Docket Nos. 91232, 91239 cons.–Agenda 27–November 2001.

ROBERT SNELSON, Appellee and Cross-Appellant, v.

DONALD KAMM, M.D., et al. (Donald Kamm, M.D., Appellant

								 								and Cross-Appellee).

Opinion filed March 20, 2003.

	JUSTICE THOMAS delivered the opinion of the court:

	Plaintiff, Robert Snelson, brought a negligence action against

defendants, Donald Kamm, M.D. (Kamm), and St. Mary’s Hospital

of Decatur (St. Mary’s). Following a jury trial in the circuit court

of Macon County, a verdict was returned in favor of Snelson and

against Kamm and St. Mary’s in the amount of $7 million. After a

hearing on defendants’ posttrial motions, the trial court granted St.

Mary’s a judgment notwithstanding the verdict (judgment n.o.v.) on the issue of proximate cause and granted Kamm a new trial on

the issue of damages, setting aside the $7 million award. The

appellate court consolidated the separate appeals by Snelson and

Kamm, and affirmed the orders of the trial court. 319 Ill. App. 3d

116. We allowed Snelson’s and Kamm’s petitions for leave to

appeal (177 Ill. 2d R. 315) and also consolidated the appeals.

	Before this court, Snelson contends that the trial court erred

by: (1) granting Kamm a new trial on the issue of damages; and (2)

granting St. Mary’s motion for judgment n.o.v. Kamm challenges certain of the trial court’s rulings and the jury’s verdict.

Specifically, Kamm claims: (1) he was improperly prevented from

examining Snelson’s medical expert as to bias; (2) the testimony of

Snelson’s medical expert should not have been admitted, because

it lacked foundation; (3) the jury was improperly instructed; (4)

certain medical bills of Snelson’s were improperly admitted into

evidence; (5) the verdict was tainted by extraneous information; (6)

the verdict was against the manifest weight of the evidence; and (7)

the verdict is excessive.

BACKGROUND

	At the June 1999 jury trial, the following evidence was

adduced. In March 1994, Snelson was 58 years old and employed

as a clerk by the Illinois Central Gulf Railroad. Snelson was referred to Kamm, a general surgeon, who suggested that Snelson

undergo a radiological procedure known as an aortogram or

arteriogram, to determine the location of arterial blockages in his

legs caused by arteriosclerosis, commonly referred to as hardening

of the arteries. Dr. Carlos Capati, a radiologist practicing at St.

Mary’s, testified that, on March 2, 1999, while attempting to

perform a translumbar aortogram on Snelson, he experienced

difficulty navigating the guide wire into the thoracic aorta. It

appeared that the guide wire instead entered the superior

mesenteric artery, which supplies blood to the intestine. Capati

withdrew the translumbar needle and the guide wire and attempted

to reinsert the guide wire into the aorta. During the second

attempt, however, Snelson’s blood pressure dropped, he

complained of abdominal and back pain and expressed an urge to

have a bowel movement. A portable commode was brought in and

Capati examined Snelson’s stool, but did not notice any

discoloration. At that point, Capati terminated the procedure and

informed Kamm that he had been unable to complete the test and

that Snelson was complaining of back and abdominal pain.

	Snelson’s son, James Snelson, testified that following the

unsuccessful aortogram, he saw his father being brought back to

his room on a stretcher, “screaming and yelling.” Once in his bed,

Snelson began complaining of “a lot of pain in his stomach.” He

was lying on his side “in a fetal position” with his eyes closed and

was sweating profusely. Snelson also complained of pressure in his

stomach and the need to use the bathroom. James stated that he

went to the nurses station and told them that his father needed a

catheter and one was provided at about 3 or 3:30 p.m. James

testified that he left St. Mary’s late that afternoon to care for his

mother and, prior to his departure, did not see Kamm visit his

father. James stated that he spoke to his father by telephone that

evening at approximately 8 p.m., and that his father still

complained of pain and was not making sense.

	The nurses on staff at St. Mary’s on March 2 and 3, 1994,

recorded notes on Snelson’s condition, but none who testified at

trial had any independent recollection of the events. The nurses’

notes indicate that, following the unsuccessful aortogram, Snelson

was returned to his room at 12:40 p.m. He was complaining of pain in his abdomen and cramping and requested a bedside

commode. A 12:44 p.m. shift assessment showed that Snelson was

alert and complaining of pain. According to the nurses’ notes, the

pain rated “7” on a scale of 1 to 10. At 12:45 p.m., Snelson had a

large bowel movement and continued to complain of severe pain

across the middle of his abdomen radiating into his back. At this

point, the nurses notified Kamm of Snelson’s complaints of

abdominal pain. In response, Kamm ordered by phone that Snelson

receive blood tests and pain medication, 50 milligrams Demerol by

muscular injection, every three hours as needed. Kamm also

ordered that Snelson’s vital signs be taken every 15 minutes for

two hours and then hourly thereafter.

	Snelson’s vital signs were then checked every 15 minutes from

12:45 p.m. to 2:30 p.m. During this period, plaintiff’s temperature

stayed below normal, his respirations were normal and remained

constant. His pulse rose during the first hour and then fell back to

normal the second hour, while his blood pressure dropped and rose

throughout the period.

	The nurses charted in their flow sheet that a catheter was

inserted to empty Snelson’s bladder around 3 p.m. A second shift

assessment at 3:35 p.m. showed Snelson’s bowel sounds were

normal, but he continued to complain of abdominal pain. At 4 p.m.,

Snelson had a bowel movement with blood-tinged mucous. The

nurses immediately paged Dr. Kamm, and were advised that he was

in surgery at another hospital. Kamm called back at 4:30 p.m. and

was advised by a nurse of the bloody bowel movement. Kamm

testified that he spoke with the nurse about Snelson’s condition at

4:30 p.m., and concluded that the bloody stool was due to a mild

hemorrhoid or fissure. Kamm told the nurse he would quickly

conclude his duties at the other hospital and would proceed directly

to St. Mary’s.

	At 6 p.m., Kamm arrived at St. Mary’s and examined Snelson

for 15 or 20 minutes. At this time, Kamm had access to the nurses’

notes, shift assessments, flow sheets and vital sign records which

had recorded Snelson’s condition. Kamm noted that Snelson’s vital

signs were stable, but he had passed several small blood-tinged

stools and was complaining of abdominal pain and difficulty

urinating. Kamm found that Snelson’s lower abdomen was tender and distended, with diminished bowel sounds. Kamm’s notes

further state the following: “Concerned about mesenteric

insufficiency or thrombo-embolus with ischemia. Will watch

closely.” Kamm testified that he was not making a diagnosis of

mesenteric ischemia, or deficiency of blood circulation to the

intestinal system, but rather was “entertaining [it] as a one of the

rare possibilities” of arteriographic puncture complications. Rather,

at the time, Kamm thought that the most likely cause of Snelson’s

pain was bleeding into his retroperitoneal area from the puncture

sites.

	Because Kamm believed that the fullness and tenderness in

Snelson’s lower abdomen was consistent with a distended bladder,

he ordered a catheter inserted. Kamm noted that the catheter

caused considerable relief in Snelson’s discomfort at that point.

Kamm believed that the catheter inserted after his 6 p.m.

examination was the first time a catheter had been used on Snelson.

However, the nurses’ flow sheet, which Kamm had available to him

at the 6 p.m. examination, indicated that a catheter had been

inserted at 3 p.m. Kamm acknowledged that a catheter could have

been ordered before he arrived as part of a postoperative order. At

any rate, it was undisputed that the catheter brought pressure relief

and lessened Snelson’s discomfort.

	Kamm further testified that, based on his 6 p.m. assessment,

he believed Snelson’s condition had stabilized, and that it was

therefore safe to increase his pain medication from 50 milligrams

to 100 milligrams of Demerol every four hours as needed. He

further ordered that Snelson have no food or liquids by mouth, that

the nurses check his vital signs every four hours, and that some

laboratory work be completed for the next morning. Kamm then

left St. Mary’s for the evening.

	After Kamm’s examination, the nurses observed Snelson at

least every hour. A nurse’s notation for that evening indicates that

Snelson had a normal bowel movement and received Demerol at 7

p.m. It was also noted that Snelson slept most of the evening. He

was awake at 10 p.m., but was back asleep at 11 p.m. No

documentation exists showing that Snelson’s vital signs were taken

at 10 p.m.

	Kamm conferred with the nurses before he went to bed around

10 p.m. and was advised that Snelson was stable and that they had

nothing new to report. At midnight, Snelson’s vital signs were

taken. The section in the shift assessment to indicate level of pain

was not marked at that time. St. Mary’s nurse Belinda Durbin

testified that at 12:45 a.m. on March 3, she administered 100

milligrams of Demerol to Snelson because he was having some

pain. She further noted, however, that if he had been experiencing

severe pain she would have made a notation of that fact in the

records. At 4 a.m., Snelson’s vital signs were taken again.

