Gapinski v. Gujrati , 2017 IL App (3d) 150502 ( 2017 )


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    Appellate Court                            Date: 2017.07.17
    10:18:09 -05'00'
    Gapinski v. Gujrati, 
    2017 IL App (3d) 150502
    Appellate Court   REBECCA GAPINSKI, Individually and as Duly Appointed
    Caption           Administrator of the Estate of Daniel W. Gapinski, Deceased,
    Plaintiff-Appellee, v. MEENA GUJRATI, M.D., and CENTRAL
    ILLINOIS PATHOLOGY, S.C., a Domestic Corporation,
    Defendant-Appellants.
    District & No.    Third District
    Docket No. 3-15-0502
    Filed             April 24, 2017
    Decision Under    Appeal from the Circuit Court of La Salle County, No. 11-L-27; the
    Review            Hon. Troy D. Holland, Judge, presiding.
    Judgment          Affirmed.
    Counsel on        Kevin J. Vedrine, Christopher J. Solfa, and Robert L. Larsen, Jr., of
    Appeal            Cunningham, Meyer & Vedrine, P.C., of Warrenville, for appellant
    Meena Gujrati.
    Matthew B. Smith and Kathleen M. Carter, of Quinn Johnston
    Henderson Pretorius & Cerulo, of Peoria, for other appellant.
    James A. McPhedran and Anthony C. Raccuglia, of Anthony C.
    Raccuglia & Associates, of Peru, for appellee.
    Panel                    JUSTICE O’BRIEN delivered the judgment of the court, with
    opinion.
    Justice Lytton concurred in the judgment and opinion.
    Justice Carter specially concurred, with opinion.
    OPINION
    ¶1         Plaintiff Rebecca Gapinski, individually and as the administrator of the Estate of Daniel
    Gapinski, deceased, sought to recover for medical malpractice she alleged was committed by
    defendant Meena Gujrati, M.D., an employee of defendant Central Illinois Pathology, S.C.
    (CIP), and resulted in Daniel’s death from renal cell cancer. The jury found in favor of
    Rebecca, and the trial court entered a judgment against Gujrati and CIP in the amount of
    $1,727,409.50, jointly and severally. Gujrati and CIP appealed. We affirm.
    ¶2                                                FACTS
    ¶3         Daniel Gapinski, the late husband of plaintiff Rebecca Gapinski, began experiencing
    headaches and vision problems in early 2007. He saw his primary care physician, who referred
    him for magnetic resonance imaging (MRI). The results of the MRI indicated an undetermined
    tumor in his brain’s pituitary region. Giueseppe Lanzino, a neurosurgeon, performed a biopsy
    and removed as much as the tumor as possible. In March 2007, while an employee of
    defendant CIP, defendant Meena Gujrati, a neuropathologist, read the biopsy slides and
    determined the mass in Daniel’s brain was a primary, benign lesion called a meningioma.
    ¶4         Following a period of limited radiation, Daniel returned to work. In late 2008, Daniel’s
    symptoms returned, and in early 2009, he saw neurosurgeon Jeff Klopfenstein, who attempted
    to schedule surgery for late February. Daniel sought a second opinion from Lanzino, who had
    moved to the Mayo Clinic. Daniel saw Lanzino on January 28, 2009, and was referred to John
    Atkinson, another neurosurgeon at Mayo Clinic, who saw Daniel the following day. Daniel
    sought an additional consultation with Daniel Prevedello of the University of Pittsburgh
    Medical Center (UPMC), who performed two surgeries in early February 2009.
    ¶5         The tissues obtained from the UPMC surgeries were evaluated in the UPMC pathology
    department, and Daniel was diagnosed with metastatic renal cell carcinoma, which had spread
    to the pituitary gland in his brain. He opted to be treated at the University of Chicago Medical
    Center (UCMC), where Russell Szmulewitz, a medical oncologist, headed Daniel’s treatment
    plan. Szmulewitz obtained Daniel’s records from OSF St. Francis Medical Center, which
    included the original tissue evaluated by Gujrati. A UCMC pathologist examined the tissues
    and found the original tissues included malignant cells, which he diagnosed as renal cell
    cancer. Daniel continued treatment at UCMC until his death.
    ¶6         Daniel and Rebecca filed their complaint on February 4, 2011, naming Gujrati, CIP, OSF
    St. Francis Medical Center (OSF), and Illinois Neurological Institute (INI) as defendants and
    alleging negligence, apparent agency, and vicarious liability. On OSF’s motion for summary
    judgment, OSF and INI were dismissed. Gujrati and CIP filed their affirmative defense,
    arguing Rebecca’s complaint was time-barred by the statute of limitations. In May 2013, they
    filed a motion for summary judgment on the same grounds, which the trial court denied.
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    ¶7          In February 2014, Gujrati, who was represented by the same law firm as CIP, sought leave
    to substitute a new law firm as counsel. Rebecca objected based on the timing of Gujrati’s
    motion, which was filed close to the scheduled start of trial. Ultimately, Rebecca agreed to the
    change in counsel if the trial court required the defense attorneys to take turns or alternate
    questioning witnesses and allowed only one of them at a time to represent the defendants. The
    trial court granted Gujrati’s motion to substitute and Rebecca’s request to ban dual
    representation. It allowed Gujrati and CIP to each have its own counsel, file individual
    pleadings, and litigate the individual cases until trial but ordered that counsel for Gujrati and
    CIP be allowed to participate only one at a time during the trial.
