Belknap v. Crawford ( 2024 )

2024 IL App (4th) 230679 FILED
May 30, 2024
NO. 4-23-0679 Carla Bender
4 th District Appellate
IN THE APPELLATE COURT Court, IL
OF ILLINOIS
FOURTH DISTRICT
JEREMY BELKNAP and SHANE BELKNAP, as ) Appeal from the
Independent Co-Administrators of the Estate of Stephanie ) Circuit Court of
E. Belknap, Deceased, ) Peoria County
Plaintiffs-Appellants, ) No. 18L104
v. )
DAVID CRAWFORD; THE PEORIA SURGICAL )
GROUP, LTD., an Illinois Corporation; CYNTHIA )
MARTIN; and THE METHODIST MEDICAL CENTER )
OF ILLINOIS, an Illinois Corporation, )
Defendants, ) Honorable
(Cynthia Martin and The Methodist Medical Center of ) Frank W. Ierulli,
Illinois, Defendants-Appellees). ) Judge Presiding.
JUSTICE LANNERD delivered the judgment of the court, with opinion.
Justices Harris and Steigmann concurred in the judgment and opinion.
OPINION
¶1 On July 10, 2019, plaintiffs Jeremy Belknap and Shane Belknap, as independent
co-administrators of the estate of Stephanie E. Belknap, deceased, filed a third-amended survival
and wrongful death action against defendants David Crawford; the Peoria Surgical Group, Ltd.,
an Illinois Corporation; Cynthia Martin; and the Methodist Medical Center of Illinois, an Illinois
Corporation (Methodist). Plaintiffs alleged Stephanie suffered serious injuries as a result of
medical care she received at Methodist from Dr. David Crawford and nurse Cynthia Martin.
Stephanie later died from her injuries.
¶2 On July 31, 2023, the trial court granted Martin and Methodist’s motion for
summary judgment with regard to plaintiffs’ counts in the third-amended complaint against them
(counts VII, VIII, IX, and X). Pursuant to Illinois Supreme Court Rule 304(a) (eff. Mar. 8, 2016),
the court found no just reason for delaying appeal of its summary judgment order. Plaintiffs appeal,
arguing the court erred in granting the motion for summary judgment. According to plaintiffs, they
presented sufficient expert testimony that Martin’s failure to communicate Stephanie’s
information to the treating physicians was a proximate cause of her injuries and death. Further,
they argued the court erred in finding summary judgment was required pursuant to our supreme
court’s decision in Gill v. Foster, 157 Ill. 2d 304 (1993). We reverse the trial court’s summary
judgment order and remand this case for further proceedings.
¶3 I. BACKGROUND
¶4 According to plaintiffs’ third amended complaint, on or about September 22, 2016,
Stephanie Belknap presented to defendant Dr. David Crawford for treatment of gastroesophageal
reflux disease with hiatal hernia. Dr. Crawford determined she was an appropriate candidate for
partial fundoplication, also known as a “toupet procedure.” The complaint alleged Stephanie “was
a substantial risk for acute recurrence of hiatal hernia due to a known history of retching and
hyperemesis.” On January 16, 2017, Dr. Crawford “attempted” the procedure on Stephanie at
defendant Methodist in Peoria, Illinois. According to the complaint, “During the 24 hours
immediately following the surgery, and before her discharge from the hospital, Stephanie Belknap
was gagging and retching all night, not tolerating a diet, and had very poor input and output.”
¶5 According to plaintiffs’ complaint, Crawford negligently failed to appreciate
Stephanie’s risk of recurrent herniation, took inadequate surgical measures to prevent Stephanie’s
recurrent herniation, and discharged Stephanie while she was in an unstable condition despite her
symptoms. Stephanie later suffered an acute recurrence of her hiatal herniation and became septic
because she did not have appropriate treatment. She died of her injuries on January 21, 2017, at
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the age of 23.
¶6 Plaintiffs alleged nurse Cynthia Martin was in charge of monitoring Stephanie’s
condition beginning around 7 a.m. on January 17, 2017. Between 7:27 a.m. and 12:43 p.m., Martin
observed that Stephanie was in constant pain and had intermittent crying, ongoing anxiety, failure
to control her pain, and also had signs of tachycardia and hypoxia. Plaintiffs alleged Martin was
guilty of one or more of the following negligent acts or omissions: “(a) Failed to fully report her
observations to Dr. Esparaz; and/or (b) Failed to fully report her findings and observations to Dr.
