Title: Dillon v. Evanston Hospital

State: illinois

Issuer: Illinois Supreme Court

Document:

Docket No. 91517-Agenda 22-January 2002.
DIANE DILLON, Appellee, v. EVANSTON HOSPITAL et 
 								al., Appellants.
	JUSTICE FREEMAN delivered the opinion of the court:
	Plaintiff, Diane Dillon, brought a medical malpractice action
in the circuit court of Cook County against, inter alios, Evanston
Hospital (hereafter hospital) and Dr. Stephen Sener. A jury found
against these particular defendants and in favor of plaintiff. The
appellate court affirmed. No. 1-98-2893 (unpublished order under
Supreme Court Rule 23). We allowed the hospital and Dr. Sener's
petition for leave to appeal (177 Ill. 2d R. 315(a)). We now affirm
the judgments below in part and reverse in part, and remand the
cause to the trial court for a new trial solely on the issue of
damages for the increased risk of future injury.

BACKGROUND
	During the course of treatment for breast cancer, Dr. Sener
surgically inserted a catheter into a vein in plaintiff's upper chest
under the clavicle. He performed the insertion on April 20, 1989.
The purpose of the catheter was to provide a means to administer
chemotherapy and to draw blood without repeatedly inserting
needles into plaintiff's veins. The catheter inserted into plaintiff
was approximately 16 centimeters long.
	After plaintiff completed chemotherapy, the catheter ceased
to function, and on July 13, 1990, Dr. Sener removed it. However,
unbeknownst to plaintiff-or Dr. Sener-the catheter was not
removed in its entirety. Rather, Dr. Sener removed only a seven-centimeter portion of the catheter. A nine-centimeter catheter
fragment remained in plaintiff. She was not informed of any
abnormality despite the fact that she had a chest X ray taken at the
hospital in December 1990.
	In December 1991, plaintiff had a routine chest X ray taken at
a different hospital. The X ray revealed that the catheter fragment
had migrated to plaintiff's heart. The tip of the fragment is
embedded in the wall of the right atrium or the right ventricle. The
rest of the fragment is floating free in plaintiff's heart.
	Upon learning that the fragment was in her heart, plaintiff met
with Dr. Sener. He could not recall his specific actions in
removing the catheter from plaintiff. However, he acknowledged
that the fragment was in her heart. Based on the length of time that
the fragment had been there, Dr. Sener recommended that plaintiff
not attempt to remove it because several risks were attendant to
removal. For example, all or part of the fragment could escape and
travel further into the heart, making retrieval more difficult, or
removal could tear the heart wall. Dr. Sener opined that it would
be more dangerous to attempt to remove the catheter fragment
than it would be to leave it in place.
	Plaintiff sought opinions from other physicians; all but one
agreed with Dr. Sener. Based on the majority of medical opinion
she received, plaintiff decided to leave the catheter fragment in her
heart.
	Plaintiff filed a complaint for medical malpractice against Dr.
Sener, Dr. David Lim, who assisted in the insertion, the hospital,
and the catheter's manufacturer, Davol, Inc., a division of Bard,
Inc. (hereafter Davol). After the completion of pretrial
proceedings, the trial court entered summary judgment in favor of
Dr. Lim. Trial commenced on plaintiff's fifth amended complaint,
which named as additional defendants radiologist Dr. Ronald Port
and nurse Kathy Henderson.
	At the close of a trial, the jury found in favor of plaintiff and
against Dr. Sener and the hospital. However, the jury found in
favor of the remaining defendants. Dr. Sener and the hospital did
not present the jury with any special interrogatories to determine
on which basis the jury found defendants to have been negligent.
The jury awarded plaintiff $1.5 million for past pain and suffering,
$1.5 million for future pain and suffering, and $500,000 for the
increased risk of future injuries. Plaintiff had not sought
compensation for past or future medical expenses. Dr. Sener and
the hospital appealed.
	The appellate court affirmed, with one justice dissenting. No.
1-98-2893 (unpublished order under Supreme Court Rule 23). Dr.
Sener and the hospital appeal. Additional pertinent facts will be
discussed in the context of the issues raised in this appeal.

DISCUSSION
I. Fifth Amended Complaint: Negligent Insertion
	Dr. Sener and the hospital first contend that plaintiff's fifth
amended complaint was untimely.
	Plaintiff filed her original complaint on July 1, 1992. Count
I alleged that the hospital was negligent in (1) allowing the
catheter to be removed in a way that caused a portion to remain in
plaintiff, (2) failing to advise plaintiff of the fact that a portion of
the catheter remained in her, and (3) providing a defective
catheter. In count II, plaintiff alleged that Dr. Sener failed to
remove the catheter. Similarly, in count III, plaintiff alleged that
Dr. Sener's actions in not removing the entire catheter were
negligent. Notably, the original complaint contained no allegations
against Dr. Sener or the hospital that the insertion of the catheter
was negligent.
	Plaintiff attached to the original complaint a report of a
reviewing health professional. The report stated that the cause of
action was meritorious because, inter alia, the catheter was
improperly placed.
