agency and i'll take those in turn and i'll try to do that to st louis st holding out it is important to note that the trial court held that the plaintiff had met her burden on holding out and we think that was correct there is evidence of bounding on holding out here it consists of not only advertising specific dr hobson but also  as miss broughton outlines interact the day that she had seen evidence will strike that she had seen advertisements before she became pregnant with alexis which is the focus of this case where the hospital was promoting itself and the quality of the doctors who practice there none of those advertisements stated that the doctors were not employed by the hospital that is evidence of holding out the hospital admitted in requests to admit answered a request to admit that dr hobson's likeness was displayed on its website in the years leading up to this bir that website did not advise the viewing public that the dr hobson was not an employee dr hobson herself admitted in her deposition that she wore scrubs during that delivery  there is an issue with the consent form that i'll touch on in regards to reliance because i want to address how the trial court thought of that but we do have problems just to highlight quickly care for about two hours fifteen minutes she was receiving anesthesia at the time she signed it that creates a question of fact about what she knew and when she knew it in regard to the independent contractor disclaimer and whether that is of sufficient basis for summary judgment it's our position that given the timing and the circumstances that that's a question for the jury in regard to reliance the law of illinois is that that satisfied if there's evidence that the plaintiff relied on the hospital versus a specific position that reliance need only be partial the plaintiff's meets the reliance element when they present evidence that they relied on the hospital and that's important in this case deliver alexis and she did so based on a couple different factors at least the advertising that i mentioned earlier that she had seen before she became paragraph six a through paragraph eight it lays out the facts that we believe are sufficient to create a fact question on reliance and why she was relying on the hospital and why she was not relying on a specific doctor and when you view that in the light most favorable to sherry as is appropriate that is something that has to go to the jury and if you look at the trial court's ruling our concern and where we think the error lies is that the trial courts you know weighted that evidence versus the consent form the language in the consent form and held that well ok you've got these things that militate in favor of the plaintiffs but at the end of the day we've got this language in the consent form so on the basis of that language the trial court held that the plaintiffs could not create a question of fact on reliance and that goes back to what i said will earlier about from our perspective that's an inappropriate weighting of the evidence you know that the court outlines then nd transcript where it actually hands down its its verdict a number of factors that the court considered and i believe there were nine of them and if you look closely at those there is evidence on both sides of those some that supports the plank that perhaps some of the sense that the courts the defense if you read some of the cases that underlie  for your time and yes your time is up and so now we go to the portion of the case where justice hutchinson will ask questions about she has any yes thank you i do mr quinn i'm or joined or got hospital privileges let's put it that way and it starts out better medicine begins with bright minds and it identifies the hospital it's the kiss walk is pleased to welcome paula hobson and the doctor happened who was it up step six nurse at this hospital before going to medical school has joined the medical staff and is practicing with dr joseph baumgartner at northern illinois fertility is there anything in that particular notice that indicates or could indicate to your client that you know that doctor haves and was not employed by the hospital i think if you look at it from the standpoint of a lay person who does not have experience with hospital practice practice groups their interactions with the hospitals and whether they are affiliated with the hospital and how i think that that language is very vague it's ambiguous and it allows for different conclusions to be drawn by a reasonable person who reads it so i think that that language certainly what invites a reasonable person to conclude that dr hobson is an employee of the hospital i do recognize that there is a reference to the northern illinois fertility but it doesn't set out that that's a separate entity from the hospital i think that involves some reading into that which you know create competing inferences or invite different conclusions now there's another news release about welcoming new doctors and there are several of the mentioned dr hudson being the nd one in order she's the only one that they talk about prior experience with the hospital and it's the same phrase they used in the other release that we just talked about that had any any  emphasis to what the hospital's trying to accomplish there they're loud being that she worked with them before and now she's back does that seem to indicate she might be employed by the hospital i think certainly does you know by highlighting the fact that she was our nurse and now she's coming back as a doctor i think that definitely highlights a preexisting relationship that dr hobson had with the hospital that a reasonable person again could draw that conclusion that oh i mean she was there as she was employed as a nurse and now she's coming back as a doctor and against the public policy is that the time the hospital to make these relationships clear and where the i think it's pretty it it's a one page document it looks like opposed to as opposed to something talked about in spiegelman i think that there were several different issues in