{ "id": 349617, "name": "STEVEN HANSEN, Special Adm'r of the Estate of Andrina Hansen, Deceased, Plaintiff-Appellee, v. BAXTER HEALTHCARE CORPORATION, Defendant-Appellant", "name_abbreviation": "Hansen v. Baxter Healthcare Corp.", "decision_date": "1999-12-15", "docket_number": "No. 1\u201498\u20143494", "first_page": "869", "last_page": "888", "citations": [ { "type": "official", "cite": "309 Ill. App. 3d 869" } ], "court": { "name_abbreviation": "Ill. App. Ct.", "id": 8837, "name": "Illinois Appellate Court" }, "jurisdiction": { "id": 29, "name_long": "Illinois", "name": "Ill." }, "cites_to": [ { "cite": "669 N.E.2d 1217", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1996, "opinion_index": 0 }, { "cite": "283 Ill. App. 3d 416", "category": "reporters:state", "reporter": "Ill. 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App. 3d", "case_ids": [ 5264505 ], "year": 1991, "pin_cites": [ { "page": "842" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/222/0833-01" ] }, { "cite": "384 N.E.2d 368", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1978, "opinion_index": 0 }, { "cite": "74 Ill. 2d 203", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 2994747 ], "year": 1978, "pin_cites": [ { "page": "210" } ], "opinion_index": 0, "case_paths": [ "/ill-2d/74/0203-01" ] } ], "analysis": { "cardinality": 1700, "char_count": 43465, "ocr_confidence": 0.763, "pagerank": { "raw": 1.245894566642549e-07, "percentile": 0.6089878212976896 }, "sha256": "841e250b598599bdbe5bd62897f5f09fc471449f395732834524e391b9198b80", "simhash": "1:2b14bd08133c675e", "word_count": 7103 }, "last_updated": "2023-07-14T20:36:09.526568+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "STEVEN HANSEN, Special Adm\u2019r of the Estate of Andrina Hansen, Deceased, Plaintiff-Appellee, v. BAXTER HEALTHCARE CORPORATION, Defendant-Appellant." ], "opinions": [ { "text": "JUSTICE WOLFSON\ndelivered the opinion of the court:\nIn the 1880s, in Germany, Otto Luer came up with the idea of a 6% taper as a way of putting a stopper in a bottle, keeping it there, and then getting it out again. Many years later, Luer\u2019s taper was used by hospital equipment manufacturers to ensure that one piece of IV set tubing would fit into another.\nThis case is about the IV sets manufactured by Baxter Healthcare Corporation (Baxter). And it is about the injuries and death suffered by Andrina Hansen (Andrina) when Baxter\u2019s IV set tubing came apart.\nAndrina\u2019s estate and her survivors sued Baxter under a products liability theory. The jury found for the plaintiffs and returned a total verdict of $18,047,000.\nBaxter raises several issues on appeal. We find sufficient evidence to support the jury\u2019s verdict as to liability and damages. We do, however, reduce the judgment to reflect a $2,800,000 setoff of a pretrial settlement.\nFACTS\nIn March 1991, Andrina was admitted to Mt. Sinai Hospital for stomach ulcer surgery. In preparation for surgery, Dr. Ricky Maddox (Dr. Maddox) inserted a catheter into Andrina\u2019s jugular vein. This catheter would allow doctors to transfuse blood or other fluids to Andrina. Andrina\u2019s catheter was connected to an IV tube manufactured by Baxter.\nBaxter designs, manufactures, and distributes IV sets to hospitals nationwide. IV sets include tubing and connectors which link segments of tubing to medical devices or catheters placed into a patient\u2019s circulatory system. In 1991, Baxter offered two types of connectors: \u201cfriction fit\u201d or \u201cluer slip\u201d connectors and \u201cluer lock\u201d connectors.\nA luer slip connector consists of a tapered, \u201cmale\u201d fitting which slips into a wider, \u201cfemale\u201d fitting to create a secure, leakproof connection. Baxter defined a luer slip connector as a product which, \u201cwhen properly inserted, must provide a reasonably secure friction fit that will not leak or easily slide out of the catheter.\u201d\nA luer lock connector consists of a luer slip connector with a threaded collar on the male fitting and a threaded flange on the female fitting which screw together to create a more secure connection. Baxter defined a luer lock connector as a product which \u201cwould provide a secure lock such that non-intentional separation of the Luer adapter from catheter *** could not occur.\u201d\nIndustry standards require luer slip connectors withstand 5V2 pounds of separation force before disconnecting, and luer lock connectors must withstand eight pounds of force. _ __\nLuer slip connectors have been used for more than 40 years, and luer lock connectors were introduced within the last 20 years. After luer lock connectors became available, IV set producers, including-Baxter, made all female fittings with flanges so these fittings could accommodate either luer slip or luer lock male fittings. At the time of Andrina\u2019s injury, Mt. Sinai used only luer slip connectors.\nDr. Henry Roztoczynski (Dr. Roztoczynski) successfully performed Andrina\u2019s surgery on March 7, 1991, and described her condition following surgery as excellent. Dr. Norbert Strohmayer (Dr. Strohmayer) assisted Dr. Roztoczynski with the surgery and saw Andrina on his morning rounds the day after her surgery. She was responsive with good vital signs.\nLater that morning, Dr. Strohmayer and Dr. Maddox heard a commotion and rushed to Andrina\u2019s room. The attending nurse, Colleen Golden (Golden), announced Andrina was having a seizure. As Dr. Strohmayer administered Valium to stop the seizure, he noticed blood pooling on Andrina\u2019s pillow. Andrina\u2019s catheter had become disconnected from the IV tube. As a result of this disconnection, an air embolism occurred. Air entered into Andrina\u2019s catheter and traveled to her brain, causing brain damage. Andrina became paralyzed. She died on June 4, 1995.