    ¶8          Also in February, the trial court granted Rebecca’s motion for partial summary judgment,
    finding that Gujrati and CIP were in an employee-employer relationship, that respondeat
    superior applied, and that CIP would be vicariously liable for Gujrati’s malpractice.
    ¶9          In April 2014, CIP moved for a protective order, seeking to have Daniel’s original biopsy
    tissue recut and evaluated by its consulting opinion witnesses. Over plaintiff's objection, the
    trial court granted CIP’s motion and ordered that Gujrati and CIP be provided 10 cuts from the
    original tissue and that Rebecca also be provided 10 cuts. Per the court’s order, the recuts were
    available to the parties for staining and evaluation. CIP was allowed additional time until May
    1, 2014, to supplement its expert disclosures with opinions based on the recuts. Gujrati and CIP
    did not thereafter disclose any witnesses based on expert evaluation of the recuts.
    ¶ 10        On June 1, 2014, Rebecca filed her “rebuttal” disclosures regarding the recuts, including
    the opinion of her neuropathologist expert witness, Hannes Vogel, that the 2007 tissues
    “demonstrate[d] metastatic clear cell carcinoma of the kidney.” CIP moved to bar Rebecca’s
    rebuttal disclosures, and Rebecca sought to convert her rebuttal disclosures to supplemental
    disclosures. The trial court denied CIP’s motion and granted Rebecca’s motion.
    ¶ 11        Daniel died on May 31, 2014, due to a metastasis to his abdomen from the kidney. Rebecca
    filed a first amended complaint, adding survival, wrongful death, and loss of consortium
    claims. Gujrati and CIP each answered and asserted affirmative defenses based on the statute
    of limitations. Gujrati and CIP also filed motions to dismiss based on the expiration of the
    statute of repose, which the trial court denied.
    ¶ 12        The trial ensued, and the following evidence was presented. Daniel’s primary care
    physician, Joel Leifheit, saw Daniel in March 2007. Daniel was complaining of headaches and
    vision problems. Leifheit ordered various tests, including an MRI, which revealed a mass in
    Daniel’s brain. Leifheit referred Daniel to Giueseppe Lanzino, a neurosurgeon at OSF St.
    Francis Medical Center in Peoria. Lanzino performed surgery in March 2007, taking a biopsy
    of the mass and removing a limited portion of the tumor. Lanzino referred Daniel for radiation
    treatment. James McGee, a radiation oncologist, provided a course of radiation treatment.
    ¶ 13        After symptoms returned in September 2008, Daniel sought treatment with a new primary
    care physician, Ricardo Calderon, who referred Daniel to an endocrinologist and a
    neuro-ophthalmologist. An MRI in January 2009 showed the tumor had grown. In January
    2009, Daniel also saw Lanzino and Atkinson, another neurosurgeon, at the Mayo Clinic.
    Daniel sought an additional opinion from Prevedello at UPMC. Prevedello performed two
    surgeries, and tissue he removed was tested. Based on the results of the tests, Daniel was
    diagnosed with metastatic renal cell carcinoma.
    ¶ 14        Rebecca testified to the chronology and details of Daniel’s illness and treatment. When she
    and Daniel met with Lanzino and Atkinson at Mayo Clinic in late January 2009, they both
    -3-
    expressed concern that the tumor was not following the growth pattern of a classic
    meningioma. Atkinson was suspicious the tumor was not a benign meningioma and thought
    that it was behaving more like a malignancy.
    ¶ 15       Even after Atkinson expressed his concern that the tumor was behaving like a malignancy,
    Daniel continued to receive treatment based on the original diagnosis of a benign meningioma.
    Rebecca and Daniel received the diagnosis of metastatic renal cell carcinoma on February 12,
    2009, from Prevedello at UPMC. Daniel’s kidney was removed in 2012, and he suffered a
    perforated bowel in 2013.
    ¶ 16       Vogel testified as a neuropathologist expert for Rebecca. He reviewed the 2007 slide that
    Gujrati examined, the slides from UPMC, and the recut slides. He also performed additional
    testing on the recut tissue. It was his opinion, based on a reasonable degree of medical
    certainty, that Gujrati deviated from the standard of care of a reasonably competent,
    well-trained pathologist or neuropathologist in reading Daniel’s biopsy samples as benign
    meningioma and not renal cell carcinoma. It was Vogel’s further opinion that Gujrati deviated
    from the standard of care in the stains she used to evaluate the tissue samples and in failing to
    include cancer as part of a differential diagnosis. Vogel also opined that Gujrati’s misdiagnosis
    was the proximate cause of the delay in Daniel’s treatment for cancer and that a different
    course of treatment would have been prescribed had Daniel been properly diagnosed.
    ¶ 17       James Brown testified as an expert in urology with a specialty in neurological oncology.
    He explained that when cancer starts in the kidney, like Daniel’s cancer, if the kidney is
    removed in an “opportune time,” the patient is cured without any further opportunity for the
    cancer to spread. Brown explained the course of treatment for someone diagnosed with
    primary kidney cancer that had spread to the brain, including removal of the kidney. When
    Daniel’s cancer was diagnosed as malignant in 2009, his kidney could not be removed because
    once he stopped taking certain medications used to treat his brain tumor, symptoms returned
    before the kidney surgery could take place. Brown explained the team approach to treatment.
    In his opinion, Daniel lost the opportunity for a cure and for the usual course of treatment
    because of the missed diagnosis.
