The H onor a b le W il li am T. Law rence , Un it ed Stat es D is tr ic t  J ud ge f or the Sou ther n D is tr ic t of Indiana, is si tt ing by d es ignat i on. 

## In the 

# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 08
- 3719 E LI S HA H UNTER, i nd i vi du al l y a nd as Per sonal Re pr e s e nt a t i v e o fthe Es t a t e o fS t a nl e y Be l l, de c e a s e d, Plai nt i f f

-Appe l l ant, v . H ETAL A M IN, M .D ., et al., D efend a nts-A pp ellees
.

A pp eal from the United S t ates Di strictC our t fo r the S outhernDi stricto f Illino is. No . 3:07- cv-00296- DRH -PMF

—David R. H ern don, Chief Ju dge . A RG UE D M AY 5, 2009

— D ECIDED O CT OB ER 1, 2009

Befo re R IPPLE a nd S Y KES, C ircu it Judges , a nd L AWR EN CE , D i s t r i ctJudg e .  L AWR EN CE , D istrict Judge. E lish a H u n te r file d th is acti on o n hero w n behal fan d a s perso nalr epres entat i ve2 N o. 08
- 3719 ofthe est ate o fher deceas ed br othe r, S tanl ey Bel l, ag ai nst n u m er ou s d efe n d an ts w h om sh e a lleg ed w er e liab le f o r Be l l ’ s dea thi n the S t. Cl ai r Co unty, I l l i noi s, j ail
. The dist ri ct c ourtgr anted sum m ar y j ud gm ent i n f avo r ofal lo f the defendants o n all of H unter’ s cl ai m s; H unter now ap peal s por ti ons ofthatr uling. Fo r the r eas ons setf or th i n thi s o pi ni o n, we affi r m i n pa r t an d r ev er se a nd re m and i n partthe j ud gm ent o fthe dist ri ct c ourt .

I . B AC KGR OUND A. F acts W hen St anl ey Bel lar ri ved atthe St
. Clai r County, I l l i noi s, j ai l on Apr i l1 3, 2 00 5, a s a fede r alpr et r i alde ta i ne e, he w as tak i ng thr ee presc ri pti on m edi cati on s: am i tr i ptyl i ne, a n a nt i de pr e s s a nttha twa s p r e s c r ib e d a s a s l e e p a i d; Pro zac, an anti depressa nt; and hy droxyz i ne, an antihi sta
m i ne tha t i s us ed to t r ea t a nxi ety . Be ca us e ami tr i pty l i ne was b ar r ed atthe j ai lpur su an t to a n I l l ino i s Depa r tment of Corr ecti ons pol i cy, Dr. H eta lA m i n, a psychi atr i st w ho was und erco ntra ct with the jail, was co nsul ted by j ail p er so n n el th e d ay aft er B e l l’s a rriv al re ga rd in g h is p rescrip tion for th e d rug. Dr. A m in pres cribed a different s l eep ai d, tr azo done, i n pla ce o fam i tr i ptyl i ne. On Apr i l2 1, 2 00 5, dur i nghi s r egul ar wee k l y v i si t to the j ail, D r. A m inm et w ith B ell to co n d u c t a p sy c h iat ric exam i nati on. Bel l, w ho suffer ed fro m bi pol ar affecti ve d iso rd er , bec am e h igh ly a git at ed an d re fu s e d to ta lk wi thDr
. Am i n in th e pr es en ce o fa j ai lo ffi ce r, i ns i st i ng th athe was e nt i tl ed to a pr i va te c o ns ul tation wi ththe d oct or . I t was the j ai l ’ s pol i cy

