2021 IL App (1st) 200484-U

No. 1-20-0484 

Second Division

June 29, 2021

NOTICE: This order was filed under Supreme Court Rule 23 and is not precedent except in the 

limited circumstances allowed under Rule 23(e)(1).

____________________________________________________________________________ 

IN THE

APPELLATE COURT OF ILLINOIS

FIRST DISTRICT

____________________________________________________________________________ 

JAMES DELEGATTO, as Special 

Administrator of the Estate of TRACY A. 

DELEGATTO, Deceased, and JAMES 

DELEGATTO, individually, 

 Plaintiff-Appellee, 

 

 v. 

ADVOCATE HEALTH and HOSPITALS, an 

Illinois Not-For-Profit Corporation,

ADVOCATE HEALTH AND HOSPITALS, 

an Illinois Not-For-Profit Corporation d/b/a 

ADVOCATE MEDICAL GROUP, et al., 

 Defendants-Appellants. 

) Appeal from the

) Circuit Court of

) Cook County. 

) 

) 

) 

) 

) 

) No. 2016 L 5928

) 

) 

) 

) 

) 

) Honorable

) Allen Price Walker

) Judge, presiding.

____________________________________________________________________________

JUSTICE COBBS delivered the judgment of the court.

Presiding Justice Fitzgerald Smith and Justice Pucinski concurred in the 

judgment. 

ORDER

¶ 1 Held: The circuit court’s grant of summary judgment in favor of defendant-appellant 

Advocate Health and Hospitals is affirmed where there is no genuine issue of 

material fact regarding apparent agency.
No. 1-20-0484 

- 2 - 

¶ 2 This appeal arises from a wrongful death action premised on medical negligence filed by 

James Delegatto (James), in his capacity as special administrator for his wife Tracy Delegatto’s 

(Tracy) estate against several defendants, including Silver Cross Hospital (Silver Cross). Silver 

Cross sought summary judgment as to the claims of vicarious liability alleging that Anthony 

Rinella, M.D., and physician assistant Douglas Stevens (PA Stevens) were agents of Silver Cross. 

The circuit court granted the motion, and James appealed, arguing that the circuit court erred in 

granting Silver Cross’s motion for summary judgment because Tracy had no notice that Dr. Rinella 

was not an agent of Silver Cross.

¶ 3 For the following reasons, we affirm.

¶ 4 I. BACKGROUND

¶ 5 The following facts are taken from the record. On June 15, 2016, James, as special 

administrator of the estate of Tracy, filed a 15-count complaint in the circuit court against various 

defendants, including Silver Cross, alleging medical negligence resulting in the death of his wife, 

and wrongful death. His complaint was subsequently amended. As relevant here, count III of the 

second amended complaint alleged that Silver Cross was vicariously liable for the acts of Dr. 

Rinella and PA Stevens, who were agents of Silver Cross and were acting in the scope and agency 

of their employment. Specifically, the complaint alleged that Silver Cross “acted in a manner that 

would lead a reasonable person to conclude that [Dr. Rinella and PA Stevens] were employees 

and/or agents of [Silver Cross]” and that Silver Cross never informed Tracy that her care was being 

provided by non-employees. The facts surrounding Tracy’s death are as follows.

¶ 6 In 2014, Tracy was injured in a motor vehicle accident. On February 9, 2015, she had an 

appointment at Pain Treatment Centers of Illinois with Dr. Faris Abusharif, a pain medicine 

specialist, regarding her complaints of cervical spinal stenosis and cervical radiculopathy. At this 
No. 1-20-0484 

- 3 - 

point, she had undergone physical therapy and epidural steroid injections; however, her pain had 

not been relieved. Dr. Abusharif suggested surgery as the next option and referred her to either Dr. 

Rinella or Dr. Cary Templin.

¶ 7 On February 19, 2015, Tracy had a consultation with Dr. Rinella, an orthopedic surgeon,

and PA Stevens. The consultation took place at the office of Dr. Rinella’s private practice, Illinois 

Spine and Scoliosis Center (ISSC). Dr. Rinella recommended that Tracy undergo spinal surgery 

to alleviate her pain. At this consultation, Tracy signed two patient forms titled “ISSC Patient 

Registration Form” and “ISSC Authorization to Release Healthcare Information.” Included in the 

first form was the following: “I authorize payment of medical benefits for any services to me by 

Illinois Spine & Scoliosis Center, to be paid directly to Illinois Spine & Scoliosis Center.” James 

accompanied Tracy to her first and all future visits with Dr. Rinella.

¶ 8 At some point, Tracy did research to determine at which hospital the surgery should be 

performed. She decided that Silver Cross was the best option, as it had a good reputation and was 

brand new. According to James’s deposition, Tracy chose Dr. Rinella because of his affiliation 

with Silver Cross, and she was adamant about having the surgery done there. Both Dr. Rinella and 

PA Stevens are independent contractors and have privileges at Silver Cross and are employed by 

“Anthony S. Rinella, M.D., S.C. d/b/a Illinois Spine and Scoliosis Center.”