\nIn 1991, Andrina\u2019s son, Thomas Hansen (Thomas), filed a medical malpractice claim against Mt. Sinai and Golden. Thomas later added survival and wrongful death claims against Baxter based on a products liability theory. Shortly before trial, all defendants except Baxter settled for $2,880,000. The trial court allocated 85% of the settlement, $2,448,000, to Thomas\u2019 wrongful death claims and 15% of the settlement, $432,000, to his survival claims.\nOn December, 24, 1997, Thomas filed an amended complaint against Baxter alone, presenting survival and wrongful death claims under both products liability and negligence theories. These claims proceeded to trial.\nAt trial, Dr. Roztoczynski testified he received a telephone call at home around 11 a.m. on the morning after Andrina\u2019s surgery and proceeded to the hospital. At the hospital Dr. Roztoczynski spoke with the intensive care unit chairman, Dr. Philip Zaret, and read Andrina\u2019s records. Dr. Roztoczynski learned Andrina\u2019s seizure began when Golden raised her from a prone to a sitting position. Dr. Roztoczynski described Golden\u2019s reaction:\n\u201cWell, what happened, the nurse during the dangling [of] the patient as I said from flat to upright position patient becomes dizzy. Suddenly, you know, [Andrina] was short of the breath and becomes hypotensive so [Golden] knew that something happened.\nAnd in this time she was not exactly sure what\u2019s happened so she call [sic] Dr. Strohmayer, who came and he immediately find [sic] out that the patient had dislodged of [sic] IV tubing from the central venous catheter. And he put the patient in the left side position to put the right side up, he did the [head-below-feet] Tren-delenburg position and start aspiration of the air which was inserted through the syringe.\u201d\nBaxter did not object to this testimony.\nDr. Roztoczynski said the luer slip connector came apart when Golden moved Andrina because \u201cwhen the nurses would dangle [the patient\u2019s feet off the bed] under the tension [the] catheter got disconnected.\u201d Dr. Roztoczynski acknowledged luer slip connectors can easily disconnect. He testified he had seen such disconnections a \u201cfew times\u201d and \u201cquite often so many times\u201d before Andrina\u2019s accident, though these previous disconnections carried less severe consequences.\nWhile on staff at Our Lady of Resurrection Hospital two to three months before Andrina\u2019s accident, Dr. Roztoczynski noticed the hospital had started using luer lock connectors. Dr. Roztoczynski said he began using luer lock connectors \u201cbecause I thought they were safe. *** [W]hen I saw this I said that\u2019s a great modernization to this [luer lock connectors], what we had before.\u201d Dr. Roztoczynski advocated luer lock connectors:\n\u201c[I]f you have a patient and the patient needs to be moved from one place to move and some tension is happened [szc], you know, taking the patient out of the bed and the tension will happen. These things happen many times, believe me. If you just have this kind of thing [luer lock connectors], and I\u2019ll say that this only one to prevent it just to change it for the luer lock adaption [szc], this thing will not happen.\u201d\nHowever, Dr. Roztoczynski testified he never mentioned luer lock connectors to his colleagues at Mt. Sinai.\nDr. Maddox testified he was a second-year surgical resident at the time of Andrina\u2019s accident. Dr. Maddox said he placed a catheter into Andrina\u2019s jugular vein on the night of her surgery. But Dr. Maddox conceded he did not mate the IV tubing with the catheter: \u201cI usually don\u2019t put the IV tubing in myself unless it\u2019s a trauma situation. But in situations like this I would let the nurses know *** that that is correct procedure using the catheter.\u201d Dr. Maddox agreed the nurses would start the IV \u2014 \u201cget it all going and deliver the patient to surgery.\u201d\nOn the morning after Andrina\u2019s surgery, around 10 a.m., Dr. Maddox was in the intensive care unit discussing other patients when Golden announced an emergency situation. According to Dr. Maddox, he interpreted Golden\u2019s comment as \u201ceither [Andrina\u2019s] having a seizure or she\u2019s dropping blood pressure.\u201d When he entered Andrina\u2019s room, she was lying prone on her bed and she was unresponsive. Dr. Maddox said Dr. Strohmayer placed Andrina in the Trendelenburg position: \u201cThe reason was that the nurse\u2019s comment initially was that she was having a seizure, and we wanted to make sure that there was no cerebral event.\u201d Dr. Maddox said he was not familiar with luer lock connectors at the time of Andrina\u2019s accident.\nDr. Strohmayer testified he heard a commotion coming from Andrina\u2019s room on the morning after her surgery, and he hurried to her room. According to Dr. Strohmayer, Golden was in Andrina\u2019s room. Dr. Strohmayer said he asked Golden what had happened:\n\u201cIf I remember the sequence correctly, she said she had sat up the patient and when the patient was sitting up, the patient became dizzy and then had a seizure and at that point we put her back to bed. And I think I got there when we were in the process of putting her back to bed. I don\u2019t know if she was already in the bed or getting in the bed; it was in that time frame.\u201d\nBaxter did not object to this testimony.\nDr. Strohmayer testified he gave Andrina medication to stop her seizure and noticed blood pooling around her shoulder. Dr. Stroh-mayer then realized Andrina\u2019s IV tubing had disconnected from her catheter and immediately reconnected them. Dr. Strohmayer was concerned Andrina had an air embolism. At trial he explained:\n\u201cAt this point there was nothing else, she had been doing very well, so it would have to be some sort of acute event. The only thing that had happened within the past few minutes which could account for an acute event was the patient had \u2014 well, we saw the disconnected IV and she had been moved in and out of the bed, so we figured logically something happened during the transfer.