NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as 

precedent by any party except in the limited circumstances allowed under Rule 23(e)(1).

2023 IL App (3d) 220221-U

Order filed November 8, 2023

____________________________________________________________________________ 

IN THE

APPELLATE COURT OF ILLINOIS

THIRD DISTRICT

2023 

DIJANA RIS, )

 ) 

Plaintiff-Appellee, ) 

 ) 

 v. ) 

 ) 

ADVOCATE HEALTH AND HOSPITALS ) 

CORPORATION d/b/a ADVOCATE GOOD ) 

SAMARITAN HOSPITAL, a corporation; LI ) 

ZHANG, M.D., S.C., a corporation; and LI ) 

ZHANG, M.D., ) 

 ) 

Defendants ) 

 ) 

(Li Zhang, M.D., Defendant-Appellant). ) 

Appeal from the Circuit Court

of the 18th Judicial Circuit, 

Du Page County, Illinois. 

Appeal No. 3-22-0221 

Circuit No. 16-L-613 

The Honorable

David E. Schwartz, 

Judge, Presiding.

____________________________________________________________________________

JUSTICE HETTEL delivered the judgment of the court. 

Presiding Justice Holdridge and Justice McDade concurred in the judgment. 

____________________________________________________________________________

 ORDER

¶ 1 Held: (1) Trial court properly dismissed physician’s motion to dismiss patient’s 2016 

medical malpractice action on statute of repose grounds where physician 

continuously treated patient until 2014; (2) trial court did not abuse its discretion 

in allowing experts to testify about the standards of care in their respective fields; 

(3) trial court did not abuse its discretion in overruling physician’s objections 

during plaintiff’s closing arguments; (4) trial court did not abuse its discretion in 

allowing hospital defendant’s special interrogatories or failing to order a new trial 
2 

based on the jury’s answers to them; and (5) trial court did not abuse its discretion 

in allowing testimony from neurologist about the cost of 24-hour attendant care 

for plaintiff. 

¶ 2 Plaintiff Dijana Ris filed a medical malpractice complaint against defendant Dr. Li Zhang, 

Zhang’s medical corporation and defendant Advocate Health and Hospitals Corp (Advocate), d/b/a 

Advocate Good Samaritan Hospital (Good Samaritan). During trial, the court entered an order

voluntarily dismissing Dr. Zhang’s medical corporation as a defendant. Following trial, the jury 

found Dr. Zhang liable and Advocate not liable and entered judgment against Dr. Zhang for 

$3,350,000. Dr. Zhang appeals, arguing that the trial court erred in (1) denying her motion to 

dismiss plaintiff’s complaint, (2) allowing plaintiff’s experts to testify about the standards of care 

in their respective fields, (3) overruling her objection to plaintiff’s comments during closing 

argument, (4) allowing Advocate’s special interrogatories and failing to order a new trial based on 

the jury’s answers to them, and (5) allowing plaintiff’s neurology expert to testify about the 

reasonable expense of necessary services for plaintiff in the future. We affirm. 

¶ 3 BACKGROUND 

¶ 4 On August 25, 2009, plaintiff Dijana Ris went to the emergency room of Good Samaritan 

complaining of severe headaches. She was admitted to the hospital and seen by Dr. Steven Beltran, 

an internal medicine physician. Dr. Beltran ordered testing, including magnetic resonance imaging 

(MRI) of plaintiff’s brain. According to the MRI report, completed by Dr. James Scheuer, an 

“abnormal signal” or “mass” was present in the right anterior frontal lobe of plaintiff’s brain, which 

could possibly be a “nonenhancing slow-growing glioma.” A glioma is a brain tumor.

¶ 5 Dr. Beltran sought a consultation from defendant Dr. Li Zhang, a neurologist. Dr. Zhang 

performed a neurological exam of plaintiff and reviewed plaintiff’s MRI. Dr. Zhang determined 

that the “abnormal signal” or “mass” identified in the MRI was most likely not a tumor but scar 
3 

tissue from an old head injury. Dr. Zhang instructed plaintiff to follow up with her for a repeat 

MRI in three months. 

¶ 6 A second MRI of plaintiff was performed in December 2009. Dr. Siddiqi, the radiologist 

who interpreted the MRI, recommended that “if no intervention is planned at this time, a follow 

up should be obtained in six months to exclude a low-grade glioma.” Dr. Zhang did not order any 

intervention, such as a biopsy, or a follow-up MRI. 

¶ 7 Plaintiff did not have another MRI until July 2014, after she hit her head at work. Dr. 

Siddiqi interpreted that MRI and found “diffuse abnormality” throughout plaintiff’s brain. He 

determined that the abnormal signal in plaintiff’s brain “has significantly progressed since 

December 2009 where it was localized to the right frontal lobe.” Because of the presence of tumors 

throughout plaintiff’s brain, the only treatment option was whole-brain radiation. Plaintiff 

underwent five weeks of whole-brain radiation in 2014. 

¶ 8 In July 2016, plaintiff filed a complaint against Dr. Zhang, her medical corporation and 

Advocate. Plaintiff alleged medical negligence and lack of informed consent. Plaintiff alleged that 

Dr. Zhang, as an actual or apparent agent of Advocate, “engaged in an ongoing and continuous 

course of negligent treatment” from August 26, 2009, to January 16, 2014, by failing to: (1) 

appreciate the significance of the abnormal findings on her 2009 MRIs, (2) order follow-up 

imaging after December 2009, (3) order appropriate diagnostic testing, (4) order a biopsy, (5) 

diagnose and treat her for glioma, and (6) refer her to a neurosurgeon. 

