The opinion of the court was delivered by: Justice Wolfson
Appeal from the Circuit Court of Cook County. Honorable Sharon Johnson Coleman, Judge Presiding.
Andrew Jones was born with severe brain damage. He led a debilitative life until he was 1½ years old, when he died of respiratory failure. In their lawsuit, Andrew's parents claimed the professional negligence of the Chicago Osteopathic Hospital was a proximate cause of Andrew's imperfect life and then his death. The jury agreed, returning a $6,300,000 verdict against the hospital, later reduced by $100,000. Chicago Osteopathic Hospital challenges the jury's verdict and several of the trial court's rulings. We affirm.*fn1
Marsha Jones (Jones) was admitted to Chicago Osteopathic Hospital (the hospital) on the morning of March 3, 1994. She was in her 42nd week of gestation -- two weeks past her due date. On the evening of March 4, 1994, after more than 30 hours of chemically-induced labor, her uterus ruptured. An emergency Caesarean section (C-section) was performed, but when Baby Andrew was born he had severe brain damage due to oxygen deprivation -- in technical terms, hypoxic ischemic encephalopathy (HIE)-- a condition which was fixed and permanent.
On March 5, 1994, Andrew was transferred to Michael Reese Hospital and, after a brief stay, was placed in a Misericordia Home, where he received the specialized, round-the-clock nursing care he required. Andrew was blind, deaf, and suffered from spastic quadriparesis -- a condition which caused Andrew's body to be very stiff and inflexible. Andrew had no control over the movement of his legs and arms, he could not suck or swallow, had to be tube fed, and required almost constant suctioning of his airway. He required oxygen regularly and at times was placed on a ventilator. In September 1995, when Andrew was 1½ years old, he died of respiratory failure.
Jones, individually and as special administrator of Andrew's estate, and Johnny Jones (Andrew's father), filed an 11-count second amended complaint against the hospital and its doctors and nurses, alleging negligence in the handling of Jones' labor. The case proceeded to trial on the survival and wrongful death claims. A jury awarded the estate $4.1 million on the survival claim and awarded the heirs $2.2 million on the wrongful death claim. On the hospital's motion for reduction pursuant to statute (735 ILCS 5/2-1205 (West 1996)), the award of medical costs on the survival claim was reduced by $100,000. All other post-trial motions were denied.
The hospital appeals, asking us to review the following questions: (1) whether the evidence was insufficient to prove the hospital breached the applicable standard of care or that the breach proximately caused plaintiffs' injuries, making it error for the trial court to have denied motions for judgment notwithstanding the verdict (JNOV) and new trial; (2) whether the hospital was denied a fair trial due to erroneous evidentiary rulings and jury instructions; and (3) whether the verdict was excessive and based on passion and prejudice, requiring remittitur or a new trial on damages.
Motions for JNOV and a New Trial
The hospital first contends the trial court erred when it denied the hospital's motions for JNOV and new trial because plaintiffs failed to prove the hospital, through its staff, breached the applicable standard of care, or, if a breach was shown, that the breach proximately caused injury.
In Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d 494, 509-10, 229 N.E.2d 504 (1967), our supreme court identified the standards by which reviewing courts measure a trial court's rulings on motions for JNOV and motions for new trial.
An appellate court reviews de novo a trial court's decision to grant or deny a motion for JNOV, but, like the trial court, must be careful not to "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." McClure v. Owens Corning Fiberglas Corp., 188 Ill. 2d 102, 132, 720 N.E.2d 242 (1999), quoting Maple v. Gustafson, 151 Ill. 2d 445, 452-53, 603 N.E.2d 508 (1992).
A motion for JNOV should be granted only in those cases where "all of the evidence, when viewed in the light most favorable to the opponent, so overwhelmingly favors movant that no contrary verdict based upon that evidence could ever stand." Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d at 510; see also, Holton v. Memorial Hospital, 176 Ill. 2d 95, 109, 679 N.E.2d 1202 (1997). As the court said in People ex rel. Dept. of Transp. v. Smith, 258 Ill. App. 3d 710, 631 N.E.2d 266 (1994), "This is clearly a very difficult standard to meet, limiting the power of the circuit court to reverse a jury verdict to extreme situations only." If reasonable minds could differ on the inferences to be drawn or the conclusions to be reached from the facts, "a trial court cannot reweigh the evidence or set aside a verdict." Maple, 151 Ill. 2d at 452-53.
A trial court's decision to grant or deny a new trial, on the other hand, is not reviewed de novo, but will be overturned only if the reviewing court finds the trial court abused its discretion. Maple, 151 Ill. 2d at 455; McClure v. Owens Corning Fiberglas Corp., 188 Ill. 2d 102, 132, 720 N.E.2d 242 (1999). In reviewing the trial court's ruling, we must keep in mind a new trial should be granted only when the jury's verdict is against the manifest weight of the evidence. Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d at 510. To be against the manifest weight of the evidence, the opposite conclusion must be clearly evident or the jury's findings must appear unreasonable, arbitrary, or not based on the evidence. Maple v. Gustafson, 151 Ill. 2d at 454.
Mindful of these standards, we have examined the record in this case. We find no support for the hospital's claim that either a new trial or JNOV is warranted.
