Title: Valfer v. Evanston NW Healthcare

State: illinois

Issuer: Illinois Supreme Court

Document:

Illinois Official Reports 
 
Supreme Court 
 
 
Valfer v. Evanston Northwestern Healthcare, 2016 IL 119220 
 
 
 
Caption in Supreme 
Court: 
 
STEVEN 
I. 
VALFER, 
M.D., 
Appellant, 
v. 
EVANSTON 
NORTHWESTERN HEALTHCARE, n/k/a NorthShore University 
HealthSystem, Appellee. 
 
 
 
Docket No. 
 
119220 
 
 
 
Filed 
 
 
May 19, 2016 
 
 
 
Decision Under  
Review 
 
Appeal from the Appellate Court for the First District; heard in that 
court on appeal from the Circuit Court of Cook County; the Hon. 
Brigid Mary McGrath, Judge, presiding. 
 
 
Judgment 
Affirmed. 
Counsel on 
Appeal 
Leslie J. Rosen, of Chicago, for appellant. 
 
David E. Dahlquist, Matthew R. Carter, J. Ethan McComb, 
Christopher J. Letkewicz and Laura B. Greenspan, of Winston & 
Strawn LLP, of Chicago, for appellee. 
 
David R. Nordwall, of Chicago, for amicus curiae Illinois Trial 
Lawyers Association. 
 
Zachary M. Bravos and Kathleen M. DiCola, of Bravos & DiCola, of 
Wheaton, for amicus curiae Association of American Physicians & 
Surgeons. 
Digitally signed by 
Reporter of Decisions 
Reason: I attest to the 
accuracy and integrity of 
this document 
Date: 2016.06.24 10:07:21 
-05'00'
 
 
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Peter S. Stamatis and Steven S. Shonder, both of Chicago, for amicus 
curiae Michael Benson. 
 
Mark D. Deaton and Thaddeus J. Nodzenski, of Naperville, for amicus 
curiae Illinois Health and Hospital Association. 
 
 
 
Justices 
 
JUSTICE THOMAS delivered the judgment of the court, with 
opinion. 
Chief Justice Garman and Justices Freeman, Kilbride, Karmeier, 
Burke, and Theis concurred in the judgment and opinion. 
 
 
 
OPINION 
 
¶ 1 
 
Plaintiff, Steven I. Valfer, M.D., brought an action in Cook County circuit court seeking 
civil damages against defendant, Evanston Northwestern Healthcare, n/k/a NorthShore 
University HealthSystem (the hospital), based on the revocation of his privileges to practice at 
the hospital following a peer review conducted pursuant to the Illinois Hospital Licensing Act 
(Licensing Act) (210 ILCS 85/1 et seq. (West 2012)). The hospital filed a motion for summary 
judgment, arguing it was immune from damages under the Licensing Act and that it did not 
violate its bylaws in connection with deciding not to reappoint plaintiff. The trial court agreed, 
finding that the hospital was immune from suit and that it had complied with its bylaws and 
had not engaged in any wilful and wanton conduct. The appellate court affirmed. 2015 IL App 
(1st) 142284. We allowed plaintiff’s petition for leave to appeal (Ill. S. Ct. R. 315 (eff. Jan. 1, 
2015)) and now affirm the appellate court. 
 
¶ 2 
 
 
 
 
BACKGROUND 
¶ 3 
 
Plaintiff is an obstetrician and gynecologist (OB-GYN) who has been licensed to practice 
medicine in Illinois since 1975. In November 2000 and September 2001, plaintiff was 
reappointed to the staff at defendant hospital. Relative to his September 2001 reappointment, 
plaintiff received a letter from the president of the hospital stating that plaintiff’s 
reappointment would terminate May 31, 2002. 
¶ 4 
 
In February 2002, plaintiff applied for reappointment at the hospital. At that time, Dr. 
Kenneth Nelson, the division chief of gynecology at the hospital, reviewed one of plaintiff’s 
gynecological surgeries and deemed that it did not meet relevant criteria. Specifically, Dr. 
Nelson learned plaintiff removed a woman’s ovaries for treatment of menorrhagia—abnormal 
menstrual bleeding. Because that condition is not a recognized indication for the removal of 
ovaries, plaintiff’s treatment raised patient safety concerns and led to a meeting between 
plaintiff and two other doctors at the hospital—Dr. Nelson and Dr. Richard Silver, who was the 
chairman of the OB-GYN department at the time. 
 
