Case Title: People ex rel. Department of Professional Regulation v. Manos

Citation: 

Docket Number: 93299

State: illinois

Court: Illinois Supreme Court

Date: 2002-12-05T00:00:00Z

Document:
Docket No. 93299-Agenda 33-September 2002.
THE PEOPLE OF THE STATE OF ILLINOIS ex rel. THE 
DEPARTMENT OF PROFESSIONAL REGULATION, 
Appellant, v. THOMAS G. MANOS, D.D.S., and MARK
KOLOZENSKI, D.D.S., Appellees.
Opinion filed December 5, 2002.

	JUSTICE FREEMAN delivered the opinion of the court:
	Defendants, Drs. Thomas G. Manos and Mark Kolozenski,
refused to produce two patient dental records and patient
appointment schedules named in a subpoena duces tecum issued
by plaintiff, the Department of Professional Regulation (hereafter
Department), pursuant to section 60d of the Civil Administrative
Code of Illinois (20 ILCS 2105/60d (West 1998) (recodified as 20
ILCS 2105/2105-105 (West 2000))). Upon granting the
Department's motion for summary judgment, the circuit court of
Cook County ordered defendants to produce the records requested
in the Department's subpoena duces tecum with the patient names
and any other identifying information redacted. On appeal, the
appellate court affirmed in part, holding that defendants must
disclose the patient appointment schedules with the names and
addresses of the patients identified therein. 326 Ill. App. 3d 698,
708. However, the appellate court also reversed in part, holding
that the Department could not compel defendants to produce the
requested dental records since they were protected by the
physician-patient privilege (735 ILCS 5/8-802 (West 2000)). 326
Ill. App. 3d at 709. We allowed the Department's petition for
leave to appeal under Supreme Court Rule 315(a) (177 Ill. 2d R.
315(a)). For the reasons that follow, we affirm the appellate
court's judgment.

BACKGROUND
	Defendants are board-certified and licensed dentists in the
State of Illinois and each has a license to practice periodontics in
this state. On November 4, 1999, defendants received a subpoena
duces tecum from the Department requesting that they produce (1)
the complete dental records-excluding X rays but including
patient history, progress notes, anesthesthia records, claim forms,
etc.-for the two patients named therein, and (2) the complete
appointment schedules for the 22 days listed, including the names,
addresses and phone numbers of the patients treated. Defendants
produced all nonprivileged documents to the Department and
withheld only those documents containing confidential and
privileged patient treatment information.
	On February 3, 2000, the Department filed a complaint in the
circuit court of Cook County to enforce its administrative
subpoena duces tecum. Among other things, the complaint stated
that defendants were the subjects of an administrative
investigation that was being conducted by the Department.
Defendants waived service of summons and answered the
complaint by asserting the physician-patient privilege as an
affirmative defense. Both parties thereafter moved for summary
judgment pursuant to section 2-1005 of the Code of Civil
Procedure (735 ILCS 5/2-1005 (West 2000)).
	On July 31, 2000, the circuit court conducted a hearing on the
Department's motion for summary judgment. After hearing
arguments from both parties, the circuit court granted the
Department's motion for summary judgment and ordered
defendants to produce the records requested in the Department's
subpoena duces tecum with the patient names and any other
identifying information removed.
	On appeal, the appellate court found that dentists are surgeons
and, accordingly, the physician-patient privilege held by patients
is applicable to them. 326 Ill. App. 3d at 707. Therefore, the
appellate court held that the Department could not compel
defendants to produce the confidential information contained in
the dental records of patients. 326 Ill. App. 3d at 709. In addition,
the appellate court found that the information contained in the
appointment schedules was not protected by any privilege. 326 Ill.
App. 3d at 708. Thus, the appellate court ordered defendants to
produce the appointment schedules for the dates listed in the
Department's subpoena with the names, addresses and phone
numbers of the patients treated. 326 Ill. App. 3d at 708.