¶ 9 Dr. Zhang and her corporation filed a motion to dismiss, alleging that plaintiff’s complaint 

was barred by the four-year statute of repose. The trial court denied the motion, finding that 

plaintiff adequately alleged that Dr. Zhang participated in a continuing course of negligent 

treatment until 2014. 
4 

¶ 10 Prior to trial, Dr. Zhang filed a motion in limine seeking to bar the testimony of Dr. Steven 

Arkin, a neurologist, regarding the cost of future care and services for plaintiff. The trial court 

denied the motion. A jury trial was held over 10 days in June 2021. 

¶ 11 Dr. Zhang testified that after first seeing plaintiff at Good Samaritan in August 2009, she 

next saw plaintiff at her private neurology practice on January 5, 2010, following plaintiff’s

December 2009 MRI. Dr. Zhang said, based on her custom and practice, she would have reviewed

the MRI and report with plaintiff, but Dr. Zhang did not remember the conversation she had with 

plaintiff. Dr. Zhang testified that plaintiff’s second MRI “reassured” her that the abnormal 

findings were consistent with a prior head injury and not a tumor. 

¶ 12 Dr. Zhang agreed she was not employing a “watchful waiting” strategy with plaintiff. If 

she had been, she would have obtained additional MRIs. Dr. Zhang saw plaintiff in her office in 

Lisle several times a year until early 2014. During that time, Dr. Zhang treated plaintiff with 

medication for migraines. Dr. Zhang testified that she “never thought [plaintiff] had glioma.” Dr. 

Zhang testified that if she suspected plaintiff had glioma, she would have referred her to a 

neurosurgeon. Dr. Zhang agreed that the standard of care required her to refer a patient with 

suspected glioma to a neurosurgeon. 

¶ 13 At trial, plaintiff presented the testimony of three experts: Dr. Steven Arkin, a neurologist; 

Dr. Manesh Aghi, a neurosurgeon; and Dr. Tracy Batchelor, a neuro-oncologist. All three agreed 

that plaintiff’s August and December 2009 MRIs showed a brain tumor that was confined to 

plaintiff’s right frontal lobe. All three experts also agreed that if Dr. Zhang had identified and 

treated the tumor in a timely manner, it would not have spread outside of plaintiff’s right frontal 

lobe, and whole-brain radiation, which caused plaintiff neurocognitive deficits, would have been 

unnecessary. 
5 

¶ 14 Dr. Arkin testified that Dr. Zhang deviated from the standard of care by failing to (1) 

recognize the possible existence of a tumor; (2) discuss with plaintiff the differential diagnosis 

contained in the 2009 MRI reports; (3) refer plaintiff to a neurosurgeon from 2009 to 2014; and/or 

(4) perform “serial surveillance on the lesion.” Dr. Arkin opined that Dr. Zhang’s failure to 

properly diagnose and treat plaintiff allowed plaintiff’s tumor to grow outside the right frontal lobe 

and into other areas of plaintiff’s brain. 

¶ 15 Dr. Arkin testified that in his practice as a radiologist he has treated patients with brain 

injuries for over 28 years and regularly determines whether patients require assistance in daily 

activities. He further opined, over Dr. Zhang’s objection, that plaintiff requires assistance with 

activities of daily living to “keep her out of danger.” Dr. Arkin determined that plaintiff needs 24-

hour assistance and supervision and asked plaintiff’s counsel to provide him with hourly rates for 

agencies in the area where plaintiff lives that provide such care. Plaintiff’s counsel provided Dr. 

Arkin with rates from two agencies: Assisting Hands, which charges $24.50 per hour, and Visiting 

Angels, which charges $25 per hour. Over Dr. Zhang’s objection, Dr. Arkin testified that the hourly 

rates charged by those agencies were consistent with what agencies charge in the area where he 

lives. Dr. Arkin concluded that plaintiff will have to spend $1.5 million on 24-hour attendant care 

throughout her lifetime. On cross-examination, Dr. Arkin admitted he never personally examined 

plaintiff but testified that he reviewed her medical records. 

¶ 16 Dr. Aghi testified that a neurosurgeon treating a patient like plaintiff would comply with 

the standard of care by: (1) performing a surgical resection, (2) performing a biopsy, or (3) 

following a “watching and waiting” approach. Dr. Aghi testified that a “watching and waiting” 

strategy requires repeat MRIs at “tight intervals” of six months or less. 
6 

¶ 17 Dr. Aghi agreed that if left untreated, glioma will spread and invade other areas of the 

brain, which is what happened to plaintiff. Dr. Aghi believed plaintiff’s tumor was “amenable to 

surgical resection” in 2009 and early 2010. Dr. Aghi agreed “there was no harm done to [plaintiff]

from August to December [2009], based on the MRI images and her options as of December or 

January of 2010.” Dr. Aghi concluded that the delay in diagnosing and treating plaintiff’s brain 

tumor caused plaintiff’s neurocognitive dysfunction and shortened her life expectancy. 

