Title: Reda v. Advocate Health Care

State: illinois

Issuer: Illinois Supreme Court

Document:

Docket No. 90487-Agenda 21-September 2001.
EMILIO REDA et al. (Susan Capra, Contemnor-Appellant), v. 
 								ADVOCATE HEALTH CARE et al., Appellees.
Opinion filed February 22, 2002.
	JUSTICE FREEMAN delivered the opinion of the court:
	During discovery in a medical malpractice action, the circuit
court of Cook County twice ordered plaintiffs, Emilio and Mary
Reda, to disclose Emilio's psychiatric records to defendants,
Advocate Health Care, formerly doing business as Lutheran
General Hospital, Inc. (hospital); Dr. Theresa Cappello; and Dr.
Melvin Katz. Plaintiffs' attorney, Susan Capra, refused, invoking
the mental health therapist-patient privilege under the Mental
Health and Developmental Disabilities Confidentiality Act (Act)
(740 ILCS 110/1 et seq. (West 2000)). The court held Capra in
civil contempt for refusing to comply with its discovery orders.
	The appellate court, inter alia, upheld the disclosure of
Emilio's psychiatric records. 316 Ill. App. 3d 1115. We allowed
Capra's petition for leave to appeal. 177 Ill. 2d R. 315(a). We now
reverse the appellate and circuit courts, and remand the cause to
the circuit court for further proceedings.

BACKGROUND
	Plaintiffs' first amended complaint alleged as follows. On
June 6, 1994, Emilio was admitted to the hospital, coming under
its care and the care of Drs. Cappello and Katz, for the treatment
of arthritis in his right knee. That day, Dr. Katz performed a total
right knee arthroplasty, i.e., knee replacement. As a result of the
surgery, Emilio developed an acute thrombosis of the popliteal
artery in his right leg. Defendants failed in several respects to
timely diagnose and treat this worsening condition. As a proximate
result of defendants' negligence, Emilio "sustained injuries of a
personal and pecuniary nature." Emilio sought recovery for these
injuries (count I), and as a result of Emilio's injuries, Mary sought
recovery for the loss of Emilio's society, companionship, and
affection (count II). In their answers, defendants denied that
plaintiffs were injured as alleged.
	In subsequent interrogatories, Dr. Katz and the hospital each
asked Emilio to specify his claimed injuries. Emilio answered each
interrogatory as follows:
		"I am not a medical doctor. Thus, I can only state what I
believe my problems are in laymen's terms. As a result of
the occurrence, I suffered severe injuries to my leg (toes
amputated and calf muscle removed) which have resulted
in disability, disfigurement, pain and suffering. I also
suffered a stroke, heart problems and kidney problems. I
would refer you to the Lutheran General Hospital records
for details; Investigation continues."
We note that Emilio's hospital records were not included in the
record on appeal.
	Plaintiffs filed their current complaint on December 17, 1996.
During pretrial discovery, defendants requested from Dr. Samuel
DeLisi Emilio's treatment records. Dr. DeLisi refused, explaining
that Emilio had not authorized their release. Plaintiffs objected to
defendants' discovery request, invoking the mental-health
therapist-patient privilege. On November 14, 1997, defendants
Cappello and the hospital moved to compel Emilio to authorize
the release of his psychiatric records from Dr. DeLisi.
	On January 19, 1998, Emilio and Mary each testified at a
discovery deposition. During Emilio's deposition, attorneys from
both sides agreed that questions regarding Dr. DeLisi's psychiatric
treatment of Emilio would be deferred pending resolution of the
motion to compel. The record contains the following pertinent
excerpts from Emilio's deposition:
			"Q. [Defense counsel] All right. My question related to
whether any doctor told you that you had sustained any
type of stroke. *** Did someone tell you that or use those
terms?
			A. I don't know about if I sustained stroke damage, but
he said I had brain-he determined I had brain damage. He
gave me a puzzle to work out, 17 pieces. I couldn't put
the puzzle together. Then, he did a couple other tests.
			And in more polite terms, he classified me one step
above an idiot.