— c o ns i s t e nt wi th a s tat eN o. 08
- 3719 3
re gul ati on

— th ata c o r r ec ti o na lo ffice r b e pr es en t dur i ng all in m at e m ed ica l ex am in at ion s. In th e ca se o fB ell, Dr
. Ami n fe l ti t was es p e c i a l l y i mpo r t a n tf o r h i s o wn sa fet y t o h av e a n offic er p re se n t b ec au s e B e l l’s file in d ica te d tha t he ha d a tt ac k ed ano ffi ce r a t an o ther i ns ti tu
tio n . A st an d o f fe n su ed , w ith B ell gr ow in g in c re as in gly bel l i ger ent a nd r efusi ng to part i ci pate in an e xam i nati on unt i lthe j ai lo ffi ce r l eft the r o o m a nd Dr
. Am i n r efus i ng to conduct the exam i nati on without th e j ai lo ffi cer bei ng pre sent. D r. A m inex p lain ed to B ell th at h is m e d i c at ion s w ou ld b e d i s c o n t i n u e d u n l e s s h e w a s ab l e t o co nd u c ta n e x a mi na ti o n; Be l ls ti l lr efus ed to sub m i t to a n e xa m i n the prese nce o fa j ai lo ffi cer . Dr. A m i n then dete rm i ned that Bel lwas refusi ngt r ea tmenta nd a sk ed Bel lt o s i g n a “R ele as e o f R es p on sib ility ” fo rm so ind ica tin g. B ell r efus e d t o s i g n th e f o r m, i n s t e a d wa d d i n g i t u p a nd th r o wi ngi t. Dr
. Am i n b el i ev ed th at Bel l was e xpe r i en cing a m ani c epis od e, w hi ch he a ttr ibuted to the f act that Bel lwas tak i ng an anti depressa nt ( Pro zac) wh i ch can cau se m an ic episod es in i nd ivi d ua ls w ith bipolar d isorders. The re for e, Dr. A m i n deci ded thatthe bestco urse o f acti o n wo ul d b e t o di s c onti nue Bel l ’ s a nti depressa nt, wh i ch h e b elie ve d w ou ld br in g h i m d o w n from h is m an ic e p iso de. Dr
. Am i n a l so s us pec te d tha t Bel ls ho uld be t ak i ng a m oo d st abi l i zer, but he co uld notm ake thatdeter m i nati on w i thout conducti ng an exam i nati on. Because B ell r efus ed to c o ns en t to a n e xa m i na ti o n, Dr
. A m i n di sc o nt i nued al lo fBel l’s m edi cati ons and planned to tr y t o exam i ne hi m ag ai n the f ol l owing w eekwh en he re turned to t h e j ail. U n for tu n at ely , B ell c om m itt ed su icid e o n A p ril 23, 20 05, l eaving be hi nd a n ote thatsa i d, am ong othe r4 N o. 08
- 3719

Th e di s t r i c t c ou r t di s m i s s e d sua spon te H u n t e r ’ s c l a i ms 1 a ga i ns tthe un na m e d de fe nd a nt s ; tha tr ul i ngi s n ota ppe a l e d. H unt erdoe s no tappe al the di s t ri c tc our t ’ s r ul i ng r eg ar di ng 2 eithe r he r § 19 83 c l a i m a g ain st D r. Am in o r he r m ed ical m alp ra ct ic e c la im s a g a in st t h e C o u n ty . thi ngs, thatS t. Cl ai r County w as re sponsibl e forhi s death be ca us e i t ha d t ak ena way hi s m edi ca ti o n.

B. Pr ocee dings Be l ow H unter’ s com pla i nt ass er ted a cl ai m pu rs uant to 42 U
. S. C
. § 1983 again st D r. A m in, St. C lai r Cou n t y Sheriff M ear l J usti ce, and S t. Clai r County, as w el l as tw o c ounts ofm edi calm al pract i ce ( one al l eging l oss o fchance of su rvi valand the othe r al l eging wrongful death) ag ai nst th o se de fen dan ts pl us t wo unna m ed empl o yees ofthe j ai l
. The di str i ct c ourtdi sm i sse d the m edic al m al pract i ce cl ai m s a gainst S heri ffJ ustice earl y in the case ; that rul i ng has not been appeal ed
. The defendants l ate r m ove d fo r sum m ar y j ud gm ent o n the re m ai ni ng cl ai m s; th ose mot i o ns wer e g r an te d i n the i r e nt i r ety a nd the di stri ctc o ur t en te r ed j udg m en t i n f av o r o fa l lo fthe defe nd ants. 1