	On April 19, 1993, plaintiff filed a second amended complaint
adding a count against Dr. Lim, which alleged that he assisted in
plaintiff's surgery and that he negligently inserted the catheter. On
March 21, 1995, the trial court granted him summary judgment.
	Plaintiff continued to amend her original complaint
throughout the pretrial proceedings as discovery was being
conducted. In January 1994, Davol answered plaintiff's fourth
amended complaint. Davol asserted the affirmative defense that
plaintiff's injuries were proximately caused by the intervening and
superceding negligent acts as described in the reports of reviewing
health professionals attached to the fourth amended complaint.
One of those reports stated in part that the catheter had been
improperly placed. On September 6, 1996, plaintiff filed answers
to supplemental interrogatories regarding her expert witness, Dr.
Michael Blank. Dr. Blank had a new opinion after reviewing the
interrogatory answers of Davol, which disclosed opinions critical
of the catheter's insertion. According to Dr. Blank, if Dr. Sener
had inserted the catheter in the manner Davol asserted, then Dr.
Blank believed that Dr. Sener had deviated from the standard of
care in inserting the catheter, which ultimately resulted in the
catheter's fracture. On November 6, 1996, in supplemental
answers to interrogatories, plaintiff disclosed that Dr. Blank might
opine, based on his review of the X rays, that Dr. Sener negligently
inserted the catheter in an improper location that ultimately
resulted in the catheter's fracture.
	In May 1997, Davol disclosed that Dr. Paul Goldfarb would
testify to his opinion that the catheter was improperly inserted,
causing it to fracture as the result of repeated compression by the
clavicle as the catheter passed over the first rib.
	On November 17, 1997, plaintiff moved to file her fifth
amended complaint adding allegations that the catheter was
improperly inserted. The trial court allowed plaintiff leave to file
because the removal of the catheter was, according to the court, "a
completion of the same process" as the insertion. Plaintiff alleged
as follows. Counts I and II alleged that Dr. Sener and the hospital
negligently inspected, inserted, and removed the catheter; failed to
ascertain that the catheter fragment remained in plaintiff; and
failed to advise plaintiff that the fragment remained in her body.
Count III alleged that Dr. Sener's actions should be considered
negligent under the theory of res ipsa loquitur. Count IV alleged
that Davol negligently designed and manufactured the catheter;
count V alleged that Dr. Port failed to see the catheter fragment in
the December 1990 X ray; and count VI alleged that nurse
Henderson improperly maintained the catheter after its insertion
in plaintiff. Jury selection began the next day.
	Dr. Sener and the hospital contend that the trial court abused
its discretion in allowing plaintiff to file her fifth amended
complaint, containing the allegations of negligent insertion,
because it was not timely. In essence, they believe that plaintiff
had ample knowledge from the outset of the litigation that Dr.
Sener inserted the catheter and improperly waited until the eve of
trial to officially allege negligence regarding the catheter's
insertion. Plaintiff responds that Dr. Sener and the hospital cannot
complain because plaintiff presented several theories of
negligence, the jury returned a general verdict against them on the
negligence claim, and they failed to submit a special interrogatory
on any matter. Dr. Sener and the hospital in turn reply that we may
not consider plaintiff's defense because she did not raise it in the
appellate court.
	We may consider plaintiff's defense of the trial court's
judgment. An appellee in the appellate court may raise a ground in
this court which was not presented to the appellate court in order
to sustain the judgment of the trial court, as long as there is a
factual basis for it. Estate of Johnson v. Condell Memorial
Hospital, 119 Ill. 2d 496, 502 (1988); Hammond v. North
American Asbestos Corp., 97 Ill. 2d 195, 209 (1983).
	Count I of the fifth amended complaint alleged several
theories of negligence in addition to the theory of which Dr. Sener
and the hospital complain, i.e., negligent insertion. They have not
challenged the sufficiency of the evidence on any of those other
theories. Also, the jury returned a general verdict against them on
the negligence claim. Section 2-1201(d) of the Code of Civil
Procedure provides in pertinent part:
			"If several grounds of recovery are pleaded in support
of the same claim, whether in the same or different
counts, an entire verdict rendered for that claim shall not
be set aside or reversed for the reason that any ground is
defective, if one or more of the grounds is sufficient to
sustain the verdict ***." 735 ILCS 5/2-1201(d) (West
2000).
Because Dr. Sener and the hospital did not submit special
interrogatories, there is no way of knowing on what theory the jury
found defendants negligent. "When there is a general verdict and
more than one theory is presented, the verdict will be upheld if
there was sufficient evidence to sustain either theory, and the
defendant, having failed to request special interrogatories, cannot
complain." Witherell v. Weimer, 118 Ill. 2d 321, 329 (1987). We shall not set aside the verdict based on this contention. 


