2026 IL App (1st) 251630
FIFTH DIVISION
September 18, 2026
No. 1-25-1630
IN THE
APPELLATE COURT OF ILLINOIS
FIRST DISTRICT
KATHLEEN SPIES and ALAN SPIES, ) Appeal from the
) Circuit Court of
Plaintiffs-Appellants, ) Cook County
)
v. ) No. 2020L008663
)
ABDUL AMINE and AMINE, M.D. S.C., ) The Honorable
) Frank J. Andreou,
Defendants-Appellees. ) Judge Presiding.
JUSTICE WILSON delivered the judgment of the court, with opinion.
Presiding Justice Oden Johnson concurred in the judgment and opinion.
Justice Mitchell concurred in part and dissented in part, with opinion.
OPINION
¶1 Plaintiffs, Kathleen Spies and Alan Spies, appeal from the entry of judgment in favor of
defendants in this medical malpractice action. Before trial, the circuit court barred plaintiffs’
retained medical expert from offering opinions on proximate causation and damages because those
opinions were not disclosed under Illinois Supreme Court Rule 213(f)(3) (eff. Jan. 1, 2018) and,
in any event, the expert declined at his deposition to offer them. The court then entered judgment
for defendants, finding that plaintiffs could not establish a causal connection between the alleged
deviations from the standard of care and the damages claimed. For the reasons that follow, we
affirm in part and reverse in part.
No. 1-25-1630
¶2 I. BACKGROUND
¶3 A. Medical Treatment and Underlying Allegations
¶4 Before the treatment at issue, Kathleen had a history of chronic back pain. In 2015, after a
work-related injury, defendant Dr. Abdul Amine, M.D., implanted an intrathecal morphine pump
to help manage that pain. An intrathecal morphine pump is a device implanted under the skin that
delivers pain medication through tubing into the intrathecal space, the area around the spinal cord
that contains cerebrospinal fluid (CSF).
¶5 On or about May 17, 2017, Kathleen presented to Advocate Christ Medical Center with
symptoms attributed to opiate withdrawal. After it was determined that her intrathecal morphine
pump was malfunctioning, Dr. Amine performed surgery on May 19, 2017, to address the
malfunctioning pump and catheter system (the first surgery).
¶6 Dr. Amine’s operative report for the first surgery described removal of the old pump,
implantation of a new pump, and insertion of a new catheter. It recited that “old tubing was
attached and the pump inserted.” The record also contains an edited version of the report in which
“old” is struck and replaced, so that the sentence reads that “new tubing was attached and the pump
inserted.” Defendants maintained that the original reference to “old tubing” was a typographical
error and that the new catheter was in fact connected to the new pump. Plaintiffs relied on the
original language to allege that Dr. Amine left old catheter tubing in place without removing,
securing, or ligating it, leaving a segment through which CSF could escape. The discrepancy
between the two versions of the operative report later became a subject of expert discovery.
¶7 Plaintiffs alleged that during the first surgery Dr. Amine “inserted a new intrathecal
catheter” but “improperly attach[ed] the old, non-functioning catheter to the new morphine pump,”
“improperly tested the new catheter, which was not attached to the pump,” and “failed to properly
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No. 1-25-1630
ligate and secure the excess catheters left in [Kathleen’s] body.” Plaintiffs further alleged that,
following the first surgery, Kathleen “experienced a leak of [CSF], from her intrathecal catheter,”
along with headaches and blackouts, which necessitated a second surgery performed by Dr. Amine
on May 26, 2017 (the second surgery), to locate and repair the leak. 1
¶8 Dr. Amine’s operative report for the second surgery stated that he observed CSF leaking
from the “old tubing” that remained in the spinal-fluid space. To stop the leak, Dr. Amine tied
knots in the old tubing, ligated it with Nurolon suture, and buried it. Kathleen returned to Dr.
Amine’s office for suture removal on June 8, 2017, the last date on which Dr. Amine treated her.
¶9 Plaintiffs alleged that, following the two surgeries, Kathleen continued to suffer severe
headaches and recurrent blackouts over the next three years, more severe than any she had
experienced before. On November 28, 2017, Dr. Brendan Gaynor performed surgery to remove
Kathleen’s implanted pain pump. Dr. Gaynor’s operative note stated that the pump was removed
because Kathleen was not tolerating the therapy due to medication side effects and discomfort
from the pump beneath her skin. The operative note further stated that, when Dr. Gaynor
disconnected the catheter and removed the pump, he observed “no egress,” or leak, of CSF from
the tubing. The remaining intrathecal catheters were not removed.
¶ 10 On April 14, 2020, Kathleen was seen by Dr. Ryan Trombly by virtual visit for chronic
back pain, leg pain, daily migraines, and pain between her shoulder blades. Dr. Trombly noted that
Dr. Gaynor had removed Kathleen’s intrathecal pump in 2017 and that her headaches had
worsened since that time. After reviewing imaging, Dr. Trombly determined that Kathleen had
1
The record contains inconsistent references to the date of the second surgery. Plaintiffs’ brief refers to May 26, 2017, while Dr. Ryan Zengou’s disclosure and other portions of the record refer to May 27, 2017. Dr. Amine’s operative report identifies May 26, 2017, as the surgery date and May 27, 2017, as the date the report was created.
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No. 1-25-1630
severe stenosis at L4-L5 and L5-S1 and required treatment for spinal headaches and lumbar
decompression.
¶ 11 On May 12, 2020, Dr. Trombly removed Kathleen’s spinal cord stimulators and her
retained intrathecal pain-pump catheters. His operative report reflected that CSF leaked after a
catheter was removed but did not identify the location of the leak. The following day, Dr. Trombly
performed lumbar decompression and fusion procedures. Kathleen testified that her blackouts and
severe headaches resolved after the May 2020 surgery. She continued treatment with Dr. Trombly
for low-back pain and later underwent an L2-L4 fusion in November 2023.
¶ 12 B. The Operative Complaint and the Claims
¶ 13 On September 20, 2022, Kathleen and Alan filed their operative fourth amended complaint
naming as defendants Abdul Amine, M.D., his professional corporation, Abdul Amine, M.D., S.C.,
and several other health-care providers. In the counts relevant to this appeal, Kathleen alleged that
Dr. Amine deviated from the standard of care during and after the May 19, 2017, surgery by,
among other things, failing to properly install and ligate the catheter tubing, resulting in chronic
headaches, blackouts, and other injuries. Alan also alleged a derivative claim for loss of
consortium.