¶ 18 Dr. Batchelor testified, over Dr. Zhang’s objection, that the standard of care for a neurooncologist with a patient who had an MRI like plaintiff’s in August 2009 required referral to a 

neurosurgeon. Based on the appearance of plaintiff’s tumor in August 2009, Dr. Batchelor testified 

he would have recommended “at a minimum a biopsy, if not a resection.” Based on the results of

the biopsy, he would have expected “a gross total resection” to be performed. Such a procedure 

would have prevented the tumor from growing and extending into multiple areas of the brain. Dr. 

Batchelor testified that “a lack of treatment between 2009 and 2014” led to the growth of plaintiff’s 

tumor, causing it to infiltrate multiple lobes of the brain. Dr. Batchelor admitted that if plaintiff’s 

tumor had been surgically resected, plaintiff would likely have a recurrence sometime during her 

lifetime because tumors “almost inevitably recur.” He testified that upon recurrence, plaintiff 

would be treated with focal radiation, which has “[f]ar less risk” than whole-brain radiation. 

¶ 19 Plaintiff also presented the testimony of Dr. Nancy Landre, a neuropsychologist. She 

testified that it is common for patients who have undergone whole-brain radiation to have cognitive 

symptoms affecting thinking, memory, processing speed, and executive functions. Dr. Landre 

administered several tests to plaintiff in 2017 and 2020, which showed plaintiff was “mildly 

impaired” in psychomotor speed, “moderately impaired” in mental flexibility, and “significantly 

impaired” in non-verbal problem solving, encoding new information, and memory. Dr. Landre 
7 

concluded that plaintiff “demonstrated consistent evidence of memory impairment.” Dr. Landre 

opined that plaintiff suffered cognitive injuries because of whole-brain radiation that are 

“permanent” and will worsen as she ages. 

¶ 20 Plaintiff’s son, Slavisa Ris, was 25 years old at the time of trial. He testified that he lives 

with plaintiff. Slavis testified that prior to 2014, plaintiff was independent and took care of the 

household herself. Now, Slavisa said he takes care of household finances because plaintiff “forgets 

sometimes what bills she’s paid.” He testified that plaintiff suffers from “short-term memory 

problems.” Slavisa is uncomfortable with plaintiff being home alone because of her memory 

problems. He testified that plaintiff does not go anywhere alone because “she can’t drive, she gets 

dizzy, [and] her concentration is bad.” 

¶ 21 Plaintiff’s sister, Marjana Balic, testified that plaintiff has experienced “a lot of memory 

problems” since her whole-brain radiation. She said plaintiff spends very little time home alone 

because Marjana feels “it’s not safe to leave her home alone.” According to Marjana, plaintiff has 

suffered falls and forgotten to take her medication.

¶ 22 Plaintiff testified that she came to the United States from Bosnia in 2003, with her son and 

husband. At that time, she spoke no English. She began working at Kohl’s in 2004, where she 

learned English. In 2009, she obtained a second job at Good Samaritan. When plaintiff went to the 

emergency room at Good Samaritan on August 25, 2009, she was not a patient of Dr. Zhang’s and 

did not ask to see Dr. Zhang. 

¶ 23 When plaintiff went to Dr. Zhang’s office in January 2010, she brought an electronic copy 

of her December 2009 MRI. Plaintiff looked at the images with Dr. Zhang but did not understand

them. Dr. Zhang did not show her the MRI report and did not tell her that the radiologist 

recommended she have a repeat MRI in six months. Plaintiff said Dr. Zhang told her she did not 
8 

have cancer or a tumor but had “chronic migraines” and treated her for those. Dr. Zhang never 

mentioned plaintiff having another MRI after December 2009. 

¶ 24 Plaintiff continued to work at Good Samaritan until 2014. When plaintiff underwent wholebrain radiation in 2014, she said she had “[n]o energy, weakness, was “nauseous all the time” and 

could barely walk. Plaintiff testified she no longer works, never leaves the house alone, and has to 

rely on others. 

¶ 25 Dr. Keith Schaible, a neurosurgeon, testified he performed a biopsy on plaintiff’s brain 

tumor on August 1, 2014. Dr. Schaible testified that surgery was not an option for plaintiff in 2014 

because the tumor “involved areas of the brain that were not accessible to surgery without 

significant risk in terms of neurological function.”

¶ 26 After plaintiff’s witnesses testified, Dr. Zhang and Advocate filed motions for a directed 

verdict, which the trial court denied. Plaintiff orally moved that Dr. Zhang’s medical corporation 

be voluntarily dismissed from the action. The trial court granted that motion and entered an order 

voluntarily dismissing Li Zhang, M.D., S.C., as a defendant.

¶ 27 Dr. Zhang and Advocate presented the testimony of several experts: Dr. Terence Roberts, 

a radiation oncologist; Dr. Joel Meyer, a neuroradiologist; Dr. Herbert Engelhard, a neurosurgeon; 

and Dr. Martin Kelly Nicholas, a neuro-oncologist. They all testified that plaintiff’s August 2009 

and December 2009 MRIs were essentially the same and did not show a single tumor contained in 

the right frontal lobe but showed “gliomatis cerebri,” tumor cells spread throughout plaintiff’s

brain. 

¶ 28 Dr. Roberts testified that “it is not possible” that plaintiff’s tumor was localized to one lobe 

in 2009 based on the presence of tumors in many other lobes in 2014. He testified that surgical 

intervention in 2009 would not have changed plaintiff’s outcome because surgery “would have 
9 

only treated a portion of her tumor.” He opined that if the tumor in the right frontal lobe had been 

removed in 2009, other tumors would have appeared and required whole-brain radiation. Dr. 

