York v. Rush-Presbyterian-St. Luke's Medical Center (222 Ill. 2d 147, 2006)

JUSTICE McMORROW

delivered the judgment of the court, with opinion.

Chief Justice Thomas and Justices Freeman, Fitzgerald, Kilbride, and Karmeier concurred in the judgment and opinion.

Justice Garman dissented, with opinion.

OPINION

Dr. James M. York suffered a spinal injury during knee replacement surgery performed at defendant Rush-Presbyterian-St. Luke’s Medical Center (Rush). As a result, Dr. York (hereinafter, plaintiff) and his wife filed a medical malpractice action in the circuit court of Cook County against the attending anesthesiologist, Dr. Abdel Raouf El-Ganzouri, and Dr. El-Ganzouri’s employer, University Anesthesiologists, S.C. Plaintiff alleged that his injuries resulted from the improper administration of a combined spinal epidural anesthesia by Dr. El-Ganzouri prior to the surgery. Specifically, plaintiff alleged that Dr. El-Ganzouri deviated from the standard of care by inserting a needle used to administer anesthesia too high on plaintiffs spine, causing the needle to pierce plaintiffs spinal cord and to result in irreversible spinal injury. Subsequent to the filing of his initial complaint, plaintiff amended his complaint to add Rush as a defendant on the theory that Dr. El-Ganzouri was Rush’s apparent agent. After a jury trial, all three defendants were found liable. The jury awarded plaintiff and his wife damages in the amount of $12,598,591.31. The appellate court affirmed the verdict against all defendants. 353 Ill. App. 3d 1.

Thereafter, all three defendants filed petitions for leave to appeal with this court. We granted Rush’s petition for leave to appeal, but denied the petition for leave to appeal filed by Dr. El-Ganzouri and University Anesthesiologists. Accordingly, this appeal solely addresses plaintiffs apparent agency claim against Rush. For the reasons that follow, we affirm the judgment of the appellate court.

BACKGROUND

As an initial matter, we note that the record in this cause is voluminous, and that we have carefully reviewed the record in its entirety. The appellate court, in its opinion below, set forth with great detail all of the evidence adduced at trial. However, since the instant appeal is limited to reviewing plaintiffs claim that Rush is liable because Dr. El-Ganzouri was Rush’s apparent agent, we do not find it necessary to set forth in detail the evidence presented at trial with respect to the underlying medical malpractice claim against Dr. El-Ganzouri and University Anesthesiologists. Accordingly, we provide only a brief overview of the facts of the medical malpractice action in order to set the context for plaintiffs claim of apparent agency against Rush.

Plaintiff is a retired orthopedic surgeon. On February 9, 1998, plaintiff underwent a cemented total left knee arthroplasty at Rush. This was the third knee surgery plaintiff had at Rush since 1997, and all three surgeries were performed by Dr. Aaron Rosenberg, an orthopedic surgeon. Upon his admission to Rush for the February 9, 1998, surgery, plaintiff signed a treatment consent form which stated, in pertinent part:

“I hereby authorize Dr. Rosenberg and such assistants and associates as may be selected by him/her and the Rush-Presbyterian-St. Luke’s Medical Center to perform the following procedure(s) upon myself/the patient ***.”

During the February 9, 1998, procedure, Dr. El-Ganzouri was plaintiffs attending anesthesiologist, and Dr. Rodney Miller was the anesthesiology resident. Shortly before plaintiff’s surgery, Dr. El-Ganzouri administered a combined spinal epidural anesthesia to plaintiff. In this procedure, the anesthesiologist first inserts a large epidural needle — known as a “Touhy” needle — through the skin and between bones in the spine, but short of the spinal column itself. It is generally accepted that the proper location for the insertion of this needle is below the spinal cord, in the lumbar area of the spine, which is at or below the L2-L3 vertebral interspace. By injecting the patient through the lumbar area, the anesthesiologist greatly reduces the risk of the needle making contact with the spinal cord. Once the Touhy needle is properly placed, the anesthesiologist then inserts a much finer needle — known as a “Whittaker” needle — into the center of the larger Touhy needle. The Whittaker needle is advanced through the Touhy needle until the Whittaker needle pierces the dura, which is a thick skin protecting an area known as the subarachnoid space. The subarachnoid space contains cerebrospinal fluid, as well as the spinal cord itself. Once the anesthesiologist pierces the dura, he or she can confirm access to the subarachnoid space by aspirating cerebrospinal fluid back through the inserted needles. Once the presence of cerebrospinal fluid is confirmed, the anesthesiologist knows that the needles are properly placed and then may inject the anesthesia through the already-inserted needles.

In preparing to insert the Touhy needle into plaintiff’s back, Dr. El-Ganzouri located the position on plaintiff’s spine where he intended to insert the needle. However, when Dr. El-Ganzouri inserted the first needle into plaintiff’s back, plaintiff expressed that he felt excruciating pain in his right hip, knee and leg, and that his right thigh cramped and his right calf swelled. Plaintiff experienced additional severe pain — described as pain radiating down his right leg, resulting in his right leg losing all sensation — when Dr. El-Ganzouri inserted the second needle. Plaintiff then underwent the knee replacement surgery on his left knee.

After the knee surgery, it was discovered that plaintiff had suffered a spinal injury. Plaintiff could neither feel nor move his right leg. In addition, plaintiff had lost bladder and bowel control and also experienced sexual dysfunction. Although plaintiff underwent extensive rehabilitation, he had only partial success in his recovery.

As a result of these events, plaintiff filed a four-count complaint in the circuit court of Cook County on November 17, 1998. Count I of the complaint alleged professional negligence against Dr. El-Ganzouri and University Anesthesiologists, S.C., stating that Dr. El-Ganzouri deviated from the standard of care in administering the combined spinal epidural anesthesia to plaintiff by improperly inserting the needles into plaintiffs spinal cord. Count II of the complaint was filed on behalf of plaintiff’s wife, Elizabeth York, and sounded in loss of consortium due to the professional negligence of Dr. El-Ganzouri and his employer, University Anesthesiologists. The remaining two counts of the complaint alleged claims of res ipsa loquitur against Dr. El-Ganzouri and University Anesthesiologists. The two counts sounding in res ipsa loquitur were subsequently dismissed with prejudice by the circuit court at the conclusion of the trial and are not at issue in this appeal.

On February 7, 2000, plaintiff filed an amended complaint. This amended complaint added Rush as a defendant and alleged:

“[Dr. El-Ganzouri was] the actual or apparent agent of Defendant, Rush, was mentoring, directing, instructing and teaching various medical students and/or residents and was acting in said capacity, and upon whom plaintiff justifiably and reasonably relied to properly administer anesthesia to the detriment of plaintiff.”