\u201d\nDr. Strohmayer testified Mt. Sinai probably used luer slip connectors for all IVs at the time of Andrina\u2019s accident. Although he did not focus his attention on IV connectors, Dr. Strohmayer also knew about luer lock connectors at this time. He had seen both luer slip and luer lock connectors at other hospitals. Dr. Strohmayer did not read any medical literature about luer slip disconnections and did not remember specific instances of previous disconnections, but he suspected \u201cit happened a few times.\u201d He said, \u201cI\u2019m sure we\u2019d seen them in IVs get disconnected because people are moving and they pop out ***.\u201d Dr. Strohmayer acknowledged luer lock connectors were less likely to disconnect during patient movement and understood luer lock connectors provided more secure connections: \u201cI just knew that it was screwed on so it\u2019s going to be harder to take off.\u201d\nDr. Donald Kuhlman (Dr. Kuhlman), an attending neurologist at Mt. Sinai in 1991, testified he consulted with Andrina\u2019s doctors after her accident. Dr. Kuhlman said he received Andrina\u2019s history when he arrived at the intensive care unit: \u201cI got the history that there was a woman who had undergone an ulcer operation and seemed to be doing fine until they sat her up at the edge of the bed when she began having a seizure and became unresponsive. *** I was also told that they noticed that her central line had become disconnected ***.\u201d Baxter did not object to this testimony. Dr. Kuhlman noted raising Andrina from a prone position could be significant to the disconnection because \u201cthat movement there is something which could have jostled things loose.\u201d\nDr. Edmund Donoghue, Cook County chief medical examiner, testified the IV disconnection caused an air embolism, which in turn caused brain damage to Andrina.\nCynthia Schiavo Pullinger (Pullinger), a group product manager for Baxter\u2019s IV products at the time of Andrina\u2019s accident, was called by Thomas as an adverse witness. Pullinger acknowledged luer lock connectors \u201ccould potentially be more secure. It\u2019s called a luer lock so it locks on.\u201d But she insisted both luer slip and luer lock connectors were safe products:\n\u201cYou have customer preference. And if a customer prefers one versus the other, they\u2019re both safe products, so you offer them what they want, you know, clinically what they decide that they need. So it\u2019s just like anything else. You offer a variety of products to fit the customer\u2019s requirements.\u201d\nPullinger concluded, \u201cThere are obviously customers that wanted friction fit. It was selling in the marketplace.\u201d\nBirendra Lai (Lai), a Baxter engineer responsible for the production of IV tubing sets, was called by Thomas as an adverse witness. Lai said the design of the luer slip connector has not changed much in more than 40 years. According to Lai, luer slips are designed to meet industry standards, and they disconnect only with more than 5 /2 pounds of separation force. Luer locks disconnect with more than eight pounds of separation force. Regarding luer slips, Lai said, \u201cif applied properly, they should not come apart.\u201d But he added, \u201cthese were designed to be detachable. So it will take five pounds of force to disconnect them. So the moment you exert more than five pounds, they will come apart. Five pounds is a lot of force.\u201d Lai said if a luer slip connector disconnected, \u201csomebody must have made a mistake in the way they connected it.\u201d\nLai conceded Baxter\u2019s luer lock patent application referred to the danger of luer slip connectors disconnecting. Lai read the patent application: \u201cTherefore, it\u2019s an object of the present invention [luer lock connector] to provide the Luer connection system in which an axillary slidable locking ring is prevented from inadvertent disengagement once it is properly engaged.\u201d When presented with a list of medical journal articles discussing cases of luer slip disconnections, Lai said Baxter would know of these articles.\nLai knew luer slip connectors were used with central venous catheters and luer lock connectors could help prevent disconnections: \u201cJust the fact that there\u2019s another locking feature there to provide extra security, yes. *** By adding more security it does help. *** I don\u2019t have any data, but common sense would suggest there could be less.\u201d Lai said luer lock connectors were \u201c[definitely more secure than the Luer slip.\u201d When asked why all male fittings do not include a threaded collar, Lai echoed Pullinger\u2019s testimony: \u201cIt\u2019s because the customers demand the Luer slip also. We put both Luer lock \u2014 We make this available to all the customers, Luer lock and Luer slips.\u201d\nWhen called by Baxter, Lai said Baxter recommends using luer lock connectors in central venous catheters, but conceded this recommendation only appears on Baxter pumps. Lai also said Baxter leaves the clinical decision of choosing a connector to the hospital.\nMargaret Foss (Foss), Baxter\u2019s vice-president of quality management, was called by Thomas as an adverse witness. Foss said she became aware of IV disconnections before 1982 when she worked as a nurse. Foss characterized IV disconnections as a \u201cwell-known\u201d and \u201crecognized\u201d complication of IV therapy with luer slip connectors. Foss added, \u201cIt is common knowledge that a locking connection provides a more secure junction than friction fit or a slip fit. That is elemental. That\u2019s basic.\u201d Foss agreed luer lock connectors were developed to guard against disconnection. She also agreed the medical community knew about luer lock connectors at the time of Andrina\u2019s accident.