Title: McDonnell v. McPartlin

State: illinois

Issuer: Illinois Supreme Court

Document:

Opinion filed June 15, 2000.
JUSTICE BILANDIC delivered the opinion of the court:
The principal issue in this appeal is whether a defendant in a medical 
negligence case who asserts that a nonparty physician's conduct was the sole 
proximate cause of the plaintiff's injury (the so-called "empty chair" defense) 
must demonstrate that the nonparty physician's conduct was professionally 
negligent, as well as the sole proximate cause of the plaintiff's injury, in 
order for the jury to be instructed on sole proximate cause (see Illinois 
Pattern Jury Instructions, Civil, No. 12.04 (3d ed. 1995) (hereinafter IPI Civil 
3d)). We hold that such a defendant is not required to demonstrate that the 
nonparty physician's conduct was professionally negligent in order for the jury 
to be instructed on sole proximate cause.
BACKGROUND
On Saturday, November 8, 1986, Moira McDonnell (plaintiff) brought her 
husband, John McDonnell (McDonnell), to the emergency room of Good Samaritan 
Hospital. McDonnell, a diabetic, had become ill the previous evening. The couple 
went to the emergency room at the direction of Dr. Barbara Loeb, with whom 
plaintiff had spoken that morning. Dr. Loeb was covering for Dr. Richard 
McPartlin III, McDonnell's regular internist. Dr. McPartlin became McDonnell's 
primary care physician in April 1986, following a surgery in which McDonnell's 
right hip was replaced for the third time. This surgery was performed at Good 
Samaritan Hospital by Dr. James Ahstrom, an orthopedic surgeon.
Dr. Thomas Mullin, Jr., was on duty in the emergency room on November 8, and 
examined McDonnell. Dr. Mullin ordered certain blood tests and an X-ray of 
McDonnell's right hip. Dr. Mullin believed that McDonnell was suffering from a 
flu virus. After Dr. Mullin discussed McDonnell's condition with Dr. Loeb by 
telephone, Dr. Loeb decided not to admit McDonnell to the hospital.
Based on McDonnell's blood glucose levels which the couple reported to Dr. 
Loeb the next day, November 9, Dr. Loeb suggested that McDonnell return to the 
emergency room that day for an accurate blood glucose reading and further 
evaluation. McDonnell returned to the emergency room on Monday, November 10, 
when Dr. McPartlin was back. Dr. McPartlin's initial impression was that 
McDonnell was suffering from a diabetic condition known as ketoacidosis, 
possibly secondary to a right hip infection. Dr. McPartlin admitted McDonnell to 
the intensive care unit.
On the afternoon of November 11, Dr. McPartlin started McDonnell on 
antibiotics and ordered an orthopedic consult with Dr. Ahstrom. In the early 
morning hours of November 12, McDonnell went into septic shock, and later 
suffered a cardiac/respiratory arrest. Dr. Michael Orth, an orthopedic surgeon 
who was covering for Dr. Ahstrom while Dr. Ahstrom was out of town, performed an 
incision and drainage of McDonnell's right hip, which was infected.
Dr. McPartlin determined, as did Dr. Orth and other consulting specialists, 
that McDonnell's right hip prosthesis must be removed as soon as McDonnell was 
medically cleared for surgery. Dr. Ahstrom, who returned to the hospital on 
November 16, believed that it was not necessary to remove the hip prosthesis, 
and that McDonnell could not survive such a surgery. Dr. Ahstrom advised 
plaintiff and McDonnell against surgery; they followed Dr. Ahstrom's advice.
In early December 1986, while Dr. Ahstrom was out of town, Dr. E. Thomas 
Marquadt, an orthopedic surgeon, consulted on the case. Dr. Marquadt concluded 
that McDonnell's life-threatening condition required removal of the right hip 
prosthesis. On December 8, McDonnell was transferred to Rush-Presbyterian St. 
Luke's Medical Center (Rush), where he underwent surgery later that month for 
removal of the hip. McDonnell remained at Rush until his death on February 16, 
1987. The cause of death was heart failure due to sepsis and a bone 
infection.
Plaintiff, as executrix of her husband's estate, subsequently filed a 
wrongful death and survival action in the circuit court of Cook County against 
Drs. Mullin and McPartlin, and their corporate employers. Plaintiff claimed, 
inter alia, that defendants' medical negligence in failing to diagnose 
and treat her husband's hip infection resulted in his death. Defendants denied 
any liability and argued, inter alia, that the conduct of Dr. Ahstrom, 
a nonparty, was the sole proximate cause of McDonnell's death. A jury found in 
favor of defendants. The circuit court entered judgment on the jury verdict and 
later denied plaintiff's post-trial motions. The appellate court affirmed. 303 
Ill. App. 3d 391. We granted plaintiff's petition for leave to appeal (see 177 
Ill. 2d R. 315), and now affirm the judgment of the appellate court.
ANALYSIS
Plaintiff argues that the jury should not have been instructed as to 
defendants' sole proximate cause defense, in the absence of competent evidence 
that Dr. Ahstrom was professionally negligent, as well as the sole proximate 
cause of McDonnell's death. Plaintiff claims that the improper jury instruction, 
coupled with defendants' improper argument, resulted in undue prejudice to her, 
warranting a new trial. Plaintiff argues, in the alternative, that she is 
entitled to a new trial because defendants used their peremptory challenges to 
exclude black members of the venire, and because various evidentiary errors 
deprived her of a fair trial.