The amended complaint pled in the alternative that “defendant Rush failed to inform plaintiff that defendant, Dr. El-Ganzouri, was an independent contractor.” The claim of apparent agency was repeated in count II of the complaint, which alleged loss of consortium on behalf of plaintiffs wife.

The jury trial in this case commenced on May 30, 2002. With respect to the underlying medical malpractice action, plaintiff presented medical experts who opined that Dr. El-Ganzouri deviated from the standard of care for anesthesiologists by inserting the spinal needles too high on plaintiffs spine during the combined spinal epidural procedure. Plaintiff introduced evidence that Dr. El-Ganzouri inserted the anesthesia needles at the T12-L1 spinal interspace rather than at the generally recommended L2-L3 spinal interspace. Plaintiffs experts opined that such improper placement of the needles would allow the spinal cord to be pierced, and that the injection of anesthesia directly into the spinal cord would kill nerves and cause the injuries that plaintiff experienced. In contrast, defendants presented medical experts who opined that Dr. El-Ganzouri satisfied the relevant standard of care in performing the combined spinal epidural anesthesia and that plaintiffs injuries were caused by a “spinal infarction” that resulted from a drop in plaintiffs blood pressure during surgery.

With respect to the apparent agency claim brought by plaintiff against Rush, plaintiff argued at trial that Rush was liable for the negligence of Dr. El-Ganzouri. Plaintiff contended that he had not been informed that Dr. El-Ganzouri was an independent contractor and not an employee of Rush. In addition, plaintiff asserted that Dr. El-Ganzouri appeared to be a Rush employee not only based upon the language in the Rush treatment consent form signed by plaintiff, but also by virtue of the fact that Dr. El-Ganzouri wore scrubs and a lab coat that bore Rush insignia. Plaintiff also maintained that he had relied on Rush to provide the anesthesiologist for his surgery.

Rush countered plaintiffs apparent agency claim by asserting that, as a doctor himself, plaintiff could not have reasonably believed that Dr. El-Ganzouri was a Rush employee. Rush argued that, based upon plaintiffs own experience as an independent contractor in the medical profession, he had to have known that Dr. El-Ganzouri was an independent contractor. In addition, Rush denied that plaintiff relied upon Rush to provide an anesthesiologist. Rather, Rush asserted, plaintiff relied upon his son, Dr. Jeff York, to choose the anesthesiologist for his surgery. According to Rush, Jeff, who was an anesthesiology resident at Rush at the time of plaintiffs surgery, was aware that Rush’s attending anesthesiologists were independent contractors employed by University Anesthesiologists. Therefore, Rush concluded, it was logical to assume that plaintiff was also aware of the independent-contractor employment status of Dr. El-Ganzouri.

As stated, this appeal revolves around the question of whether plaintiff satisfied his burden of proof at trial to support the jury’s verdict that Dr. El-Ganzouri was the apparent agent of Rush. Accordingly, we will set forth in detail the evidence adduced at trial relevant to the apparent agency issue.

Plaintiff testified that he is a retired orthopedic surgeon and that he was 72 years old at the time of trial. Plaintiff stated that he spent 27 years of his career in Somerville, New Jersey, practicing orthopedic surgery at the Somerset Medical Center. Plaintiff testified that during his time at Somerset, he was a self-employed physician and was not employed by the hospital. According to plaintiff, many of the doctors at Somerset — like himself— were solo practitioners, while some other doctors who were on staff there formed practice groups. Plaintiff testified that he “really didn’t know” about the employment relationship between Somerset Medical Center and the anesthesiologists who practiced there. Plaintiff explained: “I had no knowledge. It was none of my business. I was primarily practicing orthopedic surgery. I was not very good with numbers, figures. I let other people do that.”

Plaintiff testified that, prior to coming to Rush, he had undergone several knee surgeries, beginning in the 1970s. Plaintiff stated that he handpicked each and every doctor that performed surgery on his knees. In plaintiffs words, he “sought [the doctors] out,” and, as a result, he traveled to wherever the chosen surgeon was practicing, whether it was in another city, state, or country. By 1994, however, plaintiffs arthritic knees were getting more and more painful and swollen. At that time, plaintiff initially consulted a doctor in Boca Raton, Florida, near plaintiffs Florida home. Plaintiff, however, did not agree with this doctor’s suggested plan of treatment. According to plaintiff, it was then that he asked his son Jeff “to look into Rush.” In the following exchange between plaintiff and his counsel, plaintiff explained this process:

“Q. When did you first seek out medical care of any kind at Rush?

A. My son had an orthopedic — I mean, anesthesia residency and he knew I was looking around for somebody to do total knees. And I said, Jeff, can you find out if there’s a good man in Chicago, and that’s what he did.

Q. And had you known of Rush Pres before that discussion with your son?

A. Yes.

Q. And how did that come about?

A. I played tennis with another doctor *** and he and I were great friends *** [a]nd he was a graduate of Rush Medical School and he was an internist who trained at Rush Medical School, residency.

Q. What was your understanding about Rush then when you spoke with Jeff?

A. I knew there were good docs at Rush.

Q. Did you then eventually hook up with a doctor at Rush to consult with on your knee?

A. Dr. Aaron Rosenberg.”

On cross-examination, defense counsel revisited plaintiff’s testimony that he had his son Jeff “look into Rush.” The following exchange ensued between defense counsel and plaintiff:

“Q. And as I think you mentioned earlier this morning, [Jeff] did that for you?

A. Yes. He said a couple of the orthopedic residents recommended Aaron Rosenberg. I asked a few of my friends about Dr. Rosenberg. *** I felt very comfortable going to him.

Q. So you had Jeff check out the orthopedic surgeons at Rush, and then you asked your colleague friend *** about Dr. Rosenberg and—

A. And I asked people in Boca.

Q. You were used to making medical decisions yourself in terms of your own medical care. True?

A. I was used to choosing the surgeon.

Q. Particularly being an orthopedic surgeon, you wanted who you wanted for orthopedic surgery. True?

A. I only knew orthopedic surgery. I had the same trouble the jury has in choosing doctors and other people.”

Plaintiff testified that he became a patient of Dr. Rosenberg at Rush in 1994. Plaintiff would make an appointment to see Dr. Rosenberg when plaintiff traveled from his Florida home to Chicago to visit with his son Jeff. According to plaintiff, at the start Dr. Rosenberg had conservatively treated plaintiff’s knee problems. However, because of the worsening condition of his knees, plaintiff had to eventually have a replacement of his right knee in August 1997. Plaintiff then underwent a subsequent operation a few days later in September 1997. During this procedure, Dr. Rosenberg removed two plates and screws from plaintiff’s left knee that were from a previous operation.