    ¶ 18       On cross-examination, Brown stated that in his opinion, Daniel had stage 4 renal cell
    cancer in March 2007 and had a poor prognosis. Patients with stage 4 cancer had a five-year
    survival rate of 12 to 14% in 2007, with a median survival time of 12 to 14 months. If Daniel
    had been properly diagnosed in 2007, Brown would have told Daniel that his five-year survival
    rate was 10 to 15%, even with treatment. Because of Daniel’s brain tumor, Daniel had a very
    limited chance to live beyond 10 years. During Brown’s testimony, the defense objected on the
    grounds that his testimony was beyond the scope of his expertise and that his trial testimony
    was cumulative and duplicative of the other witnesses.
    ¶ 19       Defendant Meena Gujrati, the neuropathologist who analyzed the original biopsy tissues in
    2007, testified. Her report regarding Daniel’s tissue samples did not indicate he had cancer.
    Her final pathological diagnosis was a pituitary tumor, meningioma. Her diagnosis was based
    upon histologic examination and the clinical information she received from the surgeon
    Lanzino that the tissue looked like a meningioma. When she diagnosed Daniel in 2007, she
    was an employee of defendant CIP.
    ¶ 20       Prevedello, the neurosurgeon who operated on Daniel in February 2009, testified that he
    began treating and operated on Daniel for a meningioma based on the medical history. Because
    of bleeding from the tumor, he had to conduct two surgeries. He performed a biopsy, and his
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    analysis of the frozen section showed malignant characteristics, which he characterized as an
    aggressive meningioma. He was surprised when told by the UPMC pathologist that Daniel had
    renal cell cancer. He immediately told Daniel, which occurred on February 11. He also ordered
    an MRI, which showed a mass in Daniel’s kidney.
    ¶ 21        Russell Szmulewitz, a medical oncologist, testified. He had a subspeciality in
    genitourinary oncology, including kidney cancer, and treated Daniel for the five-year period
    before his death. The majority of patients with renal cell cancer die, and treatment merely
    delays the death. He did not know whether Daniel would have had a significantly longer
    survival had he received treatment for cancer in 2007 instead of 2009. In 2013, the cancer
    metastasized to Daniel’s abdomen. If he had been properly diagnosed, Daniel would not have
    suffered abdomen problems, later bleeding events, and seizures. In his opinion, with a proper
    diagnosis, Daniel could have been cancer free in 2007.
    ¶ 22        Susan Pannullo, a neurosurgeon and neurologist with a subspecialty in neuro-oncology,
    testified as a retained expert. She explained what the treatment plan for Daniel would have
    been in 2007 as compared to 2009, had he been properly diagnosed. As much of Daniel’s
    tumor that could be removed was removed in 2007, and a correct diagnosis would not have
    changed that outcome. Similarly, the surgeries that occurred at UPMC removed as much of the
    tumor as possible without damaging Daniel’s vision. It was unsafe to give Daniel additional
    radiation after the surgeries at UPMC because of the prior radiation he received. In her opinion,
    although “not within [her] subspecialty,” Daniel’s tumor had less chance of spreading to his
    abdomen had the proper treatment plan been provided for Daniel in 2007. The defense
    objected on the grounds that her testimony was beyond the scope of her expertise and that her
    trial testimony was cumulative and duplicative.
    ¶ 23        John Buatti testified as Rebecca’s retained radiation oncology expert. He discussed the
    reasonableness of Daniel’s treatment plan options. In his opinion, the two-year delay in
    diagnosis had a substantial impact. If Daniel had been properly diagnosed in 2007, he would
    have received more aggressive radiation to his brain tumor, within the limitations of the
    tumor’s location. Buatti would have been able to radiate the tumor with low risk with
    aggressive treatment. Daniel could not receive a therapeutic dose of radiation in 2009 because
    of the misdiagnosis in 2007. On cross-examination, Buatti acknowledged that even with all
    appropriate treatments, the success rate for renal cell carcinoma with brain metastases was 10
    to 20%, with a median survival length of 15 to 18 months for metastatic pituitary renal cell
    carcinoma. The average survival rate in 2007 for someone in Daniel’s condition would have
    been 12 to 14 months. During Buatti’s testimony, the defense objected on the grounds that his
    testimony was beyond the scope of his expertise and that his trial testimony was cumulative
    and duplicative.
    ¶ 24        Several family members testified that they accompanied Daniel to doctor appointments
    and treatment sessions and that at no time prior to the diagnosis at UPMC did any doctors
    indicate Daniel had cancer. Daniel’s evidence deposition was played for the jury. When he
    finished radiation after his brain tumor was first removed, he thought he was cancer free. None
    of the doctors he saw said he had cancer until he was diagnosed after the surgeries at UPMC.
    At that time, he was told his brain tumor was cancerous and had started in the kidney. He lost
    his opportunity to live a life because of the misdiagnosis.
    ¶ 25        Geoffrey Murdoch, an anatomic pathologist with a specialty in neuropathology at UPMC,
    testified by evidence deposition. He analyzed the tissue samples and diagnosed metastatic
    -5-
    renal cell carcinoma. Atkinson testified by evidence deposition. He was a neurosurgeon and
    pituitary specialist. In his view, Daniel’s tumor was not acting in a “benign” manner. Although
    he did not remember the conversation with Daniel and Rebecca, he would have shared his view
    with Daniel and described the tumor as “aggressive.” In his opinion, the tumor was surgically
    incurable.