Crawford.” According to plaintiff’s complaint, “[a]s a direct and proximate result of the acts and/or
omissions of *** Martin, Stephanie Belknap failed to receive appropriate treatment for a
recurrence of hiatal hernia, thereby becoming septic.” Plaintiffs also alleged she “died of her
aforementioned injuries on January 21, 2017[,] at the age of 23.” Further, plaintiffs alleged Martin
was an employee and/or agent of Methodist and was acting within the course and/or scope of her
employment when providing care for Stephanie.
¶7 Plaintiffs’ complaint included survival actions and wrongful death claims against
Crawford (counts I and II), the Peoria Surgical Group, Ltd., who allegedly employed Crawford
(counts III and IV), Dr. Joseph Esparaz, who was a surgical resident (counts V and VI), Martin
(counts VII and VIII), and Methodist (counts IX and X), as Martin’s employer.
¶8 On June 23, 2023, nurse Martin and Methodist filed a motion for summary
judgment. They argued any causal chain with regard to Martin’s alleged negligence was severed
when Drs. Crawford, Esparaz, and Mark Sarran evaluated Stephanie prior to discharging her from
the hospital. As a result, according to the motion, “Plaintiffs will be unable to identify any evidence
establishing that Nurse Martin’s alleged deviations from the standard of care were a proximate
cause of [Stephanie’s] injuries.” Later in their motion, Martin and Methodist asserted the situation
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in this case is nearly identical to the situation in Gill, 157 Ill. 2d 304. Martin and Methodist also
argued plaintiffs had not put forth any expert testimony establishing Martin’s alleged deviations
from the nursing standard of care proximately caused Stephanie’s injuries. The movants attached
the transcripts of the discovery depositions of Martin, Dr. Crawford, Dr. Esparaz, Dr. Sarran, Lynn
Barber (Stephanie’s mother), and Dr. Jeffrey Allen. They also attached plaintiffs’ amended witness
disclosures pursuant to Illinois Supreme Court Rule 213 (eff. Jan. 1, 2018).
¶9 On July 7, 2023, plaintiffs filed a response to the motion. Plaintiffs claimed “Martin
was negligent for failing to verbally report 10 out of 10 pain, dietary intolerance, and abnormal
vital signs to the surgical team both before and after the discharge decision” and Methodist was
vicariously liable for Martin’s negligent conduct. According to plaintiffs, Martin and Methodist’s
motion omitted any mention of plaintiffs’ nursing expert (Polly Gerber Zimmerman, R.N.) and
their causation expert (David Talan, M.D.). Further, plaintiffs stated the moving parties also failed
to reference the deposition testimony of Jeanette Bell, R.N., who worked the night shift of January
16, 2017, into the early morning hours of January 17, 2017. Plaintiffs attached the deposition
testimony of these witnesses to their response.
¶ 10 Plaintiffs noted proximate cause is normally a fact question for the trier of fact.
Further, according to plaintiffs, Martin and Methodist’s reliance on Gill was misplaced because
the facts in the instant case are factually inapposite. In addition, plaintiffs noted Zimmerman, their
expert nurse witness, testified in her deposition that Martin’s lack of verbal communication with
Dr. Crawford and the resident physicians was negligent and contributed to Stephanie’s injuries
and death. Plaintiffs also pointed to the following testimony from Dr. Allen:
“Based on Dr. Crawford’s testimony, (Martin) didn’t convey to him the issues that
(Stephanie) was having. That she was having, you know, persistent maximum
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scores on the pain scale, she wasn’t eating her lunch. She only ate a fourth of her
breakfast. So those are things that—look it cuts both ways. I mean he should inquire
about it, but they also should tell him about it. Those are crucial points to determine
if the patient needs to be discharged[.]”
According to Allen, a reasonable surgeon with the information Martin should have provided to Dr.
Crawford and the residents would have done the following:
“Well, I think if someone has the bad pain, has the inability to eat and has the
tachycardia, then I think to be within the standard of care you would keep the patient
overnight … and you would check labs, CBC, CMP. If there was a worry for a
perforation, you would go do a gastrograph and swallow x-ray.”
