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  "name": "MARSHA JONES, Indiv. and as Special Adm'r of the Estate of Andrew Jones, et al., Plaintiffs-Appellees, v. CHICAGO OSTEOPATHIC HOSPITAL, Defendant-Appellant",
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      "MARSHA JONES, Indiv. and as Special Adm\u2019r of the Estate of Andrew Jones, et al., Plaintiffs-Appellees, v. CHICAGO OSTEOPATHIC HOSPITAL, Defendant-Appellant."
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        "text": "JUSTICE WOLFSON\ndelivered the opinion of the court:\nAndrew Jones was born with severe brain damage. He led a debilitative life until he was IV2 years old, when he died of respiratory failure. In their lawsuit, Andrew\u2019s parents claimed the professional negligence of the Chicago Osteopathic Hospital was a proximate cause of Andrew\u2019s 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\u2019s verdict and several of the trial court\u2019s rulings. We affirm.\nFACTS\nMarsha Jones (Jones) was admitted to Chicago Osteopathic Hospital (the hospital) on the morning of March 3, 1994. She was in her forty-second week of gestation \u2014 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 \u2014 in technical terms, hypoxic ischemic encephalopathy (HIE) \u2014 a condition which was fixed and permanent.\nOn 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 \u2014 a condition which caused Andrew\u2019s 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 IV2 years old, he died of respiratory failure.\nJones, individually and as special administrator of Andrew\u2019s estate, and Johnny Jones (Andrew\u2019s father), filed an 11-count second amended complaint against the hospital and its doctors and nurses, alleging negligence in the handling of Jones\u2019 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\u2019s motion for reduction pursuant to statute (735 ILCS 5/2 \u2014 1205 (West 1996)), the award of medical costs on the survival claim was reduced by $100,000. All other posttrial motions were denied.\nThe 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\u2019 injuries, making it error for the trial court to have denied motions for judgment notwithstanding the verdict (judgment n.o.v.) 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.\nDECISION\nMotions for Judgment n.o.v. and a New Trial\nThe hospital first contends the trial court erred when it denied the hospital\u2019s motions for judgment n.o.v. 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.\nIn 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\u2019s rulings on motions for judgment n.o.v. and motions for new trial.\nAn appellate court reviews de novo a trial court\u2019s decision to grant or deny a motion for judgment n.o.v. but, like the trial court, must be careful not to \u201c \u2018usurp 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.\u2019 \u201d 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).\nA motion for judgment n.o.v. should be granted only in those cases where \u201call of the evidence, when viewed in its aspect most favorable to the opponent, so overwhelmingly favors movant that no contrary verdict based upon that evidence could ever stand.\u201d 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. Department of Transportation v. Smith, 258 Ill. App. 3d 710, 714, 631 N.E.2d 266 (1994), \u201cThis is clearly a very difficult standard to meet, limiting the power of the circuit court to reverse a jury verdict to extreme situations only.\u201d If reasonable minds could differ on the inferences to be drawn or the conclusions to be reached from the facts, \u201c[a] trial court cannot reweigh the evidence and set aside a verdict.\u201d Maple, 151 Ill. 2d at 452-53.\nA trial court\u2019s 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, 132-33, 720 N.E.2d 242 (1999). In reviewing the trial court\u2019s ruling, we must keep in mind a new trial should be granted only when the jury\u2019s verdict is against the manifest weight of the evidence. Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d at 509. To be against the manifest weight of the evidence, the opposite conclusion must be clearly evident or the jury\u2019s findings must appear unreasonable, arbitrary, or not based on the evidence. Maple v. Gustafson, 151 Ill. 2d at 454.\nMindful of these standards, we have examined the record in this case. We find no support for the hospital\u2019s claim that either a new trial or judgment n.o.v. is warranted.\nThere 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\u2019s brain damage.\nHere, as in any medical malpractice action, plaintiffs had the burden of establishing, through expert testimony, the standard of care applicable to the hospital\u2019s physicians and nurses, to identify the unskilled or negligent manner in which the hospital\u2019s physicians and nurses deviated from that standard, and to 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.