    ¶ 26        Rebecca rested, and Gujrati and CIP both moved for a directed verdict based on expiration
    of the statute of limitations. Rebecca moved for partial summary judgment, seeking a finding
    the case was timely filed. The trial court denied CIP’s motion and granted Rebecca’s motion.
    ¶ 27        The defense presented its case. Michael Naughton testified as a retained medical
    oncologist expert. In his opinion, Daniel had stage 4 renal cell carcinoma in 2007, and his
    tumor was incurable. Daniel’s median survival rate in 2007 was two years, and he had
    approximately a 10% chance of a five-year survival. Because the tumor was located near
    important structures in the brain, it would not have been possible to remove the entire tumor in
    2007. Daniel’s long-term survival was not impacted by the two-year delay in diagnosis. In his
    opinion, earlier treatment would not have altered the outcome.
    ¶ 28        McGee, Daniel’s treating radiation oncologist in 2007, testified that had he known the
    tumor was malignant and not benign, he would not have ordered more or different radiation.
    The tumor was touching areas of the brain that are very sensitive to damage from radiation,
    which limited the radiation treatment Daniel could receive.
    ¶ 29        Joseph Simpson testified as a radiation oncology expert. He opined that in 2007, Daniel’s
    condition was incurable because it had metastasized to the brain and that it was no more
    curable in 2007 than in 2009. The radiation dosage Daniel received was appropriate, regardless
    of the diagnosis. Removal of Daniel’s kidney would have helped his short-term survival but
    not his long-term chances.
    ¶ 30        Ty Abel testified as a retained neuropathology expert and as an expert on the standard of
    care applicable to Gujrati. The slides reviewed by Gujrati were consistent with a diagnosis of
    benign meningioma, and she used a reasonable choice of tests in reaching her diagnosis. Under
    the applicable standard of care, she was not required to do additional testing or seek a second
    opinion. In his opinion, her diagnosis complied with the standard of care of a reasonably
    careful neuropathologist.
    ¶ 31        Arieh Shalhav, a urological oncologist, testified. He began treating Daniel in 2009 when he
    evaluated Daniel for kidney removal surgery. Daniel’s tumor was likely always aggressive,
    and stage 4 tumors are unlikely to be cured. The small size of the kidney tumor in 2009 when it
    had already metastasized was suggestive of a cancerous component.
    ¶ 32        Gujrati testified. She diagnosed Daniel with a benign meningioma after testing the biopsy
    samples. She explained how the slides indicated meningioma, not cancer. She performed
    hematoxylin and eosin (H&E) immunohistochemical staining and other special stains. Based
    on her initial diagnosis, she did not perform a CD10 stain, which would have been more
    specific to a renal cell carcinoma. In her view, she complied with the standard of care in
    reading the slides and making the diagnosis. The standard of care did not require her to obtain
    a consultation. She agreed that Daniel had renal cell carcinoma in 2007.
    ¶ 33        The jury returned a verdict in favor of Rebecca in the amount of $1,727,409.50, and the
    trial court entered a judgment order against Gujrati and CIP. They filed motions for judgments
    notwithstanding the verdict and for a new trial. They also moved to reduce the judgment. The
    -6-
    motions were heard and denied. Gujrati and CIP timely appealed.
    ¶ 34                                             ANALYSIS
    ¶ 35       There are six issues on appeal: whether the trial court erred when it barred Gujrati and CIP
    from dual representation, allowed supplemental disclosure of the opinion of Gapinski's expert
    witness and the testimony of several of Rebecca’s expert witnesses, found the complaint was
    not barred by the statute of limitations, and denied Gujrati and CIP’s motions for a new trial
    based on the conduct of Rebecca’s attorney, and whether the jury verdict was against the
    manifest weight of the evidence.
    ¶ 36       The first issue is whether Gujrati and CIP were denied a fair trial where the trial court
    barred them from dual representation. The defense argues that by barring the attorneys for both
    defendants from both actively participating in the trial, the trial court allowed the counsel for
    each defendant to only represent its client’s interests half the time and expected both defense
    attorneys to represent the other defendant, a non-client.
    ¶ 37       The trial court has the authority to control the questioning of witnesses and the presentation
    of evidence. Ill. R. Evid. 611(a) (eff. Jan. 1, 2011). A trial judge has inherent authority to
    control his courtroom. Mason v. Snyder, 
    332 Ill. App. 3d 834
    , 842 (2002). Each defendant in a
    multidefendant case is entitled to present an expert in its defense. Taylor v. County of Cook,
    2011 IL App (1st) 093085, ¶ 36. We review a trial court’s rulings regarding the admissibility of
    witness testimony for an abuse of discretion. Taylor, 2011 IL App (1st) 093085, ¶ 23.
    ¶ 38       We find the trial court’s ruling to bar dual representation was not in error. When Gujrati
    moved to substitute counsel in February 2014, the trial was scheduled to begin June 16.
    Rebecca objected on the basis of the timeliness of the motion and the potential adverse
    consequences substitution of counsel would have on the trial date. At this point, the case had
    been pending for three years. Arguably, the trial court would have been within its discretion to
    deny Gujrati’s motion to substitute outright. Instead, it exercised discretion by offering a
    compromise to the parties. Rebecca agreed to Gujrati’s substitution of counsel if Gujrati and
    CIP were barred from both participating in the trial at the same time.