\nFoss said luer lock connectors should be used with central venous catheters: \u201cI would have to say a friction fit is not adequate for use with a central line.\u201d Called by Baxter, Foss again said her experience taught her luer lock connectors were used for central venous catheters. But Foss did not say luer slip connectors were inferior to luer lock connectors: \u201cI would not describe it that way. I would say that in their applications, friction fits meet all requirements clinically in providing a secure connection.\u201d\nMary Sandrick (Sandrick), a Mt. Sinai nurse who chaired the nursing products committee at the time of Andrina\u2019s accident, testified she knew the difference between luer slip and luer lock connectors in 1991. Sandrick had used luer lock connectors on central arterial catheters. Sandrick agreed luer slip connectors were \u201ccommonly familiar\u201d to nurses. Sandrick said she had no trouble with luer slip connectors in the course of her nursing experience, but she noted they occasionally disconnected. According to Sandrick, Baxter never advised Mt. Sinai about the risks of luer slip disconnection, though she agreed she was aware of such risks before Andrina\u2019s accident.\nLeBirdie Wilson (Wilson), Mt. Sinai\u2019s supervisor of supplies, processing, and distribution, testified she was unfamiliar with luer lock connectors at the time of Andrina\u2019s accident. Wilson said Mt. Sinai used luer slip connectors because, \u201cWe had always used them. No one had communicated any problems to me with the [IV tubing] sets.\u201d Wilson knew luer slip connectors could disconnect and had seen several disconnections in her nursing career.\nNeil Sheehan (Sheehan), Thomas\u2019 engineering expert, testified about the problems associated with luer slip connectors:\n\u201cWhen it gets put together, it is put together usually with the anticipation of it being at some point, taken apart. So there is some reluctance to jam that [male fitting] in [the female fitting] as hard as you can.\nThere\u2019s also a variation in the size of the nurse. There are very small women, very small men. There are large women, large men. There\u2019s a complete range of the amount of force that\u2019s used [to connect the fittings], just based on the person ***.\nSo on any given day, any given nurse could put together, you know, A, B, and then C and D; and they come out with very different [separation force] numbers when you went to pull it apart.\u201d\nSheehan said \u201can impact of any kind\u201d could generate more than five and one-half pounds of separation force. He added a luer lock could withstand much more than SVz pounds of force.\nSheehan testified the risk of luer slip disconnection was widely known and widely reported in the medical community. Sheehan found 20 to 30 articles in medical journals which described 70 cases of accidental luer slip disconnection from central venous catheter lines over a seven- to eight-year period before Andrina\u2019s accident. Sheehan said the risk of an air embolism from IV disconnection was common knowledge in the medical community.\nBecause an air embolism is so devastating but so preventable, Sheehan testified, \u201c[I]n all cases, in all applications, Luer locks should he used as opposed to the antiquated Luer slip design.\u201d Sheehan said, \u201cI believe that the Luer slip connection is not a safe design in any application.\u201d When asked why, Sheehan responded, \u201cBecause it can come apart. And I have not \u2014 I do not know of one IV connection that is one that you can permit it to be disconnected accidentally.\u201d Sheehan added luer slip connectors were particularly inappropriate for central venous catheters. Sheehan concluded luer slip connectors became obsolete when luer lock connectors became available.\nLouis Rofrano (Rofrano), a Baxter field sales instructor at the time of Andrina\u2019s accident, testified as Baxter\u2019s first witness. Rofrano said, \u201cfrom my experience starting in 1979 [the luer lock connector] was already a well-established product, it was in general use for specific applications, and people knew about it.\u201d Rofrano acknowledged Baxter\u2019s luer lock connector patent came in 1983, but added the luer lock connector was \u201cstandard technology elsewhere.\u201d Rofrano would not have expected hospital personnel to ask for training on luer lock connectors. But Rofrano said a Baxter salesperson would say luer lock connectors reduce the risk of accidental disconnection if asked for a luer lock demonstration. However, Rofrano agreed Baxter sales representatives were not trained to \u201cgo out and tell customers about the risk.\u201d\nRofrano said Baxter sales representatives were not actively promoting luer lock connectors because hospitals would use their own judgment in choosing an IV connector. Rofrano repeated the theme used by the other Baxter representatives who testified at trial: \u201cThat decision is up to the hospital. *** They make the choice. *** We present them with whatever products we are able to manufacture that meets [sic] their requirements.\u201d\nDr. William Schumer (Dr. Schumer), chairman of the Mt. Sinai surgery department, testified the nursing committee approved the purchase of all devices used at the hospital. Dr. Schumer could offer only recommendations to the nursing committee, but the committee seeks his approval before implementing any purchasing decisions.\nDr. Schumer was aware of luer lock connectors before Andrina\u2019s accident, though he observed most hospitals used luer slip connectors. When asked why the hospital did not switch to luer lock connectors, Dr. Schumer said: \u201cWell, they [luer slips] were being used because they were working at the time. We didn\u2019t have any trouble. If we connect these connectors together with friction, they usually hold very well. Depends on who puts it together.