Plaintiff testified he was very pleased with the results from the first knee replacement surgery performed on plaintiff’s right knee by Dr. Rosenberg in 1997. As a result, plaintiff went back to Dr. Rosenberg for a surgical replacement of his left knee in February 1998. Plaintiff stated that he would have gone to Dr. Rosenberg for the surgery even if Dr. Rosenberg had moved his practice to a different hospital.

Plaintiff testified that, prior to the left knee replacement surgery scheduled for February 9, 1998, he and his son Jeff discussed the anesthesia care for that procedure. Plaintiff explained this conversation during the following colloquy with his counsel:

“Q. Now, relative to that operation *** did you and Jeff have any discussion at all about the anesthesia care?

A. We did. I asked him if he could — I had Tom Krolick and Dr. Miller on the first operation and I liked both of them. I had asked Jeff if it was possible to have the same team.”

Plaintiff, however, testified that he was not aware how Dr. Krolick was selected to be plaintiffs anesthesiologist for his first knee surgery at Rush.

On cross-examination, defense counsel followed up on plaintiff’s testimony regarding the selection of his anesthesiologists during these earlier surgeries. Plaintiff offered additional explanation, as revealed in the following exchange with defense counsel:

“Q. I think you mentioned that for the first surgery by Dr. Rosenberg, you had Jeff intervene for you to arrange the anesthesiologist, Dr. Tom Krolick; is that right?

A. I believe Jeff said — I said we didn’t discuss anesthesia, but he said something about I will pick the anesthesia, I have a friend who owes me a favor, something like that. And Tom Krolick and I hit it off***.”

The colloquy continued:

“Q. You had asked Jeff then prior to February of ’98 to see if he could get both Tom Krolick and Rodney Miller for your February 9 procedure?

A. Yeah. When you come up from Florida to a big city, its nice to see one person you know in the operating room. I liked Rodney Miller.”

According to plaintiff, he subsequently found out that Dr. Krolick was not available for the February 9, 1998, surgery because he was scheduled to be out of the office that day. However, as plaintiff requested, Dr. Miller was assigned to his surgery as the anesthesiology resident. According to plaintiff, he was unaware prior to his surgery who the attending anesthesiologist would be. Plaintiff explained this during the following exchange with his counsel:

“Q. By the way, did you know Dr. El-Ganzouri was going to be your doctor anesthesiologist that day?

A. No I didn’t.

Q. Who did you think it was going to be?

A. I really didn’t know.

Q. And upon whom did you rely, if anyone, for the selection of an anesthesiologist?

A. I assumed Rush was going to select them. They have good docs at Rush. I knew that. I had two surgeries there.”

On cross-examination, defense counsel further inquired of plaintiff about the anesthesiology services he received during the prior operations on his knees. Plaintiff testified that in those procedures, he relied upon either the “orthopedic surgeon and/or the hospital I was going to” to select the anesthesiologist for the surgery. According to plaintiff, this reliance was based upon his “faith in the institutions.”

Plaintiffs son, Dr. Jeff York, also testified at trial. Jeff stated that in February 1998 he was employed by Rush as a resident in its anesthesiology training program. Jeff testified that he began his anesthesia residency at Rush in 1994 and completed it in 1998. As a result of his residency there, Jeff stated, he “thought highly of Rush.” According to Jeff, when his father first asked him in 1994 about the quality of care that he would receive at Rush, Jeff told his father that he was “enthusiastic about the services and nursing staff, doctors and postoperative care that he could receive.” Jeff testified that he “spoke highly of Rush and encouraged [his father] to come to the hospital for medical care.”

Jeff further explained his enthusiasm about his father’s being treated at Rush in the following colloquy between Jeff and plaintiffs counsel:

“Q. I would like you to tell the ladies and gentlemen of the jury about your initial conversation with your father about possibly coming to Chicago, Rush-Presbyterian-St. Luke’s for treatment.

A. I was very enthusiastic about my father to come to Rush-Presbyterian-St. Luke’s Medical Center for medical care. I had good knowledge of the surgeons, the nursing staff, and the postoperative care that could be given to patients as I was a resident in the anesthesia training program there.

I encouraged him to come to Rush-Presbyterian-St. Luke’s Medical Center because I thought that he could get — that he could receive good care there.

Q. Dr. York, will you tell us when you first discussed Dr. Rosenberg with your father in context of his conversation and contact with you about Rush?

A. I was encouraging my father to come to Rush-Presbyterian-St. Luke’s Medical Center for surgical care.

Q. When did you talk to your father about Dr. Rosenberg?

A. I did some research asking individuals about the quality of orthopedic surgeons on staff at Rush-Presbyterian-St. Luke’s Medical Center. And I tried to find out which surgeon did the most total knees and who had the best results. And then encouraged my father to come to Rush for surgical care.”

Jeff testified that his father traveled from Florida to see Dr. Rosenberg for treatment from 1994 to 1997. In August 1997, his father underwent the first surgery by Dr. Rosenberg on his right knee. For that surgery, Dr. Krolick — a member of University Anesthesiologists — was the attending anesthesiologist. Jeff testified that after the August 1997 surgery, his father was pleased with the results. Nine days later, his father had a surgical revision performed on his left knee by Dr. Rosenberg. Dr. Sklar was the attending anesthesiologist for that procedure. According to Jeff, his father was also pleased with the results of the second surgery. Jeff testified that Jeff’s friend Dr. Rodney Miller had been the anesthesiology resident assigned to these first two surgeries.

With respect to the February 1998 surgery at issue in the instant cause, Jeff stated that he was aware prior to that surgery that Dr. Miller would be the resident anesthesiologist assigned to his father’s case. Jeff further testified, however, that he had no contact with any of his father’s other physicians or anesthesiologists prior to that surgery. Jeff testified that he did not know which attending anesthesiologist would be assigned to his father’s surgery, as revealed by the following colloquy between Jeff and defense counsel on cross-examination:

“Q. *** And you were aware before Monday of February 9th that Dr. Miller would be doing your father’s case come Monday?