Roberts testified that the five-year delay, from 2009 to 2014, in identifying and treating plaintiff’s 

brain tumor did not alter plaintiff’s outcome, change her treatment, or change her “overall survival 

chances.” 

¶ 29 Dr. Meyer testified that plaintiff’s MRI from August 2009 showed “abnormalities outside 

the right frontal lobe.” He opined that in 2009, plaintiff’s tumor was “[n]ot amenable to be taken 

out” because it was in multiple areas of her brain. He further opined that Dr. Zhang’s delay in 

diagnosing plaintiff’s tumor did not cause any harm to plaintiff because plaintiff’s condition was 

“noncurable.” Dr. Meyer agreed that “[m]ore likely than not” plaintiff was injured by whole-brain 

radiation because she “suffered brain volume loss,” which means her brain shrunk. 

¶ 30 Dr. Engelhard testified that the standard of care did not require a biopsy or surgical 

resection of plaintiff’s tumor in 2009. Dr. Engelhard opined that observation or “watchful waiting” 

was a reasonable course of action at that time. He agreed that watchful waiting required “serial 

MRI scans” every three to twelve months. He testified that “an aggressive surgical resection” in 

2009 would not have cured plaintiff because it would not have removed all the tumor cells. He 

testified that plaintiff’s 2009 MRIs showed that “[t]his is not a curable tumor.” Dr. Engelhard 

opined that aggressive resection in 2009 or 2010 would not have altered plaintiff’s outcome 

because plaintiff “would have winded up needing radiation therapy and chemotherapy anyway.” 

¶ 31 Dr. Nicholas agreed that observation, biopsy and resection are all reasonable options for 

someone who presented like plaintiff with low-grade glioma in 2009. He explained that surgical 

resection does not cure a patient like plaintiff because “there will be cells left behind” that will 
10 

grow. Dr. Nicholas opined that Dr. Zhang violated the standard of care “when she failed to follow 

up on the MRI scans” but did not violate the standard of care in any other way.

¶ 32 During closing arguments, plaintiff’s attorney stated: 

“You will notice that the hospital in this case called expert witnesses on many issues. 

But the hospital did not defend, nor did it hire an expert to defend Dr. Zhang’s conduct in 

this case.” 

Dr. Zhang’s counsel objected, and the trial court overruled the objection. Plaintiff’s attorney 

continued: 

“You may have noticed that there were specific experts in many fields, but nobody in 

the field of neurology to defend Dr. Zhang’s conduct. Dr. Zhang did not present any 

defense through an expert witness as it relates to her failure to give informed consent.” 

Plaintiff’s counsel again objected, and the trial court overruled the objection, stating: “The jury 

has heard the evidence.” 

¶ 33 Prior to deliberations, the jury was given various instructions, including the following

instruction about closing arguments: 

 “The closing arguments given at the conclusion of the case are a summary of what the 

attorneys contend the evidence has shown. If any statement or argument of an attorney is 

not supported by the law or the evidence, you should disregard that statement or argument.” 

See Illinois Pattern Jury Instruction, Civil, No. 1.01(C)[13] (2022) (hereinafter IPI Civil 

(2022)). 

The jury was also given the following instruction regarding the burden of proof: 

 “The plaintiff has the burden of proving each of the following propositions as to the 

defendant: 
11 

First, that the defendant acted or failed to act in one of the ways claimed by the plaintiff 

as stated to you in these instructions, and in so acting, or failing to act, the defendant was 

negligent; 

Second, that the plaintiff was injured; 

Third, that the negligence of the defendant was a proximate cause of the injury to the 

plaintiff. 

If you find from your consideration of all the evidence that any of these propositions 

has not been proved as to the defendant, then your verdict shall be for the defendant. On 

the other hand, if you find from your consideration of all the evidence that all of these 

propositions have been proved as to the defendant, then your verdict shall be for the 

plaintiff and against the defendant.” See IPI Civil (2022) No. 21.02. 

¶ 34 Over plaintiff’s objection, Advocate tendered two special interrogatories to the court, 

which the court submitted to the jury: (1) “Was Li Zhang, M.D. the apparent agent of Advocate 

*** in 2009?”; and (2) “Was Li Zhang, M.D. the apparent agent of Advocate *** from 2010 

through 2014?” 

¶ 35 The jury found Dr. Zhang liable and Advocate not liable and determined plaintiff’s 

damages to be $3,350,000, which included $1,500,000 for “[t]he reasonable expense of necessary 

services reasonably certain to be received in the future.” With respect to the special interrogatories, 

the jury responded “Yes” to the first and “No” to the second. Dr. Zhang filed a motion seeking a 

new trial, and plaintiff filed a motion seeking judgment against Advocate or, alternatively, a new 

trial. The trial court denied both motions. 

¶ 36 ANALYSIS

¶ 37 I. 
12 

¶ 38 Dr. Zhang first argues that the trial court erred in denying her motion to dismiss plaintiff’s 

complaint because it was barred by the statute of repose. 