Plaintiffs concluded their response to the motion for summary judgment by arguing ample
evidence existed from the treating nurses and doctors and the retained experts to conclude Martin
breached the standard of care for a nurse, the surgical team relied on nurses to adequately and
accurately report Stephanie’s condition to them, the physicians were deprived of relevant
information in deciding to discharge Stephanie, and “a later discharge would have resulted in a
successful surgical revision without death or other complications.”
¶ 11 On July 19, 2023, Martin and Methodist replied to plaintiffs’ response. They argued
a nurse cannot offer an expert opinion on proximate cause. They also indicated plaintiffs did not
claim the existence of a genuine issue of material fact. Further, the movants asserted Dr. Talan did
not provide an expert opinion related to Martin. In addition, according to Martin and Methodist,
“[t]o prove their case, Plaintiffs were required to have a physician testify that if Dr. Crawford had
known whatever it is they claim Nurse Martin failed to communicate, then he would have, or a
reasonable physician would have, delayed the discharge or reached a different diagnosis. That
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opinion simply does not exist in Plaintiffs’ Response brief or in this case at all.”
¶ 12 On July 25, 2023, the trial court heard arguments on the motion for summary
judgment and granted the motion, explaining its decision as follows:
“Summary judgment is appropriate when there’s no genuine question of fact
regarding the nurse’s actions in this case as it relates to the fact pattern that I’ve
been presented. I believe Gill is on point.
Here, the complaint against Martin is that she was negligent for failing to
report Ms. Belknap’s condition to the doctors before and after their discharge
decision. However, I believe Gill is on point here. The doctors examined the patient,
made the discharge decision at or about 1:15 and were aware of her complaints. I
direct any review in court to Dr. Crawford’s testimony, page 105, lines 21 through
24, which indicate that he was aware that she had some pain.
So, with that, I’m going to grant motion for summary judgment, and Nurse
Martin and Methodist Medical Center will be out of the case.”
The court then entered a finding pursuant to Illinois Supreme Court Rule 304(a) (eff. Mar. 8, 2016),
finding no just reason for delaying an appeal of its order granting Martin and Methodist’s motion
for summary judgment.
¶ 13 II. ANALYSIS
¶ 14 Plaintiffs’ complaint in this case is based on the defendants’ alleged medical
malpractice. To prevail in a medical malpractice case,
“a plaintiff must prove: (1) the proper standard of care in the medical community
by which the physician’s treatment should be measured; (2) that the physician
negligently breached or deviated from the standard of care; and (3) that the resulting
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injury to the patient was proximately caused by the physician’s deviation from the
standard of care.” Buck v. Charletta, 2013 IL App (1st) 122144, ¶ 57.
¶ 15 A. Summary Judgment Principles
¶ 16 As previously stated, the trial court explained its summary judgment ruling as
follows:
“Summary judgment is appropriate when there’s no genuine question of fact
regarding the nurse’s actions in this case as it relates to the fact pattern that I’ve
been presented. I believe Gill is on point.
Here, the complaint against Martin is that she was negligent for failing to
report Ms. Belknap’s condition to the doctors before and after their discharge
decision. However, I believe Gill is on point here. The doctors examined the patient,
made the discharge decision at or about 1:15 and were aware of her complaints. I
direct any review in court to Dr. Crawford’s testimony, page 105, lines 21 through
24, which indicate that he was aware that she had some pain.”
When reviewing a trial court’s order granting summary judgment, we apply a de novo standard of
review. Morris v. Margulis, 197 Ill. 2d 28, 35 (2001).
¶ 17 Pursuant to section 2-1005(c) of the Code of Civil Procedure (735 ILCS
5/2-1005(c) (West 2022)), summary judgment “shall be rendered without delay if the pleadings,
depositions, and admissions on file, together with the affidavits, if any, show that there is no
genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter
of law.” However, as our supreme court has made clear, summary judgment is a drastic means of
disposing of litigation. Bagent v. Blessing Care Corp., 224 Ill. 2d 154, 163 (2007). Before a trial
court grants a motion for summary judgment, the party moving for summary judgment must
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establish his right to summary judgment is clear and free from doubt. Id. A court must construe
both the pleadings and the evidentiary material in the record strictly against the moving party when
deciding a motion for summary judgment. Buck, 2013 IL App (1st) 122144, ¶ 56. A genuine issue
of material fact exists if the facts are in dispute or reasonable minds could draw different inferences
from the undisputed facts. Id.¶ 18 B. Applicability of Gill v. Foster
¶ 19 Plaintiffs argue the trial court erred in finding that summary judgment was required
pursuant to Gill. According to plaintiffs, questions of fact exist whether Dr. Crawford was entirely
aware of the trend of Stephanie’s condition during the period from completion of her surgery until
Drs. Crawford, Esparaz, and Sarran met with her around 1 p.m. on January 17, when Dr. Crawford
made the ultimate decision to discharge Stephanie from the hospital.