A. Yes.

Q. And you were aware that your father specifically asked for Dr. Miller to be assigned to his case?

A. He had shown a preference to Rodney Miller because he gave him good anesthetic care previously.

Q. And when you found out that Dr. El-Ganzouri had been assigned to your father’s case for that Monday, February 9th, you voiced no objection to that assignment, is that right?

A. I wasn’t aware that Dr. El-Ganzouri had been assigned to my father’s case for Monday.

Q. Is it correct that when you learned that Dr. El-Ganzouri would be the anesthesiologist for your father’s case on the 9th of February, that you did not voice any opposition to that?

A. I wasn’t aware that Dr. El-Ganzouri was going to be my father’s anesthesiologist for that coming Monday, that coming operation.”

Jeff testified that, during the time period in which his father’s surgery occurred, anesthesiologists at Rush were assigned to surgical cases based upon their seniority and their specialty track. For example, an anesthesiology resident who was undergoing a certain type of training would be assigned to a certain type of case. The attending anesthesiologists would be assigned in the same manner.

Jeff testified that the scheduling or assignment of anesthesiologists at Rush was generally handled by Ray Narbone. Narbone was a nurse anesthetist and an employee of Rush. According to Jeff, Narbone would review a daily list of the available anesthesiology staff and would assign certain residents and attending anesthesiologists to a particular case for that day. Jeff testified that patients did not select their anesthesiologists at Rush.

Jeff stated that the first contact that a patient has with the Department of Anesthesia prior to surgery is with someone from the resident staff, who would be responsible for meeting the patient in the surgical holding area. During this preanesthesia evaluation, Jeff testified, there was no discussion of the employment relationship between the anesthesia physicians and the patient. Jeff further testified that at the time of his father’s February 1998 surgery, all the anesthesiologists — both attending and residents — wore green scrubs with the Rush logo printed on them. Outside of the surgical setting, the attending anesthesiologist would wear a white lab coat with the Rush logo on the pocket.

Jeff concluded his testimony by stating that the offices of University Anesthesiologists are located in a Rush building and, at the time of his father’s February 1998 surgery, all of the attending anesthesiologists at Rush were members of University Anesthesiologists. According to Jeff, he had no conversations with his father about University Anesthesiologists prior to his father’s surgery. Jeff stated that for his February 1998 surgery, his father indicated no preference for any attending anesthesiologist on staff. Jeff stated that he — and not his father— requested that Dr. Krolick serve as the attending anesthesiologist for that surgery.

Dr. Rodney Miller also testified at trial. Dr. Miller stated that he participated as an anesthesia resident in plaintiff’s 1997 knee surgeries at Rush. Dr. Miller stated that he also served as the anesthesiology resident during plaintiff’s February 9, 1998, surgery because plaintiff and his son, Dr. Jeff York, “requested” Dr. Miller to participate. According to Dr. Miller, plaintiff and his son Jeff had also requested Dr. Krolick to serve as the attending anesthesiologist for the February 9, 1998, surgery. However, Dr. Krolick was not available on that day for surgery. Instead, Dr. El-Ganzouri was assigned to plaintiffs case as the attending anestheologist.

With respect to the events occurring on the day of plaintiffs surgery, Dr. Miller testified as follows:

“Q. In *** the morning of February 9, 1998, did you see [plaintiff]?

A. Yes.

Q. Describe for the ladies and gentlemen of the jury where that would have been.

A. That was in the holding area. I believe it was bed 24 or 25. That’s where I saw him.

Q. Okay. Did you learn that morning who the attending anesthesiologist would be that you would be working with?

A. It was scheduled to be with Dr. Krolick; but he was unavailable at the time, so there was a last minute — Basically, Dr. Krolick was unavailable, so Dr. [El-]Ganzouri was the next available doctor and he ended up doing the case instead of Dr. Krolick.

Q. After you learned that Dr. El-Ganzouri was I think you described the next available anesthesiologist, whatever you said—

A. Yeah.

Q. —did you then go to [plaintiff] and discuss him— discuss that with him to seek his approval or acquiescence?

A. Yes.

Q. Do you remember what you told him?

A. I just told him that there has been a change. Dr. Krolick is not available and Dr. [El-]Ganzouri will be doing the anesthesia.

Q. Okay. Did [plaintiff] participate at all in the selection of Dr. El-Ganzouri to your knowledge?

A. No.”

Raymond Narbone also testified at trial as an adverse witness called by plaintiff. Narbone testified that at the time of plaintiff’s February 9, 1998, surgery, Narbone was Rush’s director of Operating Services and Chief Anesthetist-Anesthesiology. Narbone stated that his desk was located in the offices of University Anesthesiologists, and that the offices of University Anesthesiologists are located within one of Rush’s buildings. According to Narbone, 50% of his salary was paid by Rush and 50% of his salary was paid by University Anesthesiologists. Narbone, however, testified that he considers himself to be an employee of Rush.

According to Narbone, his job was to schedule cases for attending and resident anesthesiologists and to decide in which operating room the surgeries would take place. Narbone testified that he did the preliminary scheduling for plaintiff’s February 9, 1998, surgery. Narbone explained that this means that he paired up an attending anesthesiologist with a resident anesthesiologist and then assigned this pair to an available operating room. Narbone also stated that in making up the schedule, he would take into consideration requests for assignments. Once Narbone completed the preliminary scheduling, he would then give the schedule to the clinical coordinator for University Anesthesiologists for final approval.

Narbone testified that the scheduling process for a Monday surgery — as plaintiff had in the matter before us — starts on Friday afternoon. There is a schedule of surgeries that are to be performed, and also a schedule of persons available for that day. Narbone would assign the attending anesthesiologists and match them, as best he could, with the residents in their proper rotation. He also would take into consideration any special requests. Counsel for plaintiff then asked Narbone whether he would make any notation on the scheduling sheets to remind himself about such special requests. The following colloquy then occurred between the witness and counsel:

“Q. And then finally, the records — you have some kind of records that you keep there, right, a sheet you make up?

A. I don’t make it up. The scheduling secretary makes it up.

Q. And the sheet does track phone calls and stuff, though, doesn’t it?

A. No.

Q. Does it track communications about requests?

A. It tracks certain notations that I need to take into consideration when making out the schedule. It varies from all kinds of communications ***.

Q. And that’s the spot *** you would have expected if there was a phone call or a meeting for a notation to have been made about a meeting with Jeff York or a request by Jeff York and it’s not there?

A. No, not necessarily. I often get requests. People come up to me in the operating room or they will call me or something and say, you know, my sister, my brother, or what have you is having surgery, can you assign X to it?