There appears to be no serious dispute that Baby Andrew suffered severe brain injury at birth and later died due to complications stemming from the injury. The questions for the jury to resolve were whether the acts or omissions of Chicago Osteopathic Hospital were professionally negligent and whether that negligence caused Baby Andrew's brain damage.
Here, as in any medical malpractice action, plaintiffs had the burden of establishing, through expert testimony, the standard of care applicable to the hospital's physicians and nurses, to identify the unskilled or negligent manner in which the hospital's physicians and nurses deviated from that standard, and show a causal connection between that deviation and the injuries sustained. See Purtill v. Hess, 111 Ill. 2d 229, 489 N.E.2d 867 (1986); Lloyd v. County of Du Page, 303 Ill. App. 3d 544, 552, 707 N.E.2d 1252 (1999). We believe the trial court could fairly conclude plaintiffs met their burden.
The evidence showed Jones was admitted to the hospital around 11 a.m. on March 3, 1994. She had successfully given birth on three prior occasions. She was a high-risk patient because of her age (she was 39 years old), her weight (she was described as morbidly obese), and because she was two weeks past her due date with no sign of going into labor.
Chemical induction of labor began around noon with the introduction of a prostaglandin gel called Prepidil. This gel, which is injected into the cervix, is supposed to "ripen" the cervix and stimulate labor. A second application of Prepidil was given later that day.
By 5:45 a.m. on March 4, 1994, Jones' labor had not progressed. Her cervix had not dilated and the baby was at -3 station -- the same position as when Jones arrived at the hospital. Dr. Frank, a first year resident in the obstetrics unit, consulted by phone with Dr. Springer, the on-call physician. Dr. Springer gave Dr. Frank orders to begin inducing Jones with Pitocin by intravenous drip, with a beginning flow rate of 6 ccs per hour. The flow rate was to be increased by 6 ccs each hour until contractions were adequate.
At about 8 a.m., Jones began receiving Pitocin. At 11:05 a.m., Dr. Frank wrote an order to "hold Pit[ocin] at 24 ccs," after Jones reported to him her contractions were strong.
Dr. Dedelow, another first year resident who took over for Dr. Frank, examined Jones at about 3 p.m. Jones' condition was unchanged -- she was having strong contractions, but her cervix was not dilating and the baby was not descending into the birth canal.
At 6 p.m., Dr. Dedelow examined Jones again. Jones' cervix had dilated 2 centimeters (cms), which allowed Dr. Dedelow to place internal probes in Jones' uterus. The probes were attached to a monitor, which recorded on strips of graph paper Jones' contractions and the baby's heart rate. These monitor strips showed Jones' contractions were very strong -- so strong that the contractions, at their peak, recorded a pressure which exceeded 100 millimeters of mercury, which was beyond the monitor's scale, and, therefore, outside the boundaries of the machine's graph paper.
A little after 6 p.m., Jones' sister, Eva Walker, arrived at the hospital to be with her sister. As time passed, Eva testified, her sister began showing signs of tiring. Jones also began complaining of being in a lot of pain, which caused Eva to become concerned. Eva attempted to find a nurse or doctor to check on Jones, but could find no one.
After a while, Eva located a nurse, who gave Jones a shot of Demerol for the pain. The Demerol, Eva said, made Jones groggy. Shortly after receiving the Demerol, Jones reported feeling a tearing sensation. Eva became further alarmed. Again, she couldn't find a nurse or doctor, so she called her mother, Elizabeth Walker.
Mrs. Walker testified she telephoned the hospital after getting a frantic phone call from her daughter, Eva. Mrs. Walker spoke to a male doctor and asked him to check on Jones.
After her mother called the hospital, Eva testified, a doctor came into the room and examined Jones. Almost immediately, the doctor instructed Jones to push. Nothing happened.
Next, Eva said, the doctor checked the monitors and left the room. He came back with another doctor, Dr. Herbert, who took one look at Jones and moved her out of the room. Eva was told the baby had to be delivered right away.
The hospital records confirmed Eva's testimony. Jones' chart showed only one nurse's note from 8:15 p.m. to 9:20 p.m. -- a note that at 8:43 p.m. Jones was given a shot of Demerol by Orashawn Sirunsoi, a nurse who was not assigned to Jones.
Panarat Bhothachareon, the nurse who was in charge of monitoring Jones, testified she had gone on a 45 minute break sometime around 8:20 p.m. When she returned from break, she checked Jones' chart and saw that Jones had been given Demerol. The next time she checked on Jones, Bhothachareon said, it was about 9:20 p.m.
Dr. Dedelow testified he examined Jones at about 8:45 p.m. and found Jones' cervix had dilated to 3 or 4 cms. He admitted the monitor strips showed Jones' contractions had been off-scale since 6 p.m. and standard practice suggested delivery by C-section should be considered if a woman in active labor does not completely dilate after two hours of strong contractions. Nevertheless, he did not consult with either the senior resident or the on-call physician. He did not elect to proceed to a C-section. He did nothing. Moreover, he left the room and did not return until about 9:30 p.m.
At 9:44, the record shows, Dr. Dedelow examined Jones and found her cervix fully dilated (10 cms.). The baby had descended to station. He turned off the Pitocin and instructed Jones to push. At 9:52 p.m., after Jones had pushed 4 times, Dr. Dedelow testified, the baby seemed to retract back into the womb. The monitors showed the baby's heart rate decreased significantly -- a ...