	Kamm returned to the hospital on March 3, 1994, and

examined Snelson between 6 and 6:30 a.m. It appeared to Kamm

that Snelson had not improved over the prior 18 hours, and he had

an abnormally high white blood cell count. Over the next four

hours, a computerized tomography (CT) scan and abdominal X

rays were taken, which showed definite abnormalities, including the

presence of air in Snelson’s small intestine. Capati, who interpreted

the CT scan and X rays, testified that the results were consistent

with “small and large bowel infarction,” which meant that parts of

Snelson’s small and large bowel loops were gangrenous or dead.

Capati further testified that the most likely cause of that condition

was “acute embolism and thrombosis involving the superior

mesenteric artery,” meaning that a plaque or clot moving within the

blood vessel, or a preexisting plaque or clot, had blocked the

superior mesenteric artery. Capati opined that the unsuccessful

translumbar aortogram caused the death of portions of Snelson’s

intestine.

	 Kamm performed emergency exploratory surgery on Snelson

later that morning and found that almost all of his small intestine

and half of his large intestine were dead due to lack of blood

circulation to the area. It was therefore necessary to remove

approximately 95% of Snelson’s small intestine and the right half

of his large intestine. Snelson was discharged from St. Mary’s on

March 21, 1994.

	With regard to this cause of action, Kamm testified that the

nurses had adequately observed Snelson and reported to him

everything that he needed to know about Snelson’s condition

following the unsuccessful aortogram. He further stated that, if he had wanted to perform surgery sooner, he would have; however,

he did not think it was indicated. On cross-examination, Kamm

admitted that, as with any disease, there are signs and symptoms,

and that 80% of patients with mesenteric insufficiency will exhibit

abdominal pain often described as out of proportion to the physical

findings. He further agreed that blood in the stool can be

considered a sign of mesenteric ischemia and that occult blood, not

detectible by mere sight, could be found in 75% of such cases.

	Dr. James Sarnelle, Snelson’s medical expert, testified that he

is a general and vascular surgeon familiar with intestinal surgery

and the translumbar arteriogram procedure, including its risks and

complications. Sarnelle opined that, during Snelson’s unsuccessful

arteriogram, the guide wire had injured the lining of the superior

mesenteric artery, which caused a blood clot to form and,“[o]ver

time,” led to the death of the intestines from a loss of circulation.

Sarnelle testified that he was familiar with the national standard of

care for a reasonably well-qualified general surgeon as it related to

a patient in Snelson’s condition on March 2, 1994, and opined that

Kamm’s treatment of Snelson following the unsuccessful

arteriogram breached the standard of care because Kamm “did not

take any action which was necessary to save [Snelson’s] small

bowel.” Sarnelle reasoned: “[Snelson] has all the signs of

mesenteric ischemia. In fact, [Kamm] even mentions it in his note

at 6 o’clock that he is concerned about ischemia or thrombosis and

yet he does nothing, just says will watch closely.” According to

Sarnelle, Kamm should not have been watching Snelson closely but

instead should have immediately performed surgery to restore

circulation, which would have saved a large portion of Snelson’s

intestine.

	According to Sarnelle, the following signs and symptoms

should have alerted Kamm to the mesenteric ischemia: (1) Capati’s

indication that during the unsuccessful arteriogram the guide line

went into the superior mesenteric artery; (2) Snelson’s drop in

blood pressure and abdominal pain during the procedure; (3)

Snelson’s need to have an immediate bowel movement during the

procedure; (4) the bloody bowel movements following the

procedure; (5) abdominal pain that was severe enough for Kamm to increase the Demerol; and (6) the distention and tenderness of

Snelson’s lower abdomen during Kamm’s 6 p.m. examination.

	Sarnelle further opined that “a window of opportunity” existed

to prevent the permanent loss of Snelson’s intestine. At 6 p.m.,

Snelson was stable enough to have surgery, and Sarnelle testified

that, if revascularization surgery had been performed in a timely

fashion on March 2, a large portion of Snelson’s intestine could

have been salvaged and he would not now be dependent on

intravenous supplemental nutrition. Sarnelle testified that the latest

point in time that Snelson’s intestines could have been saved was

midnight on March 2, and “after that it was too late.” Sarnelle

explained that, while the length of time that intestines will remain

viable once blood supply is lost is variable from patient to patient

and cannot be determined with 100% certainty, based on the

clinical data contained in Snelson’s medical records, the latest time

his intestine could have been saved was around midnight.

	Sarnelle acknowledged that, generally, acute mesenteric

ischemia is very difficult to diagnose because the typical patient has

an onset of abdominal pain with no clear history of causation.

Additionally, the typical patient is elderly and has trouble

communicating. However, Sarnelle testified that Snelson’s case

was different because, unlike the typical patient who is admitted to

the hospital several hours after the onset of pain: (1) Snelson was

in the hospital at the time the ischemia began; (2) the problems that

developed during the unsuccessful arteriogram involved the

superior mesenteric artery; and (3) Snelson developed signs and

symptoms quickly and did not just arrive at the hospital with “some

obscure things going on.”

	Sarnelle opined that Kamm breached the appropriate standard

of care by ordering pain medication for Snelson. In that regard,

Sarnelle stated the following:

		“[Y]ou should not be giving a patient pain medicine if you

do not know what is going on. The problem with the pain

medicine is that you mask the findings, the person may

have a lot of problems going on in their abdomen,

especially mesenteric ischemia you may give pain medicine

and they could feel somewhat better, and you don’t know whether they are really getting better or I am just thinking

they are feeling better yet a catastrophe is brewing.”

	Finally, Sarnelle acknowledged that he has been involved in

approximately 200 medical malpractice cases as a consulting expert

and witness, testifying at trial about 20 times, and in all of those

cases he represented the plaintiffs. Sarnelle offered no opinion

regarding the conduct of St. Mary’s nursing staff.

	On cross-examination, Sarnelle acknowledged that, depending

on the cause of mesenteric ischemia, it can sometimes take days for

a reasonably well-qualified surgeon to diagnose that death of the

bowels has occurred. Sarnelle also admitted that the medical

literature does not set out certain symptoms as “classic,” but

explained that the literature does not differentiate between

arteriogram-induced mesenteric ischemia and other types, instead

looking at “all comers.” Sarnelle testified that he has performed

intestinal revascularization surgery twice in his career, with one

patient living and one dying. He estimated the mortality rate for

such surgery to be more than 50%.

	Grace McCallum, Snelson’s nursing expert, testified that

nurses are taught and practice the “nursing process,” which is a

critical thinking process that defines the standard of care that a

nurse should follow. McCallum opined that the nursing process

was not followed by the St. Mary’s nursing staff on March 2, 1994,

as evidenced by: (1) the failure to initiate a nursing care plan for

Snelson; (2) the failure to request that another physician examine

Snelson on the afternoon of March 2, when Kamm was unavailable

and Snelson was experiencing abdominal pain; (3) the failure to

request a physician after Snelson had a bloody bowel movement at

4 p.m.; (4) the failure to perform a new abdominal assessment

following the bloody bowel movement; (5) the failure to document

the effectiveness of the pain medication Demerol; (6) the lack of

nursing notes regarding Kamm’s 6 p.m. examination; (7) the failure

to check all ordered vital signs during the evening of March 2; and

(8) the failure to call Kamm after checking Snelson’s vital signs

around midnight on March 2. McCallum further opined that the

failure to follow the nursing process increases the likelihood of an

unfavorable outcome. However, McCallum testified that she had

no opinion as to the proximate cause of Snelson’s injury.

	Dr. William Pyle, a cardiac, vascular and thoracic surgeon,

was one of two medical experts presented by Kamm. Pyle testified

that mesenteric ischemia is difficult to diagnose and that the

ultimate mortality rate for patients suffering a mesenteric infarction

is “in excess of 90 percent.” Pyle opined that Kamm met the

standard of care in his treatment of Snelson, explaining that,

contrary to the assertions of Sarnelle, “there weren’t enough

findings or symptoms to justify surgery” on March 2. Indeed, after

reading the radiologist’s description of the procedure, Pyle

believed that an internal dissection of the mesenteric artery

occurred, rendering the artery like “wet tissue paper,” and making

revascularization impossible. Pyle noted that revascularization

surgery was also not an option if the guide wire inserted during the

arteriogram had produced a “showering” of small pieces of plaque

and debris which gradually plugged up the artery.

	Pyle further opined that Kamm complied with the standard of

care in prescribing pain medication to Snelson, testifying that the

doses were not high and that, in his experience, patients with

mesenteric ischemia have excruciating pain that is intractable to

pain medication. Pyle stated that, regardless of what caused the

ischemia and regardless of when the revascularization surgery

occurred, Snelson’s intestines most likely could not have been

saved. On cross-examination, Pyle agreed that abdominal pain out

of proportion to the physical examination findings is present in

many people with mesenteric ischemia. Other symptoms may be

abdominal distension and the urge to have a bowel movement, and

findings may include blood in the stools. Pyle believed that Kamm’s

concern about mesenteric insufficiency at 6 p.m. was appropriate

because Snelson was then exhibiting some of the signs and

symptoms of the condition. Pyle also agreed that revascularization

was a known and practiced technique and that, if possible causes

of ischemia other than dissection were considered, the probability

of revascularization existed, but was low.