¶ 9 On February 25, 2015, Dr. Rinella signed Silver Cross’s orthopedic surgery preadmission 

order and faxed it to Silver Cross. On March 9, 2015, Tracy went to Silver Cross to have 

preadmission testing conducted in accordance with Dr. Rinella’s orders. While at Silver Cross, she

signed a “Silver Cross Hospital Consent Form.” On March 26, 2015, Tracy returned to ISSC for a 

follow-up surgical consultation. Also on March 26, 2015, Darlene Fabek, an employee of Silver 
No. 1-20-0484 

- 4 - 

Cross, contacted Tracy via telephone to perform a preadmission assessment. Tracy signed and 

initialed additional Silver Cross consent forms, one on March 28 and another March 30, 2015. 

¶ 10 The consent forms signed on March 9, 2015, March 28, 2015 and March 30, 2015 are 

identical. The entire text of the forms is contained on a single page with five paragraph headers in 

bold text: “CONSENT,” “HOSPITAL SERVICES,” “PATIENT SELF-DETERMINATION 

ACT (PSDA),” “ASSIGNMENT OF INSURANCE BENEFITS,” and “FINANCIAL 

AGREEMENT.” The “HOSPITAL SERVICES” paragraph provides the following text, all in 

upper case and bolded: 

“I UNDERSTAND THAT ALL PHYSICIANS, NURSE PRACTITIONERS 

AND PHYSICIAN ASSISTANTS FURNISHING SERVICES TO ME, INCLUDING 

EMERGENCY DEPARTMENT, RADIOLOGISTS, ANESTHESIOLOGISTS, 

PATHOLOGISTS, AND THE LIKE, ARE INDEPENDENT CONTRACTORS AND 

ARE NOT EMPLOYEES OR AGENTS OF THE HOSPITAL. ________(initial)”

¶ 11 Other than the text above, and the paragraph headers, no other text under any of the other 

paragraph headers on the form is in all upper case or bolded. Tracy’s initials appear on all three 

forms in the space provided. Additionally, her handwritten signature appears at the bottom of all 

three forms attesting to the following: “I [h]ave read this form and I am satisfied that I 

understand it’s [sic] content and significance.” 

¶ 12 Also on March 30, 2015, Tracy signed a surgical consent form giving Dr. Rinella 

permission to perform the necessary surgical procedure. In pertinent part, the surgical consent form 

stated, “I understand all physicians furnishing services to me, including anesthesiologists, 

radiologist[s], pathologists, physician assistant[s], nurses anesthetists, and the like are independent

contractors and are not employees or agents of the hospital.” Dr. Rinella, assisted by PA Stevens,

-
No. 1-20-0484 

- 5 - 

performed the surgery that day at Silver Cross. Tracy was discharged two days later on April 1. A 

week after the surgery, on April 6, 2015, Tracy died.

¶ 13 During discovery, Dr. Rinella’s deposition was taken. Regarding his relationship with 

Silver Cross, he stated that he did not report to anyone at Silver Cross and there was no direct 

supervision from Silver Cross. He stated that he had maintained a surgical schedule at Silver Cross 

since 2009. In 2015, the only hospital at which he had privileges was Silver Cross. He identified a 

form which showed his reappointment of orthopedic clinical privileges at Silver Cross for the 

period of December 31, 2014 to December 31, 2016. His only role within the hospital was serving 

on the surgical committee. Silver Cross did not compensate Dr. Rinella for any services provided 

to Tracy. He stated that he was “not aware of any activity or statement or conduct by Silver Cross

Hospital that held [him] out as its agent, service[,] or employee” nor did he engage in any activity 

in which he held himself out as an agent of Silver Cross. He described his private office as 

containing multiple signs bearing the ISSC brand name, including his doorway, on the wall, on 

informational materials, and his business cards. He also identified billing statements that 

specifically show that payments are to be made out to ISSC.

¶ 14 On January 28, 2020, Silver Cross filed a “Partial Motion for Summary Judgment” as to 

James’s claims of vicarious liability against Silver Cross, in which James had alleged that Dr. 

Rinella and PA Stevens were its agents. Silver Cross first argued that neither Dr. Rinella nor PA 

Stevens were employees or actual agents of Silver Cross. On the contrary, they were independent 

contractors. Second, Silver Cross argued that neither of them were apparent agents of Silver Cross 

and that James was unable to prove any of the requisite elements for an apparent agency action 

against Silver Cross.
No. 1-20-0484 

- 6 - 

¶ 15 In his response to Silver Cross’s motion, James asserted that Tracy believed Dr. Rinella

and PA Stevens worked for Silver Cross, neither took any affirmative acts to inform Tracy 

otherwise, and she would not have consented to surgery if Dr. Rinella and PA Stevens had been 

unable to perform it at Silver Cross. Further, James asserted that there are disputed material facts, 

including whether Tracy knew or should have known that Dr. Rinella and PA Stevens were not 

agents of Silver Cross, whether Silver Cross acquiesced to Dr. Rinella and PA Stevens’s 

appearance of authority, and whether the signed consent forms are dispositive on the issue of 

agency. Attached to the response were affidavits from Matthew and Sarah Delegatto, Tracy and 

James’s children. 