¶ 20 In Gill, the plaintiff entered St. John’s Hospital (St. John’s) in Springfield, Illinois,
around December 19, 1984, for surgery to correct his reflux esophagitis, a chronic condition. Gill
v. Foster, 232 Ill. App. 3d 768, 772 (1992). On December 19, 1984, Dr. Richard McCormick
performed a surgical procedure on the plaintiff called a Nissen fundoplication. Id.¶ 21 On December 24, 1984, the plaintiff experienced vomiting. Id. at 773. On
December 26, 1984, the plaintiff complained of chest pain (id. at 773-74), and Dr. McCormick
examined the plaintiff and determined the chest pain was a normal side effect of the surgery (Gill,
157 Ill. 2d at 310). The next day, Dr. McCormick received another report of plaintiff’s pain. Id.Finally, on December 28, the plaintiff again reiterated to Dr. McCormick that he continued to have
chest pain. Id. Dr. McCormick chose not to examine the plaintiff again and discharged the plaintiff
three hours later. Id. at 310-11.
¶ 22 After Dr. McCormick discharged the plaintiff from the hospital, the plaintiff
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complained of chest pain to the discharge nurse. Id. at 309. “The nurse, aware that plaintiff had
complained of chest pain previously, examined [the plaintiff].” Id. The plaintiff indicated the
nurse, after listening to his chest, stated something was wrong and advised the plaintiff to go to his
family doctor. Id.¶ 23 The plaintiff brought a claim against the hospital, alleging the hospital breached its
“standard of care by discharging plaintiff from the hospital even though plaintiff complained of
chest pain, failing to inform the treating physician that plaintiff was complaining of chest pain at
the time of discharge, and failing to communicate plaintiff’s clinical findings to a nursing
supervisor for appropriate care.” Id. The hospital filed a motion for summary judgment denying
both the negligence of its nurses and that the alleged negligence was the proximate cause of the
plaintiff’s injuries. Id. at 309-10.
¶ 24 The trial court granted the hospital’s motion for summary judgment. Id. at 310. This
court affirmed. The plaintiff appealed this court’s decision to our supreme court. According to the
supreme court’s opinion:
“On appeal to this court, plaintiff maintains that the omissions of the nursing
staff at St. John’s Hospital contributed to the delay in diagnosing the plaintiff’s
complications, resulting in a much more difficult and complicated operation.
Plaintiff argues that the appellate court decision has the effect of requiring [the]
plaintiff to prove that defendant’s negligence was more likely than not the cause of
plaintiff’s injuries at the summary judgment stage. [The] [p]laintiff contend[ed] that
it was a jury question as to whether the nurse’s omission contributed to, and was
thus a proximate cause of plaintiff’s injuries.” Id.Our supreme court indicated it could not agree because a review of the evidence could only lead
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to the result reached by this court. Id. The court explained its reasoning as follows:
“when plaintiff was discharged from St. John’s Hospital, he was experiencing pain
in his chest for which he was taking no medication, which was similar to that which
he had been experiencing for several days prior to discharge, and which he had
reported to his attending physician on the morning of discharge. In light of these
facts, we must agree with the appellate court and find that even assuming the nurse
had breached a duty to inform the treating physician of the patient’s complaint, this
breach did not proximately cause the delay in the correct diagnosis of the plaintiff’s
condition.” Id. at 311.
As noted by our supreme court, “[i]t is uncontroverted *** that the treating physician had repeated
contacts with [the] plaintiff” after the plaintiff was exhibiting the symptoms he mentioned to the
discharge nurse, and the treating physician “failed to properly diagnose the problem.” Id. at 310.