I I . DI S C US S I ON Hu n t e r fi l e d a t i me l y a p p e a l i n wh i c h s h e a d d r e s s e s t wo asp ects o fthe dist ri ct c ourt ’ s r uling. Fi rs t, she ap p ea ls 2 the c ourt ’ s r uling tha t the County’ s pol i cy ofr equi ring a c or re c tio n s offic er to be p re se n t d u rin g p sy c h iat ric ex am i-N o. 08
- 3719 5 nati ons at the j ai l did not vi ol ate Bel l ’ s con stituti onal r i g htt o a dequa te ment alhe al tht r ea tment . S ec o nd, s he appeal s the co u rt’ s dete rm i nati on that, as a re sul t o f B ell ’s refus al oftreatm en t, D r. A m in had no d ut y tow ard hi m and ther ef or e ca nnot be li abl e fo r m edi calm al pract i ce. W e r evi ew the dist ri ct c ourt ’ s g ra nt o fsum m ar y j ud gm ent deno vo . Fe deral R ule o fCi vi lPro cedure 56( c) pro vi des tha t su m m ar y j udg m en t i s appropr i at e i f“ th e pl ea di ng s, dep osi ti o ns , a ns wer s to i nt er r o g at o r i es , a nd ad m iss ions on fi l e, to gether w i th the affi davi ts, i fany, show that there i s no ge nuine i ssue as to any m ate ri alf act and that the m oving par ty i s e nti tl ed to a j ud gm en t a s a m att ero fl aw . ” In rul i ng o n a m otion f orsum m ar y j ud gm en t, the a dm i ss ibl e e vi den ce pr es en te d b y the no nm oving p arty m us t b e b eli eved and allreason able inferen c es m u st b e d ra w n in t h e n on -m ov an t’s fav or . Zerant ev. D eLuca , 55 5 F
. 3d 582, 58 4 (7th C ir. 20 09)
. H owever, “[ a] partywh o bear s the bur den ofp ro of on a part i cul ar iss u e m ay n otr es t on it s p lea d in gs , b u t m u st affirm at ive ly d em on st ra te , by s p ec ific fa c tu al a l leg at ion s, th at th er e is a g en u in e is su e o f m at er ial fa c t t h at req u ire s t ria l.” Hem sworth v. Q uot esm it h.c om , Inc. , 47 6 F
. 3d 487, 49 0 ( 7th Cir
. 20 07)
.
A . Sec ti on 1983 C laim A gain st t h e Co u n ty The dis tr i ct c ourtf ound tha t th e County’ s pol i cy of re q u irin g a c or re c tio n s office r to b e pr es en t d u rin g p sy c h iat r i c ex ami na ti o ns a t th e j ai ldi d not v i o l at e Bel l ’ s co nst i tu ti o na lr i g htt o a dequa te ment alhe al tht r eat m en t an d th er efo r e g r an te d s um m ar y j udg m en t in f av o r o fthe6 N o. 08
- 3719 C o u n ty o n H u n t e r ’ s § 1 9 8 3 c l a i m. H u nterchal l enges that fi nd i ng. “A m un ic i pal i tymay be l i ab l e f o r ha r m t o pe r so ns i ncarc er ate d und eri ts auth ori ty i fi t m ai ntai ns a pol i cy that sancti ons the m ai ntenance ofpri son cond i ti ons that i nfr i nge upon the co nsti tuti onalr i ghts ofthe pri soners .” Est at eof

Novack ex re l
. Tur b i n v . County of Wood, 22 6 F. 3 d 5 2 5 , 5 3 0
- 3 1 ( 7 th Ci r . 2 0 0 0 ) ( c i t a t i o n a nd i nt er nal quotati on m ar ks om i tte d). M unici pal l i abi l i ty und er§ 1983 i s a p p r o p r i a t e o n l y wh e n th e p o l i c y i n qu e s t i o n i s t he “dir ect cause” o r “m oving f or ce” beh i nd a const i tuti onal vio lat ion
. Id. I n thi s ca se, wh i l e there is n o questi on that the j ai lhad an expre ss pol i cy that prev en te d Bellfro m speak i ng to Dr
. Am i n wi tho ut a j a i l o ffi c e r b e i ng pr e s e nt, tha t pol i cy did notcause any vi ol ati on o fBel l ’ s co nsti tuti onalr i ghts. H unter cor re ctl y no tes thatthe I l l i noi s Rul es ofCi vil Pro cedure provi de that physi c ian
- pati ent c om m unica
ti ons ar e, with c er ta in enum er ate d excepti ons, pri vi l ege d fr o m d isc los u re in le ga l ac tio n s. See 73 5 IL C S 5 /8 -80 2. In add i ti on, the I l l i noi s M entalH eal th and Devel opm ental Disabi l i ti es Confi denti al i ty A c t (“ the Act”) pro vi des that com m unica ti ons b etween a pati ent a nd a psychi atr i st ar e co nfi denti aland m ay n ot be di scl ose d except under c e r t a i n c i r c u ms t a n c e s . 74 0 I L C S 1 1 0 /3 ( a )
. Cl e a r l y, h o wev er, neith ero fthe se s ta tu te s cr ea te s o r s ug g es ts the exi ste nce o fa const i tuti onalr i ght o fany ki nd
. Both s tat
utes, as wellas the federa lpati ent- ther ap i st pri vi l ege r ec o g ni ze d i n Jaf

f e ev. R edm ond, 51 8 U.S
. 1 ( 1996 ) , to w hi ch H unter al so cit es , g ove rn the di scl osur e o fpati ent-N o. 08
- 3719 7