 
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¶ 5 
 
Dr. Nelson and Dr. Silver found plaintiff to be unresponsive to their concerns at the 
meeting. As a result, Dr. Nelson conducted an additional review of 21 of plaintiff’s surgical 
cases from the previous year and found that at least 50% of the cases “lack[ed] demonstrable 
indications for surgical intervention.” 
¶ 6 
 
On June 4, 2002, Dr. Nelson and Dr. Silver once again met with plaintiff, this time to 
discuss all the unnecessary surgeries. Following their discussion, plaintiff voluntarily agreed to 
refrain from performing gynecological surgery until the pending issues were resolved. Plaintiff 
still retained other privileges at the hospital such as the right to admit patients. Also on June 4, 
2002, Dr. Silver sent plaintiff a letter informing him that he would not recommend plaintiff for 
reappointment at the hospital. That same day, Dr. Silver notified the hospital operating room 
that plaintiff’s operating privileges were suspended until further notice. 
¶ 7 
 
Dr. Silver explained in his letter to plaintiff that his recommendation against reappointment 
was based on patient safety and specifically that there were “[m]ultiple surgical cases for 
which approved indications for the intended procedures appear to be lacking.” Dr. Silver also 
explained that if the executive committee accepted his recommendation against 
reappointment, plaintiff would be notified in writing. 
¶ 8 
 
On July 3, 2002, the hospital’s executive committee met to discuss plaintiff’s potential 
reappointment to the medical staff. The committee determined that it would recommend to the 
hospital’s board of directors that plaintiff not be reappointed. On July 9, 2002, the president 
and chief executive officer (CEO) of the hospital sent plaintiff a certified letter stating that the 
recommendation to deny plaintiff’s reappointment had been accepted. The letter set forth the 
reasons for the decision and explained plaintiff’s right to request a hearing under the hospital 
bylaws and plaintiff’s rights at such a hearing. 
¶ 9 
 
In 2004, the hospital held a hearing on the matter before a hearing committee, at which 
plaintiff was represented by counsel and was allowed to present evidence and examine 
witnesses. The hearing lasted three days. Plaintiff testified on his own behalf, and Dr. Nelson 
and Dr. Hansfield testified against plaintiff. Evidence was presented that both of the doctors 
testifying against plaintiff had offices in close proximity to plaintiff and were competitors of 
his. On July 21, 2004, the hearing committee upheld the executive committee’s 
recommendation against reappointment. 
¶ 10 
 
The president and CEO of the hospital notified plaintiff in writing of the hearing 
committee’s decision and reasoning and of plaintiff’s right to appeal to an appellate review 
committee. In the meantime, plaintiff continued to retain privileges that he had not voluntarily 
relinquished and was able to continue to admit patients in accordance with the hospital 
bylaws.1 
                                                 
 
1 From the time of his application for reappointment in February 2002 until the time his 
nonreappointment became final on March 16, 2005, the hospital’s computer credentialing software 
indicated that plaintiff was an active staff member at the hospital. Any changes in the computer 
software, however, had to go through the medical executive committee. Thus, in response to inquiries 
about plaintiff’s credentials in October 2002 and March 2004, the hospital sent out letters indicating 
that plaintiff was a member in good standing. This appears to be consistent with the fact that the 
decision against reappointment did not become final until March 16, 2005. 
 
 
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¶ 11 
 
Plaintiff requested appellate review, and the appellate review committee upheld the 
recommendation against reappointment. The hospital board affirmed that decision on March 
16, 2005, and plaintiff’s nonreappointment became final and effective on that date. 
¶ 12 
 
On March 15, 2007, plaintiff filed his initial lawsuit against the hospital seeking civil 
damages arising out of the hospital’s decision not to reappoint him. Thereafter, a lengthy 
procedural history (largely irrelevant to the issues presented in this appeal) ensued over the 
next seven years. 
¶ 13 
 
