Appeal from the Appellate Court for the First District; heard in that court on appeal from the Circuit Court of Stephenson County, the Hon. James J. Sullivan, Judge, presiding.
The Honorable Justice Freeman delivered the opinion of the court:
The opinion of the court was delivered by: Freeman
JUSTICE FREEMAN delivered the opinion of the court:
Plaintiffs, Rose Leonardi, as administrator of the estate of Michela Lopez, and Francesco Lopez, brought a medical malpractice action in the circuit court of Cook County. Defendants included Loyola University of Chicago and several additional corporations and individual physicians. The trial court entered judgment on a jury verdict in favor of defendants.
The appellate court affirmed. (262 Ill. App. 3d 411.) We allowed plaintiffs' petition for leave to appeal (145 Ill. 2d R. 315(a)), and now affirm the appellate court.
The record shows that on the morning of September 1, 1979, decedent, Michela Lopez, was 36 years old and seven months' pregnant. Her water broke and she was taken to a hospital. Decedent's attending physician, Dr. Thomas Tierney, had her transferred to Foster G. McGaw Hospital at Loyola University Medical Center (Loyola). Loyola was better able to deal with the most premature infants in need of intensive services and equipment. Decedent herself was not ill or at risk. However, her pregnancy was considered high risk, which required monitoring, due to the age of the fetus and because her water broke prematurely.
On the night of September 3, a nurse noticed heavy bleeding from decedent's vagina and paged a doctor. Dr. Joseph Coughlin, a Loyola resident, arrived seconds later and determined that decedent was hemorrhaging. Dr. John Gallagher, the senior Loyola resident on call that evening, arrived seconds after Dr. Coughlin. As senior resident, Dr. Gallagher supervised and managed a case until he received specific instructions from the attending physician or the attending physician was physically present.
At 9:35 p.m. Dr. Gallagher had decedent transferred to the labor and delivery room. The transfer was accomplished in less than two minutes. Decedent was in hypovolemic shock due to the loss of blood. She was receiving intravenous fluids less than three minutes after being brought to the labor and delivery room. Decedent's condition stabilized. She was alert with normal signs.
Dr. Tierney was not at the hospital when decedent was admitted. However, he instructed Loyola staff by telephone not to perform a Cesarean section until he arrived. Dr. Tierney also ordered Dr. Gallagher to perform a vaginal inspection. Dr. Gallagher's examination confirmed the existence of a placenta previa. This is a condition where the placenta is found in the lower part of the uterus rather than in its normal place in the upper part of the uterus. Where the condition is present, the placenta is partially in front of the infant, obstructing the cervix and thereby preventing the infant from coming through the cervix.
Dr. Tierney arrived at the hospital and, assisted by Dr. Henry Davis, a Loyola resident, performed a Cesarean section on decedent. At 9:58 p.m., decedent gave birth to a two-pound baby girl, Rose Angela Lopez.
When Dr. Tierney attempted to remove the placenta, massive bleeding occurred. A portion of decedent's uterine wall came away with placenta that adhered to it. Decedent again went into hypovolemic shock. Dr. Tierney discovered a placenta accreta, which is an abnormal adherence of the placenta to the uterine wall. The condition required Dr. Tierney to perform a hysterectomy. The massive bleeding continued during the operation. However, at the end of the Cesarean section and hysterectomy, decedent was awake, her blood pressure and pulse were stable, and her urine output was satisfactory.
Drs. Kanteerava Balasaraswathi and Wanda Mazurek administered general anesthesia for the surgery. Dr. Balasaraswathi extubated decedent, i.e., removed the endotracheal tube that connected decedent to the respirator. Decedent was transferred to the recovery room, where she was given supplemental oxygen by mask. She was in critical but stable condition.
On September 4, at 6 a.m., Dr. Roberta Karlman, a Loyola resident, ordered that decedent's oxygen mask be removed. Dr. Karlman planned to get decedent back to breathing normal air. At 8 a.m., decedent began to grow restless. By 9:30 a.m., decedent had cyanotic lips and was perspiring heavily, was restless, and complained of abdominal pain. These symptoms were consistent with a patient who recently underwent a large abdominal procedure and experienced massive blood loss. At 10:30 a.m., a blood gas test revealed that decedent was experiencing respiratory difficulties. Decedent was given supplemental oxygen by mask, which appeared to stabilize her.