* * *
			Q. Okay. At Lutheran General Hospital, did any
physician or doctor tell you that you had a stroke, of any
type?
* * *
			A. Not that I remember.
* * *
			Q. And then, you've told us a little bit about your
headaches. I want to ask you just a few more questions
about that.
			How frequently do you have headaches, nowadays, in
general? Is it like every day, every couple of days?
			A. Sir, them headaches have not gone away. I had
Dr.-the shrink, I kept accusing him-
			MS. CAPRA: We're not going to talk about him.
			THE WITNESS: Okay. I'm sorry."
During defense counsel's questioning of Emilio regarding his
headaches, the following colloquy occurred:
			"Q. *** When did you start having those headaches?
			A. I can't remember how far back they were, if they
were there all the time. I don't remember, sir.
			Q. Did you have any headaches like the ones you've
just described for me before you went to Lutheran General
for your surgery?
			A. No, sir. I never had-I wouldn't even take aspirins for
anything. I didn't believe in any medication for the head.
I never took nothing.
			Q. Do you take anything for the headaches now?
			A. I don't take them for the headaches. I take them
more for the heart and-I will not take medicine for
headaches, sir."
	During Mary's deposition, defense counsel questioned her
regarding, inter alia, Emilio's injuries. Answering their questions,
Mary testified regarding Emilio's comprehension following the
surgery. She testified that Emilio was not able to perform many
tasks, e.g., operating a shower faucet and cutting his food with a
knife. Mary also testified that Emilio was "very emotional" and
"very frustrated." Mary also referred to Emilio's lack of affection
subsequent to the surgery. She testified: "He's-he can be very
mean, extremely mean. And I'm always at fault. I make wrong
decisions, everything. It's a hard situation. Sometimes I want to go
crawl under the bed and stay there for ten days."
	On February 20, 1998, the circuit court denied, without
prejudice, the motion to compel production of Emilio's psychiatric
records. The court did not have before it plaintiffs' deposition
testimony. On April 7, 1998, based on plaintiffs' depositions, Dr.
Cappello and the hospital sought rehearing on their motion to
compel. On August 20, 1998, the circuit ordered plaintiffs to
submit Emilio's psychiatric records to the court for an in camera
inspection. On November 5, 1998, the court ordered plaintiffs to
disclose Emilio's psychiatric records to defendants. On March 17,
1999, the court denied plaintiffs' motion to vacate the disclosure
order and again ordered plaintiffs to disclose Emilio's psychiatric
records to defendants.
	On April 6, 1999, the circuit court held plaintiffs' attorney,
Susan Capra, in civil contempt for refusing to comply with the
court's discovery orders. The court fined Capra $100 plus $10 per
day until Capra disclosed Emilio's psychiatric records to
defendants.
	The appellate court, with one justice dissenting, upheld the
disclosure of Emilio's psychiatric records. The court concluded
that, under the Act, Emilio had placed his mental condition at
issue in this litigation. 316 Ill. App. 3d at 1118-19. Further, the
appellate court upheld the circuit court's determination that the
remaining statutory requirements for disclosure were met. 316 Ill.
App. 3d at 1119. The appellate court also vacated the circuit
court's order of contempt against Capra, finding that Capra was
not contemptuous of the circuit court, but rather had subjected
herself to a contempt finding only to secure appellate review of the
circuit court's disclosure orders. 316 Ill. App. 3d at 1119.
	The dissent concluded that Emilio had not placed his mental
condition at issue in the medical malpractice action. Rather, the
dissent opined, plaintiffs merely answered defense counsel's
questions during their depositions, and that their truthful answers
did not give rise to disclosure under the Act. 316 Ill. App. 3d at
1119-20 (South, J., dissenting).
	Capra appeals from the judgment of the appellate court. We
granted the Illinois Trial Lawyers Association leave to submit an
amicus curiae brief in support of plaintiffs. 155 Ill. 2d R. 345.

DISCUSSION
I. Scope and Standard of Review
	Because discovery orders are not final orders, they are not
ordinarily appealable. Norskog v. Pfiel, 197 Ill. 2d 60, 69 (2001).