In February 2014, the hospital filed a motion for summary judgment seeking to dismiss 
plaintiff’s breach of contract count,2 which was the sole remaining claim in the case. In its 
motion, the hospital argued that it had complied with the applicable bylaws in deciding not to 
reappoint plaintiff, and therefore it could not be held liable for breach of contract. The hospital 
further argued that, pursuant to section 10.2 of the Licensing Act (210 ILCS 85/10.2 (West 
2012)), it was immune from liability for civil damages and was likewise immune under the 
federal Health Care Quality Improvement Act of 1986 (HCQIA) (42 U.S.C. § 11101 et seq. 
(2012)). The trial court granted summary judgment in favor of the hospital on all three 
grounds. 
¶ 14 
 
The trial court first found that there was no genuine issue of material fact about whether 
plaintiff was reappointed after May 31, 2002. The court determined plaintiff was not 
reappointed after that date based on a number of facts. There were no documents advising him 
that he had been reappointed after that date as there had been for his September 2001 
appointment. All of the deposition testimony was consistent in showing that he had not been 
reappointed. And plaintiff himself participated in all of the proceedings and never once 
challenged the characterization by the hospital of the hearings and investigations as being part 
of the reappointment process. Plaintiff also took advantage of all of the protections of the 
bylaws that govern the reappointment process and never invoked the protections available to 
doctors under the peer review process. Plaintiff also acknowledged on a number of occasions 
that the proceedings dealt with reappointment. Second, the court found that the immunity set 
forth in section 10.2 of the Licensing Act applied because the hospital basically put forth 
unrebutted evidence that plaintiff was afforded adequate notice and hearing procedures and 
that the hospital’s decision upon reviewing plaintiff’s request for reappointment was based on 
patient safety concerns.3 Finally, the court determined that plaintiff provided insufficient 
evidence to support his allegations that the hospital’s decision to discharge him was really a 
product of one doctor having an economic conflict with plaintiff and another doctor having 
moral objections to his practice. 
¶ 15 
 
Plaintiff appealed and made the following arguments before the appellate court: (1) he was 
“effectively reappointed” on May 31, 2002, because he was allowed to admit patients to the 
hospital after that date, and therefore a genuine issue of material fact exists as to whether the 
hospital was required to follow the bylaws applicable to peer review and suspension as 
                                                 
 
2The parties agree that the operative contract between the litigants is the hospital’s medical staff 
bylaws, but the parties dispute which provisions of those bylaws govern the process under the 
circumstances of this case. 
 
3The trial court agreed with plaintiff’s theory that he could show “wilful and wanton misconduct” 
without showing physical harm, but disagreed that there was any evidence of “wilful and wanton 
misconduct” so as to raise a genuine issue of material fact on that score. 
 
 
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opposed to the bylaws applicable to reappointment that were applied by the hospital in this 
case; (2) immunity under the Licensing Act does not apply because the hospital was “wilful 
and wanton” in denying him privileges by failing to follow the appropriate bylaws and by 
allowing two of his competitors to partake in the peer review process; and (3) immunity under 
the HCQIA does not apply because the hospital did not follow the appropriate bylaws. 
¶ 16 
 
The appellate court affirmed the trial court’s grant of summary judgment on the basis that 
the hospital was immune from suit under section 10.2 of the Licensing Act. 2015 IL App (1st) 
142284, ¶¶ 33, 35. In so doing, the appellate court acknowledged that the immunity conferred 
by the statute contains an exception for wilful and wanton misconduct. Relying upon Lo v. 
Provena Covenant Medical Center, 356 Ill. App. 3d 538 (2005), and Larsen v. Provena 
Hospitals, 2015 IL App (4th) 140255, however, the appellate court found that to satisfy the 
wilful and wanton standard, a plaintiff must allege some type of physical harm to a person’s 
safety or the safety of others. 2015 IL App (1st) 142284, ¶¶ 24, 26-27. Otherwise, under 
plaintiff’s interpretation, which merely requires an intention to harm, the immunity of the 
Licensing Act would be rendered meaningless because every time a physician’s privileges are 
suspended, he likely suffers loss of reputation and resulting economic harm, which could 
always be said to have been intended by a defendant hospital. Id. ¶ 28. The appellate court did 
not address the other two grounds upon which the trial court granted summary judgment in 
favor of the hospital. 
¶ 17 
 
Plaintiff filed a petition for leave to appeal with this court, which we allowed. 
 