\nThe 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.\nChemical 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 \u201cripen\u201d the cervix and stimulate labor. A second application of Prepidil was given later that day.\nBy 5:45 a.m. on March 4, 1994, Jones\u2019 labor had not progressed. Her cervix had not dilated and the baby was at -3 station \u2014 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.\nAt about 8 a.m., Jones began receiving Pitocin. At 11:05 a.m., Dr. Frank wrote an order to \u201chold Pit[ocin] at 24 ccs,\u201d after Jones reported to him her contractions were strong.\nDr. Dedelow, another first-year resident who took over for Dr. Frank, examined Jones at about 3 p.m. Jones\u2019 condition was unchanged \u2014 she was having strong contractions, but her cervix was not dilating and the baby was not descending into the birth canal.\nAt 6 p.m., Dr. Dedelow examined Jones again. Jones\u2019 cervix had dilated two centimeters, which allowed Dr. Dedelow to place internal probes in Jones\u2019 uterus. The probes were attached to a monitor, which recorded on strips of graph paper Jones\u2019 contractions and the baby\u2019s heart rate. These monitor strips showed Jones\u2019 contractions were very strong \u2014 so strong that the contractions, at their peak, recorded a pressure which exceeded 100 millimeters of mercury, which was beyond the monitor\u2019s scale, and, therefore, outside the boundaries of the machine\u2019s graph paper.\nA little after 6 p.m., Jones\u2019 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.\nAfter 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\u2019t find a nurse or doctor, so she called her mother, Elizabeth Walker.\nMrs. 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.\nAfter 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.\nNext, 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.\nThe hospital records confirmed Eva\u2019s testimony. Jones\u2019 chart showed only one nurse\u2019s note from 8:15 p.m. to 9:20 p.m. \u2014 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.\nPanarat 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\u2019 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.\nDr. Dedelow testified he examined Jones at about 8:45 p.m. and found Jones\u2019 cervix had dilated to three or four centimeters. He admitted the monitor strips showed Jones\u2019 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.\nAt 9:44, the record shows, Dr. Dedelow examined Jones and found her cervix fully dilated (10 centimeters). The baby had descended to +2 station. He turned off the Pitocin and instructed Jones to push. At 9:52 p.m., after Jones had pushed four times, Dr. Dedelow testified, the baby seemed to retract back into the womb. The monitors showed the baby\u2019s heart rate decreased significantly \u2014 a condition called bradycardia. The decreased heart rate meant the baby was not getting sufficient oxygen.\nDr. Dedelow testified he tried intrauterine resuscitation measures \u2014 he turned Jones on her side, gave her oxygen, and tried to stimulate the baby by scratching the top of its head \u2014 but the situation did not improve. Dr. Dedelow then called the senior resident, Dr. Herbert.\nAt 10 p.m., Dr. Herbert saw Jones and ordered a C-section. Jones was taken to delivery and prepped for surgery. An anesthesiologist arrived around 10:15 p.m. and Dr. Herbert made the first incision at 10:20 p.m. Baby Andrew was delivered at 10:24 p.m.\nAfter delivery, the doctors determined Jones\u2019 uterus had ruptured in two places and there had been a complete placental abruption (detachment from the uterine wall). When a complete abruption occurs there is no exchange of blood or oxygen from mother to baby.\nDefense experts Dr. Thomas Kirschbaum and Dr. David Zbaraz testified the hospital\u2019s nurses and doctors acted reasonably under the circumstances and did not breach the standard of care. In reaching this conclusion, the defense experts focused on the events that transpired after 9:44 p.m. on March 4, 1994. Prior to this time, they said, Jones\u2019 labor had progressed without any significant problems.\nThe defense experts said it was reasonable to expect that vaginal delivery was imminent when, at 9:44 p.m., Jones\u2019 cervix was fully dilated. Dr. Dedelow appropriately instructed Jones to push. It was at this point, defense experts opined, Jones\u2019 uterus ruptured, causing an emergency situation. They could not say what caused the rupture, but they did not believe the Pitocin was the cause since the dosage she was receiving was relatively low.