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Docket No. 95876-Agenda 9-January 2004.

EARLEAN JINKINS, Indiv. and as Adm'r of the Estate of George
Jinkins, Deceased, Appellee, v. DR. CHOONG LEE et al.,
Appellants.

Opinion filed March 18, 2004.
 

JUSTICE FITZGERALD delivered the opinion of the court:

In this case we consider whether the doctrine of sovereign immunitybars plaintiff's claim for negligence against mental health professionals.Plaintiff, Earlean Jinkins (Earlean), filed her complaint individually and asadministrator of the estate of George Jinkins (George), her husband,against the defendants Dr. Choong Lee and Paullette Medlin, employeesof the John J. Madden Mental Health Center (Madden Center). Plaintiffalleges that defendants failed to properly diagnose and treat George'smental illness, such that George should have been subject to involuntarycommitment. This failure, plaintiff alleges, led to George's release fromMadden Center and subsequent suicide. The appellate court found thatthe claim survived. 337 Ill. App. 3d 403. For the following reasons, weaffirm the appellate court.

BACKGROUND

George resided with his wife, Earlean, and other family members inChicago. George began acting abnormally three or four months prior tohis suicide. Earlean and their children moved out of the residence when,according to Lorenzo Norwood, a lifelong friend and neighbor, George"told her to get out of the house, go live with her mother, because hedidn't want her to be there with him or there would be-instead of onebody bag, there'd be two bodies. So she left." George began drinkingheavily, was dressing in a dirty and disheveled manner, and was givingaway his money and possessions. Norwood also saw George running infront of cars "maybe three or four times." Norwood stated that Georgedid not drink before he started "acting funny," other than "when he wentto the clubs, he'd have a beer. That's about it." George did not complainabout his condition, but "he just started saying, things going to change."

On June 20, 1996, neighbors found George "laying in a puddle ofmuddy water face first" with his pants down. The neighbors broughtGeorge back to his house, where he still had his pants down; hisunderwear was bloody because he was bleeding from his rectal area.After George again attempted to run in front of a car, Norwood, aneighbor named Maurice Abernathy, and George's mother took Georgeto Christ Hospital, a private hospital, in Oak Lawn at approximately 7p.m.

Dr. Daniel Sachs, a resident in emergency medicine at ChristHospital, treated George in the hospital emergency room. He diagnosedGeorge with "acute psychosis with suicidal behavior," hemorrhoids, andconstipation. His blood-alcohol content was 0.203 and he also testedpositive for marijuana. Dr. Sachs stated his diagnosis of psychosis wasbased on the information, related by Norwood or Abernathy, that Georgewalked in front of cars intentionally, George's statements to them that he"just wants to go," and George's mother's statement that George hadbeen suicidal during the previous three weeks. George's mother told Dr.Sachs that George thought he was being poisoned and that when shecooked George would stand over her to watch if she poisoned the food.Dr. Sachs disbelieved George's denial that he was suicidal. According toa Christ Hospital social worker, Earlean arrived at the hospital later in theevening and stated that George's behavior was due to alcohol abuse.

Dr. Sachs' "plan was to have him evaluated and possibly admittedby a psychiatrist." Dr. Sachs explained, "My responsibility was to decidewhat the patient's disposition should be-is he safe to go home, or does heneed an evaluation of possible admission-but not to decide where thatshould take place." The decision as to where he would be admitted,whether it was Christ Hospital or another hospital, "was an administrativeissue rather than a doctor issue," according to Dr. Sachs. Theadministrative decision belonged to a licensed clinical social worker atChrist Hospital, Leonard Kemp.

Kemp filled out a petition asserting that George was subject toinvoluntary admission pursuant to section 3-601 of the Mental Health andDevelopmental Disabilities Code (Code) (405 ILCS 5/3-601 (West1996) (providing "[w]hen a person is asserted to be subject to involuntaryadmission and in such a condition that immediate hospitalization isnecessary for the protection of such person or others from physical harm,any person 18 years of age or older may present a petition to the facilitydirector of a mental health facility")). The Code defines a "[p]ersonsubject to involuntary admission" as "[a] person with mental illness andwho because of his or her illness is reasonably expected to inflict seriousphysical harm upon himself or herself or another person in the near future."405 ILCS 5/1-119 (West 1996). Kemp and George's mother signed thepetition, and George's mother and Abernathy were listed as witnesses.The petition stated that George was "a person who is mentally ill and whobecause of his *** illness is reasonably expected to inflict serious physicalharm upon himself *** or others in the near future." George was "in needof immediate hospitalization for the prevention of such harm," in that"George has been hearing noises and voices, thinking he is being shot at,that birds are talking to him, that he has been poisoned. He has beenrunning in front of cars trying to kill himself."