¶ 18 
 
 
 
 
ANALYSIS 
¶ 19 
 
This court conducts de novo review of a summary judgment ruling. Bruns v. City of 
Centralia, 2014 IL 116998, ¶ 13. Moreover, the construction of a statute presents a question of 
law, which this court also reviews de novo. Hayashi v. Illinois Department of Financial & 
Professional Regulation, 2014 IL 116023, ¶ 16. 
¶ 20 
 
Summary judgment is proper where the pleadings, affidavits, depositions, admissions, and 
exhibits on file, when viewed in the light most favorable to the nonmovant, reveal that there is 
no genuine issue of material fact and the moving party is entitled to judgment as a matter of 
law. 735 ILCS 5/2-1005(c) (West 2012). A party opposing a motion for summary judgment 
cannot rest on its pleadings if the other side has supplied uncontradicted facts that would 
warrant judgment in its favor (Abrams v. City of Chicago, 211 Ill. 2d 251, 257 (2004)), and 
unsupported conclusions, opinions, or speculation are insufficient to raise a genuine issue of 
material fact (Outboard Marine Corp. v. Liberty Mutual Insurance Co., 154 Ill. 2d 90, 132 
(1992)). 
¶ 21 
 
Before this court, plaintiff first argues that the appellate court erred in construing the 
Licensing Act to mean that in order to satisfy the “wilful and wanton” exception to immunity, 
plaintiff must plead and prove that physical harm resulted from the hospital’s actions. 
According to plaintiff, he has adequately shown “wilful and wanton misconduct” by merely 
alleging that the hospital did not follow its bylaws relating to the suspension of his privileges. 
In response, the hospital contends that plaintiff’s argument starts from the faulty premise that 
he was “effectively reappointed” after May 31, 2002 (the date his appointment terminated). 
The hospital contends that there is no record evidence to support plaintiff’s notion that he was 
reappointed after that date. Instead the record simply shows that he was allowed to continue on 
 
 
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with admitting privileges after that date while his application for reappointment was being 
reviewed under the specter of the issues being raised about the unnecessary surgeries. In any 
event, the hospital maintains that regardless of whether plaintiff was reappointed or not and 
whether the appropriate bylaws were followed or not, the appellate court correctly determined 
that plaintiff must plead and prove physical harm to establish wilful and wanton misconduct 
under the Licensing Act. 
¶ 22 
 
The parties’ arguments present an issue of statutory construction. When construing a 
statute, this court’s primary objective is to ascertain and give effect to the intent of the 
legislature. Barragan v. Casco Design Corp., 216 Ill. 2d 435, 441 (2005). The best signal of 
legislative intent is the language employed in the statute, which must be given its plain and 
ordinary meaning. Gillespie Community Unit School District No. 7 v. Wight & Co., 2014 IL 
115330, ¶ 31. Words and phrases should not be considered in isolation, however, and should 
be viewed in light of other relevant provisions of the statute. Midstate Siding & Window Co. v. 
Rogers, 204 Ill. 2d 314, 320 (2003). And this court presumes that the legislature did not intend 
absurdity, inconvenience, or injustice. Citizens Opposing Pollution v. ExxonMobil Coal 
U.S.A., 2012 IL 111286, ¶ 23. We will also avoid a construction of a statute that renders any 
portion of it meaningless. Lake County Grading Co. v. Village of Antioch, 2014 IL 115805, 
¶ 27. Where the statutory language is clear and unambiguous, it will be given effect without 
resort to other aids of construction. Bettis v. Marsaglia, 2014 IL 117050, ¶ 13. But if the 
meaning of an enactment is unclear from the statutory language, the court may look beyond the 
language used and consider the purpose behind the law and the evils the law was designed to 
remedy. Id. 
¶ 23 
 
Turning to the statutory language at issue, we note that section 10.2 of the Licensing Act 
provides immunity to hospitals in connection with the physician review process as follows: 
 