this consent form that might have been confusing is there anything in specific here in this single page document that might be confusing to the person signing it will talk i'm not worried about when at this point when now when it was signed but the document itself well the document itself leaving aside the timing yes judge and we do we highlight some of that or a lot of our problems with that in our brief it's a multi part consent form which a lot of the appellate court cases on this issue highlight is problematic because it is specially when you have something and only on one page if that's in fact what this says and when she receives it then you know that small print you know that has a kind of colloquial understanding or definition but you know it it fits into the larger narrative of this being a vague or confusing form when it contains multi parts when there are acknowledgments  subjects other than the independent contractor disclaimer you know if it does cover other topics including risks of the procedure discussion of alternate treatments you  know there i believe there is something about disposal of human tissue in there though if it does not focus to the person presented with that form on one particular issue and it's  ahead i'm sorry you know where there are some other cases that say if you want to make this clear you know if you want to rely on this later in support of a motion for summary judgment or a trial in a porn agency you know there are things you can do and which they have not done in this case you know the initials from for sherry pradhan are immediately adjacent to the employment status disclaimer but you know what i think if you look at the concept when i believe that it's next to something really related to billing so that is something that should be take into account as well they have the opportunity to make this clear so you have to see did they do that i mean if they didn't want one last question the the very next paragraph under the one that says i understand that the physicians who participate in the procedure are not employees or something the next paragraph says i knowledge that the training of physicians nurses or other health care personnel takes place at kishwaukee community hospital why if they're not employees would training take place at the hospital i think that is a very good question and i don't know if we raised that in our brief but as you asked the question it does catch my ear and i think that it it suggests more of a employee employer relationship between the hospital and those persons who are identified in that consent form and a if that is something that creates ambiguity that's something that should be you know resolved against the hospital moving party and i want to be sure i'm clear your walking hospital for purposes of her delivery because she had been six she had had two prior deliveries there and she had some other medical procedures and she was happy with the hospital is that correct that is one of the reasons that factually she did deliver two babies there prior if you were to read her affidavit she forth some other bases for her the reason she went there one of them being that you know she had seen these advertised at her ties men's before becoming pregnant with alexis and you know they they were promoting the quality of health care the quality of their doctors and yeah when you put that together with the prior experience that she had there which were good ones which the case law says is an acceptable reason for you know or reliance you put that all together and yes  specific to dr hobson i don't i don't know that she was what was ever asked so what she asked that in her deposition and did she give that answer in a deposition i don't believe she did and that's my question she only said she had seen and that she never specifically said she had seen any editor billboard and indicated they worked for the hospital is that correct seen advertisement related to these doctors correct dr hopson i think that's correct but i would note that the case law states that with regard to the holding out you know and the reliance it doesn't have to be reliance on a particular holding out so the fact that she may not have seen the advertisement specific to dr hobson under the case law is not something that should result in the entry of summary judgment she can rely on other things what was your client's major concern obtaining doctors they were covered by medica well i don't judge i don't think that is the case i think her major concern was making sure she could deliver at kishwaukee because if you know from i believe it's her deposition you know she was actually given the choice of well not a choice but she was given names to hospitals say you know here are some doctors that ri e believe it was community hospital and she said and as well as kids walking and she made it clear i want to deliver at kishwaukee she made the choice of the hospital and that's the only reason she even ended up seeing dr bombards who was the name that was given to her that she received through that process which i think it's significant because we're talking about  hobson dr hobson wasn't even the the doctor she initially saw dr hobson happened to be a partner i believe with dr bombards but sherrie didn't know that and that was never discussed with her so i i think the evidence shows sherri was relying on the hospital and not done anything about medicare or medicaid and with respect to dr dobson in the guard she gyn case as well and the the plaintiffs in that case had seen o b gyn seven years at an outside location and a parent agency was still resolved in the agency they all involve situations where the patient st met the doctors at the hospital didn't the case in all of those cases was that judge i can't say with respect to every case whether that was true certainly that is a fact pattern but there are you know i would i would again point you back to the williams case certainly that was a case where the plaintiffs had seen the doctor on an off site location so that's at least one case that does not fall within