¶ 14 Plaintiffs also attached to the complaint the certificate of merit and reviewing health
professional’s report required by section 2-622 of the Code of Civil Procedure (Code) (735 ILCS
5/2-622 (West 2022)). The author of the section 2-622 report was later identified as Dr. Ryan
Zengou.
¶ 15 C. The Rule 213(f)(3) Disclosure and Deposition
¶ 16 During pretrial discovery, plaintiffs initially disclosed Dr. Jonathan Citow as their
controlled expert witness under Illinois Supreme Court Rule 213(f)(3) (eff. Jan. 1, 2018). Plaintiffs
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No. 1-25-1630
thereafter moved to substitute their Rule 213 disclosures, and the circuit court entered an order
granting the motion to substitute on April 1, 2024. On April 29, 2024, plaintiffs disclosed Dr. Ryan
Zengou, a board-certified neurosurgeon practicing in Tulsa, Oklahoma, as their sole retained
medical expert under Rule 213. Dr. Zengou never treated Kathleen; he was retained to review the
medical records and offer opinions concerning the standard of care applicable to Dr. Amine’s
surgical treatment.
¶ 17 Dr. Zengou’s Rule 213(f)(3) disclosure, which was substantially identical to his earlier
section 2-622 report, stated, among other things, that he had reviewed Kathleen’s records and
would testify that Dr. Amine “improperly attach[ed] the old, non-functioning catheter to the new
morphine pump,” “failed to properly ligate and secure the excess catheters left in Kathleen Spies’
body,” that “[a]fter surgery, Plaintiff Kathleen Spies experienced headaches, which are a known
sequela of a CSF leak.” The disclosure further stated that “spinal headaches can also be a symptom
of an ongoing leak of CSF” and that plaintiff’s “blackouts” were “another known symptom of a
CSF leak.” The disclosure also stated that in May 2020 Dr. Trombly suspected and surgically
discovered an ongoing CSF leak and that Dr. Amine’s failure to investigate and correct a potential
CSF leak between May 2017 and May 2020 “was outside the standard of care.”
¶ 18 Dr. Zengou was deposed on May 28, 2024. As to the standard of care, Dr. Zengou testified
that his criticism was conditional, stating that his “whole basis” for the criticism “was whether the
old catheter was hooked up to the new pump” and that “[t]hat’s all I can base it on.” He explained
that his criticism was based on Dr. Amine’s original operative note, which referred to “old tubing”
being attached. When later asked about the edited operative note reflecting that “the new tubing
was attached,” Dr. Zengou acknowledged that, based on that note, the procedure complied with
the standard of care.
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No. 1-25-1630
¶ 19 On redirect, Dr. Zengou was asked about an edited or corrected version of the operative
note and testified, “[b]ased on the edited version, it looks like it was corrected *** I didn’t have
an edited version, no deposition.” On re-cross, he was asked about the discrepancy and testified,
“That’s correct. We all make typos.”
¶ 20 As to causation and damages, Dr. Zengou repeatedly testified that he was not offering
opinions on the sequelae or injuries plaintiff allegedly sustained:
“Q. *** And then whatever sequelae or injuries Ms. Spies sustained as a
result of that CSF leak, you’re not going to comment on; is that fair?
A. That’s fair. And my initial review was that there—my main question
was whether the old catheter was hooked up and a new catheter was left in place
not hooked up to the pump.
***
Q. Okay. And then in terms of the sequelae and injury Ms. Spies had,
that’s not something you’re commenting on, true?
A. True. I don’t know what the outcomes were of those things. I reviewed
records. There was a question of CSF of spinal headaches. I don’t know if that
was ever evaluated. I don’t know.
***
Q. And in terms of whether or not there was a second CSF leak
preoperatively, you don’t have an opinion, fair?
A. Correct.”
¶ 21 The parties disputed the scope and effect of Dr. Zengou’s disclosure and deposition
testimony. Defendants asserted that Dr. Zengou’s disclosure did not contain an opinion that Dr.
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No. 1-25-1630
Amine’s alleged negligence proximately caused Kathleen’s headaches, blackouts, or other claimed
damages and that his deposition testimony confirmed he would not offer such opinions at trial.
Defendants further asserted that Dr. Zengou had limited his standard-of-care criticism after
reviewing the edited operative note. Plaintiffs, in turn, maintained that Dr. Zengou’s disclosed
opinions adequately placed defendants on notice of his causation and damages testimony or, at a
minimum, that such testimony was a natural and logical corollary of his Rule 213(f)(3) disclosure.
Plaintiffs further maintained that any narrowing of Dr. Zengou’s standard-of-care criticism went
to the weight and credibility of his testimony, not its admissibility.
¶ 22 D. Motions in Limine and Judgment
¶ 23 On June 14, 2024, the morning of trial, the circuit court heard oral arguments on
defendants’ motions in limine, including motion in limine No. 7, which sought to bar Dr. Zengou
from offering (1) standard-of-care and (2) causation and damages testimony. In addition, it
requested dismissal of the action if he were barred from offering either form of testimony, for
failure to establish a claim. The court denied part one of the motion, and that ruling is not
challenged on appeal.
¶ 24 The court then addressed part two of the motion concerning causation and damages.
Reviewing the deposition transcript on the record, the court observed that Dr. Zengou testified that
he was “not going to comment on” Kathleen’s sequelae or injures she sustained as a result of the
CSF leak, that he “[didn’t] know *** the outcomes” of those symptoms, and could not causally
connect them to the alleged negligence. The court acknowledged that dismissing a claim pursuant
to a motion in limine was an “unusual request” but found that impaneling a jury would be futile
because the record contained no expert testimony linking the alleged breach to the claimed injury.
Concluding that plaintiffs could not prove the essential element of proximate causation without
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No. 1-25-1630
that testimony, the circuit court granted part two of motion in limine No. 7 and entered judgment
in favor of defendants.
¶ 25 In a written order entered June 18, 2024, the court memorialized its evidentiary rulings.
Consistent with its oral pronouncement, the court denied part one of motion in limine No. 7, which
concerned Dr. Zengou’s standard-of-care opinions, but granted part two, barring him from
testifying regarding damages “for the reasons stated on the record.”