¶ 16 Matthew averred that Tracy did extensive research when deciding where her surgery 

should take place and she chose Silver Cross because it was new, state of the art, and had a good 

reputation in the community. He further averred that Tracy referred to Dr. Rinella and PA Stevens 

as working at Silver Cross. Sarah’s affidavit contained the same averments.

¶ 17 Silver Cross subsequently filed a reply. Therein, Silver Cross took issue with the affidavits 

James submitted to accompany his response, namely those of himself, Matthew, and Sarah, 

arguing that the affidavits consisted of conclusory, inadmissible hearsay. Silver Cross also pointed

out James provided no support for his assertion of a question of fact as to whether Dr. Rinella and 

PA Stevens were actual agents of Silver Cross. Finally, Silver Cross argued that there was 

uncontroverted evidence that Dr. Rinella and PA Stevens were independent contractors and that 

Tracy had actual or constructive knowledge, based on the consent forms, that they were not 

employees or agents of the hospital.

¶ 18 The circuit court conducted a hearing on the summary judgment motion on March 6, 2020. 

Following the hearing, the court granted Silver Cross’s motion. In its oral ruling, the court specified 
No. 1-20-0484 

- 7 - 

that as to PA Stevens, there is “no material question of fact as to whether or not the holding-out 

requirement is met” and PA Stevens was not being held out as an employee of Silver Cross. As to 

Dr. Rinella, the court ruled that the language in the consent forms did not create an ambiguity and 

that there was no evidence to indicate that Dr. Rinella was “being held out or that the hospital 

acquiesced to the alleged apparent agency.” Also on March 6, 2020, the court granted Silver 

Cross’s summary judgment motion as to claims of agency related to Dr. Boris Nulman. James has 

not appealed from that ruling. 

¶ 19 This appeal followed.

¶ 20 II. ANALYSIS

¶ 21 A. Standard of Review

¶ 22 Summary judgment is appropriate when the pleadings, depositions, and admissions on file, 

taken together along with the affidavits, if any, evidence that there is no genuine issue of material 

fact and that the moving party is entitled to a judgment as a matter of law. 735 ILCS 5/2-1005 

(West 2018). The purpose of summary judgment is not to try a question of fact but to determine 

whether one exists. Ray v. City of Chicago, 19 Ill. 2d 593, 599 (1960). To determine whether a 

genuine issue of material fact exists, a court must construe the pleadings, depositions, admissions, 

and affidavits strictly against the moving party and liberally in favor of the opponent. Purtill v. 

Hess, 111 Ill. 2d 229, 240 (1986). Although summary judgment is to be encouraged as an aid in 

the expeditious disposition of a lawsuit, it is a drastic measure and, therefore, should be allowed 

only when the right of the moving party is clear and free from doubt. Id.

¶ 23 When confronted with a motion for summary judgment, although the plaintiff is not 

required to prove his case, he must nonetheless present some evidence to support the elements of 

his claim. Wallace v. Alexian Bros. Medical Center, 389 Ill. App. 3d 1081, 1085 (2009). The 
No. 1-20-0484 

- 8 - 

plaintiff’s failure to establish even a single element of his cause of action will render the grant of 

summary judgment in favor of the defendant appropriate. Id. (citing Bagent v. Blessing Care Corp., 

224 Ill. 2d 154, 163 (2007)). Our review of the circuit court’s grant of summary judgment is de 

novo. Id.

¶ 24 B. Apparent Agency

¶ 25 James claims that the circuit court erred in granting partial summary judgment in favor of 

Silver Cross because, under the doctrine of apparent agency, the hospital was vicariously liable for 

the negligence of Dr. Rinella1

. Ordinarily, whether an agency relationship exists is a question of 

fact. Stewart v. Jones, 318 Ill. App. 3d 552, 560-61 (2001). If, however, there is but one conclusion 

that may be drawn from the undisputed facts, a court may decide this issue as a matter of law. 

James v. Ingalls Memorial Hospital, 299 Ill. App. 3d 627, 632 (1998).

¶ 26 In reviewing a claim of apparent agency involving a hospital and actions by a physician 

working in its facility, we look to the seminal case, Gilbert v. Sycamore Municipal Hospital, 156 

Ill. 2d 511 (1993), and its progeny. In Gilbert, the hospital asserted that it could not be vicariously 

liable for the alleged negligent conduct of the decedent’s treating physician because the physician 

was neither an employee nor an agent of the hospital. Id. at 518. The supreme court rejected the 

argument, noting that under earlier decisional law, a hospital could be held liable in a medical 

malpractice action based on a principal-agent relationship between the hospital and the physician. 