Q. But when you do make a notation, that is where the notation is made?

A. No. I don’t make that notation.

Q. Who would make that notation?

A. Our scheduling secretary.

Q. So then you never make a notation. Is that what you are telling us?

A. Well, maybe to myself.”

Narbone further testified that with respect to plaintiff’s February 9, 1998, surgery, Narbone selected Dr. Miller to serve as the anesthesiology resident. Narbone testified that Dr. Miller was assigned to plaintiff’s orthopedic surgery, even though Miller was on an advanced general surgery rotation, because Dr. Miller was “requested to do the case” by plaintiffs son Jeff. Narbone stated that “[Dr. Miller] and Dr. [Jeff] York were pretty close friends as residents and Dr. Miller had done the previous surgeries that I recall.”

It was also Narbone’s recollection that on the Friday prior to plaintiffs Monday surgery, Narbone was aware that Dr. Krolick would not be available to serve as plaintiffs attending anesthesiologist because Dr. Krolick was scheduled to be out of the office on that Monday. It was at that time that Narbone made a preliminary assignment of Dr. El-Ganzouri to be the attending anesthesiologist on plaintiffs case. Narbone testified that he did not make the decision to assign Dr. El-Ganzouri to plaintiffs case on his own. Rather, Narbone believed that plaintiffs son Jeff had requested that Dr. El-Ganzouri be assigned to plaintiffs case as the attending anesthesiologist.

The following exchange occurred between plaintiffs counsel and Narbone with respect to Narbone’s recollection of the assignment of anesthesiologists to plaintiffs February 1998 surgery:

“Q. You believe that in this particular circumstance, that you did pick Rodney Miller to be the resident? True?

A. Correct.

Q. Correct?

A. Correct.

Q. And you also believe based upon a phone conversation, that you cannot give us any detail about, that Jeff York requested Dr. El-Ganzouri for his dad. Isn’t that what you believe?

A. I believe that it was requested. Whether it was by phone or not, I can’t be certain.

Q. Just so we are clear and have in context your memory, you have absolutely no memory of any kind whatsoever about a conversation over the phone or in person with Jeff York?

A. Not specifically.

Q. And you base your entire belief that he made the request for Dr. El-Ganzouri on the fact that that’s what happens virtually all the time when a family member is being operated on?

A. Yes.”

However, Narbone also testified that “he [knew] for certain” that plaintiff himself had not made the request for a specific attending anesthesiologist directly to Narbone or anyone that Narbone knew of.

Plaintiff also introduced the videotape deposition testimony of Dr. Catherine Wilson, who was plaintiffs treating psychologist during his stay from February to March 1998 in the spinal cord injury unit at the Rehabilitation Institute of Chicago. Dr. Wilson testified that, initially upon his arrival at the Rehabilitation Institute, she wrote a progress note wherein she recorded that plaintiff was extremely angry and cried a lot. Dr. Wilson explained that plaintiff was very angry at the medical profession and with his son, Jeff, as a result of the occurronces during his February 9, 1998, surgery. According to Dr. Wilson, plaintiff had a feeling of being let down by the medical profession, and no longer trusted that profession. In addition, Dr. Wilson stated that plaintiff was upset with his son because he felt his son did not do the things he said he was going to do, particularly that Jeff did not call him back about the anesthesiologist.

Defendant, Dr. El-Ganzouri, also testified at trial. Dr. El-Ganzouri was first called by plaintiff as an adverse witness, and then testified on his own behalf in defendants’ case in chief.

Dr. El-Ganzouri testified that he was the clinical director of the Rush Department of Anesthesiology from June 1980 until 2000. At that time, he decided to leave administrative work and to concentrate on clinical work and teaching. At the time of trial, Dr. El-Ganzouri was an associate professor of anesthesiology at Rush and a senior attending anesthesiologist.

Dr. El-Ganzouri testified that, prior to 1980, the anesthesiologists practicing at Rush were employees of Rush hospital. However, when University Anesthesiologists was formed in 1980, the doctors affiliated with that practice group became independent contractors. Dr. El-Ganzouri stated that the offices of University Anesthesiologists were located within one of Rush’s buildings. Dr. El-Ganzouri stated that Ray Narbone, an employee of Rush, assisted University Anesthesiologists’ clinical coordinators in making preliminary scheduling assignments. According to Dr. El-Ganzouri, once Ray Narbone had made up the initial clinical schedule, that schedule was then approved by a clinical coordinator working for University Anesthesiologists.

Dr. El-Ganzouri testified that during the times he was in the operating room, he would wear scrubs covered with the Rush logo. Dr. El-Ganzouri explained that everyone who works in the operating room wears these types of scrubs. Dr. El-Ganzouri also stated that, when he was not in the operating room, he would wear a white lab coat with a Rush logo. Dr. El-Ganzouri testified that it was common at Rush for doctors not employed by the hospital to wear such lab coats with the Rush insignia. Dr. El-Ganzouri stated that he did not know what, if anything, plaintiff knew about whether he worked for Rush or whether he was an independent contractor employed by University Anesthesiologists. According to Dr. El-Ganzouri, he would not, in the normal course of events, tell a patient that he worked for University Anesthesiologists as an independent contractor and was not an employee of Rush.

Dr. El-Ganzouri further testified that on the day of plaintiff’s February 1998 surgery, he was the attending anesthesiologist and Dr. Rodney Miller was the resident anesthesiologist assigned to the case. Dr. El-Ganzouri stated that he met plaintiff for the first time in the surgical holding area around 7 a.m. on the morning of the surgery. According to Dr. El-Ganzouri, when he received the assignment, it was the first time he knew plaintiff was going to be his patient.

Dr. El-Ganzouri testified that, although he had never before met plaintiff, plaintiff knew him. When Dr. El-Ganzouri introduced himself to plaintiff shortly before the surgery on February 9, plaintiff said, “I know you. You are the one who teaches my — Jeff my son, fiberoptic and you are famous for this.”

Defendant also submitted for consideration by the jury the videotape evidence deposition of Dr. John Glesmann. Dr. Glesmann, who lived in New Jersey at the time of trial, was the retired department director of anesthesia at Somerset Hospital in Somerville, New Jersey. Dr. Glesmann knew plaintiff from 1965 until 1991, during the time plaintiff practiced at Somerset Hospital as an orthopedic surgeon. Dr. Glesmann was an anesthesiologist who worked with plaintiff once or twice per week in the operating room and who also saw plaintiff at social occasions.

The witness testified that during the 47 years he practiced at Somerset, he was self-employed. In fact, according to Dr. Glesmann, all of the anesthesiologists at Somerset Hospital were self-employed, performed their services on a fee-for-service basis, and billed the patients directly for their services.

