Title: Simmons v. Garces

State: illinois

Issuer: Illinois Supreme Court

Document:

Docket No. 91093-Agenda 33-September 2001.
JENNIFER SIMMONS et al., Appellants, v. ROLANDO M.
GARCES, M.D., Appellee.
Opinion filed January 25, 2002.

	JUSTICE McMORROW delivered the opinion of the court:
	In this appeal we are asked to determine whether the jury's
answer to a special interrogatory is incompatible with the jury's
general verdict, and, if so, whether the special interrogatory
controls. A jury returned a general verdict in the amount of
$675,000 against defendant Dr. Rolando M. Garces and in favor
of plaintiffs Jennifer Simmons (Jennifer) and Harold King
(Harold), who had brought a medical malpractice action against
Dr. Garces following the death of their infant daughter, LaTonya
King. The jury also answered "No" to the special interrogatory:
"Did dehydration contribute to cause the death of LaTonya King?"
As a result, in response to Dr. Garces' post-trial motion, the circuit
court of Cook County entered judgment in favor of Dr. Garces on
the special interrogatory. 735 ILCS 5/2-1108 (West 2000). A
divided appellate court affirmed, concluding that the jury's answer
to the special interrogatory was "absolutely irreconcilable with the
general verdict" and the trial court therefore "properly entered
judgment in favor of defendant." 319 Ill. App. 3d 308, 322. We
allowed plaintiffs' petition for leave to appeal. 188 Ill. 2d R. 315.
For the reasons set forth below, we affirm the judgment of the
appellate court.

BACKGROUND
	LaTonya King(1) was born prematurely to Jennifer on
December 28, 1993, and was hospitalized for two weeks
thereafter. On January 21, 1994, Jennifer brought LaTonya to Dr.
Garces' clinic for a checkup. The child's weight was five pounds,
12 ounces, and Dr. Garces pronounced her a perfectly healthy
baby.
	Dr. Garces practiced in a clinic at 7106 South Jeffery in
Chicago, about a block and a half from Jennifer and Harold's
residence at 7234 South Jeffery. The clinic operated on a first-come, first-served basis. Patients would sign in when they entered
the clinic, and would be seen by the doctor in that order. Dr.
Garces had two assistants, Sharon Robinson (Sharon), a certified
medical assistant, and Shalonda Sloan (Shalonda), an 18-year-old
with no formal training in patient care. One of the responsibilities
of the assistants was to notify the doctor if a patient presented an
emergency. If that were the case, the doctor would see the patient
out of turn.
	Jennifer testified that LaTonya took her normal feeding of
four ounces of formula on the night of January 23, 1994. The next
morning, January 24, Jennifer noticed loose stool in LaTonya's
diaper when the child awoke for her feeding. Jennifer denied at
trial that LaTonya took four ounces of formula at this 6 a.m.
feeding, but was impeached with her deposition testimony to the
contrary. At 8:30 a.m. LaTonya took two ounces of water.
However, she would not take her 10 a.m. feeding, and Jennifer
became concerned. She called Dr. Garces' clinic and spoke to the
doctor, informing him of the situation, and he told her to switch to
a formula called Pedialyte. Jennifer tried to feed LaTonya the
Pedialyte, but the child would take only half an ounce.
	At 12:30 p.m. Jennifer again telephoned the clinic and spoke
to Sharon, who told her she should keep trying to get LaTonya to
take the Pedialyte. Jennifer's subsequent attempts to feed LaTonya
the formula were unsuccessful. At that point Jennifer dressed the
baby warmly and walked to the clinic, arriving at about 1 p.m.
After about 15 minutes, Shalonda called Jennifer's name and they
went to a waiting area, where Jennifer told Shalonda that LaTonya
was not sucking the bottle. Shalonda testified that she weighed and
measured LaTonya, and wrote the child's height, weight,
temperature and head circumference in a temporary chart. She
used a temporary chart because she was unable to retrieve
LaTonya's permanent chart. Shalonda then left the waiting area
and went to speak to the doctor. According to Jennifer, when
Shalonda returned, she told Jennifer that Dr. Garces wanted her to
get some Pedialyte from a drug store. Jennifer then left the clinic
and went across the street to the drug store, picked up the
Pedialyte, and went home. She stated that she left the office
because she was following the doctor's orders to obtain the
Pedialyte.
	Jennifer tried repeatedly that afternoon to feed LaTonya the
formula but to no avail. She called the clinic at 2:29 p.m. and at
2:53 p.m., each time speaking to Sharon, who told her to continue
her efforts. During the second of these calls, Jennifer told Sharon
that LaTonya was sleeping more. At 3:56 p.m. Jennifer called the
clinic again and spoke to Dr. Garces, who told her to try a different
formula and if that did not work, to take LaTonya to the
emergency room. Dr. Garces said he was concerned that LaTonya
might become dehydrated. Soon after, at about 4:13 p.m., Jennifer
called a cab. She testified that she waited inside her apartment for
it to arrive, dressed the baby warmly, and then took the cab to
South Shore Hospital.
	Dr. Thomas Bahk, an emergency room physician at South
Shore, testified that LaTonya was dead when she arrived at the
emergency room at about 4:40 p.m. She had no respiration, no
blood pressure, and no pulse. He and the emergency room nurses
performed cardiopulmonary resuscitation but were unable to
revive her. She was pronounced dead at 5:06 p.m. on January 24,
1994.
	Marcel Parungao, an emergency room nurse, testified that the
baby's rectal temperature at that time was 93.2 degrees Fahrenheit,
and her weight was five pounds, eight ounces. He also found loose
stool in her diaper. Myrna Carating, another nurse, testified that
LaTonya was wearing a diaper and pajamas, and was wrapped in
two receiving blankets that were "quite thin." According to
Carating, Jennifer told her that LaTonya had been active at 2:30
p.m. Carating also recorded that just prior to Jennifer's and
LaTonya's arrival at the emergency room, LaTonya had stiffened,
her arms had stretched, and her neck was hyperextended.
	Chicago Police Officers Charles Howard and Paul Anderson
went to the hospital on January 24 after receiving a call about
LaTonya's death. Anderson testified that Jennifer indicated she
walked to the hospital. Howard gave essentially the same
testimony, stating that a report prepared after they had gone to the
scene indicated that Jennifer walked to the hospital on January 24.
Under cross-examination, Howard and Anderson conceded that
this report was not signed by a supervisor.
	Between 5 and 6 p.m., Chicago police department Detectives
John McMurray and David Friel were assigned to investigate
LaTonya's death. After arriving at the hospital, they interviewed
hospital staff members as well as Jennifer and Harold. Friel stated
that they learned from Jennifer that she arrived at the hospital by
taxi. Friel and McMurray closed their investigation after
determining that there had been no criminal wrongdoing.