I. Sole Proximate Cause Defense
We consider first whether the jury was properly instructed as to defendants' 
theory that the conduct of Dr. Ahstrom was the sole proximate cause of 
McDonnell's death. Over plaintiff's objection, the jury was instructed pursuant 
to the long version of IPI Civil 3d No. 12.04. This instruction states in its 
entirety:
Plaintiff argues that the appellate court wrongly held that the sole 
proximate cause instruction may be given to the jury in a medical malpractice 
case "even though no expert testifies the 'conduct' of the third person nonparty 
was professionally negligent." 303 Ill. App. 3d at 398. Plaintiff maintains that 
the sole proximate cause instruction requires a defendant to establish, through 
expert testimony, that the nonparty's conduct was professionally negligent, as 
well as the sole proximate cause of the claimed injury, and that defendants here 
failed to present sufficient evidence to justify the instruction in this 
case.
In support of her argument, plaintiff cites to Freeman v. Petroff, 
275 Ill. App. 3d 904 (1995) (Freeman I), Banks v. Climaco, 283 
Ill. App. 3d 842 (1996), and Freeman v. Petroff, 288 Ill. App. 3d 145 
(1997) (Freeman II). In Freeman I, plaintiffs brought a 
medical negligence action against the obstetrician who delivered their daughter, 
seeking recovery for permanent injuries the infant suffered in connection with 
her premature birth. The defendant alleged that the hospital, a nonparty to the 
suit, was the sole proximate cause of the child's injuries. The trial court 
instructed the jury based on the long form of IPI Civil 3d No. 12.04. The jury 
returned a verdict in favor of the obstetrician.
The appellate court reversed and remanded for a new trial. The appellate 
court initially observed that, "where the conduct of a nonparty is presented as 
a defense, the third person's conduct must be both negligent and the proximate 
cause of the plaintiff's injury in order to give the second paragraph of IPI 
Civil 3d No. 12.04." Freeman I, 275 Ill. App. 3d at 909. The appellate 
court went on to hold that the defendant must establish, through expert 
testimony, the generally accepted standard of care for the particular situation, 
a deviation from that standard, and a causal connection between the third 
party's deviation and plaintiff's injury. Freeman I, 275 Ill. App. 3d 
at 909-11. Because the evidentiary record in Freeman I revealed no 
testimony establishing, inter alia, the standard of care applicable to 
the nonparty hospital, the appellate court found that the trial court erred in 
giving the sole proximate cause instruction, and that such error deprived the 
plaintiffs of a fair trial.
The defendants in Freeman I filed a petition for leave to appeal to 
this court. We denied the petition, but entered a supervisory order remanding 
the matter to the appellate court for further consideration in light of 
Leonardi v. Loyola University, 168 Ill. 2d 83 (1995). Freeman v. 
Petroff, 165 Ill. 2d 550 (1996). In Leonardi, which we discuss 
more fully below, we held, in the context of a medical negligence case, that an 
answer which denies that an injury was the result of or caused by the 
defendant's conduct is sufficient to permit the defendant to raise the sole 
proximate cause defense. Leonardi, 168 Ill. 2d  at 92-94. Following 
remand of Freeman I, the appellate court issued Freeman II. In 
Freeman II, the appellate court distinguished Leonardi and 
affirmed the holding in Freeman I. Freeman II, 288 Ill. App. 
3d at 146. Significantly, the appellate court in this case declined to follow 
Freeman II.
The Banks case, on which plaintiff also relies, distinguished 
Leonardi and held that the standard applicable to a plaintiff for 
proving medical negligence also applies to the defendant, where the defendant 
argues that someone or something other than the defendant is the sole proximate 
cause of the plaintiff's injury. Banks, 283 Ill. App. 3d at 851-52.
Freeman I, Freeman II, and Banks, on the one hand, 
and the appellate court opinion in this case, on the other hand, present 
conflicting and irreconcilable statements of Illinois law. We now resolve this 
conflict. For the reasons stated below, we hold that, in the context of a 
medical negligence case, the sole proximate cause instruction requires only that 
the defendant present some evidence that the nondefendant is the sole proximate 
cause of the plaintiff's injury. It is not necessary that the defendant also 
establish that the nondefendant's conduct was medically negligent. Accordingly, 
as to this issue, we affirm the decision of the appellate court in this case. 
Further, to the extent Freeman I, Freeman II, and 
Banks conflict with our holding today, they are overruled.
A defendant raising the sole proximate cause defense seeks to defeat a 
plaintiff's claim of negligence by establishing proximate cause solely in the 
act of another not a party to the suit. Accordingly, this defense is aptly 
referred to as the "empty chair" defense. Leonardi, 168 Ill. 2d  at 
92.
The issue of whether the sole proximate cause instruction was properly given 
or refused in a particular case has frequently arisen where the defendant has 
implicitly, if not expressly, claimed that the nonparty was both negligent and 
the sole proximate cause of the plaintiff's injury. See, e.g., 
Ballweg v. City of Springfield, 130 Ill. App. 3d 241, 248-49 (1984), 
aff'd in part & rev'd in part, 114 Ill. 2d 107 (1986) (where the 
defendant boat manufacturer argued that the sole proximate cause of the boaters' 
deaths was the conduct of the person piloting the boat when it struck the 
overhead power lines, and the conduct of the city, which maintained the power 
lines in a dangerous condition); Storm v. Brown, 15 Ill. App. 3d 29, 
32-33 (1973) (where the defendant argued that the sole proximate cause of a 
vehicular accident was the negligent conduct of a nonparty driver); French 
v. City of Springfield, 5 Ill. App. 3d 368, 371-76 (1972) (where the 
defendant municipality sought to introduce evidence that the driver of the 
vehicle in which the plaintiff was injured was intoxicated at the time of the 
accident and was the sole proximate cause of the plaintiff's injury); 
Miyatovich v. Chicago Transit Authority, 112 Ill. App. 2d 437, 441 
(1969) (where the defendant transit authority claimed that liability for the 
accident rested solely with the driver of the vehicle in which the plaintiff was 
a passenger inasmuch as that driver went through a red light). Nevertheless, 
that Illinois courts have often considered the propriety of the sole proximate 
cause instruction in cases where the defendant sought to establish the 
nonparty's negligence does not mean that the instruction requires a 
defendant to establish such negligence. Indeed, the language of the instruction 
contains no such requirement.
