (West 2000)). Specifically, plaintiff asserted that,
under the Act, defendants owed her a duty to "ensure that [she]
was assisted at all times when she needed to ambulate from her
bed to the bathroom." Plaintiff contended that defendants breached
that duty by failing to provide adequate surveillance and
supervision; failing to promptly respond to her call light, which
forced her to attempt to use the bathroom without assistance;
failing to equip her bed with a pressure-release alarm that would
have alerted the facility's staff when she got out of bed so that they
could come and assist her; failing to provide adequate staff to
ensure that residents, including plaintiff, would have assistance
when they required it; failing to attend to plaintiff's needs; and
allowing plaintiff to fall in her room as she attempted to go to the
bathroom. For her relief, plaintiff sought an award of damages
plus her costs and attorney fees.
	Defendants moved to dismiss plaintiff's cause of action under
section 2-619.1 of the Code of Civil Procedure (735 ILCS
5/2-619.1 (West 2000)). As grounds for their motion, defendants
argued that plaintiff should be precluded from proceeding with her
claims because she did not attach to her complaint the certificate
of merit and supporting report required by section 2-622 of the
Code of Civil Procedure (735 ILCS 5/2-622 (West 2000)), the
Healing Arts Malpractice Act. The circuit court found this
contention to be meritorious. It therefore dismissed plaintiff's
complaint with leave to replead.
	On plaintiff's motion, the circuit court subsequently made a
written finding pursuant to Supreme Court Rule 308(a) (155 Ill. 2d
R. 308(a)) that its dismissal order involved a question of law as to
which there is substantial ground for difference of opinion and that
immediate appeal from the order may materially advance the
ultimate termination of the litigation. The specific question of law
identified by the court was as follows:
			"In a case where the Plaintiff has sued a nursing home
for injuries sustained as a result of alleged violations by
the nursing home, its staff and employees, of the Illinois
Nursing Home Care Act [210 ILCS 45/1-101 et seq.
(West 2000)], and the regulations promulgated pursuant
thereto at 77 Illinois Administrative Code Section 300, et
seq., is the Plaintiff required to comply with the mandates
of *** the Healing Arts Malpractice Act [735 ILCS
5/2-622 (West 2000)]?
	Once the circuit court made its written finding, plaintiff
applied to the appellate court for leave to appeal from the circuit
court's dismissal order. The appellate court granted her
application. Over the dissent of one justice, the court then
answered the foregoing question of law in the negative, holding
that actions brought under the Nursing Home Care Act are not
subject to the mandates of the Healing Arts Malpractice Act. 325
Ill. App. 3d at 138.
	Defendants subsequently petitioned our court for leave to
appeal from the appellate court's judgment. We granted that
petition, and the matter is now before us for review. Because the
appeal concerns a question of law certified by the circuit court
pursuant to Supreme Court Rule 308, because it presents a
question of statutory interpretation, and because it arose in the
context of an order granting a section 2-619 motion to dismiss,
our review is de novo. Weatherman v. Gary-Wheaton Bank of Fox
Valley, N.A., 186 Ill. 2d 472, 480 (1999); Michigan Avenue
National Bank v. County of Cook, 191 Ill. 2d 493, 503 (2000);
Nowak v. St. Rita High School, 197 Ill. 2d 381, 389 (2001).
	The Nursing Home Care Act, upon which plaintiff's cause of
action is founded, was adopted more than 20 years ago "amid
concern over reports of 'inadequate, improper and degrading
treatment of patients in nursing homes.' " Harris v. Manor
Healthcare Corp., 111 Ill. 2d 350, 357-58, quoting Senate
Debates, 81st Ill. Gen. Assem., May 14, 1979, at 184 (statements
of Senator Karl Berning). It was described by one of its principal
sponsors as a " 'full reform of the nursing home industry.' "
Harris, 111 Ill. 2d  at 358, quoting Senate Debates, 81st Ill. Gen.
Assem., May 14, 1979, at 181 (statements of Senator Richard M.
Daley).
	The Act repealed the nursing homes, sheltered care homes and
homes for the aged act (Ill. Rev. Stat. 1977, ch. 111½, par. 35.16
et seq.) and
		"replaced it with a comprehensive statute which
established standards for the treatment and care of nursing
home residents; created minimum occupational
requirements for nurses aides; and expanded the power of
the Illinois Department of Public Health to enforce the
provisions of the Act." Harris v. Manor Healthcare
Corp., 111 Ill. 2d  at 358.
	A principal component of the Act is the residents' "bill of
rights," under which nursing home residents are guaranteed certain
rights, including the right to manage their own finances, the right
to refuse treatment, and the right to be free from abuse and neglect
by nursing home personnel. See 210 ILCS 45/2-101 through
2-113 (West 2000); see also Harris v. Manor Healthcare Corp.,
111 Ill. 2d  at 358.
	To ensure that nursing homes comply with the Act, the
legislature invested the Department of Public Health with
expanded regulatory and enforcement powers, and created civil as
well as criminal penalties. See, e.g., 210 ILCS 45/3-119, 3-301
through 3-318 (West 2000); see also Harris v. Manor Healthcare
Corp., 111 Ill. 2d  at 358-59. It also expressly granted nursing
home residents a private cause of action for damages and other
relief against nursing home owners and operators who violate its
provisions. 210 ILCS 45/3-601, 3-602, 3-603 (West 2000).