Thi s i s ane s pec i al l y e as y c onc l us i on t o r ea c h gi venthatthe 3 pu rpose ofthe Cou nty’ s polic y is to protectm edical prov iders (co n tin u ed ...) th e r a p i s tc o mmu n i c a t i o n s a ft e r th e f a c t, n o tth e c i r c u msta nces und erwh i ch theyar e m ade. I nd eed, rat h erthan supp or ti ng H unter’ s a sse rt i on that Bel lha d a r i g htt o s pea kwi th D r. Am i n pr i va te l y, the A ct r eco gni zes thatco m m unica ti ons between a ther api st and a pati ent m ay tak e pl ace in the pres ence ofo ther p er so n s. See 74 0 I LC S 110/2 ( defini ng “c om m unica ti on” as i ncl ud i ng “a ny co m m unica ti on m ade bya re ci pie nt o r othe r perso n to a thera pis t o r to ori n the prese nce o f o th erpe r so ns dur i ngo r i n c o nne ct i o n wi thpr o vi di ng m e nt a l he a l th o r de v e l o pme nt a l di s ab i l i t y s e r v i c e s to a re ci pie nt”)
. The A ct then prohibi ts dis c l osur e o fsuch com m unica tion s by any one, notj ust bythe ther api st. 74 0 I LC S 110/3 ( “A l lr eco rds a nd co m m unic at ions shal lbe confi denti aland shal lnotbe d i scl ose d except as provi ded i n thi s A ct. ”)
. I n other w or ds, under I l l i noi s l aw B ell ’ s co m m unica ti ons w i th Dr. A m i n w er e e quall y p rivi leged w he th er t he y took place i n th e pre sen ce of a cor re cti ons offi cero r not. A s a pr e t r i a l de t a i ne e , Be l l ha d a c o ns t i t ut i o na l r i g ht to adeq ua te ment alhe al tht r ea tment . Hunte r po i nt s to no evi dence thatsugg est s that Bel lco uld notr ecei ve ad eq ua te m en tal health treatm en t in the p resen ce of a cor re cti ons offi cer , a nd we fi nd thathe di d not hav e th e r i g htto a n exa m i na ti o n b y Dr
. Am i n wi th o utthe co r r ec ti o ns o ffice r r emai ni ngi n the r o o m . The r efo r e, the 38 N o. 08
- 3719

(
. . . c on t i nu e d) 3 f rom be in g a ttacked by offenders and a “high degree ofdef eren ce” is g iv en “to the d iscretion of pr ison ad m inistra tion to ad op t p olicies an d p rac tices to m ain tain th e safety a nd secu rity ofthi s country’ s penite nti ari es . ” Board v. Far nham , 394 F. 3d 469, 47 7 ( 7th Ci r. 2 00 5) ( c i t at i ons an d i nt er nalquo t at i on m ar ks omi t t e d)
. I nd e e d, the n e e d f or s uc h a po l i c y i s s up po r t e d b y the f actthati t i s m and ated by an Il li nois regulat ion that applie s to al l county j ail s and prov ides: “W hen a physic ian or other m edical pers onnel at tends pati ents a t the f aci li ty, a j ail offic er s hal l be pr es en tt o m ai nt ai n o rde r, pre ven tthe ftofm edi c at i on, equipm ent or s up plie s, a n d to ass ure an orderl y process . ” 20 Il l. A d m . C o d e § 70 1 .90 (f)(2). p oli cy to w hich H un ter p o in t s did not violate Bell’ s c on st itu tio n al rig h ts an d th e d ist ric t c ou rtco rre c tly f ound that there i s no bas i s forhol ding the County l i abl e under § 1 983.
B. M ed ical M alp racti ce C laim s A gain st D r. A m in The dis tr i ct c ou rt gr anted sum m ar y j ud gm ent in f avo r ofthe defe n d ants on Hu nter ’ s m edi calm al pract i ce cl ai m s. H unter appeal s that r uling o nl y with re gar d to Dr
. Am i n. The dist ri ct c ourt, ci ti ng C urtis v . Jask ey, 75 9 N
. E.2 d 962, 967 ( I l l
. A pp . Ct. 20 01) , r ule d that the physi ci an- pati ent rela tio nshi p cre ate s a duty f or the physi ci an to pro vi de com p ete nt m edi calcar e t o the pat i ent. A m edi cal m al pract i ce acti on i s pre dica ted on s u c h a d u ty . H ow ev er , w h er e th e p at ien t e x p re ss ly re fuses to conse n t to a m edi calpro cedure, no du tyN o. 08
- 3719 9

