Beard v. Barron ( 2008 )


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  •                                                FIRST DIVISION
    January 22, 2008
    No. 1-05-1006
    DEVONNA BEARD, Special Administrator    )    Appeal from the
    of the Estate of Vernestine Hudgins     )    Circuit Court of
    Deceased,                               )    Cook County.
    )
    Plaintiff-Appellant,          )
    )
    v.                                 )
    )
    JOHN T. BARRON and RUSH-                )
    PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER, )    No. 01 L 014065
    )
    Defendants-Appellees          )
    )
    )
    (Hesham Hassaballa,                     )    The Honorable
    ) Deborah Mary Dooling,
    Defendant).                   )    Judge Presiding.
    JUSTICE GARCIA delivered the opinion of the court.
    On November 4, 1999, Vernestine Hudgins died of renal
    failure associated with Stevens-Johnson syndrome, a painful
    condition where large blisters form on the skin caused by a
    hypersensitive reaction to medication.    Her daughter, the
    plaintiff Devonna Beard, filed suit against Hudgins's
    cardiologist, Dr. John T. Barron, and Rush-Presbyterian-St.
    Luke's Medical Center (Rush)1 through its agents, Dr. Hesham
    1
    Rush-Presbyterian-St. Luke's Medical Center is now known
    1-05-1006
    Hassaballa and Dr. Barron, alleging medical negligence.   The
    plaintiff's theory was that Drs. Barron and Hassaballa failed to
    timely detect a bleed in Hudgins's brain, a subdural hematoma,
    that caused Hudgins to fall into a state of constant seizures,
    status epilepticus, that in turn required the administration of
    Dilantin, an antiseizure medication.   According to the plaintiff,
    Dilantin caused Hudgins's Stevens-Johnson syndrome, which
    eventually led to renal failure, causing her death.   The jury
    returned a verdict in favor of the defendants.
    The plaintiff contends on appeal that the circuit court
    committed three reversible errors: (1) the trial court misapplied
    the Dead-Man's Act (735 ILCS 5/8-201 (West 2004)) when it
    reserved ruling on the plaintiff's motion in limine seeking to
    bar Dr. Barron from testifying about claimed conversations he had
    with Hudgins regarding prior headaches; (2) the trial court
    overruled the plaintiff's objection to the defendants' cross-
    examination of Dr. William Greenlee as beyond the scope of direct
    examination; and (3) the trial court refused to give instructions
    pursuant to Illinois Pattern Jury Instructions, Civil, Nos. 30.21
    (aggravation of preexisting condition) and 30.23 (injury from
    subsequent treatment) (2005).   The plaintiff argues that the
    as Rush University Medical Center.
    2
    1-05-1006
    errors could have affected the jury's verdict.    We affirm.
    BACKGROUND
    In early July of 1999, Vernestine Hudgins was an active 65-
    year-old woman.   She enjoyed cooking for her several adult
    children, attending church outings, shopping, and traveling.
    Hudgins also suffered from numerous cardiac conditions, some of
    which required that she be hospitalized several times a year.
    Hudgins had congestive heart failure and severe pulmonary
    hypertension, both of which were progressing.    She also had
    massive edema (swelling in her legs and abdomen), and fluid on
    her lungs.   Hudgins had an irregular heartbeat attributed to
    atrial fibrillation.   She was taking several medications,
    including the diuretics Lasix and Zaraxolyn, and blood pressure
    medications, including Digoxin and Lisinopril.
    Hudgins also had been receiving anticoagulation therapy
    (blood thinners) since 1983, when the mitral valve of her heart
    was replaced with a mechanical one.   Because blood can clot
    around mechanical valves, Hudgins took blood thinners to help
    reduce her chances of a stroke.   In July 1999, her life
    expectancy was three to five years.
    On July 6, 1999, Hudgins was admitted to Rush for a
    scheduled cardiac catheterization procedure to evaluate her
    aortic valve that had started leaking.   Rush, a teaching
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    1-05-1006
    hospital, uses an approach where a supervising doctor, the
    attending physician, oversees fellows, residents, and interns.
    The attending physician during Hudgins's July 6 admission was Dr.
    Barron, a cardiologist who had been Hudgins's physician since
    1988.   Hudgins was also treated by Dr. Ajay Baddi, a cardiac
    fellow, and Dr. Hassaballa, an intern.
    Because the cardiac procedure involved inserting a catheter
    into the artery near her groin, the anticoagulation therapy had
    to be halted before the procedure was performed.   At the time of
    her admission, Hudgins was taking the blood thinner Coumadin,
    which remained active in her system for several days.   In order
    to ensure that Hudgins's blood remained adequately
    anticoagulated, Coumadin was stopped and Heparin, a blood thinner
    that would remain in Hudgins's system for only a few hours, was
    introduced.   The idea was that Heparin would be stopped a few
    hours before the cardiac catheterization procedure began and
    restarted once the procedure was over.   Hudgins would later
    transition back to Coumadin.
    Hudgins also received a drug called Norvasc, used to treat
    high blood pressure.
    Hudgins's cardiac catheterization procedure was performed on
    July 9, 1999.   She remained at Rush for several days thereafter
    while doctors adjusted her blood thinners to a therapeutic level.
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    1-05-1006
    On July 10, Dr. Baddi performed a brief neurological exam that
    was normal and reported in Hudgins's chart that she had no new
    complaints.    Dr. Baddi made similar entries in her chart for July
    11 and 12.
    On July 12, 1999, Hudgins suffered a nosebleed and a
    headache.    On July 13, she had another nosebleed and headache.
    She was given Tylenol and a medication called Ultram.    On the
    evening of July 13, Hudgins declined further pain medication, but
    requested an ice pack for her headache.
    On July 14, 1999, Hudgins vomited twice.    As a result, she
    was given the drug Compazine.    She also experienced a 47-point
    drop in her systolic blood pressure and a 23-point drop in her
    diastolic blood pressure.    A nurse's note entered at 4:40 p.m.
    indicated that Hudgins denied any complaints, was oriented to
    person, place, and time, opened her eyes to sound, had clear and
    appropriate speech, and obeyed commands.
    On July 17, 1999, Hudgins's headache returned.    As a result,
    Dr. Barron stopped the medication Norvasc.    Hudgins did not
    report a headache for the rest of the day on July 17 or on July
    18 or 19.
    Although her blood-thinning levels were not quite where Dr.