\nDr. Dedelow\u2019s reaction to the crisis, the defense experts said, was appropriate \u2014 he attempted intrauterine resuscitation measures and, when they failed, proceeded to a C-section operation. Furthermore, the defense experts testified, the operation was performed within a reasonable time. Standards require an emergency C-section be performed within 30 minutes. In this case, Baby Andrew was delivered at 10:24 p.m., 24 minutes after the operation was ordered by Dr. Herbert. Consequently, defense experts concluded, there had been no breach of the standard of care by any of the hospital\u2019s staff.\nPlaintiffs\u2019 expert, Dr. Gerald Zatuchni, disagreed with the defense experts. In his opinion, there were several breaches of the standard of care by the hospital\u2019s staff.\nFirst, Dr. Zatuchni said, the hospital failed to provide Jones with an appropriate level of care by trained, qualified personnel. A patient receiving Pitocin, Dr. Zatuchni said, requires close observation because Pitocin is universally recognized to be associated with a higher risk of uterine rupture. The longer a patient is on Pitocin, the higher the risk. This is because Pitocin causes the uterus, which is a muscle, to contract. Like any muscle, the uterus tires when it is worked for a long time. If the Pitocin is continued after there is evidence of tiring\u2014 hyperstimulation \u2014 the continued contractions may cause the muscle fibers of the uterus to separate or \u201crupture.\u201d\nIn this case, at 8:45 p.m., Jones had been complaining of severe pain. She had been receiving Pitocin for 12 hours. Also, despite Dr. Frank\u2019s order to hold the Pitocin at 24 ccs per hour, the Pitocin, inexplicably, had been increased to 42 ccs per hour and Jones had been having strong contractions for several hours. When Dr. Dedelow examined her, she was only three to four centimeters dilated, with \u201ca long way to go\u201d to get to full dilation (10 centimeters). Yet, Dr. Dedelow did not continue to personally monitor Jones after the 8:45 p.m. examination. In fact, he didn\u2019t return to examine Jones until 9:30 p.m. or later.\nAdditionally, no obstetrical nurse was monitoring Jones since Jones\u2019 nurse went on break around 8:20 p.m. and didn\u2019t return until 9:20 p.m. or later.\nThis led to a second breach \u2014 the failure of the staff to check the monitor strips and recognize a serious situation which began developing at about 8:50 p.m.\nStarting around 8:50 p.m., the monitor strips began showing a number of short, rapid contractions, which, Dr. Zatuchni said, indicated Jones was being hyperstimulated by the Pitocin. The baby\u2019s fetal heart monitor also began showing signs of late decelerations \u2014 a situation signaling that the baby\u2019s oxygen intake may be reduced.\nSince no trained personnel was keeping Jones under close observation, no one noticed or interpreted the monitor strips. Dr. Zatuchni testified a reasonably qualified obstetrical nurse, by checking the monitor strips, should have been able to recognize the signs of hyperstimulation of the mother and a pattern of late decelerations of the baby and responded by turning off the Pitocin and calling the doctor. The failure of the obstetrical nurses at Chicago Osteopathic Hospital to make personal observation of Jones from 8:20 p.m. until 9:20 p.m.; the failure of the obstetrical nurses to supervise the delivery of the Pitocin; the failure of the nurses to check the monitors regularly; and the failure of the nurses to notice and interpret the tracings from the monitors, detect the signs of a problem, and respond by turning off the Pitocin and calling a doctor, were all breaches of the standard of care for obstetrical nurses, said Dr. Zatuchni.\nThe hospital\u2019s doctors also breached the standard of care, said Dr. Zatuchni. A qualified physician should have recognized the signs of hyperstimulation and the baby\u2019s late decelerations from the monitor strips. The appropriate response would have been to shut off the Pitocin and begin intrauterine resuscitation measures. If the resuscitation measures did not correct the situation, a C-section should have been ordered.\nIn this case, Dr. Dedelow failed to anticipate the possibility of hyperstimulation after prolonged Pitocin induction, failed to monitor Jones, and, consequently, failed to observe and interpret the monitor strips. He was not present when Jones reported feeling a tearing sensation around 9 p.m. and, consequently, was unaware Jones, more than likely, experienced a uterine rupture at that time.