	Dr. Philip Donahue, a general surgeon testifying as Kamm’s

other medical expert, also concluded that Kamm did not breach the

standard of care in his treatment of Snelson by failing to diagnose

mesenteric ischemia, prescribing pain medication or failing to

perform revascularization surgery on March 2, 1994. Donohue opined that earlier surgery was not warranted because, on the

afternoon of March 2, there was “no evidence” of acute mesenteric

ischemia, just a patient “with some non-specific complaints.” While

Donahue testified it was “a possibility” that the superior mesenteric

artery was totally blocked immediately following the arteriogram,

he believed that it had occluded over time, basing his opinion, in

part, on the fact that Snelson’s pain diminished after the

catheterization and overnight but reemerged in the early morning.

	Mary Delaney, St. Mary’s nursing expert, testified that she

was familiar with the standard of care applicable to nurses under

circumstances similar to those involved here. Delaney opined that

the nurses at St. Mary’s did not violate the standard of care in

treating or monitoring Snelson.

	On the issue of damages, Snelson presented, inter alia, his own testimony and that of his treating physician, Dr. Robert

Newlin. Newlin testified that the function of the small intestine is

to do a significant part of the digestion of food. As a result of the

March 3, 1994, surgery during which 95% of his small intestine

was removed, Snelson suffers from “short bowel syndrome,” a

condition which creates diarrhea and a lack of ability to absorb

sufficient nutrition and calories. Snelson must therefore rely on

hyperalimentation, the intravenous infusion of a solution containing

sufficient nutrients to sustain him. The solution is infused into a

vein in Snelson’s upper chest through a catheter; the catheter is

attached to a small machine that injects the nutrition directly into

his body. The catheter is a foreign body and bacteria can easily

grow on it. Snelson has therefore suffered repeated infections of

his catheter site, some of which required hospitalization. Newlin

opined that Snelson will continue to suffer from diarrhea and

require hyperalimentation for the rest of his life. While Newlin

could not say that Snelson’s short bowel syndrome had reduced his

life expectancy “to a great degree,” due to his “various problems,”

including preexisting diabetes and arteriosclerosis, Snelson “could

live another ten years.”

	Snelson testified that, after his release from the hospital, he

took medical retirement from the railroad. He must be attached to

the hyperalimentation device for 12 hours each day, usually from

9 p.m. to 9 a.m. When he unhooks the device, he must be close to a bathroom and remain there for 1 to 11⁄2 hours. Snelson testified

that he suffers from chronic diarrhea and must use the bathroom 15

to 20 times each day, consuming most of his waking hours. The

hyperalimentation bag weighs between 10 and 15 pounds and must

be kept refrigerated. There are numerous steps which must be

taken to prepare the bag on a daily basis, including the entering of

nutrients and vitamins; the preparation takes 20 to 30 minutes to

perform. Sometimes the nutrient solution causes him pain as it

enters the catheter, and he requires help from family members to

maintain the catheter and catheter site. Snelson has spent a total of

almost 11⁄2 years in the hospital since June 1994, mostly for

infections of his catheter site. A typical infection which leads to a

hospital stay for a catheter change involves chills, a high fever and

vomiting. He has had his catheter changed approximately 20 times;

the catheter removal can be painful, as are the intravenous

antibiotics used for these infections.

	 Snelson further testified that, because of the

hyperalimentation, he must “pretty well stay at home.” Although

he can eat regular food, the portions must be small and he cannot

eat certain foods, such as salad, green beans or corn, or even enjoy

his favorite drink, Kool-Aid, because those items are eliminated by

his body quickly and mostly unchanged. Snelson acknowledged

that, even before the March 3, 1994, surgery, the arteriosclerosis

made it hard to walk, restricting his ability to engage in daily

activities. Snelson stated that he still hunts and travels to

Minnesota to fish and to Indiana to see his daughter. However, if

he chooses to do anything during the day, he must be attached to

the bag during that time and then have the elimination process

occur at night, possibly resulting in his soiling himself in bed.

	In addition to this testimony, Snelson presented as economic

damages a medical bill summary totaling $595,766.35, and a lost-

wage claim of approximately 21⁄2 years with a 1993 wage rate of

$32,130.85. For purposes of his disfigurement claim, Snelson

showed the jury the catheter site on his chest where the

hyperalimentation device attaches to his body.

	Based on this evidence, the jury returned a verdict in Snelson’s

favor and against both Kamm and St. Mary’s, awarding $7 million.

Because the completed verdict form contained only the total damage award, the trial court instructed the jury to return to its

deliberations in order to itemize the verdict. Approximately 20

minutes later, the jury returned with a verdict in the same amount,

itemized as follows: (1) $600,000 for past medical expenses; (2)

$1.1 million for future medical expenses; (3) $3 million for pain

and suffering; (4) $2 million for loss of normal life; (5) $80,000 for

lost earnings; and (6) $220,000 for disfigurement.

	The appellate court majority affirmed the trial court’s grant of

a new trial on the issue of damages for Kamm and judgment n.o.v. for St. Mary’s. Justice Cook, in dissent, would have reinstated the

jury’s award of $7 million in damages. The panel upheld the jury’s

verdict in favor of Snelson and against Kamm, rejecting Kamm’s

claims that a variety of trial errors had prejudiced him. This appeal

followed.

ANALYSIS

	We first address Kamm’s claims of trial error. Kamm argues

that the trial court erred by granting Snelson’s motion in limine barring him from cross-examining Snelson’s expert, Sarnelle,

regarding his relationship with a professional witness referral

agency, Sappanaro, Inc. It is true that, generally, opposing counsel

may probe bias, partisanship or financial interest of an expert

witness on cross-examination. Sears v. Rutishauser, 102 Ill. 2d 402, 407 (1984). However, we agree with the appellate court that

Kamm’s failure to make an adequate offer of proof has resulted in

a waiver of this issue on appeal. See People v. Andrews, 146 Ill. 2d 413, 422 (1992); Sinclair v. Berlin, 325 Ill. App. 3d 458, 471 (2001).

	When a motion in limine is granted, the key to saving for review an error in the exclusion of evidence is an adequate offer of

proof in the trial court. See Sinclair, 325 Ill. App. 3d at 471. Counsel makes an adequate offer of proof if he informs the trial

court, with particularity, of the substance of the witness’

anticipated answer; an offer of proof that merely summarizes the

witness’ testimony in a conclusory manner is inadequate. Andrews, 146 Ill. 2d at 421. Here, a review of the record reveals no adequate

offer of proof, only the following statement from Kamm’s written response to the motion in limine: “The testimony of the experts for [Snelson] is that they have received other referrals from

Sappanaro.” Given this sparse information, there is no way for this

court to determine if the excluded evidence had any relevance to

the proceeding. See Andrews,146 Ill. 2d at 421 (an offer of proof serves no purpose if it does not demonstrate, both to the trial court

and to reviewing courts, the admissibility of the testimony which

was foreclosed). However, the record does show that the trial

court allowed Kamm to cross-examine Sarnelle as to the frequency

of his plaintiff-oriented testimony and to argue to the jury his

alleged bias and financial interest. Thus, where counsel failed to

explicitly state what the excluded testimony would reveal about

Sarnelle’s relationship with Sappanaro, Inc., we have no basis upon

which to conclude that the trial court erred in restricting Kamm’s

cross-examination of Sarnelle. See Holder v. Caselton, 275 Ill. App. 3d 950, 955 (1995).

	Next, Kamm argues that Sarnelle’s testimony should be

disregarded as lacking foundation. Kamm claims that Sarnelle

failed “to ground his opinions in generally-accepted scientific

principles.”

	The decision of whether to admit expert testimony is within

the sound discretion of the trial court (People v. Miller, 173 Ill. 2d 167, 187 (1996)), and a ruling will not be reversed absent an abuse

of that discretion (People v. Reid, 179 Ill. 2d 297, 313 (1997)). Expert 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.

See Wiegman v. Hitch-Inn Post of Libertyville, Inc., 308 Ill. App. 3d 789, 799 (1999). 	Here, Sarnelle testified to his credentials and

Kamm admits that they were sufficient to qualify Sarnelle as an

expert.