On cross-examination, Dr. Glesmann testified that typically, during his time as head of the anesthesiology department at Somerset, the assignment of anesthesiologists to cases was made by someone from the hospital, although he tried to honor specific requests from patients. It was his experience that the majority of cases were randomly assigned. Dr. Glesmann acknowledged that every hospital has a different way of handling assignment of cases and compensation for physicians. Dr. Glesmann noted that Somerset Hospital was a small institution and admitted that at some of the larger teaching institutions he was aware that some anesthesiologists were paid by the hospital itself.

At the close of evidence, Rush moved for a directed verdict on the issue of apparent agency in its favor and against plaintiff. Rush argued that plaintiff failed to prove both the holding out and reliance elements required to succeed on an apparent agency claim. Rush argued that the evidence presented at trial, taken in the light most favorable to plaintiff, so overwhelmingly favored Rush that no contrary verdict based upon that evidence could stand.

The circuit court denied Rush’s motion for a directed verdict. In the course of its ruling, the circuit court noted that there was no evidence presented that plaintiff signed a consent form advising him that the anesthesiologists at Rush were independent contractors and not employed by the hospital. The circuit court held that, based upon the evidence presented, a jury could reach a decision that plaintiff relied upon Rush. The circuit court did, however, comment that the case law on the apparent agency issue was “confusing” and unsettled.

Thereafter, the parties tendered to the circuit court jury instructions. Relevant to this appeal, the trial court adopted plaintiffs tendered jury instruction on apparent agency, which was based upon Illinois Pattern Jury Instructions, Civil, No. 105.10 (Supp. 2003) (hereinafter IPI Civil (Supp. 2003)).

“Under certain circumstances, the liability of a party may arise from an act or omission of that party’s apparent agent. In the present case, James York, M.D. and Elizabeth York have sued Rush Presbyterian St. Luke’s Medical Center as the principal and Abdel Raouf El-Ganzouri, M.D. as its apparent agent. Rush Presbyterian St. Luke’s Medical Center denies that any apparent agency relationship existed.

In order for an apparent relationship to have existed, James York, M.D. and Elizabeth York must prove the following:

First, that Rush Presbyterian St. Luke’s Medical Center held itself out as a provider of anesthesia services and that James York, M.D., neither knew nor should have known that Abdel Raouf El-Ganzouri, M.D. was not an employee of Rush Presbyterian St. Luke’s Medical Center.

Second, that James York, M.D. did not choose Abdel Raouf El-Ganzouri M.D. but relied upon Rush Presbyterian St. Luke’s Medical Center to provide anesthesia services.”

The circuit court refused to tender to the jury an alternative instruction submitted by Rush. Rush’s proffered instruction was identical to that given to the jury, except for providing that plaintiff was to prove that Rush held itself out as a provider of “complete” anesthesia services and that plaintiff “or others” did not choose Dr. El-Ganzouri.

On June 13, 2002, the jury returned a verdict in favor of plaintiff, and against all three defendants — including Rush. The jury awarded damages in the amount of $11,598,591.31 to plaintiff, and awarded plaintiffs wife $1 million for loss of consortium.

On August 14, 2002, Rush filed a posttrial motion requesting that the circuit court vacate the jury’s verdict in favor of plaintiff, and enter judgment notwithstanding the verdict (judgment n.o.v.) in favor of Rush. Rush asserted that it was entitled to judgment n.o.v. on the basis that the evidence at trial failed to establish that plaintiff selected Rush and accepted the services of the anesthesiology group because plaintiff believed that attending anesthesiologists were employed by Rush and because that fact was important to him. In addition, Rush requested that the circuit court grant it a new trial on the basis that the apparent agency instruction tendered to the jury was faulty for two reasons: the instruction not only failed to clarify that the jury was required to find that plaintiff relied on Rush to provide “complete” anesthesia care, but also failed to inform the jury that if it believed that plaintiff’s son Jeff selected Dr. El-Ganzouri as plaintiffs attending anesthesiologist, then the jury could have returned a verdict for the hospital.

The circuit court held a hearing on Rush’s posttrial motion on November 19, 2002. On December 19, 2002, the trial court entered an order denying the posttrial motion. Rush filed its notice of appeal on January 17, 2003.

The appellate court affirmed the judgment of the circuit court. 353 Ill. App. 3d 1. Because of the limited nature of this appeal, we focus only upon those portions of the appellate court opinion relevant to the specific issue of Rush’s liability on the basis of apparent agency.

In the appellate court, Rush argued that the circuit court erred by refusing to grant Rush judgment n.o.v. or, in the alternative, a new trial. According to Rush, the evidence adduced at trial led to the conclusion that plaintiff could not have reasonably believed that Dr. El-Ganzouri was a hospital employee and, therefore, that plaintiff did not rely on Rush to provide the attending anesthesiologist for his February 9, 1998, knee surgery.

The appellate court observed that this court, in Gilbert v. Sycamore Municipal Hospital, 156 Ill. 2d 511 (1993), set forth a three-part test for determining whether a hospital may be held liable under an apparent agency theory for the actions of an independent doctor working in its facility. Rush, however, argued that this court’s subsequent decision in O’Banner v. McDonald’s Corp., 173 Ill. 2d 208 (1996), which addressed the issue of apparent agency in the context of a slip-and-fall accident at a restaurant, was intended by this court to alter the Gilbert analysis. Rush asserted that, after O’Banner, in order for liability to attach to a hospital in a medical malpractice case involving an independent doctor, the plaintiff must prove that a representation of the hospital induced him to come to that hospital in the first instance. The appellate court disagreed.

The appellate panel noted that there has been a split in decisions rendered by our appellate court with respect to claims based upon the theory of apparent agency in medical malpractice actions. In support of its position, Rush relied on the decisions in Butkiewicz v. Loyola University Medical Center, 311 Ill. App. 3d 508 (2000), and James v. Ingalls Memorial Hospital, 299 Ill. App. 3d 627 (1998), wherein the courts held that the plaintiffs failed to satisfy the reliance element of their apparent agency claims. In opposition to Rush’s argument, plaintiff relied upon the rulings in McCorry v. Evangelical Hospitals Corp., 331 Ill. App. 3d 668 (2002), and Scardina v. Alexian Brothers Medical Center, 308 Ill. App. 3d 359 (1999), wherein the courts held that the plaintiffs sufficiently established reliance. The appellate court below determined, however, that it did not have to choose between these cases, as “our supreme court has already made the decision for us, in favor of the reasoning of Scardina and McCorry in Gilbert.” 353 Ill. App. 3d at 27.