    Barron wanted them to be, Hudgins was discharged from Rush on
    July 19, 1999.    Prior to being discharged, she was instructed on
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    1-05-1006
    giving herself an injection of a fast-acting anticoagulant called
    Lovenox.    She was also placed back on Coumadin.     According to
    members of Hudgins's family, she complained of a headache and
    appeared groggy upon discharge.
    Hudgins was taken to the emergency room (ER) at Rush on the
    morning of July 20, 1999, because her groin wound from the
    cardiac catheterization procedure began bleeding.       Dr. Barron met
    Hudgins in the ER and applied pressure to the wound.       Hudgins was
    readmitted so an ultrasound could be performed on the groin area
    to detect whether she had a pseudoaneurysm.       Coumadin was briefly
    stopped.    Once the ultrasound came back negative, Coumadin was
    restarted.    Hudgins was seen by Dr. Hassaballa, who noted that
    Hudgins was not experiencing any chest pain, dizziness, or double
    vision, but that she was "[p]ositive for headache started in
    house on last admission."    She was again given Ultram.
    On the morning of July 21, 1999, while still at Rush,
    Hudgins continued to report a headache, was nauseated, and
    vomited twice.    At 7:20 a.m., Dr. Hassaballa ordered Compazine to
    relieve the nausea and vomiting.       When Hudgins was discharged
    from Rush at 5 p.m. on July 21, she had a "mild" headache and was
    drowsy.    Hudgins declined Tylenol for her headache.     Her
    drowsiness was attributed to Compazine.
    Hudgins returned home, where she continued to experience a
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    headache.    In the early morning of July 23, 1999, one of
    Hudgins's daughters called 911 because she began turning her head
    from side to side and appeared groggy.    When the paramedics
    arrived, Hudgins's eyes were rolled back, indicative of a
    seizure.    She was taken to Westlake Hospital (Westlake), where a
    computed tomography (CT) scan was performed upon her admission.
    The CT scan showed a subdural hematoma and indicated she was in
    status epilepticus.    Additional CT scans were performed during
    her hospitalization at Westlake.
    Doctors at Westlake treated Hudgins intravenously with
    Dilantin, used to control seizures.    She remained in status
    epilepticus for about four days and fell into a coma.    On July
    28, 1999, Hudgins was transferred to Rush, where Dilantin was
    continued.    Hudgins's seizures eventually stopped, allowing her
    to be sent to rehabilitation.    However, the seizures soon
    returned.    In early September, Hudgins developed a rash that soon
    turned into open, oozing sores on her back, buttocks and thighs.
    The sores, about the size of apples, would fill with fluid and
    burst.   It was evident to Hudgins's children, who frequently
    visited, that she was in pain.    Hudgins's daughters took turns
    staying with her through the night.
    It was determined that Hudgins had developed Stevens-Johnson
    syndrome.    She also developed pneumonia and her kidneys began to
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    1-05-1006
    fail.    Hudgins died on November 4, 1999, at the age of 66.
    The plaintiff filed suit against Dr. Barron, Dr. Hassaballa,
    and Rush,2 alleging medical malpractice.   Dr. Hassaballa was
    later dropped as an individually named defendant.
    A jury trial commenced on September 23, 2004.    The
    plaintiff's theory was that the standard of care required the
    defendants to order a neurological consult of Hudgins on July 17,
    1999, as well as a CT scan by July 20 or 21.    According to the
    plaintiff, Hudgins's nausea, nosebleeds and headaches, combined
    with her anticoagulation therapy, should have placed the doctors
    on notice that she was experiencing bleeding in her brain.
    According to the plaintiff, if the bleeding had been detected
    prior to status epilepticus setting in, it could have been
    controlled without the administration of Dilantin, which she
    contended, caused the Stevens-Johnson syndrome.    The plaintiff's
    experts opined at trial that had the subdural hematoma been
    treated before the seizures developed, the subsequent
    complications would not have arisen and Hudgins would not have
    died when she did.
    As her initial witness, the plaintiff called Dr. Barron to
    2
    The plaintiff's original complaint named other defendants
    not relevant to this appeal.
    8
    1-05-1006
    testify as an adverse witness.    The medical charts of Hudgins's
    July 6, 1999, admission were also admitted into evidence.           To
    support her theory that Hudgins's brain was bleeding while she
    was still at Rush, the plaintiff presented expert testimony from
    Dr. Mary Edwards-Brown, a neuroradiologist and professor of
    radiology at Indiana University.       Dr. Edwards-Brown reviewed
    several images of Hudgins's brain, including CT scans taken on
    July 23 and July 28, 1999, at Westlake and a magnetic resonance
    imaging (MRI) scan taken at Rush on July 29.       It was Dr. Edwards-
    Brown's opinion that, within a reasonable degree of medical
    certainty, Hudgins's hematoma was in the early subacute phase,
    meaning the majority of the bleeding occurred within two days to
    a week before the July 29 MRI.    However, the images also
    indicated the bleeding had occurred over time.       Dr. Edwards-Brown
    concluded that some of the hematoma was in the late subacute
    phase, meaning it occurred as much as two months prior to the
    MRI.    Because Hudgins's clinical history indicated she was on
    anticoagulants, experienced bleeding from her nose and groin
    wound, and suffered headaches, Dr. Edwards-Brown opined the
    bleeding likely began when Hudgins reported her first headache on
    July 12.
    The plaintiff also presented the jury with the videotaped
    deposition of Dr. William Greenlee, a neuroradiologist.       Dr.
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    1-05-1006
    Greenlee testified that the July 29, 1999, MRI taken at Rush
    indicated Hudgins's bleed occurred several days to several weeks
    prior to the scan.   On cross-examination, Dr. Greenlee testified
    that when looking at the July 29, 1999, MRI and a July 28, 1999,
    CT scan together, his opinion was that the age of the bleed was
    in the "several days to a week period."
    Dr. Robert Heller, a board-certified internist from Los
    Angeles, and Dr. Omkar Markand, the Professor Emeritus in the
    neurology department at Indiana University, also testified as
    experts on behalf of the plaintiff.   Both doctors based their
    opinions, in part, on the records of Hudgins's 1999 admissions to
    Rush and Westlake.
    Dr. Markand testified that the standard of care required Dr.
    Barron to do more than just take Hudgins off Norvasc on July 17,
    1999.   Because Hudgins had experienced nosebleeds, headaches,
    nausea, and vomiting, Dr. Barron should have requested a
    neurological consult and probably should have obtained a CT scan
    of Hudgins's head.   Dr. Markand testified that because Hudgins's
    symptoms were present during her July 20, 1999, admission to
    Rush, the standard of care required both a neurological consult
    and a CT scan on July 20 and no later than the morning of July
    21.   Dr. Markand also testified that Hudgins developed Stevens-
    Johnson syndrome from receiving Dilantin.   In his opinion, had
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    1-05-1006
    Hudgins's subdural hematoma been detected by July 21 and
    immediately treated, she would not have developed status
    epilepticus, would not have required Dilantin, and would not have
    developed Stevens-Johnson syndrome.
