court my name is katherine why are you represent northwestern memorial hospital in the us today we ask the court to address the same certified question that was reviewed in the first strict can a hospital be vicariously liable under the doctrine of a parent agencies set forth in guilders and its progeny for the acts of employees of an unrelated independent clinic that is not a party to the present litigation the first district answered the question yes soliciting patients advertising themselves as all service facilities offering all necessary services to patients yet hospitals could also with liability by working through independent contractor physicians avoiding the be well known famous holding out elements that you just summarized here from you gilbert very clearly focus on the conduct of the hospital conduct of the alleged agent conduct of the planet is there anything in that holding of gilbert the moments where that contact takes place yes and it's the specific language in gilbert gilbert specifically describes negligent acts at the hospital facility it in the finding in the holden in the language of the statute or excuse me in the language of the decision fact it's go through page skipping one fifty six ill second at five twenty four quote under the doctrine of apparent authority a hospital can be held by carers liable for the negligent acts of a physician providing care at the hospital that language is fundamental to about this in the papers we are not trying to suggest that the care needs to be given within the four walls of the hospital there are many circumstances that should the judges can conceive of that anyone can see them in which the care could be given at a hospital a hospital imaging clinic that's off site an urgent care clinic which is off site that that's not the issue before this court the issue here is the care that the plaintiff claims is attributable to the hospital t claims she can sue the hospital for occurred at an independent clinic a federally operate clinic it had nothing to do with northwestern other than that the physicians at that clinic had hospital early on if there is sufficient evidence as this is of course with public work if there is sufficient evidence that the employees conduct wasn't fact related and connected to the hospital then maybe was it isn't is a sure fact question no your honor and as as i understand the question it's basically doesn't know what you just said the question is unrelated independent for if i can give it for example and want to answer the question of for example even in say a two six one five motion a motion where the plaintiff is moving to dismiss huli as a matter of law the court still needs to look at what are the allegations in the complaint to see whether or not those allegations would work within the rubric of the allegation being made or not it's it's always going to depend at some level on an understanding of the facts not an interpretation  you're saying that to six fifteen is the same thing as a three oh wait no your honor i'm i'm trying to answer the question about is this a question of fact is this not question fact that's that's why this is not a question of a fact that remains in doubt because way gilbert applies to these facts in two different ways the jury could potentially interprets the holding out a reasonable reliance elements of gilchrest as they do apply whether or not you result as a threshold matter or is that a question that the jury has to decide by which i mean we know what the facts are the facts are not in dispute the parties have agreed as to what those facts are knowing what those facts are  simply interpret those facts based on a very clear statement of the law or is the will are so broad and by the law i mean the application of guilt to these facts is that apparent agency doctrine so broad that a jury needs so one of the facts you see we have to consider all the facts so we're for we have to consider all the facts the plaintiff put in all the facts about the relationship of the two members of the word are from the hospital and that there's a great deal finding done by the evidence is sufficient to show a relationship sufficient under gilbertson which as has to do i'm asking the court to look at the facts that are alleged and decide whether or not as a matter of law did those facts create a claim that can see under guilt sounds like somebody judgment motion to me and the reason the answer to that has you know is because of this threshold problem this threshold problem is did the plaintiffs seek treatment at the hospital at all the answer to that is no she didn't so everything that you just mentioned justice types the affiliation agreement the board members the funding all of those facts related to the relationship between ury which is the clinic and northwestern which is the hospital those are all secondary to this fundamental threshold question did the plaintiffs go to northwestern for this treatment if she didn't if that wasn't her goal then gilbert doesn't even apply and  that's why trying to interpret this even on a summary judgment motion you try to look at this with all of the facts as we understand them and get them into that framework that justice freeman created in gilbert it doesn't it it just makes that's correct and the doesn't use that language but but it always comes back to that line which it always comes back to that language about providing care at a hospital and that's way even although i acknowledge as i was mistakenly quoting york that language beco relevant all of the cases that evaluate a parent agency use that in order to qualify or care given act the hospital now certainly the first district disagreed with that argument very specifically in its opinion here but that isn't really the nub of the question here does wilber apply to care given outside of the hospital facility if it doesn't then we move beyond what you were asking about justice ties isn't this just a rule really isn't this just a summary judgment question no it's not because if gilbert does not apply to these acts then there can be no application of the parent even see in this case when you think about the case about the clinic the lower case it's it's entirely consistent with what this court was describing in gilbert because the care was given at a hospital facility there's no that piece is called melanau ski there's no question th hospital on facility is so fundamental here what if what if the hospital owns the property and leases that to a clinic that's the condo case here are the rovers versus condo case the second district said that's not there's no apparent doesn't it doesn't work in that situation because it is the plaintiff was