II. Res Ipsa Loquitur


	Dr. Sener and the hospital next contend that the trial court
erred in instructing the jury on plaintiff's theory of res ipsa
loquitur against Dr. Sener. As with the prior contention, plaintiff
defends the judgment by pointing to the jury verdict. The verdict
form shows that the jury returned separate verdicts in favor of
plaintiff against Dr. Sener on both negligence and res ipsa
loquitur. Because the evidence supports the verdict based on
negligence, we shall not set aside the verdict based on this
contention. See Miller v. DeWitt, 37 Ill. 2d 273, 286-87 (1967);
735 ILCS 5/2-1201(d) (West 2000).

III. Admission of Videotape
	Dr. Sener and the hospital contend that the trial court erred in
allowing the jury to view a videotape depicting a bacterial
infection in the heart that spread to the brain. The appellate court
concluded that the trial court's ruling was not an abuse of
discretion.
	Dr. Sener and the hospital bring this assignment of error to
this court. However, their three-paragraph argument does not
contain any authority. Supreme Court Rule 341(e)(7) provides that
a litigant's brief must contain citations to the relevant authority
supporting the argument on appeal. 188 Ill. 2d R. 341(e)(7). "A
court of review is entitled to have the issues clearly defined and to
be cited pertinent authority. A point not argued or supported by
citation to relevant authority fails to satisfy the requirements of
Rule 341(e)(7)." Canteen Corp. v. Department of Revenue, 123 Ill. 2d 95, 111-12 (1988); accord Kelley v. Kelley, 317 Ill. 104, 107
(1925). Although we could, in light of the violation of Rule
341(e)(7), consider this matter waived, we instead will exercise
our discretion in this matter and address the issue on the merits
since we can discern the question sought to be resolved. See
People ex rel. Carter v. Touchette, 5 Ill. 2d 303, 305 (1955);
People v. Jung, 192 Ill. 2d 1, 12-13 (2000) (Freeman, J., specially
concurring, joined by Miller and McMorrow, JJ.); Roberts v. Dow
Chemical Co., 244 Ill. App. 3d 253, 256 (1993).
	After reviewing the record, we hold that the trial court did not
abuse its discretion by admitting the videotape as demonstrative
evidence. Dr. David Snydman, qualified and board certified in
infectious diseases, testified that the video animation would be
helpful in explaining to the jury the general development of
endocarditis, a condition for which plaintiff is now at risk. He
clearly and specifically explained the relevant differences between
the type and location of infection depicted in the videotape and the
infection that plaintiff may suffer in the future, owing to the
presence of the catheter fragment. Further, Dr. Sener and the
hospital had the right and the opportunity to cross-examine Dr.
Snydman so as to assure that the videotape could not have misled
or confused the jury.

IV. Exclusion of Cumulative Testimony
	Dr. Sener and the hospital next contend that the trial court
erred in excluding as cumulative the testimony of one of their
experts, Dr. John Raaf. The record shows that during the court's
consideration of motions in limine, the court discussed generally
the problem of cumulative testimony and informed counsel for
both sides that the court would not entertain cumulative medical
testimony and would sustain objections to such testimony.
	Dr. Richard Vasquez testified as an expert on behalf of
defendants. Dr. Vasquez opined that Dr. Sener had met the
medically relevant standard of care.
	Dr. Sener and the hospital then called Dr. Raaf as an expert.
After listening to the equivalent of approximately 20 record pages
of testimony, the trial court called a sidebar to express concern
regarding Dr. Raaf's testimony. The court stated that if Dr. Raaf
was about to testify regarding the medical standard of care, then
that testimony would be cumulative. Defense counsel stated that
Dr. Raaf's testimony would go to the medical standard of care.
Defense counsel declined to make an offer of proof as to other
matters to which Dr. Raaf could testify. The court excused Dr.
Raaf and told the jury:
			"THE COURT: Folks, after talking with the lawyers, I
have-I have determined that the last witness, Dr. Raaf, his
testimony was going to be on similar topics to those we
have covered.
			So I've decided it would be more efficient on use of
your time if we move on to another topic, okay?
			THE JURY: Thank you."
The appellate court found no abuse of discretion.
	Initially, we note plaintiff's argument, in defense of the
judgment, that we are precluded from reviewing this contention
because Dr. Sener and the hospital failed to make an offer of
proof. When a trial court excludes evidence, no appealable issue
remains unless a formal offer of proof is made. The failure to do
so results in a waiver of the issue on appeal. The purpose of an
offer of proof is to inform the trial court, opposing counsel, and a
reviewing court of the nature and substance of the evidence sought
to be introduced. However, an offer of proof is not required where
it is apparent that the trial court clearly understood the nature and
character of the evidence sought to be introduced. People v.
Peeples, 155 Ill. 2d 422, 457-58 (1993); see also In re A.M., 274
Ill. App. 3d 702, 709 (1995); M. Graham, Cleary & Graham's
Handbook of Illinois Evidence §103.7, at 23-24 (7th ed. 1999). In
this case, an offer of proof was not required because the trial court
understood that Dr. Raaf would testify as to the medical standard
of care. See First National Bank of Mount Prospect v. Village of
Mount Prospect, 197 Ill. App. 3d 855, 864-65 (1990) (offer of
proof unnecessary where expert's opinion testimony was obvious).
	Turning to the merits, the exclusion of cumulative evidence
is within the discretion of the trial court, whose ruling will not be
reversed absent a clear abuse of that discretion. Kozasa v.