    ¶ 39       The trial court considered that allowing both Gujrati and CIP to present opening and
    closing statements and question witnesses would be redundant and unnecessary and would
    prejudice Rebecca. The trial court noted that the liability at issue was vicarious as to CIP, and if
    Gujrati was found liable, CIP was also liable, and conversely, if Gujrati was not liable, CIP
    would not be liable. They shared a commonality of interests. Until shortly before trial, the
    defendants were represented by the same law firm. After Gujrati was allowed new counsel, the
    defendants filed independent pleadings until the trial started. At trial, each defendant was
    allowed to present its own expert witnesses and to question them. They were barred only from
    both participating at the same time and were not denied a fair trial.
    ¶ 40       The next issue is whether the trial court erred by allowing supplemental disclosure of the
    opinion of Vogel, Rebecca’s expert witness. Gujrati and CIP argue that the disclosure of
    Vogel’s opinions regarding the recuts was untimely and that Vogel was allowed to present
    impermissible rebuttal testimony.
    ¶ 41       Rule 213 mandates that parties supply and identify the subject matter of their witnesses; the
    witnesses’ conclusions, opinions, and their bases; the witnesses’ qualifications; and any
    reports prepared by the witnesses. Ill. S. Ct. R. 213(f)(3) (eff. Jan. 1, 2007). The opinions of an
    -7-
    expert are limited to what was disclosed per Rule 213 or in a discovery deposition. Ill. S. Ct. R.
    213(g) (eff. Jan. 1, 2007). When new or additional information becomes available, parties have
    a duty to “seasonably supplement or amend” the prior disclosure. Ill. S. Ct. R. 213(i) (eff. Jan.
    1, 2007). Supplemental disclosure is required as soon as the additional information is known.
    Lucht v. Stage 2, Inc., 
    239 Ill. App. 3d 679
    , 692 (1992). “ ‘[A] witness may elaborate on a
    previously disclosed opinion’ as long as the testimony is encompassed by the original opinion
    and is not a new reason” for it. Kovera v. Envirite of Illinois, Inc., 
    2015 IL App (1st) 133049
    ,
    ¶ 63 (quoting Wilbourn v. Cavalenes, 
    398 Ill. App. 3d 837
    , 849 (2010)). The purposes of Rule
    213 are to avoid surprise and discourage tactical gamesmanship. Sullivan v. Edward Hospital,
    
    209 Ill. 2d 100
    , 109-10 (2004). We will not reverse a trial court’s decision whether to admit
    expert opinion per Rule 213 unless it was an abuse of discretion. 
    Sullivan, 209 Ill. 2d at 109
    .
    ¶ 42        The trial court considered that the defense opened the door by asking for the recuts and that
    Rebecca’s late disclosure of Vogel’s opinion was contemplated in the order granting the
    defense motion. Rebecca was required to “seasonably supplement” Vogel’s disclosures after
    he evaluated the recuts, which she timely did. There was no surprise or prejudice to the
    defendants. Vogel’s original opinion disclosed that the 2007 tissues showed renal cell cancer,
    and his supplemental disclosure stated the same opinion. We find the trial court did not abuse
    its discretion in allowing Rebecca’s disclosure of Vogel’s opinion based on the recuts.
    ¶ 43        The third issue is whether the trial court erred in allowing the testimony of several of
    Rebecca’s expert witnesses, which Gujrati and CIP challenge as duplicative and beyond the
    scope of their areas of expertise. They also a claim proper foundation was not established for
    the testimony and it should not have been admitted.
    ¶ 44        To establish a foundation for an expert’s testimony, the proponent must establish that the
    witness is a licensed member of the school of medicine about which he will offer an opinion
    and that the witness is familiar with the methods, procedures, and treatments that other doctors
    in his or similar communities observe. Purtill v. Hess, 
    111 Ill. 2d 229
    , 242-43 (1986). When
    the foundational elements are established, the trial court then considers whether the expert is
    competent to testify in the case before it. Alm v. Loyola University Medical Center, 373 Ill.
    App. 3d 1, 5 (2007). An expert’s actual experience in practice may provide the necessary
    knowledge of the applicable standards of care and allow him to opine about whether the
    defendant deviated from the standard of care. Hubbard v. Sherman Hospital, 
    292 Ill. App. 3d 148
    , 154 (1997).
    ¶ 45        The trial court has discretion over the cross-examination of witnesses and may “permit
    inquiry into additional matters as if on direct examination.” Ill. R. Evid. 611(b) (eff. Jan. 1,
    2011). Cross-examination allows the questioning party to probe bias, partisanship, or financial
    interest and is a principal safeguard against errant expert testimony. Trower v. Jones, 
    121 Ill. 2d
    211, 217 (1988). The trial court’s admission of evidence, including expert testimony, will
    not be overturned absent an abuse of discretion. Davis v. Kraff, 
    405 Ill. App. 3d 20
    , 28 (2010).
    ¶ 46        Gujrati and CIP complain that Rebecca’s expert witnesses, Brown, Pannullo, and Buatti,
    offered duplicative testimony and were permitted to testify beyond their areas of expertise. We
    disagree. The experts established their qualifications and testified based on their knowledge
    and understanding of cancer and its treatment. They explained they worked in
    multidisciplinary teams with other tumor or cancer specialists and were familiar with the
    procedures and treatments. We find the experts’ testimonies were properly admitted and were
    not beyond their areas of expertise.