“§ 10.2. Because the candid and conscientious evaluation of clinical practices is 
essential to the provision of adequate hospital care, it is the policy of this State to 
encourage peer review by health care providers. Therefore, no hospital and no 
individual who is a member, agent, or employee of a hospital, hospital medical staff, 
hospital administrative staff, or hospital governing board shall be liable for civil 
damages as a result of the acts, omissions, decisions, or any other conduct, except those 
involving wilful or wanton misconduct, of a medical utilization committee, medical 
review committee, patient care audit committee, medical care evaluation committee, 
quality review committee, credential committee, peer review committee, or any other 
committee or individual whose purpose, directly or indirectly, is internal quality 
control or medical study to reduce morbidity or mortality, or for improving patient care 
within a hospital, or the improving or benefiting of patient care and treatment, whether 
within a hospital or not, or for the purpose of professional discipline ***. *** For the 
purposes of this Section, ‘wilful and wanton misconduct’ means a course of action that 
shows actual or deliberate intention to harm or that, if not intentional, shows an utter 
indifference to or conscious disregard for a person’s own safety and the safety of 
others.” (Emphasis added.) 210 ILCS 85/10.2 (West 2012). 
¶ 24 
 
The stated purpose of section 10.2 of the Licensing Act is “to encourage peer review by 
health care providers.” Id. As our appellate court has repeatedly noted, the legislative aim of 
the statute is to foster self-policing by the medical profession in matters unique to that 
 
 
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profession and to thereby promote the legitimate State interest in improving the quality of 
health care. 2015 IL App (1st) 142284, ¶ 23; Knapp v. Palos Community Hospital, 176 Ill. 
App. 3d 1012, 1024 (1988); Rodriguez-Erdman v. Ravenswood Hospital Medical Center, 163 
Ill. App. 3d 464, 470 (1987). 
¶ 25 
 
Reading section 10.2 as a whole, we find that the appellate court was correct in determining 
that the “wilful and wanton” exception is limited to physical harm. We agree that the only 
reasonable way to interpret the last sentence of the above-quoted section defining wilful and 
wanton misconduct is by finding that the phrase “utter indifference to or conscious disregard 
for a person’s own safety and the safety of others” clarifies the kind of intentional “harm” the 
legislature had in mind. The last phrase of the exception’s reference to safety clearly shows an 
intent that the harm contemplated is physical. Furthermore, if the legislature had intended to 
except from immunity any and all types of intentional harm, such as harm to one’s reputation 
or economic well-being, it would surely negate the immunity entirely and would lead to an 
absurd result. 
¶ 26 
 
Plaintiff contends that “even though a termination of privileges is intentional, it can be 
accomplished in conformance with the hospital’s bylaws [such that] the termination would 
most likely not be willful and wanton.” But we note that if a physician cannot show a violation 
of the hospital bylaws, there is no need to reach the statute’s immunity or the exception to that 
immunity because the physician could not establish a breach of contract in the first instance. 
On the other hand, if a physician could satisfy the statute’s exception to immunity simply by 
establishing a bylaws violation, the immunity would never apply because, according to 
plaintiff, the breach itself would establish wilful and wanton misconduct. Plaintiff is thus 
essentially asking this court to render section 10.2 a nullity in contradiction of basic principles 
of statutory construction, and therefore we must reject his argument. 
¶ 27 
 
That is not to say that we believe that the language employed in the exception is flawless. 
As both parties acknowledge, “wilful and wanton” is a tort concept that has been 
incongruously engrafted into a statute that will largely be used to provide immunity for breach 
of contract claims. This is reinforced by the reality that Illinois law views wilful and wanton 
misconduct “as an aggravated form of negligence,” i.e., a tort. Krywin v. Chicago Transit 
Authority, 238 Ill. 2d 215, 235 (2010). A breach of contract is not considered a tort because 
intent or the willfulness of the breach is not relevant (Morrow v. L.A. Goldschmidt Associates, 
Inc., 112 Ill. 2d 87, 94 (1986)) and a breach of contract presents solely economic losses that are 
not normally recoverable in tort actions (In re Chicago Flood Litigation, 176 Ill. 2d 179, 198, 
201 (1997)). Thus, because “wilful and wanton” is a tort concept that applies only to reckless 
or intentionally tortious conduct that causes physical harm to a person or property, it has no 
application to a nontort claim such as a routine breach of contract action involving a violation 
of the hospital bylaws.4 
¶ 28 
 
In support of his position that physical harm is not required, plaintiff relies upon Ziarko v. 
Soo Line R.R. Co., 161 Ill. 2d 267 (1994), and a comment in the legislative debate on the 1999 
amendment to section 10.2 that adopted the “wilful and wanton misconduct” language. We 
                                                 
 
4See Morrow, 112 Ill. 2d at 95 (There is also a rule against awarding punitive damages for breach of 
contract, and the only exception is when the conduct causing the breach is also an independent tort for 
which punitive damages are recoverable.). 
 