Guardian Electric Manufacturing Co., 99 Ill. App. 3d 669, 678
(1981) (collecting cases). This discretion includes limiting the
number of expert witnesses. See Yassin v. Certified Grocers of
Illinois, 150 Ill. App. 3d 1052, 1061 (1986); M. Graham, Cleary
& Graham's Handbook of Illinois Evidence §403.1, at 192 (7th ed.
1999).
	Dr. Sener and the hospital note that plaintiff and Davol were
allowed to present several expert witnesses to criticize various
aspects of Dr. Sener's conduct, while he and the hospital could
present only one. They posit: "It is common knowledge that in
medical malpractice cases, each side presents two or three expert
witnesses to support the conduct or criticize the conduct of the
Defendant." They assert that "[t]he abuse of discretion in this case
is the uneven treatment of the parties."
	We cannot accept this contention. As in the appellate court,
Dr. Sener and the hospital do not indicate how the evidence that
Dr. Raaf would have presented, i.e., his opinion that Dr. Sener had
met the medically relevant standard of care, was not cumulative to
the testimony of Dr. Vasquez. Nor have they shown that the expert
testimony that plaintiff and Davol presented was in any way
cumulative. Further, Dr. Sener and the hospital presented several
experts and treating physicians, who testified on various aspects
of the case for the defense. We uphold the ruling of the trial court.

V. Damages: Increased Risk of Future Injury
	Dr. Sener and the hospital next contend that the trial court
erred in instructing the jury that it could award plaintiff damages
for "[t]he increased risk of future injuries." Plaintiff's argument to
the contrary notwithstanding, we note that this issue was
adequately preserved for appellate review.
	There was evidence presented at trial establishing the
proximate causal connection between the actions of Dr. Sener and
the hospital and the catheter fragment becoming embedded in
plaintiff's heart. On medical advice, plaintiff chose not to attempt
removal of the fragment. All the expert witnesses but one believed
that the risks of injury from an attempted removal of the fragment
outweighed the risks that would exist if the catheter remained in
the heart. The attendant risks of the catheter remaining were
infection, perforation of the heart, arrhythmia, embolization, and
further migration of the fragment. At the time of trial, plaintiff had
not suffered from any of these conditions, although she did suffer
from anxiety over the fragment's presence.
	The evidence was that it was not reasonably certain that
plaintiff would in the future suffer the injuries for which she was
at risk due to the fragment's presence in her heart. Several
physicians testified about the risk of infection, with the lowest
estimated risk being close to zero and the highest being 20%. The
risk of arrhythmia was less than 5%. The risks of perforation and
migration were also small. The risk of embolization was low to
nonexistent.
	The jury instruction that addressed compensation for
plaintiff's increased risks stated in relevant part:
			"If you decide for the plaintiff on the question of
liability, you must then fix the amount of money which
will reasonably and fairly compensate her for any of the
following elements of damages proved by the evidence to
have resulted from the negligence of one or more of the
defendants, taking into consideration the nature, extent,
and duration of the injury:
			The increased risk of future injuries.
			The pain and suffering experienced and reasonably
certain to be experienced in the future as a result of the
injuries." (Emphasis added.)
This instruction was a modified combination of Illinois Pattern
Jury Instructions, Civil, No. 30.01 and No. 30.05 (3d ed. 1995).
The modification was the addition of the italicized sentence on the
increased risk of future injuries. There is no Illinois pattern jury
instruction for that element of damages.
	The jury awarded plaintiff $500,000 for her increased risk of
future injuries. The appellate court upheld the award, holding that
the trial court did not err in instructing the jury that plaintiff could
be compensated for the increased risk of future harm.
	This court has historically rejected assessing damages for
future injuries. This court has explained: "It would be plainly
unjust to require a defendant to pay damages for results that may
or may not ensue and that are merely problematical. To justify a
recovery for future damages the law requires proof of a reasonable
certainty that they will be endured in the future." Amann v.
Chicago Consolidated Traction Co., 243 Ill. 263, 267 (1909). In
1922, this court reiterated this position in Stevens v. Illinois
Central R.R. Co., 306 Ill. 370, 377 (1922).
	Based on the principles noted in Amann and Stevens, some
panels of our appellate court have denied recovery for an increased
risk of future injury that is not reasonably certain to occur. See,
e.g., Wehmeier v. UNR Industries, Inc., 213 Ill. App. 3d 6, 33-34
(1991). However, other panels of our appellate court have allowed
compensation for an increased risk of future injury,
notwithstanding the improbability of the injury's occurrence. See,
e.g., Jeffers v. Weinger, 132 Ill. App. 3d 877, 884 (1985) (finding
"that whether there is a 1% possibility [of plaintiff losing her foot]
or a 99% possibility, each is an element of damage which should
be considered by the jury"). The rationale of those decisions
allowing recovery is that "the increased risk is itself a present
injury which should be as compensable as any other present
injury." Anderson v. Golden, 279 Ill. App. 3d 398, 400 (1996);
accord Harp v. Illinois Central Gulf R.R. Co., 55 Ill. App. 3d 822,
827 (1977). In light of the above, a divergence of authority exists
in Illinois whether a plaintiff may recover damages for the
increased risk of future injuries.