The instruction as to sole proximate cause, set forth in the second paragraph 
of IPI Civil 3d No. 12.04, instructs the jury that "if you decide that the sole 
proximate cause of injury to the plaintiff was the conduct of some person other 
than the defendant, then your verdict should be for the defendant." IPI Civil 3d 
No. 12.04. The instruction clearly refers only to the "conduct of some 
person other than the defendant" (emphasis added), not the negligent 
conduct of some person other than the defendant. The "Notes on Use" 
accompanying the instruction similarly explain that "[t]he second paragraph 
should be used only where there is evidence tending to show that the sole 
proximate cause of the occurrence was the conduct of a third person" 
(emphasis added), not the negligent conduct of a third person. Thus, 
the sole proximate cause instruction contains no express requirement that the 
jury consider whether the third person's conduct was negligent. The sole 
proximate cause instruction likewise contains no implicit requirement that the 
jury consider whether the third person's conduct was negligent. We note that the 
first paragraph of IPI Civil 3d No. 12.04 implicitly refers to the third 
person's negligence by referring to the third person's "blame." The second 
paragraph of the instruction, however, contains no similar reference.
Plaintiff places much emphasis on the title of the instruction-"Concurrent 
Negligence Other Than Defendant's." The title, of course, is not a part of the 
instruction that a jury receives. In any event, the title appropriately 
describes the main provision of the instruction contained in the first 
paragraph, rather than the optional provision contained in the second, bracketed 
paragraph, which pertains to sole proximate cause.
Significantly, plaintiff's reading of the sole proximate cause instruction 
conflicts with the definition of "proximate cause" set forth in IPI Civil 3d No. 
15.01. Pursuant to this instruction, proximate cause means:
This instruction does not define proximate cause as only a "negligent cause." 
Rather, proximate cause is "that cause," "a cause," or "any cause" which 
produced the plaintiff's injury.
Based on the plain language of IPI Civil 3d No. 12.04 and consistent with the 
instructional definition of proximate cause, we conclude that the sole proximate 
cause instruction does not require that a defendant demonstrate that the third 
person's conduct was negligent, in addition to being the sole proximate cause of 
plaintiff's claimed injury.
Plaintiff argues that if the second paragraph of IPI Civil 3d No. 12.04 is 
intended to address the nonnegligent intervention of third persons, then IPI 
Civil 3d No. 12.05 is meaningless. We disagree. IPI Civil 3d No. 12.05 states in 
its entirety:
The second paragraph of IPI Civil 3d No. 12.04 applies where there is 
evidence that someone other than the defendant is the sole proximate 
cause of the plaintiff's injury. In contrast, the second paragraph of IPI Civil 
3d No. 12.05 applies where there is evidence that something other than 
the defendant's conduct is the sole proximate cause of the plaintiff's injury. 
Thus, our reading of the sole proximate cause instruction does not render moot 
IPI Civil 3d No. 12.05.
Our decision in Leonardi also supports our conclusion that IPI Civil 
3d No. 12.04 does not require a defendant to prove that the nonparty's conduct 
was both negligent and the sole proximate cause of the plaintiff's injury. In 
Leonardi, the plaintiffs brought a medical malpractice action against 
Loyola University and other defendants for fatal injuries suffered by Michela 
Lopez during and subsequent to childbirth. Lopez's attending physician, Dr. 
Thomas Tierney, died prior to trial and the plaintiffs settled with his estate. 
The remaining defendants denied any liability and argued that Dr. Tierney was 
the sole proximate cause of the plaintiffs' injuries. A jury returned a verdict 
in favor of the defendants, and the trial court entered judgment thereon. The 
appellate court affirmed. Leonardi v. Loyola University, 262 Ill. App. 
3d 411 (1993).
On appeal to this court, the plaintiffs argued, in relevant part, that the 
trial court erred by allowing the defendants to present evidence of Dr. 
Tierney's conduct, and by tendering to the jury an instruction on sole proximate 
cause pursuant to the long version of IPI Civil 3d No. 12.04. We rejected the 
plaintiffs' arguments.
We held, in Leonardi, that it is not necessary for a defendant to 
plead sole proximate cause as an affirmative defense. Rather, a defendant's 
general denial of liability is sufficient to permit the defendant to raise the 
sole proximate cause defense and present evidence that the claimed injury was 
the result of another cause. Leonardi, 168 Ill. 2d  at 93-94. We 
explained:
In Leonardi, we also rejected the plaintiffs' contention that the 
trial court erred by instructing the jury pursuant to the long form of IPI Civil 
3d No. 12.04. We recognized a defendant's right not only to rebut evidence 
tending to show that the defendant's acts are negligent and the proximate cause 
of the claimed injuries, but also to endeavor to establish that the conduct of a 
third person, or some other causative factor, is the sole proximate cause of the 
plaintiff's injuries and, assuming some competent evidence is presented, to have 
the jury instructed on this theory. Leonardi, 168 Ill. 2d  at 101. The 
second paragraph of IPI Civil 3d No. 12.04 properly reflects the defendant's 
right to attempt to negate a single element of the plaintiff's medical 
negligence claim, i.e., the element of proximate cause.