Fisher v. Lexington Health Care, Inc., 188 Ill. 2d 455, 461 (1999).
	In granting private remedies to nursing home residents, the
General Assembly embraced the concept of a "private attorney
general." It realized that the Department of Public Health could
not police every nursing home on a daily basis and could not
detect every violation of the Act. It also realized that nursing home
residents themselves are in the best position to know of and seek
redress for violations. See Springwood Associates v. Lumpkin, 239
Ill. App. 3d 771, 777 (1992).
	Under section 3-601 of the Act, owners and licensees of a
facility are liable to a resident for injuries caused by the intentional
or negligent acts or omissions of their employees or agents. 210
ILCS 45/3-601 (West 2000). Section 3-602 requires licensees to
pay actual damages and costs and attorney fees to nursing home
residents whose rights under the Nursing Home Care Act are
violated. 210 ILCS 45/3-602 (West 2000). Section 3-603 permits
nursing home residents to maintain an action under the Nursing
Home Care Act for any other type of relief permitted by law,
including injunctive and declaratory relief. 210 ILCS 45/3-603
(West 2000).
	The cause of action asserted by plaintiff in the case before us
is premised on the foregoing statutory provisions. There is no
dispute that the allegations of plaintiff's complaint, if proved,
would entitle her to relief under the Act. Defendants' challenge to
her cause of action is based solely on procedural grounds. They
argue that plaintiff should be precluded from proceeding against
them under the Nursing Home Care Act because she did not
comply with section 2-622 of the Code of Civil Procedure (735
ILCS 5/2-622 (West 2000)), commonly referred to as the Healing
Arts Malpractice Act.
	The Nursing Home Care Act itself contains no special
procedures regulating the conduct of private rights of action
brought pursuant to its provisions. Such actions are therefore
governed by article II of the Code of Civil Procedure (735 ILCS
5/2-101 et seq. (West 2000)), also known as the Civil Practice
Law (735 ILCS 5/1-101(b) (West 2000)), and by the Illinois
supreme court rules on civil proceedings in the trial court (134 Ill.
2d R. 1).
	Among the provisions of article II of the Code of Civil
Procedure is section 2-622 (735 ILCS 5/2-622 (West 2000)), the
Healing Arts Malpractice Act. That statute, however, does not
apply to all civil actions. By its terms, it is applicable only to
"action[s], 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 2000).
	In damage actions based on "medical, hospital or other
healing art malpractice," section 2-622 requires the plaintiff's
attorney or the plaintiff, if the plaintiff is proceeding pro se, to file
an affidavit, attached to the complaint, declaring that he has
consulted with a health-care professional who has determined, by
written report, that "there is a reasonable and meritorious cause for
filing of such action." A copy of the written report, "clearly
identifying the plaintiff and the reasons for the reviewing health
professional's determination," must be attached to the affidavit.
735 ILCS 5/2-622(a)(1) (West 2000). Failure to comply is
grounds for dismissal under section 2-619 of the Code of Civil
Procedure (735 ILCS 5/2-619 (West 2000)). 735 ILCS 5/2-622(g)
(West 2000).
	No affidavit or report of the type described by section 2-622
was attached to plaintiff's complaint. The absence of such
supporting documentation was the basis for the circuit court's
order granting defendants' motion to dismiss. The circuit court
correctly recognized, however, that its dismissal order can be
sustained only if plaintiff's cause of action under the Nursing
Home Care Act is subject to the requirements of the Healing Arts
Malpractice Act. That is why the court certified the question of
law before us today.
	When the applicability of section 2-622 was raised in the
circuit court, the threshold issue addressed by the parties and
considered by the court was whether plaintiff's cause of action
sounded in "medical, hospital or other healing art malpractice"
within the meaning of that statute. In holding that it did, the trial
court relied on Taylor v. City of Beardstown, 142 Ill. App. 3d 584
(1986), and Kolanowski v. Illinois Valley Community Hospital,
188 Ill. App. 3d 821 (1989). Those cases, however, involved
claims against hospitals based on common law negligence
principles, not statutory actions against nursing home owners or
licensees pursuant to the Nursing Home Care Act. In addition,
both concerned situations where there was an issue as to whether
and in what manner patients should have been physically
restrained.
	There is no question that the decision to physically restrain a
hospital patient requires the exercise of medical judgment. The
same is true of the decision to restrain the resident of a nursing
home. The Nursing Home Care Act specifically states that
restraints or confinements may not be employed "except as
ordered by a physician." 210 ILCS 45/2-106(b) (West 2000). In
the case before us, however, restraints are not at issue. No claim
is made that plaintiff should have been restrained and was not or
that her injuries were the proximate result of some failure by
defendants to employ appropriate physical confinements.
	Under the Nursing Home Care Act, actionable neglect
includes a failure to provide adequate "personal care" which
failure results in physical injury to the resident. 210 ILCS
45/1-117 (West 2000). "Personal care" is defined to mean
assistance with, among other things, "movement, bathing or other
personal needs or maintenance, or general supervision and
oversight of the physical and mental well-being" of the resident.
210 ILCS 45/1-120 (West 2000). These are the predicate for
plaintiff's claim here. As described earlier in this disposition, the
gravamen of plaintiff's complaint is that defendants breached their
statutory duties to her by failing to provide the supervision and
assistance necessary under the circumstances to enable her to
move safely from her bed to the bathroom in her room.