¶ 39 The Code of Civil Procedure (Code) (735 ILCS 5/13-212(a) (West 2016)) imposes a fouryear statute of repose on causes of action for professional medical negligence. Hanks v. Cotler, 

2011 IL App (1st) 101088, ¶ 18. Section 13-212(a) of the Code provides that an action for damages 

against a physician or hospital may not be brought “more than 4 years after the date on which 

occurred the act or omission or occurrence alleged in such action to have been the cause of such 

injury or death.” 735 ILCS 5/13-212(a) (West 2016). 

¶ 40 However, “a plaintiff is not barred by the statute of repose if she can demonstrate that there 

was an ongoing course of continuous negligent medical treatment.” (Emphasis in original.) 

Cunningham v. Huffman, 154 Ill. 2d 398, 406 (1993). “To prevail under this cause of action a 

plaintiff must demonstrate: (1) that there was a continuous and unbroken course of negligent 

treatment, and (2) that the treatment was so related as to constitute one continuing wrong.” 

(Emphasis in original.) Id. Under this doctrine, the negligent medical treatment continuum begins 

with the defendant’s first negligent medical treatment and continues until the defendant’s last 

negligent treatment, at which point the repose period begins to run. Ferrara v. Wall, 323 Ill. App. 

3d 751, 756 (2001) (citing Cunningham, 154 Ill. 2d at 405). 

¶ 41 In this case, Dr. Zhang first treated plaintiff at Good Samaritan in September 2009, and 

continued treating plaintiff several times a year until January 2014. Plaintiff filed her medical 

negligence complaint against Dr. Zhang in 2016, alleging that Dr. Zhang negligently treated her 

from 2009 to 2014, by failing to (1) appreciate the significance of the abnormal findings on her

2009 MRIs, (2) order follow-up imaging after December 2009, (3) order appropriate diagnostic 
13 

testing, (4) order a biopsy, (5) diagnose and treat her for glioma, and (6) refer her to a 

neurosurgeon. 

¶ 42 Plaintiff’s complaint adequately alleged a continuing course of negligent medical treatment 

by Dr. Zhang that began in 2009 and continued until January 2014, the last date Dr. Zhang treated 

plaintiff. Thus, the statute of repose began running in January 2014. See Cunningham, 154 Ill. 2d 

at 406; Ferrara, 323 Ill. App. 3d at 756. Plaintiff filed her complaint in 2016, well before expiration 

of the four-year statute of repose. See 735 ILCS 5/13-212(a) (West 2016). Thus, the trial court 

properly denied Dr. Zhang’s motion to dismiss.

¶ 43 II.

¶ 44 Dr. Zhang next argues that the trial court erred in allowing Dr. Aghi and Dr. Batchelor to 

testify about the standards of care in their respective medical fields. She contends that their 

testimony was cumulative to that of Dr. Arkin, so the trial court should have barred it. 

¶ 45 A plaintiff in a medical malpractice case must prove (1) the standard of care against which 

the physician’s conduct must be measured, (2) that the defendant was negligent by failing to 

comply with that standard, and (3) that the defendant’s negligence proximately caused the

plaintiff’s injuries. Freeman v. Crays, 2018 IL App (2d) 170169, ¶ 21. “The proximate cause 

element of a medical malpractice case must be established by expert testimony to a reasonable 

degree of medical certainty.” Krivanec v. Abramowitz, 366 Ill. App. 3d 350, 356-57 (2006). 

¶ 46 The admission of evidence is left to the discretion of the trial court. Hubbard v. Sherman 

Hospital, 292 Ill. App. 3d 148, 155 (1997). The trial court may, in its discretion, exclude 

cumulative evidence. Id. The trial court’s decision to admit or exclude evidence will be disturbed 

only when there is a “clear abuse of discretion.” Id. 
14 

¶ 47 Medical expert testimony is not cumulative if physicians from various medical specialties 

testify about their respective medical specialties and the standards of care applicable thereto. See 

Dahan v. UHS of Bethesda, Inc., 295 Ill. App. 3d 770, 781 (1998). Additionally, testimony from 

multiple medical experts is not cumulative where one is a specialist in the defendant’s field of 

medicine and testifies about the standard of care applicable thereto and another is a specialist in 

another field of medicine and offers opinions on causation. See Cetera v. DiFilippo, 404 Ill. App. 

3d 20, 45-46 (2010). 

¶ 48 At trial, Dr. Arkin testified as a neurologist and the standard of care applicable to a 

neurologist, like Dr. Zhang. In contrast, Dr. Aghi testified as a neurosurgeon and the standard of 

care applicable thereto, while Dr. Batchelor testified as a neuro-oncologist and the standard of care 

applicable thereto. Because Dr. Aghi and Dr. Batchelor testified about the standards of care 

applicable to their respective specialties, which were different than Dr. Arkin’s, their testimony 

was not cumulative of Dr. Arkin’s testimony. See Dahan, 295 Ill. App. 3d at 781. 