As a result, the discharge nurse’s failure to report information the doctor was already aware of
could not have been the proximate cause of any delay in the plaintiff’s treatment. Id.¶ 25 Unlike what happened in Gill, in the case sub judice, questions of fact exist
regarding whether Drs. Crawford, Esparaz, and Sarran had a complete understanding of
Stephanie’s condition during the period between the completion of her surgery and Dr. Crawford’s
decision to discharge her.
¶ 26 We note Dr. Crawford testified in his deposition that it is important to make sure a
patient’s pain and nausea are controlled when determining whether discharge is appropriate. When
asked how he made sure this was the case, Dr. Crawford testified he relies heavily on the nursing
staff. However, he also testified he did not typically review notes made by the nursing staff that
are kept in the hospital’s electronic record system. According to Dr. Crawford, the electronic
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record system does not make it easy to find those notes with regard to a patient’s pain level, dietary
information, vitals, and physical observations. As a result, Dr. Crawford testified he primarily
relies on “verbal communication with those who are in direct contact with the patient.” In other
words, he relies on important information being relayed from the nursing staff to the resident
physicians who then relay the information to him. In some cases, he indicated the nurses might
bring the information to him directly. Dr. Crawford indicated it was his understanding that Dr.
Esparaz’s reports to him on Stephanie’s condition were based in part on information being
provided to Dr. Esparaz by the nursing staff with regard to her pain and nausea.
¶ 27 Dr. Crawford indicated he did not recall receiving any phone calls from any nursing
staff about Stephanie after her surgery. With regard to Stephanie’s pain level after the surgery, this
information was not reported to him on an ongoing basis. He also indicated he did not know if this
information was reported to anybody from the surgical team. He did not recall being told Stephanie
last reported her pain before being discharged as 10 out of 10.
¶ 28 Later, when Dr. Crawford was being questioned by the attorney representing
defendants Martin and Methodist, Dr. Crawford testified he did not recall any member of the
nursing staff bringing any questions or concerns regarding Stephanie to his attention. Further, Dr.
Crawford indicated he did not have any information regarding any communication that might have
taken place between the nursing staff and the medical residents.
¶ 29 Dr. Esparaz, who was a resident during the period of time at issue in this case,
testified he would expect to be contacted by a nurse if a patient had continuing abnormal pain.
While a nurse placing this kind of information into the patient’s chart would be adequate to put
him on notice if he read the chart, he did not remember if he read Stephanie’s chart in this case.
According to Dr. Esparaz, he relied on the nursing staff and Dr. Sarran, his junior resident, for
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information about Stephanie’s condition between her surgery and her time of discharge. When he
saw Stephanie at the time the discharge decision was made, he recalled she was doing well and
indicated she wanted to go home. He said her pain was controlled. His assessment was based on
his observation of Stephanie. He did not recall receiving any information about Stephanie from
the nursing staff. Dr. Esparaz acknowledged it was important to take a patient’s trends into
consideration when making a discharge decision. He also indicated he was not aware Stephanie
had been repeatedly screaming out that she wanted to go home, consistently been assessing her
pain as a 10 on a 10 scale, only eaten 25% of her breakfast, and refused to eat her lunch on the day
of her discharge.
¶ 30 Dr. Sarran, who was also a resident at the time of the incidents in this case, testified
he saw Stephanie during his rounds on the morning of January 17, 2017, at 7:23 a.m. At that time,
he observed Stephanie was having some abdominal pain. The nursing staff and Stephanie’s mother
indicated Stephanie had suffered some dry heaving. He indicated he likely relied on nursing staff
and Stephanie’s mother for his note that Stephanie was tolerating a clear liquid diet. He did not
recall whether he was aware that Stephanie had been given any opioid painkillers and antinausea
agents throughout the night. According to Dr. Sarran, it would have been the job of the nursing
staff to report changes in Stephanie’s pain level to him, and he would have relied on Martin to
convey to him whether Stephanie was not responding adequately to her pain medication. Sarran
testified he did not recall whether Martin reported to him that Stephanie had been given a double
dose of morphine at 4:34 a.m. on January 17 and she was not responding to a single dose. He also
did not recall Martin reporting to him Stephanie had been given a third dose of morphine at 6:31
a.m. Dr. Sarran acknowledged a dose of morphine should be effective for six hours, which meant
Stephanie was complaining of abdominal pain when she should have been feeling the effects of
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three doses of morphine when he saw her at 7:23 a.m. on January 17. In addition, Dr. Sarran
testified his medical note indicated he did not believe Stephanie was ready for discharge at 7:24
a.m. because her pain needed to be controlled and he wanted to see how she did on a “full-liquid
diet, graduated liquid diet.” Dr. Sarran testified his note indicated a reasonable time to reconsider
Stephanie’s discharge would be between 7:30 p.m. on January 17 and 7:30 p.m. on January 18.