	A similar situation was presented in Owens v. Manor Health
Care Corp., 159 Ill. App. 3d 684 (1987). In that case, a nursing
home resident who had fallen and broken his hip while attempting
to get out of his wheel chair brought suit against the facility under
the Nursing Home Care Act. Among his allegations were that the
facility had failed to provide adequate supervision, failed to attend
to his needs, and negligently allowed him to remove himself from
his wheelchair.
	The nursing home moved to dismiss on the grounds that
plaintiff's complaint was fatally defective because it did not
include a written report from a health professional, as required by
section 2-622. The circuit court granted that motion, but the
appellate court reversed. It held that the negligence alleged in the
complaint did not constitute "healing art malpractice" within the
meaning of section 2-622 because it did not arise from medical
diagnosis or treatment.
	In the appellate court's view,
		"[t]he plaintiff merely fell as he attempted to remove
himself from his wheelchair. Expert testimony from a
health-care professional is not required to assess the acts
of the defendant. The determination to be made is not
inherently one of medical judgment." Owens v. Manor
Health Care Corp., 159 Ill. App. 3d at 688-89.
Accordingly, the court concluded that plaintiff was not required to
comply with section 2-622. It therefore reversed the judgment
dismissing plaintiff's claim with prejudice and remanded the cause
to the circuit court for further proceedings. Owens v. Manor
Health Care Corp., 159 Ill. App. 3d at 689.
	Although the appellate court in the case before us reached the
same result, it employed a different analysis. The Owens court
focused on the nature of the particular wrongdoing alleged in the
complaint. Under its approach, the pivotal inquiry is whether the
negligence claimed by a nursing home resident could be construed
as "healing arts malpractice." If it cannot, section 2-622 is
inapplicable. If it can, however, the reasoning of Owens would
require that section 2-622 be followed.
	Under the Owens approach, a possibility remains that some
claims under the Nursing Home Care Act will be subject to section
2-622's requirements. The appellate court in this case, however,
found that an irreconcilable conflict existed between the Nursing
Home Care Act, on the one hand, and the legislative package with
which section 2-622 was enacted, on the other. It resolved the
conflict by holding: (1) that the Nursing Home Care Act was more
specifically applicable to plaintiff's cause of action than section
2-622 and (2) that requiring nursing home residents to comply
with section 2-622 as a condition of filing suit under the Nursing
Home Care Act would thwart the purpose of the Act. Based on
these principles, the appellate court found it unnecessary to assess
whether particular conduct would otherwise constitute "healing art
malpractice." It ruled simply that the mandates of section 2-622
are not binding on plaintiffs who seek recovery under the Nursing
Home Care Act. 325 Ill. App. 3d at 136-38.
	The approach taken by the appellate court is sound. In
construing the statutes at issue in this case and the relationship
between them, the court may consider the reason and necessity for
the legislation, the evils it was designed to remedy, and the objects
and purposes the General Assembly sought to achieve. See People
v. Woods, 193 Ill. 2d 483, 487 (2000). Section 2-622 postdates the
Nursing Home Care Act and had a different objective than that
statute. As indicated earlier in this disposition, the Nursing Home
Care Act was directed specifically at reforming the nursing home
industry. Section 2-622, on the other hand, is one of a number of
provisions added to the Code of Civil Procedure in 1985 by Public
Act 84-7, eff. August 16, 1985, in response to what was perceived
by the General Assembly to be a crisis in the area of medical
malpractice litigation. Miller v. Rosenberg, 196 Ill. 2d 50, 60
(2001).
	The Nursing Home Care Act sought to achieve its purposes by
expanding the criminal and civil liability of nursing home owners
and licensees and by encouraging nursing home residents to press
their claims as private attorneys general. Under the Act, litigation
was viewed as an engine of reform. Just the opposite was true of
the medical malpractice reform legislation with which section
2-622 was enacted. That set of laws viewed private damage claims
as detrimental. Rather than expand opportunities for plaintiffs to
seek redress, the medical malpractice reform legislation was
designed to protect defendants. Its provisions were enacted with
a view to reducing the number of medical malpractice suits and
lowering the size of the awards in medical malpractice cases
where plaintiffs succeed in establishing their claims. Miller v.
Rosenberg, 196 Ill. 2d  at 60-61, quoting Ill. Ann. Stat., ch. 110,
2-109, Historical & Practice Notes, at 30 (Smith-Hurd Supp.
1992).
	The opposing nature of the two sets of laws is evident from
their provisions. The medical malpractice reform legislation
expressly bans recovery of punitive damages in all cases in which
the plaintiff seeks damage by reason of medical, hospital or other
healing art malpractice. 735 ILCS 5/2-1115 (West 2000). By
contrast, the Nursing Home Care Act allows plaintiffs to recover
common law punitive damages upon proof of willful and wanton
misconduct on the part of defendants. Dardeen v. Heartland
Manor, Inc., 186 Ill. 2d 291, 300 (1999).
	In medical malpractice actions, plaintiffs must pay their own
attorney fees. In addition, the amount of fees a plaintiff may pay
his or her own lawyer on a contingency basis is limited. The higher
recovery, the lower the permissible rate. 735 ILCS 5/2-1114
(West 2000). Private rights of action for damages under the
Nursing Home Care Act, on the other hand, actually benefit from
a fee-shifting provision. The attorney fees for a successful plaintiff
must be paid by the defendant nursing home licensee, not the
plaintiff, and the amount of fees that the plaintiff's attorney may
receive is not subject to any statutory maximum. 210 ILCS
45/3-602 (West 2000).
