randall regularly sock hair was silver cross hospital the reason being that his pediatrician since birth had privileges there it's honest you did that when the paramedics arrived at the family home in order transport rail to the hospital that his mother asked that needs clear that ms gore actually went to silver cross hospital believing that her son and been taken there by the paramedics and although she didn't remember doing so in originally question about this in her deposition when protein as attorney had the opportunity to question her and presented she agreed and had no reason rather to disagree with the accuracy of that note the reality is that when ms gore went to silver cross hospital was unable to find her son she from the program and she was told by whoever she spoke with  st joe's it was explained a patient mother that one speech in arrives here they become our responsibility rayna was taken by the paramedics from his home to provino he arrived there shortly before ten am and dr patricia point after her arrival she was provided with inside a one page form and it's this form that serves the entire basis of proving his motion for summary judgment as well as the entire basis for the lower court's granting of that motion and this r the individual responsible for the patient's care were status in this case by the paramedics secondly once ms gore was informed that her son was in fact being treated at provino she too began to reasonably rely where he should be receiving here and his mother's decision was not followed she wanted her son to be treated that silver cross hospital so the paramedics clearly made the decision to take randal to be closer hospital than monsignor the court specifically reason that when the paramedics do that the implication becomes clear that they're choosing to bring the patient to the closest hospital because they believe it's necessary in their were lying on that hospital to provide for that care that monte a consent form he did not have a consent form the petion that piece was unconscious however a consent form would have made no difference when you're looking to the paramedics and their reliance in their decision making that decision making was already done well before the consent form ever enters into the picture so both elements the holding out of provino as a hospital capable of providing emergency care to patients like randall robinson and reliance on their ability to do so or accomplish me gets to rely on the hospital to provide the care that only knowing that it's an emergency facility and that it has emergency services available at it but she's actually told on the foam that now that her son is there he is quote all responsibility she permanently told that the hospital is treating him is responsible for her son and she reasonably begins to rely on that representation once she's given this consent form the analysis is already complete paramedics obviously is an area hospital it holds itself out as providing emergency room services under the kilburn and says it's set forth by our supreme court they're holding themselves out as a facility capable of providing emergency room care and accepting patients lie randall robinson which is the reason why the paramedics know that there a facility available to take patients like this so they're holding themselves out as having that functionality is being able to receive those patients and the paramedics act in r right so you can paramedics not a party to the suit and they were in fact never deposed in this case so you know they're they're separate but once be it the wording of the consent form does not it's not relevant in the sense that these elements required to establish a claim of a parent agency were already established by the time the consent form ever came into play but if we look at his sentiment the court believes that  here he's equally incapable of making a decision relative to where he should be treated and his mother was not in control of his hair because she wanted to be treated at another hospital in fact went to that hospital believing that that's where he was being treated and when she found out that he had not been transferred the patient can get the services that is the that's needed on and the form determines the legal relationship between the people who are actually doing service and the hospital where the services are being performed on which seems to me to be different from what you're saying which is that the hospital is  provided from then that's enough to establish the holding out requirement here when you look to the police and the actions of the paramedics it's clear that they were acting in reliance on the ability of probing provide the necessary care to randall the form enters in to the equation when it's presented to miss or well after the care has already been initiated after dr kelly has already been assigned to care for the patient and certainly well after the paramedics me that initial decision to bring party i'll just surgeons and the like are not employees nor agents of st joseph medical center but a couple things this form is printed on letterhead provino letterhead which in the upper left corner has an capitalized larger font pro vino under that smaller lowercase font st joseph medical center it does not go on to explain who in fact does employ these physicians and it certainly doesn't go on to explain that the hospital is attempting to limit its liability and there are having privileges at a given facility and some of these forms in the cases cited by defense counsel actually go on to specifically states that the hospital is not responsible for the care of the missed care provided out within its facility none of that none of that is made clear in this form it's a simple broad statement that one entity st joseph medical center doesn't employ these physicians there's certainly no  explanation in a reader of this form could understand that that means that while this hospital doesn't provino does there's no inclusion of the of pro being a hospital in this disclaimer so the form in another itself is ambiguous in addition to all the other circumstances involving the presentation of this form that resulted poll questions of fact your signature ambiguous because of omission because of the lack of description relative to all the other forms that have been deemed by this court and others to be sufficient to inform the reader of the lack of