\nA third breach, according to Dr. Zatuchni, was the failure to order a C-section earlier \u2014 sometime between 9:15 and 9:30 p.m. on March 4, 1994. In Dr. Zatuchni\u2019s opinion, when Dr. Dedelow examined Jones at 9:44 p.m., found her to be fully dilated, and told her to push, Jones had already experienced partial rupture of the uterus. When she began to push, there was further rupture, which led to the baby\u2019s bradycardia.\nWaiting until 9:44 p.m. to shut off the Pitocin and start intrauterine resuscitation measures, when bradycardia had already begun, said Dr. Zatuchni, breached the standard of care. Had Baby Andrew been delivered earlier, in response to the problems evident from the monitor strips, said Dr. Zatuchni, the prolonged period of severe hypoxia would have been avoided and the brain injury to Baby Andrew would have been prevented or greatly diminished. Waiting until 10:20 p.m. to perform the C-section, Dr. Zatuchni said, was a breach of the standard of care.\nIn summary, the hospital\u2019s breach of the standard of care was not limited to a single act or omission. It was the chain of events during the course of Jones\u2019 labor \u2014 a series of errors or omissions \u2014 which eventually led to Baby Andrew\u2019s injury. This chain of events began with the hospital\u2019s failure to provide Jones with a proper and necessary level of supervision by qualified obstetrical nurses and physicians at a critical period of her labor. Because Jones\u2019 labor was not closely monitored by trained, qualified obstetrical nurses and physicians, indications of hyperstimulation and fetal distress, which appeared on the monitor strips, were not observed or recognized. In turn, the failure to recognize these problems led to two things: one, the Pitocin was not discontinued, which led to uterine rupture; two, there was a delay in deciding to proceed to C-section, leading to a longer period of hypoxia for the fetus. In short, the hospital was not paying attention. As a result, Baby Andrew suffered severe brain damage.\nFinally, Dr. Zatuchni said, even if the hospital\u2019s staff had acted reasonably until 9:44 p.m., the delivery which occurred at 10:24 p.m. was not timely. Once bradycardia developed at 9:52 p.m., Dr. Zatuchni explained, delivery by forceps should have been attempted or a C-section should have been accomplished sooner. Under the attendant circumstances, a delivery within the 30-minute standard was not acceptable. An anesthesiologist, Dr. Zatuchni said, should have been available within five minutes.\nAlthough, on appeal, the hospital makes disparaging remarks about Dr. Zatuehni\u2019s credentials, the fact remains the trial court found him qualified as an expert witness. Furthermore, it is clear to this court Dr. Zatuchni\u2019s testimony, in conjunction with the other evidence, provides a solid basis for the jury\u2019s verdict against the hospital. See Witherell v. Weimer, 118 Ill. 2d 321, 337, 515 N.E.2d 68 (1987) (expert opinion held to a reasonable degree of medical certainty furnishes an adequate basis for jury\u2019s finding that causation was proved); Plooy v. Paryani, 275 Ill. App. 3d 1074, 657 N.E.2d 12 (1995) (causal connection between negligence and injury may be established by expert testimony regarding medical probabilities); Swaw v. Klompien, 168 Ill. App. 3d 705, 714, 522 N.E.2d 1267 (1988) (proximate cause established by expert testimony that injury was caused by treating doctor\u2019s failure to treat plaintiffs hematoma). Cases cited by the hospital, in which the expert testimony failed to show a causal connection between the breach and the injury, do not apply.\nWe find no error in the trial court\u2019s denial of the hospital\u2019s motions for judgment n.o.v. and new trial. The evidence, viewed in a light most favorable to the plaintiffs, does not overwhelmingly support the hospital. Nor does it appear to us that the jury\u2019s verdict is against the manifest weight of the evidence.\nTrial Errors\nA. Violations of in limine Orders\nThe trial court granted the hospital\u2019s motion in limine, barring plaintiffs from making any reference to Dr. Herbert\u2019s study on Prepidil or to the fact that Prepidil lacked Food and Drug Administration approval. At trial, after plaintiffs already informed the jury in opening argument and through the testimony of several witnesses that Jones had been included in Dr. Herbert\u2019s study, the hospital objected when, in cross-examining Dr. Herbert, plaintiffs asked whether the use of Prepidil contributed to a delay in Jones\u2019 labor and delivery.\nRuling on this belated objection, the trial court said: \u201cit is waived as to anything that\u2019s come out. I\u2019m not striking anything because you never objected or brought it up.\u201d The court, however, barred plaintiffs from making any further inquiry into the matter, saying, \u201cYou can argue what is out there, but you may not continue to question her in an area that\u2019s already been granted.