Id. at 520-22. In discussing the “realities of modern hospital care,” the court explained, in relevant 

part that: 

1

In his briefs, James limits his arguments of apparent agency to Dr. Rinella. 
No. 1-20-0484 

- 9 - 

“ ‘[G]enerally, people who seek medical help through the emergency room 

facilities of modern-day hospitals are unaware of the status of the various professionals 

working there. Absent a situation where the patient is directed by his own physician or 

where the patient makes an independent selection as to which physicians he will use while 

there, it is the reputation of the hospital itself upon which he would rely. Also, unless the 

patient is in some manner put on notice of the independent status of the professionals with 

whom [he] might be expected to come into contact, it would be natural for him to assume 

that these people are employees of the hospital.’ ” Id. at 521 (quoting Arthur v. St. Peters 

Hospital, 169 N.J. Super. 575, 583 (1979)). 

¶ 27 Recognizing the applicability of apparent agency in other contexts, the Gilbert court held 

that the doctrine was equally available in the unique context of a medical malpractice action. Id. 

at 524. The court held that a hospital may be held vicariously liable under the doctrine of apparent 

agency for the negligent acts of a physician providing care at a hospital, “regardless of whether 

the physician is an independent contractor, unless the patient knows, or should have known, that 

the physician is an independent contractor.” Id. at 524. Having concluded the doctrine’s 

applicability in the context of medical malpractice claims, the court set forth the following three 

elements a plaintiff must plead and prove to hold a hospital liable: 

“ ‘(1) the hospital, or its agent, acted in a manner that would lead a reasonable 

person to conclude that the individual who was alleged to be negligent was an employee 

or agent of the hospital; (2) where the acts of the agent create the appearance of authority, 

the plaintiff must also prove that the hospital had knowledge of and acquiesced in them; 

and (3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent 
No. 1-20-0484 

- 10 - 

with ordinary care and prudence.’ ” Id. at 525 (quoting Pamperin v. Trinity Memorial 

Hospital, 144 Wis. 2d 188, 207-08 (1988)). 

¶ 28 The first element, referred to as “holding out,” is satisfied if the hospital holds itself out as 

a provider of care without informing the patient that the care is provided by independent 

contractors. Id. at 525. The focus of the “holding out” element is whether the patient knows or 

should have known that the physician is an independent contractor. Id. at 524. The second Gilbert

element, “appearance of authority,” is frequently grouped with the “holding out” element. LambRosenfeldt v. Burke Medical Group, Ltd., 2012 IL App (1st) 101558, ¶ 26, (citing Wallace, 389 

Ill. App. 3d at 1087). The third, or the reliance element, is satisfied if the plaintiff relies upon the 

hospital to provide medical care, rather than on a specific physician. Gilbert, 156 Ill. 2d at 525. 

The “critical distinction” is whether the plaintiff sought care from the hospital itself or looked to 

the hospital merely as a place for his or her personal physician to provide medical care. Id. at 525-

26 (quoting Pamperin, 144 Wis. 2d at 211-12). 

¶ 29 With these several principles in mind, we consider James’s arguments, as set out in his 

brief. 

¶ 30 C. Holding Out

¶ 31 James contends that Silver Cross acted in a manner that led Tracy to reasonably conclude 

that Dr. Rinella was its agent. In support, he argues that there is no evidence that Tracy knew that 

Dr. Rinella was not an “agent/employee” of Silver Cross and Silver Cross failed to place her on 

notice. Although he does not dispute that a consent form was signed by Tracy, it is his contention

that consents are not dispositive on the issue of apparent agency.

¶ 32 We agree with James that consents are not dispositive. However, with respect to the 

holding out factor, “whether a patient signs a hospital consent to treatment form that contains clear 
No. 1-20-0484 

- 11 - 

and unambiguous independent contractor disclaimer language is an important factor to consider 

*** because it is unlikely that a patient who signs such a form can reasonably believe that her 

treating physician is an employee or agent of a hospital when the form contains specific language 

to the contrary.” Lamb-Rosenfeldt, 2012 IL App (1st) 101558, ¶ 27. Indeed, having a patient sign 

a treatment consent form which expressly provides that the physicians on staff at the hospital are 

not employees or agents of the hospital may make proving the holding out element extremely 

difficult. James, 299 Ill. App. 3d at 633. In fact, in Steele v. Provena Hospitals, the court stated 

that if “ ‘the patient is in some manner put on notice of the independent status of the professionals 

with whom he might be expected to come into contact[,]’ ” the hospital is not vicariously liable.