Dr. Sachs prepared a certificate accompanying the petition pursuantto section 3-602 of the Code (405 ILCS 5/3-602 (West 1996) (statingthat "[t]he petition shall be accompanied by a certificate executed by aphysician, qualified examiner, or clinical psychologist which states that therespondent is subject to involuntary admission and requires immediatehospitalization")). The certificate stated that Dr. Sachs had examinedGeorge, and that based on the examination, George was "a person whois mentally ill and because of his *** illness is reasonably expected toinflict serious physical harm on *** [him]self or another in the near future."Dr. Sachs wrote in the certificate that the "patient's mother and twobrothers [sic] say that he has repeatedly tried to kill himself by walkinginto street in front of cars. He tells them, 'I just want to go.' "

George was held overnight at Christ Hospital. George was disruptiveand given 10 milligrams of Haldol at approximately 11:45 p.m. Atapproximately 3 a.m. the next day, George attempted to escape thehospital, but was found by hospital security in a nearby car dealership lotand returned to Christ Hospital. At approximately 6 a.m. that same day,after his blood-alcohol content had decreased below 0.10, George wastransferred in restraints by ambulance to Madden Center, a mental healthcare facility operated by the Illinois Department of Human Services (see20 ILCS 1705/4 (West 2002)). Dr. Sachs believed that Christ Hospitalmay have transferred George to Madden Center because George lackedinsurance. Dr. Sachs spoke on the telephone with Dr. Hasina Javed, theintake psychiatrist who worked the shift prior to defendant, Dr. Lee,regarding George.

Dr. Choong Lee, a board-certified psychiatrist, was the "intakepsychiatrist" at Madden Center. Dr. Lee examined George pursuant tosection 3-610 of the Code (405 ILCS 5/3-610 (West 1996) (providingthat within "24 hours, excluding Saturdays, Sundays and holidays, afteradmission of a respondent pursuant to this Article, the respondent shall beexamined by a psychiatrist" who, "shall not be the person who executedthe first certificate. If the respondent is not examined or if the psychiatristdoes not execute a certificate pursuant to section 3-602, the respondentshall be released forthwith")). In his deposition, Dr. Lee testified thatintake psychiatry is not a specialized role, but that "intake psychiatry isonly in our state hospital. I don't think any other place, a private hospitalhas such an intake psychiatry position." Dr. Lee stated that he decided ifa patient required hospitalization or needed outpatient or other care, buthe was not responsible for the subsequent treatment of the patients atMadden Center. As to the decision to admit a particular patient, Dr. Leestated, "[t]hat is totally a clinical decision after the intake psychiatristreviews the record, talks with the patient, and talks with the family, andgets the collateral information."

Paulette Medlin is a licensed clinical professional counselor and holdsa master's degree in rehabilitation counseling. She held the position of"psychologist three" at Madden Center. She works in "intake, and her jobis to gather information towards an evaluation of persons presenting tointake for admission or non-admission to the hospital." Medlin stated thatshe was to assist Dr. Lee, but the final decision as to involuntary admissionof a patient belonged to Dr. Lee.

Dr. Lee reviewed Christ Hospital's paperwork. He and Medlinspoke with George and his wife for 30 to 45 minutes. Dr. Lee and Medlinthen spoke to George and his mother separately for 5 or 10 minutes.According to Dr. Lee, Earlean disputed the contents of the petition forinvoluntary admission, stated that George was not suicidal, and told Dr.Lee that she wanted to take George home. Dr. Lee stated that despiteGeorge's denial of the events recounted in the petition, Dr. Lee assumedthat the events had actually happened.

Dr. Lee's diagnosis of George was "alcohol related disorder, NOS[not otherwise specified]" and alcohol abuse. Dr. Lee did not believe thatGeorge was suicidal, but instead that there was some low risk of suicidebecause of the alcohol and drug use. Dr. Lee said the suicide risk waslower because of the family support. He admitted, however, this opinionwould have changed if he had known that Earlean had left George threeweeks prior to the examination. Dr. Lee also did not think George wassuicidal because "he didn't have a past suicide attempt either and didn'thave any history prior of psychiatric hospitalization." Dr. Lee thought thatdrugs and alcohol were the primary causes of the psychiatric symptoms,but he was not able to rule out other causes. Dr. Lee disagreed with Dr.Sachs' diagnosis, and opined that George's use of alcohol influenced Dr.Sachs' opinion. As to whether George should have been admitted, Dr.Lee stated, "at the time he was not certifiable, so that's why I didn't admithim." George had a right to go home because he was not "certifiable."

Dr. Lee admitted that a doctor-patient relationship existed betweenhimself and George during the intake procedure. If the wife or his motherhad requested admission, Dr. Lee stated, "probably I'd have to admit thepatient." Dr. Lee and Medlin referred George to a community healthcenter for outpatient treatment. Medlin's report stated that George refusedthe referral and that he wanted to seek help for himself.

George left Madden Center with Earlean and his mother that samemorning and went home. Soon after arriving home, he shot himself in thehead. His family took George back to Christ Hospital, where he died.