	Dr. Tae Lyong An, a forensic pathologist with the Cook
County medical examiner's office, conducted an autopsy.
According to Dr. An, LaTonya's death was caused by
"dehydration due to gastroenteritis." LaTonya had sunken eyeballs
and poor skin turgor,(2) or tension, both of which, according to Dr.
An, are consistent with dehydration. Under cross-examination, Dr.
An conceded that premature babies can be born without fully
developed subcutaneous tissue and fat, and thus could have sunken
eyeballs without being dehydrated. In addition, premature infants
can have excess skin that would appear wrinkly and have less
tension. Dr. An also acknowledged that there was just a four-ounce difference between the weight recorded for LaTonya on
January 21 (5 pounds, 12 ounces), and her weight on January 24
in the emergency room (5 pounds, 8 ounces). That is a weight loss
of 4.4%, which Dr. An conceded would be unlikely to cause death
by dehydration. He also acknowledged that his report included no
finding of tubular necrosis in the kidneys, a condition that is
consistent with death by severe dehydration, nor did he find any
anatomic or pathologic evidence of inflammation in the stomach
or small intestine, a condition that constitutes the definition of
gastroenteritis. Dr. An explained that there is such a thing as
"functional change of the intestine" which, though not
anatomically found, can cause diarrhea. "We call it
gastroenteritis," he said. "That is nothing unusual."
	Dr. An also testified that he did not think there was any
evidence of hypothermia as a possible cause of death. He said he
had information that Jennifer took LaTonya to the hospital by taxi.
He did not remember that Jennifer walked to the hospital.
	Jennifer and Harold, acting individually and as co-special
administrators of LaTonya's estate, brought a wrongful-death
action against Dr. Garces, alleging that LaTonya's death was a
proximate result of Dr. Garces' negligence. Attached to the
complaint was a physician's report asserting that LaTonya "died
from dehydration."
	Plaintiffs presented the expert testimony of Dr. Gilbert Given,
a board-certified pediatrician, to establish that Dr. Garces deviated
from the applicable standard of care and that his negligent conduct
resulted in LaTonya's death from dehydration. Dr. Given testified
that, in his opinion, LaTonya "was severely dehydrated and this
contributed to her death." He said dehydration, which he defined
as a loss of body fluids,(3) is determined by the percent of weight
loss. A loss in body weight of more than 10% or 12% usually
indicates severe dehydration. In such instances, the child's
circulation becomes involved, and the child may have lower blood
pressure. According to Dr. Given, LaTonya was 12% to 14%
dehydrated, based on a comparison of her weight on January 21,
1994 (5 pounds, 12 ounces), and her weight at autopsy, which Dr.
Given said was about 5 pounds. The appropriate treatment in
LaTonya's case would have been "hospitalization and IV fluids." 	Dr. Given opined that Dr. Garces' failure to see LaTonya and
intervene on January 24 amounted to negligence which contributed
to the child's death. According to Dr. Given, "more likely than
not, if Dr. Garces had intervened with appropriate IV fluids
[LaTonya] would not have died."
	On direct examination, Dr. Given was asked about
inconsistencies in evidence he had reviewed. He responded that
there were "numerous" inconsistencies, "[e]ven to the point of
how the baby got to the hospital. It was noted by one officer that
the mom took a cab. Someone else noted that the mom walked."
	Dr. Given conceded on cross-examination that the medical
examiner's report included no findings of tubular necrosis of the
kidneys, nor did it include any findings of inflammation of the
stomach, the large intestine or the small intestine. The report also
did not mention the exact number of times LaTonya had diarrhea,
nor did it describe LaTonya's input of fluid prior to her death. As
far as Dr. Given knew, no one made any determination as to the
amount of fluids LaTonya took in or expelled "during this illness."
	He also acknowledged that he did not know to a reasonable
degree of medical certainty the exact extent of the dehydration that
LaTonya suffered. "How dehydrated the child, the baby, was, I
don't know," Dr. Given said.
	Dr. Garces denied that he was negligent, and denied that any
claimed act or omission on his part was a proximate cause of
plaintiffs' claimed injuries. He presented expert testimony to
establish that LaTonya's death was not caused by dehydration but
rather that it resulted from hypothermia, or possibly from
suffocation.
	Dr. Michael Kaufman, who was certified in anatomic
pathology and cytopathology, testified that he found no significant
evidence in the medical records or the autopsy report to indicate
that LaTonya died from dehydration. He opined instead that the
cause of death was hypothermia, or possibly suffocation. He noted
that LaTonya's weight had changed by only 4.4% from January 21
until the time she was weighed in the emergency room on January
24 "just at the point of death." Such a weight loss, he said, is
"insignificant" and insufficient to cause or contribute to cause
death by dehydration.
	Dr. Kaufman also noted that there was no indication of any
elevation in the levels of blood urea nitrogen, sodium or
creatinine. This, he said, was inconsistent with death due to
dehydration. In addition, the gross and microscopic findings in the
autopsy report showed no evidence of gastroenteritis. The autopsy
report also included no reference to any findings of acute tubular
necrosis, which Dr. Kaufman said was inconsistent with severe
dehydration.
	According to Dr. Kaufman, the most likely cause of death was
hypothermia. He noted that LaTonya's temperature as recorded in
the emergency room on January 24 was 93.2 degrees, which he
termed "markedly depressed." In order for death to result from
hypothermia, which is defined as a subnormal body temperature,
it must be of a significant enough degree that it alters the normal
body metabolism and creates an abnormal heart rhythm. Dr.
Kaufman said he found nothing in LaTonya's autopsy report that
was inconsistent with a death by hypothermia.
	Dr. William Wittert, a board-certified pediatrician, also
testified for the defense. Dr. Wittert opined that LaTonya did not
die of dehydration. He noted that, according to the record
testimony, LaTonya took four ounces of fluid between 9 and 10
p.m. on January 23, another four ounces at 6 a.m. on January 24,
and two ounces at 8:30 a.m., plus a half ounce of Pedialyte later in
the morning. At the same time, there were only two references to
output in terms of stool: the loose stool that Jennifer said she
found in the diaper at 6 a.m., and the loose stool found in
LaTonya's diaper at the emergency room. According to Dr.
Wittert, these inputs and outputs of fluid are inconsistent with
dehydration. He noted, in addition, that LaTonya's weight loss
from January 21 to January 24 was only four ounces, or about
4.34%. Such a weight loss could represent mild dehydration but is
not life-threatening. Even if the weight loss were as high as 10%,
"babies should not die from that level of dehydration."
	As to other possible causes of LaTonya's death, Dr. Wittert
said he did not have an opinion to a reasonable degree of medical
certainty as to what caused her death. However, he pointed to the
child's 93.2 degree temperature, which he described as "very low."
Most babies, he said, would probably survive that temperature, but
LaTonya was small and preterm, and in her case this temperature
might have contributed to or caused her death. He also said the
child might have suffocated.