When asked if he had an opinion on what he expected nurses to communicate to him, Dr. Sarran
responded:
“Yes. I would just say that I expect the nurses to communicate to me,
certainly, any patient that’s in distress, any patient that’s at risk of decompensation
or deterioration, and anybody that—any patient that is—whose needs are—or needs
or complaints are outside the limits of our normal postoperative encounters, and
certainly, above or beyond the ordered medications and interventions.”
He was also asked what he recalled about the encounter with Stephanie and Dr. Crawford on the
afternoon of January 17. He responded:
“I recall that Dr. Crawford sat with Stephanie and her mother for an
extended period of time, longer than is normal for—or longer than is, I guess,
expected in this setting. I’m sorry, I shouldn’t—not expected, longer than what is
standard, I suppose—to discuss any—the concerns that—any concerns that her
mother had. I recall that she was anxious about discharge, but that at the end of the
conversation, we had met and answered all of their concerns.”
He did not recall what Stephanie’s mother’s specific concerns were. However, he indicated at the
end of the conversation everyone, including Stephanie’s mother, felt that it was appropriate for
Stephanie to go home at that time.
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¶ 31 On redirect examination from plaintiffs’ counsel, Dr. Sarran indicated he had no
specific recollection Stephanie only had 480 milliliters of fluid intake, only ingested 25% of her
breakfast, had ingested none of her lunch, or that at the time of discharge Stephanie was reporting
her pain as a 10 on a 10 scale. Dr. Sarran indicated Stephanie’s pain level was something he would
have liked to have known.
¶ 32 Finally, Martin testified in her deposition she would document any communication
she had with the surgical team. She also indicated she would expect the surgical team to rely upon
her analysis of the details of a patient’s condition when considering whether to discharge the
patient. According to Martin, when Stephanie came into her care at 7 a.m., she had been reporting
her pain as a 10 on a 10 scale all night. During Martin’s shift on January 17, 2017, Stephanie
consumed 25% of her breakfast and none of her lunch. Martin testified that around 7:27 a.m., she
documented Stephanie’s self-reported pain level was a 10 on a 10 scale. Stephanie was crying out
in pain at that time, including hollering she wanted to go home. She was also anxious, and her
facial expressions indicated she was not happy. Martin indicated efforts were made to console her.
¶ 33 According to Martin, Stephanie was given Hycet around 7:30 a.m. By 8:30 a.m.,
Stephanie was reporting her pain to be an 8 out of 10 due to the Hycet. However, by 9:18 a.m.,
Stephanie was reporting her pain was back at a 10 on a 10 scale. Her pain was never charted again
before she was discharged. Martin indicated Stephanie must have still been complaining of pain
at 12:47 p.m. because Martin gave her Hycet again. Martin did not recall seeing or talking to Dr.
Crawford about Stephanie’s condition on January 17, 2017. She also did not recall talking to the
surgical residents about Stephanie’s condition.
¶ 34 When the evidence in this case is viewed in a light most favorable to plaintiffs, it is
not clear Drs. Crawford, Esparaz, or Sarran were ever fully aware of Stephanie’s condition.
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Because it was difficult for the doctors to acquire all of a patient’s relevant information from the
electronic records system, Dr. Crawford and the residents relied on the nurses to personally deliver
to them important information about a patient’s condition, even though the nurses may have
already entered the same information into the electronic record keeping system.
¶ 35 As a result, while the doctors certainly made observations and conclusions with
regard to Stephanie’s condition while they were in direct contact with her, it is not clear from the
record that they had all the relevant information with regard to Stephanie’s condition necessary to
fully evaluate her situation. For example, the record does not establish that any of the doctors were
aware during their direct observation of Stephanie that she had been administered pain medication
shortly before they evaluated her condition. In addition, the record also does not establish the
doctors were aware Stephanie had been crying out that she wanted to go home while she was in
severe pain earlier that morning.
