Almon B. Heastie v. Daniela Roberts, et al.

Plaintiff, Almon B. Heastie, brought an action in the circuit court
of Cook County to recover damages for personal injuries he sustained
in a fire which took place while he was involuntarily restrained on a
cart while awaiting treatment in the emergency room of the Columbia
Olympia Fields Osteopathic Hospital and Medical Center (the
Hospital). Named as defendants were the Hospital; Jason Humphrey,
one of the Hospital's security guards; an emergency room technician
named Dawn Epley; and two registered nurses who were involved in
plaintiff's care, Daniela Roberts and Josephine Onyema. Following a
jury trial, a verdict was returned in favor of all defendants and against
plaintiff. The appellate court reversed and remanded for a new trial on
the grounds that the circuit court had erred in dismissing, on the
pleadings, a negligence count asserted by plaintiff based on the
doctrine of res ipsa loquitur. No. 1–03–3463 (unpublished order
under Supreme Court Rule 23). We granted defendants' petition for
leave to appeal. 210 Ill. 2d R. 315. For the reasons that follow, the
judgment of the appellate court is affirmed in part and reversed in
part, and the cause is remanded to the circuit court for further
proceedings.

BACKGROUND

The litigation which gave rise to this appeal commenced in the
fall of 1998, approximately nine years ago. The trial court proceedings
lasted more than half a decade, culminating in a month-long jury trial
during the summer of 2003 involving the testimony of approximately
two dozen witnesses. The resulting record is voluminous. For now,
we need only summarize the basic facts of the case. Additional details
will be supplied as necessary during the course of our analysis.

Plaintiff is a 50-year-old male whose intelligence is in the
extremely low to borderline deficient range. On the evening of
October 3, 1998, paramedics responded to a call that he was in need
of medical attention. When they arrived on the scene, they found him
lying intoxicated in a residential driveway and transported him to the
emergency room of the Hospital, a Level 1 trauma center. Plaintiff had
a history of alcohol abuse and had been taken to the same emergency
room in an intoxicated condition before.

When plaintiff arrived at the Hospital, medical personnel assessed
his condition. They determined that he was not suffering from
anything requiring immediate medical intervention. He was, however,
extremely drunk, unable to stand, uncooperative, disoriented, and incapable of making rational decisions for himself.1 He was also
yelling and combative.

Daniela Roberts, who was serving as the Hospital's emergency
room's charge nurse, believed that plaintiff was in immediate danger
of harming himself or others. In accordance with the Hospital's
restraint and seclusion policy, nurse Roberts therefore decided that he
should be restrained on a cart and moved to an area away from other
patients. To accomplish this, nurse Roberts required the assistance of
three other persons: defendants Onyema, who was also a nurse; Dawn
Epley, the emergency room technician; and Jason Humphrey, the
hospital security guard.

Roberts, Onyema and the others succeeded in placing plaintiff on
the cart and securing him there using four-point "hard" (i.e., rigid)
restraints, which were locked over plaintiff's wrists and ankles, then
attached to the cart with straps and buckles. Once plaintiff was thus
restrained, he was wheeled into a separate section of the emergency
room area known as the cast room, so called because it was where
casts were applied to the limbs of injured patients.

The cast room was partitioned off from the other parts of the
emergency room by windowless walls and a door. The room
contained a sink, electrical outlets, lights and equipment, and a variety
of supplies used in applying casts. Because of the danger of fire in
such an environment, the room was equipped with a heat detector. It
did not, however, have a smoke detector.

The Hospital had a different room it normally used to sequester
patients. The cast room was used for plaintiff instead because the
regular seclusion room was in use and the cast room was available. In
accordance with the Hospital's policy, Hospital staff were required to
search plaintiff for contraband when he was restrained and
sequestered. That was not done. Pursuant to Hospital policy, a
physician was supposed to review the need to restrain him within an hour. That was not done. Hospital policy also required that staff check
on plaintiff's behavior and degree of control at 15-minute intervals.
While nurse Roberts did look in on plaintiff according to that schedule
for the first hour, she became occupied with another emergency room
patient and did not check on plaintiff after 9 p.m.

Sometime after 9 p.m., an intern working in the emergency room
heard plaintiff yelling and went into the cast room to see what he
wanted. The intern ascertained that plaintiff required a urinal, then left,
advising a nurse of what was going on. Epley, the emergency room
technician, subsequently closed the door to the cast room so that other
emergency room patients would not have to listen to the noise plaintiff
was making.