\u201d\nAfter this ruling, the only other mention of Dr. Herbert\u2019s Prepidil study came when plaintiffs questioned defense expert, Dr. Zbaraz, about the possible side effects for both Prepidil and Pitocin. The hospital objected. The objection was overruled.\nThe hospital now argues it was prejudiced by plaintiffs\u2019 violation of the in limine order because mention of the study \u201csuggested to the jury that the Prepidil combined with the Pitocin to cause the uterine rupture and, worse, that the Hospital was more interested in using Jones as a guinea pig.\u201d Because an in limine order always remains subject to reconsideration by the court during trial, an in limine motion, whether granted or denied, does not preserve issues for review. Konieczny v. Kamin Builders, Inc., 304 Ill. App. 3d 131, 136, 709 N.E.2d 695 (1999). Failure to object to the evidence at trial forfeits the issue on appeal. Konieczny, 304 Ill. App. 3d at 136.\nFurthermore, violation of a motion in limine is not per se reversible error. See People v. Baptist, 76 Ill. 2d 19, 389 N.E.2d 1200 (1979). In order for a violation of an in limine order to serve as the basis for a new trial, the party seeking the exclusion of the evidence must have been deprived of a fair trial. See Kwon v. M.T.D. Products, Inc., 285 Ill. App. 3d 192, 673 N.E.2d 408 (1996).\nHere, plaintiffs violated the motion in limine. But we find no prejudice flowing from the violation. Several hospital witnesses testified Jones\u2019 inclusion in the study did not alter her treatment. In addition, plaintiffs\u2019 expert did not denounce the Prepidil study or the hospital\u2019s use of Prepidil to induce labor. Nor did plaintiffs attribute any breach of care to Jones\u2019 inclusion in the study. Plaintiffs theory of the case was that Jones\u2019 uterine rupture was caused by the extended use of Pitocin and had nothing to do with the Prepidil. Under these circumstances, the violation of the order did not deprive the hospital of a fair trial.\nAnother in limine order, this one barring \u201call physicians\u201d from saying how they personally would have handled a particular situation, was allegedly violated when plaintiff cross-examined a defense expert, Dr. Kirschbaum. But, at trial, when plaintiff asked Dr. Kirschbaum, based on his deposition testimony, whether it was his opinion that the C-section should have been called for five minutes earlier, the hospital objected only on the grounds that the question went beyond the scope of direct examination.\nEven if we ignore the fact that the hospital is raising a new theory on appeal, we find no error. Plaintiff did not ask Dr. Kirschbaum to say what he would have done but, whether, in his expert opinion, he believed the operation should have occurred sooner. This was part of plaintiffs theory of the case. Certainly, plaintiffs had the right to question a defense expert on the timing of the operation.\nB. Rulings on Motions in limine\nThe hospital claims the trial court erred when it granted plaintiffs\u2019 motion in limine barring Dr. Zbaraz from expressing the opinion that Jones\u2019 uterus ruptured because of an \u201cundetected cervical laceration.\u201d Our review of the record, however, convinces us this opinion was properly excluded since it was not based on any \u201cspecialized knowledge and experience and grounded in recognized medical thought.\u201d Dominguez v. St. John's Hospital, 260 Ill. App. 3d 591, 595, 632 N.E.2d 16 (1993).\nThe medical treatise cited by Dr. Zbaraz as support for his opinion \u2014 Williams Obstetrics \u2014 does not mention tears of the cervix as a possible cause for spontaneous uterine rupture and Dr. Zbaraz admitted he never before witnessed or reviewed a case where an undetected cervical laceration caused uterine rupture. There was no other offer of proof on this issue. Also, though Jones had given birth on three prior occasions, there was no evidence Jones had undergone any prior surgeries or procedures which might have caused such a tear. The doctor\u2019s conclusion was pure speculation. The trial court did not abuse its discretion by excluding this testimony.\nThe hospital was not left without any recourse. The trial court did not prevent defense experts from offering other opinions on the cause of Jones\u2019 uterine rupture. Dr. Zbaraz was allowed to testify the rupture occurred \u201cin the lower uterine segment, which is the weakest part of the uterus.\u201d He also told the jury, in accord with recognized medical authority, uterine rupture can be associated with prior uterine surgery or other procedures, which may weaken the walls of the uterus.