2013 IL App (3d) 110374, ¶ 138 (quoting York v. Rush-Presbyterian-St. Luke’s Medical Center, 

222 Ill. 2d 147, 182 (2006)). 

¶ 33 Nevertheless, citing to York v. El-Ganzouri, 353 Ill. App. 3d 1 (2004), aff’d, RushPresbyterian, 222 Ill. 2d 147 (2006), James argues that a consent form that identifies “physicians” 

without identifying the treating physician is not determinative. In Rush-Presbyterian, our supreme 

court held that the evidence presented failed to place the plaintiff on notice that Dr. El-Ganzouri, 

the treating physician, was an independent contractor, and not an employee, of Rush. 222 Ill. 2d 

at 196. Instead, the consent form signed by the plaintiff authorized: “Dr. Rosenberg and such 

assistants and associates as may be selected by [him] and the Rush-Presbyterian-St. Luke’s 

Medical Center to perform the following [procedures] upon [myself].” Id. at 153. Significantly, “

‘the language of the consent providing that Rush could select physicians to assist in the knee 

surgery could reasonably be interpreted as allowing Rush to select anesthesiologists.’ ” Id. at 197 

(quoting El-Ganzouri, 353 Ill. App. 3d at 30-31). Further, during the plaintiff’s interactions with 

Dr. El-Ganzouri, the doctor wore either scrubs covered with the Rush logo or a lab coat that 
No. 1-20-0484 

- 12 - 

displayed the Rush emblem. Id. at 196. Thus, the court held that the treatment consent form signed 

by the plaintiff failed to alert the plaintiff that Dr. El-Ganzouri was an independent contractor. Id.

at 197.

¶ 34 Significantly, in Rush-Presbyterian, the court emphasized that it was making no departure 

from its holding in Gilbert that if a patient knows, or should have known, that the allegedly 

negligent physician is an independent contractor, that patient may not seek to hold the hospital 

vicariously liable under the apparent agency doctrine for any malpractice on the part of the 

physician. Id. at 202. “In other words, if a patient is placed on notice of the independent status of 

the medical professionals with whom he or she might be expected to come into contact, it would 

be unreasonable for a patient to assume that these individuals are employed by the hospital.” Id.

¶ 35 Accordingly, we find James’s argument to be not only unpersuasive but not supported by 

the substantial body of Illinois law developed on this issue. In essence, what James seeks is a 

consent form, tailor made and specific to every treating physician. Here, the consent forms signed 

by Tracy clearly state, “all physicians.” As no physician is excluded, the only fair reading would 

mean that every physician with privileges at Silver Cross is included within that broad category. 

Notably, this same argument was raised by the plaintiff in Prutton v. Baumgart, 2020 IL App (2d) 

190346. There, our sister court in the Second Judicial District held that the subject consent form 

that communicated that all physicians were independent contractors did not need to specifically 

identify a physician by name. Id. ¶ 54. We agree with that holding in Prutton. 

¶ 36 As a practical matter, were a hospital to engage in specifically naming every treating 

physician, we can well imagine what folly would occur if, for instance, the treating physician’s 

name was misspelled, or if his name appeared different in form than the patient had previously or 

generally known it, or if there was a mistake made in identifying the correct physician. Here, “all 
No. 1-20-0484 

- 13 - 

physicians” was sufficient to put Tracy on notice that Dr. Rinella was neither an employee nor an 

agent of Silver Cross. Under Gilbert, nothing more was required by Silver Cross. Neither, we 

might add, was more required under Rush-Presbyterian. 

¶ 37 Here, not only did Tracy’s consent form identify “all physicians,” but it also identified as 

independent contractors “emergency department, radiologists, anesthesiologists, pathologists, and 

the like” language which James additionally argues rendered the consent form ambiguous. To that 

point, James argues that a jury could find that Tracy reasonably believed that only the physicians 

identified in the particular subgroups (radiologists, anesthesiologists, pathologists, and the like) on 

the consent form were independent contractors and that all others were not. He maintains that the 

absence of Dr. Rinella’s practice group, as well as inclusion of the phrase “and the like” rendered 

the form confusing.

¶ 38 James’s argument that the practice group to which Dr. Rinella belonged was not included 

on the form simply lacks merit. There is no dispute that Dr. Rinella is a physician. It is axiomatic 

that although all medically trained physicians are not surgeons, all medically trained surgeons are 

physicians. The form applies to “All Physicians,” and the word “including” cannot be read to 

narrow that broad category. It merely identifies additional types of medical practitioners who are 

also independent contractors. Thus, the practice group to which Dr. Rinella is associated was 

included within the broad category of “all physicians.”

¶ 39 As an aside, it has not escaped our notice that the separate grouping of emergency 

departments, radiologists, anesthesiologists, and pathologists commonly appears in consent forms 

in more than a few cases decided by our court. See Prince v. Kiel, 2020 IL App (4th) 190773-U, 

¶ 8 (“emergency physicians, pathologists, radiologists, and anesthesiologists”); Mizyed v. Palos 

Community Hospital, 2016 IL App (1st) 142790, ¶ 8 (“emergency room physicians, radiologists, 
No. 1-20-0484 

- 14 - 

pathologists, anesthesiologists”); see also Martis v. Pekin Memorial Hospital, Inc., 395 Ill. App. 