that fact pattern but they were not cases like this where the patients chose the doctors who were delivered at the hospital the weekend's cases in the same footing as is your argument is that correct does the fact that the patient did not st encounter the doctor in the hospital that far a finding of the parent agency or reliance i think that's why i pointed to williams because think williams says no it doesn't and there are there are other cases you know there are there are probably other states that and that same vein but williams is certainly one i can point to right now your brief essentially seems to argue that this court should hold back carious liability applies to anyone providing treatment in the hospital is that your position  necessarily judge i think under the facts of this case that the hospital should be held responsible for any for the the negligence of any physician where the patient the plaintiffs can satisfy the elements of the parent agency so maybe not and not in every case can the plaintiffs say i was relying on the hospital you know there are plenty of cases on appeal where the plaintiff loses plaintiff cannot prove reliance or can't prove holding out so i don't think i would stated that broadly i would say under the facts this case plaintiff has met the burden typical hobson's choice in what respect that you have free choice of only one thing that is offered we seem that your argument relates to both hospital and to  doctor so you have two choices you can either go to the hospital you want or you can go to the doctor that you want or you you can even come up with a rd possibility or choice and that is go to the hospital you want and also get the doctor you want and so the the question then becomes are these choices that you make  are supposed to be based upon some sort of holding out that the hospital has made and apparently was was made before the choices or choice w holding out that she did see where she highlights and she even mentioned it in her deposition as well i don't want to confine it i think just to or for affidavit but it certainly does lay out that she saw advertisements which are relevant to holding out under the case law she didn't see those before she became pregnant with alexis and before she made the decision that she wanted to rely on the hospital in this case so the answer that question i think would be yes there were holding out that she that exist in this case before she made that decision bigger factor was her choice the hospital that she wanted to go to had to be covered by her insurance you know i don't know that she was asked that question judge so i don't know that i can speak to that if that's hospital or hospital she could go to that they would pay for it in the record well i suppose i read it a little differently that there was there was at least another piece that that she wanted to go to  because she felt that it was a hospital with a good reputation of providing quality care on the basis of you know holding it out that she had seen on that issue the advertisements as well as based on  past experiences that she had there so that specific question which is why i said i i don't know that i could answer is how did she herself wait those things the you know who would pay for it or how would it be paid for versus her just personal preference i can't absolutely answer that question about which is more important or how you were wouldn't weigh those but she certainly was not asked in that regard i think that she clearly has set forth that but instead she was relying at least in part on the reputation and what she understood to be the relationship between the doctors in the hospital just as a technological point if anyone at any time has an issue hearing or understanding me please do let me know i'm happy to adjust as much as i can to make sure that what i'm saying is clear and easily understandable ju like to start with your point about hobson's choice because as delightful as the turn of phrase is in this particular situation i think it's actually a really important point point that the doctrine of the parent agency is not about a choice between taking all or nothing it is not about whether or not a patient can treat at a hospital or can treat with her doctor but not bill the point of the doctoring of the parent agency as the court the supreme court decided d in guilt is addressing a legal and it's not about whether a patient has the opportunity to treat where she wants with whom she wants it's about whether the hospital has properly explained to patients the employment status of the providers if on hospital hold itself as a provider of care and if a patient relies on that holding out then the hospital may be responsible for the activists independent contractors but as the gilbert court emphasized if a patient no was or should have known that for treating physician is an independent contractor then the hospital is not responsible for the actions of that patient and that's the point that the the circuit court reached in this case illinois courts have worked to refine the policy announced in gilbert ever since the decision came down more than twenty five years ago it's a difficult it was a it was a difficult inequity that the court was seeking to address this idea that a hospital could advertise the services but hire independent contractors a legal matter of weight any responsibility so the question became per gilbert whether or not a hospital has made clear to its patients that care is being provided by independent contractors and in that situation liability will attach to a hospital only where the patient is the a parent or a sensible agent of the hospital but and this is the most important poi point here as as courts throughout this state have helped if a patient notes or should have know that the treating physician is an independent contractor then the hospital will not be live and therefore the relevant include becomes whether the plaintiffs knew the physician was an independent contractor so back again to your question just clarence it's not a choice of whether a patient