    It was Dr. Heller's opinion that Dr. Barron's treatment fell
    below the standard of care because he ignored Hudgins's symptoms
    of headache, nausea and vomiting, and did not properly evaluate
    those symptoms in light of her anticoagulation therapy by
    ordering a neurological consult or a CT scan of her head.    Dr.
    Heller also opined that Dr. Hassaballa's treatment fell below the
    standard of care because he failed to properly report Hudgins's
    symptoms of intracranial bleeding to Dr. Barron, his attending
    physician, and failed to properly evaluate Hudgins with either a
    neurological consult or a CT scan.
    The defendants presented expert testimony from Dr. Albert
    Ehle, a neurologist and professor of neurology at the University
    of Chicago, Dr. Joel Meyer, a neuroradiologist with Evanston
    Northwestern Health Care, and Dr. Dan Fintel, a cardiologist at
    Northwestern.   Drs. Barron and Hassaballa also testified for the
    defense.
    According to Dr. Meyer, the July 23, 1999, CT scan of
    Hudgins's brain indicated the hematoma was acute, meaning it had
    occurred within hours or up to one or two days prior to the scan.
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    1-05-1006
    Dr. Hassaballa and Dr. Barron each testified that his
    respective care of Hudgins met the applicable standard of care.
    Dr. Barron testified that Hudgins's nosebleeds and headaches were
    not significant because she had experienced them before.   He also
    testified that because Compazine resolved Hudgins's vomiting,
    this was "strong evidence" that the vomiting was not "cephal in
    origin."
    Dr. Ehle testified that the standard of care did not
    require either a neurological consult or a CT scan on July 17,
    1999, when Norvasc was discontinued.   In his opinion, there was
    "no evidence" that the plaintiff had the kind of "persistent,
    progressive headaches" that are symptomatic of a subdural bleed
    during her first admission to Rush.    Dr. Ehle also testified that
    the standard of care did not require either a neurological
    consult or a CT scan during Hudgins's second admission to Rush.
    Dr. Ehle also found it "significant" that Hudgins was "well-known
    to the service [provider]" and accordingly her doctors, including
    Drs. Barron and Hassaballa, would be "sensitive to any subtle
    changes in her behavior that could have been an indication of
    something going on."   According to Dr. Ehle, the Stevens-Johnson
    syndrome could have been caused by antibiotics Hudgins
    received, as well as by Dilantin.
    Dr. Fintel testified that in his opinion, the standard of
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    1-05-1006
    care did not require either a neurological consult or a CT scan
    during Hudgins's first or second admission to Rush.     According to
    Dr. Fintel, clinical signs of a subdural hematoma include a
    persistent change in mental status, the inability to follow
    commands, clumsiness, neurological abnormalities, and severe
    persistent headaches that do not respond to drugs and intensify
    over time.   According to Dr. Fintel, Hudgins did not experience
    any of these symptoms while at Rush.     Dr. Fintel also testified
    that the complications Hudgins experienced following the subdural
    bleed were "inevitable and unavoidable" as well as "not
    predictable."
    The jury returned a verdict in favor of the defendants, and
    the circuit court entered judgment on the verdict.    The
    plaintiff's posttrial motion was denied, and this timely appeal
    followed.
    ANALYSIS
    I.   Dead-Man's Act
    In keeping with her theory that Dr. Barron and Dr.
    Hassaballa failed to recognize Hudgins's headaches as symptomatic
    of a bleed in her brain, the plaintiff filed two motions in
    limine seeking to prevent Dr. Barron from testifying that Hudgins
    had experienced headaches in the past.    It was the plaintiff's
    theory that such testimony would violate the Dead-Man's Act (the
    13
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    Act) (735 ILCS 5/8-201 (West 2004)).    The trial court ruled it
    was required to first determine under Hoem v. Zia, 
    159 Ill. 2d 193
    , 
    636 N.E.2d 479
     (1994), whether the plaintiff's experts would
    "open the door" to any prior conversations or events between Dr.
    Barron and Hudgins before deciding whether any prior
    conversations were admissible.    The court stood by its ruling
    even after being informed Dr. Barron would be the first witness
    to testify.
    Although the plaintiff contends otherwise, the issue in this
    case turns on the nature of the evidence presented regarding any
    prior conversations between Hudgins and Dr. Barron.    It is
    therefore an evidentiary issue, not an issue of statutory
    construction.    Accordingly, we review the trial court's ruling
    for an abuse of discretion.    In re Estate of Hoover, 
    155 Ill. 2d 402
    , 420, 
    615 N.E.2d 736
     (1993).
    The Dead-Man's Act provides, in relevant part:
    "In the trial of any action in which any
    party sues or defends as the representative
    of a deceased person ***, no adverse party or
    person directly interested in the action
    shall be allowed to testify on his or her own
    behalf to any conversation with the deceased
    *** or to any event which took place in the
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    1-05-1006
    presence of the deceased ***, except in the
    following circumstances:
    (a) If any person testifies on behalf of
    the representative to any conversation with
    the deceased *** or to any event which took
    place in the presence of the deceased ***,
    any adverse party or interested person, if
    otherwise competent, may testify concerning
    the same conversation or event."   735 ILCS
    5/8-201(a) (West 2004).
    Our supreme court has explained that the Act serves two
    purposes: (1) protecting decedents' estates from fraudulent
    claims; and (2) equalizing the position of the parties in regard
    to the giving of testimony.    Gunn v. Sobucki, 
    216 Ill. 2d 602
    ,
    609, 
    837 N.E.2d 865
     (2005), citing Hoem, 
    159 Ill. 2d at 201
    ; see
    also M. Graham, Cleary & Graham's Handbook of Illinois Evidence
    §606.1, at 334 (8th ed. 2004).
    The plaintiff argues the trial court's decision to reserve
    ruling on her motions permitted Dr. Barron to inject his prior
    experiences with Hudgins and to testify about conversations with
    her involving prior headaches.    She complains about five specific
    instances in the examination of Dr. Barron in support of her
    claim.
    15
    1-05-1006
    The first three instances transpired when Dr. Barron was
    called as an adverse witness in the plaintiff's case-in-chief.