	In addition to authorizing statutory fee awards, the Nursing
Home Care Act contains a number of additional provisions whose
purpose is to encourage plaintiffs to bring private rights of action.
Under the Act, damages may be recovered through class actions.
210 ILCS 45/3-604 (West 2000). Exhaustion of administrative
remedies is not required prior to commencing suit. 210 ILCS
45/3-604 (West 2000). The damages a plaintiff recovers may not
be taken into consideration for purposes of considering the
plaintiff's eligibility for medical assistance under the Public Aid
Code (305 ILCS 5/1-1 et seq. (West 2000)). 210 ILCS 45/3-605
(West 2000). In addition, a nursing home licensee is prohibited
from taking any retaliatory action against a resident who asserts a
private right of action to recover damages from it, regardless of the
outcome. 210 ILCS 45/3-608 (West 2000).
	The medical malpractice legislation of which section 2-622
is a part contains no corresponding incentives for pursing damage
claims. To the contrary, it provides a disincentive for the filing of
healing arts malpractice claims. It does so by subjecting
unsuccessful litigants to suits for malicious prosecution in which
the medical provider is relieved of the obligation to plead and
prove special injury. 735 ILCS 5/2-109 (West 2000); Miller v.
Rosenberg, 196 Ill. 2d  at 63-64.
	The applicability of section 2-622 to Nursing Home Care Act
proceedings cannot be assessed independently of the remainder of
the medical malpractice legislative package with which it was
enacted. If plaintiff's private right of action for damages under the
Nursing Home Care Act were bound by the terms of section
2-622, it would likewise be bound by the other statutes directed at
medical malpractice which were inserted into the Code of Civil
Procedure by the legislature when it adopted section 2-622. There
would be no principled way to differentiate between the various
statutory restrictions. As a result, the remedies available to
plaintiff would be drastically curtailed and her right to recover
attorney fees would be lost. Core provisions of the Nursing Home
Care Act would be rendered inoperable. Such a result would be
contrary to a basic rule of statutory interpretation, namely, that
whenever possible courts must construe statutes so that no part is
rendered a nullity. See Bonaguro v. County Officers Electoral
Board, 158 Ill. 2d 391, 397 (1994).
	In reaching this conclusion, we are aware that many types of
claims actionable under the Nursing Home Care Act have nothing
whatever to do with medical or healing art malpractice. Nursing
home residents are entitled to invoke the provisions of the Nursing
Home Care Act to obtain damages for violation of any of the rights
enumerated in the statute. 210 ILCS 45/3-602 (West 2000). These
include the right to manage financial affairs (210 ILCS 45/2-102
(West 2000)); the right to retain and use personal property (210
ILCS 45/2-103 (West 2000)); the right to be free from abuse or
neglect (210 ILCS 45/2-107 (West 2000)); the right to unimpeded
private and uncensored communication (210 ILCS 45/2-108
(West 2000)); the right to free exercise of religion (210 ILCS
45/2-109 (West 2000)); the right to be discharged after giving
written notice of desire to be discharged (210 ILCS 45/2-111
(West 2000)); and the right to refuse to perform labor for the
facility (210 ILCS 45/2-113 (West 2000)). In addition, the Act
imposes liability on the owner and licensee of a nursing home for
any intentional or negligent act or omission by their agents or
employees which injures a resident. 210 ILCS 45/3-601 (West
2000).
	Where the intentional or negligent act or omission does not
involve a resident's medical care and the situation is not one
where expert testimony from a health-care professional is
necessary in order to assess the defendant's actions, there is no
possible basis for invoking the Healing Arts Malpractice Act. In
such cases, it is undisputed that a nursing home resident's
complaint would not be subject to dismissal for failure to comply
with section 2-622 of the Code of Civil Procedure (735 ILCS
5/2-622 (West 2000)). See Owens v. Manor Health Care Corp.,
159 Ill. App. 3d at 688-89. As a result, the broad remedial
provisions of the Nursing Home Care Act would retain some
viability even if 2-622 were applied to Nursing Home Care Act
claims involving a resident's medical care. That viability,
however, would be more theoretical than real.
	The overwhelming majority of civil cases against nursing
homes arising from the treatment of residents involve falls, as this
case does. Indeed, one commentator has observed that nursing
home cases involving causes of injuries other than falls are too few
to permit statistical analysis. Annotation, L. Frantz, Patient Tort
Liability of Rest, Convalescent, or Nursing Homes, 83 A.L.R.3d
871, 878 (1978). As defendants' conceptualize these cases, a
nursing home's failure to take the precautions necessary to prevent
a resident from taking an injurious fall implicates the exercise of
medical judgment. If defendants' position were accepted, there
would therefore be few cases involving private rights of action
against nursing homes where compliance with section 2-622 and
the related provisions governing medical malpractice provisions
would not be necessary. Correspondingly, there would be few
opportunities for injured nursing home residents to avail
themselves of the Nursing Home Care Act's special remedies and
protections. As a practical matter, the opportunities the General
Assembly meant to confer on such residents to protect themselves
and enforce the law would be fundamentally compromised.