Rather, they are reviewable on appeal from the final judgment.
People ex rel. Scott v. Silverstein, 87 Ill. 2d 167, 171 (1981).
	However, it is well settled that a contempt proceeding is an
appropriate method for testing the correctness of a discovery order.
Norskog, 197 Ill. 2d  at 69; People ex rel. General Motors Corp. v.
Bua, 37 Ill. 2d 180, 189 (1967) (collecting cases); Lewis v. Family
Planning Management, Inc., 306 Ill. App. 3d 918, 922 (1999).
When an individual appeals from a contempt sanction imposed for
violating, or threatening to violate, a discovery order, the contempt
finding is final and appealable and presents to the reviewing court
the propriety of that discovery order. See Norskog, 197 Ill. 2d  at
69; Silverstein, 87 Ill. 2d  at 171-72, 174.
	Generally, a trial court's rulings on discovery matters will not
be disturbed on appeal absent a manifest abuse of discretion.
However, the applicability of a statutory evidentiary privilege, and
any exceptions thereto, are matters of law subject to de novo
review. Norskog, 197 Ill. 2d at 70-71; D.C. v. S.A., 178 Ill. 2d 551,
559-60 (1997). In this case, the determination of whether Emilio
introduced his mental condition as an element of his claim, so as
to waive the statutory mental-health therapist-patient privilege, is
a matter of law subject to de novo review. However, the circuit
court's secondary findings required under the Act are factual
questions subject to an abuse-of-discretion standard. D.C., 178 Ill. 2d  at 560.


II. The Mental-Health Therapist-Patient Privilege
	In determining whether Emilio's psychiatric records are
privileged under the Act, it is first necessary to look at the
language of the Act itself. See Niven v. Siqueira, 109 Ill. 2d 357,
365 (1985). The legislative intent of a statute is best determined
from the plain and ordinary meaning of the statutory language.
Bonaguro v. County Officers Electoral Board, 158 Ill. 2d 210, 216
(1994); see, e.g., People v. Pawlaczyk, 189 Ill. 2d 177, 195 (2000).
If the legislative intent is clear from the statutory language, the
court must confine its inquiry to a consideration of that language
and must not look to extrinsic aids. People ex rel. Baker v. Cowlin,
154 Ill. 2d 193, 197 (1992). Where the language is clear and
unambiguous, we must apply it as written. Paris v. Feder, 179 Ill. 2d 173, 177 (1997); see Sassali v. Rockford Memorial Hospital,
296 Ill. App. 3d 80, 83 (1998). However, if the statutory language
is susceptible of more than one interpretation, the court may look
beyond the language to consider the purposes of the statute. In re
B.C., 176 Ill. 2d 536, 542-43 (1997); see Sisters of the Third Order
of St. Francis v. People ex rel. Barra, 151 Ill. App. 3d 875, 877-78
(1987).
	The Act provides: "All records and communications shall be
confidential and shall not be disclosed except as provided in this
Act." 740 ILCS 110/3(a) (West 2000). The records made
confidential under the Act refer to "any record kept by a therapist
or by an agency in the course of providing mental health or
developmental disabilities service to a recipient concerning the
recipient and the services provided"; the communications made
confidential under the Act refer to "any communication made by
a recipient or other person to a therapist or to or in the presence of
other persons during or in connection with providing mental health
or developmental disability services to a recipient. Communication
includes information which indicates that a person is a recipient";
and " '[r]ecipient' means a person who is receiving or has received
mental health or developmental disabilities services." 740 ILCS
110/2 (West 2000).