    -8-
    ¶ 47       The defendants further argue that Vogel improperly testified as to what he would have
    done in testing the slides instead of what the standard of care required. This argument is not
    supported by the record. Vogel testified that in his opinion, to a reasonable degree of medical
    certainty, Gujrati’s analysis of the slide was a deviation from the standard of care. He then
    discussed what he would have done in compliance with the standard. He did not use his
    personal practice to establish the standard of care.
    ¶ 48       The defendants argue that the trial court allowed Rebecca’s witnesses to provide volunteer
    statements during cross-examination, rather than answering with a “yes” or “no.” The cross
    examination of the expert witnesses was properly allowed by the trial court. The witnesses
    either answered “yes” or “no” or with a statement that explained why a “yes” or “no” answer
    was inappropriate. We find Gujrati and CIP were not denied a fair trial by the court’s
    evidentiary rulings regarding expert witness testimony.
    ¶ 49       The fourth issue is whether the trial court erred when it denied Gujrati and CIP’s motion for
    summary judgment and for a directed verdict on limitation grounds. They argue the evidence
    overwhelmingly established that Rebecca had knowledge of Daniel’s injury and that Gujrati
    caused the injury more than two years before she filed her complaint, making her complaint
    untimely.
    ¶ 50       The statute of limitations for medical malpractice claims is two years from “the date on
    which the claimant knew, or through the use of reasonable diligence should have known *** of
    the existence of the injury or death for which damages are sought.” 735 ILCS 5/13-212(a)
    (West 2012). Time begins to run under section 212(a) when the plaintiff reasonably discovers
    the defendant’s negligence might have contributed to the injury, not when the plaintiff knows
    of the injury. Mackey v. Sarroca, 
    2015 IL App (3d) 130219
    , ¶ 15. The time when a plaintiff
    knew or should have known of the injury and that it was wrongfully caused are generally a
    question of fact but can be determined as a matter of law where the facts are undisputed and
    only one conclusion may be drawn from them. Castello v. Kalis, 
    352 Ill. App. 3d 736
    , 744
    (2004). The trial court’s denial of motions for summary judgment and for a directed verdict are
    reviewed de novo. Young v. Alden Gardens of Waterford, LLC, 
    2015 IL App (1st) 131887
    ,
    ¶ 42; Jones v. DHR Cambridge Homes, Inc., 
    381 Ill. App. 3d 18
    , 28 (2008).
    ¶ 51       Rebecca used reasonable efforts to determine whether Daniel had an injury and whether it
    was wrongfully caused. After the initial benign diagnosis in 2007 and subsequent treatment,
    Daniel was warned to watch for the recurrence of his symptoms. When his symptoms returned
    in September 2008, Daniel saw his primary care doctor, and in January 2009, Daniel met with
    a neurosurgeon. Daniel next saw Lanzino and Atkinson in late January 2009, and both doctors
    observed the tumor was not acting like a benign tumor. Rebecca testified that she began to
    suspect cancer after the meeting with Lanzino and Atkinson. However, both Lanzino and
    Atkinson consulted with Daniel for a meningioma, and neither informed them that Daniel had
    cancer. When Daniel saw Prevedello at UPMC in early February, he, too, treated Daniel as if
    he had a meningioma. Prevedello was surprised when he was informed by the pathologist that
    the tissues he removed during the surgery were malignant. He immediately informed Daniel
    and Rebecca that he had renal cancer on either February 11 or 12, 2009.
    ¶ 52       We find the complaint was timely filed on February 4, 2011. Up until the results from the
    tissues removed during the UPMC surgeries were delivered to Prevedello, Daniel was treated
    for a benign tumor. When his symptoms returned in 2008, he immediately sought medical
    advice and did so again when the symptoms continued in 2009. Throughout the term of his
    -9-
    illness, Daniel used reasonable diligence in securing treatment. He was not aware until
    February 11 or 12, 2009, that the tumor was cancerous. Once he discovered that he was injured
    and that his injury was wrongfully caused, he and Rebecca filed their complaint within two
    years. The trial court did not err in denying Gujrati and CIP’s motions for summary judgment
    and a directed verdict.
    ¶ 53       The fifth issue is whether the trial court erred in denying Gujrati and CIP’s motion for a
    new trial based on the conduct of Gapinski’s counsel. Gujrati and CIP accuse plaintiff’s
    counsel of running “roughshod” over the trial court and their rights. They also complain of
    counsel’s objections during trial, improper questioning on cross-examination, and violation of
    the trial court’s in limine rulings.
    ¶ 54       Attorney misconduct and improper argument may be the basis for a new trial. Grillo v.
    Yeager Construction, 
    387 Ill. App. 3d 577
    , 600-01 (2008) (citing First National Bank of
    La Grange v. Glen Oaks Hospital & Medical Center, 
    357 Ill. App. 3d 828
    , 833 (2005)). To
    support the grant of a new trial, the improper conduct must substantially prejudice the party.
    
    Grillo, 387 Ill. App. 3d at 601
    . When a trial court sustains an objection and gives the jury a
    limiting instruction, any prejudice from the improper comment is cured. Grillo, 
    387 Ill. App. 3d
    at 601. We review a trial court’s denial of a motion for a new trial for an abuse of discretion.
    Graham v. Northwestern Memorial Hospital, 
    2012 IL App (1st) 102609
    , ¶ 21.