	At trial, Kamm failed to either object to the admissibility of

Sarnelle’s testimony or file a motion for an evidentiary hearing to

determine its admissibility under Frye v. United States, 293 F. 1013 (D.C. Cir. 1923). See Donaldson v. Central Illinois Public Service Co., 199 Ill. 2d 63, 76-77 (2002) (the admission of expert testimony is governed by the standards expressed in Frye, which dictates that scientific evidence is only admissible at trial if the methodology or scientific principle upon which the opinion is based

is “ ‘sufficiently established to have gained general acceptance in

the particular field in which it belongs’ ”), quoting Frye, 293 F. at 1014. Because the record shows that Kamm did not object to the

underlying foundation of Sarnelle’s testimony at trial, we find that

this issue has been forfeited on appeal. See People v. Moore, 171 Ill. 2d 74, 98 (1996) (defendant waived Frye issue by failing to present expert testimony at Frye hearing); see also Reed v. Northwestern Publishing Co., 124 Ill. 2d 495, 519 (1988) (a party waives evidentiary issues by failing to object at trial).

	Citing Kleiss v. Cassida, 297 Ill. App. 3d 165, 174 (1998), and Aguilera v. Mount Sinai Hospital Medical Center, 293 Ill. App. 3d 967 (1997), Kamm argues that, despite his failure to

object to the complained-of testimony, the trial court should have

entered judgment n.o.v. in his favor because of the alleged deficiencies in the testimony. We disagree. Both Kleiss and Aguilera are distinguishable and do not support Kamm’s position.

	In Kleiss, the plaintiff farmer alleged that his crops were damaged by the defendant’s spraying of herbicide on nearby farms.

The plaintiff’s expert testified that the herbicide could have

traveled two miles in the air to the plaintiff’s property. However,

the expert had no reasons whatsoever for his opinion other than

“20 to 30 years experience.” In affirming judgment n.o.v. for the defendant, the appellate court held that “[w]hen an expert testifies

simply that plaintiff should win but is unable to support that

conclusion with reasoned analysis, the expert’s testimony is

worthless, provides no assistance to the jury, and should be

stricken.” Kleiss, 297 Ill. App. 3d at 174. In contrast to the expert in Kleiss, Sarnelle’s testimony was replete with reasoned analysis supporting his opinions. Sarnelle carefully explained that his

opinions were based on the clinical data contained in Snelson’s

medical records such as the onset and severity of pain, the vital

signs, the appearance of blood in the stools, and that Snelson had

been in the hospital having a procedure done in the area of his

mesenteric artery when his problems began.

	In Aguilera, the plaintiff’s decedent was taken to the emergency room complaining of numbness on the right side of his

body. About six or seven hours later, a CT scan was taken, revealing a brain hemorrhage. The patient died a few days later.

The plaintiff presented two experts who testified that the

emergency room physician’s delay in taking the CT scan caused the

decedent’s death. It was the plaintiff’s theory that a diagnosis of

the condition would have triggered surgical intervention to prevent

the decedent’s death. However, on cross-examination, the plaintiff’s

experts admitted that they would defer to a neurosurgeon as to

whether surgery should have even been performed, yet the only

neurosurgeons testifying in the case stated that surgery would not

have been appropriate. The appellate court held that a directed

verdict for the defendant was proper because, without supporting

testimony from a neurosurgeon, the plaintiff’s expert’s testimony

was insufficient to show that surgery would have occurred absent

defendant’s conduct. Aguilera, 293 Ill. App. 3d at 975. Here, in contrast, there was no question that Sarnelle was qualified to

render the opinions he offered at trial, and there was no missing

link failing to establish all of the elements of Snelson’s case.

	While Kamm contends that Sarnelle’s opinions were not

adequately supported, the basis for a witness’ opinion generally

does not affect his standing as an expert; such matters go only to

the weight of the evidence, not its sufficiency. See National Bank of Monticello v. Doss, 141 Ill. App. 3d 1065, 1072 (1986). Indeed, the weight to be assigned to an expert opinion is for the jury to

determine in light of the expert’s credentials and the factual basis

of his opinion. See Wiegman, 308 Ill. App. 3d at 799; Treadwell v. Downey, 209 Ill. App. 3d 999, 1003 (1991).

	In Wilson v. Clark, 84 Ill. 2d 186, 194 (1981), this court held that an expert may give an opinion without disclosing the

underlying facts or data. Rather, the burden is placed upon the

adverse party during cross-examination to elicit the facts

underlying the expert opinion. Wilson, 84 Ill. 2d at 194. Here, as the appellate court noted, “Kamm conducted a vigorous cross-

examination of Sarnelle, challenging the bases and soundness of his

opinions.” 319 Ill. App. 3d at 136. Thus, it was up to Kamm to

reveal any alleged deficiency in Sarnelle’s testimony, a fact which

the trial court recognized in denying Kamm’s motion for judgment n.o.v., stating: “[T]he criticism of Dr. Sarnelle by [Kamm] really goes to the weight of the evidence or testimony presented by him, and I believe that was all argued to the jury at the time. I think

suffice it to say that the jury had the option of accepting the

testimony of either side’s expert witnesses ***.” The trial court did

not err in this regard.

	Kamm further contends that the trial court erred by giving

certain jury instructions at Snelson’s request. However, the plaintiff

has the right to have the jury clearly and fairly instructed on any

theory supported by the evidence. Leonardi v. Loyola University, 168 Ill. 2d 83, 100 (1995). This court, in Leonardi, further stated:

		“The question of what issues have been raised by the

evidence is within the discretion of the trial court. The

evidence may be slight; a reviewing court may not reweigh

it or determine if it should lead to a particular conclusion.

[Citation.] The test in determining the propriety of

tendered instructions is whether the jury was fairly, fully,

and comprehensively informed as to the relevant

principles, considering the instructions in their entirety.”

Leonardi, 168 Ill. 2d at 100.

	Kamm first argues that Snelson’s instruction No. 26, alleging

Kamm’s negligence in “prescribing pain medication to Robert

Snelson once he was concerned with mesenteric insufficiency,” was

improper because Sarnelle never testified that Snelson suffered any

injury from the prescription of pain medication. It was Snelson’s

theory at trial that administering pain medication in his case was a

deviation from the standard of care because such medication made

his condition more difficult to diagnose. Sarnelle testified that, in

his opinion, based on a reasonable degree of medical and surgical

certainty, no pain medication should have been given to a patient

in Snelson’s condition because it “may mask the findings.”

Additionally, Donahue and Kamm himself testified that Demerol,

the pain medication which Kamm prescribed for Snelson, is a

narcotic analgesic that can cause sedation and that the patient’s

condition can be reassessed only when the medication “wears off.”

Because the instant case involved a failure to timely diagnose, we

find that there was sufficient support for Snelson’s theory and that

no abuse of the trial court’s discretion occurred in giving this

instruction. See Holton v. Memorial Hospital, 176 Ill. 2d 95, 119 (1997) (to the extent a plaintiff’s chance of recovery or survival is lessened by the malpractice, he should be able to present evidence

to a jury that the defendant’s malpractice, to a reasonable degree

of medical certainty, proximately caused the increased risk of harm

or lost chance of recovery).

	Kamm further argues that he was prejudiced when, over his

objection, the trial court gave Snelson’s instructions based on

Illinois Pattern Jury Instructions, Civil, Nos. 1.03, 1.04, B45.03.A,

30.01 (1995) (hereinafter IPI Civil (1995)). We first address

Snelson’s instruction No. 3, which provided: “A fact may be

proved by circumstantial evidence. Circumstantial evidence

consists of proof of facts or circumstances which give rise to a

reasonable inference of the truth of the facts sought to be proved.”

IPI Civil (1995) No. 1.03. Kamm contends that there was no

circumstantial evidence concerning him presented in this case.

However, Kamm’s expert, Donahue, testified that part of the basis

for his opinion that the occlusion of the blood supply was not

immediate was that Snelson’s pain had diminished following the

catheterization and then reemerged the next morning. Therefore,

if Snelson’s pain had not actually diminished overnight, the factual

basis for Donahue’s opinion was weakened. To that end, and

because no direct evidence existed, Snelson presented

circumstantial evidence as to his level of pain after midnight on

March 2. Nurse Durbin testified that, while the medical records did

not show Snelson’s level of pain during the midnight shift

assessment, at 12:45 a.m. Snelson received 100 milligrams of

Demerol and that Snelson was therefore in pain at that time. In

Illinois, in a civil case where any of the evidence is circumstantial

a party is entitled to an instruction on circumstantial evidence. See Kane v. Northwest Special Recreation Ass’n, 155 Ill. App. 3d 624, 630 (1987). We therefore agree with the appellate court that the

trial court, in the case at bar, did not err in giving IPI Civil (1995)

No. 1.03.

	Kamm further argues that IPI Civil (1995) No. 1.04, regarding

a juror’s life experiences, was improperly given. Snelson’s

instruction No. 4 provided: “In considering the evidence in this

case you are not required to set aside your observation and

experience in the affairs of life but you have a right to consider all

the evidence in the light of your own observation and experience in the affairs of life.” IPI Civil (1995) No. 1.04. Kamm argues that

the jury should not have received this instruction because jurors

may not attempt to resolve issues of medical malpractice from any

personal knowledge they may possess. See IPI Civil (1995) No.

