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THIRD DIVISION
May 9, 2001

JUSTICE BURKE delivered the opinion of the court:

Plaintiff Margarita Rivera, as mother and next friend ofOsvaldo Rivera, a minor, appeals from an order of the circuit courtgranting defendant Dr. Enrique Arana's motion for summary judgmentbased on the court's determination that defendant was immune frommedical malpractice liability pursuant to the Good Samaritan Act(745 ILCS 49/25 (West 1998)). On appeal, plaintiff contends thatthe trial court erred in granting summary judgment because genuineissues of material fact existed. She also contends that theimmunity provided by the Good Samaritan Act should not apply to acause of action against a physician under the Abused and NeglectedChild Reporting Act (Child Reporting Act) (325 ILCS 5/4.02 (West1998)). For the reasons set forth below, we affirm.

On September 20, 1994, Dr. Arana treated Osvaldo Rivera(Osvaldo), the minor child of plaintiff, for a foot infection whenhis aunt, Marie Baez, who was then Osvaldo's legal guardian,brought him to Arana's office. On July 3, 1997, plaintiff filed amedical malpractice complaint against Arana, alleging that hefailed to take an adequate history or perform an adequateexamination of Osvaldo, he failed to record signs of child abuse,and he failed to report suspected child abuse. Defendant answeredand, as an affirmative defense, alleged that the Good Samaritan Actbarred plaintiff's claims. Thereafter, on December 30, 1999,defendant filed a motion for summary judgment based on lack ofliability pursuant to the Good Samaritan Act.

Dr. Arana presented his deposition and the depositions ofMarie Baez and Gloria Miranda in support of his motion for summaryjudgment. Arana, in his deposition, stated that he is ananatomical and clinical pathologist as well as a generalpractitioner at the Pro-Health Medical Center in Chicago. InSeptember 1994, three other doctors were working in the clinic withhim and two medical assistants, one of whom was Miranda. Aranasaw Osvaldo only one time on September 20, 1994. Arana's recordsregarding Osvaldo included an information/consent for treatmentform and his handwritten notes. Arana's notes stated that Osvaldowas brought in by his aunt, Baez. Arana was seeing one of Baez'schildren and Baez asked that he also examine Osvaldo for infectedfeet. According to Arana, Osvaldo was an add-on patient becauseBaez requested of his medical assistant "to be seen by [Arana] asan add-on without an appointment." Arana further stated thatseeing Osvaldo "was sort of a[n] emergency, because [Baez] had --she requested to be seeing [sic] the child as an emergency." Baeztold Arana that she was Osvaldo's legal guardian, that she had nomoney, and she did not have a public aid medical card for Osvaldo. Arana told Baez that that was okay and that he would see Osvaldo. In taking a history, Baez did not know about Osvaldo's familyhistory, nor whether he had an immunization card. Baez stated thatOsvaldo was living with her because his mother did not want him. She told Arana that she was in the process of getting legalguardian papers for Osvaldo and a public aid card.

Dr. Arana performed a routine examination upon Osvaldo, whichhe stated took 15 to 20 minutes. Osvaldo was a normal child withnormal health, except that he was thin and underweight for his age(three years). It was Arana's belief that Osvaldo suffered frompoor nutrition. Upon examination of Osvaldo's feet, Arana notedthat the plantar surfaces of his feet were slightly infected. Bothfeet showed superficial ulcers on the anterior surfaces, close tothe toes. There was mild inflammation, indicated by slightredness, and infection, indicated by slight yellow discoloration. There were no open wounds, no odor, and no pus. Because both feetwere similar, Arana asked Baez if Osvaldo had been walking aroundbarefoot since many children get foot infections from walkingaround barefoot. Baez did not know. Baez also did not know whathappened to cause the foot condition and could not provide anyinformation on how long the condition had existed. Arana gave Baeza prescription for an antibiotic and topical ointment.⁽¹⁾