	Defendants complain that if nursing home residents are not
held to the requirements of section 2-622 when they bring
statutory claims under the Nursing Home Care Act, the courts will
be creating a synthetic, unreasonable and unworkable distinction
between nursing homes, on the one hand, and hospitals and
physicians, on the other. What defendants fail to appreciate is that
the decision to differentiate nursing home owners and licensees
from healing arts practitioners originated with the legislature, not
the judiciary. Section 2-622 was enacted after passage of the
Nursing Home Care Act. At the time section 2-622 was adopted
in 1985, the Nursing Home Care Act had already been in effect for
approximately five years. Had the General Assembly wished to
subject claims against nursing home owners and licensees to
section 2-622's requirements, it could easily have included them
in the statute's provisions, just as it did with hospitals. It did not.
	While defendants may find it anomalous to treat litigation
against the owners and licensees of nursing homes differently than
actions against hospitals, the General Assembly may have had
sound reasons to do so. First and foremost, nursing homes have
been plagued by an extensive history of patient abuse not shared
by hospitals. In contrast to hospitals, which have historically
delivered care through professional physicians and nurses, most
care in nursing homes is delivered by nonprofessional or
paraprofessional aides. In addition, while the majority of private
hospitals are not-for-profit, the majority of nursing homes,
including the nursing home in this case, are profit-making
enterprises, raising the concern that profit motives may adversely
affect the care that nursing home patients receive. See Regan,
Regulating the Business of Medicine, 30 Colum. J.L. & Soc.
Probs. 635, 669 (1997).
	It is important to note, moreover, that while claims under the
Nursing Home Care Act may sometimes involve a resident's
medical care, they do not directly implicate the individual health-care providers. A failure to provide adequate medical care that
"results in physical or mental injury to a resident, or in the
deterioration of a resident's physical or mental condition"
constitutes neglect (210 ILCS 45/1-117 (West 2000)) and is
prohibited by the Act (210 ILCS 45/2-107 (West 2000)). The only
defendants liable for damages, costs, and attorney fees under the
Act, however, are the owners and licensees of the nursing home.
See 210 ILCS 45/3-601, 3-602 (West 2000). Nothing in the
Nursing Home Care Act requires owners or licensees to be
medical professionals themselves, and nothing in the Act
authorizes nursing home residents to recover damages for medical
malpractice from the individuals who actually provided the care.
Suits against those individuals must be asserted independently of
the Nursing Home Care Act.
	The justification for section 2-622 is therefore absent when
a resident brings a statutory claim against the nursing home's
owner or licensee under the Nursing Home Care Act. Such cases
pose no threat to the viability of the medical profession. They
present no danger of compromising the ability of medical
professionals to provide care to patients. They serve only to ensure
that nursing home owners and licensees are held to account for
violation of their legal obligations, as the General Assembly
intended when it passed the Nursing Home Care Act into law.
	For the foregoing reasons, the appellate court's answer to the
question of law certified by the trial court was correct. Plaintiffs
who assert private rights of action under the Nursing Home Care
Act are not required to comply with the mandates of section
2-622. As a result, the circuit court should not have dismissed the
action brought by the plaintiff in this case based on her failure to
attach to her complaint the materials specified by that statute. The
appellate court's judgment is therefore affirmed.

Affirmed.
	I respectfully dissent. The majority finds that the Nursing
Home Care Act (Act) (210 ILCS 45/1-101 et seq. (West 2000))
and section 2-622 of the Code of Civil Procedure (Code) (735
ILCS 5/2-622 (West 2000)), known as the Healing Art
Malpractice Act, are wholly incompatible, so that section 2-622
does not apply to any claims brought under the Act. However,
when two statutes conflict, the court has a duty to interpret the
statutes in a way that avoids inconsistency and that gives effect to
both statutes where reasonably possible. McNamee v. Federated
Equipment & Supply Co., 181 Ill. 2d 415, 427 (1998). To that end,
I believe that section 2-622 does apply to claims under the Act
alleging that nurses or other health-care professionals employed by
nursing homes caused injury to residents because of healing art
malpractice.
	According to section 1-108(b) of the Code (735 ILCS
5/1-108(b) (West 2000)), article II of the Code applies to
proceedings brought under a statute that does not itself regulate
procedure. The Act does not regulate pleadings. Nonetheless, the
majority correctly notes that section 2-622 does not apply to all
actions. Section 2-622 applies to: "any action *** 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 2000). Therefore, we should determine whether a "healing
art malpractice" claim can ever be alleged under the Act.
	The phrase "healing art" includes "an entire branch of
learning dealing with the restoration of physical or mental health."
Lyon v. Hasbro Industries, Inc., 156 Ill. App. 3d 649, 654 (1987);
see also Owens v. Manor Health Care Corp., 159 Ill. App. 3d 684,
687 (1987). "Malpractice" is defined as"[f]ailure of one rendering
professional services to exercise that degree of skill and learning
commonly applied under all the circumstances in the community
by the average prudent reputable member of the profession with
the result of injury *** to the recipient of those services." Black's
Law Dictionary 959 (6th ed. 1990). In evaluating whether a claim
involves healing art malpractice, Illinois courts have focused on
the nature of the negligent act rather than the location where the
conduct occurred. Milos v. Hall, 325 Ill. App. 3d 180, 184 (2001);
Lyon, 156 Ill. App. 3d at 655.