    Dr. Barron testified that he had been Hudgins's doctor since
    1989, and he gave a history of the numerous ailments from which
    Hudgins suffered.    He also explained Hudgins's transitions from
    Coumadin to Heparin and back to Coumadin during her July 6, 1999,
    admission to Rush.    Dr. Barron acknowledged that during the
    period of transition, Hudgins was at a greater risk for bleeding
    and for suffering a stroke.    He acknowledged that a headache
    could be a sign of brain-related bleeding.    A nosebleed, however,
    was not, by itself, a sign of brain-related bleeding.    Dr. Barron
    testified that a nosebleed was not necessarily a sign of
    spontaneous bleeding and explained that nosebleeds could be
    caused by irritation from several sources.    Dr. Barron also
    testified that Hudgins reported nosebleeds in the past, although
    he did not recall charting any of those nosebleeds.    Dr. Barron
    acknowledged that he learned Hudgins was suffering headaches
    during the July 6, 1999, admission, but he would not necessarily
    report his evaluation of those headaches in her chart.    He also
    testified that he responded to her headaches by taking her off
    Norvasc on July 17.    He additionally acknowledged that the
    easiest way to determine whether headaches were due to bleeding
    in her brain was with a CT scan.
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    1-05-1006
    The plaintiff questioned Dr. Barron about his progress notes
    of Hudgins's first admission to Rush, which were admitted into
    evidence.    When asked why his progress notes did not discuss his
    evaluation of Hudgins's headaches, Dr. Barron explained his
    neurological exams were not necessarily written, but that he
    evaluated her speech, mentation and motions every time he saw
    her.    He further explained that he only recorded "important
    factors."    The first instance in Dr. Barron's testimony that the
    plaintiff contends violated the Dead-Man's Act then occurred.
    "Q.   Was it not important on July 16th
    that Mrs. Hudgins had had headaches during
    the days prior to that?
    A. [Mrs.] Hudgins had headaches in the
    past as well, frequent headaches in the past.
    My conversations with her for the past ten
    years --
    MS. THOMAS [Plaintiff's Attorney]: Move
    to strike, Your Honor.
    THE COURT: It's stricken.   The jurors
    are instructed to disregard the answer.   Dr.
    Barron, just respond to the question asked.
    ***
    THE WITNESS [Dr. Barron]: In my judgment
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    1-05-1006
    it was not."
    The second instance transpired after counsel for the
    plaintiff asked Dr. Barron to read the note he made in her chart
    on July 17, 1999, when Norvasc was discontinued.
    "A. [Dr. Barron]: It says Cardiology.
    Vital signs stable, which is VSS. *** Patient
    doing well except complains of headache.
    Dieresis continues.      Exam, less edema.    Plan,
    DC Norvasc.    Number 2, check PT today.      If
    INR of 2.0, may DC home on 7.5 milligrams PO,
    which means by mouth, every ghs, which means
    at night.    Coumadin.    Then I signed it.
    Q.     That's the extent of your note --
    A.     Yes.
    Q.     -- on the 17th?   And this is what we
    discussed earlier this morning where in
    response to plaintiff's headaches during this
    admission, you ordered that she be
    discontinued from Norvasc?
    A.     Are you referring specifically to
    the 17th or to the 13th when it was held?
    Q.     The 17th.
    A.     Specifically the 17th she told me
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    1-05-1006
    that --
    [MS. Thomas]: Your Honor, motion in
    limine.
    ***
    THE COURT: Start another question.
    Strike all that.    Just start another
    question.    And wait for the question.     If you
    don't understand, say I don't understand.       If
    you do, just answer the question asked.       Go
    ahead.
    Q.     Mrs. Hudgins, her Norvasc was
    discontinued on the 17th, correct?
    A.     Permanently discontinued, yes."
    On the above record, we find no error to have occurred.           The
    plaintiff's timely objections, sustained by the trial court, kept
    any offensive testimony from the jury.      To the extent Dr.
    Barron's answer referenced an improper subject, the trial court
    properly instructed the jury to disregard the testimony.         The
    jury is presumed to follow the trial court's instructions.
    People v. Taylor, 
    166 Ill. 2d 414
    , 438, 
    655 N.E.2d 901
     (1995).
    Consequently, any error that may have occurred was cured.
    The plaintiff, in effect, argues that had her motions in
    limine been granted prior to Dr. Barron taking the stand, no risk
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    1-05-1006
    to the plaintiff of Dr. Barron testifying to such matters would
    have occurred.   A grant of the motion in limine would have
    obviated any need of the plaintiff having to object and avoid
    giving the jury the impression that she was trying to hide
    evidence.
    As this court noted in Compton v. Ubilluz, 
    353 Ill. App. 3d 863
    , 871, 
    819 N.E.2d 767
     (2004), trial courts are at a
    disadvantage in ruling on motions in limine because such motions
    are "considered in a vacuum, before the presentation of the full
    evidence at trial that may justify admission or require
    exclusion."   Here, we cannot say the trial court abused its
    discretion by waiting until Dr. Barron actually testified in
    order to determine whether the plaintiff would open the door to
    any testimony that would otherwise be prohibited by the Act.    The
    better approach may have been to grant the motion subject to
    reconsideration had the door been opened.   However, no reversible
    error occurred where the trial court sustained the timely
    objections.   See, e.g., Crumpton v. Walgreen Co., 
    375 Ill. App. 3d 73
    , 84, 
    871 N.E.2d 905
     (2007) (to the extent any prejudice
    occurred by the defendant's violation of the motion in limine,
    "it was cured by the circuit court's instruction to the jury to
    disregard counsel's question").
    The third instance of which the plaintiff complains happened
    20
    1-05-1006
    when Dr. Barron, still testifying as an adverse witness in the
    plaintiff's case, was asked about Hudgins's symptoms on July 20,
    1999, when she returned to Rush after her groin wound began
    bleeding.
    "Q.    And you knew she came in, and she
    was having headaches on the 20th when she
    came in with her groin bleed, correct?
    A.    When she -- not on the day that she
    came in on the 20th.   I did not know that.
    And she did not report this to me.   And I had
    no indication that she did have headaches
    that morning.
    Q.    But by the time you signed the
    discharge note and the order on the morning
    of the 21st, it was clear that she had had
    headache yesterday and she was having
    headache, nausea, and vomiting in the
    morning, correct?
    A.    Yes.
    Q.    You knew that?
    A.    Yes.
    Q.    Yet that was not enough for you to
    order a CT scan?
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    1-05-1006
    A.   Because she had it several times
    before and in previous admissions as well.
    MS. THOMAS: Move to strike.