 
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find, however, that both matters actually support the appellate court’s interpretation of the 
language. 
¶ 29 
 
Ziarko involved a truck-train collision that resulted in substantial physical injury. Id. at 
269. This court was called upon to consider the parameters of the term “willful and wanton 
conduct” and concluded that the term is “a hybrid between acts considered negligent and 
behavior found to be intentionally tortious.” Id. at 275. Furthermore, even the quote from 
Ziarko that plaintiff now relies upon shows the connection between tortious behavior and 
physical harm and safety: 
“Willful and wanton conduct includes that which was performed intentionally. 
[Citation.] However, unlike intentionally tortious behavior, conduct characterized as 
willful and wanton may be proven where the acts have been less than intentional—i.e., 
where there has been ‘a failure, after knowledge of impending danger, to exercise 
ordinary care to prevent’ the danger, or a ‘failure to discover the danger through *** 
carelessness when it could have been discovered by the exercise of ordinary care.’ 
[Citation.]” Id. at 274. 
¶ 30 
 
Plaintiff points to a comment on the Senate floor when the 1999 amendment to section 10.2 
was added, which indicates that the legislature intended to adopt the “standard definition” of 
“wilful and wanton” along the line of Ziarko. We note that the definition of the term that the 
legislature actually provided for in the statute speaks for itself. But we also conclude that, 
consistent with Ziarko, the standard definition limits the concept of wilful and wanton to 
physical harm. 
¶ 31 
 
Plaintiff argues that the appellate court’s holding “eviscerates” this court’s decision in 
Adkins v. Sarah Bush Lincoln Health Center, 129 Ill. 2d 497 (1989), which involved the 
immunity in a different statute, section 2b of the Medical Practice Act (Ill. Rev. Stat. 1985, ch. 
111, ¶ 4406). Adkins held that “there is, in cases involving private hospital staff privileges, a 
‘rule of non-review’ under which, as a matter of public policy, internal staffing decisions of 
private hospitals are not subject, except as hereinafter stated, to judicial review.” Adkins, 129 
Ill. 2d at 506. The court went on to observe that the “judicial reluctance to review these internal 
staff decisions reflects the unwillingness of courts to substitute their judgment for the 
professional judgment of hospital officials with superior qualifications to consider and decide 
such issues.” Id. at 507. The court further found, however, that “[a]n exception exists [to the 
rule of non-review] when the decision involves a revocation, suspension or reduction of 
existing staff privileges. In such cases, the hospital’s action is subject to a limited judicial 
review to determine whether the decision was made in compliance with the hospital’s bylaws.” 
Id. at 506-07. The court went on to note that the physician in that case was given the basic due 
process rights of notice and a full opportunity to defend himself in a hearing. Id. at 510. 
¶ 32 
 
We do not find Adkins controlling under the circumstances of the present case. Here, 
plaintiff was represented by counsel at all times and was afforded a thorough course of due 
process hearings and reviews. Plaintiff never once complained that the wrong process was 
followed until he filed his amended complaint in circuit court. Adkins also involved a different 
statute, section 2b of the Medical Practice Act. Moreover, Adkins did not conduct an analysis 
of the actual language of the statutory immunity in that case, nor did it consider any arguments 
similar to the ones presented in this case based on the statutory language of section 10.2 of the 
Licensing Act. Additionally, a year after Adkins was decided, this court expressly held that 
 
