Smith v. Menet

JUSTICE NASH,

dissenting:

There are two grounds upon which I disagree with the majority and on which I would affirm the judgment of the circuit court in this case.

First, defendants have waived review of the issue, upon which the majority has found a basis to reverse the verdict and judgment below, for failure to make a specific objection in trial. Although the majority opinion finds that defendants’ general objection to the form of the question in trial was sufficient to preserve the claimed error for review, its conclusion is not supported by the record.

After plaintiff’s expert witness responded affirmatively to a foundational question that he had an opinion “whether or not Dr. Menet’s conduct fell within the standard of good medical care in attending Mr. Smith,” defendants objected, as follows:

“MR. CUNNINGHAM: Your Honor, I must interpose an objection based on that Wilson v. Clark case. I think there has been an inappropriate foundation laid and I also object to the form of the question as well.”

Defendants’ objection was overruled without further discussion and the witness responded that it was his opinion that defendant’s conduct “was below the standard of care.” After further testimony by the witness defendants again objected, as follows:

“MR. CUNNINGHAM: Your Honor, once again I would make an objection based on Wilson vs. Clark, based on foundation, and based on the wording of the question.
I think it’s inappropriate in accordance with the jury instructions that are tendered to the jury at the end of the case as far as having them being able to evaluate what it is the doctor testified to.”

After a discussion outside the presence of the jury which is not contained in the record, defendants’ objection was overruled.

In their post-trial motion defendants did offer the specific objection to the use of the phrase “good” medical care in qualifying plaintiff’s medical expert which is now made on appeal. They also there raised the objection to foundation made in trial under Wilson v. Clark (1981), 84 Ill. 2d 186.

On appeal, however, defendants neither cite nor address Wilson v. Clark, to which they referred in trial in support of the objection made then. In this court defendants contend, instead, that the use of the term “good” medical care in qualifying plaintiff’s expert witness to express an opinion as to the care with which defendant treated plaintiff was error requiring reversal and a new trial. In my view, the majority does not give proper attention to those long-standing rules of waiver which apply when a party seeks review of an issue on appeal. The general rule was stated by our supreme court in DeMarco v. McGill (1949), 402 Ill. 46, 55, as follows:

“The rule is that if evidence objected to is competent for any purpose, the party objecting must call the attention of the court specifically to any limitations which he believes should be imposed upon its application to the issues. The trial court is entitled to know what specific insufficiencies exist in the introduction of evidence, and it is unfair to make objections on appeal after concealing the real objections from the lower court. (People v. McCurrie, 337 Ill. 290.) The rule is that a party objecting to evidence must point out the objections specifically so as to afford the adverse party an opportunity to correct it. (Illinois Iowa Power Co. v. Rhein, 369 Ill. 584.) A party who seeks to exclude a piece of evidence should be explicit and disclose to the trial court all defects in the proposed proof which he expects to urge upon this court in the event of an appeal. Forest Preserve Disk v. Lehmann Estate, Inc. 388 Ill. 416.”

It is well established that to be preserved for review “an issue must have been specifically raised both by a timely objection at trial and in defendant’s post-trial motion.” (Von Seggren v. Smith (1987), 151 Ill. App. 3d 813, 815; Hargrove v. Neuner (1985), 138 Ill. App. 3d 811, 816.) Where the grounds of objection to the admission of testimony were not included in the objection made in the trial court, it will not be considered on appeal. (Pyse v. Byrd (1983), 115 Ill. App. 3d 1003, 1006-07; see also McMahon v. Richard Gorazd, Inc. (1985), 135 Ill. App. 3d 211, 225-26; Moore v. Farmers Insurance Exchange (1982), 111 Ill. App. 3d 401, 411.) An objection must be sufficiently specific to apprise the trial court of the grounds of objection. (Dotson v. Sears, Roebuck & Co. (1987), 157 Ill. App. 3d 1036, 1041; see Dixon v. Industrial Comm’n (1975), 60 Ill. 2d 126, 132.) It is also the rule that specific objections to evidence, based on particular grounds, are a waiver of objections to all grounds not specified. (Barreto v. City of Waukegan (1985), 133 Ill. App. 3d 119, 130.) Where the ground of an objection is of a character that may be remedied or avoided, the party objecting must point out the objection specifically, so as to give his opponent the opportunity to correct it. Chicago Steel & Wire Co. v. Coating Research (1977), 53 Ill. App. 3d 943, 945-46.

These precepts were not followed in trial here, where defendant urged other objections to the testimony of plaintiff’s expert witness, but did not call to the attention of the trial court or plaintiff, at that time, the claimed error in the form of plaintiff’s question to the witness. By this means defendant has, thus far, succeeded in preserving for future use a claim of error which the trial court had no opportunity to consider during trial, and which plaintiff could not revise or correct in trial, if she wished to do so. I would hold that defendants have waived consideration of this issue on appeal.

If considered on the merits, I would also find that the use of the phrase “good medical care” in qualifying plaintiff’s expert witness to give an opinion does not require reversal in this case.