    THE COURT: No.    Based on your question
    overruled.   It will stand."
    The plaintiff relies on Vazirzadeh v. Kaminski, 
    157 Ill. App. 3d 638
    , 
    510 N.E.2d 1096
     (1987), and Theofanis v. Sarrafi,
    
    339 Ill. App. 3d 460
    , 
    791 N.E.2d 38
     (2003), to argue this
    testimony was improper.
    In Vazirzadeh, the issue was whether the defendant doctor
    failed to diagnose and treat the decedent's symptoms of a
    pulmonary embolism.      The decedent's symptoms, including shortness
    of breath and chest pain, were not disputed.     The defendant
    doctor, while testifying as an adverse witness in the plaintiff's
    case, testified, in response to questions from his own attorney,
    that the decedent told him that his chest pain was of short
    duration, was relieved by belching, and was not significant.       On
    appeal, this court held that the testimony was barred by the Act,
    as the plaintiff had not questioned the defendant about that
    conversation between the doctor and the decedent.        Vazirzadeh,
    
    157 Ill. App. 3d at 645
    .
    Theofanis also involved the situation where the defendant
    doctor was cross-examined by his own attorney after being called
    22
    1-05-1006
    as an adverse witness in the plaintiff's case.     There, the
    defendant doctor sought to testify to a conversation with the
    decedent about which the plaintiff's attorney had not asked.
    In this case, unlike in Vazirzadeh or Theofanis, the
    complained-of testimony was elicited by the plaintiff's own
    attorney during an adverse examination.     One of the objectives of
    the Act is fundamental fairness.      Wasleff v. Dever, 
    194 Ill. App. 3d 147
    , 153, 
    550 N.E.2d 1132
     (1990).     This purpose is not
    fulfilled where, as in this case, the plaintiff is permitted to
    elicit testimony from the defendant medical doctor during an
    adverse examination insinuating that he missed important symptoms
    exhibited by his patient, while, at the same time, denying him
    the opportunity to answer questions, posed by the plaintiff, as
    to why he did not find these symptoms significant to warrant
    further testing.    Our supreme court has noted:
    "It would be palpably unjust if a litigant
    were permitted to call an adverse party and
    examine him as to one fact or phase of a
    transaction in his favor and then invoke the
    bar of the statute when the party examined
    sought to testify further with regard to the
    same transaction for the purpose of
    explaining his former testimony or correcting
    23
    1-05-1006
    an erroneous impression left thereby."
    Perkins v. Brown, 
    400 Ill. 490
    , 497, 
    81 N.E.2d 207
     (1948).
    We recognize that the court in Perkins was interpreting a
    prior version of the Dead-Man's Act which dealt with
    "conversations" or "transactions" while the current Act discusses
    "conversations" or "events."     Compare Vazirzadeh, 
    157 Ill. App. 3d at 644
    , with Zorn v. Zorn, 
    126 Ill. App. 3d 258
    , 261-63, 
    464 N.E.2d 879
     (1984) (each case taking a different view as to the
    legislature's intent by the change in language).      Nonetheless, we
    determine, given the facts of this case, that it would be
    fundamentally unfair to allow the plaintiff to specifically ask
    Dr. Barron why he did not order a CT scan on July 21, the
    question suggesting that Hudgins presented with symptoms that
    were new and concerning, and then use the Dead-Man's Act to bar
    his response why he did not feel the symptoms to be new or
    concerning.
    The last two instances of which the plaintiff complains
    transpired during Dr. Barron's direct examination in the
    defendants' case-in-chief.
    "Q.    Did she, over the years, ever have
    nose bleeds?
    A.    She had several nose bleeds.
    24
    1-05-1006
    Q.    Did she, over the years, have
    complaints of headache that she at least felt
    was due to hypertensive medication?
    MS. THOMAS: Objection, motion in
    limine."
    The parties then discussed the matter outside of the
    presence of the jury.      Counsel for the plaintiff argued that
    there were no reports of prior headaches in any of the charts
    admitted into evidence.      Counsel also explained that defense
    counsel had produced two notations of headaches in Hudgins's
    medical records that had not been admitted, one from 1992 and the
    other from 1995.      The plaintiff's attorney argued that she had
    not opened the door to any records prior to Hudgins's July 6
    admission, and consequently, any testimony regarding headaches
    preceding that date should be barred.      The court ruled:
    "This is what I'm going to do on this.
    Dr. Barron is going to be limited -- saying
    you are tracking on the Dead Man's Act as to
    the conversation.    Dr. Barron is going to be
    limited to talking about any headaches that
    there is actually a record of on a prior
    treatment of Ms. Hudgins.    Whether it's in
    his medical chart or some other chart, if it
    25
    1-05-1006
    was recorded at the time, then Dr. Barron can
    talk about it."
    When Dr. Barron's testimony resumed, the following occurred.
    "Q. *** Doctor, while she was on the
    medications that you told me about, did the
    patient have complaints of nose bleeds?
    A.     Yes.
    Q.     Did the patient have complaints of
    headache?
    A.     Yes.
    Q.     Did the patient have complaints of
    nausea and vomiting?
    A.     Yes.
    Q.     Was Tylenol given for the headaches?
    A.     Yes.
    Q.     In dealing with congestive heart
    failure patients, you know and have an
    understanding of what side effects all of the
    medications that patients such as Ms. Hudgins
    can have from those medications?
    A.     Yes."
    The plaintiff asserts this ruling, too, was erroneous.     We
    disagree.    We find the supreme court's decision in Hoem, 
    159 Ill. 26
    1-05-1006
    2d 193, instructive.
    In Hoem, the issue at trial was whether the defendant
    doctors failed to diagnose and prevent the decedent's impending
    heart attack.    The plaintiff, in her case-in-chief, called an
    expert who testified that the decedent's medical records showed
    clear signs of a prior heart attack, clear warning signs of an
    impending heart attack, and that on October 31, 1988, the
    decedent had described angina, a symptom of heart disease, to Dr.
    Zia, one of the defendants.    It was the plaintiff's expert's
    opinion that based upon the information Dr. Zia recorded in his
    office notes, Dr. Zia should have recognized the decedent's
    complaints as symptomatic of heart disease and responded
    accordingly.
    Dr. Zia testified about the October 31, 1988, exam in the
    defendants' case-in-chief.    According to Dr. Zia, the decedent
    had not described angina but, rather, had described
    musculoskeletal pain.    Consequently, Dr. Zia did not believe the
    decedent was suffering from heart disease.