 
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“the exception for willful or wanton misconduct that is contained in section 2b of the Medical 
Practice Act was intended to apply only to the immunity created within that section of the 
Medical Practice Act, and not to the entirely separate immunity created by section 10.2 of the 
Hospital Licensing Act.” Cardwell v. Rockford Memorial Hospital, 136 Ill. 2d 271, 278 
(1990). We also note that Adkins was decided 10 years before the legislature supplied the 
definition of “wilful and wanton misconduct” contained in section 10.2 of the Licensing Act in 
question here. For all of these reasons, then, Adkins does not militate against the result we 
reach in this case. 
¶ 33 
 
Plaintiff asserts that the appellate court’s decision gives hospitals absolute immunity for 
their staffing decisions and would deprive doctors of access to the courts in breach of contract 
cases. Amici curiae in support of plaintiff, the Association of American Physicians and 
Surgeons, the Illinois Trial Lawyers Association, and Dr. Michael Benson, argue in similar 
fashion that the appellate court’s decision would open the door to “sham peer review” and 
would shield intentional discrimination without any remedies for the physicians who suffer 
from such misconduct. We disagree. 
¶ 34 
 
Our decision today should not be interpreted as condoning sham peer review. Section 10.2 
of the Licensing Act immunizes a hospital and those involved in its quality reviews from civil 
damages only, and then only if the review was undertaken based on the actual purpose 
specified by the statute—i.e., to maintain or improve the quality of health care. 
¶ 35 
 
First, we note that the statute does not provide absolute immunity from all legal challenges 
to all decisions made by hospital peer review committees. Other remedies, such as injunctive 
and declaratory relief, remain available, and this is consistent with the notion expressed in 
Adkins that a hospital’s actions are subject to limited judicial review to determine whether the 
decision was made in compliance with the hospital’s bylaws. If a physician has a quarrel with 
his treatment under the bylaws, he can bring a timely claim for injunctive relief to make sure 
the proper procedures are followed. Also, tort actions that allege physical harm, such as 
physical harm resulting from intentional infliction of emotional distress, would be subject to 
the “wilful and wanton misconduct” language of the Licensing Act because physical harm is a 
part of such claims. Moreover, the Illinois statute cannot be read to take precedence over 
federal civil rights statutes that might be applicable for certain types of misconduct. 
¶ 36 
 
Second, and most importantly, we note that section 10.2 is clear and expressly states that its 
immunity is only afforded in a case like the present one where the purpose of the decision or 
action on the part of the hospital is “internal quality control *** or the improving or benefiting 
of patient care and treatment, whether within a hospital or not, or for the purpose of 
professional discipline.” 210 ILCS 85/10.2 (West 2012). In the event that a plaintiff physician 
alleges well-pleaded facts—which are not based on mere speculation or unsupported 
conclusions—to indicate that the purpose of the discipline was not based on the grounds 
enunciated in the statute but was instead a sham, he or she may advance his claim beyond a 
motion to dismiss on the pleadings. 
¶ 37 
 
We realize that the “wilful and wanton misconduct” exception is silent about motive and 
instead only speaks to whether the decision of the hospital was intentional or not. However, 
this point does not address whether the general immunity language of the statute is applicable 
in the first instance, which requires that the purpose of the hospital’s decision be for quality 
health care and not some other sham purpose. See 210 ILCS 85/10.2 (West 2012). 
 
 
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¶ 38 
 
Here, plaintiff’s claim advanced beyond the pleadings despite the conclusory nature of his 
allegations. Instead his claim was only disposed of after a full hearing on the hospital’s motion 
for summary judgment. As the trial court correctly noted, plaintiff alleged that one doctor had 
“economic cause for doing harm and another ha[d] moral objections to his practice but 
[plaintiff] provided insufficient evidence to raise a genuine issue of material fact to refute the 
[hospital’s] evidence” on those matters. 
¶ 39 
 