The appellate court held that “those cases that have sought to incorporate the holding of O’Banner into the medical malpractice context have analyzed their cases with the wrong focus.” 353 Ill. App. 3d at 29. The appellate court reasoned that, under Gilbert, when a patient relies on a hospital for the provision of support services, even when a physician specifically selected for the performance of a procedure directs the patient to that particular hospital, there may be sufficient reliance under the theory of apparent agency for liability to attach to the hospital should the supporting physician commit malpractice.

The appellate court held that there was no inconsistency between this approach and the holding in O’Banner. In support of this conclusion, the appellate court noted that the Illinois Supreme Court Committee on Pattern Jury Instructions in Civil Cases highlighted the unique dynamic between doctor and patient in the hospital setting when it explained that its instruction for apparent agency in medical malpractice cases “should not be used without modification where apparent agency is alleged in contexts other than medical negligence,” and then cited to O’Banner. IPI Civil (Supp. 2003) No. 105.10, Notes on Use, at 27. 353 Ill. App. 3d at 30. The appellate court noted that that same committee also observed that “[a] pre-existing physician-patient relationship will not preclude a claim by the patient of reliance upon the hospital.” IPI Civil (Supp. 2003) 105.10, Comment, at 27, citing Malanowski v. Jabamoni, 293 Ill. App. 3d 720, 727 (1997). 353 Ill. App. 3d at 30.

The appellate court explained that, unlike the scenario in O’Banner, where the plaintiffs contact with the injury-causing instrumentality at the defendant’s place of business could have come about through nothing more than mere happenstance, in cases such as that at bar, a plaintiff comes into contact with the injury-causing instrumentality — a negligent doctor — because he relies on the hospital to provide a physician. The appellate court further stressed that there is no injustice in this imposition of vicarious liability. As the Gilbert court pointed out, hospitals advertise themselves as centers for complete medical care and reap profits when competent service is provided by the independent doctors in their facilities. Additionally, the appellate court reasoned that its holding would encourage hospitals to provide better supervision and quality control over the independent physicians working in their facilities. In sum, the appellate court held that there was sufficient supporting evidence to sustain the verdict in favor of plaintiff.

Rush further argued on appeal that the circuit court erroneously instructed the jury on the apparent agency issue. The appellate court observed that whether to provide a particular jury instruction is within the sound discretion of the trial court, and the court’s decision will be reversed only in the event of an abuse of that discretion. In this case, the circuit court admonished the jury using IPI Civil (Supp. 2003) No. 105.10. The appellate court rejected Rush’s argument that the instruction, as given, did not accurately reflect the law.

Rush argued, inter alia, that the instruction tendered by the circuit court to the jury was erroneous because the court refused to allow Rush to add the phrase “or others” to the relevant portion of the pattern instruction: “[Tjhat [plaintiff] or others did not choose Abdel Raouf El-Ganzouri M.D. but relied upon Rush Presbyterian St. Luke’s Medical Center to provide anesthesia services.” (Emphasis added.) The appellate court observed that Rush’s proposed addition of the “or others” language derived from the notes to the pattern instruction, which explain that the phrase should be used ‘.‘where there is evidence that a person or persons other than the plaintiff or the decedent relied upon the principal to provide the medical care under consideration.” IPI Civil (Supp. 2003) No. 105.10, Notes on Use, at 27. The appellate court rejected Rush’s argument that the omission of the “or others” language was an abuse of discretion. The appellate court acknowledged that Rush did present evidence, direct and circumstantial, that plaintiff relied on his son, Dr. Jeff York, to procure his anesthesiologist, and this would have justified the inclusion of the “or others” language in the instruction. However, contrary to Rush’s assertion, the jury’s consideration of Dr. Jeff York’s potential involvement in the choice of anesthesiologists was not precluded under the given instruction. The appellate court held that, under the given instruction, plaintiff had to prove not only that he did not choose Dr. El-Ganzouri to be his anesthesiologist, but also that he, instead, had relied on Rush. Under the given instruction, had the jury believed that plaintiff had relied on Dr. Jeff York, and not Rush, it still could have returned a finding of no liability. Thus, the appellate court determined that the jury was fairly apprised of the law under the instruction it received.

We granted Rush’s petition for leave to appeal. 177 Ill. 2d R. 315(a). The Illinois Hospital Association and the Metropolitan Healthcare Council were granted leave to file an amicus curiae brief in support of Rush. In addition, Advocate Health Care was also granted leave to file an amicus brief on behalf of Rush. Finally, we granted the Illinois Trial Lawyers Association (ITLA) leave to submit an amicus curiae brief in support of plaintiff.

ANALYSIS

In its appeal to this court, Rush asserts that plaintiff adduced insufficient evidence at trial to establish Rush’s vicarious liability under the doctrine of apparent agency for the negligent actions of Dr. El-Ganzouri. Accordingly, Rush contends, the circuit court was required to enter judgment n.o.v. in favor of Rush or, in the alternative, grant Rush a new trial. Rush further asserts that the appellate court erred in affirming the circuit court’s denial of Rush’s posttrial motions. We begin our review of Rush’s claims by setting forth the standards for granting each of these two forms of relief.

A judgment n.o.v. should be granted only when “all of the evidence, when viewed in its aspect most favorable to the opponent, so overwhelmingly favors [a] movant that no contrary verdict based on that evidence could ever stand.” Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d 494, 510 (1967). In other words, a motion for judgment n.o.v. presents “a question of law as to whether, when all of the evidence is considered, together with all reasonable inferences from it in its aspect most favorable to the plaintiffs, there is a total failure or lack of evidence to prove any necessary element of the [plaintiffs] case.” Merlo v. Public Service Co. of Northern Illinois, 381 Ill. 300, 311 (1942). Because the standard for entry of judgment n.o.v. “is a high one” (Razor v. Hyundai Motor America, 222 Ill. 2d 75, 106 (2006)), judgment n.o.v. is inappropriate if “reasonable minds might differ as to inferences or conclusions to be drawn from the facts presented.” Pasquale v. Speed Products Engineering, 166 Ill. 2d 337, 351 (1995). A court of review “should not usurp the function of the jury and substitute its judgment on questions of fact fairly submitted, tried, and determined from the evidence which did not greatly preponderate either way. [Citations.]” Maple v. Gustafson, 151 Ill. 2d 445, 452-53 (1992). We review de novo the circuit court’s decision denying defendant’s motion for judgment n.o.v. McClure v. Owens Corning Fiberglas Corp., 188 Ill. 2d 102, 132 (1999).