¶ 36 Stephanie had repeatedly self-reported her pain as a 10 on a 10 scale, had repeatedly
cried out that she wanted to go home while complaining of severe pain, and had been administered
multiple doses of morphine when she was seen by the medical residents when they assessed her
on the morning of January 17. Stephanie was still being given Hycet for her pain that morning—
which seemed to provide some temporary pain relief to Stephanie who would soon self-report her
pain back at a 10 on a 10 scale. When the evidence in this case is viewed in a light most favorable
to plaintiffs for purposes of summary judgment, Drs. Crawford, Esparaz, and Sarran were not
aware when they determined Stephanie could be discharged that she (1) was given Hycet before
they met with her, (2) had complained of 10 out of 10 pain with periods of short term relief after
taking pain medicine that morning, (3) had cried out that she wanted to go home that morning
while also rating her pain as a 10 on a 10 scale, (4) had been intaking progressively smaller
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amounts of her meals up to the point where she had only 25% of her breakfast and none of her
lunch the day they discharged her, and (5) had experienced dry heaving.
¶ 37 This is not a situation like Gill where the plaintiff had been making the same
consistent complaints of chest pain, was not taking any medication for the chest pain, and Dr.
McCormick was aware of the plaintiff’s chest pain. In this case, Stephanie’s pain complaints were
fluctuating, and she was on multiple doses of painkillers. While Drs. Crawford, Esparaz, and
Sarran believed they were able to judge Stephanie’s pain level and condition during their direct
observations, the evidence is not clear they were aware of Stephanie’s fluctuating conditions or
the amount of pain medicine she was on during their direct observations. As a result, the trial court
erred in granting Martin and Methodist’s motion for summary judgment based on Gill.
¶ 38 C. Proximate Cause Evidence
¶ 39 Although not relied upon by the trial court, Martin and Methodist argue this court
can affirm the trial court’s summary judgment order on other grounds. According to Martin and
Methodist, even if Martin had not reported Stephanie’s condition to Drs. Crawford, Esparaz, or
Sarran and questions of fact exist regarding what the physicians knew about Stephanie’s condition,
plaintiffs’ evidence is still insufficient to sustain the proximate cause element of their malpractice
claim against Martin and Methodist.
¶ 40 They contend plaintiffs have no evidence Dr. Crawford would have acted
differently if he had complete knowledge of Stephanie’s condition during the period between the
completion of her surgery and his final assessment of her on January 17 when he made the
discharge decision. According to their brief, nurse Martin’s failure to verbally advise Dr. Crawford
of this information cannot be the proximate cause of his decision to discharge her because he
testified he had all the information he needed to make the discharge decision. We first note this is
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a conclusory statement by Dr. Crawford.
¶ 41 It does not appear he ever specifically indicated his discharge decision would have
been the same if he had known the following: Stephanie had been self-reporting pain of 10 on a
10 scale throughout the night and morning; she suffered from anxiety that morning and appeared
unhappy; she cried out and hollered that she wanted to go home and had to be consoled by the
nursing staff; she received only short term relief from the pain medicine she was being given; she
complained of abdominal pain to Dr. Sarran on the morning of January 17, even though she had
three active doses of morphine in her system; she had been given Hycet shortly before Drs.
Crawford, Esparaz, and Sarran met with her and made the discharge decision; her liquid diet meal
intake had dropped from 50% on January 16, to 25% at breakfast on January 17, to her refusing
her lunch on January 17; she experienced dry heaving; and Dr. Esparaz and Dr. Sarran, who
Crawford was relying on for information and assessment of Stephanie’s condition, also were
unaware of this information.
¶ 42 Regardless, even assuming, arguendo, Dr. Crawford would have testified his
discharge decision would have been the same had he known all this information, this would not
automatically entitle Martin and Methodist to summary judgment. According to our supreme court,
when a physician testifies he would not have acted differently regardless of the fact he did not have
certain information, a plaintiff is
“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.”
Snelson v. Kamm, 204 Ill. 2d 1, 45-46 (2003).