    ¶ 55       Gujrati and CIP offer a number of instances in which they maintain plaintiff’s counsel
    acted egregiously, interjected improper commentary, violated motions in limine and the dual
    representation bar, and substituted different criteria instead of using the standard of care. The
    evidence does not support their claims. We did not discover any examples of egregious
    behavior by plaintiff’s counsel that would justify a new trial. In other instances of which the
    defendants complain, the trial court properly sustained the defense objections or overruled
    Rebecca’s objections. The court struck Rebecca’s question in violation of the motion in limine
    and barred counsel from moving forward on that line of questioning. Comments by plaintiff’s
    co-counsel were directed toward trial logistics and did not violate the dual representation bar.
    We find there was no impropriety in the conduct of plaintiff’s counsel such that the defense
    was substantially prejudiced and no error by the trial court in denying the defendants’ motion
    for a new trial.
    ¶ 56       The final issue is whether the jury verdict was against the manifest weight of the evidence.
    Gujrati and CIP argue that Rebecca failed to establish that Gujrati’s misdiagnosis was the
    proximate cause of Daniel’s injury and death and that the jury’s verdict was not supported by
    the evidence.
    ¶ 57       To sustain a cause of action for medical malpractice, a plaintiff must allege and prove
    (1) the proper standard of care applicable to measure the medical professional’s conduct, (2) a
    deviation from the standard, and (3) an injury that was proximately caused by the deviation.
    Willaby v. Bendersky, 
    383 Ill. App. 3d 853
    , 863-64 (2008). In medical malpractice cases,
    expert testimony is generally needed to establish the standard of care and its breach. 
    Willaby, 383 Ill. App. 3d at 864
    (citing Snelson v. Kamm, 
    204 Ill. 2d 1
    , 43-44 (2003)). This court
    reverses a jury verdict only when it was against the manifest weight of the evidence. 
    Snelson, 204 Ill. 2d at 35
    .
    ¶ 58       The defense argues that its witnesses were more credible and believable than the experts
    for Rebecca and that the testimony of their experts defeated the theory of the case supported by
    Rebecca’s experts. The jury was responsible for determining issues of witness credibility. Both
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    sides presented evidence in favor of their theory of the case. The jury chose Rebecca’s theory
    over Gujrati and CIP’s theory and found the testimony of Rebecca’s experts more compelling
    than the testimony of the defense experts. Rebecca’s witnesses established the standard of care
    and that Gujrati deviated from it and caused injury. We find the jury’s verdict was not against
    the manifest weight of the evidence.
    ¶ 59       For the foregoing reasons, the judgment of the circuit court of La Salle County is affirmed.
    ¶ 60      Affirmed.
    ¶ 61       JUSTICE CARTER, specially concurring.
    ¶ 62       I join the majority opinion without reservations. However, I write separately in order to
    present an additional rationale in support of the holding, finding that the defendants were not
    denied a fair trial when the trial court limited the defendants’ attorneys to participating only
    one at a time during the trial. It is not uncommon for judges in some cases encompassing
    claims or defenses held by multiple parties, such as class actions, derivative lawsuits, mass tort
    actions, or other representative actions, to place some controls over the litigation, including
    empowering one attorney to conduct part of the trial. See Principles of the Law: Aggregate
    Litigation § 1.05 cmts. b, c (Am. Law Inst. 2009). Likewise, it would not be unusual, in a
    situation where the parties’ litigation interests are nominally the same, for the judge to place
    some reasonable limitations on the parties regarding trial participation, subject to due process
    concerns. The decisions made by a trial judge in overseeing his or her courtroom or in
    maintaining the progress of a trial are generally reviewed for an abuse of discretion. See In re
    D.T., 
    212 Ill. 2d 347
    , 356 (2004).
    ¶ 63       The due process clause of both the Illinois and United States Constitutions requires, at a
    minimum, that litigants have a full and fair opportunity to litigate an issue before they are
    bound by that issue’s resolution. U.S. Const., amends. V, XIV; Ill. Const. 1970, art. I, § 2;
    Central Illinois Public Service Co. v. Allianz Underwriters Insurance Co., 
    158 Ill. 2d 218
    ,
    225-26 (1994) (insurers were deprived of procedural due process when they were barred from
    participating at trial and also denied a severance). A fundamental requirement of due process is
    that a party be afforded the opportunity to be heard at a meaningful time and in a meaningful
    manner, with the operative term being “ ‘meaningful.’ ” In re D.W., 
    214 Ill. 2d 289
    , 316
    (2005); see Mathews v. Eldridge, 
    424 U.S. 319
    , 333 (1976) (citing Armstrong v. Manzo, 
    380 U.S. 545
    , 552 (1965)). “ ‘Due process is flexible and calls for such procedural protections as
    the particular situation demands’ ” related to time, place, and circumstances. 
    Mathews, 424 U.S. at 334
    (quoting Morrissey v. Brewer, 
    408 U.S. 471
    , 481 (1972)). However, meaningful
    participation does not mean that parties with a common interest have a right to overlap their
    questions and arguments. That is, a principle complimentary to due process is the rule that trial
    court judges may manage a trial in order to promote efficiency within the limits of due process.
    See Ill. R. Evid. 611(a) (eff. Jan. 1, 2011).
    ¶ 64       Illinois Rule of Evidence 611 sets out the basic principle that the trial court has the
    authority to control all aspects of a trial, including the order of presentation of evidence and the
    manner in which the proceedings will be conducted in general. See Ill. R. Evid. 611(a) (eff.