105.02. However, jurors are allowed to use their own observation

and experience in assessing damages. See Baird v. Chicago, Burlington & Quincy R.R. Co., 63 Ill. 2d 463, 472-73 (1976). Therefore, where the record clearly shows that the jurors were also

instructed that they could not use their personal knowledge to

determine the issues of professional negligence (see IPI Civil

(1995) No. 105.02), the trial court did not abuse its discretion in

giving IPI Civil (1995) No. 1.04.

	Kamm also contends that the trial court erred by giving

Snelson’s instruction No. 20, a verdict form that provided, in

pertinent part, as follows:

			“We find that the total amount of damages suffered by

Robert Snelson as a proximate cause of the occurrence in

question is itemized as follows:

* * *

		The pain and suffering experienced and reasonably certain

to be experienced in the future as a result of the injuries

***.” See IPI Civil (1995) Nos. B45.03.A, 30.05.

Kamm argues that there was no competent evidence to support an

award for future pain and suffering, “as no party testified that

[Snelson] was reasonably certain to experience pain and suffering

in the future as a result of injuries allegedly caused by Dr. Kamm.”

However, at trial Snelson testified that he suffers from chronic

diarrhea, that he sometimes experiences pain when the nutrients

enter his body through the hyperalimentation catheter, and that he

has experienced sickness and pain in association with the repeated

infections and replacements of his catheter. This evidence was

sufficient to warrant giving Snelson’s instruction No. 20, and we

therefore agree with the appellate court that the trial court did not

abuse its discretion by submitting it to the jury. See Leonardi, 168 Ill. 2d at 100 (plaintiff has the right to have the jury clearly and

fairly instructed on any theory supported by the evidence).

	Finally, Kamm contends that the trial court erred by giving a

modified version of IPI Civil No. 30.01 that replaced “disability”

as an element of damages with “loss of a normal life.” We note that

the portion of the instruction at issue is actually contained in IPI

Civil (1995) No. 30.04, which is one of a number of “element of

damages” phrases that may be inserted between the two paragraphs

of IPI Civil No. 30.01 to complete that general damages

instruction. See IPI Civil (1995) Nos. 30.01, 30.04, Notes on Use.

Kamm argues that it was error to use this modified instruction, first

proposed in Smith v. City of Evanston, 260 Ill. App. 3d 925 (1994), because the Smith version was not an approved instruction at the time of the instant trial, citing Supreme Court Rule 239(a)

(177 Ill. 2d R. 239(a)).

	Rule 239(a) provides that whenever IPI contains an instruction

applicable in a civil case, and the court determines that the jury

should be instructed on the subject, the IPI instruction shall be

used, unless the court determines that it does not accurately state

the law. 177 Ill. 2d R. 239(a). However, the notes on use for IPI

Civil (1995) No. 30.04, which were available at the time of the

1999 trial, state: “If the trial court rules that the Smith case is applicable, then the phrase ‘loss of a normal life’ may be

substituted for the term ‘disability.’ ” IPI Civil (1995) No. 30.04,

Notes on Use. Indeed, since the instant case has been on appeal,

the IPI committee has formally adopted “loss of a normal life” as

an accepted alternative to “disability” where the trial court

determines that “loss of a normal life” more accurately describes

the element of damages claimed and would be less confusing to the

jury. See IPI Civil (2000) No. 30.04.01, Notes on Use. Here, the

trial court, after lengthy discussion at the instructions conference,

agreed with Snelson that the loss of a normal life instruction was

appropriate. Thus, the trial court complied with Rule 239(a),

because it gave the modified instruction believing it to more

accurately state the applicable law. Further, while the trial judge

later stated, in ruling on posttrial motions, that he believed his

decision to give the modified instruction was “in error,” he

reasoned that this was because “loss of a normal life is merely a

component of a compensable damage element and not an

independent element in and of itself.” To the contrary, loss of a normal life has been recognized as a separate element of

compensable damages in Illinois. See Turner v. Williams, 326 Ill. App. 3d 541, 551 (2001).

	Kamm also claims prejudice from the use of the loss of a

normal life instruction, arguing that “the extremely subjective

nature of this element may have allowed the jury to decide issues

in this case on the basis of sympathy rather than the testimony and

evidence.” Not only is this argument speculative, but it is

repudiated by the addition of the element to the IPI instructions.

See Turner, 326 Ill. App. 3d at 551 (the addition of IPI Civil (2000) No. 30.04.01, which allows either loss of a normal life or

disability to be given as an instruction, depending on the nature of

the evidence at trial, illustrates that the use of an instruction on loss

of a normal life is not contrary to Illinois law). Therefore, where

Kamm has failed to show error or prejudice in the giving of the

modified instruction, we see no abuse of the trial court’s discretion

requiring reversal. See Thompson v. MCA Distributing, Music Corp. of America, 257 Ill. App. 3d 988, 991 (1994) (a new trial will be granted because of improper jury instructions only where

the party has suffered serious prejudice from the offending

instruction).

	We next address Kamm’s contention that the trial court erred

by admitting into evidence Snelson’s exhibit No. 16, a summary of

his medical bills covering five years and many different providers,

which totalled $595,766.35. Kamm claims that this exhibit included

“all” of Snelson’s medical bills incurred since entering St. Mary’s

on March 2, 1994, and that no attempt was made to separate and

distinguish the medical expenses he incurred for treatment of his

preexisting health problems. However, we reject this claim based

on Snelson’s uncontradicted testimony that the summary included

only bills received for medical services related to his intestinal

problem, including those costs and problems associated with

hyperalimentation.

	Kamm also argues that the exhibit did not distinguish those

medical expenses Snelson claimed were due to Kamm’s alleged

medical negligence from those Snelson would have incurred had a

successful revascularization occurred. While Kamm contends that

he objected to the “totality of the bills,” we agree with the appellate court that the record reveals he specifically objected to only two

bills contained in the summary: (1) the initial hospitalization bill

from St. Mary’s, for $52,814.59; and (2) a bill from Dr. Thomas

Fulbright, a neurologist, for $471. The record further shows that

Snelson’s counsel suggested that the summary might be changed

to delete Fulbright’s bill and the objectionable portions of the

hospital bill, and then the following colloquy occurred:

			“MR. KEHART [Kamm’s counsel]: I just wanted to

preserve my objection.

			THE COURT: At this point it is going to be admitted

and then we will work out the details of what gets back to

[the jury] later.”

However, neither the trial court nor any of the parties ever raised

the issue again and Snelson’s exhibit No. 16 was admitted

unchanged.

	The admission of evidence is within the sound discretion of the

trial court and a reviewing court will not reverse the trial court

unless that discretion was clearly abused. Gill v. Foster, 157 Ill. 2d 304, 312-13 (1993). We acknowledge that,“[i]n proving damages,

the burden is on the plaintiff to establish a reasonable basis for

computing damages.” Gill, 157 Ill. 2d at 313. Here, however, Snelson suggested deleting those medical charges that Kamm

claimed were not causally related to his alleged negligence, and

Kamm not only failed to accept this suggestion when it was made,

but failed to reassert his objection later, allowing the unaltered

exhibit to go to the jury. Accordingly, we hold that any valid

objection Kamm may have had for admitting the medical bills into

evidence was waived by his failure to make specific contemporary

objections at trial so that any defect could have been cured. See

Janisco v. Kozloski, 261 Ill. App. 3d 963, 966 (1994); see also Simmons v. Garces, 198 Ill. 2d 541, 567 (2002) (failure to object in a timely manner waives objections).

	Kamm also argues that the jury verdict was “irrevocably

tainted” because the jury considered “extra-judicial information.”

We reject this contention, as it is not supported by the record and

is based solely on the jury’s submission of the following question

to the trial court during deliberations: “Was it possible a Break [sic] Brachial Arteriogram could have been preformed [sic] once Dr. Kamm was concerned with mecenteric [sic] insufficiency? or any procedure that could have shown blockage or reduced

circulations [sic]?”

	It is true that independent investigation by the jury may

constitute error so prejudicial as to require reversal. See People v. Holmes, 69 Ill. 2d 507, 519 (1978); Johnson v. Danville Cash & Carry Lumber Co., 200 Ill. App. 3d 196, 199 (1990). In order to set aside a verdict, however, the losing party must show

“competent and credible evidence of an improper external influence

on the jury.” Johnson, 200 Ill. App. 3d at 199. In the instant case, we find, as did the appellate court, that Kamm does not support his

claim with any evidence that the jury acted improperly. 319 Ill.

App. 3d at 144. Rather, Kamm contends that the jury’s question

shows that it considered extraneous information because “[n]o

witness, even Dr. Sarnelle, opined that a second or ‘brachial

arteriogram’ should have been attempted.” However, Sarnelle did

testify that, rather than a translumbar arteriogram, he preferred “a

different route *** into the brachial artery, which is in the arm.”