¶ 49 Moreover, the testimony of Dr. Batchelor and Dr. Aghi was not cumulative of Dr. Arkin’s 

because it was offered for a different purpose. Dr. Arkin’s testimony was necessary to establish 

the first two elements of plaintiff’s malpractice claim against Dr. Zhang: (1) the standard of care 

applicable to Dr. Zhang, a neurologist, and (2) that Dr. Zhang was negligent by failing to comply 

with that standard of care. See Freeman, 2018 IL App (2d) 170169, ¶ 21. However, the testimony 

of Dr. Aghi and Dr. Batchelor was offered for a different purpose -- to establish that Dr. Zhang’s 

negligence proximately caused plaintiff’s injuries. See id. Expert testimony was necessary to prove 

that element of plaintiff’s case. See Krivanec, 366 Ill. App. 3d at 356-57. Because the testimony 

of Dr. Aghi and Dr. Batchelor was offered to prove causation, rather than the standard of care 
15 

applicable to Dr. Zhang, that testimony was not cumulative to Dr. Arkin’s, and the trial court did 

not abuse its discretion in allowing it. See Cetera, 404 Ill. App. 3d at 45-46. 

¶ 50 III. 

¶ 51 Next, Dr. Zhang argues that the trial court erred in overruling her objections to statements 

made by plaintiff’s counsel during closing arguments about defendants’ failure to call a witness to 

defend Dr. Zhang’s conduct. 

¶ 52 “Attorneys are permitted wide latitude in their closing arguments.” Wilson v. Moon, 2019 

IL App (1st) 173065, ¶ 46 (citing Guzeldere v. Wallin, 229 Ill. App. 3d 1, 13 (1992)). “Comments

on evidence during closing argument are proper ‘if they are either proved by direct evidence or are 

a fair and reasonable inference from the facts and circumstances proven.’ ” Id. ¶ 47 (quoting 

Guzeldere, 229 Ill. App. 3d at 13); see also Lebrecht v. Tuli, 130 Ill. App. 3d 457, 484 (1985) (“an 

attorney may argue the evidence and reasonable inferences from it”). 

¶ 53 In closing arguments, counsel can point out that his or her client presented unrebutted 

expert testimony on an issue. See Kinzinger v. Tull, 329 Ill. App. 3d 1119, 1128 (2002); Lebrecht, 

130 Ill. App. 3d at 484. Counsel can also assert during closing arguments that the opposing party 

did not call an expert witness because it “couldn’t find one” who would contradict the opinions 

provided by his or her client’s experts. See Wilson, 2019 IL App (1st) 173065, ¶ 50; Kinzinger, 

329 Ill. App. 3d at 1127-28. 

¶ 54 Improper remarks during closing argument generally do not constitute reversible error 

unless they result in substantial prejudice. Ittersagen v. Advocate Health and Hospitals Corp., 

2020 IL App (1st) 190778, ¶ 87, aff’d, 2021 IL 126507. Substantial prejudice means that, absent 

the remarks, the outcome of the trial would have been different. Id. If counsel makes inappropriate 

statements during closing argument, the error is generally cured if the trial court instructs the jury 
16 

that “closing arguments are not evidence and that any argument not based on the evidence should 

be disregarded.” Wilson, 2019 IL App (1st) 173065, ¶ 51 (citing Lecroy v. Miller, 272 Ill. App. 3d 

925, 933 (1995)). 

¶ 55 In examining whether a party has been denied a fair trial because of an opposing party's 

closing argument, considerable deference is extended to the trial court's judgment because the trial 

court is in a superior position to assess the accuracy and effect of counsel's statements. In re

Salmonella Litigation, 198 Ill. App. 3d 809, 820 (1990). Thus, the trial court’s ruling will not be 

disturbed unless there is a clear abuse of discretion. Oak Brook Park District v. Oak Brook 

Development Co., 170 Ill. App. 3d 221, 241 (1988). 

¶ 56 Here, plaintiff’s counsel’s twice stated during closing arguments that defendants failed to 

call an expert witness to defend Dr. Zhang’s conduct. Dr. Zhang’s counsel objected to these 

statements, and the trial court overruled the objections. Dr. Zhang contends that plaintiff’s 

counsel’s comments deprived her of a fair trial by shifting the burden of proof. We disagree. 

¶ 57 Plaintiff’s counsel’s statements about defendants’ failure to present an expert witness to 

defend Dr. Zhang’s conduct was a proper argument based on the evidence. See Wilson, 2019 IL 

App (1st) 173065, ¶ 50; Kinzinger, 329 Ill. App. 3d at 1127-28; Lebrecht, 130 Ill. App. 3d at 484. 

Moreover, even if the comments were improper, they did not deprive Dr. Zhang of a fair trial

because the comments were cured by the trial court’s instructions to the jury. See Wilson, 2019 IL 

App (1st) 173065, ¶ 51. Here, the trial court instructed the jury: “A closing argument is given at 

the conclusion of the case and is a summary of what an attorney contends the evidence has shown. 

If any statement or argument of an attorney is not supported by the law or the evidence, you should 

disregard that statement or argument.” See IPI Civil (2022) No. 1.01(C)[13]. The trial court also 

instructed the jury that plaintiff had the burden of proving defendants’ negligence. See IPI Civil 
17 

(2022) No. 21.02. Under these circumstances, we cannot say that the comments of plaintiff’s 

counsel during closing arguments substantially prejudiced Dr. Zhang so that the outcome of the 

trial would have been different if the statements had not been made. See Ittersagen, 2020 IL App 

(1st) 190778, ¶ 87.

¶ 58 IV. 

¶ 59 Dr. Zhang also argues that the trial court abused its discretion in allowing Advocate’s 

special interrogatories to be provided to the jury and entering a verdict in favor of Advocate in 

light of the jury’s answers to the special interrogatories. She contends that the jury’s answers to 

the interrogatories and its verdict in favor of Advocate were irreconcilably inconsistent. 