Dr. Arana further stated that he did not notice anything thatappeared to be a burn. He had seen cigarette burns before andOsvaldo's feet did not have any cigarette burns on them, nor did hesee any marks that appeared to be healed burns. Arana did not haveany discussion with Baez about abuse at home and, when he sawOsvaldo, there were no signs of child abuse as far as medicalevidence and he never considered the possibility that Osvaldo wasa victim of child abuse. He learned later from his attorney thatOsvaldo was a victim of child abuse. Arana further stated that hehad attended many seminars on child abuse and, when he examinedOsvaldo, he was aware of the statute requiring reporting ofsuspected child abuse.

Because of Osvaldo's low weight, Dr. Arana believed thatOsvaldo needed a cell blood count (CBC) and a Chem 20 test to ruleout anemia. He advised Baez that she should bring Osvaldo back thenext week for these tests, with or without a public aid card. According to his testimony, Arana wrote on Osvaldo's chart, "returnone week, and then no charge because she didn't have any money orpublic aid card." Arana did not charge Baez for the visit"[b]ecause she didn't have any money. This woman was poor, and sherequested to be seen as an emergency, as an add-on-case, stating toGloria Miranda that she didn't have a Public Aid card." Aranatestified that he does a lot of charity cases.

Marie Baez, in her deposition, stated that she was Osvaldo'saunt; her brother was the boy's father. Osvaldo lived with hermost of his life, on and off. His mother, Margarita Rivera,abandoned Osvaldo when he was a couple of weeks old by leaving himon a street corner with his father. Baez further stated that herbrother would often bring Osvaldo to stay at her home. Baez tookOsvaldo in because her brother would leave him with everyone andanyone, "dope heads, crack heads, anybody." When her brother wasjailed, Osvaldo began to live with Baez permanently. Osvaldo'smother never had any contact with him during the time he was withBaez, even though Baez attempted to arrange contact between Riveraand Osvaldo.

Baez further stated that every time Osvaldo came to her home,he had lice. She also stated that Osvaldo always had pink eye, wascongested, and sick. She further stated that Osvaldo had hadproblems in the past with foot fungus or infection. However, shenever took Osvaldo to a doctor until he began to live with herpermanently. She treated him herself because she had three of herown children and knew how to take care of them. Baez also statedthat she got temporary custody of Osvaldo when her brother went tojail so that she had a right to take him for medical treatment.

Baez further stated that she first brought Osvaldo to Dr.Arana for pink eye, but she could not remember when. When she took Osvaldo, one of her own children had pink eye. According to Baez,Arana looked at Osvaldo, told her he had pink eye, but stated thathe could not give her a prescription because she had no public aidcard. Baez received medication for her own child, which she usedfor both children. Baez was not charged for this visit.

Baez also stated that when her son had the measles inSeptember 1994, she took him to Dr. Arana, and also brought Osvaldowho had a foot fungus, although she did not have an appointment foreither child. According to Baez, Osvaldo had blisters of pus onhis feet, the skin was peeling, there was cracking between thetoes, the feet were sweaty, and stunk. Baez denied that there wereany burns on his feet. Baez further stated that Arana simplylooked at Osvaldo's feet. She denied that Arana examined Osvaldoand that Arana gave her a prescription. According to Baez, Aranasimply told her to keep Osvaldo's feet dry and let them breathe. Baez subsequently used her daughter's eczema medication onOsvaldo's feet. Baez also denied that Arana advised her to returnwith Osvaldo the following week for other treatment.