¶ 26 E. Plaintiffs’ Motion to Reconsider
¶ 27 Following a granted extension of time, plaintiffs filed a motion to reconsider the circuit
court’s June 14 and June 18, 2024, rulings on August 2, 2024. The motion was fully briefed, but
before the motion could be heard, plaintiffs’ counsel, Albert Brooks Friedman, died. The circuit
court stayed its ruling on the motion and granted plaintiffs until March 10, 2025, to retain substitute
counsel. When plaintiffs had not retained new counsel by that date, the court granted them a final
extension until June 4, 2025.
¶ 28 On June 4, 2025, plaintiffs’ current counsel, William Fitzpatrick, was granted leave to
appear and to file a supplemental brief in support of the motion. Defendants thereafter filed a
supplemental response, and the court set the motion for argument on July 23, 2025. Following
argument, the court denied the motion. In its ruling, the court stated that it “treat[ed] the original
Defendants request for dismissal in motion in limine #7 as a motion for summary judgment and
grants it in favor of defendant.” The court also addressed the procedure it had followed, stating
that “the mechanism of dismissal *** can’t be a motion in limine *** dismissing the case by way
of a motion in limine is not proper.” The court concurrently “denie[d] the plaintiffs request to
require the defendant to file a motion for summary judgment and den[ied] plaintiffs[’] request to
respond to the motion for summary judgment.”
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¶ 29 Plaintiffs filed a timely notice of appeal on August 21, 2025. This court has jurisdiction
over this appeal pursuant to Illinois Supreme Court Rule 301 (eff. Feb. 1, 1994).
¶ 30 II. ANALYSIS
¶ 31 This appeal presents two related but analytically distinct questions. First, whether the
circuit court erred in granting that portion of defendants’ motion in limine No. 7 that barred
plaintiffs’ sole Rule 213(f)(3) expert, Dr. Zengou, from testifying on proximate causation and
damages. Second, whether the circuit court, having barred that testimony, properly entered
judgment for defendants. Because proximate causation in this case required expert testimony, the
evidentiary ruling was necessarily dispositive. We address the two issues in turn.
¶ 32 A. Standard of Review
¶ 33 The parties dispute the applicable standard of review. Defendants contend that the decision
to bar Dr. Zengou was an evidentiary ruling reviewed for an abuse of discretion (see Gomez v. The
Finishing Co., 369 Ill. App. 3d 711, 723 (2006)), and that the balance of the court’s order, having
disposed of the case as a matter of law, is reviewed de novo (see Zameer v. City of Chicago, 2013
IL App (1st) 120198, ¶ 12). Plaintiffs contend that de novo review governs in its entirety because,
in denying reconsideration, the circuit court expressly stated that it was treating defendants’
request for dismissal in motion in limine No. 7 as a motion for summary judgment. See Adams v.
Northern Illinois Gas Co., 211 Ill. 2d 32, 43 (2004).
¶ 34 We begin with the evidentiary ruling. It is well settled that the decision to admit or exclude
evidence is in the trial court’s “inherent power” and will not be disturbed absent an abuse of
discretion. Agnew v. Shaw, 355 Ill. App. 3d 981, 990 (2005). An abuse of discretion occurs where
the trial court acts arbitrarily without conscientious judgment, exceeds the bounds of reason, and
ignores recognized principles of law. Alm v. Loyola University Medical Center, 373 Ill. App. 3d
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No. 1-25-1630
1, 4 (2007). A ruling on a motion in limine is reviewed de novo only where the issue it presents is
a pure question of law. Schandelmeier-Bartels v. Chicago Park District, 2015 IL App (1st)
133356, ¶ 25. Here, the decision to bar Dr. Zengou’s testimony did not present a pure question of
law. It required the circuit court to evaluate the scope of his disclosed opinions and deposition
testimony and to determine whether plaintiffs had an adequate evidentiary basis to elicit causation
and damages opinions at trial. We therefore review that ruling for an abuse of discretion.
¶ 35 We are unpersuaded by plaintiffs’ contention that the circuit court’s later characterization
of its ruling as a summary judgment requires de novo review of the decision to bar Dr. Zengou’s
testimony. The standard of review is not dictated by the label the circuit court attached to its ruling;
it depends on the nature of the appellant’s contentions and the question presented for review. In re
Estate of Burd, 354 Ill. App. 3d 434, 436 (2004). Plaintiffs cite no authority for the proposition
that a circuit court’s treatment of the resulting disposition as summary judgment displaces the
abuse of discretion standard otherwise governing the antecedent evidentiary ruling. Even accepting
that the court treated the resulting disposition as a summary judgment, that characterization does
not govern the standard applicable to the underlying decision to bar Dr. Zengou’s causation and
damages opinions, which turned on the scope and adequacy of his disclosed and sworn opinions
and remains an evidentiary determination reviewed for an abuse of discretion.
¶ 36 The separate question—whether the circuit court properly entered judgment after
excluding that testimony—is reviewed de novo. That determination, that the exclusion left
plaintiffs unable to prove an essential element and thereby entitled defendants to judgment as a
matter of law, is a dispositive legal ruling. See In re Pension Reform Litigation, 2015 IL 118585,
¶ 43 (reviewing court reviews the trial court’s decision on a question of law de novo). Accordingly,
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we apply an abuse of discretion standard to the evidentiary ruling and de novo review to the
resulting judgment.
¶ 37 B. The Circuit Court Did Not Abuse Its Discretion in Barring Dr. Zengou’s Causation
and Damages Testimony
¶ 38 Plaintiffs contend that the circuit court erred in barring Dr. Zengou from offering causation
and damages opinions, arguing that those opinions were adequately disclosed, or were at least a
natural and logical corollary to the opinions set forth in his Rule 213(f)(3) disclosure. For the
reasons that follow, we find that the circuit court did not abuse its discretion.
¶ 39 To prevail in a medical-malpractice action, plaintiffs have the burden of proving (1) the
proper standard of care by which to measure a defendant’s conduct, (2) a negligent breach of the
standard of care, and (3) that the resulting injury was proximately caused by the breach. Seef v.
Ingalls Memorial Hospital, 311 Ill. App. 3d 7, 15 (1999). Each element must be established
through expert testimony. Id. As to causation in particular, the connection between the alleged
deviation and the injury “must be established by expert testimony to a reasonable degree of medical
certainty,” and it “must not be contingent, speculative, or merely possible.” Townsend v. University
of Chicago Hospitals, 318 Ill. App. 3d 406, 413 (2000). Where a plaintiff cannot create a triable
issue on proximate cause, no prima facie case exists. Id.
