Strino v. Premier Healthcare Associates
365 Ill. App. 3d 895, 850 N.E.2d 221 (2006)
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Rule of Law:
An agency relationship for medical decision-making can be established through circumstantial evidence, including a patient's silence and non-verbal cues when their spouse is making medical decisions on their behalf, allowing a jury to determine the existence and scope of such agency. Furthermore, under the 'two-issue' rule, an appellate court will not reverse a general verdict for an alleged error in instructing the jury on a particular issue (like contributory negligence) if there was another distinct issue (like primary negligence) that could independently support the verdict, and no special interrogatory was requested to ascertain the jury's specific findings.
Facts:
- In September 1996, Maria Strino chose Dr. James Lindemulder as her obstetrician and agreed to attempt a vaginal birth after cesarean (VBAC) for her next child.
- On March 27, 1997, Maria was admitted to Rush-Copley Medical Center for delivery, and Dr. Lindemulder prescribed medicine to induce labor.
- On the morning of March 28, 1997, Maria received more labor-inducing medicine, and after 10 a.m., she began experiencing hyperstimulation with decreasing fetal heart rates.
- Around 3:45 p.m., Dr. Lindemulder suggested using forceps for immediate delivery due to fetal heart decelerations.
- Frank Strino, Maria's husband, told Dr. Lindemulder not to use forceps and instead demanded a cesarean section, allegedly threatening to sue or physically assault the doctor.
- Dr. Lindemulder testified that he then directly asked Maria if he could use the forceps, and she 'closed her eyes, shook her head no and looked away.'
- Dr. Lindemulder performed an emergency cesarean section, finding Maria's uterus ruptured, and delivered Joseph at 4:10 p.m. through the rupture.
- Joseph suffered severe damage due to lack of oxygen during the birthing process and required constant care until his death in November 1998 at 20 months of age.
Procedural Posture:
- Maria and Frank Strino, individually and on behalf of Joseph's estate, sued Dr. James Lindemulder and his employer, Premier Healthcare Associates, in the trial court in 2000.
- Plaintiffs sought recovery for alleged negligent failure to warn of VBAC risks and negligent failure to deliver the fetus in a timely manner, claiming Dr. Lindemulder's negligence caused Joseph's death and suffering.
- Defendants asserted that Dr. Lindemulder complied with the standard of care and that plaintiffs acted with contributory negligence by denying his request to use forceps.
- The trial court judge instructed the jury on agency and contributory negligence, and refused a battery-focused consent instruction requested by plaintiffs.
- During deliberations, the jury sent several questions to the judge, including one about distinguishing negligence and contributory negligence, and later reported being deadlocked.
- The judge reread all instructions to the jury after denying a defense motion for a mistrial (which plaintiffs did not join).
- The jury returned a general verdict in favor of the defendants.
- Plaintiffs appealed the trial court's judgment.
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Issue:
1. Does a patient's silence and non-verbal communication in response to a spouse's medical decision provide sufficient evidence for a jury to find an agency relationship, thereby making the spouse's decision binding on the patient? 2. Does the 'two-issue' rule preclude appellate review of an allegedly erroneous jury instruction on contributory negligence in a survival action when a general verdict was returned and no special interrogatory was requested to clarify the jury's specific finding on the primary negligence issue?
Opinions:
Majority - Presiding Justice McNulty
Yes, sufficient evidence was presented for a jury to find that Frank Strino acted as Maria Strino's agent for medical decisions. The court held that agency can be established by circumstantial evidence, including the situation of the parties, their acts, and the alleged principal's silence when knowingly allowing another to act for them. Dr. Lindemulder's testimony that Maria heard Frank forbid the use of forceps and remained silent, followed by her own non-verbal 'no' gesture when directly asked, provided a basis for a reasonable person to conclude that Maria implicitly authorized Frank to speak on her behalf, or ratified his request. Therefore, the trial court did not abuse its discretion by admitting Dr. Lindemulder's testimony regarding Frank's actions or by instructing the jury on agency. Additionally, yes, the 'two-issue' rule precludes appellate review of the allegedly erroneous jury instruction on contributory negligence. The court applied the 'two-issue' rule, which states that where a general verdict is returned and there are two distinct issues (like primary negligence and contributory negligence), and no special interrogatory was requested, it is presumed that all issues were determined in favor of the successful party. Since the jury could have found in favor of the defendants based on their claim of no negligence, the court could not determine whether any error in the contributory negligence instruction affected the verdict. Thus, the alleged error did not warrant reversal. The court also affirmed other trial court rulings, finding no abuse of discretion in restricting cross-examination regarding omitted deposition testimony (as it was not materially inconsistent) and upholding the rejection of a battery-focused jury instruction in a negligence case. Other objections were deemed waived due to lack of citation to authority or failure to object at trial.
Concurring - Justice Tully
Justice Tully concurred in the judgment.
Concurring - Justice O’Malley
Justice O’Malley concurred in the judgment.
Analysis:
This case clarifies the evidentiary standards for establishing agency in medical decision-making, emphasizing that a patient's non-verbal actions and even silence can contribute to a finding of apparent authority for a family member. It reinforces the importance of using special interrogatories to preserve specific issues for appellate review, as the 'two-issue' rule can otherwise insulate general verdicts from reversal even if some jury instructions were erroneous. The decision highlights the responsibility of litigants to make timely objections at trial and cite relevant legal authority on appeal to avoid waiver of arguments, thus shaping litigation strategy for medical malpractice cases and general tort law.