ar i ses o n behal fo fthe physi ci an t o p er f or m the proc ed u re . E rg o, th e p h ys icia n ca n n otbe h e ld liab le f orf ai l i ng to per f or m the du ty. That i s a co rr ect sta tem en t o fI l l i noi s l aw and supp or ts a fi ndi ngtha t Dr
. Am i n c anno t be he l d l i ab l e f o r f ai l i ng to c o nduc t ane xa m i na ti on of B el l, i na smuch as the r ec o r d i s quite cl ea r tha t Bel lr efus ed to c o ns en t to the ex ami na ti o n o ffer ed byDr
. Am i n b ec au se o fthe p resen ce of the j ailofficer. The probl em i s that H unter’ s m al pract i ce cl aim agai nst D r. A m inis n o t b as ed so lely on th e fa c t t h at D r. A m in did notco nd uct an exam i nati on o fB ell. Rather, bo th H unter’ s co m pla i n t and her bri efi n opposi ti on t o Dr. Ami n’ s mo t i o n f o r s ummar y j ud g men tma k e c l e ar that she a l so al l ege s that Dr. A m i n com m i tte d m al pract i ce by disc onti nuing Bell ’ s m edi cati on. Dr. A m i n ar gues that he ha d no c ho i c e b ut t o do s o b e c a us e Be l l had re fused tr eat m ent. The f act is , how eve r, thatBel ldi d not re fuse to continue hi s m edi cati on; ra ther, he re fu se d to su bm it to a p sych iatri c ex am ination by D r . A m in. T he re i s no ev i dence to support D r. A m i n’s bar e a sse rt i on that i t was nece ssa ryf orBel lto be exam i ned by h im i n or der f o r his pr ev i o us l y - pr es cr ibe d m edi ca ti o n t o b e co ntinue d; i nde ed, D r. A m i n o ffer s no e xpl an at i o n o fwhy that w oul d be th e c ase . The as ser ti on i s be l i ed by the f act th at B ell h a d b e en at the j ailf or over a w eek before Dr
. Am i n’ s at te m pt to e xa m i ne hi m a nd ha d b ee n t ak i ng h is m ed ica tio n d u rin g t h at tim e. T h e f a c t t h at D r. A m in att em pted to exam i ne Bel lo n that parti cul arday had nothi ng to do with Bel lhi m sel f; i t was si m plythe day th at D r. A m inw as sc h ed u led t o s e e p at ien ts atth e jail.10 N o. 08
- 3719 Fu rthe r, a w eek earli er D r . A m in had cha ng ed Be ll ’s presc ribed sl eep ai d fr om am i tr i ptyl i ne to tr az od one, demons tr at i ngtha t he c o ul d a nd di d m ake dec i si o ns r e g a r di n gB e l l ’ s me d i c a t i o n s w i th o u te x a mi n i n gh i m. The deci si on to di sco nti nue Bel l ’ s m edi cati on was an o th ers uchde ci si o n. Dr. A m i n’s deposi ti on t est i m ony is that he bel i eve d that Bel lwas experi enci ng a m ani c epi sode that w as ca us ed bythe ant i depr es sa nthe wa s ta k i ng . The r efo r e, he dec i ded to di sc o nt i nue Be l l ’ s an ti depr es sa nt, wh ic h h e b e l i e v e d wo ul d b r i ngh i m do wn fr o m hi s ma ni c e pi s o de and al l ow h im to co nd uct a psychi atr i c exam i nati on o n hi s ne xtv isi t. Thatwas a t r ea tmentde ci si o n t o whi cha du ty att ached. W hetherth e otherel em ents ofa m edi cal m alp ra c tic e c laim

— vi o l at i o n o fthe s ta nda r d o fc ar e an d proxim ate cause

— al so ar e pr ese nt i n thi s ca se re m ai ns be see n, as tho se i ssues were not ra i sed i n the dist ri ct c ourt .