At approximately 9:30 p.m., the heat alarm in the cast room
activated the emergency room's fire alarm bells. A psychotherapist
named Tim Jenkins, who had been standing nearby, was the first to
respond. He opened the door and saw smoke and fire. Plaintiff was
still secured to the cart by the rigid restraints. He was on fire, as was
the wall behind him. Flames from the fire were so high they reached
the ceiling.

Jenkins attempted to extinguish the flames on plaintiff's body
using a curtain that divided treatment bays in the cast room, but the
smoke and flames drove him from the room before he could put the
fire out. An intern named Dr. David Gilchrist then located a fire
extinguisher and was able to use it to stop the fire.

According to Epley, there was also fire on the floor of the room.
Epley got down on her hands and knees and put it out using a sheet
she had carried with her into the room. She then released the brakes
on the cart to which plaintiff was restrained and wheeled him into a
trauma room. Once plaintiff was in the trauma room, Epley cut the
restraints from his wrists and ankles. A physician named Simeakis
realized that plaintiff needed to be resuscitated and intubated him to
enable him to breathe. By this time a trauma team was on the scene
and plaintiff, who was badly burned, was transported by helicopter to
Loyola University Medical Center (Loyola).

When examined by doctors at Loyola, plaintiff was found to be
suffering from third degree burns to both upper extremities, inhalation
injury, and full thickness burns to the anterior torso, bilateral groins, genitalia, and bilateral lower extremities. Extensive debridement and
grafting was required. His right thumb and some of his fingertips had
to be amputated. Multiple surgeries were ultimately required,
including surgery on his penis and surgery to repair and reconstruct
his hands. Plaintiff remained on a respirator and unconscious for
weeks after the accident. As a result of his injuries he is unable to live
independently and will require the assistance of a care giver for the
remainder of his life.

An investigation of the fire was conducted by law enforcement
authorities, led by a detective from the Olympia Fields police
department. The detective was never able to reach an opinion as to
how or by whom the fire was started. A lab report indicated the
presence of an accelerent in plaintiff's pants, but where the accelerant
came from was unknown. Although a State police officer reported to
the Olympia Fields detective that he had found a disposable lighter on
the floor of the cast room sometime after the fire had been
extinguished, the significance of that discovery, if it had any, could
never be ascertained by authorities. None of the witnesses who were
involved in putting the fire out or who were in the cast room
immediately before or after the blaze ever saw the lighter, the lighter
exhibited no apparent signs of fire damage, it bore no fingerprints, and
there was no evidence linking it to plaintiff. Plaintiff himself could not
even recall being at the Hospital, much less how the fire started.

Four days after the fire, the Hospital, through one of its
administrators, sent a letter to Daniela Roberts, the emergency room
charge nurse on duty when the accident occurred. The letter advised
nurse Roberts that her employment with the Hospital was being
terminated because of the incident involving plaintiff. Termination was
to take effect immediately based on an employee-behavior policy
authorizing such termination in cases involving negligence or patient
abuse or mistreatment.

Plaintiff ultimately brought a negligence action against defendants
in the circuit court of Cook County to recover damages for the
personal injuries he sustained as a result of the fire. As the case
progressed, plaintiff amended his complaint multiple times. The fifth
version, and the one at issue here, contained three counts. Count I
alleged that defendants had been negligent for restraining him
improperly, for failing to search him for contraband before restraining him on the cart, for not adequately monitoring him, and for not
providing timely notice to a physician that they had placed him in fourpoint
restraints in the cast room. Count II, directed solely against the
Hospital, averred that the institution was negligent for not installing
a smoke detector in the cast room and for failing to provide adequate
training to Hospital personnel regarding the proper use of fire
extinguishers.

The focus of this appeal is the third count. That count, which
named all defendants, asserted a claim for negligence based on the
doctrine of res ipsa loquitur. It alleged that (1) "in the ordinary course
of the operation of a hospital emergency room, fires do not start in the
rooms of patients who, like Plaintiff, Almon Heastie, are put in
restraints because they are at risk to harm themselves or who are not
capable of protecting themselves from harm" unless the hospital or its
personnel have been negligent, and (2) that "the cast room, the fourpoint
restraints, the manner in which the restraints were applied,
whether Plaintiff, Almon Heastie, was searched for items that could
cause him injury, such as matches or a lighter, and all other aspects of
the condition of Plaintiff" were under defendants' control.