	Cases such as Stevens and Amann and the decisions of our
appellate court which adhere to them represent the majority view:
			"The traditional American rule *** is that recovery of
damages based on future consequences may be had only
if such consequences are 'reasonably certain.' Recovery
of damages for speculative or conjectural future
consequences is not permitted. To meet the 'reasonably
certain' standard, courts have generally required plaintiffs
to prove that it is more likely than not (a greater than 50%
chance) that the projected consequence will occur. If such
proof is made, the alleged future effect may be treated as
certain to happen and the injured party may be awarded
full compensation for it; if the proof does not establish a
greater than 50% chance, the injured party's award must
be limited to damages for harm already manifest." Wilson
v. Johns-Manville Sales Corp., 684 F.2d 111, 119 (D.C.
Cir. 1982).
Accord 2 D. Dobbs, Remedies §8.1(7), at 407 (2d ed. 1993); J.
King, Causation, Valuation, and Chance in Personal Injury Torts
Involving Preexisting Conditions and Future Consequences, 90
Yale  L.J. 1353, 1370-72 (1981); Note, Damages Contingent Upon
Chance, 18 Rutgers L. Rev. 875, 876 (1964) (all-or-nothing
approach "is the majority rule in the United States"). As one court
has explained: "In evaluating damages in a tort action, a trier is
concerned with reasonable probabilities, not with possibilities."
Healy v. White, 173 Conn. 438, 443, 378 A.2d 540, 544 (1977),
overruled, Petriello v. Kalman, 215 Conn. 377, 576 A.2d 474
(1990). "[A] consequence of an injury which is possible, which
may possibly ensue, is a risk which the injured person must bear
because the law cannot be administered so as to do reasonably
efficient justice if conjecture and speculation are to be used as a
measure of damages. On the other hand, a consequence which
stands on the plane of reasonable probability, although it is not
certain to occur, may be considered in the evaluation of the
damage claim against the defendant. In this way, to the extent that
men can achieve justice through general rules, a just balance of the
warring interests is accomplished." Budden v. Goldstein, 43 N.J.
Super. 340, 347, 128 A.2d 730, 734 (1957).
	Not all jurisdictions follow the majority rule. For example, in
Petriello v. Kalman, 215 Conn. 377, 576 A.2d 474 (1990), the
Supreme Court of Connecticut provided an analysis that revealed
the problems inherent with the majority approach. That court
criticized the "all-or-nothing" approach as follows:
		"In essence, if a plaintiff can prove that there exists a 51
percent chance that his injury is permanent or that future
injury will result, he may receive full compensation for
that injury as if it were a certainty. If, however, the
plaintiff establishes only a 49 percent chance of such a
consequence, he may recover nothing for the risk to which
he is presently exposed. Although this all or nothing view
has been adopted by a majority of courts faced with the
issue, the concept has been severely criticized by
numerous commentators. By denying any compensation
unless a plaintiff proves that a future consequence is more
likely to occur than not, courts have created a system in
which a significant number of persons receive
compensation for future consequences that never occur
and, conversely, a significant number of persons receive
no compensation at all for consequences that later ensue
from risks not rising to the level of probability. This
system is inconsistent with the goal of compensating tort
victims fairly for all the consequences of the injuries they
have sustained, while avoiding, so far as possible,
windfall awards for consequences that never happen."
Petriello, 215 Conn. at 393-94, 576 A.2d  at 482-83.
Accord DePass v. United States, 721 F.2d 203, 208 (7th Cir. 1983)
(Posner, J., dissenting) ("A tortfeasor should not get off scot-free
because instead of killing his victim outright he inflicts an injury
that is likely though not certain to shorten the victim's life"); 90
Yale L.J. at 1376-81 (criticizing all-or-nothing approach as
arbitrary); 2 G. Boston, Stein on Personal Injury Damages §9:16,
at 9-31 through 9-32 (3d ed. 1997) (same). 
	We believe that the split of authority in our appellate court
compels us to revisit this issue and reexamine our holdings in
Amann and Stevens. Our review of cases from other jurisdictions
indicates a trend toward allowing compensation for increased risk
of future injury as long as it can be shown to a reasonable degree
of certainty that the defendant's wrongdoing created the increased
risk. Anderson, 279 Ill. App. 3d at 400 (citing cases); see also
United States v. Anderson, 669 A.2d 73 (Del. 1995); 2 J. Nates, C.
Kimball, D. Axelrod & R. Goldstein, Damages in Tort Actions
§13.02 (2001); 2 G. Boston, Stein on Personal Injury Damages
§9:16, at 9-30 (3d ed. 1997) ("Compensation should be given for
the fact of increased susceptibility"). This reasoning shows that
"[t]he primary motivation of the courts for permitting damages for
such an injury is fairness." 2 J. Nates, C. Kimball, D. Axelrod &
R. Goldstein, Damages in Tort Actions §13.02, at 13-8 (2001).
Further, based on the principle of single recovery, "[o]ur legal
system provides no opportunity for a second look at a damage
award so that it may be revised with the benefit of hindsight."