Plaintiff, however, contends that this court's subsequent decision in 
Holton v. Memorial Hospital, 176 Ill. 2d 95 (1997), requires that there 
be evidence that the nonparty physician was professionally negligent before the 
jury may be instructed on the sole proximate cause defense. We disagree. In 
Holton, the plaintiffs filed a medical negligence action against 
Memorial Hospital and other defendants for injuries that Patricia Holton 
sustained when her medical condition was misdiagnosed and inappropriately 
treated. The plaintiffs settled with all defendants except the hospital. As to 
that defendant, the plaintiffs claimed that the hospital's nursing staff had 
failed to timely and accurately report Patricia's symptoms. The trial court 
entered judgment on the jury verdict in favor of the plaintiffs. The appellate 
court affirmed, modifying only the amount of the judgment. Holton v. 
Memorial Hospital, 274 Ill. App. 3d 868 (1995). This court reversed the 
judgment in favor of the plaintiffs and remanded the cause for a new trial. The 
principal issue we resolved in Holton was whether application of the 
"loss of chance" doctrine in medical malpractice cases lessens the plaintiff's 
burden of proving proximate cause. Holton, 176 Ill. 2d  at 98. We also 
considered various trial errors. In particular, we considered the hospital's 
claim that the trial court erred in denying the sole proximate cause 
instruction. We found no error, inasmuch as the hospital never argued or 
presented evidence that "only the negligence of persons other than the 
hospital employees," i.e., the treating physicians, proximately caused 
the plaintiffs' injury. (Emphasis in original.) Holton, 176 Ill. 2d  at 
134.
As the plaintiff concedes, the issue we address today was not before this 
court in Holton. Further, our holding in that case was premised on the 
complete absence of evidence and argument by the hospital that the conduct of 
the nonparty physicians was the only proximate cause of the plaintiffs' 
injuries. Although we tangentially referred to the nonparty physicians' 
negligence, we did not expressly consider, as we do now, whether evidence of 
such negligence is a necessary predicate to the sole proximate cause 
instruction. Holton, therefore, is inapposite.
We observe also that negligent conduct and proximate cause are distinct, 
albeit related, concepts. Given their relationship, there is a pronounced 
tendency when considering one to include the other. We cannot, however, ignore 
the truism that every injury need not proceed from a negligent cause. 
Accordingly, where there is some competent evidence that the sole proximate 
cause of a plaintiff's claimed injury lies in the conduct of someone other than 
the defendant, the defendant is entitled to have the jury instructed pursuant to 
the second paragraph of IPI Civil 3d No. 12.04, notwithstanding the absence of 
evidence tending to establish that the third person's conduct was negligent. 
That the third person is a physician does not change this result. As the 
appellate court in this case correctly recognized, "People, doctors included, 
make judgments that, in hindsight, turn out to be mistaken. Those judgments 
might not be professionally negligent when made. Yet, injury resulted." 303 Ill. 
App. 3d at 397.
IPI Civil 3d No. 12.05 also demonstrates that "proximate cause" is not 
synonymous with "negligent cause." As already discussed, this instruction 
directs a jury to consider whether "something" other than the defendant's 
conduct was the sole proximate cause of the plaintiff's injury. That "something" 
has, in the past, included a variety of nonnegligent causes. See, e.g., 
Roach v. Springfield Clinic, 223 Ill. App. 3d 597, 615 (1991), 
aff'd in part & rev'd in part on other grounds, 157 Ill. 2d 29 
(1993) (condition of the fetus in the womb); Schuchman v. Stackable, 
198 Ill. App. 3d 209, 225 (1990) (falling tree top); Burge v. Morton, 
99 Ill. App. 3d 266, 268-69 (1981) (penicillin-resistant bacteria); Bauer v. 
J.B. Hunt Transport, Inc., 150 F.3d 759, 762 (7th Cir. 1998) (foul 
weather).
Plaintiff emphasizes the fact that defendants did not simply argue that some 
blameless conduct was the sole proximate cause of McDonnell's death; rather, 
defendants argued, in closing, that Dr. Ahstrom's negligent conduct was the sole 
proximate cause. Plaintiff claims there was insufficient evidence to support 
defendants' argument and that she was, therefore, unduly prejudiced.
The issue of whether a defendant is entitled to argue to the jury that the 
nonparty physician was negligent is separate and distinct from the issue of 
whether a defendant is entitled to have the jury instructed on the defense of 
sole proximate cause. The sole proximate cause instruction, like any jury 
instruction, requires that there be some evidence to justify the theory of the 
instruction. Leonardi, 168 Ill. 2d  at 101. As decided above, evidence 
of the nonparty's negligence is not required to justify the sole proximate cause 
instruction.
Whether a defendant may argue that the nonparty physician is negligent is 
governed by the same principles applicable to other arguments made in closing. 
The general rule is that a party is "privileged to discuss the evidence 
introduced and all reasonable inferences that may be drawn therefrom." 
Forest Preserve District v. Alton R.R. Co., 391 Ill. 230, 236 (1945). 
Only competent evidence, of course, will be considered in determining whether a 
given argument is proper. See Schaffner v. Chicago & North Western 
Transportation Co., 129 Ill. 2d 1, 19-20 (1989).