	Dr. Wittert also opined that Dr. Garces and his staff possessed
the requisite skill and met the applicable standard of care in this
case. According to Dr. Wittert, nothing that Dr. Garces did caused
harm to LaTonya.
	The instructions to the jury stated plaintiffs' claims as
follows: Dr. Garces was negligent on the day of LaTonya's death
by (a) failing to examine LaTonya after Jennifer brought her to the
clinic when he should have known that the child was experiencing
diarrhea, drowsiness, and the inability to suck;(4) (b) failing to
follow up by taking phone calls from Jennifer, when he should
have known of LaTonya's symptoms; (c) failing to refer LaTonya
to a physician or hospital for examination, diagnosis, or IV
treatment when he knew or should have known of her symptoms;
or (d) permitting his staff to provide inappropriate medical advice
or decisions over the phone. The jury was instructed that it must
not decide the question of professional negligence based on
personal experience but only from expert testimony.
	The parties disagreed as to which instruction should be given
for proximate cause, with plaintiffs arguing for the long form of
Illinois pattern instruction No. 15.01, and defendant urging the
short form. See Illinois Pattern Jury Instructions, Civil, No. 15.01
(2000). The trial court agreed to give the long form, which stated
that:
			"When I use the expression 'proximate cause,' I mean
any cause which, in natural or probable sequence,
produced the injury complained of. It need not be the only
cause, nor the last or nearest cause. It is sufficient if it
concurs with some other cause acting at the same time,
which in combination with it, causes the injury." Illinois
Pattern Jury Instructions, Civil, No. 15.01 (2000).
	Once the court agreed to give the long-form instruction,
defendant argued that a special interrogatory was needed in order
for the jury to determine specifically whether dehydration caused
LaTonya's death. According to defendant's counsel, if the jury
determined that dehydration was not involved in LaTonya's death,
then Dr. Garces could not be liable because "[t]hat's their whole
case."
	Plaintiffs' counsel objected, arguing that the jury had heard
evidence of a variety of causes of death, and that it would be
prejudicial to plaintiffs to "make it very narrow" with this special
interrogatory. According to counsel, the jury might think that
LaTonya's death was the result of a combination of causes. The
court asked, "What if they think it's suffocation?" Plaintiffs'
counsel answered: "[I]f [the jurors] think it's suffocation, there's
been no testimony from the plaintiffs that suffocation would make
the doctor responsible, so they wouldn't even get to this. They
would be on Verdict Form B [in favor of Dr. Garces]."
	The court suggested that a more appropriate interrogatory to
test the jury's verdict would be: "Did dehydration contribute to
cause the death of LaTonya King?" The court gave this
interrogatory over plaintiffs' objection.
	During their deliberations, the jury sent out a note asking three
questions:
			"(1) If we have already decided on Form A or Form B,
what is the purpose of the dehydration form?
			(2) Is the dehydration form mandatory?
			(3) Do we have to be unanimous on the dehydration
form?"
	The court's response to the first question was: "It is the law."
The court answered "Yes" to both the second and third questions.
	A short time later, the jury returned its verdict, finding in
favor of plaintiffs in the amount of $675,000. The jury answered
the special interrogatory in the negative. Defense counsel moved
for entry of judgment in favor of Dr. Garces on the basis of the
inconsistency.
	After allowing the parties to brief the issue, the court entered
judgment on the special finding in favor of defendant, rejecting
plaintiffs' argument that the jury's special finding was not
absolutely irreconcilable with the general verdict. The court stated:
		"[P]laintiffs concede their liability expert determined that
dehydration at least contributed to LaTonya's death. The
plaintiffs during the trial presented only one causation
expert and no other theory or mechanism for death that
was independent of dehydration. This Court finds that the
special finding was absolutely irreconcilable with the
general verdict."
	Plaintiffs appealed, and the appellate court affirmed. In
reaching this decision, the appellate court stated:
			"Plaintiffs presented no expert testimony to establish
any other causation of death but dehydration. ***
			When the jury was asked to focus its attention on the
particularized question of whether dehydration
contributed to cause LaTonya's death, it answered 'No.'
Plaintiffs' attempt to establish a causal connection
between defendant's negligence and LaTonya's death then
failed for lack of expert testimony.
			*** [T]here is no reasonable hypothesis remaining on
which to reconcile the jury's answer to the special
interrogatory with the general verdict. The trial court
properly entered judgment on the special interrogatory."
319 Ill. App. 3d at 317-18.
	We allowed plaintiffs' petition for leave to appeal. 188 Ill. 2d
R. 315.

ANALYSIS
	Plaintiffs' main argument before this court is that the jury's
special finding was not irreconcilable with the general verdict, and
therefore the trial court should have entered judgment on the
general verdict and not on the special finding. According to
plaintiffs, the central issue here is not whether LaTonya died of
dehydration, but rather whether Dr. Garces was negligent and
whether his negligence was a proximate cause of LaTonya's death.
Plaintiffs contend that regardless of the medical cause of death,
LaTonya would be alive today were it not for Dr. Garces'
negligence in failing to examine LaTonya and refer her to an
emergency room in the early afternoon on January 24. Thus it was
not inconsistent for the jury to find Dr. Garces liable for
LaTonya's death and at the same time conclude that dehydration
did not contribute to cause her death. Plaintiffs argue in the
alternative that the jury's special finding was against the manifest
weight of the evidence. They also contend that the special
interrogatory should not have been given because it was confusing
and not in proper form.
	Plaintiffs additionally point to various instances of alleged
misconduct on the part of defense counsel that they assert deprived
them of a fair trial. They also claim that the trial court erred in
admitting certain evidence and barring other evidence, and in
refusing to give a missing-evidence instruction.
	Special interrogatories are governed by section 2-1108 of the
Code of Civil Procedure, which states:
			"Unless the nature of the case requires otherwise, the
jury shall render a general verdict. The jury may be
required by the court, and must be required on request of
any party, to find specially upon any material question or
questions of fact submitted to the jury in writing. Special
interrogatories shall be tendered, objected to, ruled upon
and submitted to the jury as in the case of instructions.
Submitting or refusing to submit a question of fact to the
jury may be reviewed on appeal, as a ruling on a question
of law. When the special finding of fact is inconsistent
with the general verdict, the former controls the latter and
the court may enter judgment accordingly." 735 ILCS
5/2-1108 (West 2000).
	A special interrogatory serves "as guardian of the integrity of
a general verdict in a civil jury trial." O'Connell v. City of
Chicago, 285 Ill. App. 3d 459, 460 (1996). It tests the general
verdict against the jury's determination as to one or more specific
issues of ultimate fact. Noel v. Jones, 177 Ill. App. 3d 773, 783
(1988); Gasbarra v. St. James Hospital, 85 Ill. App. 3d 32, 38
(1979). A special interrogatory is in proper form if (1) it relates to
an ultimate issue of fact upon which the rights of the parties
depend, and (2) an answer responsive thereto is inconsistent with
some general verdict that might be returned. Noel, 177 Ill. App. 3d
at 783; Gasbarra, 85 Ill. App. 3d at 38. Special findings are
inconsistent with a general verdict only where they are "clearly
and absolutely irreconcilable with the general verdict." Powell v.