¶ 40 “The purpose of discovery rules, governing the ‘timely disclosure of expert witnesses, their
opinions, and the bases for those opinions[,] is to avoid surprise and to discourage strategic
gamesmanship.’ ” Spaetzel v. Dillon, 393 Ill. App. 3d 806, 812 (2009) (quoting Thomas v. Johnson
Controls, Inc., 344 Ill. App. 3d 1026, 1032 (2003)). Rule 213 disclosures are mandatory and strict
compliance is required. Sullivan v. Edward Hospital, 209 Ill. 2d 100, 109 (2004). At the same
time, the rule is to be liberally construed to do substantial justice between the parties, and it
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operates as “a shield to prevent unfair surprise but not a sword to prevent the admission of relevant
evidence on the basis of technicalities.” Ill. S. Ct. R. 213, Committee Comments (adopted Mar.
28, 2002); Clayton v. County of Cook, 346 Ill. App. 3d 367, 377 (2004).
¶ 41 Rule 213(f)(3) requires parties to furnish, among other things, the subject matter,
conclusions, and opinions of controlled expert witnesses who will testify at trial. Ill. S. Ct. R.
213(f)(3) (eff. Jan. 1, 2018). Illinois Supreme Court Rule 213(g) (eff. Jan. 1, 2018) limits expert
opinions at trial to “[t]he information disclosed in answer to a Rule 213(f) interrogatory, or in a
discovery deposition.” An expert “may elaborate on a disclosed opinion as long as the testimony
states logical corollaries to the opinion rather than new reasons for it.” (Emphasis in original.)
Jones v. Beck, 2014 IL App (1st) 131124, ¶ 16. Conversely, an opinion that was never properly
disclosed falls outside the scope of permissible direct examination and, “[e]xcept upon a showing
of good cause,” “shall not be admissible upon objection.” Ill. S. Ct. R. 213(g) (eff. Jan. 1, 2018).
¶ 42 Applying these principles, the dispositive question is not whether Dr. Zengou was critical
of Dr. Amine’s care as plaintiffs suggest, but whether he disclosed—and was prepared to offer—
an admissible opinion, to a reasonable degree of medical certainty, that Dr. Amine’s alleged
deviations proximately caused Kathleen Spies’s claimed injuries, including her postoperative
headaches and blackouts. On this record, he did not.
¶ 43 Dr. Zengou’s Rule 213(f)(3) disclosure stated that, during the first surgery, Dr. Amine
“improperly attach[ed] the old, non-functioning catheter to the new morphine pump,” “improperly
tested the new catheter, which was not attached to the pump” and failed to “ligate and secure the
excess catheters.” Those statements identify alleged deviations from the standard of care during
the first surgery, but they do not disclose an opinion that those deviations proximately caused
Kathleen’s claimed injuries. The disclosure addressed symptomology only after the second
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surgery, stating that, “[a]fter surgery, [Kathleen] experienced headaches, which are a known
sequela of a CSF leak,” that “[s]pinal headaches can also be a symptom of an ongoing leak of
CSF,” and that her “blackouts” were “another known symptom of a CSF leak.” Plaintiffs rely on
those statements as causation opinions, or at least as a basis from which causation testimony at
trial would be a logical corollary. We disagree. The statements describe only a general medical
association that headaches and blackouts can be symptoms of a CSF leak. They do not express an
expert opinion that Kathleen’s particular headaches or blackouts were, more likely than not,
proximately caused by a leak attributable to Dr. Amine’s alleged negligence.
¶ 44 To the extent Dr. Zengou’s written disclosure left any doubt about whether he would offer
a causation opinion, his deposition eliminated it: he confirmed he had no such opinion. At his
deposition, Dr. Zengou repeatedly and affirmatively declined to offer any opinion on the sequelae
of the claimed CSF leak, namely, the headaches and blackouts that form the core of plaintiffs’
claimed damages. When asked whether those sequelae were “outside [his] area of expertise—or
outside [his] knowledge base,” he answered, “Correct.” When asked whether he was going to
comment on “whatever sequelae or injuries Kathleen sustained as a result of that CSF leak,” he
responded, “That’s fair. *** my main question was whether the old catheter was hooked up and a
new catheter was left in place not hooked up to the pump.” And again, when asked whether he was
going to comment on “sequelae and injury,” he was unequivocal: “True. I don’t know what the
outcomes were of those things *** There was a question of CSF or spinal headaches. I don’t know
if that was ever evaluated. I don’t know.” At most, Dr. Zengou’s testimony shows that the opinions
he was prepared to offer concerned Dr. Amine’s alleged deviation from the standard of care, not
whether that deviation caused Kathleen’s claimed injuries. Nothing in his disclosure or deposition
indicates that he believed, to a reasonable degree of medical certainty, that Kathleen’s headaches
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were caused by a CSF leak attributable to Dr. Amine’s negligence. Thus, the trial court did not
abuse its discretion in barring Dr. Zengou from offering at trial a causation opinion that he
disclaimed under oath in his deposition. See Mack v. Viking Ski Shop, Inc., 2014 IL App (1st)
130768, ¶ 19 (holding trial court did not abuse its discretion in excluding proximate cause
testimony where the opinion was never disclosed and the expert testified at deposition that he did
not intend to offer it).
¶ 45 Plaintiffs nevertheless argue that the circuit court should have construed Dr. Zengou’s
disclosure more liberally. They acknowledge that although Dr. Zengou’s disclosures were “not
optimal,” they were sufficient to permit him to testify that defendants’ deviations caused the CSF
leak requiring the second surgery and that the leak “might or could” have caused Kathleen’s
headaches and blackouts, citing Geers v. Brichta, 248 Ill. App. 3d 398, 407 (1993). We are not
persuaded. We acknowledge the general rule that “[a] physician may testify to what might or could
have caused an injury despite any objection that the testimony is inconclusive.” (Emphasis added.)
Id. But that principle presupposes an expert with a reliable foundation for the opinion. In Geers,
each physician had personally examined the plaintiff, reviewed her medical history, and stated that
the opinion was offered to a reasonable degree of medical certainty. Id. at 408. On that basis, the
testimony was admitted. Id.