\nNext, the hospital claims it was prejudiced when the trial court granted plaintiffs\u2019 motion in limine to bar Dr. Kirschbaum from testifying a subsequent incident at Michael Reese Hospital contributed to Baby Andrew\u2019s brain injury.\nAgain the record does not support the claim. The hospital voluntarily abandoned any objection to the motion when, at trial, defense counsel agreed Dr. Kirschbaum would not offer testimony about the Michael Reese incident.\nC. Closing Argument\nThe hospital alleges it was denied a fair trial when, during closing argument, plaintiffs\u2019 counsel made disparaging remarks about the hospital, incorrectly instructed the jury on the burden of proof, and told the jury there was a presumption of damages. There was no objection to these statements during plaintiffs\u2019 closing argument.\nGenerally, an attorney is given wide latitude during closing argument. Moore v. Centreville Township Hospital, 246 Ill. App. 3d 579, 616 N.E.2d 1321 (1993). In addition, failure to object to comments made during closing argument is considered a forfeiture of the error. Lewis v. Cotton Belt Route \u2014 St. Louis Southwestern Ry. Co., 217 Ill. App. 3d 94, 576 N.E.2d 918 (1991). Only when the comments constitute plain error may the court consider the claim of error in the absence of objection. Sutton v. Overcash, 251 Ill. App. 3d 737, 623 N.E.2d 820 (1993).\nIn this case, regardless of any forfeiture due to the hospital\u2019s failure to object, we find no error. The comments, viewed in context of the entire closing argument, were not improper.\nD. Admission of Evidence\nThe hospital claims the trial court erred on six occasions when it admitted or excluded certain testimony. We decline to conduct an individual examination of each claim. Let it suffice to say we have reviewed the record thoroughly and find no error in the trial court\u2019s decisions on the admission of evidence. See In re Estate of Hoover, 155 Ill. 2d 402, 615 N.E.2d 736 (1993) (A trial court\u2019s evidentiary ruling is a matter of discretion and will not be reversed absent a clear abuse of discretion).\nE. Jury Instructions\nThe hospital first contends the jury instructions and verdict form were flawed because they included, as an element of damages, \u201closs of normal life.\u201d The term \u201closs of normal life\u201d was introduced in Smith v. City of Evanston, 260 Ill. App. 3d 925, 631 N.E.2d 1269 (1994). In Smith, the trial court granted a new trial on damages, believing the jury had misunderstood the pattern instruction on disability. The appellate court affirmed, agreeing the jury had been confused by the pattern instruction. The remedy, said the court, was to substitute the term \u201closs of normal fife\u201d for \u201cdisability\u201d when instructing the jury at a new trial.\nAfter Smith, some courts adopted \u201closs of normal life\u201d as an element of damages without analysis. See Hearn v. American River Transportation Co., 303 Ill. App. 3d 619, 707 N.E.2d 1283 (1999) (damages for pain and suffering and loss of normal life were within limits of fair and reasonable); Lang v. Lake Shore Exhibits, Inc., 305 Ill. App. 3d 283, 290, 711 N.E.2d 1124 (1999) (verdict form included a category of \u201closs of normal life resulting from the injury\u201d which, the reviewing court said, is commonly understood to mean compensable damages for disability).\nBut in Torres v. Irving Press, Inc., 303 Ill. App. 3d 151, 707 N.E.2d 248 (1999), the court, in dicta, expressed displeasure with the Smith court\u2019s substitution of the term \u201closs of normal life\u201d for \u201cdisability\u201d and urged adherence to the recommended pattern jury instruction on \u201cdisability.\u201d The court said:\n\u201c[W]hat is a normal life? This is an exceedingly subjective standard which makes damages especially difficult to quantify.\u201d 303 111. App. 3d at 157.\nRecently, in Tornabene v. Paramedic Services of Illinois, Inc., 314 Ill. App. 3d 494, 502, 731 N.E.2d 965 (2000), we approved the view expressed in Torres:\n\u201cWe believe that Torres is an accurate statement of Illinois law. The trial court is directed to issue IPI Civil 3d No. 30.04, should the issue arise on remand.\u201d\nTornabene was decided after the jury trial in this case.\nIn the case before us, the following instruction was given:\n\u201cIf you decided for plaintiff on the survival claim, you must fix the amount of money which will reasonably and fairly compensate the estate for any of the following elements of damages proved by the evidence ***\nThe pain and suffering experienced.\nThe disability experienced.\nThe loss of normal life.\nThe medical expenses incurred.\nWhether any of these elements of damages has been proved by the evidence is for you to determine.\u201d\nOn the verdict form for the survival count, however, the term \u201closs of normal life\u201d was Usted instead of \u201cdisabiUty\u201d as an element of damages.