\u201d In 44 years of medical practice, Dr. Schumer had no experience with luer slip disconnections before Andrina\u2019s accident, although he was aware of the risks associated with disconnection. Dr. Schumer said all Mt. Sinai resident and intern physicians knew of these risks.\nAccording to Dr. Schumer, the hospital did switch to luer lock connectors following Andrina\u2019s accident. In contemplating such a switch, Dr. Schumer did not need to study the medical journals. He testified, \u201cWell, I had read literature prior [to the accident], so I knew about the background on the situation and I knew that Luer locks would probably be safer.\u201d Dr. Schumer continued:\n\u201cIt [disconnection] never happened to me so therefore I treated \u2014 I accepted friction connections [as safe]. ***\nHowever, I knew that they could come apart. There had been reports that these things would come apart, so I must \u2014 you know, my feeling at the time was that with my experience, I could still rely on friction connections. It\u2019s only after this episode that I recognized that we have to be more careful than we were before.\u201d\nWilliam McVay (McVay), Baxter\u2019s engineering expert, testified luer' slip connectors are not unreasonably dangerous without a warning. McVay said luer slip and luer lock connectors have a propensity to disconnect to some degree: \u201cThey\u2019re both very low in their tendency to disconnect, but it\u2019s very difficult for me to find that there is a significant difference between the two in the tendency for disconnection.\u201d\nAccording to McVay, luer locks do not eliminate the risk of IV disconnection. Instead, \u201c[t]he Luer lock fitting simply adds a margin of safety over the Luer [slip] fitting.\u201d McVay said, \u201ca safer approach would be to use a Luer lock with that particular central line.\u201d McVay reiterated, \u201cI would believe that one would, if given the option, would use a Luer lock over a Luer slip ***.\u201d McVay testified luer slip connectors were not safe to use with central venous catheters, but Baxter had no duty to provide any warning.\nAt the close of the three-week trial, Thomas filed another amended complaint, substituting his brother Steven Hansen (Steven) as plaintiff and voluntarily dismissing the negligence counts. The jury returned an $18,047,000 general verdict in favor of Steven. On February 20, 1998, the trial court entered judgment on the jury\u2019s verdict, allocating 92% of the verdict, $16,547,000, to the survival claim and 8% of the verdict, $1,500,000, to the wrongful death claim.\nBaxter filed a motion seeking a setoff of the entire $2,880,000 settlement. On March 11, 1998, the trial court allowed a setoff of only $1,932,000. On September 8, 1998, the trial court denied Baxter\u2019s posttrial motion.\nThis appeal followed.\nDECISION\nBaxter\u2019s appeal raises several issues, ranging from Baxter\u2019s legal duty to the trial court\u2019s setoff. We address these issues in turn.\n1. Products Liability\nBaxter contends its luer slip connector was not dangerous as a matter of law.\nTo recover on a products liability claim, the plaintiff must show an injury resulted from an unreasonably dangerous condition of the product which existed when the product left the defendant\u2019s'Tcontrol. Hunt v. Blasius, 74 Ill. 2d 203, 210, 384 N.E.2d 368 (1978). Whether a product is unreasonably dangerous is normally a question of fact for the jury (Wille v. Navistar International Transportation Corp., 222 Ill. App. 3d 833, 842, 584 N.E.2d 425 (1991)), though whether a duty to warn exists is a question of law (Modelski v. Navistar International Transport Corp., 302 Ill. App. 3d 879, 887, 707 N.E.2d 239 (1999)).\nUnreasonably dangerous conditions include manufacturing defects, design defects, and failures to warn of a product\u2019s dangerous propensities. Lamkin v. Towner, 138 Ill. 2d 510, 528, 563 N.E.2d 449 (1990). This case involves allegations of a design defect and a failure to warn.\na. Failure to Warn\nA duty to warn arises when a product manufacturer has greater knowledge of a product\u2019s dangerous propensities than a consumer has. Kokoyachuk v. Aeroquip Corp., 172 Ill. App. 3d 432, 439, 526 N.E.2d 607 (1988); see McColgan v. Environmental Control Systems, Inc., 212 Ill. App. 3d 696, 700, 571 N.E.2d 815 (1991). The purpose of product warnings is to apprise consumers of the product\u2019s dangers they don\u2019t know about, enabling them to take protective precautions. Mazikoske v. Firestone Tire & Rubber Co., 149 Ill. App. 3d 166, 174, 500 N.E.2d 622 (1986). No duty to warn arises when the product\u2019s dangers are commonly appreciated. Mazikoske, 149 Ill. App. 3d at 174.\nIn medical device cases, the intended audience for product warnings is not the patients on whom these devices are ultimately used. Instead, Illinois employs the \u201clearned intermediary doctrine.\u201d Under this doctrine, prescription drug and medical device manufacturers have a duty to warn physicians of a drug\u2019s or a device\u2019s dangerous propensities, and physicians, in turn, using their medical judgment, have a duty to convey any relevant warnings to their patients. See Martin v. Ortho Pharmaceutical Corp., 169 Ill. 2d 234, 238, 661 N.E.2d 352 (1996); Kirk v. Michael Reese Hospital & Medical Center, 117 Ill. 2d 507, 517-18, 513 N.E.2d 387 (1987); Pluto v. Searle Laboratories, 294 Ill. App. 3d 393, 396, 690 N.E.2d 619 (1997); Tongate v. Wyeth Laboratories, 220 Ill. App. 3d 952, 958, 580 N.E.2d 1220 (1991).\nIn the context of the learned intermediary doctrine, then, a medical device manufacturer has no duty to warn physicians of a device\u2019s dangers which the medical community generally appreciates. Proctor v. Davis, 291 Ill. App. 3d 265, 277, 682 N.E.2d 1203 (1997), citing Wooten v. Johnson & Johnson Products, Inc., 635 F. Supp. 799, 803 (N.D. Ill. 1986). The duty to warn analysis is objective. Klen v. Asahi Pool, Inc., 268 Ill. App. 3d 1031, 1035, 643 N.E.2d 1360 (1994). If a manufacturer has no duty to warn, the device cannot be unreasonably dangerous for the manufacturer\u2019s failure to warn. Proctor is instructive.