¶ 46 Dr. Zengou provided no such foundation. Physicians “may testify to what might or could
have caused an injury,” so long as their opinions are based on reliable sources of information such
as examination of the patient or his medical records. (Emphasis added.) Ackerman v. Yapp, 2020
IL App (1st) 182708, ¶ 43 (citing Iaccino v. Anderson, 406 Ill. App. 3d 397, 407 (2010)). Here,
Dr. Zengou never examined Kathleen. He also testified that he had “reviewed the medical records
from [Advocate Health Hospitals] *** years ago,” and that he received only approximately 80
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pages of nursing records shortly before his deposition. Nothing in the record shows that he
reviewed the full, pertinent course of Kathleen’s care necessary to support a causation opinion.
Plaintiffs acknowledge the limitation in his record review but argue that it bears only on the weight
or credibility of his opinions, not their admissibility, and that the adequacy of his foundation was
not yet at issue because the case did not proceed to trial. But plaintiffs, as the proponents of the
testimony, were required to establish a reliable foundation for the causation opinion they sought
to elicit. See id. ¶¶ 39 (proponent of expert testimony must establish both the expert’s
qualifications and the reliability of the information underlying the opinion). On this record, they
did not do so.
¶ 47 Nor did Dr. Zengou state, to a reasonable degree of medical certainty or anything
equivalent, that Dr. Amine’s alleged deviations were a proximate cause of Kathleen’s injuries. As
discussed above, he expressly declined to speculate or offer an opinion on that theory. Thus,
plaintiffs failed to establish both that Dr. Zengou had a reliable foundation for the proposed
causation opinion and that he had disclosed such an opinion in the first place in either plaintiffs’
Rule 213 disclosure or deposition. Accordingly, we cannot say that the circuit court abused its
discretion in barring his causation testimony.
¶ 48 We turn to plaintiffs’ principal contention that a causation opinion was a natural and logical
corollary to Dr. Zengou’s disclosed opinions, such that barring it was an unduly rigid application
of Rule 213. Particularly, plaintiffs’ allege Dr. Zengou opined in his disclosure and deposition that
“headaches and blackouts can be among the symptoms of a spinal fluid leak” and that “a natural
and logical corollary to that opinion would be the opinion that the post-operative headaches and
blackouts suffered by the Plaintiff might or could have been caused by the CSF Leak she
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experienced after the May 19, 2017 surgery” and “whether they were or not is a factual issue for
the jury.”
¶ 49 The logical-corollary doctrine permits an expert to elaborate upon a disclosed opinion; it
does not permit a party to supply, for the first time at trial, an opinion that was never disclosed at
all. As this court has recognized, trial testimony does not violate Rule 213 where it “did not
advance a new theory of negligence or new reasons for [the expert’s] opinion” (Foley v. Fletcher,
361 Ill. App. 3d 39, 48 (2005)), or where the opinion is “ ‘an elaboration on, or a logical corollary
to, the originally revealed opinion’ ” (Aguilar-Santos v. Briner, 2017 IL App (1st) 153593, ¶ 50
(quoting Spaetzel, 393 Ill. App. 3d at 813). But “there is a fine line between elaboration and a new
opinion; if the witness crosses that line, the testimony should be excluded.” 10 Jeffrey S. Kinsler
& Jay E. Grenig, Illinois Practice, Civil Discovery § 13:30 & n.24 (2d ed. 2025) (collecting cases);
see Lisowski v. MacNeal Memorial Hospital Ass’n, 381 Ill. App. 3d 275, 291-92 (2008) (expert
witness was not entitled to testify in medical malpractice action regarding patient’s alleged
depression after surgical procedure, where expert’s disclosure failed to specify that expert would
testify regarding depression and suicide). The disclosure of a retained expert’s opinions and their
bases “is a bright line rule and must be followed.” Seef, 311 Ill. App. 3d at 24.
¶ 50 The premise common to the cases permitting elaboration is the prior disclosure of an
underlying opinion that the trial testimony refines. Here, that premise is plainly absent. Plaintiffs’
Rule 213(f)(3) disclosure described plaintiff’s headaches and blackouts as “known sequela” or
“symptom[s]” of a CSF leak, but it did not disclose an opinion that Dr. Amine’s alleged deviations
proximately caused those injuries, stated to a reasonable degree of medical certainty. Nor did Dr.
Zengou supply such an opinion at his deposition; to the contrary, he testified that the sequelae of
the claimed CSF leak fell outside his knowledge base and that he was not going to comment on
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them. A causation opinion that was never disclosed, and that the expert expressly declined to offer,
cannot be the logical corollary of a disclosed causation opinion because no such opinion existed
to elaborate upon.
¶ 51 Plaintiffs’ citation of Meeks v. Dissanayake, 2021 IL App (1st) 191420-U, is factually
distinguishable. In Meeks, the reviewing court found that the expert’s pretrial disclosures included
an opinion that the defendant nurses’ deviations “ ‘proximately caused the [d]ecedent’s death,’ ”
such that the challenged trial testimony was a permissible elaboration of a disclosed proximatecause opinion. Id. ¶ 72. Here, by contrast, no proximate-cause opinion was disclosed in the first
instance. Meeks thus illustrates the very requirement that defeats plaintiffs’ position: a corollary
must elaborate upon a disclosed opinion, and there was none.
¶ 52 Moreover, neither does the absence of the phrase “to a reasonable degree of medical
certainty” in the Rule 213, by itself, establish that the circuit court barred Dr. Zengou on a mere
formality. We agree with plaintiffs that there is “no magic” in that formulation and that an expert’s
failure to recite it does not render an otherwise grounded causation opinion inadmissible. See
Dominguez v. St. John’s Hospital, 260 Ill. App. 3d 591, 595 (1993). But the circuit court did not
bar Dr. Zengou because his disclosure omitted this term of art. It barred him because the substance
of a case-specific causation opinion, an opinion connecting Dr. Amine’s alleged deviations to
plaintiff’s headaches and blackouts, was never disclosed and never offered. The principle plaintiffs
invoke excuses the absence of particular words; it does not excuse the absence of the opinion itself.