ANALYSIS
	Neither party disputes the appellate court's judgment
affirming the circuit court's ordering of defendants to produce the
appointment schedules for the dates listed in the Department's
subpoena duces tecum with the names, addresses and phone
numbers of the patients treated. Therefore, the sole issue before
this court is whether the Department can compel defendants to
produce the confidential material contained in their patient
records. The question is one of statutory interpretation and, as
such, our standard of review is de novo. People v. Rivera, 198 Ill. 2d 364 (2001).
	The Department initially maintains that the broad
investigatory powers bestowed upon it by the General Assembly
in the Civil Administrative Code of Illinois (20 ILCS 2105/2105-1
et seq. (West 2000)) prevail over any assertion of the physician-patient privilege that a subject of an investigation might raise.
Stated differently, it is the Department's position that the
physician-patient privilege has no applicability during the course
of an investigation. This is so, the Department argues, because the
Illinois Dental Practice Act (225 ILCS 25/1 (West 2000)) and the
Civil Administrative Code empower the Department, in the course
of an investigation, to compel the production of any books, papers,
records, or any other documents which the agency deems relevant
or material to any such investigation at any time. We cannot agree.
	We first note that the legislature did not expressly state in the
Civil Administrative Code that the investigatory powers given to
the Department override the physician-patient privilege which
exists in Illinois. That privilege, which was codified by the
General Assembly in section 8-802 of the Code of Civil Procedure
(see 735 ILCS 5/8-802 (West 1994)(1)), stands as a testament to the
legislature's recognition of a patient's interest in maintaining
confidentiality in his or her medical dealings with his or her
health-care provider. However, the privilege is not limitless, and
the General Assembly has specifically delineated 10 exceptions in
which the privilege may yield. See 735 ILCS 5/8-802 (West
2000). None of the exceptions, however, refer to the investigatory
powers of the Department. To hold as the Department suggests
would force this court to read a provision into the Civil
Administrative Code that is not there and to read an exception into
the physician-patient privilege statute that also is not there. This
we are not prepared to do because " '[t]he only legitimate function
of the courts is to declare and enforce the law as enacted by the
legislature, to interpret the language used by the legislature where
it requires interpretation, and not to annex new provisions or
substitute different ones, or read into a statute exceptions,
limitations, or conditions which depart from its plain meaning.' "
Bronson v. Washington National Insurance Co., 59 Ill. App. 2d
253, 261-62 (1965), quoting Belfield v. Coop, 8 Ill. 2d 293, 307
(1956).
	Our conclusion in this regard is in keeping with this court's
history in upholding the viability of the privilege against the broad
powers of an investigatory authority. In People v. Bickham, 89 Ill. 2d 1 (1982), a grand jury issued two subpoenas duces tecum to a
doctor for the medical records of 63 patients. Bickham, 89 Ill. 2d 
at 2. One of the patients consented to the disclosure, but the
consent of the other patients was never secured. Bickham, 89 Ill. 2d  at 3-4. The circuit court ordered the doctor to turn over the
records, but he refused and was cited for contempt of court. The
matter ultimately reached this court. We noted that, contrary to the
State's position, none of the exceptions to the physician-patient
privilege set forth in the statute applied to the facts of the case. We
therefore held that except for the records released by the single
patient, the remainder of the patient information requested from
the grand jury was protected by the privilege. We so held despite
our acknowledgment of "the desirability in maintaining the
breadth of the grand jury's power to conduct investigations
regarding criminal violations." Bickham, 89 Ill. 2d  at 5-6.
	We note that a grand jury has extensive powers to subpoena
witnesses and obtain any documents relevant to any matter under
investigation. 725 ILCS 5/112-4(b) (West 2000). Like the
appellate court below, we believe that "[i]f, as in Bickham, the
broad power of the grand jury to investigate criminal violations
must yield to the privacy concerns protected by the physician-patient privilege, then *** the investigatory powers of the
Department must also yield." 326 Ill. App. 3d at 709. We,
therefore, reject the Department's contention that its broad
investigatory powers under the Civil Administrative Code of
Illinois and the Illinois Dental Practice Act prevail over the
statutorily enacted physician-patient privilege.
	The Department next contends that even if the statutory
physician-patient privilege is applicable to its investigations, the
appellate court erred in holding that dentists fall within the
statute's ambit. In other words, the Department maintains that the
physician-patient privilege does not apply to dentists. Defendants
respond that dentists are indeed surgeons and thus included under
the physician-patient privilege.
	Whether a dentist falls within the purview of the physician-patient privilege is a matter of first impression in this state. At
common law, the communications between a doctor and a patient
were not privileged. Geisberger v. Willuhn, 72 Ill. App. 3d 435,