At trial, defendants introduced evidence from which a jury could conclude 
that defendants did not deviate from the standard of care from November 8, when 
McDonnell was first treated in the emergency room, through the afternoon of 
November 12, when McDonnell was in septic shock and his right hip was incised 
and drained. As to the period following septic shock, defendants introduced 
extensive evidence that all of the physicians involved in McDonnell's care, with 
the exception of Dr. Ahstrom, were in agreement that antibiotics alone could not 
cure the infection and that the right hip prosthesis-a foreign object in the 
body and a breeding ground for bacteria-must be removed. The physicians who were 
in agreement with Dr. McPartlin on this issue included a cardiologist, a 
nephrologist, an infectious disease specialist, an orthopedic surgeon, and a 
general surgeon. Dr. Ahstrom was alone in his belief that nonsurgical 
intervention was sufficient.
Although there was expert testimony that a good-faith disagreement as to the 
appropriate medical treatment to give in a particular case may exist without any 
implication of negligence, based on the testimony of Drs. Orth and Ahstrom, a 
reasonable inference could be made that this case did not present simply a 
good-faith disagreement. Dr. Orth, the orthopedic surgeon who cared for 
McDonnell in Dr. Ahstrom's absence, testified that an orthopedic surgeon who 
refuses to recognize that a prosthesis can be the breeding ground for bacteria, 
and bases treatment decisions on that impliedly faulty premise, deviates from 
the standard of care. Notably, Dr. Ahstrom's testimony as to the relationship 
between a hip prosthesis, bacteria, and infection was equivocal. Defendants 
could, therefore, reasonably infer and argue that Dr. Ahstrom simply refused to 
recognize what every other physician involved in McDonnell's care knew, 
i.e., nonsurgical intervention would not cure the infection. 
Plaintiff's own internal medicine and infectious disease expert, Dr. Dieter 
Gump, testified that Dr. Ahstrom erred grievously by not removing the hip 
sooner, rather than later. According to Dr. Gump, by the time the hip was 
removed at Rush, McDonnell's death was a foregone conclusion.
Evidence was also introduced that the infection treated in November 1986 
related back to McDonnell's April 1986 surgery in which Dr. Ahstrom replaced 
McDonnell's right hip for the third time. Dr. Marquadt testified that removing 
the old cement is the most critical part of a subsequent hip replacement 
surgery, and that the presence of old cement could cause a low-grade infection 
to develop and smolder. Dr. Ahstrom acknowledged that, during the third hip 
replacement surgery, he "would almost be willing to bet" that some old cement 
had been left in McDonnell's hip.
Based on the foregoing evidence, a reasonable inference could be made that 
Dr. Ahstrom was professionally negligent, and that such negligence was the sole 
proximate cause of plaintiff's claimed injury. Accordingly, defendants were 
entitled to make this argument to the jury.
II. Batson Claim
We next examine plaintiff's claim that defendants exercised their peremptory 
challenges to exclude black members of the venire, in violation of Batson v. 
Kentucky, 476 U.S. 79, 90 L. Ed. 2d 69, 106 S. Ct. 1712 (1986).
The rule announced in Batson, that the State may not use peremptory 
challenges to purposefully exclude members of the venire based on their race, 
applies with equal force to private litigants in civil cases. Edmonson v. 
Leesville Concrete Co., 500 U.S. 614, 114 L. Ed. 2d 660, 111 S. Ct. 2077 
(1991). The Batson rule also applies where, as here, the party making 
the Batson claim is not the same race as the excluded jurors. 
Powers v. Ohio, 499 U.S. 400, 113 L. Ed. 2d 411, 111 S. Ct. 1364 
(1991).
Batson established a three-step process for evaluating a claim that 
a party's peremptory challenges have been exercised in a discriminatory manner. 
First, the party making the Batson claim must establish a prima 
facie case of purposeful discrimination. If a prima facie case is 
made, the burden then shifts to the other party to articulate a race-neutral 
reason for striking the venirepersons in question. The trial court must then 
determine whether the party making the Batson claim has met the burden 
of establishing purposeful discrimination. Batson, 476 U.S.  at 96-98, 
90 L. Ed. 2d  at 87-89, 106 S. Ct. at 1723-24; Hernandez v. New York, 
500 U.S. 352, 358-59, 114 L. Ed. 2d 395, 405, 111 S. Ct. 1859, 1865-66 
(1991).
Explanations advanced by the party against whom a Batson claim has 
been made must be clear and reasonably specific, but need not rise to the level 
of a challenge for cause. Batson, 476 U.S.  at 97-98 & n.20, 90 L. Ed. 2d  at 88 & n.20, 106 S. Ct.  at 1723-24 & n.20. Indeed, unless a 
discriminatory intent is inherent in a party's explanation, the reason offered 
will be deemed race-neutral. Hernandez, 500 U.S.  at 360, 114 L. Ed. 2d  
at 406, 111 S. Ct.  at 1866. Mere assertions, however, of nondiscriminatory 
motive for exercising a peremptory challenge are insufficient to rebut a 
prima facie case. Batson, 476 U.S.  at 97-98, 90 L. Ed. 2d  at 
88, 106 S. Ct.  at 1723-24.
Where a trial court rules on the ultimate question of purposeful 
discrimination, the preliminary issue of whether a prima facie showing 
has been made becomes moot. Hernandez, 500 U.S.  at 359, 114 L. Ed. 2d  
at 405, 111 S. Ct.  at 1866; People v. Hudson, 157 Ill. 2d 401, 427-28 
(1993); People v. Mitchell, 152 Ill. 2d 274, 289-90 (1992). In such 
instances, a reviewing court need only consider whether the trial court's ruling 
as to the validity of the proffered reasons for challenging particular jurors 
was in error. Hudson, 157 Ill. 2d  at 428; Mitchell, 152 Ill. 2d  at 289-90. Because a trial court's finding on the ultimate issue of 
discrimination rests largely on credibility determinations, it is entitled to 
great deference on review and will not be set aside unless clearly erroneous. 