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If a plaintiff presents such expert testimony, “a factual dispute as to proximate cause would be
created sufficient for the jury to resolve.” Id.¶ 43 One of plaintiffs’ experts in this case, Dr. Allen, testified it was his opinion
Stephanie suffered an intra-abdominal rupture of the fundus of the stomach sometime after her
surgery but before she was discharged from the hospital. He based this diagnosis on the following:
she initially did well after the surgery; she then developed dry-heaves; she was not tolerating her
meals; she complained her pain was a 10 on a 10 scale; and she became tachycardic. Allen testified
these are all signs of intra-abdominal complications. Allen was critical of the fact no labs or X-
rays were done on Stephanie while she was doing poorly. With regard to the nursing staff at the
hospital, which included Martin, Allen testified they failed to convey Stephanie’s condition to Dr.
Crawford. According to Allen’s testimony, if a patient like Stephanie has bad pain, is unable to
eat, and has tachycardia, the standard of care would require the patient be kept overnight, additional
lab work done, and possibly additional procedures be performed, such as a gastrograph and
swallow X-ray. Allen stated if Stephanie had been kept overnight at the hospital, the changes in
her pain level could have been monitored by medical professionals rather than by Stephanie’s
mother, who Dr. Crawford testified had issues.
¶ 44 D. Rule 213 Witness Disclosure
¶ 45 Next, defendants Martin and Methodist argue plaintiffs should not be able to rely
on any opinion by Dr. Allen that a violation of the standard of care by Martin was a proximate
cause of Stephanie’s premature discharge from the hospital because plaintiffs’ amended witness
disclosure pursuant to Rule 213 did not indicate Allen would be offering this opinion. We disagree.
¶ 46 As plaintiffs point out in their reply brief, Rule 213(g) states:
“(g) Limitation on Testimony and Freedom to Cross-Examine. The
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information disclosed in answer to a Rule 213(f) interrogatory, or in a discovery
deposition, limits the testimony that can be given by a witness on direct
examination at trial. Information disclosed in a discovery deposition need not be
later specifically identified in a Rule 213(f) answer, but, upon objection at trial, the
burden is on the proponent of the witness to prove the information was provided in
a Rule 213(f) answer or in the discovery deposition. Except upon a showing of good
cause, information in an evidence deposition not previously disclosed in a Rule
213(f) interrogatory answer or in a discovery deposition shall not be admissible
upon objection at trial.
Without making disclosure under this rule, however, a cross-examining
party can elicit information, including opinions, from the witness. This freedom to
cross-examine is subject to a restriction that applies in actions that involve multiple
parties and multiple representation. In such actions, the cross-examining party may
not elicit undisclosed information, including opinions, from the witness on an issue
on which its position is aligned with that of the party doing the direct examination.”
(Emphases added.) Ill. S. Ct. R. 213(g) (eff. Jan. 1, 2018).
Dr. Allen’s opinions were given during what appears to be a discovery deposition.
¶ 47 E. Summary Judgment Ruling is Reversed
¶ 48 Considering the trial court and this court are required to construe both the pleadings
and the evidentiary material in the record strictly against defendants Martin and Methodist as they
moved for summary judgment (Buck, 2013 IL App (1st) 122144, ¶ 56) and also the drastic nature
of granting a motion for summary judgment (Bagent, 224 Ill. 2d at 163), we hold the trial court
erred in granting Martin and Methodist’s motion for summary judgment. Genuine issues of
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material fact exist in this case regarding the relevant issues.
¶ 49 III. CONCLUSION
¶ 50 For the reasons stated, we reverse the trial court’s order granting defendants Martin
and Methodists’ motion for summary judgment and remand this case for further proceedings.
¶ 51 Reversed and remanded.
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Belknap v. Crawford, 2024 IL App (4th) 230679Decision Under Review: Appeal from the Circuit Court of Peoria County, No. 18-L-104;
the Hon. Frank W. Ierulli, Judge, presiding.
Attorneys David R. Nordwall, of Law Office of David R. Nordwall LLC, of
for Chicago, M. Tod Melton, of Melton Law Firm, LLC, of Rock
Appellant: Falls, for appellants.
Attorneys Christopher J. Drinkwine, of Heyl, Royster, Voelker & Allen,
for P.C., of Rockford, for appellees.
Appellee:
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