¶ 53 C. Plaintiffs’ Common-Knowledge Theory of Causation
¶ 54 Plaintiffs alternatively contend that, even if Dr. Zengou’s causation testimony was properly
barred, dismissal of the entire action was error because certain components of their claim required
no expert causation testimony. They observe that the CSF leak following the first surgery, and the
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resulting need for a corrective second surgery, are undisputed. From this, plaintiffs reason that,
because the circuit court permitted Dr. Zengou to testify to a standard-of-care deviation, a jury
finding such a deviation could award the damages attendant to the second surgery (i.e., medical
expenses, associated pain and suffering, any scarring or temporary disability, etc.) without expert
causation testimony. Plaintiffs rely on Bombagetti v. Amine, 254 Ill. App. 3d 817 (1993), for the
proposition that, in such circumstances, causation is obvious, and the resulting damages fall within
the common knowledge of laypersons.
¶ 55 Although we agree with the general rule derived from Bombagetti, we disagree that it
applies here. Foremost, a plaintiff in a medical-malpractice action must present at least some
evidence on every essential element of the claim; absent such evidence, the defendant is entitled
to judgment as a matter of law. Sullivan, 209 Ill. 2d at 123. Those elements are the applicable
standard of care, a negligent deviation from that standard, and an injury proximately caused by the
deviation. Seef, 311 Ill. App. 3d at 15. “Unless the medical professional’s negligence is ‘grossly
apparent’ or the treatment at issue is within the common knowledge of a layperson, ‘expert medical
testimony is required to establish the applicable standard of care and the medical professional’s
deviation therefrom.’ ” White v. Advocate Condell Medical Center, 2026 IL App (1st) 240450,
¶ 122 (quoting Gulino v. Zurawski, 2015 IL App (1st) 131587, ¶ 60). Proximate cause, in turn,
must be established by expert testimony to a reasonable degree of medical certainty; “ ‘[t]he mere
possibility of a causal connection is not sufficient’ ” and the causal connection may not be
“ ‘contingent, speculative or merely possible.’ ” Id. (quoting Susnis v. Radfar, 317 Ill. App. 3d
817, 827 (2000)). Thus, deviation from the standard of care, standing alone, does not establish
proximate cause.
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¶ 56 Moreover, Bombagetti does not advance plaintiffs’ theory; if anything, it illustrates why it
fails. In that case, the surgeon removed the wrong spinal disc, an error that indisputably
necessitated a second, corrective surgery. Bombagetti, 254 Ill. App. 3d at 818. Months later, the
patient suffered a new back injury that was diagnosed as a facet dislocation. Id. at 818-19. After a
directed verdict established the defendant’s breach, the only questions that remained were
proximate cause and damages. Id. at 819. The plaintiff’s expert testified that the wrong-level
surgery caused the spine to collapse and shift, producing retrolisthesis and subluxation, and that
these conditions were, with a “ ‘fairly high probability,’ ” responsible for the patient’s later pain—
though he acknowledged no “ ‘objective evidence’ ” that the facet had been compromised by the
error. Id. at 819, 821. The defendant and his own expert conceded that the error more probably
than not caused the plaintiff’s injury, even though the defendant’s expert could not identify the
precise level at which the facet dislocation occurred, testifying that, if such a dislocation existed,
it could have occurred elsewhere in the spine. Id. at 821. On those admissions, the trial court
directed a verdict against the defendant on negligence and proximate cause, leaving only damages
for the jury. Id.
¶ 57 Bombagetti thus establishes a limited principle: a medical expert may testify to more than
one possible cause of an injury without identifying the precise cause, leaving to the jury whether
the evidence establishes causation. Id. at 821-22. But that principle presupposes an expert opinion
establishing some causal link in the first instance. In Bombagetti, the plaintiff’s expert, though
unable to state the cause with certainty, connected the wrong-level surgery to the plaintiff’s later
spinal conditions and pain, and the defendant and his own expert conceded that point. Id. at 822.
Plaintiffs have offered no comparable opinion here. As discussed, their Rule 213(f)(3) disclosure
did not state, to a reasonable degree of medical certainty, that Dr. Amine’s alleged deviations
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proximately caused Kathleen’s injuries after either surgery or necessitated the subsequent surgery.
As a matter of law, Dr. Zengou could not testify beyond the scope of that disclosure. In any event,
he affirmatively declined at his deposition to offer such an opinion, eliminating any claimed
ambiguity in the disclosure regarding the scope of his causation testimony. Bombagetti therefore
does not cure the absence of a disclosed causation opinion from Dr. Zengou.
¶ 58 Nor can lay inference or common knowledge fill that gap. Even accepting that Kathleen
had a CSF leak after the first surgery and required a second surgery, those facts establish only a
sequence of events. They do not answer the antecedent medical question whether any assumed
deviation by Dr. Amine caused the leak, Kathleen’s later symptoms, or the need for the subsequent
surgery. In a medical-malpractice action, proximate cause must be established through expert
testimony to a reasonable degree of medical certainty; a causal connection that is merely possible,
speculative, or inferred from sequence alone is insufficient. White, 2026 IL App (1st) 240450,
¶ 122. This case presented a complex causation inquiry involving neurosurgical procedures, which
was further complicated by Kathleen’s extensive medical history and the record’s indication that
she had experienced similar, though less severe, symptoms before Dr. Amine’s treatment.
Determining whether any deviation during either May 2017 procedure caused the spinal-fluid leak
or Kathleen’s later symptoms therefore required medical expertise beyond ordinary lay
understanding. See, e.g., Advincula v. United Blood Services, 176 Ill. 2d 1, 23-24 (1996) (and cases
cited therein); Walski v. Tiesenga, 72 Ill. 2d 249, 257 (1978) (noting that examples of this exception
in medical malpractice cases include instruments left in a patient’s body after surgery and X-ray
burns). The record reveals no glaring, self-evident negligence; the issue instead turns on competing
interpretations of operative findings and medical records. The narrow common-knowledge
exception therefore does not apply.
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¶ 59 D. Entering Judgment Based on Motion in Limine No. 7 Was Reversible Error
¶ 60 Plaintiffs next challenge the circuit court’s entry of judgment after it barred Dr. Zengou
from offering causation and damages testimony. Although we have concluded that the evidentiary
ruling itself was not an abuse of discretion, a separate question remains whether that ruling
supplied a proper procedural basis for terminating plaintiffs’ entire action before trial. We
conclude that it did not.
¶ 61 Foremost, plaintiffs’ briefing on this point is limited. Their opening brief invokes the circuit
court’s conversion principally to support de novo review but does not separately develop, with
pertinent authority, an argument that the conversion itself was improper. Generally, a point not
supported by argument and authority is deemed forfeited. See Ill. S. Ct. R. 341(h)(7) (eff. Oct. 1,
2020); see also Hall v. Naper Gold Hospitality LLC, 2012 IL App (2d) 111151, ¶ 12 (“Mere
contentions, without argument or citation to authority, do not merit consideration on appeal.”).