3d 943, 945 (2009) (“radiologists, pathologists, anesthesiologists”); cf. Gore v. Provena Hospital, 

2015 IL App (3d) 130446, ¶ 8 (“all doctors furnishing service to me, including emergency 

department physicians, radiologists, anesthesiologists, pathologists, cardiologists, surgeons, and 

the like”). The recurring grouping of these medical practitioners suggests to us a commonality 

among them, that also distinguishes them from the group generally characterized as “all 

physicians.”

¶ 40 In our common experience, emergency room practitioners, radiologists, pathologists, and 

anesthesiologists play some role in the treatment of illness, but their function is generally ancillary 

to that of the treating physician. These medical practitioners have been generally characterized by 

our courts as providing hospital support services. See Rush-Presbyterian, 222 Ill. 2d at 194 (“If a 

patient has not selected a specific physician to provide certain treatment, it follows that the patient 

relies upon the hospital to provide complete care—including support services such as radiology, 

pathology, and anesthesiology—through the hospital’s staff.”). “Hospitals hold themselves out to 

the public as providing a broad range of services, including medical care and treatment. Thus, 

patients tend to assume that hospital physicians, such as emergency room specialists, radiologists, 

anesthesiologists, and pathologists function as an integral part of the hospital enterprise.” 22 

Robert John Kane and Lawrence E. Singer, Illinois Practice, The Law of Medical Practice in 

Illinois § 30:4 (3d ed. 2021). Although these medical practitioners may have a role in the medical 

treatment, some may not recognize them as medical doctors or physicians. “[D]ue to the nature of 

their practice, radiologists, pathologists, and anesthesiologists are often ‘invisible physicians,’ who 

are not seen by the patients and whose names the patients do not even know[.]” Norman Bard and 

Matthew Gaier, New York Medical Malpractice, § 4:22 (Jan. 2020). 
No. 1-20-0484 

- 15 - 

¶ 41 That said, we find that the form’s specific reference to these subgroups of medical 

practitioners creates no internal inconsistency. Neither does their reference implicitly contradict 

the form’s earlier reference to “all physicians.” In fact, earlier cases decided by our court, in which 

the same or similar phraseology has been included in the challenged consent form, have found the 

forms to be neither ambiguous nor lacking in clarity. See, e.g., Prutton, 2020 IL App (2d) 190346, 

¶ 54; Mizyed, 2016 IL App (1st) 142790, ¶¶ 8, 62; Gore, 2015 IL App (3d) 130446, ¶ 8; Frezados 

v. Ingall Memorial Hospital, 2013 IL App (1st) 121835, ¶¶ 5, 22; Lamb-Rosenfeldt, 2012 IL App 

(1st) 101558, ¶¶ 4, 26. We conclude that the Silver Cross form’s express reference to these 

particular medical practitioners does no more than clarify the independent contractor status of these 

subgroups. 

¶ 42 Further, the phrase “and the like” which follows directly after the named subgroups, does 

no more than generally reference medical practitioners like those within the specific referenced 

subgroups. See Macmillan Dictionary, 

https://www.macmillandictionary.com/dictionary/british/and-the-like (last visited June 23, 2021) 

(defining “and the like” as “used for including other similar people or things in what you are 

saying”). Neither the specific reference nor the general “and the like” language negates or modifies

the broader classification of “all physicians” in which Dr. Rinella falls. 

¶ 43 As further support for his contention of Silver Cross’s holding out, James argues that its 

consent form was misleading and inadequately informative. He cites to Spiegelman v. Victory 

Memorial Hospital, 392 Ill. App. 3d 826 (2009), as apposite. In Spiegelman, the plaintiff presented 

at Victory Memorial Hospital’s emergency room for treatment. Id. at 828. Prior to treatment, she 

signed a consent form consisting of eight paragraphs, two of which were the alleged source of 

confusion. Paragraph 3 provided that the patient was aware that during her visit to the Emergency 
No. 1-20-0484 

- 16 - 

Department of the hospital, “hospital employees will attend to my medical needs as may be 

necessary.” Id. at 829. Paragraph 4 provided that the patient understood that “the Emergency 

Department physician and [the] attending physician are independent contractors and not agents or 

employees of Victory Memorial Hospital.” Id. at 829.

¶ 44 As described in the court’s opinion, the form in Spiegelman was in multipart format and 

contained various provisions unrelated to the independent contractor disclaimer. Id. at 837.

Immediately preceding the paragraph containing the independent contractor disclosure was a 

paragraph stating that the patient is aware that hospital employees will attend to her needs. Id.

Additionally, the signature line on the form was placed beneath a separate unnumbered paragraph 

concerning the release of property. Id. On appeal, the court held that the jury could rightfully infer 

that the plaintiff was confused as to which doctors were employees of the hospital and which were 

independent contractors. Id. Of particular note, while in the emergency room, the plaintiff had 

complained of dizziness and problems with her vision, and there was evidence that her condition 

worsened rapidly. Id.; see also Schroeder v. Northwest Community Hospital, 371 Ill. App. 3d 584, 

587, 594 (2006) (where the consent form provided that the patient’s care would be managed by 

“[his] personal physician or other physicians who are not employed” by the hospital, this court 

held that the language could be reasonably construed to mean that his personal physician was 

employed by the defendant hospital).