Sometime after the September office visit, Baez was severelybeaten by her husband and was hospitalized. She was comatose for9 days and received 37 stitches in her neck. It was at this timethat her husband allegedly abused Osvaldo, which abuse is theunderlying basis of plaintiff's medical malpractice claim in thislawsuit. Baez was adamant that her husband had never abused any ofthe children prior to this time. According to her, he was aperfect father but a bad husband. Baez stated that she learned ofher husband's abuse of Osvaldo from newspapers and the news whileshe was in the hospital. She heard that her husband had beaten upOsvaldo, burned him, or put Nair in his eyes. She also learnedthat her children were taken away by the Department of Children andFamily Services. She vehemently denied ever discussing herhusband's abuse of Osvaldo with anyone either before, during, orafter her hospitalization, and, in fact, denied any knowledge of itat all. Baez also reiterated that she never paid Dr. Arana forOsvaldo's treatment and that she never received a bill for hisservices.

Gloria Miranda, in her deposition, stated that she was Dr.Arana's medical assistant. During the time she worked for Arana,the clinic took care of many public aid patients. Miranda did notknow Osvaldo prior to September 20, 1994, but did know Baez and herchildren. When Baez brought Osvaldo to the clinic on September 20,she told Miranda that she had Osvaldo, who was her brother's son,because her brother was in jail and Osvaldo's mother did not wanthim. According to Miranda, Baez told her that she was attemptingto get a medical card for Osvaldo and that she had brought Osvaldoto the clinic because he had a foot fungus or infection.

Miranda further stated that the visit was not a scheduledappointment. Baez just walked in, which, according to Miranda, wasa typical occurrence at the clinic. Miranda had Baez fill out aninformation sheet for Osvaldo, and then she took Osvaldo's vitalsigns and reported them on his chart. Miranda also stated that shelooked at Osvaldo's feet, probably when she was weighing him, andnoticed that the bottom of his feet were red. With respect topayment by Baez, Miranda stated that even if Baez had returned witha medical card, the clinic may have not billed her because the cardmight not be retroactive for the September 20 visit. Miranda alsostated that Dr. Arana took this visit as a charity case and thatpublic aid was not billed for the visit.

On March 29, 2000, the trial court granted defendant's motionfor summary judgment based on its determination that Dr. Arana wasimmune from liability under the Good Samaritan Act. In so ruling,the court considered the three factors necessary for application ofthe Act. The trial court first noted that plaintiff did notcontest the issue of notice of injury. According to the court, thepertinent "illness or injury" was the purported child abuse. Thetrial court then concluded that it was clear from all of thedeposition testimony that Arana received no fee for his services,nor did he ever bill for them. According to the trial court, evenif Arana intended to bill for them, his intention was irrelevant. With respect to whether Arana saw Osvaldo on an emergency basis,the trial court noted that both Arana and Baez characterized thevisit as an emergency. Additionally, Arana testified that theinfection could spread throughout the minor's system and causeserious harm if it were not treated. The trial court then reliedupon an Oklahoma case to define emergency in its broadest sense. It concluded, based on the "testimony of Dr. Arana, the Act'spurpose and meaning, relevant case law and the dictates of logic,"that Arana provided emergency care to Osvaldo. Because all threefactors were satisfied, the trial court concluded that Arana wasimmune from liability. This appeal followed.

A motion for summary judgment is properly granted when thepleadings, depositions, admissions, and affidavits on fileestablish that no genuine issue as to any material fact exists and,therefore, the moving party is entitled to judgment as a matter oflaw. 735 ILCS 5/2--1005(c) (West 1998); Cramer v. InsuranceExchange Agency, 174 Ill. 2d 513, 530, 675 N.E.2d 897 (1996). Wereview the trial court's granting of such a motion de novo. McNamee v. State, 173 Ill. 2d 433, 438, 672 N.E.2d 1159 (1996).

Section 25 of the Good Samaritan Act provides:

"Any person licensed under the MedicalPractice Act of 1987 or any person licensed topractice the treatment of human ailments in anyother state or territory of the United States who,in good faith, provides emergency care without feeto a person, shall not, as a result of his or heracts or omissions, except willful or wantonmisconduct on the part of the person, in providingthe care, be liable for civil damages." 745 ILCS49/25 (West 1998).⁽²⁾

It is the intent of the legislature that the provisions of the GoodSamaritan Act be liberally construed. 745 ILCS 49/2 (West 1998). A three-part test is employed to determine whether the GoodSamaritan Act applies. "First, the doctor must not have notice ofthe illness or injury; second, the doctor must provide emergencycare, and third, the doctor must not charge a fee." Villamil v.Benages, 257 Ill. App. 3d 81, 84, 628 N.E.2d 568 (1993).