State Farm Fire & Casualty Co., 243 Ill. App. 3d 577, 581 (1993).
If a special interrogatory does not cover all the issues submitted to
the jury and a "reasonable hypothesis" exists that allows the
special finding to be construed consistently with the general
verdict, they are not "absolutely irreconcilable" and the special
finding will not control. Powell, 243 Ill. App. 3d at 581. In
determining whether answers to special interrogatories are
inconsistent with a general verdict, all reasonable presumptions are
exercised in favor of the general verdict. Bilderback v. Admiral
Co., 227 Ill. App. 3d 268, 270 (1992).
	We conclude that the jury's special finding in the instant case
is "absolutely irreconcilable" with the general verdict. As noted,
the jury answered "No" to the special interrogatory: "Did
dehydration contribute to cause the death of LaTonya King?"
Plaintiffs based their entire case on the theory that Dr. Garces'
negligence caused LaTonya's death by allowing her to become
severely dehydrated. If, as the jury concluded, dehydration did not
contribute to cause LaTonya's death, then the necessary link
between Dr. Garces' alleged negligence and LaTonya's death is
missing, and he could not be found liable. The special finding thus
is irreconcilable with the general verdict in favor of plaintiffs and
against Dr. Garces.
	As in every negligence case, plaintiffs here needed to establish
more than the standard of care and a deviation from that standard.
They also were required to show a casual connection between the
deviation and the injury, in this case LaTonya's death. Evanston
Hospital v. Crane, 254 Ill. App. 3d 435, 441 (1993). In a medical
malpractice case, proximate cause must be established by expert
testimony to a reasonable degree of medical certainty. Aguilera v.
Mount Sinai Hospital Medical Center, 293 Ill. App. 3d 967, 972
(1997); accord Townsend v. University of Chicago Hospitals, 318
Ill. App. 3d 406, 413 (2000).
	Plaintiffs here presented the testimony of one expert, Dr.
Given, who opined that LaTonya was severely dehydrated and that
this contributed to her death. According to Dr. Given, it was more
likely than not that LaTonya would have survived if Dr. Garces
had intervened with appropriate IV fluids.
	As the appellate court below correctly noted, plaintiffs
presented no expert testimony establishing any cause of death
other than dehydration. In addition, while defendant's experts did
suggest other possible causes, i.e., hypothermia and suffocation,
plaintiff's attorney disputed these theories in closing argument.
Moreover, the trial record reveals no expert testimony establishing
that Dr. Garces would have been to blame if LaTonya died from
either of these other causes. Plaintiffs' counsel conceded as much
when, in arguing against the giving of the special interrogatory, he
stated that if the jury thought LaTonya died of suffocation, "there's
been no testimony from the plaintiffs that suffocation would make
the doctor responsible, so [the jurors] wouldn't even get to this.
They would be on verdict form B [in favor of Dr. Garces]." Absent
expert testimony linking Dr. Garces' conduct to death by
hypothermia or suffocation, and given the jury's rejection of
dehydration as a cause of death, there is no reasonable hypothesis
remaining on which to reconcile the jury's special finding with the
general verdict.
	Notwithstanding the foregoing, plaintiffs argue that it does not
matter whether LaTonya died of dehydration or some other
specific medical cause. What is important, they contend, is that
LaTonya was ill and Dr. Garces failed to examine and treat her
accordingly, thus proximately causing her death. Hence there is no
inconsistency between the jury's finding that dehydration was not
a cause of LaTonya's death, and the general verdict in favor of
plaintiffs and against Dr. Garces. Plaintiffs assert that:
		"It is irrefutable that had Dr. Garces seen LaTonya and
referred her to an emergency room for care as he should
have in the early afternoon [of January 24], she would be
alive today. The hypothermia and suffocation speculation
about the medical cause of death that the defense
presented does not make a difference in a legal causation
analysis; had proper care been given, LaTonya would not
have been in a position to become hypothermic or have
accidentally suffocated."
	The gist of this argument appears to be that, regardless of the
specific cause of death, Dr. Garces had a duty to examine LaTonya
and refer her to an emergency room for care. If LaTonya had been
sent to an emergency room in the early afternoon on January 24,
she would not have been in a position to become hypothermic or
suffocate on the way to the hospital later that day.
	This argument lacks merit. It is well settled that two distinct
requirements must be met in order to establish proximate cause.
The defendant's conduct must be shown to be an actual cause of
the plaintiff's injury, and it must be a legal cause as well. Lee v.
Chicago Transit Authority, 152 Ill. 2d 432, 455 (1992); Nelson v.
Thomas, 282 Ill. App. 3d 818, 828 (1996). Actual cause, or cause
in fact, can be established only where "there is a reasonable
certainty that a defendant's acts caused the injury or damage." Lee,
152 Ill. 2d  at 455. A defendant's acts are a legal cause only if they
are "so closely tied to the plaintiff's injury that he should be held
legally responsible for it." McCraw v. Cegielski, 287 Ill. App. 3d
871, 873 (1996). A determination as to legal cause is "a policy
decision that limits how far a defendant's legal responsibility
should be extended for conduct that, in fact, caused the harm."
Lee, 152 Ill. 2d  at 455.
	In the instant case, even if we were to conclude, which we do
not, that Dr. Garces' failure to examine LaTonya and refer her to
an emergency room was an actual cause of LaTonya's death, this
would not establish that his conduct proximately caused her death.
It would still have to be shown that Dr. Garces' conduct was a
legal cause. However, this cannot be so, given the facts in this
case. As noted, the only cause of death linked by expert testimony
to Dr. Garces' conduct was dehydration. See Aguilera, 293 Ill.
App. 3d at 972; Townsend, 318 Ill. App. 3d at 413. Accordingly,
if the cause of death were anything other than dehydration, Dr.
Garces could not be held legally responsible. The link to his
conduct would simply be too attenuated to support a judgment of
liability. Cf. Lee, 152 Ill. 2d  at 455; McCraw, 287 Ill. App. 3d at
873.
	Plaintiffs rely upon Cohen v. Sager, 2 Ill. App. 3d 1018
(1971), and Bilderback v. Admiral Co., 227 Ill. App. 3d 268
(1992), for support of their contention that the special
interrogatory in the instant case was not irreconcilable with the
general verdict. In both Cohen and Bilderback, a general verdict
was found to have addressed issues not covered by special
findings, and there was thus no inconsistency. Plaintiffs' reliance
upon these cases is misplaced.