not seeking care at candelo plaintiff was seeking care from a private physician who happened to have space in that vicinity and that is what is to caregiving in that private clinic simply by virtue of being on having staff privileges at a hospital here in hospital avoid the appearance of already agency in some way by clarifying the nature of the relationship to the public how how is the hospital to do that your honor and i advertise in i believe here was the clinic was saying that they have northwestern as a partner in the collaborator the clinics website lists it's not hospitals and other organizations with whom it works it's not just northwestern there were a number of hospitals who are identified as earners of erie and is ok but it does northwestern benefit financially no it does not anyway it does not there's been some for giving free services i don't know the answer to that question but i do know the answer to is when there's a discussion about medicare reimbursement and medicaid reimbursement that is not a profit center that most of the time a hospital isn't even recovering the full the centers that are directly on the ground in places that need this care the most they are the hospitals are not engaging with that simply because they're trying to encourage more people to use the hospital where they're trying that and more clients come to the hospital that's not the concern that illuminated gilbert in billboard's the concern was possible for advertising their services their soliciting patients actively their competitive they're doing that by trying to say we offer the best services we serve every single need that you may have come to our hospital directly and then when patients do go to the hospital directly suddenly there were issues related to whether or not a patient can sue the hospital this is a different situation this is hospitals in gauging community service trying to assist these facilities but functionally in a way that's no different than the hospitals relationships with private physicians it's the same process physicians that eerie or any of these other clinics still need to apply for staff privileges still need to go through the same vetting process and then the relationship is simply one of staff privileges questions about do you support these entities economically or not that's not that's not the question the question is how closely are these two entities connected in terms of the staff in terms of the actual position here and again it's no different than a private physicians office that's what i was starting to address just face to you is the concern the this decision is allowed to stand in its current form the mere fact of giving a private physician staff privileges at a hospital arguably creates the appearance that that physicians that private physician is acting as the hospital at that point there becomes an argument for any plaintiff it may be an argument that the it's a poor argument maybe that's the fact washing that gets resolved and the jury comes back and trial to resolve any negligence question raised by a patient even if it's treatment given at a private facility by a private physician and there was never any relationship to the hospital at all how many more cases are we going to see that can't get resolved on summary judgment there cannot be a ruling on summary judgment because as you suggested just size isn't this just a question of fact for the jury to decide no not needs to be does gilbert even apply here because if it doesn't you find yourself in the space that hospitals were in before get a parent agency doesn't apply you can establish that there's no actual agency there for the claim the claim has to go away conceivably that argument can be made on a motion to dismiss but we weren't in a position to make that clear because of the way the word is interpreted gilbert and that's what we're asking this court to resolve how is gilbert properly interpreted what is the scope of gilbert is it's so broad as to encompass any any claim based on the actions of a staff position and that leads to the second important policy problem that's created by this decision if he answer is it's a fact assertion you're going to have to resolve this on summary judgment or more likely all of this is going to have to go to trial there's a way for the hospitals to avoid that result stop  stop supporting these clinics it's too serious a liability the exposure is too significant at that point the very people this court sought to help in gilbert are the people who are being analyze hospitals have to make that choice they won't and they're sort of charity care they see that my time is up if there are no questions thank you is whether the business relationship reasonably of peers  satisfy the elements of the gilbert chess or can she and that's true regardless of the business relationship between the the agent and the principal and can we go back to your first  what the actual business relationship was with joe and does that all tied into you'll be able to get treated down the line of premises that were you're going with this well there's if it's really there's several bases upon which to  northwestern hospital she was expressly told that she did not go to the clinic for purposes of paper prenatal care she went there for for free tests she was solicited to be a patient that's what happens here they faced her to becoming patient of the put it quote unquote by telling her that in reality the livery would be a north western and in reality the here she clearly was relying on the reputation of the hospital these representations the major her used her to undergo care at the clinic which she considered to be vicious which was told the same thing as undergoing here at north people who were north western it was north western that was vital this fair that's what this case is all about not the actual relationship doesn't matter that whether they were independent contractors or not the point is that the appearance that was given to her based upon know that representations are being made and acquiesce into this record replete with information that supports that evidence that supports that just aren't that they are point out that  was a partnership between the two of them provide care they knew that the northwest was holding out this their relationship to individuals and that clearly they had to recognize which influenced people it was them to be in fact if you look at the testimony if you look at the filiation it's clear that they are only themselves as partners to provide quality health care comprehensive here in the form of a diet rendered by western that they might not be able to render by itself that's why they're working