People v. Munson, 171 Ill. 2d 158, 175 (1996); Hudson, 157 Ill. 2d  at 428.
In the present case, plaintiff challenged Dr. McPartlin's peremptory strike 
of venirepersons Patricia Houk, Richard Craver, and David Knuckles, as well as 
Dr. Mullin's peremptory strike of venirepersons Rannal Bankhead and Grant 
Henderson. The trial court found no Batson violation.
Preliminarily, we observe that plaintiff does not make any argument before 
this court as to venireperson Henderson. Any Batson issue as to this 
individual is therefore waived. See 177 Ill. 2d R. 341(e)(7).
As to venireperson Houk, the trial court found that she was not black, and 
thus declined to consider plaintiff's Batson claim. This court has 
frequently recognized that the trial court is in the best position to observe 
the demeanor of potential jurors. E.g., People v. Williams, 
173 Ill. 2d 48, 67 (1996); People v. Fair, 159 Ill. 2d 51, 74 (1994); 
Mitchell, 152 Ill. 2d  at 296. We likewise recognize that the trial 
court is in the best position to determine whether a potential juror is a member 
of the racial group which is purportedly the target of a party's peremptory 
strikes. Accordingly, we find no reason to reject the trial court's finding as 
to Houk.
With respect to the remaining three venirepersons, the record reveals that 
the trial court ruled, in each instance, on the ultimate issue of purposeful 
discrimination. Accordingly, the issue of whether plaintiff made out a prima 
facie case is moot, and we limit our review to a determination of whether 
the trial court's finding of no purposeful discrimination was clearly erroneous. 
See Hudson, 157 Ill. 2d  at 428; Mitchell, 152 Ill. 2d  at 
289-90.
Richard Craver
The record reveals that Dr. McPartlin's counsel excused venireperson Craver 
based primarily on Craver's courtroom demeanor, i.e., "the way that he 
looked, where he looked and how he answered some of the questions." Counsel also 
described an incident during voir dire in which, while counsel 
questioned another panel of jurors, Craver muttered something to another juror, 
prompting counsel to turn his attention back to Craver. Counsel described this 
as an "embarrassing moment," and expressed his concern that he may have offended 
Craver. The trial court recalled this incident, stating, "Well, I remember this 
kind of notably. I remember [Craver] like leaning over and saying something at a 
time when no one else was." The trial court also later recalled Craver's 
hesitancy in answering counsel's follow-up query during the incident.
A prospective juror's courtroom demeanor may constitute a legitimate and 
race-neutral reason for excluding that individual. People v. Andrews, 
155 Ill. 2d 286, 303 (1993); People v. Young, 128 Ill. 2d 1, 20 (1989). 
Because such a subjective explanation for exercising a peremptory strike lends 
itself to pretext, such an explanation must be closely scrutinized. People 
v. Williams, 164 Ill. 2d 1, 19 (1994). The record indicates that the trial 
judge appropriately scrutinized counsel's explanation. The trial judge's 
determination as to counsel's credibility is entitled to great deference. 
See Munson, 171 Ill. 2d  at 175; Hudson, 157 Ill. 2d  at 428. We 
cannot say, therefore, that the trial judge's ruling was clearly erroneous. See 
Young, 128 Ill. 2d  at 21 (concluding that the trial judge's finding 
that the prosecutor's concern was an "honest one" was not clearly 
erroneous).
David Knuckles
Dr. McPartlin's counsel explained that he excused venireperson Knuckles based 
on a negative experience Knuckles had had with the medical profession in 
connection with his mother's death a few years earlier. Knuckles described his 
mother's doctor as "one of those diet quacks." Knuckles had a "negative feeling" 
after her sudden death, and believed that the doctor could have done some things 
differently. He explained that "[i]t was a case where you would think because 
she's going to the doctor everything was fine, then you get sick and die." When 
asked by Dr. McPartlin's counsel whether, despite this experience, he could be 
fair in this particular case, Knuckles responded, "After being here I can say, 
yes, maybe. Before I came in the room, no. But after the Judge and hearing 
everything I could say yes."
An equivocal statement by a veniremember as to the ability to be fair and 
impartial may constitute a race-neutral reason for the exercise of a peremptory 
challenge. See People v. Wiley, 165 Ill. 2d 259, 282 (1995). In light 
of Knuckles' equivocal representation as to his ability to be fair, the trial 
court's finding that counsel's challenge of Knuckles was not racially motivated 
was not clearly erroneous.
Rannal Bankhead
The record indicates that Dr. Mullin's counsel excused venireperson Bankhead 
because Bankhead seemed "overtly hostile" to Dr. McPartlin's counsel. The trial 
court "absolutely" agreed, stating that Bankhead's manner of answering questions 
indicated he was "real angry" and "hostile."
The very procedures governing peremptory challenges are designed to afford 
both parties a fair opportunity to detect bias or hostility on the part of 
prospective jurors. See People v. Moss, 108 Ill. 2d 270, 276 (1985). 
Accordingly, a venireperson's demeanor which evinces a hostile attitude may 
constitute a legitimate race-neutral reason for excluding that individual. 
Munson, 171 Ill. 2d at 179-82; People v. Taylor, 171 Ill. App. 
3d 261, 267-69 (1988). Further, confirmation in the record that the trial court 
observed the same demeanor as the challenger lends credence to a purported 
race-neutral explanation. Munson, 172 Ill. 2d  at 182. We find, 
therefore, that the trial court's ruling that counsel's proffered reason for 
excluding Bankhead was race-neutral was not clearly erroneous.