\nThe term \u201closs of normal life\u201d has almost universally been interpreted as a component of disability which compensates for a change in the plaintiffs lifestyle. See Holston v. Sisters of the Third Order of St. Francis, 247 Ill. App. 3d 985, 1005, 618 N.E.2d 334 (1993) (disability damages include the loss of the enjoyment of life); Martin v. Cain, 219 Ill. App. 3d 110, 115, 578 N.E.2d 1161 (1991) (jury\u2019s failure to award disability damages was error since there was evidence plaintiffs lifestyle had been changed); Sands v. Glass, 267 Ill. App. 3d 45, 50, 640 N.E.2d 996 (1994) (jury ignored proven element of damages when it awarded nothing for disability despite clear evidence that plaintiffs Ufestyle had changed).\nIn Abbinante v. O\u2019Connell, 277 Ill. App. 3d 1046, 1052, 662 N.E.2d 126 (1996), the court said it was not an abuse of discretion for the trial court to have substituted a \u201closs of normal life\u201d instruction for the pattern disability instruction because the Smith court\u2019s definition of \u201closs of normal life\u201d as the diminished ability to enjoy the life previously experienced by the plaintiff \u201cwas more closely tailored to the evidence presented in this case than the [pattern] disability instruction.\u201d\nBaby Andrew\u2019s injury occurred at birth. There could have been no \u201clifestyle change\u201d since he never had experienced normal life before the injury occurred. Whether \u201clifestyle change\u201d is a necessary element of a \u201closs of normal life\u201d instruction is something we need not decide in this case. We find the trial court erred when it gave the jury a survival count damages instruction that included both \u201cdisability\u201d and \u201closs of normal life.\u201d We also find the survival count verdict form, which included loss of normal life but not disability, should not have been used.\nThe question remains whether the erroneous instruction and verdict form require reversal of the verdict and a new trial on damages. We believe reversal is not required.\n\u201cJury instructions are to be \u2018considered as a whole and where the jury has not been misled and the [complainant\u2019s] rights have not been prejudiced by minor irregularities, those alleged errors cannot serve as a basis for [error].\u2019 \u201d Konieczny v. Kamin Builders, Inc., 304 Ill. App. 3d 131, 137, 709 N.E.2d 695 (1999), quoting Zuelsdorf v. Montgomery Ward & Co., 64 Ill. App. 3d 408, 414, 380 N.E.2d 1130 (1978). Here, there can be no question that Baby Andrew suffered severe disabilities. The jury was not asked to compensate for \u201cdisability\u201d in addition to \u201closs of normal life\u201d on the verdict form. The award of $2 million would have been a reasonable award for disability. There was no double award. In the context of this case, we believe the jury reasonably understood \u201closs of normal life\u201d as the degree of disability Baby Andrew suffered as a result of the injury. Consequently, we find the substitution of the term \u201closs of normal life\u201d for \u201cdisability\u201d on the verdict form did not unfairly prejudice the hospital and does not warrant a new trial on damages.\nThe hospital next contends the father\u2019s and siblings\u2019 loss of society was not proven and, thus, the jury should not have been allowed to consider their loss as elements of the wrongful death action. Furthermore, says the hospital, the verdict form, which contained separate lines for listing the amount of damages to be awarded to the father and siblings, exacerbated the situation by suggesting damages should be awarded.\nWe do not agree the trial court erred by allowing the jury to consider the father\u2019s and siblings\u2019 loss of society as elements of damages. In Seef v. Sutkus, 145 Ill. 2d 336, 583 N.E.2d 510 (1991), our supreme court held a rebuttable presumption existed in favor of a parent\u2019s loss of society, even when the child is stillborn. Though the presumption does not extend to siblings, they may recover for the \u201cdeprivation of the companionship, guidance, advice, love and affection of the deceased,\u201d if this element of damages is proven. In re Estate of Finley, 151 Ill. 2d 95, 102, 601 N.E.2d 699 (1992). In this case, there was no direct testimony by the siblings about their relationship with Baby Andrew. Lack of direct testimony is not fatal, however, if there is other evidence from which the jury can determine loss of society damages. DeYoung v. Alpha Construction Co., 186 Ill. App. 3d 758, 770-71, 542 N.E.2d 859 (1989).