\nIn Proctor, a doctor injected a steroid into a patient\u2019s eye to correct the patient\u2019s blurred vision. The patient had an adverse reaction to the steroid, and his eye was eventually removed. The patient filed a products liability claim against the steroid\u2019s manufacturer, alleging the manufacturer failed to warn physicians about possible risks associated with injecting the steroid into patients\u2019 eyes. The jury returned a verdict in favor of the patient, and the court denied the manufacturer\u2019s motion for judgment notwithstanding the verdict.\nOn appeal, we said, \u201cIn Illinois, there is no duty to warn of a risk that is already known by those to be warned.\u201d Proctor, 291 Ill. App. 3d at 277,. citing Kokoyachuk, 172 Ill. App. 3d 432. We continued: \u201cIn the context of prescription drug litigation, this principle means that a drug manufacturer need not provide a warning of risks known to the medical community.\u201d Proctor, 291 Ill. App. 3d at 277. But after reviewing the record, we noted the \u201cimbalance of access to information\u201d about the adverse propensities of the steroid. Proctor, 291 Ill. App. 3d at 282-83. \u201cAlthough it is assumed that physicians will keep abreast of current medical literature,\u201d some of the literature available to physicians was generated by the manufacturer and was misleading. Proctor, 291 Ill. App. 3d at 284.\nWe found, \u201cThere is no record evidence to support the hypothesis that the medical community knew of these dangerous propensities.\u201d Proctor, 291 Ill. App. 3d at 279-80. The manufacturer had a duty to warn because, \u201cDoctors who have not been sufficiently warned of harm ful effects of a drug cannot be considered \u2018learned intermediaries\u2019 ***.\u201d Proctor, 291 Ill. App. 3d at 283.\nUnlike the medical community in Proctor, the medical community here knew the risks associated with the prescription product. Foss and Sheehan testified the risk of luer slip disconnection was commonly known by the medical community. The articles Sheehan found on luer slip disconnection reinforce this conclusion. Additionally, unlike the doctors in Proctor, the doctors here knew the risks associated with the product. Mt. Sinai\u2019s chairman of surgery, Dr. Schumer, and all the doctors treating Andrina knew luer slip connectors could disconnect and knew the grave risks associated with IV disconnections. Nurse San-drick and nurse Wilson acknowledged they knew luer slips could disconnect.\nWe find, as a matter of law, Baxter had no duty to warn Mt. Sinai\u2019s doctors about risks the doctors and the medical community already were aware of. This issue should not have reached the jury.\nExtinction of the duty to warn theory does not end this case. The jury returned a general verdict. Neither party submitted special interrogatories. We cannot know whether the jury\u2019s verdict was based on a duty to warn, a defective design, or both. The case went to the jury on both theories, each with its own instructions. Case and statutory law tell us when more than one theory is presented, the general verdict will be upheld if there was sufficient evidence to sustain either theory. Witherell v. Weimer, 118 Ill. 2d 321, 329, 515 N.E.2d 68 (1987); Luther v. Norfolk & Western Ry. Co., 272 Ill. App. 3d 16, 23, 649 N.E.2d 1000 (1995); see 735 ILCS 5/2 \u2014 1201(d) (West 1996).\nb. Defective Design\nBaxter contends there was not enough evidence of a defective design to support a verdict based on that theory. We believe there was.\nWe have set out the evidence in some detail. It tells a story of a company that made and sold two kinds of IV sets \u2014 the luer slip and the luer lock. The luer slip could and did come apart inadvertently, even when properly connected, despite compliance with industries standards. Baxter knew that. In addition, nurses at times would, for convenience, loosely connect the luer slip. Baxter should have known that. If the practice can be characterized as abnormal, it also can be anticipated, and, therefore, objectively reasonable to foresee. See Kerns v. Engelke, 76 Ill. 2d 154, 165, 390 N.E.2d 859 (1979).\nBaxter also knew the luer slip would be used with central venous catheters, creating a potentially dangerous situation for unsuspecting patients, the ultimate consumers. It should have come as no surprise to Baxter that patients move in bed. They sit up at times. Lines get caught and tangled. Again, \u201cobjectively reasonable to expect, not merely what might conceivably occur.\u201d (Emphasis omitted.) Winnett v. Winnett, 57 Ill. 2d 7, 12-13, 310 N.E.2d 1 (1974). See C. Chapman & T. Hoffman, Product Liability in Illinois, at II \u2014 2 (3d ed. 1999).\nAt the same time, Baxter made and sold a luer lock line that did not come apart inadvertently. The luer lock line cost only a few pennies more than the luer slip. The existence of the luer lock line takes out of the case any claim there was no feasible alternative design.\nThe question presented to the jury was whether the luer slip connector was \u201cunsafe when put to a use that is reasonably foreseeable considering the nature and functions of the\u201d connector. Illinois Pattern Jury Instructions, Civil, No. 400.06 (3d ed. 1995). That is, a product is defective \u201cif it is not safe for such a use that can be expected to be made of it.\u201d Dunham v. Vaughn & Bushnell Manufacturing Co., 42 Ill. 2d 339, 343, 247 N.E.2d 401 (1969).\nThe plaintiffs expert, Neil Sheehan, told the jury the luer slip connection is not a safe design. Why not? \u201cBecause it can come apart.\u201d Sheehan was referring to unintentional disconnection, a failure of the line \u201cto perform in the manner reasonably to be expected in light of [its] intended nature and function.