Nevertheless, forfeiture is a limitation on the parties, not on this court’s authority, and we may
consider an inadequately developed issue where the record permits meaningful review. See Vance
v. Joyner, 2019 IL App (4th) 190136, ¶¶ 80-81; Marzouki v. Najar-Marzouki, 2014 IL App (1st)
132841, ¶ 12. We exercise that discretion here. We review de novo whether, after excluding Dr.
Zengou’s opinions, the circuit court properly entered judgment for defendants. Pension Reform
Litigation, 2015 IL 118585, ¶ 43.
¶ 62 We do not understand Illinois law to permit a motion in limine to be used as a substitute
for the procedures governing dispositive motions. “Motions in limine are not designed to obtain
rulings on dispositive matters but, rather, are designed to obtain rulings on evidentiary matters
outside the presence of the jury.” (Emphasis in original.) Cannon v. William Chevrolet/Geo, Inc.,
341 Ill. App. 3d 674, 681 (2003). Unlike a motion in limine, recognized dispositive procedures
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provide the nonmoving party with defined protections concerning notice and an opportunity to
respond, amend, or present opposing evidence before judgment is entered. See, e.g., 735 ILCS 5/2-615(a) (West 2024) (requiring the movant to “point out specifically the defects complained of, and
shall ask for appropriate relief,” thereby giving the nonmovant notice and an opportunity to
respond or amend); id. § 2-619(c) (permitting the nonmovant to present “affidavits or other proof”
denying or otherwise defeating the asserted grounds for dismissal); id. § 2-1005(c) (affording the
nonmovant an opportunity to demonstrate a genuine issue of material fact); see also Cook County
Cir. Ct. R. 2.1(f) (Aug. 21, 2000) (providing that, “except by prior leave of court and for good
cause shown,” summary judgment motions must be presented for “entry of a briefing schedule”
no later than 45 days before trial).
¶ 63 Illinois courts have reversed where the in limine procedure was used to circumvent those
protections. In Silverstein, the defendants orally moved in limine on the scheduled trial date to bar
the plaintiff’s standard of care expert. Silverstein v. Brander, 317 Ill. App. 3d 1000, 1002-03
(2000). The court ruled the next day and disqualified the expert. Id. at 1003. Defendants
immediately sought summary judgment and, after being required to submit a written motion,
obtained a hearing less than 24 hours later despite the plaintiff’s request for the response time
afforded by the local rules. Id. at 1003-04. Defense counsel candidly admitted that he had presented
the motion as one in limine “ ‘for [his] own strategic reasons.’ ” Id. at 1004. This court reversed,
holding that defendants could not use the in limine procedure to “avoid the requirements for
dispositive motions” after “misleadingly present[ing] a potentially dispositive motion as a motion
in limine.” Id. at 1005-06.
¶ 64 Peterson v. Randhava, 313 Ill. App. 3d 1 (2000), reached the same result, although, outside
the in limine context. There, during the pretrial stage, defendants filed an Illinois Supreme Court
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Rule 137 (eff. Feb. 1, 1994) sanctions motion, based on an allegedly false allegation within the
complaint, and the circuit court thereafter stayed discovery on all issues except that allegation.
Peterson, 313 Ill. App. 3d at 5. After denying sanctions, the court sua sponte treated the sanctions
motion as one for summary judgment and simultaneously entered judgment for defendants. Id. at
5-6. This court reversed, holding that the plaintiff had neither adequate notice that summary
judgment would be considered nor an opportunity to develop and present evidence concerning the
other issues raised by his complaint. See id. at 10-12.
¶ 65 The improper use of an in limine motion to obtain dispositive relief, however, does not
invariably require reversal. In Seef, an action arising from the stillbirth of the plaintiffs’ child, the
hospital moved in limine one week before trial to bar testimony that its nurses deviated from the
standard of care by failing to notify the treating physician sooner, arguing that plaintiffs could not
establish that the alleged delay proximately caused the child’s death. Seef, 311 Ill. App. 3d at 11-12. The trial court granted the motion, and the hospital immediately sought and was granted
dismissal of the claim against it for a lack of proximate cause. Id. at 12. On appeal, even assuming
arguendo that the dismissal was actually an untimely summary judgment ruling, this court
affirmed because plaintiffs lacked expert testimony establishing proximate cause and the treating
physician testified that earlier notice would not have altered his treatment. See id. at 17-20. Thus,
“there were no genuine issues of material fact for a jury to consider,” and further proceedings
would have been a “useless act.” (Internal quotation marks omitted.) Id. at 18-20.
¶ 66 Okic v. Fullerton Surgery Center, Ltd., 2019 IL App (1st) 181074, adopted that rationale
and labeled it as a prejudice inquiry. There, the circuit court granted several motions in limine, one
week before trial, that ultimately barred the plaintiff from presenting any evidence that his surgery
had been negligently performed. See id. ¶¶ 81-85. On appeal, this court held that the motions were
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“improper and untimely dispositive motions” but resulted in “no actual prejudice” because,
inter alia, the plaintiff identified no other evidence or anticipated testimony that could support his
surgical-negligence claim. Id. ¶¶ 84-85.
¶ 67 Plaintiffs’ procedural challenge therefore presents two questions: whether, as in Silverstein
and Peterson, they were deprived of the protections accompanying dispositive relief and, if so,
whether, as in Seef and Okic, the error nevertheless caused no actual prejudice. We conclude that
plaintiffs were deprived of those protections and that the deprivation was prejudicial.
¶ 68 Although presented, argued, and ruled upon as a motion in limine, motion in limine No. 7
sought more than the exclusion of Dr. Zengou’s standard of care and causation testimony. It also
sought dismissal of the entire case upon a favorable evidentiary ruling, asserting that plaintiffs
would then have “no expert to comment on standard of care or damages” and that “this matter
should be dismissed.” The circuit court acknowledged its peculiar posture at the June 14 hearing,
describing it as “an unusual request to have a case dismissed in limine,” and observing that,
“because we’re at trial now *** I can’t grant summary judgment.” Nevertheless, after limiting Dr.