¶ 45 Initially, we note that unlike in Spiegelman, there are no conflicting paragraphs in the 

Silver Cross consent form regarding employees and independent contractors. In fact, unlike in 

Spiegelman, text regarding independent contractors and employees appears only in the single 

bolded paragraph which we have set out above. Also, unlike in Spiegelman, Tracy was presented 

with and signed the same consent form on three separate occasions and on all three occasions, she 
No. 1-20-0484 

- 17 - 

indicated her satisfaction in understanding the consent and its significance. Additionally, the 

signature line was neither obscured nor hidden near unrelated text. Although the signature line 

appears at the end of the form, there was space provided just to the right of the employer-agency 

disclaimer on which Tracy initialed, signifying her review of the same. Finally, unlike in 

Spiegelman, there is nothing in the record to indicate that when Tracy initialed and signed the 

consent form that she was dizzy or confused on any of the three separate occasions. In sum, we 

find Spiegelman inapposite. 

¶ 46 We have considered whether any of the additional provisions in the consent form either 

altered or negated the one provision in the consent form which defined the employment 

relationship between Dr. Rinella and Silver Cross. Having reviewed the form, we conclude that 

they do not. Moreover, that other provisions in the form might have lacked clarity or raised 

questions regarding the particular subject matter included therein, a matter about which we express 

no opinion, is not relevant on the issue of apparent agency and we need not consider those

provisions here. We would again point out, however, that Tracy acknowledged, via her signature 

on multiple occasions, that she was satisfied that she understood the content and significance of 

the consent form.

¶ 47 Neither are we persuaded by James’s argument that the Silver Cross form was inadequate 

because it could have included more specificity. See Churkey v. Rustia, 329 Ill. App. 3d 239, 244-

45 (2002) (physician was not liable under apparent agency doctrine where patient signed consent 

form that indicated that the hospital contracted with independent groups of physicians, specified 

the physician’s group’s name, and stated that independent physicians or groups were not hospital 

employees). It is sufficient that the consent form set forth the relationship between the physician 

and the hospital with enough clarity that the consenting patient is on notice.
No. 1-20-0484 

- 18 - 

¶ 48 In sum, we find no ambiguity in the Silver Cross consent form, and James has not 

succeeded in citing us to any. In our view, the consent form, which Tracy signed on more than on 

one occasion, was clear and unambiguous. Thus, James has failed to satisfy the first element of an 

apparent agency claim, holding out, rendering summary judgment appropriate. See Wallace, 389 

Ill. App. 3d at 1085. 

¶ 49 D. Apparent Authority

¶ 50 Notwithstanding that Tracy signed the consent form identifying “all physicians” as 

independent contractors, James contends that Dr. Rinella acted in a manner that led her to 

“reasonably conclude” that he was an “agent/employee” of Silver Cross and that Silver Cross 

acquiesced in that conduct. With respect to Dr. Rinella’s conduct, he argues that he “could not 

recall any indicia” of Dr. Rinella’s purported branding, and had there been evidence of the same, 

it would have been attached as an exhibit to Silver Cross’s motion for summary judgment. Further, 

he maintains that there is “competing testimony” regarding Dr. Rinella’s branding efforts, thus 

creating a question of credibility which a jury should be permitted to answer.

¶ 51 We note here, as we did earlier, that generally, the holding out element and the apparent 

authority element are treated as one. See Lamb-Rosenfeldt at ¶ 26 (citing Wallace, 389 Ill. App. 

3d at 1087). James has failed to offer sufficient evidence on the holding out element. Thus, we 

could end our analysis here. However, as James has set forth these additional arguments separate 

from his holding out claims, in the interest of completeness, we will address them.

¶ 52 Contrary to James’s assertions, included in the record as exhibits are the “ISSC Patient 

Registration Form,” which identifies ISSC as the entity to whom payment for medical benefits 

were to be paid and which was signed by Tracy on February 19, 2015. Additionally, the 

“Authorization to Release Healthcare Information” bore the ISSC logo in the top left corner and 
No. 1-20-0484 

- 19 - 

was also signed by Tracy on February 19, 2015. In addition to these exhibits, Dr. Rinella’s 

deposition testimony reveals a practice independent of oversight or control by Silver Cross. Facts 

taken from the record show that, other than for purposes of the surgical procedure, Tracy was seen 

at Dr. Rinella’s office, and not at the hospital. Appointments with Dr. Rinella were made by calling 

Dr. Rinella’s office, and not the hospital. Dr. Rinella testified that Silver Cross exercised no 

authority or supervisory oversight over his practice. Tracy’s referral to Dr. Rinella occurred as a 

result of her treatment by Dr. Abusharif, and not based on any advertisement either by Silver Cross

or Dr. Rinella concerning his affiliation with the hospital. Additionally, nothing in the record 

suggests even that Dr. Abusharif was affiliated with the hospital. In this case, the surgeon of 

Tracy’s choice, Dr. Rinella, and the hospital of her choice, Silver Cross, happened to enjoy a 

relationship. That Tracy elected to proceed with Dr. Rinella as her surgeon because of his 

affiliation with Silver Cross is not evidence of apparent authority, especially in the face of a 

consent form which clearly defined the relationship as one of independent contractor. 