Petriello, 215 Conn. at 395, 576 A.2d  at 483. 
	Based on this reasoning, the appellate court in this case relied
on the appellate court's decision in Anderson. There, the court
stated that where a defendant's negligence causes a plaintiff to
suffer a present injury, the plaintiff is entitled to compensation for
the full extent of the injury. If a defendant's negligence places a
plaintiff at greater risk of sustaining future injuries than if the
negligence had not occurred, the appellate court saw " 'no
legitimate reason why [the plaintiff] should not receive present
compensation based upon the likelihood of the risk becoming a
reality.' " Anderson, 279 Ill. App. 3d at 401, quoting Petriello, 215
Conn. at 396, 576 A.2d  at 483. The Anderson court held that a
plaintiff who has competent evidence which shows that a
defendant has negligently caused her to bear the burden of an
increased risk of future injury may present evidence of the
increased risk as an element of present damages.
	The Anderson court further noted that the treatment of an
increased risk of future injury as a present injury does not run
afoul of the general rule that possible future damages are not
compensable absent evidence that such damages are reasonably
certain to occur. The court reasoned that this rule stems from the
principle that damages may not be awarded on the basis of
speculation or conjecture. An award of damages for an increased
risk of future injury is proper only if it can be shown to a
reasonable degree of certainty that the risk was proximately caused
by the defendant's negligence. Therefore, there is no element of
speculation or conjecture in awarding damages for increased risks.
Anderson, 279 Ill. App. 3d at 400-01.
	Like the court in Anderson, we also believe that the
Connecticut court's approach to this issue better comports with
this state's principle of single recovery. An entire claim arising
from a single tort cannot be divided and be the subject of several
actions, regardless of whether or not the plaintiff has recovered all
that he or she might have recovered. This is true even as to
prospective damages. There cannot be successive actions brought
for a single tort as damages in the future are suffered, but the one
action must embrace prospective as well as accrued damages.
Mason v. Parker, 295 Ill. App. 3d 1096, 1098 (1998), quoting
Radosta v. Chrysler Corp., 110 Ill. App. 3d 1066, 1068-69 (1982);
accord 1 D. Dobbs, Remedies §3.1, at 277-78 (2d ed. 1993) ("The
damages remedy is not conditional, and it is not payable
periodically as loss accrues unless a statute so provides. So the
damages award is traditionally made once, in a lump sum to
compensate for all the relevant injuries, past and future"). Indeed,
this court long ago so held in the specific context of a medical
malpractice action. See Howell v. Goodrich, 69 Ill. 556, 559-60
(1873) ("For such a cause of action *** there can not be
successive suits brought from time to time, as damages may in the
future be suffered, but the recovery is once for all, and may
embrace prospective as well as accrued damages").
	The single recovery principle requires that all damages, future
as well as past, must be presented and considered at the time of
trial. "This in turn faces the tribunal with the difficult and
uncertain task of prophecy, with no chance for second-guessing
where the prophecy turns out to be mistaken, or where the parties
have failed to present all items of their claims." 4 F. Harper, F.
James, & O. Gray, Torts §25.2, at 498 (2d ed. 1986).
	Also, this court has previously held in a different context:
			"There is nothing novel about requiring health care
professionals to compensate patients who are negligently
injured while in their care. To the extent a plaintiff's
chance of recovery or survival is lessened by the
malpractice, he or she should be able to present evidence
to a jury that the defendant's malpractice, to a reasonable
degree of medical certainty, proximately caused the
increased risk of harm or lost chance of recovery. We
therefore reject the reasoning of cases which hold, as a
matter of law, that plaintiffs may not recover for medical
malpractice injuries if they are unable to prove that they
would have enjoyed a greater than 50% chance of survival
or recovery absent the alleged malpractice of the
defendant. [Citations.] To hold otherwise would free
health care providers from legal responsibility for even
the grossest acts of negligence, as long as the patient upon
whom the malpractice was performed already suffered an
illness or injury that could be quantified by experts as
affording that patient less than a 50% chance of
recovering his or her health." Holton v. Memorial
Hospital, 176 Ill. 2d 95, 119 (1997).
The theories of lost chance of recovery and increased risk of future
injury have similar theoretical underpinnings. See Anderson, 669
A.2d at 75-76; 2 D. Dobbs, Remedies §8.1(7), at 408 (2d ed.
1993).
	We realize that our decision to recognize damages for the
increased risk of future injury is at odds with our previous
holdings in Stevens and Amann. However, we note that those cases
are over 80 years old, and that scientific advances now enable the
medical community to more accurately determine the probability
of future injuries than in the past. The risk therefore of undue
speculation is lessened. We further note that the split in our
appellate court has caused mixed results in cases such as this,
where some parties recovered compensation, while others did not.
Fairness requires that this court speak to this issue definitively.
Having reviewed all of the authorities on this issue, we believe our
decision will provide needed stability in this matter for the bench
and the bar.