436-37 (1979). Nevertheless, as alluded to in our discussion
regarding the Department's broad investigatory powers, our
General Assembly has statutorily protected from disclosure certain
information obtained by a physician or surgeon in his professional
relationship with a patient (735 ILCS 5/8-802 (West 1994)).
Therefore, any questions regarding the privilege must be resolved
by interpreting section 8-802, which states in pertinent part:
			"No physician or surgeon shall be permitted to disclose
any information he or she may have acquired in attending
any patient in a professional character, necessary to enable
him or her professionally to serve the patient ***." 735
ILCS 5/8-802 (West 1994).
In interpreting the statute, our primary goal is to ascertain and give
effect to the intention of the legislature. People v. Woodard, 175 Ill. 2d 435, 443 (1997). This inquiry appropriately begins with the
language of the statute (Woodard, 175 Ill. 2d at 443), as the
language used by the legislature is the best indication of legislative
intent (Nottage v. Jeka, 172 Ill. 2d 386, 392 (1996)). "To
accomplish this goal, words used in the statutory provision should
be given their plain and ordinary meaning." People v. Hicks, 164 Ill. 2d 218, 222 (1995). Where the words themselves are
unambiguous, there is no need to resort to external aids of
interpretation. Hicks, 164 Ill. 2d  at 222. However, when the
language used is susceptible to more than one equally reasonable
interpretation, the court may look to additional sources to
determine the legislature's intent. Hicks, 164 Ill. 2d  at 222.
	The parties disagree as to whether dentists are physicians, but
the primary focus of both parties centers around whether dentists
are surgeons. With respect to both contentions, the parties cite to
cases outside of Illinois as support for their respective positions.
However, we believe that our resolution of these questions best
rests with a review of the language used by the General Assembly
in other legislative acts which address the medical and dental
professions.
	Under the Illinois Medical Practice Act of 1987, the
legislature defines a physician to be "a person licensed under the
Medical Practice Act to practice medicine in all of its branches or
a chiropractic physician licensed to treat human ailments without
the use of drugs and without operative surgery." 225 ILCS 60/2
(West 2000). In order to practice dentistry in the State of Illinois,
one must be licensed to do so under the Illinois Dental Practice
Act (225 ILCS 25/8 (West 2000) ("[n]o person shall practice
dentistry without first applying for and obtaining a license for such
purpose from the Department")). The legislature defines a dentist
as "a person who has received a general license pursuant to
paragraph (a) of Section 11 of this [Illinois Dental Practice] Act
and who may perform any intraoral and extraoral procedure
required in the practice of dentistry and to whom is reserved the
responsibilities specified in Section 17." 225 ILCS 25/4(d) (West
2002). In this case, defendants are only licensed under the Illinois
Dental Practice Act to practice dentistry; therefore, it is clear that
they are not considered "physicians" according to the legislature's
own definition. Accordingly, dentists are not physicians for
purposes of the physician-patient privilege. Therefore, we must
determine whether dentists are surgeons.
	Since the legislature does not provide us with a definition of
"surgeon" within the statutes, we look to other sources for its plain
and ordinary meaning. A surgeon is defined as "a medical
specialist who performs surgery." Webster's Third New
International Dictionary 2300 (1993). Surgery is defined as "a
branch of medicine that is concerned with diseases and conditions
requiring or amenable to operative or manual procedures."
Webster's Third New International Dictionary 2301 (1993). As
alluded to above in the legislature's definition of a dentist under
the Illinois Dental Practice Act, section 17, "Acts Constituting the
Practice of Dentistry," states:
			"A person practices dentistry, within the meaning of
this Act:
			(1) Who represents himself as being able to diagnose or
diagnoses, treats, prescribes, or operates for any disease,
pain, deformity, deficiency, injury, or physical condition
of the human tooth, teeth, alveolar process, gums or jaw;
or
			***
			(3) Who performs dental operations of any kind[.]"
(Emphases added.) 225 ILCS 25/17(1), (3) (West 2000).
The definition of the word "operate" is "to perform surgery."
Webster's Third New International Dictionary 1580 (1993). Given
the above plain and ordinary meanings of the key operative words
at issue in this case, and section 17 of the Illinois Dental Practice
Act, we find it difficult to make any other conclusion but that
dentists are indeed surgeons.
	A review of the historical underpinnings of our dental practice
statute strengthens our conclusion. The first known dental act to
exist in Illinois was established in 1881 and was entitled "An Act
to insure the better education of Practitioners of Dental Surgery,
and to regulate the practice of Dentistry in the State of Illinois."
(Emphasis added.) Ill. Rev. Stat. 1881, ch. 38a, par. 33 et seq.
	In 1905, the General Assembly repealed the 1881 Act and
replaced it with a new dental Act. In this 1905 dental act, the
legislature provided the State of Illinois with its first definition of
the practice of dentistry:
			"Any person shall be regarded as practicing dentistry or
dental surgery within the meaning of this act, who shall