Dr. Syed Ali, a psychiatrist and expert witness for defendants,testified in his deposition that he had worked both in private practice andfor the state. As part of his duties at the Illinois State Psychiatric Institute,he was responsible for making determinations as to whether or notpatients should be admitted. Some of these patients were referrals fromemergency rooms with a petition for involuntary commitment. He testifiedthat there is "absolutely" no difference in procedures, standards, orprocesses in involuntary commitment of patients between a private hospitaland a state hospital. An identical standard of care is applicable to bothprivate and state hospitals. Dr. Ali stated that Dr. Lee attributed the priorsuicide attempts to alcohol abuse and that withdrawal from alcohol couldhave made George suicidal. "Alcoholic psychosis is more prevalent whenthere is alcohol withdrawal rather than in alcohol intoxication," accordingto Dr. Ali. Other diagnoses could be "schizophrenia" and "manicdepressive illness."

Dr. Ali stated that once George arrived at Madden Center, Dr. Leecould have kept George for 24 hours, unless there were no grounds tohold the individual in the eyes of the examiner. Dr. Ali believed Georgewould have benefitted from "staying longer at Madden and should havestayed at Madden longer and be admitted there." However, the issuefacing Dr. Lee was whether George was "certifiable" such that he wassubject to involuntary admission. The threshold for "certifiability,"according to Dr. Ali, is "imminent risk" of suicide, which requires a highdegree of probability.

Earlean, individually and as the administrator of George's estate, fileda 12-count complaint, and among the defendants named were two stateemployees, Dr. Lee and Paulette Medlin.⁽¹⁾ The complaint, consisting ofcounts for wrongful death and survival, charged defendants with negligenttreatment of George which proximately caused his death on June 21,1996. The complaint alleged that "in providing medical care to [George],it was the duty of Dr. C Lee, to possess and apply the knowledge andskill ordinarily possessed and applied by reasonably well-qualifiedphysicians in the same or similar communities," and that Dr. Lee hadbreached that duty. As to Medlin, the complaint alleged "while providingservices to [George], it was the duty of the Defendant, P. Medlin, topossess and apply the knowledge and skill ordinarily possessed andapplied by reasonably well-qualified psych-3's in the same or similarcircumstances," and that Medlin breached that duty. Both defendantsadmitted the allegations as to their respective duties, but denied that theybreached those duties. The circuit court granted the defendants' motionfor summary judgment on the grounds that the doctrine of sovereignimmunity barred the action. Thus, subject matter jurisdiction properly layin the court of claims rather than the circuit court.

A majority of the appellate court reversed the circuit court's grant ofsummary judgment to the defendants. 337 Ill. App. 3d 403. The majoritystated that it believed that the duty owed to George by Dr. Lee and byMedlin arose independent of their state employment and that thereforeEarlean could proceed against them in circuit court. 337 Ill. App. 3d at416. This decision, according to the majority, was consistent with thereasoning in Madden v. Kuehn, 56 Ill. App. 3d 997 (1978), and Watsonv. St. Annes Hospital, 68 Ill. App. 3d 1048 (1979), and their progeny.In those cases, the courts held that sovereign immunity did not bar amedical malpractice action against a state doctor where the source of thedoctor's duty arose out of the physician-patient relationship rather than thedoctor's status as a state employee. 337 Ill. App. 3d at 416. JusticeWolfson dissented, distinguishing Madden and Watson, and questionedthe continued validity of those cases in light of this court's decision inHealy v. Vaupel, 133 Ill. 2d 295 (1990). 337 Ill. App. 3d at 419(Wolfson, J., dissenting) (noting that in Healy, this court stated," '[w]ithout commenting on the correctness of that decision, we decline toextend Madden to the present case' "), quoting Healy, 133 Ill. 2d at 313.Instead, Justice Wolfson found that because "the defendants never treatedGeorge," the reasoning of Kilcoyne v. Paelmo, 204 Ill. App. 3d 139(1990), controlled. 337 Ill. App. 3d at 418-19 (Wolfson, J., dissenting).Justice Wolfson noted that in Kilcoyne, the court found that the decisionto institutionalize a person was not an obligation that equated with thoseduties generally owed to patients by their doctors. 337 Ill. App. 3d at 419(Wolfson, J., dissenting), quoting Kilcoyne, 204 Ill. App. 3d at 144-45.We granted the defendants' petition for leave to appeal. 177 Ill. 2d R.315(a).

ANALYSIS

Summary judgment is proper where the pleadings, depositions, andadmissions on file, when viewed in the light most favorable to thenonmoving party, reveal that there is no genuine issue as to any materialfact and that the moving party is entitled to judgment as a matter of law.735 ILCS 5/2-1005(c) (West 2002); Quad Cities Open, Inc. v. City ofSilvis, No. 95972, slip op. at 13 (January 23, 2004). We review the grantof summary judgment de novo. Quad Cities Open, Inc., slip op. at 13.

Article XIII, section 4, of the Illinois Constitution of 1970 provides,"Except as the General Assembly may provide by law, sovereign immunityin this State is abolished." Ill. Const. 1970, art. XIII,