	Section 10(a) of the Act provides: "Except as provided herein,
in any civil, criminal, administrative, or legislative proceeding ***
a recipient, and a therapist on behalf and in the interest of a
recipient, has the privilege to refuse to disclose and to prevent the
disclosure of the recipient's record or communications." 740 ILCS
110/10(a) (West 2000). Section 10(a) then lists exceptions to this
evidentiary privilege. The first exception, which is at issue in this
case, provides in pertinent part:
			"(1) Records and communications may be disclosed in
a civil, criminal or administrative proceeding in which the
recipient introduces his mental condition or any aspect of
his services received for such condition as an element of
his claim or defense, if and only to the extent the court in
which the proceedings have been brought *** finds, after
in camera examination of testimony or other evidence,
that it is relevant, probative, not unduly prejudicial or
inflammatory, and otherwise clearly admissible; that other
satisfactory evidence is demonstrably unsatisfactory as
evidence of the facts sought to be established by such
evidence; and that disclosure is more important to the
interests of substantial justice than protection from injury
to the therapist-recipient relationship or to the recipient or
other whom disclosure is likely to harm. *** [F]or
purposes of this Act, *** in any action in which pain and
suffering is an element of the claim, mental condition
shall not be deemed to be introduced merely by making
such claim and shall be deemed to be introduced only if
the recipient or a witness on his behalf first testifies
concerning the record or communication." 740 ILCS
110/10(a)(1) (West 2000).
Thus, before the circuit court can order disclosure, it must find that
the recipient has introduced his mental condition as an element of
his claim or defense. The recipient does not introduce his mental
condition merely by claiming pain and suffering. If the recipient
has not placed his mental health at issue, disclosure of the records
or communications is not permitted. If the recipient has introduced
his mental condition, the court must conduct an in camera
examination of the evidence to determine if it is, inter alia,
relevant, probative, and not unduly prejudicial.
	The appellate court held that Emilio had introduced his mental
condition as an element of his claim. The court observed that
plaintiffs, in their depositions, testified regarding Emilio's
headaches, loss of memory, decline in comprehension, difficulties
in performing daily activities, and changes in personality. The
appellate court reasoned:
		"Plaintiffs contend that Emilio's marked changes in
personality, loss of memory, deficits in comprehension
and difficulty performing routine tasks are neurological
injuries only. We, however, believe that these 'injuries'
may be reasonably interpreted or characterized as
psychological traumas. Accordingly, we believe that
testimony given by plaintiffs regarding these 'injuries'
placed Emilio's mental health at issue." 316 Ill. App. 3d
at 1119.
	Assigning error to the appellate court, Capra contends that
Emilio "suffered brain damage, which has produced many
behavioral consequences" and that he now is experiencing
"physical limitations and the everyday frustrations that go along
with them." Capra urges an interpretation of "mental condition,"
as used in the Act, that excludes physical injuries. Agreeing with
the appellate court, defendants contend that Emilio's "cognitive
deficiencies" may have been "a manifestation of a mental
condition completely unrelated to his medical treatment."
Defendants urge an interpretation of "mental condition" that
includes physical injuries with a psychological component.
	We agree with Capra that Emilio had not introduced his
mental condition as an element of his medical malpractice claim.
Therefore, he has not waived the statutory privilege, and
disclosure of his psychiatric records is not permitted.
	Emilio did not place his mental condition at issue merely by
claiming damages for what is a neurological injury, i.e., stroke
and/or other brain damage. As the dissenting justice in the
appellate court aptly noted: "A neurological injury is not
synonymous with psychological damage ***. Nor does
neurological injury directly implicate psychological damage." 316
Ill. App. 3d at 1120 (South, J., dissenting). If that were true, in
every case in which the plaintiff claimed damages stemming from
a physical injury to the brain, the door to discovery of the
plaintiff's mental-health records would automatically open, and
the limited exception in section 10(a)(1) of the Act would
effectively eviscerate the privilege.
	Our interpretation of section 10(a)(1) of the Act accords with
earlier case law. Interpreting a predecessor statute, our appellate
court held that a litigant claiming pain and suffering does not ipso
facto place his or her mental condition at issue. See Tylitzki v.
Triple X Service, Inc., 126 Ill. App. 2d 144, 148-50 (1970); Webb
v. Quincy City Lines, Inc., 73 Ill. App. 2d 405, 407-09 (1966). The
court in Webb found it difficult to conclude that one undergoing
pain and suffering necessarily suffers deterioration in mental
condition, and held that a mere allegation of pain and suffering
originating in physical trauma did not ipso facto result in "trauma
affecting the mentality." Webb, 73 Ill. App. 2d at 408. The court
refused to "open a Pandora's box of inquiry into the mental
condition of the claimant where it is not specifically made a part
of the claim." Webb, 73 Ill. App. 2d at 409.