treat, or profess to treat any of the diseases or lesions of
human teeth or jaws or extract teeth or shall prepare and
fill cavities in human teeth or correct the malposition of
teeth or supply artificial teeth as substitutes for natural
teeth: *** This act shall not prevent students from
performing dental operations ***." (Emphases added.)
Ill. Rev. Stat. 1905, ch. 91, par. 39.
	The General Assembly amended the dental surgery act in
1929 and expanded the definition of dentistry and its practitioners.
The definition-of-dentistry provision was amended to provide the
following:
			"A person practices dentistry or dental surgery, within
the meaning of this Act, who represents himself as being
able to diagnose, treat, remove stains and concretions
from teeth, operate or prescribe for any disease, pain,
injury, deficience, deformity or physical condition of the
human teeth, alveolar process, gums or jaw ***."
(Emphases added.) Ill. Rev. Stat. 1929, ch. 91, par. 60.
	Public Act 84-365, effective January 1, 1986, repealed
Illinois' 1909 dental act and replaced it with an act titled "The
Illinois Dental Practice Act," which was "[a]n Act to regulate the
practice of dentistry in the State of Illinois ***." Ill. Rev. Stat.
1985, ch. 111, pars. 2301 through 2357. Lastly, in 1992, with the
General Assembly's codification of this state's statutes as the
Illinois Compiled Statutes, the statute was codified under chapter
225, "Professions and Occupations." See 225 ILCS 25/1 et seq.
(West 1992). This remains the operative act to date.
	The foregoing lengthy excursion into the historical
background of dental practice in this state serves to underscore the
fact that our legislature has viewed surgery to be part and parcel of
a dentist's professional responsibilities. This is evidenced not only
by the titling of the act itself as "Dental Surgery" (1885 through
1977) and the use of key words such as "dental surgery" and
"dental operations," but through the evolution and expansion of
the acts that constituted the practice of dentistry with the addition
of the term "operate" in 1929. It should be noted that the term
"operate" has never left Illinois' dental act statutes since 1929.
Thus, the historical legislation of our dental practice statute
supports the conclusion that dentists are surgeons within the
meaning of the physician-patient privilege. Accordingly, we
conclude that dentists are surgeons and, as such, information
acquired by dentists in attending any patient in a professional
character, necessary to enable dentists to professionally serve the
patient, are confidential for purposes of the physician-patient
privilege (735 ILCS 5/8-802 (West 1994)).
	Having concluded that dentists fall within the ambit of the
statutory privilege, we must next determine whether operation of
the privilege protects the information requested by the Department
in this case. Defendants maintain that the privilege prevents them
from producing confidential patient records unless one of the
exceptions listed in the physician-patient privilege applies and, in
this case, defendants argue that none of the exceptions are
applicable. We agree.
	The exceptions outlined in the physician-patient privilege are
as follows:
			"except only (1) in trials for homicide when the
disclosure relates directly to the fact or immediate
circumstances of the homicide, (2) in actions, civil or
criminal, against the physician for malpractice, (3) with
the expressed consent of the patient, or in case of his or
her death or disability, of his or her personal
representative or other person authorized to sue for
personal injury or of the beneficiary of an insurance
policy on his or her life, health, or physical condition, (4)
in all actions brought by or against the patient, his or her
personal representative, a beneficiary under a policy of
insurance, or the executor or administrator of his or her
estate wherein the patient's physical or mental condition
is an issue, (5) upon an issue as to the validity of a
document as a will of the patient, (6) in any criminal
action where the charge is either first degree murder by
abortion, attempted abortion or abortion, (7) in actions,
civil or criminal, arising from the filing of a report in
compliance with the Abused and Neglected Child
Reporting Act, (8) to any department, agency, institution
or facility which has custody of the patient pursuant to
State statute or any court order of commitment, (9) in
prosecutions where written results of blood alcohol tests
are admissible pursuant to Section 11-501.4 of the Illinois
Vehicle Code or (10) in prosecutions where written
results of blood alcohol tests are admissible under Section
5-11a of the Boat Registration and Safety Act." 735 ILCS
5/8-802 (West 1994).
	The primary purpose of the physician-patient privilege is to
encourage free disclosure between a doctor and a patient and to
protect the patient from embarrassment and invasion of privacy
that disclosure would entail. See LoCoco v. XL Disposal Corp.,
307 Ill. App. 3d 684, 689 (1999), citing People v. Herbert, 108 Ill.
App. 3d 143, 149 (1982). The physician-patient privilege is one of
trust and confidence in which the patient knowingly seeks the
doctor's assistance and the doctor knowingly accepts the person as
a patient. See XL Disposal Corp., 307 Ill. App. 3d at 689, quoting
Reynolds v. Decatur Memorial Hospital, 277 Ill. App. 3d 80, 85
(1996). The legislature has recognized the patient's interest in
maintaining confidentiality in his or her dealings with a physician