liability or the disclaimed liability on the part of the hospital here they stopped at this form stops at simply just stating that these doctors are not employees o medical center doesn't go on to explain or agents were agents it doesn't go on to explain that provino is not employing them that they're employed by an outside entity there's there's no understanding no lay person reading this language would understand what the hospital's attempting to entirely and figure it's because it's not explaining that by not being an employer agent of this one entity st joseph medical center but that then means that the hospital proving a hospital cannot or is not responsible for care going on within its walls as both the gilbert and nor courts have noted it's reasonable it's natural that a layperson would understand or i'm sorry would believe that the care being provided within hospitals walls or being provided by employees of that hospital  this one sentence simply doesn't go far enough it doesn't provide an explanation that only person would understand that the hospital is not liable for the actions of physicians providing care within the fall thank you thank you take that hand out of controversy because it's a moment with a cold admission by the plaintiff i'd like to refer there's been discussion about a telephone call at ten fifteen this this note does not say the mother called protein rat their silver cross hall provino and said the mother was at silver cross very upset because the kid was supposed to care quote without informing the patient that unquote that care is being provided by independent contractors none on spital employee as that's the your case and gilbert  argument that the e m t stole my hands and on the back hospital it was the only reliance that counts because it shows the hospital that's exactly what happened in steel in steel it was an adult patient the romance would be a parent agency was disclaimed in this consent form that was signed by the atoll patient who was dead she died eventually and so there was no other evidence on that still stands treatment had already started so the consent doesn't count well obviously the consent counts because if nothing else it means that the consented to continue treatment of this independent physician at the it looks to me like silver crossed it five minutes later at ten twenty four things are recorded a medical exam and we don't know if the doctor just walked in and look at him or if she actually examined him there's  it's uncontroverted that the mother is the earth of the vast majority of the time a son is there for four hours relatively in stable condition he was there during his discharge you know of the distance between silver cross and freddy in the hospital there's no evidence about when the plaintiff arrived this court can take judicial notice where these hospitals are it's really literally down the road a matter of no need ten minutes apart but she also damper proved in this case what treatment was provided the un taking the bibles and apparently a phone call with dr jane walking into the room or perhaps examining him and a c t or treatment by an non hospital employee if i may have a moment your hono closest hospital and they did that it was the mother who was the legal guardian who had the sole authority to sign neck consent and she voluntarily did sell you know we know she had a car that day we and taking on the silver comet again he's presenting wet one incident of vomiting the night before and a cough or sneeze and sore throat so it's not that this was an emerging emergency situation she really wanted up and delivered to provino does not make the e m t s a legal guardian able to give consent or not the plane death agreed to consented to treatment or continuing treatment at the same time she was aware that the doctor it's not a hospital employee and the fact that another chose the hospital doesn't invalidate the consent as this court calvin's deal because the plaintiff was clearly and i mean  whether it be by participate directly in a phone conversation with somebody approach me that her son was now minos responsibility she certainly was relying on to provide for her minor son's care she was not providing on rely on i should say and had never had a treatment from dr kelly or at proving a previously she was certainly relying on the hospital and not on a specific position afrobeat which is sufficient under the law  sufficient corner of the reliance element she was certainly rely on the hospital consent form that is limited and that is provided to her well after the fact that well after treatment had been initiated and not undo this reason will realize that she had on her being a hospital on the hospital itself and not on a specific position regarding the steelcase that he says is not instructive here they act ace involves a consent act does go into much greater detail but i apologize i was just forty from a different consent form goes on to explain that each of the medical practitioners exercises his or her own independent medical judgment and is solely responsible for the care treatment and services that they or her request directs and it goes in a much greater detail regarding the independent nature of the physicians providing care within its facilities it does not contain a one line simple seat statement like the form that we cross hospital in fact where she is presented with this record over cross hospital she had no reason to disagree with the veracity of that note so at most it raises a question of fact gilbert both of those cases i direct course to consider the realities of modern hospital care in deciding issues of repair agency in this case the reality of hospital care is that hospitals have relationships with e m t services they hold themselves out of those e m t services as being evil of providing trauma care emergency room care and those sorts of things and in this case the paramedics relied on the hospital that that's a different issue from whether from who's responsible it is not in order to lead a claim of a parent agency or to maintain and claim of a parity agency as the courts as the our supreme court has set forth the need to prove the holding out and our alliance in this piece those two elements are established both by the paramedics who were undoubtedly the ones in control of and those responsible for making the decision to take randal to probe into they were also reestablish