C. J uri sdict i on T h e r e i s o n e fi n a li s s u e th a tme r i t s a b r i e fdi s c u s s i o n . We cl early h ave j uri sdic ti on o verthi s a pp eal, i nasm uch as i t incl ud es a 4 2 U.S
. C. § 1 983 c laim . H ow eve r, i t i s no t cl earwh etherj uri sdic ti on o verH unter’ s m al p racti ce cl ai m i s dependent on the supp lem entalj uri sdic ti on sta tute, 28 U
. S. C. § 1 367, o r w hetherdi ver si ty j uri sdic ti on i s pre sent. H unter ass er ts the l att er ; howev er , nei ther H unte r’s co m pla i nt norherj uri sdic ti onalst ate m ent s ets f or th the st ate s o fci tize n sh ip ofthe i nd i vi du alpart i es, but r atheri nd i cate s o nl y where they resi de. “[ R]e si dence and c i ti zenshi p ar e not syno nym s and i t i s t h e latte rN o. 08
- 3719 11 th at m at te rs for p u rp os e s o f d ive rs ity j u ris d ict ion .” M eye rs on v. Har r ah’s Eas tChi cago Cas i no , 29 9 F
. 3d 61 6, 61 7 ( 7th Ci r . 2 00 2)
. In a ddi ti o n, Hunte r s ue s bo thi ndi vi dual l y a nd as the perso nalr epres en tati ve ofBel l ’ s e sta te, a nd “ the fe de r a ldi v e r s i t y s t a t ut e t r e a t s ‘ the l eg a lr e pre senta ti ve ’ o fa decedent’ s e sta te ( orthe est ate o fan i nfa nt o r an i ncom petent) as a ci ti zen o fthe sam e s tat e as the dece dent. ” G usta fso n v . zum B run nen , 54 6 F
. 3d 398, 400-01 (7th Cir. 200 8 ) (c iting 28 U
. S. C
. § 1332(c)(2))
. N o m enti on o fBel l ’ s s tat e ofci ti zenshi p at the ti m e o f his d eath i s con tained i n th e record , althou gh H un ter’s cou n se lsugg est ed at or alar gum ent that he w as a ci ti zen of M iss ou ri. B ec au se on ly st at e la w cl a i m s n ow rem ain i n thi s ca se, the dist ri ct c ourtsho uld d ete rm i ne o n re m and w hetherthe re quir em ents f ordi ver si ty j uri sd ict ion are sa tis fied . I f th ey are n ot, th e c ou rtsh ou ld th ende te r m ine whethe r i t i s appr o pr i at e to c o nt i nue to exe rcise sup p lem en tal j uri sd iction over H un ter’s m alp ra c tic e c laim s. See Leist erv. D ovetail, Inc. , 54 6 F
. 3d 8 7 5 , 8 8 2 ( 7 th C i r . 2 0 0 8 ) ( “ Whe n th e fe d e r a lc l a i m i n a ca se dr o ps o utb efo r e tr i al, the pr es um pti o n is th at th e di s t r i c tj ud g e wi l lr el i nqui s h j ur i s di c t i o n o v e r a nys up p lem en tal cl aim to the stat e cou rts.”)
. Conclusi on F o r the r ea so ns s etf o r th a bov e, the j udg m en t o fthe dist ri ct c ourti s affi rm ed w i th r ega rd to H unter’ s § 19 83 cl ai m ag ai nst the County. W i th re gar d t o H unter’ s m edi cal ma l p r a c t i c e c l a i ms a g a i n s tD r . A mi n, th e g r a n to fs u m-12 N o. 08
- 3719

m ar y j ud gm ent i s r eve rs ed and rem anded f orfurther pr o ce eding s co ns i st en t wi ththi s o pi ni o n. A FFI RMED i n pa r ta nd R EVER S ED a nd

R EMAND ED i n part .

S YKES, Cir cu i tJudg e, d isse nt i ng . I agr ee w ith m y c oll eagues that s u m m ar y j ud gm ent forS t. Cl ai r County on H unter’ s § 19 83 cl ai m was appropri ate . Idi s a g r e e , h o weve r, w i th the maj o r i t y ’ s de c i s i o n t o r e i nstat e H unt er ’ s m edi cal

- m al pr ac ti ce c l ai m a g ains t Dr
. Am i n. The di st r i ctc o ur t pr o per l y e nt er ed su m m ar y j udg m en t ag ainst H unter on that c l ai m as well, and Iw ou ld affi rm the j ud gm ent in i ts enti re ty. U nd erI l l i noi s l aw “[ t] he duty o fa phys icia n to r ender co m pet en t m edi ca lc ar e ar i se s as a c ons eq ue nc e o fthe physi ci an- pati ent r el ati onshi p. ” C urtis v . Jask ey, 759 N
. E.2 d 962, 968 ( I l l
. App. Ct
. 2 00 1)
. A phy si ci anmustha ve the pati en t’ s co ns en t be f o r e r en der i ngt r ea tment . “ Abse nt co ns en t, whethe r e xpr es s o r im pl i ed, a phy si ci anha s no ri ght t o re nd erm edi caltr eat m ent t o a pati ent. ” Id. The I l l i no i s S upr eme Co urt ha s emphas i ze d tha t “a pa ti en t nor m al l y m ust conse nt to m edi caltr eat m ent of an y ki nd .” Keiner v. C m ty. C o nv a lescent C tr. ( In reE s t at eof Lo nge way ) , 54 9 N
. E. 2d 29 2, 2 97( I l l
. 1 98 9) ( emphas is ad ded)
. And
“ b e c a u s e a p h y s i c i a n mu s to b t a i n c o n s e n tfr o m a pat i en t pr i o r t o i ni ti at i ngmedi ca lt r ea tment, . . . theN o. 08
- 3719 13 pat i en t ha s a co m m o n l aw right t o wi thho l d c o ns en t an d thus r efuse t re atm ent. ” Id. Th i s “ i nc o r po r a t e s a l lty pes o fmedi ca lt r ea tment, i nc l udi ng l i fe- sa ving o r l i fe- su st aini ng pro cedures. ” Id. A ccor dingl y, w h er e a pati ent r efuses conse nt to tr eat m ent, I l l i noi s ho l ds that no duty t o re nd erco m p et en t t re atm ent a ri ses and no a cti on f or m ed ica l m alp ra c tic e m ay be m ain ta in ed
. Se eCur t i s, 759 N
. E.2 d at 9 68 ( “W here a pati ent re fuses to conse nt to a m ed ical proce du re , no du ty ar i ses o n behal fo fa phys ici an t o perf or m thatpro cedure such thatthe physi ci an can be held l iable for f ail ing to pe rform i t.”)
. M y c o l l ea g ue s co nc l ude tha t al th o ug h the se pr i nci ple s precl ud e l i abi l i ty predi cate d o n Dr. A m i n’s f ai l ed at te m p t t o c on d u c t a p sy c h iat ric ex am in at ion of B ell, th e do ct o r no ne th el es s m ayb e hel d l i ab l e f o r di sc o ntinui ngBe l l ’ s m edi ca ti o n. Idi sa g r ee . A s the f o r eg o i ng author i ti es m ake cl ear, a p hysi ci an’ s r i ght t o re nd er m edi ca lt r ea tment