can treated a hospital or whether a patient can treat with her physician but not both the patient can do that is the question of understanding the question of whether the hospital has made clear the employment relationship between those entities and if the hospital then the hospital may not be responsible for the actions of the physician so that's the critical distinction and gilbert late that out specifically it in that decision the illinois supreme court tried to clarify except for one who seeks care from a specific physician if a person who voluntarily enters a hospital without objecting to his or her admission to that hospital then the person is seeking care from the hospital and did the patient enter the hospital with the understanding or still believe that she was seeking care from the hospital if stuck here in the circuit court found that based on the underlying purton could not satisfy that nd element what the circuit court decided is she did not justifiably rely on any perceived she didn't justify or ugly rely on any perceived holding out because she was seeking care for her specific position but actually based on the facts of this case she can't satisfy either requirement or gilbert kishwaukee did not hold itself out as the provider of care without informing her that her contractors and we see that from the language of the consent form as courts have held as this court held just mclaren i know you were on that sure key panel as those decisions have emphasized when a general consent form includes a paragraph that clearly identified without confusing language that the positions are independent contractors and not employees or agents of the hospital in that situation when the language is clarified clear clearly given to a patient that satisfied feels the fundamental requirement that a hospital inform the patient that care is being provided by an independent contractor and this case is analogous to cases in illinois the language of the consent forms is analogous to language that is found exactly that that is a clear statement that the physicians are independent contractors not physicians and such and then you are asking about the specific language in the consent forms and actually of the there there are two in the st consent form physician services is actually highlighted bolded underlined and in that paragraph states as as was read physicians providing care are independent practitioners and are not employees or agents of kishwaukee community hospital and the patient ms program was actually quired to initial that paragraph she was that required to initial every paragraph on that page she was required to initial that one because it was so fundamental and in the nd consent form again she find  there is and even clearer statement that physicians who participate in her procedure in that case and obstetrical delivery are independent contractors so the hospital did provide specific language language that has been found consistently by all in the illinois courts to clearly identify that a position of independent contractor that's not holding out now to be sure all of my courts have said that in certain circumstances there can be additional evidence of a holding out but that consent form is the most important and this is not a case where there is additional evidence of the holding out that would make the consent form less clear or more confusing this is actually something it at the time of delivery that could have potentially been confusing in the face of the consent form there was an identifier which was on the tag of the script not visible to the public so there's not that additional potential evidence somehow take this out of that analysis of whether there was a clear statement by the hospital explaining to a patient this particular position is an independent contractor so there is no holding out sufficient in this case to implicate the concerns identified in gilbert and the nd piece of this reasonable reliance is also not a does not practice this case that implicate the policy concerns identified in gilbert and justice bridges you around being a little bit about this the very point that that is raised by gilbert and you too just mclaren did the patient design that she wanted to treat with this hospital or did she want to treat with a specific physician here she asked to treat with a physician who would who services would eventually lead her to deliver but she treated with that those physician in their private offices she traded with them outside of the hospital if it had been fundamental when miss prudence called her medicaid provider that she treat kishwaukee as opposed to treating with someone who would accept her insurance she gets the stuff of calling her provider it all she was concerned about was treating at the hospital she could have gone to the hospital and sought some sort of referral directly from the hospital that's not what happened here here she looked for a specific position to provide her services and eventually for that position to deliver her at a hospital with which she was in the earlier that's what makes this now a gift  would be at the hospital that appears inconsistent with the paragraph immediately before it to me tell me how it isn't two physicians who participate in the procedure and are independent contractors but somehow other physicians may not be so right there it's a clear statement that all physicians are independent practitioners full stop the nd paragraph does not suggest anything different it merely discusses the possibility of training and the best analogy i can get support for that would be thinking of an academic institution just because there are physicians routing through or perhaps doing studies or doing any of the number of things that physicians do while training those positions are not necessarily and the result of our employees i should say very seldom but are not always employees of that hospital there a myriad reasons someone may be observing or training and that does not create some sort of an employment relationship that's the distinction and nothing in this paragraph