¶ 60 “A special interrogatory is a question posed to the jury for its consideration during 

deliberations that supplements its consideration of the case[.]” Inman v. Howe Freightways, Inc., 

2019 IL App (1st) 172459, ¶ 117. The purpose of a special interrogatory is “to test a general verdict 

against the jury’s conclusion on one or more specific issues of ultimate fact.” Id. “A special 

interrogatory serves ‘as guardian of the integrity of a general verdict in a civil jury trial.’ ” Simmons

v. Garces, 198 Ill. 2d 541, 555 (2002) (quoting O'Connell v. City of Chicago, 285 Ill. App. 3d 459, 

460 (1996)). 

¶ 61 “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.” Id. “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.” Id. at 556. “In determining whether answers to special
18 

interrogatories are inconsistent with a general verdict, all reasonable presumptions are exercised

in favor of the general verdict.” Id. 

¶ 62 When the general verdict and the answer to the special interrogatory are not “clearly and 

absolutely irreconcilable,” the trial court should enter judgment in accordance with the general 

verdict. See Stanphill v. Ortberg, 2017 IL App (2d) 161086, ¶ 29 (citing Simmons, 198 Ill. 2d at 

556). Courts are reluctant to set aside a general verdict “unless the special findings exclude every 

reasonable hypothesis consistent with the general verdict.” Patur v. Aetna Life & Casualty, 90 Ill. 

App. 3d 464, 468 (1980). 

¶ 63 A trial court’s decision to grant or deny a party’s request for a special interrogatory is

reviewed for an abuse of discretion. Cotton v. Coccaro, 2023 IL App (1st) 220788, ¶ 28. We review

de novo whether the jury’s answer to a special interrogatory is inconsistent with a general verdict.

See McCutchen v. Bigler, 101 Ill. App. 3d 696, 697 (1981) (whether general verdict and special

interrogatory are inconsistent is question of law); Leonard v. Illinois Department of Employment 

Security, 311 Ill. App. 3d 354, 356 (1999) (questions of law are subject to de novo review). 

¶ 64 In this case, plaintiff alleged that Advocate was liable for her injuries based on the doctrine 

of apparent agency/apparent authority. Under this doctrine, a hospital can be held vicariously liable 

for the negligent acts of a physician providing care at the hospital even if the physician is an 

independent contractor unless the patient knows or should have known that the physician is an 

independent contractor. Gilbert v. Sycamore Municipal Hospital, 156 Ill. 2d 511, 524 (1993). For 

a hospital to be liable under the doctrine, the plaintiff must show (1) the hospital held the physician 

out as having authority or knowingly acquiesced in the physician’s exercise of authority; (2) based 

on the acts of the principal and agent, the plaintiff reasonably concluded that an agency relationship 

existed; and (3) the plaintiff reasonably relied on the physician’s apparent authority to her
19 

detriment. See id. Whether a physician is an apparent agent of a hospital is a question of fact. See 

id. at 524. 

¶ 65 Dr. Zhang contends that the jury’s affirmative response to the first special interrogatory, 

which asked if Dr. Zhang was an apparent agent of Advocate in 2009, is “clearly and absolutely 

irreconcilable” with its general verdict in favor of Advocate. We disagree. 

¶ 66 The jury could have found that Dr. Zhang was an agent of Advocate in 2009, but was not 

guilty of negligence and/or did not cause an injury to plaintiff until 2010 or thereafter, when she 

was no longer an apparent agent of Advocate. That conclusion is supported by the testimony of 

defendants’ experts, Dr. Nicholas and Dr. Engelhard, who opined that Dr. Zhang did not breach 

the standard of care until she failed to obtain serial imaging of plaintiff in 2010 and thereafter. That 

conclusion is also supported by plaintiff’s expert, Dr. Aghi, who testified “there was no harm 

done” to plaintiff by Dr. Zhang in 2009. Because the jury’s answer to the special interrogatory and 

its general verdict were not “clearly and absolutely irreconcilable,” the jury’s verdict must stand. 

See Stanphill, 2017 IL App (2d) 161086, ¶ 29. 

¶ 67 Furthermore, Dr. Zhang forfeited her claim that the jury’s answer to the first special 

interrogatory and the general verdict in favor of Advocate were inconsistent by failing to object 

before the jury was discharged. The Code states: “When any special finding of fact is inconsistent 

with the general verdict, the court shall direct the jury to further consider its answers and verdict.” 

735 ILCS 5/2-1108 (West 2020). If a party believes a special interrogatory and general verdict are 

inconsistent, it must object as soon as the jury returns its verdict and answer. See Strauss v. 

Stratojac Corp., 810 F.2d 679, 682-83 (7th Cir. 1987) (analyzing section of Federal Code of Civil 

Procedure nearly identical to section 2-1108 of the Code). A party’s failure to object while the jury 

is still present in the courtroom results in the party’s forfeiture of an objection to an alleged 
20 

inconsistency between the special interrogatory and the general verdict. See id. at 683; Team

Contractors, L.L.C. v. Waypoint Nola, L.L.C., 976 F.3d 509, 515 (5th Cir. 2020); DiBella v.

Hopkins, 403 F.3d 102, 117 (2d Cir. 2005); Howard v. Antilla, 294 F.3d 244, 250 (1st Cir. 2002). 