\u201d Dunham, 42 Ill. 2d at 342.\nAt first blush, Sheehan\u2019s opinion seems too simple. But the law does not necessarily discourage simplicity. Our case law is grounded in a simple question posed by the Restatement: Was the product safe when put to its foreseeable use? Restatement (Second) of Torts \u00a7 402A (1965).\nBased on testimony about the luer slip design, the jury could have found it posed an unreasonable risk of harm beyond that contemplated by Andrina as she lay in her hospital bed.\nHere, the jury had additional evidence to consider \u2014 the feasible alternative design of the luer lock. We realize the existence of a safer design does not, as a matter of law, require a verdict that the luer slip was unreasonably dangerous. Kerns, 76 Ill. 2d at 166.\nAt the same time, it is well established the jury in a design defect case may consider evidence of \u201can alternative design which is economical, practical and effective.\u201d Kerns, 76 Ill. 2d at 162-63; Murphy v. Chestnut Mountain Lodge, Inc., 124 Ill. App. 3d 508, 515, 464 N.E.2d 818 (1984); Sutkowski v. Universal Marion Corp., 5 Ill. App. 3d 313, 319, 281 N.E.2d 749 (1972).\nIn Derrick v. Yoder Co., 88 Ill. App. 3d 864, 410 N.E.2d 1030 (1980), the plaintiff lost an arm when he was thrown into a steel splitting machine\u2019s unguarded recoiler, an allegedly defective design. We allowed the jury to consider proof that a safety device which could have obviated the danger was available to the manufacturer-defendant at less than a prohibitive cost. Derrick, 88 Ill. App. 3d at 875. In this case, all the manufacturer, Baxter, had to do was look to its own catalogue.\nIn short, the evidence of defective design could be considered by the jury in both of the ways approved in Palmer v. Avco Distributing Co., 82 Ill. 2d 211, 219-20, 412 N.E.2d 959 (1980): (1) evidence that Andrina could expect to use the luer slip without risk of harm; and (2) a connector that would prevent foreseeable harm without hindering its function or increasing its price had been designed.\nWhether the jury used the \u201cconsumer expectation test\u201d or a \u201crisk/ benefit analysis,\u201d or both \u2014 which it may do (see Lamkin, 138 Ill. 2d at 529; Besse v. Deere & Co., 237 Ill. App. 3d 497, 501, 604 N.E.2d 998 (1992)) \u2014 it decided the defective design issue against Baxter, and we cannot say that decision was against the manifest weight of the evidence.\n2. Proximate Cause\nHaving concluded the jury could have found Baxter\u2019s design unreasonably dangerous, we do not see proximate cause as a serious issue.\nNurse Golden\u2019s account of the events leading to Andrina\u2019s injury was presented to the jury through Doctors Roztoczynski, Strohmayer, and Kuhlman. Of course, nurse Golden\u2019s statements were hearsay, but they went in without objection. The hearsay could be considered by the jury \u201cand *** be given its natural probative effect.\u201d People v. Williams, 139 Ill. 2d 1, 15, 563 N.E.2d 431 (1990).\nHere, nurse Golden spoke to the doctors shortly after the event, at a time when she would have no motive other than to report accurately. The jury was free to give the hearsay whatever weight it thought appropriate. See M. Graham, Cleary & Graham\u2019s Handbook of Illinois Evidence \u00a7 801.8, at 740 (7th ed. 1999).\nNurse Golden offered the jury a fairly clear picture of what happened, certainly enough for the jury to infer an inadvertent uncoupling of the line took place when the nurse sat up the patient.\nEvidence of proximate cause can be direct or circumstantial. Tweedy v. Wright Ford Sales, Inc., 64 Ill. 2d 570, 575, 357 N.E.2d 449 (1976). Proximate cause can be inferred from an affirmative factual base. Baltus v. Weaver Division of Kidde & Co., 199 Ill. App. 3d 821, 833, 557 N.E.2d 580 (1990). Liability may be found whether the defective design of the defendant\u2019s product is the sole or a contributing cause of a plaintiffs injury. Besse, 237 Ill. App 3d at 502, citing Coney v. J.L.G. Industries, Inc., 97 Ill. 2d 104, 454 N.E.2d 197 (1983).\nThere was enough evidence here for the jury to find a defective design was a cause of the inadvertent uncoupling of a Baxter luer slip that was being used in a reasonably foreseeable manner, resulting in Andrina\u2019s air embolism and later brain damage. The trial court did not err when it refused to grant Baxter\u2019s motion for judgment notwithstanding the verdict due to failure to prove proximate causation.\n3. Jury Instructions\nBaxter challenges jury instructions, given and not given, on the duty to warn and defective design issues.\nBecause we hold the duty to warn claim should not have reached the jury, there is no need to consider the instructions given on that issue.\nWe have reviewed the nonpattern instructions offered by Baxter on the defective design issue. We find the trial court properly exercised its discretion in refusing these instructions. They were argumentative and incomplete. See Swartz v. Sears, Roebuck & Co., 264 Ill. App. 3d 254, 267, 636 N.E.2d 642 (1993). The pattern instructions given the jury fairly and correctly stated the law on design defect. See Baier v. Bostitch, 243 Ill. App. 3d 195, 207, 611 N.E.2d 1103 (1993).\nBaxter also complains about the trial court\u2019s refusal to instruct the jury on learned treatises: \u201cScientific medical treatises are not evidence or proof of statements contained therein.\u201d\nIn fact, journals were used at trial, without objection, for the non-hearsay purpose of proving the medical community\u2019s notice of complaints about luer slips. Because the duty to warn issue is out of the case, and because the instruction would have served no useful purpose, we conclude the failure to give Baxter\u2019s proposed instruction was not an abuse of discretion. See Linn v. Damilano, 303 Ill. App. 3d 600, 606-07, 708 N.E.2d 533 (1999).