	Nursing homes may employ health-care professionals. For
example, nursing homes that employ nurses and provide nursing
services are subject to the Act, which states that it applies to
facilities that "provide[], through its ownership or management,
personal care, sheltered care or nursing for 3 or more persons."
(Emphasis added.) 210 ILCS 45/1-113 (West 2000). Healing art
malpractice claims can be brought against nurses. See, e.g., Moyer
v. Southern Illinois Hospital Service Corp., 327 Ill. App. 3d 889,
903-04 (2002); Shanks v. Memorial Hospital, 170 Ill. App. 3d 736,
737 (1988).
	The Act clearly authorizes the courts to hold nursing homes
liable for the actions of its employees. Section 3-601 provides:
"The owner and licensee are liable to a resident for any intentional
or negligent act or omission of their agents or employees which
injures the resident." 210 ILCS 45/3-601 (West 2000). Medical
malpractice is a type of negligence claim. See Black's Law
Dictionary 959 (6th ed. 1990). It logically follows that a nursing
home can be held liable under section 3-601 when its health-care
professional employee commits healing art malpractice, causing
injury to a resident. The majority seems to acknowledge as much.
Slip op. at 11-12.
	The majority correctly recognizes that there are some conflicts
between the Act and the medical malpractice reform legislation.
Slip op. at 9-10. The reform legislation, including section 2-622,
includes certain procedural and remedial rules that differ from
rules of the Act. A conflict arises between these two sets of
legislation, then, when a plaintiff raises a healing art malpractice
claim under the Act. While the majority views this conflict as
proof of the "opposing nature" of these statutes, rendering them
mutually exclusive, I view them as conflicts to be resolved through
the application of statutory construction principles. Slip op. at 9.
When two statutes conflict, the more specific statute controls over
the more general provisions unless the legislature makes it clear
that it intends the more general statute to be controlling. Stone v.
Department of Employment Security Board of Review, 151 Ill. 2d 257, 266 (1992).
	The appellate court applied this statutory construction
principle. 325 Ill. App. 3d 129, 135-36. The majority briefly
acknowledges and agrees with the appellate court's conclusion
that the Act should apply because it is more specifically applicable
to plaintiff's cause of action than section 2-622. Slip op. at 8. In
reaching this conclusion, the appellate court discussed two
approaches: the traditional approach examining the nature of the
cause of action and the Tosado plurality approach looking to the
category of defendants (Tosado v. Miller, 188 Ill. 2d 186, 195
(1999)). 325 Ill. App. 3d at 135-36.
	In Tosado, we evaluated whether to apply the two-year statute
of limitations from the Code (735 ILCS 5/13-212(a) (West 1992))
or the one-year limitations period from the Tort Immunity Act
(745 ILCS 10/8-101 (West 1996)) to a medical malpractice claim.
Tosado, 188 Ill. 2d  at 190-91. The Tosado plurality focused on the
class of defendants in determining which was more specific
because the Tort Immunity Act was enacted with the legislative
intent to provide protection to a specific class of defendants, local
governmental entities. Tosado, 188 Ill. 2d  at 195. Five members
of the court did not agree with this approach in that case. Tosado,
188 Ill. 2d  at 197-98 (Freeman, C.J., specially concurring); 188 Ill. 2d  at 198-200 (Heiple, J., specially concurring); 188 Ill. 2d  at 200
(Harrison, J., dissenting); 188 Ill. 2d  at 201-11 (McMorrow, J.,
dissenting, joined by Rathje, J.). The Act, in contrast, is not
designed to protect defendant nursing homes. Therefore, I
conclude that the Tosado approach is not relevant to the present
case.
	I do agree with the appellate court's conclusion in this case
that we should apply the traditional rule that the nature of the
cause of action determines which statute is more specific and
therefore controlling. See, e.g., Hernon v. E.W. Corrigan
Construction Co., 149 Ill. 2d 190, 196 (1992). However, I believe
the appellate court incorrectly focused on the nature of plaintiff's
cause of action. We should not review plaintiff's claims because
of the procedural posture of the present case. We review only the
general certified question, which requires us only to determine
when, if ever, section 2-622, and impliedly the other medical
malpractice reform legislation, applies to claims brought under the
Act. Slip op. at 3. These sets of laws conflict only with regard to
medical malpractice claims. Thus, we must assess whether the Act
or the medical malpractice reform legislation more specifically
addresses medical malpractice claims.
	The Act and the medical malpractice reform legislation both
encompass malpractice claims. As discussed above, the Act
generally addresses negligence claims by enabling claimants to
hold liable the owner and licensee of a nursing home facility for
"any intentional or negligent act or omission of their agents or
employees which injures the resident." (Emphasis added.) 210
ILCS 45/3-601 (West 2000). Medical malpractice is one type of
negligence claim. See Black's Law Dictionary 959 (6th ed. 1990).
In contrast, the medical malpractice reform legislation, including
section 2-622, makes procedural and remedial amendments
applicable specifically to medical malpractice claims rather than
all negligence claims. Thus, I conclude that the specific provisions
of the medical malpractice reform legislation should apply to
healing art malpractice claims brought under the Act, which
addresses negligence only generally, because the legislature did
not clearly indicate an intent that the general provisions apply.
Stone, 151 Ill. 2d  at 266.