Plaintiff contends that the trial court erred in grantingsummary judgment to defendant because two issues of material factexisted. Plaintiff does not contest the fact that Dr. Arana had nonotice of the injury or illness for which he treated plaintiffminor prior to his treatment--in fact, plaintiff admits that Aranahad no notice.

Plaintiff contends that there is a dispute as to whether ornot Dr. Arana would be paid for his services. Plaintiff maintainsthat because Osvaldo was to return the following week with a publicaid card, Arana intended to be paid. Plaintiff also contends thatthe number of times Arana treated Osvaldo is in dispute and ismaterial to the issue before this court because it goes to thequestion of whether a physician-patient relationship existed. According to plaintiff, because there was an ongoing physician-patient relationship, Arana had a reasonable expectation of beingpaid.

In Villamil, the defendant doctor's office forwarded a letterrequesting the plaintiffs' public aid number following the doctor'sdelivery of the plaintiffs' premature infant. In concluding thatthe third factor required for application of the Good Samaritan Actwas met, the court stated:

"Although a request for a public aid numberwas sent, nothing was ever produced toindicate that a bill was sent either toplaintiffs or public aid. The statuteprovides that service must be madegratuitously. Since the defendant was notpaid and the plaintiffs were unable to produceanything that indicated they had received abill, we must find that the services wererendered gratuitously. The fact that thepublic aid letter was sent is a red herring,the statute mentions nothing of intent, andtherefore, even if the public aid letter couldbe construed as an intent to bill in thefuture, the fact that no bill was ever sent orpayment provided must be controlling on thisissue." Villamil, 257 Ill. App. 3d at 92.

The facts of the case before us are similar to those in Villamil. Baez was told to return to the doctor the following week withOsvaldo's public aid card. However, she did not. There is noevidence that a bill was ever sent to Baez, plaintiff, or publicaid. Baez specifically testified that she was not billed. As inVillamil, whatever Dr. Arana's intentions were with respect topossible billing in the future for his services, they areirrelevant. Arana stated that he was never paid and this fact iscontrolling.

We also reject plaintiff's argument that the number of timesDr. Arana treated Osvaldo is material. She cites to no authorityto support her position. Failure to cite to relevant authoritywaives the issue. Campbell v. Wagner, 303 Ill. App. 3d 609, 613,708 N.E.2d 539 (1999). Like the issue of intent, Arana'sexpectations are irrelevant. As with intent, the statute mentionsnothing with respect to expectations. The pertinent fact is thatno fee was charged or received.

Based on the foregoing, we conclude that there was no questionof material fact precluding the trial court's decision that Dr.Arana rendered his services to Osvaldo gratuitously and received nofee. Arana sent no bill, no bill was received and, moreimportantly, Arana was paid nothing.

Plaintiff next contends that the trial court erred in relyingon an Oklahoma case to define "emergency." According to her,because the trial court relied on the "proposition that the phrase[emergency care] must be given the broadest possible meaning andthat an emergency occurs whenever a person appears or is perceivedto be ill or in need of succor," the trial court expanded the scopeof emergency to include a routine examination. Plaintiff furtherargues that the trial court's reliance on the Oklahoma case ismisplaced because the Oklahoma statute defined emergency, whereasthe Illinois statute does not. It is plaintiff's position thatOsvaldo's foot fungus did not present an emergency situation. Plaintiff urges us to adopt, as a matter of law, the definition ofemergency in Black's Law Dictionary and to limit the conditions tothose defined in medical literature, such as Merck's Manual.