III. Evidentiary Errors
Plaintiff also argues that she was unfairly prejudiced at trial by (1) 
improper evidence and argument by defendants as to contributory negligence and 
mitigation of damages; (2) improper restriction of plaintiff's cross-examination 
of Dr. McPartlin; (3) defendant's violation of a motion in limine 
barring evidence of the prior trial in this matter; (4) improper use of leading 
questions in the examination of Dr. McPartlin by his own counsel; and (5) the 
cumulative effect of the foregoing errors. We consider each claimed error in 
turn.
Contributory Negligence and Mitigation of Damages
Plaintiff argues that the trial court erred in allowing defendants to present 
evidence and argument concerning (i) the refusal by plaintiff, McDonnell, and 
their daughter, Nula McDonnell, to consent to hip removal surgery; (ii) the 
alleged refusal by plaintiff to follow Dr. Mullin's instructions after the 
November 8 emergency room visit, and to return to the emergency room on November 
9; and (iii) the alleged failure of plaintiff and Nula to allow artificial 
ventilation of McDonnell on November 11 and 12. Plaintiff argues, generally, 
that defendants and the trial court failed to distinguish between contributory 
negligence and mitigation of damages. Plaintiff also argues, more particularly, 
that a plaintiff has no obligation to mitigate damages by submitting to serious 
or major surgery. See Hall v. Dumitru, 250 Ill. App. 3d 759 (1993).
Generally, errors at trial relating solely to damages will not be considered 
on appeal where it is evident that the jury, having found in favor of the 
defendant as to liability, never reached the question of damages. Mulvey v. 
Illinois Bell Telephone Co., 53 Ill. 2d 591, 599 (1973). An exception 
exists where errors which go to the question of damages are "so pervasive and 
prejudicial as to create the likelihood that they may have affected a jury's 
decision on the issue of liability." Mulvey, 53 Ill. 2d  at 599-600.
In the instant case, plaintiff brought a wrongful death claim and a survival 
claim. Plaintiff brought the wrongful death claim on behalf of herself and the 
McDonnells' three adult children-Anne Dougherty, Nula McDonnell, and Richard 
McDonnell. Under the Wrongful Death Act, the contributory negligence of one or 
more of the beneficiaries on whose behalf the action is brought is not a 
defense. Rather, any damages awarded "shall not include any compensation with 
reference to the pecuniary injuries resulting from such death, to such 
contributorily negligent person," who shall not share in the award. Ill. Rev. 
Stat. 1987, ch. 70, pars. 1, 2. Consistent with the Wrongful Death Act, the jury 
was instructed that the contributory negligence of plaintiff or Nula barred 
recovery by that individual or individuals, but that those individuals who were 
not contributorily negligent may be awarded their pecuniary damages.
Plaintiff brought the survival claim on behalf of McDonnell's estate for 
personal injuries suffered by McDonnell. See Ill. Rev. Stat. 1987, ch. 110½, 
par. 27-6. As to this claim, the jury was instructed that a patient's failure to 
exercise ordinary care in obtaining treatment or in following reasonable medical 
advice does not absolve the physician's negligence; it only absolves the 
physician from damages caused by the patient's failure to exercise ordinary 
care. See IPI Civil 3d No. 105.08.
Based on the foregoing, it is clear that the evidence and argument of which 
plaintiff complains went only to the question of damages. The jury, however, 
found in favor of the defendants as to liability, and thus never reached the 
question of damages. We need not, therefore, consider whether the trial court 
erred in permitting such evidence and argument. See Mulvey, 53 Ill. 2d  
at 599. Assuming, however, that the trial court erred, this is not a case where 
such error is so pervasive as to affect the jury's decision as to liability. The 
record reveals that the jury heard argument and testimony over a period of four 
weeks. In addition to the testimony of the parties, the jury heard testimony 
from no less than 12 medical professionals, including four orthopedic surgeons, 
four internists, one nephrologist, one emergency medicine specialist, one 
geriatric specialist, and one emergency room nurse. The transcripts consume over 
3,000 pages. Of this voluminous record, only a slight portion involves evidence 
as to contributory negligence and mitigation of damages. The defendants' closing 
arguments reflect the lack of emphasis on these issues. In closing, Dr. Mullin's 
counsel touched on these issues twice, and then only briefly. Similarly, the 
coverage afforded these issues by Dr. McPartlin's counsel is small, in relation 
to counsel's argument as a whole. Given the length of this trial and the sheer 
volume of evidence placed before the jury, the relatively small amount of 
evidence and argument as to contributory negligence and mitigation of damages 
was not pervasive at all, much less so pervasive as to affect the jury's 
decision on liability.
Cross-Examination of Dr. McPartlin
Plaintiff argues that the trial court improperly restricted her 
cross-examination of Dr. McPartlin. Dr. McPartlin testified that, during his 
treatment of McDonnell in 1986, he relied on the "Bone sepsis criteria." 
Plaintiff attempted to impeach Dr. McPartlin with an article purportedly 
establishing that the Bone sepsis criteria were first published in 1992. 
Defendants objected to the use of the article because it had not been disclosed 
in discovery. The trial court sustained the objection and struck any testimony 
regarding the date of the Bone article.
The scope of cross-examination rests within the discretion of the trial court 
and will not be disturbed on review absent a clear abuse of that discretion 
resulting in manifest prejudice to the party claiming error. Leonardi, 
168 Ill. 2d  at 102; People v. Kitchen, 159 Ill. 2d 1, 37 (1994). One 
purpose of cross-examination is to test the credibility of the witness. 