suggests an employment relationship simply acknowledging that physicians nurses and other health care personnel may be training does not suggest that they are training as employees of case walking community hospital but as a lay person looking at that would you agree that if the hospital says well we're training them we have some responsibility for th some responsibility meeting giving them access and i'm not trying to be coy with that answer is it for example as we all know health care information is intensely personal and is private and can't be disseminated outside without the patient's consent that that privacy concerns the privacy implication is entirely unrelated to an employment a suggestion of an employment relationship so it phrase the question why would kishwaukee have an interest in training these people if it were not for the fact that they're holding them out  as professionals in their field in that hospital i think the difference is the last phrase the core use professionals in their field i agree that's what the hospital would be pulling them out of but not sort of be akin to somebody observing these proceedings were we still in the courthouse and elgin and somehow they're just saying that the court we're responsible for the person who subserving those proceedings that person certainly had to gain access to the courtroom and i realize courtrooms are public spaces slightly different situation but there's still no implication of an employment relationship it's a training exercise and even i as a lay person i don't think i would assume there's an employment relationship i think i would be more inclined to assume there's some sort of the an academic reason for that and i would hope that the hospital would take my consent or they would allow somebody into my hospital room and i don't know who that person is that what this paragraph speaks to not an employment relationship i do not think it's inconsistent ok you know the the big gorilla in this room is when this consent was tendered according to the deposition and according to the information we have in this record and it is after she is in the hospital d getting ready to deliver getting ready for an epidural shot even though she had two other children i think that you know giving birth is a remarkable situation when you're not always looking at the papers shoved in your face if this was so important to the hospital why wasn't this tendered at a different time there there could be any number of reasons for that your honor from the time of presentation at the hospital until she's that room and she's in a position where she can actually sign off on these documents certainly not there from the record when they were given  versus when they were under the system but the much more important point relates back to well there are two things one concerns the timing of this it was a couple of hours after she arrived at the hospital but it was also i think more than six hours before she gave birth so this is a just situation where she's in the delivery actually pushing the baby out and that really back to my nd point which is illinois teleports have not drawn a distinction between the validity of the consent and the circumstances in most situations where the consent was a change in fact you look at cases like wallace versus alexian brothers medical center or course is proving a in both of those cases the were signed after treatment began now there is a distinction there because the consent forms were signed in both cases by a guardian but they were signed after treatment began and the point there is this isn't a situation only course a set of treatment begins then it's too late you can't get a pile of binding consent when you absolutely can't and that's been held consistently more than once it's  not directly analogous but it's not dissimilar from the idea that you can get a valid consent from a non english speaking person as long as the consensus finding in the situation it validly finds there was no suggestion that it wasn't understood in fact there's a provision here that specifically states that the patient acknowledges that she understands the terms of the consent she signed off on and that is binding that she recognized that she had read these documents she understood what they meant she  reported with her treatment the fact that she was in labor does not and i and i mean labor she was not actively delivering the fact that she was a labor doesn't change the validity of the consent most of the cases that we've seen in this area deal with emergency room and certainly i'm not saying that these cases gilbert to some of these other should only deal with the emergency room but checking into an emergency room is a little different than checking in under regular circumstances to give birth to a child in the emergency room they trios you and they they send you in as allegedly had an emergency in delivery there is usually time unless you have stayed at home to a lot more circumstances so as she's checking into the hospital why isn't the form tendered then and your honor i can't answer that question from the information in the record but it does appear that that way the forms were handled in that they were handled the four ship again and exactly as you say someone had waited too long and presented in the at the hospital actively delivering the baby that would be a different situation from this where she would simply laboring and she end but she was in the process of it being administered for a girl but i think what the court if i if i can just add one thing to that i don't if the court has a follow up i don't want to interrupt that but that also speak to the situation in this particular case where this is a situation where the plane to presented at the hospital because she was seeking care from the hospital and had no other relationship with this position she had been treating with these physicians and with northern illinois fertility the entire course of her pregnancy this was a capstone to it so this is not a situation where she didn't know these physicians she had never