— and ther efor e hi s duty t o re nd er co m pete ntt r ea tment

— ar i se s when a phy si ci an - pat i en t relationsh ip is establi sh ed and de p en d s up on th e pa tient’s conse nt . P rescr ibi ng m edi cati on i s a f or m o fm edi cal tr eat m ent. H er e, a physi ci an- pati ent r el ati onshi p w as not est abl i shed and th er ef or e a r i ght t o tr eatdi d not a ri se b e c a u s e B e l lr e fu s e d t o c o n s e n tt o th e p s y c h i a t r i c e x a mina tion th at w as a ne cess ary p red icate to D r. A m in’s tr ea tmentde ci si o ns

— i ncl ud i ng the deci si on t o presc ribe m edi cati on f orthe tr eat m ent o fBel l ’ s then-e xtant psy chi atr i c co ndi ti on. B ec au se Be l lr efus ed to c o ns en t to the exam i nati on, Dr. A m i n h ad n o ri ght t o re nd ertr eat
m en t

— no r i g ht, tha t is, t o pr es cr ibe medi ca ti o n. As s uch, th er e is n o d u t y an d th er efo re n o b as is for a m ed ica lm al pr ac ti ce a ct i o n.14 N o. 08
- 3719 To be m or e s peci fi c, the und i sputed f acts ar e a s fol l ows: Bel lwas boo ked i nto the S t. Cl ai r County J ai l a w eek bef or e Dr. A m i n’s f ai l ed att em pt to exam i ne hi m . W hen he arr ived , he was t aking ce rt ai n pres cri pti ons f or bi pol ardi sor der. O n e w as Pro zac, an a nti depressa nt; anothe r w as El avi l( am i tr i ptyl i ne) , so m eti m es presc ribed as a s l eep ai d . E l avi lwas cl ass i fi ed as a “ concern m edi cati o n” unde rI l l i no i s Depa r tmentofCor r ec ti o ns pol i cy, a nd the departm ent did not perm i t i ts use i n I l l i noi s cor re cti onalf aci l i ti es. A ccor dingl y, Dr. A m i n substi tuted an alt er n at ive sle ep a id