Because Dr. Zhang did not object to the alleged inconsistency between the jury’s answer to the 

special interrogatory and its general verdict while the jury was still empaneled, she forfeited her 

claim that the answer and interrogatory were irreconcilably inconsistent. 

¶ 68 V. 

¶ 69 Finally, Dr. Zhang argues that the trial court abused its discretion by allowing Dr. Arkin to 

testify regarding the cost of future expenses plaintiff will incur as a result of her brain injuries. Dr. 

Zhang contends that Dr. Arkin’s testimony was speculative and not based on his own examination 

of plaintiff. 

¶ 70 Generally, expert testimony will be admitted if the expert has some experience and 

knowledge that is not common to laypersons and his testimony will aid the jury. Kunz v. Little Co.

of Mary Hospital & Health Care Centers, 373 Ill. App. 3d 615, 624 (2007) (citing Thompson v.

Gordon, 221 Ill. 2d 414, 428 (2006)). An expert may acquire specialized knowledge or experience

through practical experience, scientific study, education, training or research. Id. (citing 

Thompson, 221 Ill. 2d at 428-29). “An expert need only have knowledge and experience beyond 

that of an average citizen.” Thompson, 221 Ill. 2d at 429. Accordingly, “[e]xpert testimony is 

admissible if the proffered expert is qualified by knowledge, skill, experience, training, or 

education, and the testimony will assist the trier of fact in understanding the evidence.” Snelson v.

Kamm, 204 Ill. 2d 1, 24 (2003). 

¶ 71 A medical expert witness may not base his opinions on guess, conjecture, or speculation. 

Soto v. Gaytan, 313 Ill. App. 3d 137, 146 (2000). However, an expert witness is permitted to 
21 

provide an opinion based on facts not within his personal knowledge if those facts are of the type 

reasonably relied upon by experts in the particular field. Iaccino v. Anderson, 406 Ill. App. 3d 397, 

407 (2010). “Illinois law does not require an expert witness to physically examine or personally 

know the patient in order to render an expert opinion in the case.” In re Estate of Hoover, 155 Ill. 

2d 402, 421 (1993). 

¶ 72 The decision to allow an expert to testify lies within the “sound discretion of the trial court.” 

Thompson, 221 Ill. 2d at 428. We may not disturb a circuit court’s decision to allow expert witness 

testimony absent an abuse of discretion. Kunz, 373 Ill. App. 3d at 624.

¶ 73 Here, Dr. Arkin testified that he has treated patients with brain injuries like plaintiff’s for 

28 years and has helped coordinate care for those patients. Dr. Arkin testified that he reviewed 

plaintiff’s medical records and determined that plaintiff required 24-hour care because of her brain 

injuries caused by whole-brain radiation. Dr. Arkin’s conclusion is consistent with the testimony 

of plaintiff’s sister and son, who testified that they do not feel comfortable leaving plaintiff alone 

because she has suffered falls, become confused, and forgotten to take her medication. Dr. Arkin’s 

conclusion is also supported by the testimony of Dr. Landre, who performed neurological testing 

on plaintiff and determined that she suffers from permanent memory impairment, which will 

worsen as she ages. Because of Dr. Arkin’s experience in treating patients with brain injuries like 

plaintiff, the trial court did not err in allowing Dr. Arkin to testify that plaintiff would need 24-

hour assistance and supervision. See Snelson, 204 Ill. 2d at 24. 

¶ 74 Dr. Zhang further contends that Dr. Arkin’s testimony should have been barred because 

Dr. Arkin relied on plaintiff’s counsel to help him determine the cost of 24-hour care for plaintiff. 

We disagree. Dr. Zhang testified that plaintiff’s counsel provided him with the hourly rates of 

two agencies that provide the care plaintiff needs in the geographic area where she is located. Dr. 
22 

Zhang further testified that the rates charged by those agencies were similar to the rates charged 

in his geographic area for the care of patients, like plaintiff, with brain injuries. Dr. Arkin was not 

required to have personal knowledge of the hourly rate of attendant care where plaintiff lives but 

was allowed to obtain that information from an outside source since it was necessary for this 

determination of the future costs of plaintiff’s care. See Iaccino, 406 Ill. App. 3d at 407.

¶ 75 Finally, Dr. Zhang argues that the trial court should have prohibited Dr. Arkin’s testimony 

because Dr. Arkin did not personally examine plaintiff. Again, we disagree. Here, Dr. Arkin was 

thoroughly cross-examined and admitted that he did not physically examine plaintiff. However, 

Dr. Arkin testified that he reviewed plaintiff’s medical records, which physicians, like him, 

typically rely on. As our supreme court stated: “Illinois law does not require an expert witness to 

physically examine or personally know the patient in order to render an expert opinion in the case.” 

Hoover, 155 Ill. 2d at 421. 

¶ 76 How much care plaintiff will need in the future and the cost of such care were not within 

the knowledge of members of the jury. Therefore, expert testimony was necessary to aid the jury 

in determining those issues. See Kunz, 373 Ill. App. 3d at 624; Thompson, 221 Ill. 2d at 428. The 

trial court did not abuse its discretion by allowing Dr. Arkin to testify about those issues based on 

his knowledge and experience. 

 CONCLUSION

¶ 77 The judgment of the circuit court of Du Page County is affirmed. 

¶ 78 Affirmed.