or surgeon by enacting the physician-patient privilege in section
8-802. Bickham, 89 Ill. 2d  at 6. As with other statutory privileges,
the physician-patient privilege is a legislative balancing between
relationships that society feels should be fostered through the
shield of confidentiality and the interests served by disclosure of
the information. See Parkson v. Central DuPage Hospital, 105 Ill.
App. 3d 850, 854 (1982). Lastly, the physician-patient privilege is
for the benefit of the patient and is not to be used as a shield by
doctors. Bickham, 89 Ill. 2d  at 6.
	In the present case, the Department alleges in its verified
complaint that defendants are the subjects of an administrative
investigation that was being conducted by the Department. In
furtherance of this investigation, the Department requested the
complete dental records of the two patients named in its subpoena
duces tecum. While defendants complied with the subpoena duces
tecum by producing all nonconfidential documents, they refused
to furnish any portions of the patients' records obtained in a
professional manner in order to treat their patients. Because
dentists are surgeons, we agree with our appellate court that the
Department cannot compel the production of confidential patient
dental records absent a showing that one of the 10 statutory
exceptions applies (735 ILCS 5/8-802 (West 1994)). 326 Ill. App.
3d at 708. As we noted in our earlier discussion regarding the
Department's contention that the privilege did not apply to
Department investigations, our General Assembly created the
physician-patient privilege for the benefit of patients. To help
guard this benefit, the legislature established a limited number of
circumstances in which physicians and surgeons are allowed to
produce confidential patient record information. Courts must apply
these existing exceptions and cannot create additional exceptions
to the privilege. See Bickham, 89 Ill. 2d  at 6; see also People ex
rel. Birkett v. City of Chicago, 184 Ill. 2d 521, 528 (1998) ("this
court has repeatedly concluded that the extension of an existing
privilege or establishment of a new one is a matter best deferred
to the legislature"). As we noted previously, investigations
conducted by the Department are not listed as an exception under
the physician-patient privilege to compel physicians and surgeons
to produce confidential patient records. If we were to concede to
the Department's request in this case, we not only would be
creating another exception to the privilege, but would cause the
privilege to be mute in its purpose. Accordingly, we conclude that
the physician-patient privilege enacted by our legislature prevents
defendants in this case from producing any confidential patient
dental records as requested in the Department's subpoena duces
tecum.
	The Department next argues that deleting the patient names
and identifying information from the records removes the records
from protection under the physician-patient privilege. The
Department contends that this approach safeguards the privacy
concerns of the patients that lie at the heart of the privilege while
allowing the Department to discharge its investigatory duty under
the Civil Administrative Code.
	We find our appellate court's decision in Parkson v. Central
DuPage Hospital, 105 Ill. App. 3d 850 (1982), to be helpful in
addressing the Department's contention. In Parkson, the
Department sought specific medical information concerning
nonparty patients. Parkson, 105 Ill. App. 3d at 855. In response to
the Department's assertion that the physician-patient privilege
would not be violated by excluding the names and identifying
numbers from the patient records, the appellate court stated:
			"Whether the patients' identities would remain
confidential by the exclusion of their names and
identifying numbers is questionable at best. The patients'
admit and discharge summaries arguably contain histories
of the patients' prior and present medical conditions,
information that in the cumulative can make the
possibility of recognition very high. [Citation.] As the
patients disclosed this information with an expectation of
privacy, their rights to confidentiality should be
protected." Parkson, 105 Ill. App. 3d at 855.
The appellate court also rejected the Department's request to
require the production of the patient records through the entry of
a protective order, finding that the physician-patient privilege
would still be violated. Parkson, 105 Ill. App. 3d at 855.
	We believe the rationale employed in Parkson to be
applicable to the present case. As in Parkson, the two named
patients whose records were subpoenaed by the Department are
not parties to this case. In addition, we note that the Department
has the names of the two patients whose records it is seeking, as
shown in its subpoena duces tecum. Therefore, even if the names
were redacted along with any other identifying information, the
possibility of recognizing and equating a record to each patient
would not be difficult. Thus, we hold that merely deleting the
patient names and other identifying information from patient
records would violate the physician-patient privilege.

CONCLUSION
	For the foregoing reasons, the appellate court's judgment is
affirmed.
Affirmed.
 
 
1.      1Public Act 89-7, which amended section 8-802, was held
unconstitutional in Best v. Taylor Machine Works, 179 Ill. 2d 367, 378
(1997). Therefore, the statutory language reverts to the preamended
language as indicated in Public Act 87-803, section 2, effective July 1,
1992.