Defendants challenged plaintiff's complaint in a combined motion
to dismiss under sections 2–615 and 2–619 of the Code of Civil
Procedure (735 ILCS 5/2–615, 2–619 (West 2004)).2 The section
2–615 component of the motion took issue with how issues of duty
had been pled in the complaint. The section 2–619 portion of the
motion raised a statute of limitations issue. See 735 ILCS
5/2–619(a)(5) (West 2004). Defendants' motion also sought dismissal
of plaintiff's res ipsa loquitur count, but did not specify the
procedural predicate on which that request for relief was based.

Following a hearing, the circuit court dismissed the res ipsa
loquitur count and reserved a ruling on the statute of limitations issue.
While defendants never indicated the procedural basis for their attack
on plaintiff's res ipsa count and invoked evidentiary issues as well as
points of law and questions regarding the sufficiency of plaintiff's
allegations, the circuit court treated this as a dismissal on the pleadings pursuant to section 2–615 of the Code of Civil Procedure
(735 ILCS 5/2–615 (West 2004)). As the court observed, "what [it
had] to decide at this moment is the complaint, not what the evidence
is because the Court hasn't heard the evidence."

After the court dismissed the res ipsa count based on the
complaint and the arguments of counsel, the cause proceeded to trial
before a jury. At the outset of the trial, the circuit court denied a
motion in limine filed by plaintiff seeking to bar defendants from
arguing that plaintiff himself was negligent or that his negligence
caused or contributed to his injuries. At the same time, the court also
granted motions in limine filed by defendants to prevent plaintiff from
presenting evidence that "something other than plaintiff" caused the
fire and to preclude testimony from certain of plaintiff's experts or
others that the failure to perform a contraband check was the
proximate cause of plaintiff's injuries.

Plaintiff moved for reconsideration of the in limine rulings. When
that request was denied, he filed a motion for a mistrial, arguing that
the circuit court's rulings would preclude him from receiving a fair
trial. The circuit court rejected plaintiff's argument and denied his
motion for mistrial.3

In light of the circuit court's pretrial rulings, including dismissal
of count III containing the res ipsa doctrine, plaintiff ultimately
proceeded before the jury only on two of the negligence theories set
forth in count I of his complaint, specifically, that defendants failed to
restrain him properly and had not properly and adequately monitored
him while he was in the restraints. Consistent with the circuit court's
decision, the res ipsa doctrine was not argued to the jury. The claim
asserted by plaintiff in count II was also not presented to the jury, and
that count is not at issue on this appeal.

Defendants, for their part, urged the jury to reject plaintiff's
claims on the grounds that plaintiff alone was responsible for the
injuries he sustained. Defendants' theory was that because plaintiff
was by himself in the cast room when the fire started and because a lighter was subsequently found on the cast room floor, plaintiff must
have used the lighter to ignite the blaze.

As noted earlier, investigators were unable to establish the actual
cause of the fire. No one involved in the incident reported seeing the
lighter, and there were no fingerprints or other evidentiary items
connecting plaintiff to the lighter. Defendants, however, contended
that their theory was supported by an occupational therapist who
treated plaintiff after the accident. In particular, they cited an entry in
the therapist's notes that "[p]er patient, did not mean to set self on
fire."

The existence of the therapist's entry was not disputed. Its basis,
however, was vigorously challenged. In the course of being
questioned at trial, the therapist admitted that she could not recall
what she had asked plaintiff to elicit this response or how exactly he
had communicated it to her when he was still intubated and could not
speak. In fact, she stated that she had no independent recollection that
plaintiff had ever told her anything about the fire's origins.

The therapist surmised that her notation was based on the way
plaintiff nodded his head in response to something she asked him. She
admitted, however, that plaintiff was in pain and on intravenous pain
medication during the interview; that she did not know how well
oriented he really was; and that if plaintiff had nodded his head in
response to her question, she could not be sure whether he actually
meant "no, I didn't start the fire" instead of "no, I didn't mean to set
myself on fire." In the end, she specifically conceded that she simply
could not say whether the assumptions on which her notation was
based were accurate or not.