Sarnelle further testified that when Kamm became concerned about

ischemia following his examination of Snelson on March 2, he

could have done an arteriogram where he would “go in through the

arm to see the circulation.” Kamm’s claim must therefore be

rejected because it is unsubstantiated by any “competent and

credible” evidence and the record shows that the jury could have

formulated its question based on the evidence presented at trial.

	Kamm also argues that the jury’s verdict was against the

manifest weight of the evidence, contending that “all of the credible

evidence on the applicable standard of care supported only a

verdict in favor of Dr. Kamm.” Again, we disagree.

	It is well established that, in an appeal from a jury verdict, a

reviewing court may not simply reweigh the evidence and

substitute its judgment for that of the jury. Rhodes v. Illinois Central Gulf R.R., 172 Ill. 2d 213, 242 (1996); Doser v. Savage Manufacturing & Sales, Inc., 142 Ill. 2d 176, 189-90 (1990). Indeed, a reviewing court may reverse a jury verdict only if it is

against the manifest weight of the evidence. Rhodes, 172 Ill. 2d at 242. A verdict is against the manifest weight of the evidence where the opposite conclusion is clearly evident or where the findings of

the jury are unreasonable, arbitrary, and not based upon any of the

evidence. Leonardi v. Loyola University of Chicago, 168 Ill. 2d 83, 106 (1995); Maple v. Gustafson, 151 Ill. 2d 445, 454 (1992).

	Here, Snelson’s medical expert, Sarnelle, testified, inter alia, that, based upon a reasonable degree of medical certainty, had

there been surgery in a timely fashion on March 2, a large portion

of Snelson’s intestines could have been saved and he would not

require hyperalimentation to survive. In turn, Kamm’s experts, Pyle

and Donahue, testified that, even had revascularization been

attempted on March 2, the surgery would not have been successful.

As we earlier found, and contrary to Kamm’s assertion, we see no

“scientific poverty” in Sarnelle’s testimony that would put the

jury’s verdict in doubt. Rather, as the appellate court so aptly

stated:

			“This case involved a classic battle of the experts.

Witnesses qualified in their fields stated their opinions and

gave their reasons for those opinions. Not surprisingly, the

plaintiff’s experts did not agree with the defense experts.

The jury needed to listen to the conflicting evidence and

use its best judgment to determine where the truth could

be found. The jury found in favor of Snelson and against

Kamm, and this court ‘should not usurp the function of

the jury and substitute its judgment on questions of fact

fairly submitted, tried, and determined from the evidence

which did not greatly preponderate either way.’ Maple, 151 Ill. 2d at 452-53.” 319 Ill. App. 3d at 145.

	We now address Snelson’s argument that the trial court

abused its discretion by ordering a new trial on the issue of

damages. The determination of whether a new trial should be

granted rests within the sound discretion of the trial court, whose

ruling will not be reversed unless it reflects an abuse of that

discretion. Maple, 151 Ill. 2d at 455; Reidelberger v. Highland Body Shop, Inc., 83 Ill. 2d 545, 548 (1981). “If the trial judge, in the exercise of his discretion, finds that the verdict is against the

manifest weight of the evidence, he should grant a new trial; on the

other hand, where there is sufficient evidence to support the verdict of the jury, it constitutes an abuse of discretion for the trial court

to grant a motion for a new trial.” Maple, 151 Ill. 2d at 456.

	Illinois courts have repeatedly held that the amount of

damages to be assessed is peculiarly a question of fact for the jury

to determine (Lee v. Chicago Transit Authority, 152 Ill. 2d 432, 470 (1992); Baird v. Chicago, Burlington & Quincy R.R. Co., 63 Ill. 2d 463, 472-73 (1976)) and that great weight must be given to

the jury’s decision (see Hastings v. Gulledge, 272 Ill. App. 3d 861, 863-64 (1995); McMahon v. Richard Gorazd, Inc., 135 Ill. App. 3d 211, 230 (1985)). The very nature of personal injury cases

makes it impossible to establish a precise formula to determine

whether a particular award is excessive or not. See McMahon, 135 Ill. App. 3d at 230. Additionally, judges are not free to reweigh the

evidence simply because they may have arrived at a different

verdict than the jury. Drews v. Gobel Freight Lines, Inc., 144 Ill. 2d 84, 97 (1991); see also Hulke v. International Manufacturing Co., 14 Ill. App. 2d 5, 49 (1957) (the question of excessiveness is not to be determined by what we as judges think the damages

should have been; the court has no right to substitute its judgment

for that of the jury). Indeed, a court reviewing a jury’s assessment

of damages should not interfere unless a proven element of

damages was ignored, the verdict resulted from passion or

prejudice, or the award bears no reasonable relationship to the loss

suffered. Gill v. Foster, 157 Ill. 2d 304, 315 (1993). Given this precedent, we believe the trial court, in the instant case, abused its

discretion in setting aside the jury’s verdict as excessive.

	When reviewing a question as to the adequacy of damages, the

court must consider the record as a whole. See Hastings, 272 Ill. App. 3d at 864. Here, after reviewing the record in its entirety, it

is clear that not only did the record support the jury’s verdict, but

the trial court’s rationale for granting a new trial was, for the most

part, faulty. The trial court’s stated reasons for granting a new trial

on damages may be summarized as follows: (1) there was error in

giving the “loss of normal life” instruction; (2) the jury’s question

showed “[it was] attempting to base a decision on something other

than the evidence presented”; (3) the jury’s rapid itemization of the

verdict indicated “there could not have been any meaningful

discussion as to the allocation”; (4) the pretrial settlement demand showed that Snelson’s $10 million request in closing “was not

made in good faith”; and (5) the amount of the verdict was based

“at least in part on sympathy” and was unreasonable given

Snelson’s “surviving” and his “overall medical condition.”

	As to the first two bases, we have already found that the

giving of the “loss of normal life” instruction was not error and that

the jury’s question was insufficient to show it was improperly

considering extrajudicial information. Thus, contrary to the trial

court’s belief, these were not legitimate reasons for overturning the

jury’s verdict.

	Next, while the trial court believed the jury took only an

additional “five or ten minutes” to deliberate after the court

explained to the jury that it had failed to itemize the damages, the

record shows, and Kamm admits, that the jury actually took

approximately 20 minutes to complete the itemized verdict form.

The trial court’s assumption that the lack of a lengthy delay meant

“there could not have been any meaningful discussion as to the

allocation” was speculation and ignored the possibility that the jury

had previously deliberated on the individual damage elements but

neglected to fill out that portion of the verdict form. Further, we

agree with Snelson that it appears the elements of damages were

itemized “in a thoughtful way,” where the medical costs awarded

were rounded to the nearest large whole number, the future

medical awarded related to Snelson’s current expenses of $7,000

to $10,000 per month for hyperalimentation, which will continue

for the remainder of his 10-year life expectancy, and the lost-wages

amount was taken directly from the closing argument suggestion.

Therefore, because the calculations and proportions of the award

demonstrate a strong relation to the evidence presented, the jury’s

determination cannot be against the manifest weight of the

evidence. See Jones v. Chicago Osteopathic Hospital, 316 Ill. App. 3d 1121, 1138 (2000) (if a jury’s award falls within the

flexible range of conclusions reasonably supported by the evidence,

it must stand).

	The trial court also stated that because Snelson had offered to

settle the case at the start of trial for $500,000, his closing

argument to the jury requesting $10 million was not made in good

faith. However, the actual amount of Snelson’s pretrial settlement offer was not $500,000, but rather $1 million, the limits of Kamm’s

policy. Additionally, while the trial court assumed that the

settlement offer was based upon the predicted value of the case as

determined by Snelson’s counsel, we agree with Justice Cook’s

dissent that the demand for the policy limits and its subsequent

withdrawal on the record were most likely made to lay a

foundation for a possible “wrongful-refusal-to-settle claim.” 319

Ill. App. 3d at 149 (Cook, J., dissenting). Thus, we believe the

basis for the trial court’s finding that Snelson’s $10 million request

was not made in good faith is erroneous.

	Finally, we address the trial court’s belief that the verdict was

excessive given Snelson’s medical condition and the sympathy it

engendered. In granting Kamm a new trial on damages, the trial

court stated, in pertinent part:

			“[T]he $7 million verdict *** under the circumstances

of this case is definitely outside the range as what is fair

and reasonable based on all of the evidence presented.

			The first reason that I believe that is the case is that the

$2 million which was attributed to the loss of a normal life

and the $3 million which was attributed to pain and

suffering are excessive when viewed in the light of the

plaintiff’s overall medical condition which existed prior to

this occurrence and his ability to function after this

occurrence.

* * *

			Furthermore, I believe [the experts] all testified that the

condition suffered by the plaintiff *** [has] a very high

degree of fatality. Here we have the plaintiff surviving.