    The supreme court found that the plaintiff's expert's
    testimony and the introduction of Dr. Zia's office notes opened
    the door to Dr. Zia's testimony under subsection 8-201(a) of the
    Act.    The court found the plaintiff's expert, by putting his
    "gloss" on the notes, insinuated that the decedent visited Dr.
    27
    1-05-1006
    Zia specifically for a heart-related problem.      Hoem, 
    159 Ill. 2d at 201
    .   The court explained:
    "In this case, allowing the representative of
    the deceased to introduce her version of why
    [the decedent] went to Dr. Zia, without
    giving an equal opportunity to Dr. Zia, would
    not advance the policy behind the Act.    Under
    these circumstances, we find it fundamentally
    unfair to deny Dr. Zia an opportunity to
    explain his view of what happened.   Left
    unchallenged, [the plaintiff's expert's]
    comments would have remained with the jury as
    the only testimony regarding the conversation
    between Dr. Zia and [the decedent]."     Hoem,
    
    159 Ill. 2d at 202
    .
    In this case, we similarly find that the plaintiff, by
    presenting expert testimony establishing that Drs. Barron and
    Hassaballa violated the standard of care by failing to recognize
    Hudgins's symptoms to be indicative of a subdural bleed, opened
    the door to Dr. Barron's testimony that he did not find the
    symptoms, including the headaches, to be suspect.
    The plaintiff would have us find that Dr. Barron's testimony
    about prior headaches referenced conversations that occurred well
    28
    1-05-1006
    before Hudgins's July 1999 admissions.      However, we draw no such
    conclusion.    Rather, we find the prior conversation to be those
    that were documented in the medical records admitted at trial and
    to which the plaintiff opened the door, namely, the complaints
    Hudgins made while at Rush in July 1999.     The plaintiff's
    experts, including Drs. Heller and Markand, interpreted those
    records as indicating Hudgins was experiencing new symptoms,
    including headaches and nosebleeds, that Dr. Barron should have
    recognized as possibly indicating a subdural bleed.     Once the
    door was opened to these conversations, Dr. Barron was entitled
    to explain his view--that he did not consider these symptoms to
    be new because Hudgins had had them before.
    The fifth instance happened while Dr. Barron, still
    testifying for the defense, was being cross-examined by the
    plaintiff's attorney.     Counsel asked Dr. Barron about the
    medications Hudgins was taking and whether she reported a
    headache to him on July 21, 1999.
    "Q.    Did you know or not know, Doctor,
    whether she had headache, nausea, and
    vomiting on the morning of the 21st?
    A.    I was aware from the previous notes
    that she had epigastric pain.   This is
    commonly seen in patients with heart failure,
    29
    1-05-1006
    nausea, vomiting.    The headache was of no
    consequence.    I assessed it as of no
    consequence and viewed this patient's
    previous history, her medications, that it
    did not strike me as important.
    Q.     It wasn't important?
    A.     It was her [sic] ordinary [Mrs.]
    Hudgins."
    We do not find this testimony to be referencing any prior
    conversations or events.      Moreover, as the plaintiff failed to
    make any objection to the testimony, she has waived her
    contention that it violated the Act for purposes of appeal.      See
    In re Estate of Netherton, 
    62 Ill. App. 3d 55
    , 59, 
    378 N.E.2d 800
    (1978); see also Malanowski v. Jabamoni, 
    332 Ill. App. 3d 8
    , 11,
    
    772 N.E.2d 967
     (2002).
    We consequently find no error in the circuit court's
    application of the Dead-Man's Act in this case.
    II.    Cross-examination of Dr. Greenlee
    The plaintiff next contends the trial court committed
    reversible error when it ruled the defendants' cross-examination
    of Dr. Greenlee was within the scope of direct examination.
    Dr. Greenlee is the neuroradiologist who interpreted the
    July 29, 1999, MRI of Hudgins's brain at Rush.       He indicated his
    30
    1-05-1006
    findings in a report also dated July 29, 1999.   That report
    states, "[c]orrelative examination is a noncontrast CT scan of
    the brain from [Westlake] Hospital dated July 28, 1999."   Written
    in the "impression" section of the report is "subdural hematoma
    in the late subacute stage which is seen along the right frontal,
    right parietal and right occipital lobes."
    Prior to trial, the plaintiff disclosed Dr. Greenlee as an
    independent expert witness pursuant to Supreme Court Rule 213(f)
    (210 Ill. 2d R. 213(f)).    The plaintiff's Rule 213(f) disclosure
    states, "Dr. Greenlee is expected to testify consistent with his
    MRI Report dated July 29, 1999."
    On September 13, 2004, Dr. Greenlee gave a videotaped
    deposition.   At the time the deposition was taken, Dr. Greenlee
    no longer worked at Rush.   As far as can be determined from the
    record, when Dr. Greenlee gave his deposition, he was presented
    with films of Hudgins's July 28, 1999, CT scan taken at Westlake,
    and of the July 29 MRI scan taken at Rush, and the report he
    created interpreting the July 29 MRI.   On direct examination by
    the plaintiff's attorney, Dr. Greenlee stated his July 29 report
    determined Hudgins's subdural hematoma was in the late subacute
    stage, meaning the bleeding began several days to several weeks
    prior to the scan.   Dr. Greenlee was not able to approximate the
    date on which the bleeding began with more accuracy, explaining,
    31
    1-05-1006
    "[A]ccurately dating subdural hematomas on MR[I] is difficult
    because there's quite a bit of variability in the appearance of
    subdural hematomas in the subacute stage."   Dr. Greenlee also
    explained MRI reports describe a hematoma in "the most advanced
    stage of breakdown."   Thus, Hudgins's subdural hematoma was
    classified as being in the late subacute stage "even though there
    [were] still blood products which would be from the early
    subacute stage."   Dr. Greenlee also testified if he wanted to
    more specifically age a subdural hematoma showing characteristics
    of the early and the late subacute stages, he would refer to the
    patient's clinical history or "compare [the MRI scan] to the CT
    scan."
    Dr. Greenlee testified he used a CT scan of Hudgins's brain
    taken at Westlake on July 28, 1999, as a comparison in order to
    determine whether the subdural hematoma had changed; for
    instance, whether "there was increasing mass effect or new
    bleeding."   Dr. Greenlee also explained comparing CT scans and
    MRI scans was somewhat like comparing apples and oranges because
    "[d]ifferent scans show different things to advantage."    Dr.
    Greenlee testified "within the ability to compare CT and MR[I]"
    there had been "no significant change in the size of the subdural
    hematoma or the degree of mass effect" between July 28 and July
    29.   Dr. Greenlee, however, did not testify on direct examination
    32
    1-05-1006
    that he attempted to date the subdural hematoma by interpreting
    the CT scan.