    Jan. 1, 2011). In addition, under Illinois Rule of Evidence 403 (eff. Jan. 1, 2011), evidence can
    be excluded based on consideration of undue delay, waste of time, or needless presentation of
    cumulative evidence. As to examination of witnesses, Professor Wigmore indicated that it had
    - 11 -
    long been a tradition that but one attorney should question during a single stage in the
    examination of a single witness. 3 John H. Wigmore, Evidence § 783 (Chadbourn rev. ed.
    1970). Professor Wigmore pointed out that the rule had been recognized in both judicial
    proceedings generally and in a few statutes. 
    Wigmore, supra
    . It thus appears that there is no
    rule prohibiting judges, at their discretion, from allowing examination of witnesses and
    presentation of arguments to be split or divided between the attorneys for parties with identical
    interests.
    ¶ 65       That same authority existed in the English common-law tradition as found in Campbell’s1
    Report of Cases determined at Nisi Prius. Where separate attorneys appeared for several
    defendants with the same interest, only one counsel could be heard when addressing the jury or
    when conducting examination of the witnesses. Chippendale v. Masson (1815) 171 Eng. Rep.
    56; 4 Camp. 174; cf. Doe v. Roe (1809) 170 Eng. Rep. 1155; 2 Camp. 280 (generally the
    examination of a witness should be carried out by only one counsel when a party is represented
    by several attorneys, but there can be exception to that rule if justice requires). In Chippendale,
    Chief Justice Gibbs2 stated:
    “[T]he interest of the defendants being the same, I can only hear one counsel. This is a
    rule I received from a judge of whom no one can speak without respect and almost
    reverence; I mean my very learned and excellent predecessor, Chief Justice
    Mansfield.[3] By this rule I will abide. It cannot be left in the power of a number of
    defendants whose interests are precisely the same, by separating in their defences, to
    make 20 causes out of one. I consider it a remote possibility that such an attempt should
    be made; but rules of practice must be framed with a view to enforce the regular and
    decorous conduct of judicial business. I therefore consider it as established, that where
    several defendants in the same interest defend separately, the counsel who happens to
    be senior, and he alone, can address the jury. The witnesses are to be examined by
    counsel successively, in the same manner as if the defence were joint and not separate.”
    Chippendale, 171 Eng. Rep. at 56-57; 4 Camp. at 174-75.
    ¶ 66       In the instant case, the trial judge had the same concerns as those found in the old English
    case. The trial court was concerned with protecting witnesses from unduly confusing and
    excessive cross-examination and repetitive arguments. At the posttrial motion hearing, the trial
    court explained its reasoning as to the dual representation procedure:
    “To have both Defendants present an opening statement, closing statement and
    question the witnesses I think would have been redundant and unnecessary given the
    facts and circumstances that we have here. The trial took nearly a month as we
    conducted it. I think it was well within this court’s discretion to limit the Defendants in
    the manner that it did to prevent repetition and to assure the trial proceeded in a timely
    manner.
    1
    John Campbell, 1st Baron Campbell, PC, QC (September 17, 1779 to June 24, 1861) Chief Justice,
    Queen’s Bench (March 5, 1850 to June 24, 1859).
    2
    Sir Vicary Gibbs, PC, KC (October 27, 1751 to 1820) Chief Justice of the Common Pleas (1814 to
    1818).
    3
    Sir James Mansfield, SL, KC (1733 to November 23, 1821) Chief Justice of the Common Pleas
    (1799 to 1814).
    - 12 -
    This is not a circumstance where liability of each Defendant was based on some
    kind of different facts at different times or some kind of factual differences. It was
    liability, it was just that, it was vicarious liability. If Dr. Gujrati was found liable,
    Central Illinois Pathology was also going to be found liable. I think to allow multiple
    closing arguments, to allow multiple opening statements, and to allow multiple
    questioning would have prejudiced the Plaintiff in this case and would have been an
    inefficient use of trial time.”
    ¶ 67       Earlier, before the trial, the trial judge articulated his reasoning as follows:
    “I think it comes down to a trial management issue as to questioning of witnesses, and
    Mr. Vedrine’s point it’s something the court is going to have to deal with at trial if an
    issue comes up where that witness has been asked the question by one counsel and the
    other counsel is going to try to ask the same question, the court is going to have to deal
    with this. This court wants an efficient trial. I don’t want to keep dealing with
    questions, nuances of questions. I want it to run efficiently.”
    ¶ 68       Given a court’s power to control the conduct of trial procedure, the trial judge can, at his
    discretion, split examination of witnesses and divide the opening statements and closing
    arguments between counsel for separately represented defendants with identical interests. In
    this particular case, the trial judge reasoned that to allow multiple arguments and questions
    would have been redundant and unnecessary given the nature of the case, since if Dr. Gujrati
    was found liable, then Central Illinois Pathology would also be found liable based on
    principles of vicarious liability. The defendants had a commonality of interest in the defense.
    ¶ 69       Defendants in the instant case have failed to point to any evidence or argument that they
    were prevented from introducing at the trial. The defendants simply do not show they were
    prejudiced in any manner. Nothing in the procedures that were followed resulted in unfairness
    to any party, violated fundamental due process, or constituted an abuse of discretion. Both
    defendants, through their attorneys, were afforded the opportunity to be heard at a meaningful
    time and in a meaningful manner during this trial.
    ¶ 70       Thus, for the reasons stated above, I respectfully specially concur with the majority
    opinion.
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