	The Act became effective March 1, 1980, and Public Act
84-7, which contained section 2-622 and other medical
malpractice reform provisions, became effective August 15, 1985.
We presume the legislature acts rationally, enacting statutes with
full awareness of all previous enactments. State v. Mikusch, 138 Ill. 2d 242, 247-48 (1990). We presume the legislature enacted
reform to medical malpractice actions with knowledge of the Act.
If the legislature wanted to make the Act completely immune to
these reform measures, it could have excluded professional health-care services in nursing homes. It did not. We should not read into
a statute limitations or exceptions that depart from its plain
meaning. Lauer v. American Family Life Insurance Co., 199 Ill. 2d 384, 390-91 (2002). In addition, where two statutes directly
conflict, typically the later-here the medical malpractice reform
legislation-should prevail because it constitutes the more recent
expression of legislative intent. Jahn v. Troy Fire Protection
District, 163 Ill. 2d 275, 282 (1994).
	Apparently the majority eschews application of these statutory
construction principles because it concludes that these laws as a
whole are inherently in opposition. Slip op. at 9. I disagree. The
Act responded to "concern over reports of 'inadequate, improper
and degrading treatment of patients in nursing homes.' " Harris v.
Manor Healthcare Corp., 111 Ill. 2d 350, 357-58 (1986), quoting
81st Ill. Gen. Assem., Senate Debates, May 14, 1979, at 184
(statements of Senator Berning). The Act explicitly conferred
certain rights on nursing home residents, including "the right to
manage their own finances, the right to refuse treatment, and the
right to be free from abuse and neglect by nursing home
personnel." Fisher v. Lexington Health Care, Inc., 188 Ill. 2d 455,
461 (1999); 210 ILCS 45/2-101 through 2-113 (West 2000).
	The purpose of section 2-622 and other medical malpractice
legislation enacted by Public Act 84-7 was to respond to "what
was perceived to be a crisis in the area of medical malpractice."
Bernier v. Burris, 113 Ill. 2d 219, 229 (1986). The legislature
sought to address this crisis by reducing the amount of frivolous
suits filed and to eliminate such suits at an early stage before
litigation expenses have mounted. DeLuna v. St. Elizabeth's
Hospital, 147 Ill. 2d 57, 65 (1992).
	The purposes of these two statutes should not be characterized
solely in terms of encouraging or discouraging litigation, or of
being pro-plaintiff or pro-defendant. The goal of improving
nursing home care is not impeded by eliminating frivolous healing
art malpractice lawsuits against health-care professionals.
	The majority discusses the provisions of the medical
malpractice reform legislation that impose procedural and
remedial limitations absent from the Act, including a prohibition
of recovery of punitive damages (735 ILCS 5/2-1115 (West
2000)) and a lack of corresponding availability of recovery of
costs and attorneys' fees (210 ILCS 45/3-602 (West 2000)). Slip
op. at 9-10. However, in some cases the majority overstates the
importance of certain provisions in support of its conclusion that
the two statutes are by nature in opposition. Slip op. at 9.
	For example, the majority asserts that the medical malpractice
reforms "provide[ ] a disincentive for the filing of healing arts
malpractice claims *** by subjecting unsuccessful litigants to suits
for malicious prosecution." Slip op. at 10. The reform litigation
does remove the requirement of pleading and proving special
injury from malicious prosecution claims. 735 ILCS 5/2-109
(West 2000). However, claimants still must prove that the healing
art malpractice claim was filed without probable cause and with
malice. Miller v. Rosenberg, 196 Ill. 2d 50, 58 (2001). Therefore,
all unsuccessful litigants will not be sued for malicious
prosecution. The purpose of section 2-109 was to "liberalize the
availability of a suit for malicious prosecution as a means of
punishing and discouraging the filing of ill-grounded medical
malpractice cases." Miller, 196 Ill. 2d  at 63, quoting Ill. Ann. Stat.,
ch. 110, par. 2-109, Historical & Practice Notes, at 31 (Smith-Hurd Supp. 1992). Thus, this provision should not deter plaintiffs
with potentially viable claims, and it should not impede the Act's
general purpose of improving nursing home care.
	In addition, the majority notes that the medical malpractice
reform legislation limits contingency fees that can be paid to
attorneys. 735 ILCS 5/2-1114 (West 2000); slip op. at 9-10. When
evaluating the constitutionality of this contingency fee provision,
however, we stated that we did not believe that section 2-1114
"will work to limit litigants access to the courts." Bernier v.
Burris, 113 Ill. 2d 219, 251 (1986). Finally, the majority
emphasizes provisions in the Act that encourage plaintiffs to bring
private rights of action, including the ability of plaintiff to file
class action suits. 210 ILCS 45/3-604 (West 2000). Class action
suits will rarely, if ever, be an appropriate format for raising
medical malpractice cases which by nature typically involve a
specific instance of negligence by an individual health-care
professional in the care of an individual patient rather than a
consistent, widespread pattern of negligence by the same
defendant.