Following the therapist's testimony, plaintiff's counsel sought
leave to present rebuttal evidence. The purpose of that evidence was
to refute defendants' contention that plaintiff was solely responsible
for his own injuries by showing that if plaintiff did set himself on fire
with a lighter, as defendants theorized, he was able to do so only
because Hospital personnel had failed to search him for contraband,
as Hospital policy required. The circuit court rejected that request on
the grounds that the search was no longer an issue in the case.

At the conclusion of the trial, plaintiff tendered a set of proposed
jury instructions including negligence instructions containing the res ipsa doctrine. Plaintiff had prepared those instructions earlier to
correspond with count III of his amended complaint. Notwithstanding
the dismissal of count III, plaintiff argued in conference that the res
ipsa doctrine should still apply. The instructions were refused.

The jury ultimately returned a verdict in favor of defendants and
against plaintiff. Plaintiff filed a posttrial motion pursuant to section
2–1202 of the Code of Civil Procedure (735 ILCS 5/2–1202 (West
2004)), which was denied. Plaintiff then appealed to the appellate
court, raising numerous contentions of error pertaining to the
admissibility of evidence, the applicability of contributory negligence,
and the circuit court's refusal to permit him to proceed on his res ipsa
loquitur claim.

The appellate court reversed and remanded for a new trial in an
unpublished order under Supreme Court Rule 23, with one justice
dissenting. In ruling as it did, the appellate court first held that plaintiff
had satisfied the elements of the res ipsa loquitur doctrine and that the
res ipsa count should not have been stricken from his fifth amended
complaint. The court further held that the circuit court erred in barring
plaintiff from presenting evidence that defendants had deviated from
the applicable standard of care by failing to search him for contraband
before restraining him to a bed in the emergency room. In the
appellate court's view, plaintiff should have been allowed to present
that evidence to the jury along with defendants' evidence that plaintiff
was responsible for his own injuries. Because the court concluded that
the foregoing errors entitled plaintiff to a new trial, it did not reach the
additional points of error plaintiff had raised. Heastie v. Roberts, No.
1–03–3463 (March 16, 2005) (unpublished order under Supreme
Court Rule 23).

Defendants moved for rehearing. After the appellate court denied
that motion, defendants petitioned our court for leave to appeal. 210
Ill. 2d R. 315. We denied that petition, but issued a supervisory order
directing the appellate court to vacate its Rule 23 order and to
reconsider the case in light of our opinion in Sullivan v. Edward
Hospital, 209 Ill. 2d 100 (2004). Heastie v. Roberts, 216 Ill. 2d 685
(2005) (table).

On remand, the appellate court concluded that the testimony
plaintiff sought to adduce regarding his claim that the defendant
nurses had deviated from the applicable standard of care did not comport with our holding in Sullivan v. Edward Hospital and that the
circuit court had therefore not abused its discretion when it granted
defendants' motion in limine to exclude that evidence. The court
continued to hold, however, that the circuit court should not have
granted defendants' motion to dismiss plaintiff's claim based on res
ipsa loquitur. Applying the standards applicable to motions to dismiss
under section 2–615 of the Code of Civil Procedure (735 ILCS
5/2–615 (West 2004)), the court held that count III of plaintiff's
complaint sufficiently set forth the elements of the res ipsa doctrine
and that the circuit court erred in striking the count from the
complaint. The appellate court therefore once again reversed and
remanded to the circuit court for a new trial. No. 1–03–3463
(unpublished order under Supreme Court Rule 23). As with the
original disposition, one justice dissented.

Following the appellate court's second ruling, defendants filed a
new petition for leave to appeal. 210 Ill. 2d R. 315. The basis for that
petition was that the appellate court's interpretation and application
of the res ipsa loquitur doctrine in this case was inconsistent with this
court's decision in Sullivan v. Edward Hospital, 209 Ill. 2d 100
(2004), and represented an unwarranted expansion of the doctrine.
Defendants also asserted that prohibiting use of the doctrine in this
case was not reversible error because plaintiff failed to adduce
evidence to establish the elements of the doctrine and did not meet his
burden of proving proximate cause. Defendants' petition was allowed.
210 Ill. 2d R. 315.

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For the full text of this opinion, go to: http://www.state.il.us/court/Opinions/SupremeCourt/2007/November/102428.pdf