worked with these physicians she was in an emergency and she had to receive the services she knew of these positions were and she presented at the hospital because her private physician wanted her to deliver at that hospital that's crucial for the justifiable reliance p iece of this analysis well let's talk about who how she got the cash walkie she had experience there her previous doctor apparently left the state or was no longer available in that geographical area so she called the insurance and said i want to go to kishwaukee i need a new doctor can you give me some information well apparently they gave her information about another hospital as well but they gave her the names of these doctors so why do you say that she was relying more on the doctors than she was relying on the hospital and its quality of care so this goes back again to what is the policy articulated in gilt gilbert was the case trying to prevent hospitals from soliciting patients advertising to them and not telling them that they will that patients who wanted to treat at th hospital might be paid treating with independent contractor physician this is a case where the patient wanted to treat she she said she wanted to treat at kishwaukee but she had insurance and she had the opportunity to select her lucky she didn't do that she asked i have particular insurance i have medicaid all her medicaid provider not to what he said i want to deliver at the top spittal in this case she has testified that is because she delivered there previously but it could be because she lived closer to kishwaukee not really consider the myriad reasons why it might be more convenient for a patient to want to go to that particular hospital the plaintiffs initially treated that rush because the plaintiffs wanted to use an orthopedic surgeon affiliated with rush there was a specific connection there but the ultimate finding of potential liability surgeon at rush rush also supplied additional physicians assistants through the end of the physiology department and it was the anesthesiologist supplied by rush who created who was chooses her private physician based on the availability of that private physician in the private physician where that physician has staff privileges and even if your brother is referenced to the idea that simply because a physician has that privileges at a particular hospital that does not create an agency relationship between the middle and the physician but most insurance companies  the back of a card that you carry in your wallet or wherever you happen to carry it says before extraordinary proceedings and of course i'm paraphrasing here paraphrasing here but and pregnancy although it's a happens a lot it's still considered somewhat extraordinary because of the length and general cost you must consult with your insurance company and get pre approval not pre approval to be pregnant but pre approval to go to a hospital and engage a doctor so she did what she was told to do she wasn't told to go to kishwaukee st and they recommended back there she went to insurance company st why why is that still not relying on kishwaukee primarily as the hospital in which to deliver because she's not relying on to schlocky for that she's relying on medicaid to give her information about what sort of a little options are she's not relying on trish lucky to get her recommendation  could the advertisement that justice hutchinson ran earlier so i will read it again now that was published by the hospital with dr imagine by all lead a reasonable person the conclude the employer and employee relationship i don't believe so and actually i think just the actions of when it says an operative language in this particular advertisement that would keep a reasonable person from northern illinois illinois fertility in dekalb this is not an advertisement that states for it and for example dr husband was of stone tricks nurse but now has returned  staff or something to that effect that's not or as a hospital for you or so or something to that effect his return to the community after a medical school is actually specifies the doctor hobson is on the medical staff which relationship to the average person but does it in fact satisfy the whole that requirement of gilberto i don't believe that it does because it's not holding dr hobson out as an employee of the hospital but to the extent that the court could find that it does to the extent the court says look this is an advertisement dr house and cases on it that's why the consent form becomes important  because the consent form clarifies any potential confusion that may exist and i don't think there is confusion but to the extent the court were to find that the hospital has made in the consent form exaggerate clear and to what again just a such a it's an ass when we have the plane entering the hospital she's in labor and two hours later she's given this consent might this not affect her  labor she was unable to read the documents understand the documents the consent forms or give are going to say that there is no testimony about that and i would i would hazard a guess that most women who have been through the process of having a child understand that you're not on able to read or think over the course of delivery again that's why it's important that this is not a situation where she was children i had my question is when this consent form was presented to air what i did she really binding and incidentally i should add that those are situations of enormous stress where for have to take for example and wallet it's apparent to is being candid consent forms for her fourteen year old child who's been struck by a car and has been is in such serious condition that eventually she dies that consent it's still binding that's an enormously stressful to situation that even illinois courts are that illinois courts have found even then the patient is able or the guardian is able to give finding consent and more to your point what happens if she doesn't want to give consent well well addresses that in that situation to consent need not be obtained  if an