	The majority also asserts that the Act would be limited further
by the other medical malpractice reform provisions that were
passed with section 2-622. Slip op. at 10-11. I believe that these
other medical malpractice reforms will not frustrate the purposes
of the Act. Section 2-622 was a part of Public Act 84-7, which
amended sections 2-1109, 2-1205, 8-2001, and 8-2003 of the
Code (Ill. Rev. Stat. 1985, ch. 110, pars. 2-1109, 2-1205, 8-2001, 
8-2003) and added sections 2-114, 2-611.1, 2-622, 2-1010,
2-1012 through 2-1020, 2-1114, 2-1115, 2-1701 through
2-1719, and 8-2501 to the Code (Ill. Rev. Stat. 1985, ch. 110,
pars. 2-1020, 2-1114, 2-1115, 2-1701 through 2-1719, 8-2501).
	In examining all of these provisions, only one appears
relevant to the potential concern of discouraging litigation or
reducing recovery against nursing homes besides the attorney fees
and punitive damages issues already discussed. Section 2-1205 of
the Code (735 ILCS 5/2-1205 (West 2000)) addresses reduction
in amount of recovery, but we have interpreted the specific
language of this provision as limiting negligence actions against
only hospitals and physicians. Bernier v. Burris, 113 Ill. 2d 219,
242 (1986); 735 ILCS 5/2-1205 (West 2000) (section 2-1205
states that it applies to "any judgment in an action to recover for
that injury based on an allegation of negligence or other wrongful
act, not including intentional torts, on the part of a licensed
hospital or physician"). Therefore, no other provision of the
medical malpractice reform legislation potentially conflicts with
the purposes of the Act.
	In addition, as the majority concedes, there are many types of
actionable claims under the Act that do not involve healing art
malpractice. Slip op. at 11. Given these numerous other claims
that will not be subject to the medical malpractice reform
legislation, I disagree with the majority's assertion that "[c]ore
provisions of the Nursing Home Care Act would be rendered
inoperable" in all cases. Slip op. at 11. I do not believe that the
handful of conflicting provisions and the majority's
characterization of the opposing purposes of the statutes are
sufficient to support its conclusion that the medical malpractice
reform legislation does not apply to any claims brought under the
Act, especially in the absence of supporting statutory language.
	In fact, I do not believe that these differences about attorney
fees and punitive damages significantly limit the Act because these
limits would apply only to the narrow class of healing art
malpractice claims brought against health-care professionals
employed by nursing homes. The majority dismisses this
distinction because "[t]he overwhelming majority of civil cases
against nursing homes" involve falls, so the medical malpractice
reform legislation will apply to most claims brought under the Act.
Slip op. at 12. I disagree. It is not clear that many, much less all,
falls resulting in injury are caused by medical malpractice by
health-care professionals employed by nursing homes. Ordinary
negligence through inadequate staffing and unsafe premises
conditions, for example, may contribute to a fall by a nursing
home resident. In addition, again, the procedural posture of this
case requires us to review only the appellate court's response to
the broad certified question of the trial court. Slip op. at 3. It is
irrelevant and inappropriate for us to evaluate whether plaintiff's
claims involving her fall or hypothetical cases involving falls
necessarily would be subject to the medical malpractice reform
legislation.
	The holding of the majority has the disturbing and illogical
consequence that healing art malpractice by the same health-care
professional will be subject to different procedural and remedial
rules solely based on the physical location of malpractice. The
majority responds that the legislature may have had sound reasons
to treat these two health-care service providers differently,
including the history of patient abuse unique to nursing homes and
the greater prevalence of care by nonprofessional or
paraprofessional aides in nursing homes. Slip op. at 13. However,
claims of patient abuse likely do not implicate efforts-or lack
thereof-to restore physical or mental health by health-care
professionals, so these claims do not sound in healing art
malpractice. In addition, nonprofessionals by definition are not
health-care professionals potentially subject to malpractice claims.
The majority's explanations do not adequately address why the
legislature would want to treat nursing homes differently from
hospitals specifically concerning healing art malpractice claims.

CONCLUSION
	I acknowledge that certain medical malpractice reform
provisions conflict with the Act when a plaintiff brings a healing
art malpractice claim under the Act. Several principles of statutory
construction indicate that we should resolve this conflict by
applying the medical malpractice reform provisions, including
section 2-622, to such claims. By applying the reform legislation,
all medical malpractice cases will be treated consistently, allowing
both statues to operate together. See McNamee, 181 Ill. 2d  at 427.
The reform legislation more specifically addresses healing art
malpractice claims. See Hernon, 149 Ill. 2d  at 196. We presume
the legislature enacted the reform legislation with knowledge of
the Act, and the reforms did not exclude claims brought under the
Act from their scope. See Mikusch, 138 Ill. 2d  at 247-48. The
reform legislation is the later enactment of the two conflicting sets
of laws. See Jahn, 163 Ill. 2d  at 282. I believe the majority should
have applied these principles in order to avoid the unwarranted
consequence that healing art malpractice claims will be subject to
differing procedural and remedial rules solely on the basis of the
physical location of where the malpractice occurred.
	I believe the appellate court and the majority are mistaken in
responding to the certified question that plaintiffs suing nursing
homes under the Act never have to comply with section 2-622. I
assert that we should follow established principles of statutory
construction by applying the medical malpractice reform
legislation to the narrow class of claims brought under the Act
alleging healing art malpractice by health-care professionals
employed by nursing homes that caused injury. Therefore, I would
answer the certified question by stating that a plaintiff bringing
suit under the Act is required to comply with the Healing Arts
Malpractice Act if he or she alleges a healing art malpractice
claim.
	CHIEF JUSTICE McMORROW and JUSTICE THOMAS
join in this dissent.