	In Cohen, the plaintiff claimed she suffered injuries when the
automobile in which she was a passenger was struck by the
defendant's vehicle. The jury returned a general verdict in favor of
the defendant, but found in response to special interrogatories that
inclement weather and icy conditions were not the proximate
cause of the accident, and that the defendant was guilty of
negligence that contributed to cause the accident. The trial court
entered judgment in favor of the plaintiff on the special findings,
which it ruled were inconsistent with the general verdict. The
appellate court reversed, holding that the special findings "did not
exclude every reasonable hypothesis consistent with the general
verdict" (Cohen, 2 Ill. App. 3d at 1020), and there was thus no
inconsistency. According to the court, the jury could have found,
consistent with the general verdict, that "while the defendant was
negligent in causing the collision, no injury was suffered or that
[the plaintiff's] injury was not proximately caused by the
defendant's negligence." Cohen, 2 Ill. App. 3d at 1021.
	In Bilderback, where the plaintiff alleged that he was fired in
retaliation for seeking workers' compensation benefits, the jury
returned a general verdict in favor of the plaintiff, but found in
response to special interrogatories that his discharge had been
recommended and authorized on the belief that the plaintiff had
shoved a supervisor and given false information to the company
nurse. The trial court agreed with the defendant that the special
findings were inconsistent with the general verdict, and it therefore
entered judgment in favor of the defendant. The appellate court
reversed, holding that the general verdict addressed an issue that
was not determined by the special findings, and there was thus no
inconsistency. According to the court, the jury found in its general
verdict that the actual reason for the plaintiff's discharge was that
he was pursuing workers' compensation benefits. There were no
special interrogatories asking this specific question, and the
interrogatories that were given "d[id] not establish that anything
else was the actual reason" for the discharge. Bilderback, 227 Ill.
App. 3d at 271.
	In the instant case, unlike Cohen and Bilderback, the issue
addressed by the special interrogatory was not peripheral but rather
was an ultimate question of fact upon which the rights of the
parties depended: "Did dehydration contribute to cause the death
of LaTonya King?" See Noel, 177 Ill. App. 3d at 783. Because
dehydration was the only cause of death linked by expert
testimony to Dr. Garces' conduct, the jury's negative answer to
this interrogatory effectively eliminated any other "reasonable
hypothesis" that might have reconciled the special finding with the
general verdict. See Powell, 243 Ill. App. 3d at 581. The special
finding removed from consideration the only cause of death that,
based on the evidence presented at trial, could be proximately
connected to Dr. Garces' conduct. Any other basis for the general
verdict postulating a different cause or causes would lack the
requisite causal connection to Dr. Garces. The general verdict and
the special finding in the instant case are absolutely irreconcilable.
	Plaintiffs argue in the alternative that the special interrogatory
is against the manifest weight of the evidence. According to
plaintiffs, the evidence in support of dehydration as the cause of
death was "overwhelming," and "[n]o other legitimate
explanations for LaTonya's death were submitted to the jury." We
disagree.
	" 'A verdict is against the manifest weight of the evidence
where the opposite conclusion is clearly evident or where the
findings of the jury are unreasonable, arbitrary and not based upon
any of the evidence.' " Maple v. Gustafson, 151 Ill. 2d 445, 454
(1992), quoting Villa v. Crown Cork & Seal Co., 202 Ill. App. 3d
1082, 1089 (1990). In the instant case, contrary to plaintiffs'
contentions, there was ample expert testimony to support the
special finding that dehydration did not contribute to cause
LaTonya's death.
	Dr. Kaufman, one of defendant's experts, testified that he
found no significant evidence in the medical records or the autopsy
report to indicate that LaTonya died of dehydration. He noted that
LaTonya's weight had dropped by only 4.4% from January 21
until the time she was weighed in the hospital emergency room on
January 24 "just at the point of death." Such a weight loss, he said,
is "insignificant" and insufficient to cause or contribute to cause
death by dehydration. In addition, there was no indication of any
elevation in the levels of blood urea nitrogen, sodium or
creatinine. This, Dr. Kaufman said, was inconsistent with death
due to dehydration. The gross and microscopic findings in the
autopsy report showed no evidence of gastroenteritis, which Dr.
An, the medical examiner, asserted had led to dehydration in this
case. The autopsy report also included no findings of acute tubular
necrosis, which Dr. Kaufman said was inconsistent with severe
dehydration.
	Dr. Kaufman's testimony also provided an alternative cause
of death, hypothermia, that was unrelated to defendant's alleged
negligence. Dr. Kaufman noted that LaTonya's temperature as
recorded in the emergency room on January 24 was 93.2 degrees,
which he described as "markedly depressed." He said he found
nothing in LaTonya's autopsy report that was inconsistent with
death by hypothermia.
	Dr. Wittert, another of defendant's experts, stated that "[t]his
child did not die from dehydration." He noted that, according to
the record testimony, LaTonya took in some 10½ ounces of fluid
during the period prior to her death, but there were only two
references to output in terms of stool: the loose stool in her diaper
at 6 a.m. on January 24, and the loose stool found in her diaper
later in the day at the emergency room. According to Dr. Wittert,
these inputs and outputs of fluid were inconsistent with
dehydration. He also testified that the weight loss recorded for her
between January 21 and January 24 could represent mild
dehydration but was not life-threatening. Even if the weight loss
were as high as 10%, Dr. Wittert said, "babies should not die from
that level of dehydration."
	Plaintiffs' expert, Dr. Given, conceded on cross-examination
that the medical examiner's report included no findings of tubular
necrosis, nor did it include any findings of inflammation of the
stomach, the large intestine or the small intestine. He also
conceded that he did not know, to a reasonable degree of medical
certainty, the exact extent of the dehydration that LaTonya
suffered.
	The jury had ample expert evidence on which to base a special
finding that dehydration did not contribute to cause LaTonya's
death. Given this evidence, we cannot say that the opposite
conclusion was clearly evident, or that the special finding was
unreasonable, arbitrary, and not based upon any of the evidence.
See Maple, 151 Ill. 2d  at 454. We agree with the trial and appellate
courts below that the special finding here was not against the
manifest weight of the evidence.
	 Plaintiffs also contend that the special interrogatory should
not have been given in the first instance because it was confusing
and not in proper form. Again, we disagree.
	As noted, a special interrogatory is in proper form if (1) it
relates to an ultimate issue of fact upon which the rights of the
parties depend, and (2) an answer responsive thereto is
inconsistent with some general verdict that might be returned.
Noel, 177 Ill. App. 3d at 783; Gasbarra, 85 Ill. App. 3d at 38. In
addition, it should be a single question, stated in terms that are
simple, unambiguous, and understandable; it should not be
repetitive, confusing, or misleading. Snyder v. Curran Township,
281 Ill. App. 3d 56, 61 (1996). It need not contain all of the
elements of negligence and is proper if it focuses on one element
that is dispositive of the claim. Snyder, 281 Ill. App. 3d at 60-61.