Kitchen, 159 Ill. 2d  at 37. Assuming, arguendo, that the trial 
court erred in preventing plaintiff from testing Dr. McPartlin's credibility as 
to his reliance on the Bone criteria in 1986, we conclude that plaintiff's 
planned impeachment of Dr. McPartlin was not significant enough to affect the 
outcome of the trial.
Dr. McPartlin testified over a period of several days, explaining in great 
detail the significance of each symptom, laboratory value, and test result 
reflected in the records from McDonnell's hospitalization, as well as the 
medical bases underlying his treatment decisions. The doctor's purported 
reliance on the Bone sepsis criteria constitutes one very small part of his 
testimony. Further, we note that the limited testimony that was taken on this 
subject suggests that the criteria may have existed in some fashion prior to 
their purported publication under Bone's name in 1992. We also observe that the 
significance of whether Dr. McPartlin, in fact, could have relied upon the Bone 
criteria in 1986 is diminished by the testimony of plaintiff's expert, Dr. Gump, 
who acknowledged that McDonnell did not satisfy the criteria until November 12. 
Thus, to the extent the trial court abused its discretion by restricting 
plaintiff's cross-examination of Dr. McPartlin, no manifest prejudice resulted 
to plaintiff.
Motion in Limine
Plaintiff next argues that the trial court erred in denying her motion for a 
mistrial made after a defense witness referred to the prior trial of this 
matter, in violation of the court's in limine order. The remark of 
which plaintiff complains occurred during cross-examination of Dr. Jack 
Franaszek, one of Dr. Mullin's expert witnesses. When asked how many hours Dr. 
Franaszek devoted to this case, the doctor answered, "I remember billing 
approximately $4,000 in this case through the trial of last year." 
(Emphasis added.) The trial court, after discussing the matter with counsel, 
denied plaintiff's motion for a mistrial and took a short recess. Questioning of 
Dr. Franaszek then resumed. After closing arguments, the trial court instructed 
the jury that it may not consider any testimony that may have suggested there 
was a previous trial.
A trial court is vested with broad discretion to determine the propriety of 
declaring a mistrial. Where the alleged error, however, did not prejudice the 
complaining party, or otherwise impair that party's right to a fair trial, no 
mistrial will be declared. People v. Jones, 123 Ill. 2d 387, 410 
(1988). Error that occurs through the violation of a motion in limine 
is subject to the same analysis, i.e., such a violation will be deemed 
an appropriate ground for mistrial only where the violation resulted in the 
denial of a fair trial. See Kutchins v. Berg, 264 Ill. App. 3d 926, 930 
(1994); Northern Trust Bank v. Carl, 200 Ill. App. 3d 773, 778 
(1990).
It is undisputed that Dr. Franaszek's testimony violated the court's in 
limine order. At issue is whether the trial court abused its discretion in 
denying plaintiff's motion for a mistrial based on such violation. We conclude 
that no abuse of discretion occurred.
Dr. Franaszek's reference to the prior trial was brief, devoid of any 
specifics, and occurred during the course of lengthy and complex proceedings. To 
the extent any prejudice resulted, it was cured by the court's instruction to 
the jury to disregard such testimony. See Jones, 123 Ill. 2d  at 408-10 
(holding that a motion for mistrial was properly denied where the witness's 
improper reference to the "last trial" did not disclose the parties or the 
outcome of the earlier proceeding and where the trial court admonished the jury 
to disregard the witness's answer). The jury is presumed to have followed the 
court's instruction to disregard this testimony. See People v. Taylor, 
166 Ill. 2d 414, 438 (1995).
Leading Questions
Plaintiff argues that the trial court erred in allowing Dr. McPartlin's 
counsel to ask leading questions of his client. Although we agree that error 
occurred, we find any error was harmless.
Plaintiff called Dr. McPartlin as an adverse witness, and appropriately 
questioned the doctor as if under cross-examination. See 735 ILCS 5/2-1102 (West 
1998). Subsequent questioning of Dr. McPartlin by his own counsel should have 
been conducted as a redirect examination. See M. Graham, Cleary & Graham's 
Handbook of Illinois Evidence §607.4, at 417-18 (7th ed. 1999). Over plaintiff's 
objection, however, the trial court allowed Dr. McPartlin's counsel to ask his 
client leading questions, as if conducting cross-examination. Upon later 
realizing its error, the trial court instructed the jury that plaintiff's 
counsel "was correct in his objection to leading questions." Significantly, 
plaintiff's counsel agreed to the curative instruction because it removed from 
the jurors' minds the idea that he had done something wrong by objecting. 
Further, a review of Dr. McPartlin's testimony reveals that not all of the 
questions asked by his counsel were leading, and many of the questions that were 
leading related to preliminary or inconsequential matters. Under the 
circumstances, any error is harmless.
Cumulative Error
Finally, plaintiff argues that the cumulative effect of the foregoing errors 
was highly prejudicial. We disagree. As discussed above, none of the errors 
alleged require reversal in this case. Looking at the matters cumulatively, the 
record reveals that the trial, taken as a whole, was fair. Thus, plaintiff is 
not entitled to a new trial on this basis. See Lawson v. G.D. Searle & 
Co., 64 Ill. 2d 543, 558-59 (1976) (recognizing that minor improprieties 
during a lengthy, complex and difficult trial do not warrant reversal where the 
trial as a whole was fair).
CONCLUSION
For the foregoing reasons, we find that the jury was properly instructed as 
to defendants' sole proximate cause defense; that no Batson violation 
occurred; and that any evidentiary errors at trial were harmless. Accordingly, 
we affirm the judgment of the appellate court, affirming the judgment of the 
circuit court in favor of defendants.
Affirmed.