	Accordingly, we hold simply that a plaintiff must be permitted
to recover for all demonstrated injuries. The burden is on the
plaintiff to prove that the defendant's negligence increased the
plaintiff's risk of future injuries. A plaintiff can obtain
compensation for a future injury that is not reasonably certain to
occur, but the compensation would reflect the low probability of
occurrence. See Feist v. Sears, Roebuck & Co., 267 Or. 402, 410,
517 P.2d 675, 679 (1973) (" 'Admittedly the probability of
[plaintiff] getting epileptic seizures is low and it should be
weighed by the jury accordingly' "), quoting Schwegel v.
Goldberg, 209 Pa. Super. 280, 287-88, 228 A.2d 405, 409 (1967).
This "fits comfortably within traditional damage calculation
methods." Anderson, 669 A.2d  at 78, citing Petriello, 215 Conn.
at 397-98, 576 A.2d  at 484; accord 2 G. Boston, Stein on Personal
Injury Damages §9:16, at 9-30 through 9-31 (3d ed. 1997) (stating
that the solution is not in denying recovery, but in "letting the jury
determine on a common sense basis the amount of damages which
will reasonably compensate the plaintiff"). "The defendant's
proper remedy lies in objecting to the excessiveness of the verdict
in an appropriate case." 2 J. Nates, C. Kimball, D. Axelrod & R.
Goldstein, Damages in Tort Actions §13.02, at 13-9 (2001).
	Having determined that this element of damages is
compensable, we now consider whether the jury was properly
instructed thereon. The record shows that Dr. Sener and the
hospital failed to object with specificity to the form of the
instruction and to offer their own versions thereof. Accordingly,
we could consider this issue waived for appellate review. See 155
Ill. 2d R. 366(b)(2)(i); Deal v. Byford, 127 Ill. 2d 192, 203 (1989).
	However, the waiver rule is a principle of administrative
convenience, an admonition to the parties; it is not a jurisdictional
requirement or any limitation upon the jurisdiction of a reviewing
court. In this regard, this court has recognized that a reviewing
court may, in furtherance of its responsibility to provide a just
result and to maintain a sound and uniform body of precedent,
override considerations of waiver that stem from the adversarial
nature of our system. In re C.R.H., 163 Ill. 2d 263, 274 (1994);
Hux v. Raben, 38 Ill. 2d 223, 224-25 (1967); accord 155 Ill. 2d R.
366(a)(5). In this case, for reasons which we will explain, we
deem that this responsibility outweighs the waiver by Dr. Sener
and the hospital. See, e.g., Welch v. Johnson, 147 Ill. 2d 40, 48
(1992); American Federation of State, County & Municipal
Employees, Council 31 v. County of Cook, 145 Ill. 2d 475, 480
(1991).
	In Illinois, the parties are entitled to have the jury instructed
on the issues presented, the principles of law to be applied, and the
necessary facts to be proved to support its verdict. The decision to
give or deny an instruction is within the trial court's discretion.
The standard for determining an abuse of discretion is whether,
taken as a whole, the instructions are sufficiently clear so as not to
mislead and whether they fairly and correctly state the law. See
Magna Trust Co. v. Illinois Central R.R. Co., 313 Ill. App. 3d 375,
388 (2000); accord Korpalski v. Lyman, 114 Ill. App. 3d 563, 568
(1983).
	In this case, there is no pattern jury instruction on the
increased risk of future injury as an element of damages.
Accordingly, this is a situation where our pattern instructions are
inadequate and additional instruction is appropriate. See Balestri
v. Terminal Freight Cooperative Ass'n, 76 Ill. 2d 451, 454-55
(1979). Under Supreme Court Rule 239(a) (177 Ill. 2d R. 239(a)),
a nonpattern instruction is permissible if it is simple, brief,
impartial, and nonargumentative. Where a unique factual situation,
or a point of law, is presented, a nonpattern instruction may be
given if it is accurate and will have no improper effect on the jury.
Magna Trust, 313 Ill. App. 3d at 388.
	Applying these principles to this case, we conclude that the
instruction which the jury received on this element of damages did
not adequately state the law. We earlier quoted the jury's
instruction on damages, which included the following description
of this element: "The increased risk of future injuries."
	This instruction fails to instruct the jury on several important
legal requirements, e.g., the increased risk must be based on
evidence and not speculation, and, more importantly, the size of
the award must reflect the probability of occurrence. For example,
as a result of Petriello, Connecticut Civil Jury Instruction No.
2-40(c) was promulgated:
			"Damages-Compensation for Increased Risk of Injury
			***
			The plaintiff claims that he/she has suffered an
increased risk of [alleged future complication] as a result
of the defendant's negligence. The plaintiff is entitled to
recover damages for physical harm resulting from a
failure to exercise reasonable care. If the failure to
exercise reasonable care increases the risk that such harm
will occur in the future, the plaintiff is entitled to
compensation for the increased risk. In order to award this
element of damages, you must find a breach of duty that
was a substantial factor in causing a present injury which
has resulted in an increased risk of future harm. The
increased risk must have a basis in the evidence. Your
verdict must not be based on speculation. The plaintiff is
entitled to compensation to the extent that the future harm
is likely to occur as measured by multiplying the total
compensation to which the plaintiff would be entitled if
the harm in question were certain to occur by the proven
probability that the harm in question will in fact occur."