A special interrogatory is to be read in context with the court's
other instructions to determine how it was understood and whether
the jury was confused. LaPook v. City of Chicago, 211 Ill. App. 3d
856, 866 (1991); Morton v. City of Chicago, 286 Ill. App. 3d 444,
451 (1997). A trial court may not conclude from the mere fact of
inconsistency between a general verdict and a special interrogatory
that the jury was confused by the interrogatory. Blakey v. Gilbane
Building Corp., 303 Ill. App. 3d 872, 882 (1999). To do so would
nullify the provision of section 2-1108 of the Code of Civil
Procedure (735 ILCS 5/2-1108 (West 2000)) that states that a
special interrogatory controls where there is inconsistency. Blakey,
303 Ill. App. 3d at 882, citing Borries v. Z. Frank, Inc., 37 Ill. 2d 263, 266 (1967).
	The special interrogatory in the instant case is in proper form
and is not confusing. It asks a single, straightforward question
relating to an ultimate issue of fact upon which the rights of the
parties depend: whether dehydration contributed to cause
LaTonya's death.
	Interrogatories similar to that in the instant case were upheld
in Costa v. Dresser Industries, Inc., 268 Ill. App. 3d 1 (1994), and
Bluestein v. Upjohn Co., 102 Ill. App. 3d 672 (1981). In Costa, the
plaintiff claimed that her husband died of mesothelioma as a result
of exposure to asbestos-containing products manufactured, sold or
used by the defendants. The jury, which found in favor of the
defendants, answered "No" to this special interrogatory: "Do you
find that Dominic Costa died from the disease of mesothelioma?"
The court in Costa found no error in the giving of this
interrogatory. The plaintiff's entire case was based on the claim
that her husband died of mesothelioma as a result of asbestos
exposure. Thus, a special finding that he did not die of
mesothelioma was dispositive of the plaintiff's claim.
	In Bluestein, the plaintiff sought damages for injuries
allegedly resulting from his ingestion of Cleocin, a drug
manufactured by the defendant. The jury returned a general verdict
in favor of the plaintiff, but answered "No" to a special
interrogatory asking whether Cleocin was a proximate cause of the
plaintiff's injuries. Because of this answer, the trial court entered
judgment in favor of the defendant. The reviewing court in
Bluestein affirmed, concluding that the jurors' answer to the
special interrogatory "reflected their acceptance of [the
defendant's] argument that the plaintiff was suffering from a
disease that was completely unrelated to his ingestion of Cleocin."
Bluestein, 102 Ill. App. 3d at 676.
	In the instant case, as in Costa and Bluestein, the special
interrogatory asked a single question relating to an ultimate issue
of fact that was dispositive of plaintiffs' claim. The interrogatory
was proper.
	Plaintiffs, however, cite to Blakey v. Gilbane Building Corp.,
303 Ill. App. 3d 872, 881-82 (1999), where an inconsistent special
finding was held to be misleading because, inter alia, it used a
term, "sole proximate cause," that had not been defined for the
jury. According to plaintiffs, the situation in the instant case is
similar: the trial court did not define "dehydration," which is
perhaps the key term in the special interrogatory. Plaintiffs
therefore claim that "[i]t is understandable that the jury had
difficulty comprehending the special interrogatory."
	We find no merit in this argument. Plaintiffs' expert, Dr.
Given, defined dehydration, as did every other physician who
testified at trial. As the appellate court below correctly noted,
"although the court did not define the term 'dehydration,'
dehydration was extensively discussed and defined through expert
testimony. The jury did not consider the special interrogatory
without having heard extensive testimony on the subject." 319 Ill.
App. 3d at 319.
	Plaintiffs also point to the questions that the jury asked about
the special interrogatory as evidence that they were confused. As
noted, after the jurors began deliberations, they sent out a note
asking these questions:
			"(1) If we have already decided on Form A or Form B,
what is the purpose of the dehydration form?
			(2) Is the dehydration form mandatory?
			(3) Do we have to be unanimous on the dehydration
form?"
The court's answer to the first question was: "It is the law," and it
answered "Yes" to the second and third questions.
	We agree with the trial and appellate courts that the questions
asked by the jury do not reflect confusion. As the appellate court
noted: "The questions regarded procedure. The jury did not appear
confused about the actual question posed in the special
interrogatory." 319 Ill. App. 3d at 319.
	Construing Dr. Garces' special interrogatory in conjunction
with the proximate-cause instructions given by the trial court, we
find no reason to conclude that the interrogatory was unclear or
that the jury was confused by it. See LaPook, 211 Ill. App. 3d at
866; Morton, 286 Ill. App. 3d at 451. The special interrogatory
was in proper form, and it fulfilled its intended function of serving
as a check on the jury's general verdict. See Noel, 177 Ill. App. 3d
at 783; Gasbarra, 85 Ill. App. 3d at 38.
	Plaintiffs additionally point to various instances of alleged
misconduct on the part of defense counsel that they assert deprived
them of a fair trial. They also claim that the trial court erred in
admitting certain evidence and barring other evidence, and that
these alleged errors unfairly tainted the proceedings. In addition,
plaintiffs contend that the trial court's refusal to give a missing-evidence instruction unfairly prejudiced them.
	After a careful review of the record, we conclude that none of
these alleged errors or instances of alleged misconduct prevented
plaintiffs from receiving a fair trial. Any error that might have
occurred did not affect the outcome of the case. See Lawson v.
G.D. Searle & Co., 64 Ill. 2d 543, 559 (1976) (plaintiff not entitled
to absolutely error-free trial). " 'Where it appears that an error did
not affect the outcome below, or where the court can see from the
entire record that no injury has been done, the judgment or decree
will not be disturbed.' " Lawson, 64 Ill. 2d  at 559, quoting Both v.
Nelson, 31 Ill. 2d 511, 514 (1964). Here the jury returned a
substantial ($675,000) general verdict in plaintiffs' favor.
Plaintiffs were not unfairly prejudiced. See McDonnell v.
McPartlin, 192 Ill. 2d 505, 534-35 (2000).
	With regard to the allegations of misconduct, plaintiffs
contend that defendant's counsel (1) demeaned the requirements
for bringing suit, (2) were untruthful about defendant's requesting
a jury trial and other matters, (3) exaggerated plaintiffs' burden of
proof, (4) flauted prior court rulings by, e.g., commenting on
Harold's absence from the courtroom, (5) made improper
comments about how long the trial was taking, (6) violated
Supreme Court Rule 213(g) (177 Ill. 2d R. 213(g)) by eliciting
improper testimony during direct examination of Dr. Wittert, one
of defendant's experts, and (7) made improper pleas for sympathy
for the defense.