* * *

			I think in the context of this case and this case only,

with the plaintiff appearing in Court out of necessity as he

has and with the feeding unit, which I in no way criticize

plaintiff for because that’s a fact of life, it is something

that he has to have. I just think under the circumstances it

was inevitable that the verdict was based at least in part on

sympathy was [sic] the result here.”

	The evidentiary basis for the award of damages for loss of a

normal life and pain and suffering was the loss of 95% of Snelson’s

small intestine, which has necessitated his dependence on

hyperalimentation for survival and has resulted in his suffering from

numerous infections and chronic diarrhea. The appellate court

majority admits that “Snelson undeniably suffered a serious injury”

and states that “[t]his issue is a close one.” 319 Ill. App. 3d at 133.

The majority nonetheless upholds the trial court’s grant of a new

trial on the issue of damages because Snelson’s injury did not

diminish his life expectancy, he acknowledged that his restricted

ability to engage in daily activities was largely attributable to his

preexisting physical problems, and he did not present evidence that

his condition was likely to deteriorate in the future. 319 Ill. App.

3d at 133. We, however, believe that, even taking into

consideration the majority’s concerns, the injuries suffered by

Snelson were shown by the evidence to be significant and

devastating, and nothing has been presented that would compel us

to conclude that the verdict was excessive.

	We agree with Snelson that “[i]t is a vast oversimplification to

state that [his] damages are limited because he still tries to live by

occasionally going fishing.” It is indisputable that the loss of

Snelson’s small intestine has radically affected his life and subjected

him to phenomenal suffering. He has lost the ability to enjoy food

and to consume many foods. He has had to endure bouts of

diarrhea 15 to 20 times a day, every day, for over eight years and

counting. As Snelson further argued: “Every decision–to even

leave the house–requires the trade-off to occur; must he have

immediate access to a bathroom, or must he take the bag with him

and then affect his ability to sleep that evening or, even worse, to

soil his bed.” Therefore, we find that, regardless of his prior

medical condition, the jury’s damage award for loss of a normal life

was clearly demonstrated and supported by the evidence regarding

the limitations on Snelson’s freedom, mobility, and the change in

nearly every element of his daily routine caused by the loss of his

small intestine. Perhaps Snelson’s own comment at trial made the

point most succinctly: “When you are hooked up 12 hours a day,

you don’t have no days left.” Similarly, we find the jury’s award

for pain and suffering was adequately supported by evidence of the infections, diarrhea, and hospitalizations caused by Snelson’s

“short bowel syndrome” and his need for hyperalimentation.

	Additionally, we find that the trial court improperly considered

Snelson’s survival in determining the verdict to be excessive. The

jury found that Kamm was guilty of negligence in his treatment of

Snelson and the trial court denied Kamm’s motion for judgment

n.o.v. In determining whether the injuries Snelson did suffer merit the jury’s damage award, it is irrelevant that the negligence did not

cause Snelson’s death.

	In sum, an abuse of discretion will be found where there is no

recognizable basis in the record to support the granting of a motion

for a new trial. See Greco v. Coleman, 138 Ill. App. 3d 317, 322 (1985). Here, the jury’s damage award was not against the

manifest weight of the evidence. There were no trial errors that

occurred that persuade this court that the award in the instant case

was not fair and reasonable compensation for Snelson’s injuries.

Additionally, we have carefully scrutinized the record and do not

find that the amount of the verdict is so large as to be a result of

passion and prejudice or a shock to the judicial conscience. See

Baird, 63 Ill. 2d at 473. Therefore, we hold that the trial court abused its discretion in granting a new trial on damages.

	Finally, we address Snelson’s claim that the trial court erred in

granting judgment n.o.v. for St. Mary’s on the issue of proximate cause. Snelson acknowledges that he presented no expert

testimony indicating that St. Mary’s conduct was a proximate

cause of his injury. He also acknowledges that Kamm testified that

no act or omission of the nursing staff affected his course of

treatment of Snelson. Nevertheless, Snelson argues that a question

of fact as to proximate cause was sufficiently established by the

evidence.

	A motion for judgment n.o.v. presents a question of law and should be entered “in those cases in which all of the evidence,

when viewed in its aspect most favorable to the opponent, so

overwhelmingly favors [the] movant that no contrary verdict based

on that evidence could ever stand.” Pedrick v. Peoria & Eastern R.R. Co., 37 Ill. 2d 494, 510 (1967). A decision on a motion for judgment n.o.v. is subject to de novo review by this court. McClure v. Owens Corning Fiberglas Corp., 188 Ill. 2d 102, 132 (1999).

	In medical negligence cases against hospitals based on

vicarious liability for the conduct of its nurses, it is necessary for a

plaintiff to present expert testimony to establish the standard of

care and that its breach was the cause of the plaintiff’s injury. Jones v. Chicago HMO Ltd. of Illinois, 191 Ill. 2d 278, 296 (2000). The rationale for requiring expert testimony is that a lay juror is not

skilled in the profession and thus is not equipped to determine what

constitutes reasonable care in professional conduct without the

help of expert testimony. Jones, 191 Ill. 2d at 295.

	Snelson in essence argues that St. Mary’s nurses deviated from

the standard of care by failing to (1) advise Kamm at 6 p.m. that

they had inserted a catheter at 3 p.m. and (2) advise Kamm that

Snelson continued to experience some pain through the evening

after Kamm left at 6 p.m. The problem with Snelson’s argument is

that there was no expert testimony presented at trial that either of

these matters constituted a deviation from the nursing standard of

care.

	Snelson’s first expert, Dr. Sarnelle, had no opinions about the

nurses’ conduct. Snelson’s other expert, nurse McCallum, did not

testify that either of the cited omissions amounted to a deviation

from the standard of care. Although McCallum was critical of the

nurses’ failure to document the effect of the Demerol, she did not testify that this was a proximate cause of Snelson’s injury in this

case. Moreover, she did not testify that a failure to inform Kamm

of pain before the closing of the “window of opportunity” was a

deviation from the standard of care. She also acknowledged that

she was not qualified to offer any opinion regarding the proximate

cause of Snelson’s injury.

	McCallum testified about eight matters on which she was

critical of the nurses. Conspicuous by its absence is any mention

that it was a breach of the nursing standard of care to fail to orally

advise Kamm that a catheter had been inserted at 3 p.m. This may

be because the nurse notes and flow sheets to which Kamm had

access at his 6 p.m. visit listed that a catheter had been inserted. It

may also be because this was not something that was important for

Kamm to know or for the nurses to communicate. Indeed, this

theory of negligence based on what was or was not communicated

about the catheter was not even a theory relied upon by Snelson at trial. At any rate, the general rule must be applied here–that except

in very simple cases, expert testimony is necessary in professional

negligence cases to establish the standard of care and that its

breach was the proximate cause of the plaintiff’s injury. See Jones, 191 Ill. 2d at 296; Addison v. Whittenberg, 124 Ill. 2d 287, 297 (1988); see also Natasi v. United Mine Workers of America Union Hospital, 209 Ill. App. 3d 830, 837-398 (1991) (although nursing experts testified that failure to notify doctor was a deviation from

standard of care and delays in diagnosis could cause “poorer

ultimate results,” there was no medical testimony to substantiate

that omissions of nursing staff ultimately had any impact on

outcome of treatment and therefore directed verdict for hospital

was proper).

	Nurse McCallum also testified that she was critical of the

nursing staff’s apparent failure to take Snelson’s vital signs at 10

p.m. Snelson, however, does not explain how the failure to take

vital signs at 10 p.m. helped to cause his injury. More importantly,

there was no expert testimony that the conduct of the nurses on

this matter was a proximate cause of Snelson’s injury.

	As previously mentioned, there was no expert testimony that

the nurses’ failure to inform Kamm of Snelson’s complaints of pain

constituted a breach of the standard of care and was a proximate

cause of Snelson’s injury. Kamm knew about Snelson’s complaints

of pain at the 6 p.m. visit. Kamm clearly anticipated that Snelson

would continue to experience more pain and so he increased his

dosage of Demoeraol from 50 mg.illigrams to 100 mg.milligrams, as

needed. That Kamm was ordering Demoeraol instead of watching

Snelson for pain was the criticism leveled against Kamm by

Snelson’s expert. That Kamm knew about Snelson’s pain and yet

was unconcerned about it beyond his ordering of Demoeraol means

that the nurses’ conduct on this matter could not have been the

proximate cause of Snelson’s injury even if there had been

testimony that they deviated from the standard of care in failing to

advise of pain.

	The outcome of this case is controlled by our previous

decision in Gill v. Foster, 157 Ill. 2d 304 (19943). There, the plaintiff was admitted to the hospital and surgery was performed.

Several days after the surgery and while still in the hospital, the plaintiff complained to his surgeon that he was having chest pain.

Two days later at the time of his discharge, the plaintiff complained

to a nurse of chest pain. The discharge nurse, aware that the

plaintiff had complained of pain before, did her own examination.