Defendant contends that it was proper for the trial court torely upon the Oklahoma case because Illinois courts, in construingthe Good Samaritan Act, take a broad approach to interpretation,which was the approach taken in Oklahoma. Defendant also maintainsthat routine examinations can be a part of emergency care.

No Illinois case, addressing the Good Samaritan Act, hasdefined emergency or emergency care. In fact, our independentresearch has revealed only three Illinois cases that defineemergency, although in unrelated contexts. In Young v. Forgas, 308Ill. App. 3d 553, 561, 720 N.E.2d 360 (1999), the issue was whatconstituted an emergency call for purposes of the Tort ImmunityAct. The court defined "emergency" as an "urgent need forassistance or relief," quoting Merriam-Webster CollegiateDictionary 377 (10th ed. 1998). In Nagel v. Gerald Dennen & Co.,272 Ill. App. 3d 516, 520, 650 N.E.2d 547 (1995), in interpretingwhat was an emergency motion, the court defined emergency as:

" 'A sudden unexpected happening; anunforeseen occurrence or condition; perplexingcontingency or complication of circumstances;a sudden or unexpected occasion for action;exigency; pressing necessity. Emergency is anunforeseen combination of circumstances thatcalls for immediate action without time forfull deliberation.' Black's Law Dictionary522-23 (6th ed. 1990)."

The last Illinois case to define emergency was Opyt's Amoco, Inc.v. Village of South Holland, 149 Ill. 2d 265, 277-278, 595 N.E.2d1060 (1992). The court, in interpreting the constitutionality ofa village Sunday closing ordinance, quoted Black's Law Dictionary,giving the same definition quoted above.

Several other jurisdictions have addressed the definition of emergency with specific reference to Good Samaritan laws. Thetrial court here relied upon one of them, i.e., Jackson v. MercyHealth Center, Inc., 864 P.2d 839 (Okla. 1993). In Jackson, thecourt stated that "[k]eeping in mind that the Act's purpose is toinvite medical providers to intervene, the term 'emergency' must begiven the broadest sense possible." Jackson, 864 P.2d at 845. Accordingly, the court concluded that "[w]ithin the Act's intendedmeaning an emergency occurs whenever a stranger appears (or may beperceived) to be ill or in need of succor." Jackson, 864 P.2d at845.

In Breazeal v. Henry Mayo Newhall Memorial Hospital, 234 Cal.App. 3d 1329, 286 Cal. Rptr. 207 (1991), the court provided thefollowing explanation of emergency:

"An emergency within the meaning of theGood Samaritan statutes exists when there isan urgent medical circumstance of so pressinga character that some kind of action must betaken. [Citations.] It would seem obviousthat in determining whether a patient'scondition constitutes such an emergency thetrier of fact must consider the gravity, thecertainty, and the immediacy of theconsequences to be expected if no action istaken. However, beyond observing that theseare the relevant considerations, the varietyof situations that would qualify asemergencies under any reasonable set ofcriteria is too great to admit of anythingapproaching a bright line rule as to just howgrave, how certain, and how immediate suchconsequences have to be." Breazeal, 234 Cal. App. 3d at 1338, 286 Cal. Rptr. at 213.

The Breazeal court concluded that the issue of whether an emergencyexists is an issue of fact. Breazeal, 234 Cal. App. 3d at 1337,286 Cal. Rptr. at 213. See also Jackson, 864 P.2d at 846 (Summers,J., dissenting) (agreeing with Breazeal that a bright line rule isnot feasible and whether an emergency exists may be a question offact for the jury). Lastly, in Kearns v. Superior Court, 204 Cal.App. 3d 1325, 1328, 252 Cal. Rptr. 4, 6 (1988), the court statedthat "[a]n emergency exists '... where the exigency is of sopressing a character that some kind of action must be taken.'[Citation.]"