\nIn this case we learned, through the testimony of Jones and her mother, that the family tried to maintain a bond with Baby Andrew, despite his limited ability to interact. There were occasions, they said, when the father and siblings accompanied Jones to the hospital and the Misericordia Home. Also, Baby Andrew was able to be with the family for Thanksgiving and Christmas. The trial court, when ruling on the posttrial motion, cited photographs which were made part of the record (though not part of the record on appeal), depicting Mr. Jones with Baby Andrew. Though the evidence was limited, there was some basis for allowing the jury to consider the siblings\u2019 loss of society as elements of the wrongful death action.\nThe jury, however, should not have been allowed to apportion the wrongful death damages, and separate lines for that purpose should not have been placed on the verdict form. Barry v. Owens-Coming Fiberglas Corp., 282 Ill. App. 3d 199, 205, 668 N.E.2d 8 (1996). The Wrongful Death Act (740 ILCS 180/0.01 et seq. (West 1996)) provides for distribution by the judge, based on a certain statutory formula. Barry, 282 Ill. App. 3d at 205.\nDespite this error, we conclude here, as we did in Barry, the erroneous verdict form does not warrant a new trial on damages. The verdict form, in addition to the separate lines, asked the jury to award a total amount. The record shows the trial court orally instructed the jury on the form, telling it \u201cany amount from \u2018zero to whatever\u2019 could be inserted in the individual blanks as long as the total amount was consistent.\u201d There is no evidence the separate lines inflated the overall award, especially since, as the trial court noted, the amounts awarded to the father and brothers was significantly less than the amount requested. In light of these facts, we find no support for the hospital\u2019s claim of prejudice stemming from the verdict form.\nF. Excessiveness of the Verdict\nThe hospital also contends the damages awarded on the wrongful death and survival claims are excessive and the product of passion and prejudice. It asks for a remittitur or a new trial on damages.\nAn award of damages is left \u201cto the sound, intelligent judgment, or good sense, of the jury.\u201d Antol v. Chavez-Pereda, 284 Ill. App. 3d 561, 571, 672 N.E.2d 320 (1996). A jury award should be reversed on appeal only if it is evident that the amount \u201cresulted from passion or prejudice, and that the amount falls outside the limits of fair and reasonable compensation and shocks the judicial conscience.\u201d Lundquist v. Nickels, 238 Ill. App. 3d 410, 435, 605 N.E.2d 1373 (1992). If a jury\u2019s award falls within the flexible range of conclusions reasonably supported by the evidence, it must stand. Chambers v. Rush-Presbyterian-St. Luke\u2019s Medical Center, 155 Ill. App. 3d 458, 468, 508 N.E.2d 426 (1987).\nIn light of the nature and extent of Baby Andrew\u2019s injuries, which he endured over the 18 months he survived, we cannot say the $4 million awarded Baby Andrew\u2019s estate in the survival action was excessive or the product of passion or prejudice. Nor can we say $2.2 million was not fair compensation for the family\u2019s loss of society. The evidence showed Marsha Jones to be a dedicated and devoted mother to Baby Andrew during his lifetime. Her loss of his future companionship, love, and affection can hardly be disputed. The father and siblings, too, were denied the opportunity of ever having a relationship with Andrew normally available to fathers and brothers.\nCONCLUSION\nFor the reasons stated, we affirm the judgment entered by the trial court.\nAffirmed.\nHALL, EJ., and BURKE, J., concur.\nAfter oral argument in this case Justice Cerda recused himself. He was replaced by Justice Hall, who fully participated in the preparation of this opinion.",
        "type": "majority",
        "author": "JUSTICE WOLFSON"
      }
    ],
    "attorneys": [
      "Robert Marc Chemers and Daniel G. Wills, both of Pretzel & Stouffer, Chtrd., and Nicholas A. Riewer and Leigh Handelman, both of Bollinger, Ru-berry & Garvey, both of Chicago, for appellant.",
      "Michael S. Baird, of Stotis & Baird, Chartered, of Chicago, for appellees."
    ],
    "corrections": "",
    "head_matter": "MARSHA JONES, Indiv. and as Special Adm\u2019r of the Estate of Andrew Jones, et al., Plaintiffs-Appellees, v. CHICAGO OSTEOPATHIC HOSPITAL, Defendant-Appellant.\nFirst District (3rd Division)\nNo. 1-99-2938\nOpinion filed September 20, 2000.\n\u2014 Rehearing denied November 1, 2000.\nRobert Marc Chemers and Daniel G. Wills, both of Pretzel & Stouffer, Chtrd., and Nicholas A. Riewer and Leigh Handelman, both of Bollinger, Ru-berry & Garvey, both of Chicago, for appellant.\nMichael S. Baird, of Stotis & Baird, Chartered, of Chicago, for appellees."
  },
  "file_name": "1121-01",
  "first_page_order": 1141,
  "last_page_order": 1158
}