¶ 53 Regardless, the purpose of a motion for summary judgment is to determine whether a 

triable question of fact exists, not to try a question of fact. Pielet v. Pielet, 2012 IL 112064, ¶ 53.

“In determining whether a genuine issue as to any material fact exists, a court must construe the 

pleadings, depositions, admissions, and affidavits strictly against the movant and liberally in favor 

of the opponent.” Adams v. Northern Illinois Gas Co., 211 Ill. 2d 32, 43 (2004). Material facts are 

those facts that might affect the outcome of the case under the applicable substantive law. 

GreenPoint Mortgage Funding, Inc. v. Hirt, 2018 IL App (1st) 170921, ¶ 17.

¶ 54 Material to the outcome of this case is whether Silver Cross provided notice to Tracy that 

Dr. Rinella was an independent contractor. Even accepting that Dr. Rinella’s office space was 

barren and that there was no signage on the door, no business cards bearing the name of his 
No. 1-20-0484 

- 20 - 

practice, and no support staff to receive phone calls or visitors at his office, on the facts in this 

case, the absence of those things could not defeat the effect of the three signed Silver Cross consent 

forms, or we might add, the surgical consent form, which contained the same language and was 

also signed by Tracy. 

¶ 55 We pause momentarily merely to state the obvious. Without signage on Dr. Rinella’s door

or support staff in Dr. Rinella’s office to receive calls and visitors, a patient would likely not know

whether he or she was in the right place, seeing the right doctor, receiving the right treatment at 

the scheduled time. Moreover, and although we find it incredible, that James never saw any 

evidence of branding does not mean that Tracy saw none. Finally, given the forms regarding billing 

and treatment, there is no expectation that Dr. Rinella would have needed to state the obvious.

¶ 56 To defeat a claim of vicarious liability, all that was required of Silver Cross was evidence

that Tracy had either actual or constructive notice of Dr. Rinella’s status as an independent 

contractor. See Mizyed, 2016 IL App (1st) 142790, ¶ 58. The consent forms provided to Tracy by 

Silver Cross, that she signed, not once, but on three separate occasions, and that clearly and 

unambiguously informed every signatory that “all physicians” were independent contractors were 

sufficient to put Tracy on notice of Dr. Rinella’s relationship to Silver Cross. Further, it has long 

been settled that absent fraud, the act of signing a document evidences the signer’s knowledge of 

its contents. Id. ¶ 54. Here, on each of the three identical consent forms, Tracy acknowledged by 

her signature that she was satisfied that she understood what she was signing. Clearly, Tracy had 

notice of Dr. Rinella’s status. On this record, there is not one scintilla of evidence that Dr. Rinella 

acted in any manner that would lead Tracy to reasonably conclude that he was either an agent or 

an employee of Silver Cross.
No. 1-20-0484 

- 21 - 

¶ 57 As part and parcel of his apparent agency argument, James contends that Silver Cross had 

knowledge of Dr. Rinella’s “appearance of authority” and acquiesced to that appearance. In 

support, James asserts the following: (1) there is no evidence that Dr. Rinella took any steps to 

place Tracy on notice that he was not an agent of Silver Cross; (2) Dr. Rinella never testified that 

he informed Tracy that he was not an agent or employee of Silver Cross; and (3) there is no 

evidence of branding of Dr. Rinella’s practice.

¶ 58 Obviously, if Dr. Rinella gave no appearance of Silver Cross’s apparent authority, Silver 

Cross could not have acquiesced in that appearance. Having found no evidence in the record that 

Dr. Rinella gave the appearance of authority, we necessarily conclude that Silver Cross did not 

acquiesce. 

¶ 59 E. Reliance

¶ 60 Having found that neither the holding out nor apparent authority elements have been met, 

we need not address the reliance element. See Frezados, 2013 IL App (1st) 121835, ¶ 25 (citing 

Bagent, 224 Ill. 2d 154, 163 (2007) (recognizing that “[b]ecause we conclude that plaintiff has 

failed to raise a factual question as to the ‘holding out’ element of his cause of action, we need 

not determine whether there is evidence going to show plaintiff’s justifiable reliance”). 

¶ 61 III. CONCLUSION

¶ 62 Based on our review of the record, we find no material issue of fact as to whether Silver 

Cross held out Dr. Rinella as either its agent or employee. Here, the question is resolved, without 

more, by the consent form which clearly and unambiguously informed Tracy that “all physicians” 

were independent contractors and not employees of the hospital. Accordingly, and for the reasons 

stated, we affirm the judgment of the circuit court.

¶ 63 Affirmed.