    When cross-examined by defense counsel, Dr. Greenlee was
    asked whether MRI or CT technology was preferred in dating
    hematomas.   Dr. Greenlee responded that there was no preference,
    but that each technology showed different things.   In looking at
    Hudgins's CT scan, Dr. Greenlee testified the hematoma was
    "probably less than one to two weeks old."    By comparing the CT
    scan with the MRI, Dr. Greenlee's opinion, based upon a
    reasonable degree of medical certainty, was the hematoma was in
    the "several days to a week period."
    Prior to the presentation of Dr. Greenlee's deposition at
    trial, the plaintiff's attorney argued defense counsel's cross-
    examination went beyond the scope of direct examination and
    focused on Dr. Greenlee's interpretation of the Westlake CT scan
    rather than the Rush MRI.   The plaintiff also asserted Dr.
    Greenlee essentially testified as an undisclosed expert witness
    on behalf of the defendants.   The trial court overruled the
    plaintiff's objection.   The plaintiff contends on appeal the
    trial court's ruling was in error.
    As a general rule, cross-examination is limited to the scope
    of direct examination.   Leonardi v. Loyola University of Chicago,
    
    168 Ill. 2d 83
    , 105, 
    658 N.E.2d 450
     (1995).    "However,
    33
    1-05-1006
    circumstances resting within the witness' knowledge may be
    developed on cross-examination that explain, qualify, discredit,
    or destroy the witness' direct testimony, even though that
    material may not have been raised on direct examination."
    Leonardi, 
    168 Ill. 2d at 105-06
    .       The scope of cross-examination
    does not refer to the actual material discussed during direct
    examination, but rather to the subject matter of the direct
    examination.   Neal v. Nimmagadda, 
    279 Ill. App. 3d 834
    , 840, 
    665 N.E.2d 424
     (1996).   The scope of cross-examination lies within
    the sound discretion of the trial court and will not be disturbed
    on review absent an abuse of that discretion.       Leondardi, 
    168 Ill. 2d at 102
    .
    In this case, the subject matter of Dr. Greenlee's direct
    testimony was the age of Hudgins's subdural bleed.      Asking Dr.
    Greenlee to date the age of the bleed based on the July 28 CT
    scan, which had been used as a comparison when the July 29 MRI
    was dated, was not beyond the scope of this subject matter,
    especially where it served to explain the testimony Dr. Greenlee
    gave during direct examination.    This court cannot say the
    circuit court abused its discretion.
    III.   Jury Instructions
    A.   Instruction based on IPI Civil (2005) No. 30.23
    The plaintiff tendered an instruction based on Illinois
    34
    1-05-1006
    Pattern Jury Instructions, Civil, No. 30.23 (2005) (hereinafter
    IPI Civil (2005) No. 30.23), titled "Injury from Subsequent
    Treatment."   The trial court refused to give the instruction
    because there was no evidence of subsequent medical negligence or
    of subsequent treatment causing or aggravating an injury.
    The plaintiff's tendered instruction states, "If defendants
    negligently cause a condition of the plaintiff, then the
    defendants are liable not only for the plaintiff's damages
    resulting from that condition, but are also liable for the
    plaintiff's damages sustained by the plaintiff arising from the
    efforts of health care providers to treat the condition caused by
    the defendant."    The jury's verdict was that the defendants were
    not negligent.    The plaintiff maintains that omitting the
    instruction was still error even in the face of the jury's
    verdict for the defendants.    The plaintiff contends this is so
    because the tendered instruction is not strictly a damages
    instruction and the failure to give the tendered instruction may
    have led to a verdict in favor of the defendants because "the
    jury could be confused as to the applicable law."
    The Comments to IPI Civil (2005) No. 30.23 support the
    plaintiff's position that the instruction may have an impact on a
    jury beyond damages because "[a] jury might perceive the
    subsequent provider as the wrongdoer and 'acquit[] the defendant
    35
    1-05-1006
    on that basis.' "    IPI Civil (2005) No. 30.23, Comments, at 141,
    quoting Kolakowski v. Voris, 
    94 Ill. App. 3d 404
    , 413, 
    418 N.E.2d 1003
     (1981).   The operative notion behind the instruction,
    however, is the existence of a "subsequent provider as the
    wrongdoer."
    On the record before us, as the trial court found, there was
    no subsequent wrongdoer; nor has the plaintiff identified any
    subsequent wrongdoer.    The plaintiff maintains that the
    instruction may be given when "there is evidence that a
    subsequent health care provider caused or aggravated the injury"
    without any showing that such a subsequent provider was
    negligent.    IPI Civil (2005) No. 30.23, Notes on Use, at 141.
    Before this instruction should be given, however, it is necessary
    that "the issue of the subsequent medical provider having caused
    or aggravated an injury [be] injected into the case."    IPI Civil
    (2005) No. 30.23, Comments, at 141.    The circuit court found no
    such issue present in this case.
    While the plaintiff focuses on Dilantin being prescribed,
    which likely led to the development of the Stevens-Johnson
    syndrome which in turn led to renal failure and the death of
    Hudgins, there was no evidence that the medical care providers at
    Westlake had any choice but to administer Dilantin when Hudgins
    was admitted in status epilepticus.    In other words, there was no
    36
    1-05-1006
    reasonable basis to contend that the jury might perceive the
    health care providers at Westlake to be wrongdoers in prescribing
    Dilantin and "acquit the defendants on that basis."   The
    plaintiff's theory was that the defendants were negligent in not
    discovering the subdural hematoma earlier, and had they done so,
    the need to prescribe Dilantin might have been avoided.     The
    administration of Dilantin at Westlake was of no consequence
    under the plaintiff's theory.
    We find no error on the part of the circuit court in
    rejecting this instruction.
    B.   Instruction based on IPI Civil (2005) No. 30.21
    A similar situation exists regarding the trial court's
    refusal to give the plaintiff's instruction based on Illinois
    Pattern Jury Instructions, Civil, No. 30.21 (2005) (hereinafter
    IPI Civil (2005) No. 30.21), titled "Measure of Damages--Personal
    Injury--Aggravation of Pre-Existing Condition--No Limitations."