This was clearly the correct result based on this record, and plaintiff makes no effort to put 
forth a contrary argument before this court. We find that a case cited by plaintiff—Levitin v. 
Northwest Community Hospital, 64 F. Supp. 3d 1107 (N.D. Ill. 2014)—is instructive and 
shows that the proper result was reached in this case. In Levitin, the plaintiff alleged a plethora 
of well-pleaded facts to indicate that the peer review process in that case was not undertaken in 
reasonable belief that the disciplinary action was in furtherance of quality health care but rather 
to retaliate against the plaintiff for complaining about another doctor’s abusive behavior and 
false complaints. In denying the hospital’s motion to dismiss, the federal district court in 
Levitin noted that at this stage in the proceedings, the plaintiff’s factual allegations were 
presumed to be true and, if true, would ultimately deprive the hospital of immunity. Id. at 1121. 
This was so because the plaintiff had alleged plausible grounds “to doubt that [the defendants] 
acted under the reasonable belief that their actions were taken in the furtherance of quality 
health care.” Id.5 The court cautioned, however, that the “evidence adduced in discovery and 
presented on summary judgment or at trial may cast the case in a different light,” such that 
immunity might be found to be applicable. Id. 
¶ 40 
 
Similar to Levitin, the hospital’s initial motion to dismiss in the present case was denied. 
This case, however, presents the scenario envisioned in Levitin where the facts adduced on 
summary judgment cast the case in a different light and establish that there is no genuine issue 
of material fact as to the purpose of the hospital’s decision to not reappoint plaintiff.6 
¶ 41 
 
Plaintiff next argues that as construed by the appellate court, section 10.2 of the Licensing 
Act (1) constitutes impermissible special legislation because it grants hospitals absolute 
immunity for their staffing decisions and (2) deprives doctors of the right to access the courts. 
We find no merit to plaintiff’s arguments. 
                                                 
 
5As an additional basis for its decision, the court in Levitin found that the allegations also 
established that the defendants engaged in wilful and wanton misconduct. For the reasons noted above, 
we do not agree with that statement. But we do agree that a hospital cannot claim immunity for actions 
that are a sham and which are not actually undertaken in reasonable belief that they are in furtherance of 
quality health care. This is because in such a case the hospital’s action would not fall within the 
immunity language of the statute in the first place. 
 
6Mallapudi v. Mercy Hospital & Medical Center, No. 07 C 2053, 2007 WL 4548293, at *9 (N.D. 
Ill. Dec. 17, 2007), is another case where a federal district court found the plaintiff’s allegations of a 
sham purpose at work in his dismissal to be sufficient to survive a motion to dismiss. But the court 
noted that the immunity of the Licensing Act may ultimately be found to be applicable at a later stage in 
the proceedings. The court also explained that even at the pleading stage, the plaintiff’s “allegations 
must plausibly suggest that the plaintiff has a right to relief, raising the possibility above a speculative 
level; if they do not, the plaintiff pleads [him]self out of court.” (Internal quotation marks omitted.) Id. 
at *4. 
 
 
- 11 - 
 
¶ 42 
 
A statute violates the special legislation clause of the Illinois Constitution only if (1) it 
confers on a person, entity, or class of persons or entities a special benefit or exclusive 
privilege that is denied to others who are similarly situated and (2) the classification is 
arbitrary. Big Sky Excavating, Inc. v. Illinois Bell Telephone Co., 217 Ill. 2d 221, 236-37 
(2005). Plaintiff’s argument starts from the faulty premise that section 10.2 of the Licensing 
Act confers absolute immunity on hospitals for their staffing decisions. Thus, there is no need 
to consider his argument further, other than to note that our decision correctly prescribes the 
limits of the immunity available under the Licensing Act and there is no special benefit being 
conferred to which others similarly situated are not entitled. Nor is the classification the statute 
draws in creating limited immunity for hospitals an arbitrary one. 
¶ 43 
 
We also note that there is no support for plaintiff’s contention that the Licensing Act denies 
physicians access to the courts. Again, we have explained that physicians may bring injunctive 
and declaratory actions to force compliance with hospital bylaws, they may maintain tort 
actions where physical harm is alleged as part of the wilful and wanton component, and they 
may maintain other kinds of civil damage actions against a hospital where the hospital’s acts or 
decisions can be said to be a sham rather than in furtherance of quality health care. 
¶ 44 
 
Our resolution of the above-discussed issues renders it unnecessary for us to address the 
remaining issues raised by the parties. 
 
¶ 45 
 
 
 
 
CONCLUSION 
¶ 46 
 
For the foregoing reasons, we affirm the appellate court’s decision to affirm the trial 
court’s order granting summary judgment in favor of the hospital. 
 
¶ 47 
 
Affirmed.