\n4. Damages\nBaxter contends the jury\u2019s verdict was excessive.\nThe determination of an adequate verdict lies particularly within the jury\u2019s province. Carter v. Kirk, 256 Ill. App. 3d 938, 947, 628 N.E.2d 318 (1993). A verdict falling \u201c \u2018within the flexible range of conclusions which can reasonably be supported by the facts,\u2019 \u201d will withstand judicial review. Best v. Taylor Machine Works, 179 Ill. 2d 367, 412, 689 N.E.2d 1057 (1997), quoting Lee v. Chicago Transit Authority, 152 Ill. 2d 432, 470, 605 N.E.2d 493 (1992). This one does.\nThe jury heard testimony of Andrina\u2019s final four years of tortured existence. She could not speak or walk, she needed full-time nursing care, she lacked motor control in half her body, and she experienced excruciating pain at all times. Those and other dire consequences of line uncoupling persuade us we ought not to second guess the jury\u2019s award of damages.\n5. Setoff\nBaxter contends the trial court erred in refusing a lump-sum set-off of the pretrial settlement.\n\u201cA plaintiff is only entitled to one recovery and only one satisfaction for claimed injuries pursuant to one cause of action.\u201d Readel v. Towne, 302 Ill. App. 3d 714, 718, 706 N.E.2d 99 (1999). Under the Joint Tortfeasor Contribution Act (740 ILCS 100/2(c) (West 1996)), the amount of a settlement between a plaintiff and a settling tortfeasor is set off against any recovery the plaintiff may receive later from another nonsettling tortfeasor \u201cfor the same injury or wrongful death for which the tortfeasor was ultimately found liable.\u201d Pasquale v. Speed Products Engineering, 166 Ill. 2d 337, 368-69, 654 N.E.2d 1365 (1995).\nWhen a case involves both survival and wrongful death claims, the allocation should be made according to the claim. Readel, 302 Ill. App. 3d at 719. That is, damages for the decedent\u2019s conscious pain and suffering should be allocated to the survival claim, while damages for the loss of benefits to the decedent\u2019s survivors should be allocated to the wrongful death claim. Muro v. Abel Freight Lines, Inc., 283 Ill. App. 3d 416, 420, 669 N.E.2d 1217 (1996).\nApportioning the settlement amount among various claims rests within the trial court\u2019s discretion (Muro, 283 Ill. App. 3d at 419), but the court should evaluate the fairness and reasonableness of the allocation (Readel, 302 Ill. App. 3d at 721).\nThe trial judges apportioned the settlement and the verdict as follows:\nWrongful Death \u2014 Percentage Survival \u2014 Percentage\nSettlement $2,448,000 85% $432,000 15%\nVerdict $1,500,000 8% $16,547,000 92%\nBefore trial, Baxter never objected to the court\u2019s settlement allocation. After trial, the court allowed Baxter to setoff the full $432,000 amount of the survival claim settlement and allowed Baxter to set off only $1,500,000 of the wrongful death claim settlement, leaving $948,000 of the settlement outside the setoff. Because we do not have a report of proceedings from March 11, 1998, we cannot determine whether the court articulated reasons for its allocation of the verdict.\nIn his brief, Steven says:\n\u201cApart from the critical fact of timely asserting an objection to the settlement and allocation, plaintiff concedes that the Second District\u2019s decision in Readel, if followed by this Court, would require a set off of the entire amount of the pretrial settlement ($2,880,000) thus reducing the judgment to $15,167,000.\u201d\nBaxter\u2019s failure to object to the settlement allocation waived any argument the settlement apportionment was unfair or unreasonable. Readel, 302 Ill. App. 3d at 717. But Baxter challenges the posttrial apportionment of the jury\u2019s verdict, not the pretrial settlement. The same three people who received the settlement proceeds recovered under both the wrongful death and the survival claim which proceeded to trial. Based on Steven\u2019s concession, as well as our unwillingness to allow a double recovery, we set off the full amount of the pretrial settlement.\nCONCLUSION\nFor the reasons we have set out above, we affirm the judgment in\nfavor of the plaintiff, modified by our setoff of the full amount of the pretrial settlement, resulting in a total judgment of $15,167,000.\nAffirmed and modified.\nCAHILL, EJ., and BURKE, J., concur.\nWe believe our analysis of legal duty to warn is consistent with Illinois law. For that reason, there is no need to determine whether there ever can be a causal relationship between an injury and a failure to warn about a danger that is well known in the appropriate community.", "type": "majority", "author": "JUSTICE WOLFSON" } ], "attorneys": [ "William R. Quinlan, Michael I. Rothstein, Mary Patricia Benz, David M. Jenkins, and Brian J. Alesia, all of Quinlan & Grisham, Ltd., of Chicago, for appellant.", "Kevin M. Forde, Janice R. Forde, and Kevin R. Malloy, all of Kevin M. Forde, Ltd., and Paul B. Episcope, John C. Erb, and David S. Jasmer, all of Law Offices of Paul B. Episcope, Ltd., and John Rokacz, of John Rokacz & Associates, all of Chicago, for appellee." ], "corrections": "", "head_matter": "STEVEN HANSEN, Special Adm\u2019r of the Estate of Andrina Hansen, Deceased, Plaintiff-Appellee, v. BAXTER HEALTHCARE CORPORATION, Defendant-Appellant.\nFirst District (3rd Division)\nNo. 1\u201498\u20143494\nOpinion filed December 15, 1999.\nRehearing denied January 11, 2000.\nWilliam R. Quinlan, Michael I. Rothstein, Mary Patricia Benz, David M. Jenkins, and Brian J. Alesia, all of Quinlan & Grisham, Ltd., of Chicago, for appellant.\nKevin M. Forde, Janice R. Forde, and Kevin R. Malloy, all of Kevin M. Forde, Ltd., and Paul B. Episcope, John C. Erb, and David S. Jasmer, all of Law Offices of Paul B. Episcope, Ltd., and John Rokacz, of John Rokacz & Associates, all of Chicago, for appellee." }, "file_name": "0869-01", "first_page_order": 889, "last_page_order": 908 }