    According to the plaintiff, the tendered instruction concerned "a
    pre-existing condition which rendered [Hudgins] more susceptible
    to injury."   The instruction states, "If you decide for the
    plaintiff on the question of liability, you may not deny or limit
    the plaintiff's right to damages from this occurrence because any
    injury to Vernestine Hudgins resulted from a pre-existing
    37
    1-05-1006
    condition which rendered her more susceptible to injury."3
    Again, the jury's verdict was that the defendants were not
    negligent.    Again, the plaintiff maintains that IPI Civil (2005)
    No. 30.21 "is not strictly a damages instruction," citing as her
    principal authorities Dabros v. Wang, 
    243 Ill. App. 3d 259
    , 
    611 N.E.2d 1113
     (1993), and Shvartsman v. Septran, Inc., 
    304 Ill. App. 3d 900
    , 
    711 N.E.2d 402
     (1999).
    The plaintiff contends the trial court refused the
    instruction because "such an instruction did not belong in a
    3
    A tension between the rejected instructions likely would
    have arisen had both IPI Civil (2005) No. 30.21 and IPI Civil
    (2005) No. 30.23 been given in this case.    Under IPI Civil (2005)
    No. 30.23, the plaintiff's contention appears to be that the
    failure of the defendants to timely detect the brain bleed on or
    about July 17, 1999, led to the required medical treatment of
    administering Dilantin at Westlake, which gave rise to the
    damages suffered by the plaintiff.    However, under IPI Civil
    (2005) No. 30.21, the plaintiff's contention appears to be that
    the brain bleed was a preexisting condition, apparently placing
    no responsibility on the defendants for the existence of the
    condition.    We agree with the defendants that the giving of both
    instructions would have confused the jury.
    38
    1-05-1006
    medical malpractice/loss of change action."   We do not share the
    plaintiff's understanding of the circuit court's ruling.     Rather,
    the trial court ruled that the instruction did not apply "in this
    medical malpractice/loss of chance case."   The circuit court's
    ruling turned not on the application of the doctrine of loss of
    chance but on the nature of the claimed "preexisting condition"
    present in this case.   The facts of this case do not support the
    plaintiff's claim of error based on the authorities cited by the
    plaintiff.
    In Dabros, a mother took her months-old child to her
    pediatrician because of her concern over what she characterized
    as a "bruise" on the side of the infant's left leg near the knee.
    Over the next few months, the mark on the infant's leg started to
    rise, became discolored and continued to grow.   Eventually, the
    mother was referred to the defendant doctor, who recommended
    immediate surgery to remove the growth from the plaintiff's leg.
    The plaintiff's theory of the case was that by excising the mark
    (hemangioma) when he should not have, the defendant aggravated
    her already present injury, not that he caused in any way the
    hemangioma itself.   The existence of the condition of the
    hemangioma was uncontested and served as the basis for the
    medical treatment the plaintiff received and complained of.    We
    found error in not giving IPI Civil 3d No. 30.21, but found the
    39
    1-05-1006
    error harmless because "it was not possible for the jury to have
    been confused as to what type of injury it was required to find
    in order to hold defendant liable for negligently treating
    plaintiff."    Dabros, 
    243 Ill. App. 3d at 270
    .
    Shvartsman addresses the situation where the plaintiff had a
    preexisting condition that made her more susceptible to injury.
    In Shvartsman, the plaintiff suffered an injury to her right
    knee, resulting in a displacement of her kneecap, the claimed
    injury in the lawsuit.   The plaintiff had a preexisting condition
    in both knees that made her more susceptible to displace her
    kneecap.    As one of two grounds for reversing the verdict for the
    defendant, we found the circuit court erred in refusing to
    instruct the jury with IPI Civil 3d No. 30.21 "because the jury
    was not properly informed of the legal effect of a preexisting
    injury."    Shvartsman, 304 Ill. App. 3d at 905.
    Both Dabros and Shvartsman stand for the proposition that
    where there is evidence of a preexisting condition that is
    aggravated by the claimed negligence or that makes the plaintiff
    more susceptible to the type of injury complained of, IPI Civil
    No. 30.21 should be given.   That proposition has no application
    here.
    In her main brief, the plaintiff contends that "[i]t was
    [her] theory, as articulated to the court, that the pre-existing
    40
    1-05-1006
    condition, the brain bleed, without treatment, developed into a
    subdural hematoma that caused seizures."   The defendants
    challenge this assertion: "[I]t was never quite clear in the
    trial court exactly what plaintiff considered the 'pre-existing
    condition rendering her more susceptible to injury' to be.
    Sometimes she argued that it was 'the need for anticoagulation'
    *** other times that it was the subdural hematoma."
    Regardless, what is clear is that the "brain bleed" was not
    a preexisting condition in the manner of the preexisting
    conditions in Dabros and Shvartsman.   Contrary to the plaintiff's
    claim, the brain bleed was not a preexisting condition but a
    condition that may have arisen sometime after she was first
    admitted to Rush in July 1999 (there was conflicting expert
    testimony as to when the brain bleed may have begun).   This
    condition in turn triggered medical treatment that led to the
    development of Stevens-Johnson syndrome, which in turn led to
    renal failure.   As made clear by the instructions, the jury was
    charged with determining whether the brain bleed developed during
    Hudgins's stay at Rush.   If the brain bleed arose after Hudgins
    left the care of the defendants, then no liability could attach
    to the defendants for their failure to detect a condition that
    did not exist when she left the defendants' care.   Thus, the
    brain bleed was not a preexisting condition as that term is used
    41
    1-05-1006
    in either Dabros or Shvartsman to warrant the giving of IPI Civil
    (2005) No. 30.21.    The circuit court did not err in rejecting the
    plaintiff's proposed instruction.4
    CONCLUSION
    For the reasons stated above, the judgment of the circuit
    court of Cook County is affirmed.
    Affirmed.
    4
    We also question the role IPI Civil (2005) No. 30.21 would
    have played in the jury's deliberation in light of the following
    non-IPI "loss of chance" instruction given over the defendants'
    objection.    "If you decide or if you find that the plaintiff has
    proven that a delay in diagnosis and treatment of Vernestine
    Hudgins' brain bleed lessened the effectiveness of the medical
    services which she received, you may consider such delay as one
    of the proximate causes of her claimed injuries and death."     The
    jury's verdict for the defendants logically requires the
    conclusion that the delay in diagnosis and treatment of the brain
    bleed was not a proximate cause of the claimed injuries.    Because
    there was no negligent delay, it necessarily follows that the
    circuit court's rejection of the instruction along the lines of
    IPI Civil (2005) No. 30.21 was at most harmless error.    See
    Dabros, 
    243 Ill. App. 3d at 270
    .
    42
    1-05-1006
    CAHILL, P.J., and R. GORDON, J., concur.
    43