— tr az o do ne

— an d sc h ed u led B ell for an ex am in at ion th e f o llow in g w ee k d u rin g h is re gu lar vis it t o th e jail. A s m y c o llea gu es ex p lain , at t h at ap p oin tm en t B ell bec am e agitated at the p resen ce of a correctional offi c e r. H e w as to ld t h a t t h e o ffice r w as req u ire d to rem ain in th e roo m du ring the exam i nati on, and a t thi s his ag i ta ti o n inc r ea sed. Dr
. Am i n made a t en ta ti ve j udg m en t b as ed on B ell’s be h av ior t h at h e w as su ffer in g a m an ic ep iso d e a n d n ee d ed a d iffer en t m ix of p sy c h ot ro p ic m edi cati ons. The docto r tes ti fi ed i n hi s deposi ti on that Pro zac can ca use m ani a in pati ents w i th bi pol ardisorder and he thoughtBe ll s houl d sto p taking i t; he a l so suspecte d Bellneeded a m oo d stabi l i zer . But the doctor ne ed ed to cond uc t a fullps ych iatri c ex a m in a t ion before presc ribi ng m edi cati ons. Dr. A m i n tried t o ex pla i n to Bel lthathe ne eded to conduct the exam i nati on i n or der to presc ribe m edi cati on an d tha t Bell ’s medi ca ti o n wo ul d b e di sc o nt i nue d i fhe refused to be exam ined
. T his only an gered B e ll m oreN o. 08
- 3719 15 and he ul ti m ate l y r efused to be exam i ned. H e was gi ven a “ Rel eas e o fResponsibi l i ty” f or m , wh i ch he cru m ple d up and thr e w a wa y . Dr
. Ami n pl a nn e d t o a t t e mpt an oth er ex am th e fol low ing w eek. B ut bas ed on B ell ’s r e fu s a l to c on se n t t o th e p sy c h iat ric ex am in at ion, his pri orm ed i cati ons w er e di sco nti nued and no new ones wer e pr es cr ibe d. Be l lc o m m i tt ed su ic i de be f o r e hi s ne xt appo i nt m en t wi thDr
. Am i n. M y c ol l eagues hav e co ncl ud ed that the di sco nt in uati on of B ell ’ s pri orm edi cati ons i s s epara tel y a cti onabl e e ven though the f ai l ed psychi atr i c exam i nati on i s no t. The y b as e th i s co nc l us i o n o n a s ubs i di ar y o ne : tha t th e p sy c h i a tr ic e x am in at ion w as n otn ec es sa ry for D r. A m in to c o nt i nue t o pr es cr ibe the medi ca ti o ns Be l lwas t ak i ng when he en tered the j ai l
. M aj
. o p. a t 9. The r e i s no su ppo r t f o r thi s i n the r ec o r d. Dr ug - pr es cr i pti o n de ci si o ns are m ed ical d ecis io ns , and H un ter p resen ted no ex p ert m edi ca le vi den ce t o c o nt r adi ctDr
. Am i n’ s te st i m o ny that he nee ded a curr ent psy chi atr i c exam i nati on bef or e pr escr ibi ng m edi cati ons. M y c o l l e a g ue s p o i ntt o the f a c ttha twh e n Be l lfi r st ar ri ved atthe j ai l, Dr. A m i n substi tuted tr azo done f or ami tr i pty l i ne , Be l l ’ s pr ev i o us l y p resc r ibe d s l ee p a i d, a nd th at h e m ad e t h is d ec isio n w ith ou t e x am in in g B ell. This does not est abl i sh thatthe psychiat ricexam was unne c e s s a r y t o D r . Ami n ’ s p r e s c r i p t i o n d e c i s i o n s a tthe ti m e he fi rs t a tte m p ted to exam i ne Bel l
. I t i s undis pu ted th at D r. A m in m ad e the dru g sub stitut ion up on B ell ’s adm i ssi on to the j ai l because sta te re gul atio n s p ro hibi ted t h e use o fam i tr i ptyl i ne. That Bel lwas continued16 N o. 08
- 3719
o n thi s su bs ti tu te s l ee p a id an d hi s o th ermedi ca ti o ns d u rin g his firs t w ee k in th e jail

—b efo re h e s aw D r. A m in

— does not est abl i sh thata psychi atr i c exam i nati on was unnecessary t o the t re atm ent deci sio ns Dr. A m i n needed t o ma k e w h e n h e fi r s ts a w B e l la w e e kl a t e r . A t t h e t i me ofhi s a dm i ssi on into the j ai l, Bel lhad not yetse en Dr
. Am i n o rr efus ed th e psy ch i at r i c ex ami na ti o n, a nd hi s c o nt i nu e d r e c e i pto fh i s p r i o r p r e s c r i pt i o n med i cati ons du ring this in teri m per i od f al l s withi n I l l i noi s’ d oc tr in e o fi m p lied co n se n t. C urtis, 759 N
. E.2 d at 9 67- 68 ( conse nt i s i m pli ed base d on an e xi sting em er ge n c y o r othe r ci rcum sta nces und erwh i ch the patien t’ s a ctual con sen t can not be obtaine d ). Butwhena ctua lc o ns en t to t r ea t ha s b ee n s o ug hta nd r efus ed, thi s do ctri ne f al l s awaya nd the do ct o r ha s no ri ght t o tr eat . Id. at96 8. Once Bel lr efused to c on sent to th e psy ch i at r i c ex ami na ti o n, Dr
. Am i n l ac k ed th e r i g ht to re nd ertr eat m ent. T h is m eant he had no r i ght t o presc r ibe medi ca ti o ns

— either thos e Bel l had bee n taki ng or ne w medi ca ti o ns . Bec au se o f Bel l ’ s r efus al, no phy si ci an p atie nt r el ati onshi p w as est abl i shed and no r i ght o r du ty to tre at aro se . T h e r e for e, th er e is n o b as is for m ed ica lm al pract i ce l i abi l i ty. The di str i ct c ourtpro pe rlyente re d sum m ar y j ud gm ent forDr. A m i n. A ccor dingl y, Im ust re spectfully di sse nt.

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