	Even if, as defendants maintain, the psychiatric records have
a bearing on causation, relevancy is not decisive of whether a
plaintiff has introduced his mental condition as an element of his
claim. D.C., 178 Ill. 2d  at 566; see Tylitzki, 126 Ill. App. 2d at
148-51 (rejecting argument that questioning of plaintiff's
psychiatrist was necessary to determine whether claim of pain and
suffering resulted from physical trauma sustained in the accident
or from some other cause). Although defendants might be denied
access to information that could benefit their case, any
"unfairness" is the same that is present any time a privilege against
disclosure is exercised. Evidentiary privileges, generally, " 'are not
designed to promote the truth-seeking process, but rather to protect
some outside interest other than the ascertainment of truth at
trial.' " Norskog, 197 Ill. 2d  at 83, quoting D.C., 178 Ill. 2d  at 561-62.
	Moreover, it is not enough that defendants, under their theory
of the case, placed Emilio's mental condition at issue. Also, while
Mary had her own case for loss of society, she could not place
Emilio's mental condition at issue in his case. To waive the
statutory privilege, the Act requires the "recipient" of mental-health services to introduce his or her mental condition. 740 ILCS
110/10(a)(1) (West 2000); D.C., 178 Ill. 2d at 564-65; see People
v. Gemeny, 313 Ill. App. 3d 902, 911 (2000) (collecting cases)
(section 10(a)(1) exception applies only when a party affirmatively
places his or her own mental condition at issue). The court in
Tylitzki, 126 Ill. App. 2d at 149, explained:
			"[I]t is the affirmative aspect which should be
controlling. The privilege is too important to be brushed
aside when the mental condition of the plaintiff may be
only peripherally involved. It is not difficult to consider
the many ways in which it could be argued that mental
conditions were at issue, and soon there would exist more
areas of inquiry deemed exceptions to the privilege than
there would be areas of inquiry protected by the
privilege."
	Our conclusion supports, and is supported by, the purpose of
the Act. The Act represents a comprehensive revision and repeal
of previous statutes pertaining to psychotherapeutic
communications. See Laurent v. Brelji, 74 Ill. App. 3d 214, 216
(1979). When viewed as a whole, the Act constitutes a strong
statement by the General Assembly about the importance of
keeping mental-health records confidential. Norskog, 197 Ill. 2d 
at 71-72. Confidentiality motivates persons to seek needed
treatment. Further, by encouraging complete candor between
patient and therapist, confidentiality is essential to the treatment
process itself. Norskog, 197 Ill. 2d  at 72 (and cases cited therein).
	The legislature carefully drafted the Act to maintain the
confidentiality of mental-health records except in the specific
circumstances explicitly enumerated. In each case where
disclosure is allowed under the Act, the legislature has been
careful to restrict disclosure to that which is necessary to
accomplish a particular purpose. Exceptions to the Act are
narrowly crafted. Norskog, 197 Ill. 2d  at 71. "Consequently,
anyone seeking the nonconsensual release of mental health
information faces a formidable challenge and must show that
disclosure is authorized by the Act." Norskog, 197 Ill. 2d  at 72.
	We note the suggestion of amicus that the determination of
whether Emilio has placed his mental condition at issue should be
based solely on the allegations of the underlying complaint. While
pertinent cases contain references to pleadings (see, e.g., D.C., 178 Ill. 2d  at 566; Tylitzki, 126 Ill. App. 2d at 151; Webb, 73 Ill. App.
2d at 409), section 10(a)(1) of the Act does not contain such a
limitation. In interpreting a statute, it is never proper for a court to
depart from plain language by reading into a statute exceptions,
limitations, or conditions which conflict with the clearly expressed
legislative intent. County of Knox ex rel. Masterson v. The
Highlands, L.L.C., 188 Ill. 2d 546, 556 (1999). A party may
introduce his or her mental condition in several ways during the
course of litigation, including, e.g., in the pleadings, answers to
written discovery, a deposition, in briefs or motions, in argument
before the court, or by stipulation. Based on the record before us,
we hold that Emilio had not introduced his mental condition as an
element of his claim as required by section 10(a)(1) of the Act.