She then told the plaintiff that something was wrong, but did not

inform the treating physician. At the time of his discharge, the

plaintiff actually had a herniation of his stomach into his chest,

which required surgery at another hospital two weeks later.

	The plaintiff alleged in Gill that the hospital deviated from the standard of care by failing to inform his treating physician that the

plaintiff was complaining of pain at the time of his discharge. This

court found, however, that even assuming that the nurse breached

the standard of care in failing to inform the doctor of the plaintiff’s

complaint, it could not have been the proximate cause of delay in

the correct diagnosis of the plaintiff’s condition because the doctor

had repeated contacts with the patient yet failed to diagnose the

problem or examine him more thoroughly. Gill, 157 Ill. 2d at 310- 311.

	Similar to Gill, there was no indication in the present case that Kamm would have taken a different course of action had he been

informed that Snelson had some pain after Kamm left at 6 p.m.

Moreover, Snelson did not even allege that St. Mary’s nurses

deviated from the standard of care in failing to apprise Kamm of

any further pain.

	Snelson’s suggestion that it is impossible for a plaintiff to

prove causation where the doctor testifies that “he would not have

acted differently regardless of what information could have been

given him [by the nurses]” is a red herring for two reasons. First,

Snelson mistakenly assumes that a doctor will not be willing to tell

the truth about whether the conduct of hospital nurses affected his

decision-making ability. Second, a plaintiff would always be free to

present expert testimony as to what a reasonably qualified

physician would do with the undisclosed information and whether

the failure to disclose the information was a proximate cause of the

plaintiff’s injury in order to discredit a doctor’s assertion that the

nurse’s omission did not affect his decisionmaking. See Seef v. Ingalls Memorial Hospital, 311 Ill. App. 3d 7, 26-27 (1999) (O’Mara Frossard, P.J., dissenting). In such a case, a factual dispute as to proximate cause would be created sufficient for the

jury to resolve. We do not, of course, have such a factual dispute

in the present case.

	Snelson claims that he was “foreclosed” from presenting such

evidence due to the appellate court majority’s decision in Seef. We find no merit to this claim given that the trial in this case took place

in June 1999, while the Seef decision was not filed until December 1999 (see Seef, 311 Ill. App. 3d 7).

 	To support his position that expert testimony establishing causation is not required, Snelson relies upon Holton v. Memorial Hospital, 176 Ill. 2d 95 (1997), and Suttle v. Lake Forest Hospital, 315 Ill. App. 3d 96 (2000). Neither of those cases, however,

supports Snelson’s position. Holton and Suttle do not set aside the requirement that a plaintiff present expert testimony asserting that

a defendant hospital deviated from the standard of care, and that

that deviation was the proximate cause of the plaintiff’s injury.

	In Holton, the hospital’s nursing staff did not inform the plaintiff’s two treating physicians that the plaintiff’s symptoms had

progressed to partial paralysis. Unlike the present case, there was

expert testimony in Holton to connect the nurses’ particular deviation from the standard of care to the plaintiff’s injury. The

two treating doctors testified that they based their erroneous

diagnosis and treatment on the incomplete information supplied by

the nurses. Holton, 176 Ill. 2d at 108-09.

	To define what evidence is necessary to establish a jury

question on proximate cause, Holton adopted the rule used by the appellate court in Northern Trust Co. v. Louis A. Weiss Memorial Hospital, 143 Ill. App. 3d 479, 487 (1986) (“ `  ‘[e]vidence which shows to a reasonable [degree of medical] certainty that negligent

delay in diagnosis or treatment *** lessened the effectiveness of

treatment is sufficient to establish proximate cause'’ ”), quoting

Jemsdames v. United States, 483 F. Supp. 581, 585 (N.D. Cal. 1980). Holton, 176 Ill. 2d at 115. In Northern Trust, the plaintiff’s expert specifically testified that the hospital breached the standard of care

in failing to have a “specially trained nurse” on call to monitor the

plaintiff’s meconium baby. The plaintiff connected that breach to the plaintiff’s injury with expert testimony indicating that a

specially trained nurse would have notified the doctor of the baby’s problems, that if the doctor had been notified he would have

undertaken certain diagnostic steps and treatment, and that the

delay in treatment increased the probability of harm. Northern Trust, 143 Ill. App. 3d at 486-88. Thus, the appellate court rejected the hospital’s argument that the jury verdict against the

hospital should be reversed for lack of a connection between the

hospital’s omissions and the baby’s brain injury. Northern Trust, 143 Ill. App. 3d at 487.

	Neither Holton nor Northern Trust supports the notion that Snelson in this case should be excused from presenting expert

testimony to show that the failure to notify Kamm of the insertion

of the catheter and of continued pain amounted to deviations from

the standard of care and that those deviations were a proximate cause of Snelson’s injury. Unlike the present case, the plaintiffs in

both of the cited cases presented expert evidence connecting a

particular breach of the standard of care to the plaintiffs’ injuries.

Thus, neither case is helpful to Snelson.

	Snelson attempts to fit the circumstances of this case under the

shelter of the appellate court decision in Suttle, 315 Ill. App. 3d 96. There, the appellate court reversed a judgement n.o.v. for a hospital, holding that the question of whether the doctor’s

treatment of the plaintiff would have been the same if he had been

accurately informed of the plaintiff’s true condition was a question

of fact for the jury. Suttle, however, is distinguishable and actually supports the judgments of both lower courts in this case.

	In Suttle, the appellate court specifically noted that the plaintiff had presented expert testimony establishing the standard of care.

The plaintiff also presented evidence of the hospital nurses’

violations of the various provisions of the Illinois Administrative

Code to establish the standard of care. The plaintiff further

presented expert testimony that, to a reasonable degree of medical

certainty, the hospital nurses’ breaches of the standard of care led

to a delayed diagnosis that was one of the proximate causes of the

plaintiff’s injuries. Moreover, the treating doctor testified that the

hospital’s breach resulted in a delay in his taking appropriate

action. Suttle, 315 Ill. App. 3d at 104-05. Under these circumstances, the court concluded that the issues regarding the

standard of care and proximate cause were questions of fact properly to be decided by the jury. Suttle, 315 Ill. App. 3d at 105. Unlike in Suttle, Snelson presented no expert testimony that the hospital breached the standard of care, resulting in a proximate

cause of his injuries.

	Despite Snelson’s suggestion to the contrary, Suttle did not hold that a case should be submitted to the jury whenever a

plaintiff presents some evidence that hospital nurses failed to

communicate some information to a treating physician. Instead,

Suttle merely distinguished the case before it from this court’s decision in Gill, 157 Ill. 2d 304, noting that summary judgment for the hospital in Gill was proper even though a nurse failed to inform the doctor that the patient being discharged from the hospital was

complaining of chest pain because the doctor knew of the

plaintiff’s pain. Suttle, 315 Ill. App. 3d at 104. Suttle further noted, however, that unlike Gill, there was a factual dispute in the case before it as to what the doctor would have done if he had received

the information assessing the patient’s blood pressure. Suttle, 315 Ill. App. 3d at 104. This was because the plaintiff’s expert

explicitly testified that the lack of an assessment by the nurses led

to a delayed diagnosis that was a proximate cause of the plaintiff’s

injury, while the treating doctor testified that his treatment would

have been the same even if he knew of the condition of the

placenta. Suttle, 315 Ill. App. 3d at 104.

	Given the complete absence of expert evidence connecting any

deviation from the standard of care by St. Mary’s with Snelson’s

injury, we conclude that the evidence so overwhelming favored St.

Mary’s that no contrary verdict based on the evidence could ever

stand. In entering judgment n.o.v. for St. Mary’s, the trial judge stated that in his 21 years on the bench he had always given great

deference to jury verdicts and had never entered a judgment n.o.v. before. He then explained that he was compelled to enter judgment

n.o.v. for St. Mary’s because Snelson completely failed to present any expert evidence that any of the claimed deviations from the

nursing standard of care were the proximate cause of his injury. We

agree with the judgments of the trial and appellate courts on this

point. Accordingly, we affirm the judgment n.o.v. in favor of St. Mary’s.

CONCLUSION

	For the foregoing reasons, the judgment of the appellate court,

rejecting Kamm’s claims of error in No. 91232, is affirmed. As to

Snelson’s appeal, No. 91239, the appellate court and circuit court

judgments are reversed with respect to Kamm and the cause is

remanded to the circuit court of Macon County with directions to

reinstate the $7 million award against Kamm. The trial court erred

in granting Kamm a new trial on damages, as the jury’s verdict in

that regard was supported by the evidence, and we find no reason

to overturn it. However, the appellate court and circuit court

judgments with respect to the granting of judgment n.o.v. for St. Mary’s are affirmed.

No. 91232–Appellate court judgment affirmed.

No. 91239–Appellate court affirmed in part

and reversed in part;

circuit court affirmed in part

 and reversed in part;

cause remanded with directions.

	JUSTICE RARICK took no part in the consideration or

decision of this case.