(Emphasis added.)
	In the present case, the instruction given failed to convey the
principles of law expressed in the italicized portion of the
Connecticut instruction. While not prescribing its use verbatim,
we hold that the essence of this instruction fairly and correctly
states the law on this element of damages.
	Our responsibility to provide a just result requires reversal on
this issue. The partial dissent, pointing to the dictionary meaning
of "risk," concludes that the jury instruction given in this case
"was sufficient to describe the type of assessment the jury was
required to make." Slip op. at 21 (Harrison, C.J., concurring in
part and dissenting in part).
	However, it must be remembered that juries are composed of
laypersons who are not trained to separate issues and to disregard
irrelevant matters. That is the purpose of jury instructions. The
function of jury instructions is to convey to the jury the correct
principles of law applicable to the submitted evidence and, as a
result, jury instructions must state the law fairly and distinctly and
must not mislead the jury or prejudice a party. See Ono v. Chicago
Park District, 235 Ill. App. 3d 383, 386 (1992); Pry v. Alton &
Southern Ry. Co., 233 Ill. App. 3d 197, 214 (1992); Fravel v.
Morenz, 151 Ill. App. 3d 42, 45 (1986). In the context of this
issue, reliance on a dictionary is inadequate to fulfill this purpose.
	Our responsibility to maintain a sound and uniform body of
precedent likewise requires reversal on this issue. As we earlier
noted, today's decision represents a departure from the previous
holdings of this court. There was a split of authority in the
appellate court over whether the increased risk of future injury was
compensable as an element of damages. Further, those appellate
court decisions that allowed recovery did not discuss the form of
the instruction. We have now definitively spoken to this issue. A
retrial, in which a jury may apply the correct legal principles to the
submitted evidence, is appropriate to maintain a sound and
uniform body of precedent.
	The jury in this case was inadequately instructed on the
increased risk of future injury as an element of damages.
Accordingly, we reverse plaintiff's damages award for the
increased risk of future injury, and remand the cause to the trial
court for a new trial solely on that element of damages.

CONCLUSION
	For the foregoing reasons, the judgments of the circuit and
appellate courts are affirmed in part and reversed in part, and the
cause remanded to the circuit court of Cook County for further
proceedings consistent with this opinion.
Appellate court affirmed in part
and reversed in part;
circuit court affirmed in part
and reversed in part;
cause remanded.


	CHIEF JUSTICE HARRISON, concurring in part and
dissenting in part:


	The appellate court's judgment affirming the judgment of the
circuit court should be upheld without qualification. Contrary to
my colleagues, I would not remand for a new trial on the element
of damages for increased risk of future injuries. The damages
instruction tendered by plaintiff was adequate as given. Although
my colleagues are quite right that the jury's assessment of
increased risk must be based on evidence, not speculation, that is
true of every element of damages. Indeed, it is true of every
element of plaintiff's cause of action.
	Juries are told this at the outset of their deliberations. Illinois
Pattern Jury Instructions, Civil, No. 1.01(3) (1995), specifically
cautions the jury that its verdict "must be based on evidence and
not upon speculation, guess or conjecture." We do not require this
caveat to be repeated in the instructions governing the other
aspects of a plaintiff's claim, and there is no reason to require such
repetition with respect to a plaintiff's claim for damages based on
increased risk of future injuries.
	I am also unpersuaded by the majority's contention that the
damages instruction tendered in this case failed to adequately
apprise the jury that the size of its award for increased risk of
future injuries must reflect the probability that such injuries will
occur. The instruction was specifically phrased in terms of "risk."
By definition, risk includes "the product of the amount that may be
lost and the probability of losing it." Webster's Third New
International Dictionary 1961 (1986). Accordingly, the charge to
the jury here was sufficient to describe the type of assessment the
jury was required to make.
	Even if the revisions to the instruction proposed by my
colleagues would have been helpful to the jury, that is not an
adequate basis under the law for disturbing the jury's verdict. In
assessing the sufficiency of the jury's instructions, the issue is not
whether our court could have phrased the instructions in a better
way. It is whether the instructions given, considered as a whole
and read as a series, were sufficiently clear so as not to mislead the
jury and whether they fairly and correctly stated principles of law
which pertain to the case. See Eaves v. Hyster Co., 244 Ill. App.
3d 260, 262 (1993).
	If the defendants in this case believed that the wording in the
instruction on damages was incorrect, incomplete, or otherwise
inadequate, it was their duty to object to that instruction and to
offer their own remedial versions. Deal v. Byford, 127 Ill. 2d 192,
203 (1989). They did not do so. In the trial court, defendants'
objection was that the issue of increased risk of future injuries
should not be presented to the jury at all. Defendants did not take
issue with the way that issue was set forth in the instruction
tendered by plaintiff, and defense counsel declined an express
invitation by the trial judge to propose alternative language. Under
these circumstances, any claim of error with respect to the wording
of the instruction has been waived. See Diaz v. Chicago Transit
Authority, 174 Ill. App. 3d 396, 401-02 (1988).
	In all other respects, I am in complete accord with the
majority's disposition.