A new trial should be granted only when the verdict is contrary to the manifest weight of the evidence. Mizowek v. De Franco, 64 Ill. 2d 303, 310 (1976). A verdict is contrary to the manifest weight of the evidence when the opposite conclusion is clearly evident or when the jury’s findings prove to be unreasonable, arbitrary and not based upon any of the evidence. McClure, 188 Ill. 2d at 132, quoting Maple, 151 Ill. 2d at 454, quoting Villa v. Crown Cork & Seal Co., 202 Ill. App. 3d 1082, 1089 (1990). A reviewing court will not reverse a circuit court’s decision with respect to a motion for a new trial unless it finds that the circuit court abused its discretion. Maple, 151 Ill. 2d at 455. We are mindful that credibility determinations and the resolution of inconsistencies and conflicts in testimony are for the jury. See People v. Rodriguez, 291 Ill. App. 3d 55, 66 (1997).

With the above-described procedural framework in mind, we turn to the merits of the instant appeal. This court first applied the apparent agency doctrine in a medical malpractice context in Gilbert v. Sycamore Municipal Hospital, 156 Ill. 2d 511 (1993). In Gilbert, we addressed the question of whether a hospital may be held vicariously liable for the negligence of a physician who is not an employee of the hospital but who, rather, is an independent contractor. We held that a hospital may be vicariously liable under such circumstances pursuant to the doctrine of apparent agency. Although the parties in the instant cause do not dispute that Gilbert applies to the facts before us, the parties do, however, vigorously disagree as to how the Gilbert decision should be interpreted and whether this court’s subsequent opinion in O’Banner v. McDonald’s Corp., 173 Ill. 2d 208 (1996), altered our holding in Gilbert.

In Gilbert, plaintiffs decedent suffered chest pains and was taken by ambulance to the defendant hospital and admitted to the emergency room. In the hospital’s emergency room, decedent signed a consent form prepared by the hospital which stated, in pertinent part:

“ ‘The undersigned has been informed of the emergency treatment considered necessary for the patient whose name appears above and that the treatment and procedures will be performed by physicians and employees of the hospital. Authorization is hereby granted for such treatment and procedures.’ ” Gilbert, 156 Ill. 2d at 516.

The defendant hospital was a full-service, acute-care facility, having an active staff of 14 to 20 physicians. Many of these physicians, however, practiced through professional organizations, and the hospital considered them to be independent contractors, including those who practiced in the emergency room. Gilbert, 156 Ill. 2d at 514-15. The hospital emergency room, however, in all other respects was considered to be a “hospital function,” wherein the hospital employed the emergency room nurses and owned the emergency room equipment. Gilbert, 156 Ill. 2d at 515-16. The physicians billed emergency room patients separately for their services, while the hospital billed the emergency room patients for the remainder of the expenses. Gilbert, 156 Ill. 2d at 516. The evidence showed that the hospital did not advise emergency room patients that emergency room physicians were independent contractors rather than hospital employees. Gilbert, 156 Ill. 2d at 516.

Decedent was examined in the emergency room by Dr. Frank, a physician affiliated with Kishwaukee Medical Associates, Ltd. (KMA). Gilbert, 156 Ill. 2d at 516-17. Decedent had requested to be examined by Dr. Stromberg, another KMA physician. However, Dr. Stromberg’s call that day was covered by Dr. Frank, who had never before met decedent. Dr. Frank administered several tests to decedent, none of which revealed any sign of heart disease or a heart problem. Accordingly, Dr. Frank released decedent to return home. Later that evening, decedent died as a result of a heart attack. An autopsy revealed the presence of heart disease at the time of his death.

Thereafter, plaintiff, as special administrator of decedent’s estate, brought a medical malpractice and wrongful-death action against Dr. Frank and the hospital. The claim against the hospital alleged that the hospital, through its agents and employees — including Dr. Frank— negligently failed to perform various acts in relation to the diagnosis and treatment of decedent. The hospital moved for summary judgment, contending that Dr. Frank was neither the agent nor the employee of the hospital. The circuit court granted summary judgment in favor of the hospital, holding that the hospital could not be held vicariously hable because Dr. Frank was an independent contractor. On appeal, a majority of the appellate court affirmed. This court reversed and remanded for further proceedings. We held a genuine issue of material fact existed as to whether the physician was acting as the hospital’s apparent agent.

In Gilbert, the hospital asserted that it could not be vicariously liable for the alleged negligent conduct of Dr. Frank because he was neither an employee nor an agent of the hospital. We rejected this argument, noting that it had already been established under prior case law that a hospital could be liable in a medical malpractice action based upon a principal-agent relationship between the hospital and the physician. Gilbert, 156 Ill. 2d at 518. However, at the time Gilbert was decided, there was a split in the appellate court with respect to the extent of agency required to impose liability: in some decisions, the appellate court held that a hospital could be vicariously liable for the negligence of a physician who was the apparent agent of the hospital. In other decisions, the appellate court had refused to impose vicarious liability upon a hospital based upon an agency relationship unless the physician was an actual agent of the hospital. Gilbert, 156 Ill. 2d at 519.

Gilbert held that those decisions which refused to find a hospital liable on the basis of apparent agency “overlooked] two realities of modern hospital care.” Gilbert, 156 Ill. 2d at 520. The first “reality” involves the “business of a modern hospital.” Gilbert, 156 Ill. 2d at 520. The Gilbert court explained:

“ ‘[HJospitals increasingly hold themselves out to the public in expensive advertising campaigns as offering and rendering quality health services. One need only pick up a daily newspaper to see full and half page advertisements extolling the medical virtues of an individual hospital and the quality health care that the hospital is prepared to deliver in any number of medical areas. Modern hospitals have spent billions of dollars marketing themselves, nurturing the image with the consuming public that they are full-care modern health facilities. All of these expenditures have but one purpose: to persuade those in need of medical services to obtain those services at a specific hospital. In essence, hospitals have become big business, competing with each other for health care dollars.’ ” Gilbert, 156 Ill. 2d at 520, quoting Kashishian v. Port, 167 Wis. 2d 24, 38, 481 N.W.2d 277, 282 (1992).

The second “reality” of modern hospital care discussed by the Gilbert court involves the reasonable expectations of the public:

“ ‘[GJenerally 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.’ ” Gilbert, 156 Ill. 2d at 521, quoting Arthur v. St. Peters