	We lastly observe that the fundamental fairness exception to
the mental-health therapist-patient privilege (see D.C., 178 Ill. 2d
551) does not apply here. In D.C., we agreed with the appellate
court that the plaintiff had not introduced his mental condition into
the case within the meaning of section 10(a)(1) of the Act. D.C.,
178 Ill. 2d  at 566-67. However, this court held that "fundamental
fairness commands that the privilege yield." D.C., 178 Ill. 2d  at
568. We have explained this holding as follows:
		"Underpinning this ruling was our refusal to place our
imprimatur on plaintiff's wielding the privilege as a
sword to manipulate the legal system, coupled with the
recognition that, after in camera inspection, the trial court
restricted discovery to information which met all other
requirements of section 10(a)(1) of the Act and had little
to do with plaintiff's mental health treatment and more to
do with plaintiff's conduct at the time of the accident.
Furthermore, the information was obtainable from no
other source and could, potentially, absolve defendants of
any liability and bar plaintiff's recovery. We concluded
that, on balance, the interests of substantial justice and
fundamental fairness outweighed plaintiff's right to assert
the confidentiality privilege under the unique facts of the
case." Norskog, 197 Ill. 2d  at 82, explaining D.C., 178 Ill. 2d 551.
	As in Norskog, the facts in this case are distinguishable from
those in D.C. The record here does not show that plaintiffs are
invoking the mental-health therapist-patient privilege to exploit or
subvert the legal process. "Indeed, the confidentiality privilege is
being employed precisely as intended-to shield information which
our legislature has seen fit to protect." Norskog, 197 Ill. 2d  at 83.
	Also, unlike D.C., information regarding Emilio's injuries is
available from several additional sources. The record contains
references to Emilio's medical records maintained by the hospital
and various physicians. Defendants may question and contest all
opinions and conclusions contained therein. Specifically regarding
Emilio's mental condition, defendants may have Emilio tested or
examined by a mental-health expert and present a defense based
on the expert's opinion. See 166 Ill. 2d R. 201(a); accord 4 R.
Michael, Illinois Practice §31.3, at 104 (1989) ("The physical or
mental condition of any party whose condition is in issue may be
examined by an expert chosen by the adverse party"). Thus,
defendants would be able to argue that any or all of Emilio's
behavioral or cognitive limitations are based on a mental condition
and not their negligence.
	Also, unlike D.C., there is absolutely no indication that
anything that might be revealed in Emilio's mental-health records
would completely bar his recovery and absolve defendants of
liability. See Norskog, 197 Ill. 2d  at 83-84. Any information
contained in Emilio's psychiatric records would go only to
damages and not liability. Plaintiffs seek damages for several
severe physical injuries.
	As we concluded in Norskog:
			"In sum, the fundamental fairness considerations which
drove our opinion in D.C. are not present in this case.
Absent truly extraordinary circumstances, not present
here, the statutory privilege must prevail. To recognize a
fundamental fairness exception in this case would
eviscerate the statutory privilege." Norskog, 197 Ill. 2d  at
85.
Our disposition of this appeal obviates the need to address other
issues raised by the parties, such as the existence or sufficiency of
the circuit court's findings regarding the Act's secondary
requirements. See Norskog, 197 Ill. 2d  at 80.
	Accordingly, we reverse the judgment of the appellate court
and the circuit court's discovery order. Further, we reverse the
contempt finding against Capra on this basis. See In re Marriage
of Bonneau, 294 Ill. App. 3d 720, 723 (1998) ("where the trial
court's discovery order is invalid, a contempt judgment for failure
to comply with the discovery order must be reversed").

CONCLUSION
	For the foregoing reasons, the judgment of the appellate court
and the discovery order of the circuit court of Cook County are
reversed, and the cause is remanded to the circuit court for further
proceedings consistent with this opinion.
Appellate court reversed;
circuit court reversed;
cause remanded.