In addition to the above definitions, we have consulted twomedical dictionaries. The Attorney's Dictionary of Medicinedefines "emergency" as "[a]n urgent demand for medical or surgicalaction; a medical or surgical condition demanding immediateaction." 2 J.E. Schmidt, Attorney's Dictionary of Medicine E-71(1999). Stedman's Medical Dictionary defines "emergency" as "[a]nunlooked for contingency or happening; a sudden demand for action." Stedman's Medical Dictionary 456 (24th ed. 1982).

We reject plaintiff's contention to define "emergency," as amatter of law, with a bright line rule and limit emergency care tothose conditions outlined in medical journals. As the Breazealcourt noted, there are a variety of situations which may qualify asemergency care under the particular facts of a case, yet may notfall within any specific definition of emergency and may not beidentified in medical literature as an emergency. Accordingly, aflexible broad definition, given the purposes of the Good SamaritanAct and the need for medical providers to intervene and take careof individuals under a variety of situations without the threat ofliability, is more logical. Rather than a bright line rule, webelieve that whether an emergency situation exists is to beresolved based on the unforeseen, unexpected combination ofcircumstances presented which require the need for immediateaction, assistance, or relief. Based on this definition, weconclude that the situation that Dr. Arana was presented was anemergency situation. Osvaldo had an inflammation and, moreimportantly, an infection in his feet that required immediateattention. The ulcers could have turned into a more serious andsevere infection absent treatment. We therefore conclude thatthere was no question of fact precluding the trial court'sdetermination that Arana rendered emergency care to Osvaldo.

Based on the foregoing, we find that the trial court properlygranted defendant's motion for summary judgment.

Plaintiff next contends that the Good Samaritan exceptionshould not apply to a cause of action against a physician for hisfailure to report suspected child abuse pursuant to the ChildReporting Act. In essence, it appears that plaintiff is askingthis court to recognize a private cause of action under the ChildReporting Act for a physician's failure to report suspected childabuse.

Section 4 of the Child Reporting Act requires a physician,among others, "having reasonable cause to believe a child known tothem in their professional or official capacity may be an abusedchild or a neglected child [to] immediately report or cause areport to be made." 325 ILCS 5/4 (West 1998). Section 4.02provides:

"Any physician who willfully fails to reportsuspected child abuse or neglect as requiredby this Act shall be referred to the IllinoisState Medical Disciplinary Board for action inaccordance with paragraph 22 of Section 22 ofthe Medical Practice Act of 1987." 325 ILCS5/4.02 (West 1998).

We conclude that plaintiff has waived this issue by failing toraise it in the trial court. In other cases reviewing the issue onappeal of whether a private cause of action exists under aparticular statute, the issue had first been raised in the trialcourt. See, e.g., Du Page Forklift Service, Inc. v. MaterialHandling Services, Inc., 195 Ill. 2d 71, 76, 744 N.E.2d 845 (2001);Abbasi ex rel. Abbasi v. Paraskevoulaskos, 187 Ill. 2d 386, 388,718 N.E.2d 181 (1999); McNeil v. Carter, 318 Ill. App. 3d 939, 941,742 N.E.2d 1277 (2001); Rekosh v. Parks, 316 Ill. App. 3d 58, 61,735 N.E.2d 765 (2000); Gonzalzles v. American Express Credit Corp.,315 Ill. App. 3d 199, 210, 733 N.E.2d 345 (2000). Becauseplaintiff failed to plead a cause of action under the ChildReporting Act in the trial court, and thus failed to have the trialcourt determine the propriety of such a cause of action, she haswaived the issue.

Affirmed.

HALL, P.J., and WOLFSON, J., concur.

1. Arana's findings also indicated that Osvaldo suffered from"[b]ilateral mild conjunctiva inflammation," an inflammation of theeyes which, according to Arana, could have occurred from crying.

2. Previously, the statute also contained the language "andwithout prior notice of the illness or injury" following "goodfaith." This language was deleted by P.A. 90--742,