However, at approximately 11 a.m., decedent's blood pressure dropped significantly. At 11:35 a.m., decedent suffered respiratory arrest. The doctors believed that the cause was a saddle block pulmonary embolus, which is a blood clot at the point of separation of two blood vessels. Until this time, decedent had not shown any signs of pulmonary embolism.
At 11:40 a.m., Dr. Roque Pifarre performed an emergency pulmonary embolectomy. The operation required Dr. Pifarre to break decedent's sternum and massage the embolus, which had lodged at the very beginning of the pulmonary artery and impeded blood flow to the arteries. The clot broke into many pieces that dispersed through the arteries. Decedent's life was saved, but she suffered irreversible brain damage. She was discharged from Loyola over a year later, on October 17, 1980.
On October 20, 1980, decedent was admitted to the Norridge Nursing Center. During her stay there, decedent could not independently perform any activity of daily living, e.g., walking, eating, dressing, etc. She lacked bladder and bowel control. Although she could smile when happy, she could not articulate words; she could make only unintelligible noises. Decedent's arms and legs were severely bent and were unable to be straightened. Decedent would cry out in pain when her arms and legs were moved for physical therapy. Decedent died on January 25, 1985.
Plaintiffs eventually filed a fourth-amended complaint against several defendants, including Loyola and certain resident physicians, Drs. Gallagher, Coughlin, Davis, and Mazurek; and Dr. Balasaraswathi and his corporate employer. Dr. Tierney died subsequent to the bringing of this lawsuit; his estate was substituted as a defendant. Prior to jury selection, plaintiffs settled with Dr. Tierney's estate, which was dismissed from this lawsuit.
The complaint contained survival counts that alleged damages for injuries to decedent as a result of the negligent Cesarean section, administration of anesthesia for the Cesarean section, and resuscitation. The complaint also contained wrongful death counts that alleged damages for injuries to decedent's next of kin as a result of the same negligent acts.
The jury returned a verdict for defendants and the trial court entered judgment thereon. The appellate court affirmed. (262 Ill. App. 3d 411.) Plaintiffs appeal. We will refer to additional pertinent facts as they relate to the issues plaintiffs raise before this court.
Plaintiffs present four issues in this appeal. They contend the trial court erred by: (1) allowing defendants to present evidence of Dr. Tierney's conduct, despite that he was not a party at trial; (2) tendering to the jury an instruction on sole proximate cause; and (3) permitting defendants to improperly cross-examine plaintiffs' medical experts. Plaintiffs also contend (4) that the jury's verdict was against the manifest weight of the evidence.
I. Evidence of Dr. Tierney's Conduct
Plaintiffs assign error to the trial court's evidentiary rulings on (A) a motion in limine and (B) a hypothetical question to an expert witness, both regarding the conduct of Dr. Tierney. Of course, the admissibility of evidence is a matter for the sound discretion of the trial court, and its decision will not be reversed on appeal unless that discretion has been clearly abused. Gill v. Foster (1993), 157 Ill. 2d 304, 312-13, 193 Ill. Dec. 157, 626 N.E.2d 190.
Prior to trial, the trial court denied plaintiffs' motion in limine to bar the introduction of evidence regarding the alleged negligence of any person other than the named defendants. At trial, the court allowed defendants to question several witnesses regarding Dr. Tierney's duties and responsibilities as decedent's attending physician. The appellate court upheld the trial court's ruling. 262 Ill. App. 3d at 415-16.
Plaintiffs contend that evidence of Dr. Tierney's conduct was irrelevant and, therefore, inadmissible. Indeed, plaintiffs oppose the concept of the "empty chair" defense, also known as and hereafter referred to as the sole proximate cause defense. This defense seeks to defeat a plaintiff's claim of negligence by establishing proximate cause in the act of solely another not named in the suit. Hall v. Clark (Mo. 1957), ...