together and it's specific here trevor's is a diagnostic here the ultrasound so for this woman it shouldn't be any surprise that she thought that reputation of northwestern about which she was already familiar with a large hospital were expected on her first that's what's required with respect that with respect to the actions of the agent then the question will be what actually the only limitation is you need to be able to satisfy the elements of this comment that your decision says makes reference to in a hospital of course it does that was the context in which that case came up and that's it's very difficult to know when you go into the emergency room who works for who and who's it and the contractor and so the court adopt this idea because the changing nature of the medical world treatment world well in twenty years certainly evolved even beyond what hospitals were doing twenty some years ago pales in comparison to what they're doing today it pales in comparison to the fact that my spittles like northwestern and others in illinois are just and those include things like joint ventures the blue things like partnerships with humanity lives like this and when they gauges those partnerships for the specific purpose of having that women funnel patients to the hospital that's what this is about the clinic made a deal to funnel patients to the hospital in return for wish the hospital was right was about twenty five million dollars but the benefits to the behemoths don't stop with which the amount of money to get met mr mr janet their first lawyer your first premise which is correct that there's a lot more joint ventures that that would they have between hospitals that would never pose a problem as to whether there was an agent i mean the fact is you know del norte hospital in center of the page being part of the northwestern system if northwestern was sued there i don't think we have the same type of case here a that isn't a problem in with respect to relationships whether it's this or any other business there's relationships all over the place between one company and another company that would not implicate agency puts in every instance i think under circumstances where northwest the public in this case so yes you mean what you say and that's an interesting point they specifically said it in their own advertising they need to reset it so never consing they knew what your he was doing  well that's part of the charitable and community activities of the hospital if we expand this principle me on the floor was the hospital house was not to do charity work anymore well number one  outlets and they're not just ones with their name on this patient groups that they're providing joint here in partnership with telling people they're actually providing the care jointly with what it is and i would sit under those circumstances i appeal and for good reason i don't think i need to restate that there are more reasons today and that relates to the claim the one thing i would say i don't write short of time so couple of quick points if i may and that is this case really honor the question you're asked to decide today is does gilbert apply when a patient doesn't seek care act hospital and justice tyson want to be very clear because i'm concerned about the narrow issue you're going to hold me to we're not saying that the care has to be within the four walls of the hospital care to see a hospital facility that hospital facility that has the may have facilities all over the city that's a fundamental distinction because this is not an argument that ospital could never be responsible for care given outside new hospital the problem is whether or not the plaintiff sought care at a hospital facility here the plaintiff didn't and justice burke your question is exactly the concern that northwestern is trying to raise here this case is no difference on the facts objective leave you look at the facts it's no different than an allegation that a plaintiff elected to treat with the right position in that private physician forward on that claim that a hospital can move sued or any care pension was sued for any care given by a private physician in the private physicians office and this is where examples are helpful to understand  in that situation based on what the first district has determined in this case the hospital could potentially have to go to trial for any negligence allegation that her claims then happen months before the patient ever even sets what  hospital the patient need never even vonda spill but this is still has to be some relationship that's exactly right there has to be some relationship and that relationship has to be that the patient was trying to treat at the hospital that's why that language is in gilbert that's why that distinction is so fundamental what about a patient who has back issues and treats with his position goes to the private physician stays in gauges and of course a conservative treatment there is some sort of negligence related to that but the patient is told that eventually he may treat was told may have to treat russia bench woolley under the facts of this case and under the framework that the first district has decided gilbert uses that is a possibility what if that pri hospitals is the interpretation that the first district has given to gilbert so broad that somehow there's an issue related to both hospitals or even as you justice thomas were saying there shouldn't be any relationship any issue for a network of hospitals but even the plaintiffs counsel seem to suggest perhaps there would be a problem there is a network of hospitals a plaintiff elects to treat at one hospital can she sue another totally unrelated hospital for that care suggesting that there is some sort of a relationship between these entities there traction with agreements there are joint venture agreements because they're part of a network the look on your face justice i suggest that makes no sense and i completely agree and that is the concern that is the concern in this case if there is no anchor to gilbert and that anchor is the patient sought treatment from the hospital if that anchor isn't there then gilbert broadens so much that conceivably a hospital could be on facing trial on liability for any of those potential issues that could arise in a private physician presumably wants to write that if the patient does not seek treatment at a hospital doesn't apply at the hospital at a hospital facility at a hospital facility not not within the four walls of the hospital but if the patient is not seeking treatment at a hospital facility gilbert doesn't like that's the ruling the court should make that's the ruling we asked the court to make and