	We note initially that in the majority of the instances cited by
plaintiffs, the court either sustained counsel's objection or granted
appropriate relief such as striking a comment or an answer. In
these instances, then, any potential error was cured. See Diaz v.
Kelley, 275 Ill. App. 3d 1058, 1066 (1995). At other times,
plaintiffs' counsel failed to object in a timely manner. In these
instances, plaintiffs' objections thus were waived. See Diaz, 275
Ill. App. 3d at 1072; Golden v. Kishwaukee Community Health
Services Center, Inc., 269 Ill. App. 3d 37, 49 (1994). The trial
court also overruled some of the objections of plaintiffs' counsel,
but these rulings were well within the court's discretion, and, as
noted, did not affect the outcome of the case. See Taluzek v.
Illinois Central Gulf R.R. Co., 255 Ill. App. 3d 72, 83 (1993)
(evidentiary rulings will not be overturned absent a clearly evident
abuse of discretion; in order to warrant reversal, error must have
been substantially prejudicial and affected the outcome of the
case); see also King v. American Food Equipment Co., 160 Ill.
App. 3d 898, 911 (1987) (abuse of discretion may be found only
where no reasonable person would take the view adopted by the
trial court), quoting In re Marriage of Asch, 100 Ill. App. 3d 293,
296 (1981).
	Moreover, many of these claims of alleged misconduct came
during opening statement or closing argument. Questions as to the
prejudicial effect of remarks made during opening statement and
closing argument are within the discretion of the trial court, and
determinations as to such questions will not be overturned absent
a clear abuse of discretion. Rockwood v. Singh, 258 Ill. App. 3d
555, 558 (1993); Magna Trust Co. v. Illinois Central R.R. Co., 313
Ill. App. 3d 375, 395 (2000); Sawicki v. Kim, 112 Ill. App. 3d 641,
645 (1983). In determining whether there has been an abuse of
discretion, we may not substitute our judgment for that of the trial
court, or even determine whether the trial court exercised its
discretion wisely. Griffith v. Mitsubishi Aircraft International,
Inc., 136 Ill. 2d 101, 115 (1990). We do not find an abuse of
discretion here. The trial court properly informed the jury that
opening statements and closing arguments were not evidence.
	Plaintiffs also contend that the trial court erred in admitting
evidence as to whether Jennifer took a taxi or walked to South
Shore Hospital. Plaintiffs moved in limine to bar this evidence,
arguing that it was collateral. According to plaintiffs, defendant's
experts indicated in their depositions that this issue was irrelevant
to their opinions. Defendant, on the other hand, argued that the
issue was relevant to Jennifer's credibility, asserting that she told
an emergency room nurse and the initial investigating officers that
she walked, but later told detectives that she took a taxi. The trial
court denied plaintiffs' motion to bar this evidence.
	As the appellate court correctly noted, plaintiffs have waived
this issue for review. They failed to object when Dr. An, the
medical examiner, gave testimony on this matter. Under cross-examination, Dr. An testified that he had information that Jennifer
took LaTonya to the hospital by taxi, and he did not remember her
walking. The denial of a motion in limine does not in itself
preserve an objection to disputed evidence that is introduced later
at trial. "When a motion in limine is denied, a contemporaneous
objection to the evidence at the time it is offered is required to
preserve the issue for review." Brown v. Baker, 284 Ill. App. 3d
401, 406 (1996). Plaintiffs made no such objection here.
	Moreover, plaintiffs' counsel elicited testimony on this issue
from Dr. Given on direct examination. When asked about
inconsistencies in evidence he had reviewed, Dr. Given stated that
there were numerous inconsistencies, "[e]ven to the point of how
the baby got to the hospital. It was noted by one officer that the
mom took a cab. Someone else noted that the mom walked." Thus,
as the appellate court noted, plaintiffs not only failed to object at
trial, but introduced the evidence themselves. They cannot now
complain that the trial court erred in admitting the evidence. Reid
v. Sledge, 224 Ill. App. 3d 817, 822 (1992).
	Plaintiffs next argue that the trial court erred in striking the
testimony of Chicago Police Sergeant John McMurray, who in
January 1994 was one of the detectives who investigated
LaTonya's death. During his testimony, McMurray stated that he
had learned from Officers Charles Howard and Paul Anderson that
they had erroneously put in their report that Jennifer walked to the
hospital. This report was the only one from Officers Howard and
Anderson that the trial court had allowed in evidence. A second
report indicated that she took a cab, but this report did not surface
until after the trial had begun, and the trial court therefore had
ordered it barred. McMurray's testimony indirectly brought in the
issue of this second report, and the trial court stated that this
testimony thus was a violation of the previous order. The trial
court also stated that McMurray's testimony violated another order
with respect to unidentified persons who allegedly gave him
information about how Jennifer arrived at the hospital. On
defendant's motion, the trial court struck McMurray's entire
testimony, which took up 34 pages in a trial transcript that totaled
nearly 2,000 pages.
	As noted, it is within the discretion of the trial court to make
evidentiary rulings, and these determinations are not to be
overturned absent a clear abuse of discretion. Taluzek, 255 Ill.
App. 3d at 83. We cannot say that there was such an abuse of
discretion here. Even if there were some error, it was harmless.
Plaintiffs were able to introduce some of the main elements in
McMurray's testimony through Chicago Police Detective David
Friel, who was McMurray's partner in the investigation of
LaTonya's death. Friel testified, as did McMurray, that he learned
that Jennifer arrived at the hospital by taxi, and that they closed
their investigation by determining that there was no apparent
criminal wrongdoing in LaTonya's death. Plaintiffs were not
unfairly prejudiced by the striking of McMurray's testimony. See
McDonnell, 192 Ill. 2d  at 534-35.
	Plaintiffs argue in addition that the defense was able to "soil"
their case by introducing evidence to the effect that Jennifer and
Harold were told to hire a lawyer and that they then changed their
story about how Jennifer arrived at the hospital. Only two of the
instances cited by plaintiffs took place before the jury. In the first,
which came during closing argument, defendant's counsel stated
that:
		"[Jennifer] tells half the people that she walked, and you
heard two Chicago police officers get up on that witness
stand and say, I learned that she walked. *** Someone
around that emergency room said, get a lawyer. And then
you hear a later version by some later arriving detectives
who say the story really sounds better, if you're going to
sue someone, let's make it a cab."
	Plaintiffs' counsel objected, and the court responded by
reminding the jury that closing arguments are not evidence. The
court told the jury: "You've heard the evidence. Rely on your
collective memory of what the evidence is."
	"The scope and character of closing argument are left to the
discretion of the trial judge, who enjoys the best position to view
the demeanor of counsel and the atmosphere of the trial.
[Citation.] Accordingly, determinations regarding closing
arguments will not be reversed absent an abuse of discretion."
Rockwood, 258 Ill. App. 3d at 558. Given that the trial court
reminded the jury that closing arguments are not evidence, we
cannot say that the court's determination here was an abuse of
discretion.