emergency arises and treatment is required to protect the patient's health but if that's not the situation then the hospital is entitled and in fact required to advise the patient of the or if you look at the cases that the defendant is relying on for this idea that the timing of the consent forms is not relevant and should be considered i think is the court is identify those involved in cases where there is emergency life saving perhaps a carrot issue and i think what the courts are are doing that are saying as a matter of public policy  they're going to hold a particular way on the issue of apparent age and that does not fit into this fact pattern for which reason the public policy that's expressed and gilbert should control and that is that there is a unique relationship between doctors and patients and doctors and hospitals and the hospitals want the benefit of the business that they get and they want to protect themselves on the other hand against claims against them for the negligence of the doctors and if they want to do that then they have to put the play on clear on equivocal notice at a proper and timely point in time and this case as questioning the defense we don't see that here she did not have a choice you know she had administered anaesthesia already a test savannah stays at eight minutes  well maybe a little different factually certainly the principle is the same the timing does notas and the timing can invalidate the disclaimer that's contained in the consent for the hospital in complete control of this process they can present and acquire signatures when they want to if they fail to do that in a proper and timely time they have to bear the consequences of that and not the patient and that is consistent with the over all the cases that fall over secondly you know to this question about did she see the care of a specific position or the hospital the hospital certainly has a point of view about that but we cannot deny in the summary just stating what mrs broughton said about that because that is abbott and that's set forth in her deposition and set forth in her affidavit and she clearly says that she chose not specifically system but she chose the hospital  i think a lot of what the defense has argued here today and certainly i think it's reflected in the trial court ruling is that the consent form was somehow dispositive of the of this and should overcome all of the evidence presented by the that holding out and reliance and that is just not the law bill moyers reflected in every case additional evidence can be introduced there is additional evidence outside the consent form on both holding out and know that whether she thought a particular size was not relevant hospital by owned by the holding out that they made to the public in general so although we do have holding out that she did rely on i want to make it clear that while they did hold out dr dobson specific advertisement mrs does not lose this issue but she didn't see that and factually i will point the court hospital or where it says to learn more click on find a doctor in another press release says headline his hospital welcomes new doctors what is a reasonable person to think when they read about those that that there is an employment relationship and with regard to finish up on the training language in the consent form the classic question the fact there are some questioning the defense suggested length justice hutchinson do you have any questions probably not i'd only be repeating myself thank you very good justice bridges do you have any questions the most significant most significant point that is the timing element i don't think turkey and james had similar facts where you have a pla who is already for all intents and purposes a patient of the hospital patients already receiving care there is no informed consent different for consent means anything it means that a person has to be given a choice before they accept care subject to the provisions or disclaimers that the hospital wants to use against them at a future  date i don't think that turkey or james indicate that they don't have that same fact pattern and i would want to see james you know other since whether or not the doctors in that case were specifically listed or whether their practices were listed on the consent form in this case we know neither d already occurred and the patient was brain dead is next correct i think i think that is a recitation of the facts of the case i mentioned fraud yellowness simply in response to the defen and said it was different in terms of the conduct that had occurred you know the negligence had occurred by the time that the consent form was signed in that case then for broader principle that i believe supports a plane that the timing of the consent form is important is relevant and we can invalidate the consent form thank you i missed when justice mclaren had no further question and the doctor who delivered that was no longer available because he left to go out of state is that correct my understanding yes has there been anything put a record as to whether or not during those prior births the same disclaimer was presented to fly and i'm sorry on a little feedback there just it was a very tough was there anything to indicate one way or the other whether or not she knew whether or not the doctor was an employee of the hospital or not my understanding judge of the record is the only the only evidence we have on that is i think from sherry problems that this is where she said she believes that dr hurst was his name was in employee of the hospital  to your question about what did consent forms for those prior pregnancies contain in terms of a disclaimer if any contractors i don't think that that exist in the record because i think if it did we would be hearing more about that from the defense ok i have no further questions thank you justice like jensen do you have any other questions know thank you that's just bridges no thank you ok thank you we've heard from both parties there have been questions asked and answered i believe the case is is now completed and