The jury was instructed as to the requisite standard of care by which defendant’s conduct was to be measured by an instruction combining Illinois Pattern Jury Instructions, Civil, Nos. 105.01 and 105.02 (2d ed. 1971) (hereinafter IPI Civil 2d), as follows:

“In treating a patient, a doctor who holds himself out as a specialist and undertakes service in a particular branch of medical, surgical or other healing science, must possess and apply the knowledge and use the skill and care which reasonably well-qualified specialists in the same field, practicing in the same locality or in similar localities, ordinarily would use in similar cases and circumstances. A failure to do so is a form of negligence called malpractice.”

Defendants do not now question the correctness of the instruction given by the trial court. They urge, however, that the standard of care expressed in the instruction has been equated to that of “acceptable medical standards,” citing Gorman v. St. Francis Hospital (1965), 60 Ill. App. 2d 441, and Alton v. Kitt (1982), 103 Ill. App. 3d 387, and that plaintiff’s medical expert incorrectly defined the standard of care applicable to defendant as that of “good medical care,” a higher standard than is required.

I would note first that plaintiff’s expert, Dr. Golomb, at no time sought to define the applicable standard of care in the trial of the case. To the contrary, the witness declined to do so when plaintiff’s counsel inquired of him whether Dr. Menet’s failure to do further evaluation of decedent after his April 5, 1984, visit was medical negligence. The witness responded, “Well, you’re defining it. You asked me if it was below the standard of care and I’ve stated it is.” The reference to “good” medical care, to which defendants now object with specificity, arose in this case only during the qualifying questioning of the expert witness by plaintiff’s counsel in which he inquired, “[D]o you have an opinion, based upon a reasonable degree of medical certainty and as a Board-certified and practicing specialist in the field of internal medicine, as to whether or not Dr. Menet’s conduct fell within the standard of good medical care in attending Mr. Smith.” (Emphasis added.) The witness responded that it was his opinion Dr. Menet’s conduct was below the standard of care, and he related the basis for his opinion as reflected in defendant’s conduct.

I do not share the hypertechnical concern of my colleagues that by this exchange the jury was led to consider that the standard of care to be applied was anything more or less than that stated in the instruction given by the trial court. Use of the word “good” in the context applied here does no violence to the court’s instruction and does not suggest defendants should be held to any higher standard of care than expressed by that instruction. Reference in the opinion to the dictionary definitions of “good” is unnecessary, and perhaps misleading, as the jury was not so instructed and could only have tested defendant’s conduct on the standard set forth in the court’s instruction.

As noted in the comment to IPI Civil 2d No. 105.01, the court in Holtzman v. Hoy (1886), 118 Ill. 534, 536, stated that the medical standard of care requires the skill “which a good physician would bring to a similar case under like circumstances.” (Emphasis added.) (IPI Civil 2d No. 105.01, Comment, at 319.) This court stated the rule in Olander v. Johnson (1930), 258 Ill. App. 89, as follows:

“The duty which a physician and surgeon owes his patient is to bring to the case at hand that degree of knowledge, skill, and care which a good physician and surgeon would bring to a similar case under like circumstances. While this rule, on the one hand, does not exact the highest degree of skill and proficiency attainable in the profession, it does not contemplate merely average merit. (Holtzman v. Hoy 118 Ill. 534; 21 R. C. L. Physicians and Surgeons, sec. 27.) To this extent he is liable and no further. He is not required to possess the highest, but reasonable skill. The burden of proof is upon the plaintiff in an action for malpractice to show the want of such care, skill, and diligence and also to show that the injury complained of resulted from failure to exercise those requisites. (McKee v. Allen 94 Ill. App. 147; Goodman v. Bigler, 133 Ill. App. 301; 21 R. C. L. Physicians and Surgeons, sec. 49.)” 258 Ill. App. 89, 95.

I have no quarrel with the settled rule that the standard of care against which a medical defendant’s conduct is to be measured is that “reasonable skill which a physician in good standing in the community would use in a similar case” (Newell v. Corres (1984), 125 Ill. App. 3d 1087, 1094), and it is not measured against the highest degree of skill possible, or a best possible care standard (125 Ill. App. 3d 1087, 1094; Northern Trust Co. v. Skokie Valley Community Hospital (1980), 81 Ill. App. 3d 1110, 1126-27). However, that is not the question presented in this case. The standard of care to be applied was correctly stated in the instructions to the jury. Use of the phrase “good medical care” in qualifying the expert witness was clearly not intended to elevate the requisite standard of care and would be considered as equivalent to the phrase “acceptable medical standards” which defendant offers as a short description of the standard of care. In the cases noted herein, the courts commonly use language such as “good standing,” “good medical practice,” “physicians in good practice,” and “good practitioner” in describing the medical standard of care and, in my view, that is all that occurred here. “Good” medical care in this context means no more than the application of the skill and knowledge which a reasonably well-qualified practitioner in the field would have used. When the expert witness responded that defendant’s conduct was below the requisite standard of care, and the jury was instructed as it was, no untoward prejudice to defendants could have followed from the form of the question to which they now object.

For these reasons Í would affirm the judgment of the circuit court.