	The other instance cited by plaintiffs that took place before
the jury was the following stipulation:
			"MR. KARASIK [defendant's counsel]: Yes your
honor. I believe counsel is willing to stipulate that Mr.
King did learn that his wife was advised to contact an
attorney sometime on the night of January 24, 1994. So
stipulated?
			MR. BRENT [plaintiffs' counsel]: So stipulated."
	Given that this instance consisted of a stipulation by the
parties, we fail to see how plaintiffs could have been unfairly
prejudiced by it. Cf. People v. Bowman, 221 Ill. App. 3d 663, 666
(1991) ("[D]efendant cannot participate in an agreement and
stipulation which accrues to his benefit, and then complain on
review about the inevitable result of the agreement. He invited or
agreed to the procedure and is now estopped from asserting it as
error").
	The remaining instances of "evidence" cited by plaintiffs all
took place out of the presence of the jury. We do not see how any
of these instances could have affected the outcome here as it
pertains to the jury's special finding. Accordingly, we conclude
that plaintiffs were not unfairly prejudiced.
	Plaintiffs also challenge the trial court's refusal to strike any
evidence suggesting that Jennifer was contributorily negligent.
Plaintiffs contend that there were many "subtle intimations" that
if Jennifer had only done the right thing, LaTonya would have
survived. They point, for example, to defense counsel's comment
in his closing argument about the "walking to the hospital issue."
According to plaintiffs, any suggestion that Jennifer walked rather
than rode to the hospital "was used to suggest that Jennifer, and
not Dr. Garces, should be to blame."
	Near the end of the trial, after both sides had rested, plaintiffs
asked the court to go back and strike any evidence that suggested
or implied that Jennifer was negligent. Plaintiffs did not identify
specific examples of evidence that they wanted stricken. The trial
court denied the request, noting that there had been no claim of
contributory negligence. Therefore, any evidence suggesting that
someone other than defendant was at fault would simply go to the
issue of whether Dr. Garces was negligent, which was the central
issue in the trial. The court also stated that it would be an
"insurmountable task" to go back to the beginning of the trial and
"go witness by witness," determining which testimony should be
stricken, and then telling the jury to strike that evidence. The court
would have to restate the testimony for the jurors in order to
refresh their memories, and then would be in the somewhat
awkward position of telling the jury to strike that same testimony.
	We agree with the trial court and with the appellate court,
which expressly upheld this ruling. A defendant is always free to
offer evidence that the conduct of a third person was the sole
proximate cause of the plaintiff's injuries. McDonnell, 192 Ill. 2d 
at 520-21. We also note plaintiffs' failure to identify for the trial
court the specific examples of evidence that it wanted stricken. It
was unreasonable for plaintiffs to expect the trial court to scour the
record in search of error. See People v. Biloche, 414 Ill. 504, 511
(1953).
	Finally, plaintiffs argue that they were unfairly prejudiced
when the trial court refused to give a missing-evidence instruction.
Such an instruction would advise the jury that, if a party fails to
offer evidence that is within its power to produce, the jury may
infer that this evidence would be adverse to that party. See Illinois
Pattern Jury Instructions, Civil, No. 5.01 (3d ed. 1995) (hereinafter
IPI Civil 3d No. 5.01). The evidence at issue here was LaTonya's
measurements, particularly her weight, which, according to
testimony at trial, were recorded when Jennifer and LaTonya went
to Dr. Garces' clinic in the afternoon on January 24. Plaintiffs
argued to the trial court that because this record was never
produced, they were entitled to have an IPI Civil 3d No. 5.01
missing-evidence instruction given.
	The trial court refused to give the instruction, stating that it
would be inappropriate because defendant offered a "plausible
reason" for its failure to produce the record. We agree with the
trial court and with the appellate court, which upheld this
determination. The decision whether to give an IPI Civil 3d No.
5.01 missing-evidence instruction is within the sound discretion of
the trial court. Schaffner v. Chicago & North Western
Transportation Co., 129 Ill. 2d 1, 22 (1989). This instruction is
warranted only if "there was no reasonable excuse for failure to
produce the evidence." Brown v. Moawad, 211 Ill. App. 3d 516,
531 (1991). Here, defendant provided a reasonable explanation.
The permanent chart that was generated for LaTonya on January
21, 1994, when she made her first visit to the clinic, was out of the
office for billing and was not available on January 24. For that
reason, LaTonya's measurements that were taken at the clinic on
January 24 were recorded on a temporary chart. The information
from the temporary chart was never entered into the permanent
chart because Dr. Garces did not see LaTonya on that day.
	It was not an abuse of discretion for the trial court to refuse to
give an IPI Civil 3d No. 5.01 instruction here. Plaintiffs were not
unfairly prejudiced, particularly in light of the fact that the court,
while refusing the instruction, nevertheless allowed plaintiffs to
argue whatever inferences they felt the jury should draw from
defendant's failure to produce the record. Accordingly, in his
closing argument, plaintiffs' counsel told the jury that:
		 "We also heard that Jennifer went to the clinic and was
never seen by the doctor. There's a dispute about what
happened then. Was she weighed? Was LaTonya King
weighed? Well, was the temperature taken? Was the head
circumference taken? Did we see that chart? Did we see
those measurements? Did we get that weight when we
were doing all the math? *** Did we get the one weight
that really mattered in this case?"
Plaintiffs thus were able to argue the missing-evidence issue to the
jury.

CONCLUSION
	We hold, as did the appellate court, that the jury's special
finding was absolutely irreconcilable with the general verdict, and
the trial court therefore properly entered judgment in favor of
defendant. The special interrogatory was in proper form and was
not confusing, and the jury's response to it was not against the
manifest weight of the evidence. Plaintiffs received a fair trial.
They were not unfairly prejudiced by the alleged errors and
instances of alleged misconduct that they put forth. For the
foregoing reasons, we affirm the judgment of the appellate court.
	Affirmed.
	 
	 
1.      1LaTonya was survived by her parents and three siblings, including
her twin sister, LaToya. 

2.      2According to Dr. An's testimony and that of other medical
professionals in this case, when well-hydrated skin is pinched, it returns
quickly to its original state, and thus has good skin turgor, or tension.
Skin that is dehydrated, however, returns more slowly to its original
state. 

3.      3This definition of "dehydration" was echoed by every physician
who testified at trial. Dr. An, the medical examiner, termed it "loss of
water from the body"; Dr. Michael Kaufman, one of two defense
experts, defined it as "essentially a relative loss of body fluids"; and Dr.
William Wittert, the other defense expert, explained that it is "a clinical
state where the body or a patient or a person loses excess body water." 

4.     4In his opening statement, plaintiffs' counsel asserted that
"drowsiness, diarrhea, and unwillingness to suck [are] classic signs of
dehydration for a 26-day-old baby."