Zengou’s causation and damages testimony, the court entered judgment for defendants, concluding
in its written order that plaintiffs “cannot establish a causal connection between the alleged
deviations from the standard of care and the damages claimed.” Neither the oral ruling nor the
written judgment identified a specific procedural vehicle for that disposition. At the
reconsideration hearing, however, the court clarified, “I am converting it to summary judgment,
and I’m granting it in favor of the defense.”
¶ 69 Indeed, motion in limine No. 7 was, in substance, an untimely motion for summary
judgment. See Peterson, 313 Ill. App. 3d at 9 (a motion should be treated according to its substance
rather than its title). Accordingly, once defendants sought dismissal of the action based on the
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No. 1-25-1630
evidentiary ruling, that relief had to be pursued through the procedures governing summary
judgment.
¶ 70 We recognize, however, that the timing of defendants’ dispositive request was largely a
product of the case’s unusual procedural posture. Trial was scheduled for June 14, 2024. Plaintiffs
did not disclose Dr. Zengou until April 29, 2024, and defendants did not depose him until May 28,
2024, only 17 days before trial. It was only then that the limits of Dr. Zengou’s opinions became
clear, after the 45-day summary-judgment deadline had passed. Thus, unlike in Silverstein, nothing
in the record suggests that defendants had an earlier opportunity to raise the dispositive issue but
strategically chose instead to proceed by motion in limine. Even so, the timing did not eliminate
the procedural protections accompanying dispositive relief. Rule 2.1(f) permitted defendants to
seek leave, for good cause, to present an otherwise untimely summary judgment motion, thereby
affording plaintiffs notice and an opportunity to respond. Cook County Cir. Ct. R. 2.1(f) (Aug. 21,
2000) (permitting a summary judgment motion after the 45-day deadline upon prior leave of court
and good cause shown).
¶ 71 Nonetheless, the record suggests that the circuit court viewed further dispositive procedure
as unnecessary because, in its view, the causation deficiency could not be cured. At the June 14
hearing, after barring Dr. Zengou’s causation testimony, the court concluded that plaintiffs lacked
an expert who could connect the alleged negligence to Kathleen’s injuries. It reasoned that “if you
don’t have the evidence now and I impanel a jury, the evidence isn’t going to change,” and that a
directed verdict in defendants’ favor would likely follow at the close of plaintiffs’ case. That view
persisted on reconsideration, where the court explained that it saw no reason to impanel a jury and
have the parties present their evidence “only to have me say *** you don’t have causation,”
because, in its view, “[t]hat issue *** [was] not *** in dispute.” The court then converted its ruling
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to summary judgment and granted judgment for defendants. When plaintiffs objected and
requested the procedural safeguards accompanying summary judgment, including an opportunity
to respond, the court nevertheless adhered to its ruling.
¶ 72 Although the circuit court did not expressly invoke Seef and Okic, its ruling tracked their
general rationale that the absence of dispositive procedural protections may be nonprejudicial
where the record establishes that the nonmovant lacks the evidence needed to sustain the claim.
See Seef, 311 Ill. App. 3d at 18-20 (affirming dismissal of the claim against the hospital where
plaintiffs lacked expert causation testimony and identified no other evidentiary support in the
record); Okic, 2019 IL App (1st) 181074, ¶¶ 82-85 (affirming the dispositive exclusion of a
surgical-negligence theory where the record made clear that plaintiff could not present evidence
supporting the foreclosed claim). We conclude, however, that rationale does not apply here
because the present record does not establish that plaintiffs could not present other competent
evidence of causation.
¶ 73 For instance, we agree with plaintiffs that Dr. Amine was not foreclosed as a potential
source of evidence bearing on causation. A defendant physician may be called as an adverse
witness and may provide professional opinion testimony, although the burden of eliciting and
introducing the necessary proof remains with the plaintiff. See Fawcett v. Reinertsen, 131 Ill. 2d
380, 385-86 (1989) (recognizing that a plaintiff may seek to establish the standard of care through
the defendant physician’s professional opinion testimony as an adverse witness). Although
Fawcett concerned the standard of care, Bombagetti illustrates that a defendant physician’s
medical testimony may form part of the evidence supporting proximate cause when considered
with other medical testimony. See Bombagetti, 254 Ill. App. 3d at 821-22 (considering the
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No. 1-25-1630
defendant physician’s testimony together with other expert testimony in concluding that the
evidence sufficiently supported proximate causation).
¶ 74 Here, in his operative report from the second surgery, Dr. Amine documented that Kathleen
returned with CSF collecting around the pump pocket, that he “definitely determined that there
[was] a CSF leak somewhere,” and that the leak prompted him to return her to surgery. During
that procedure, he found “[n]o leakage from the new pump or the new tubing” and identified that
“the leakage was from the old tubing,” which he then ligated. Dr. Amine likewise testified at his
deposition that, if Kathleen was experiencing a headache at that time, it was “probably because of
the little fluid leaking.” This account was consistent with plaintiffs’ theory that the original catheter
tubing had not been properly secured or ligated during the first surgery, and it potentially linked
the resulting leak to Kathleen’s headache and the need for a second procedure.
¶ 75 We emphasize the limited significance of this evidence to the issue before us. We do not
hold that Dr. Amine’s testimony establishes proximate cause, that plaintiffs may establish
causation through his testimony alone, or that plaintiffs ultimately can satisfy their burden of proof.
Nor do we determine what testimony would be admissible on remand or what evidence would be
sufficient to establish causation. Those questions remain open because the record does not reveal
what Dr. Amine himself might have said had he been asked. It is that evidentiary gap, not any
assessment of the merits, that defines our narrow holding: unlike in Seef and Okic, the present
record does not establish that plaintiffs could present no competent evidence to support their claims
or that judgment for defendants was therefore inevitable.
¶ 76 That conclusion also accords with the broader principles governing dispositive relief. The
Code of Civil Procedure is to be “liberally construed” so that controversies are determined
“according to the substantive rights of the parties.” 735 ILCS 5/1-106 (West 2024). And although
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No. 1-25-1630
summary judgment is an appropriate means of disposing of litigation where warranted, it remains
“a drastic means of disposing of litigation and, therefore, should be allowed only when the right
of the moving party is clear and free from doubt.” Adams, 211 Ill. 2d at 43. The record here falls
short of that standard. Thus, before plaintiffs’ entire action could be terminated, they were entitled
to the procedures governing that dispositive determination.
¶ 77 Nor was this deprivation harmless. Prejudice may exist where it is impossible to know
“what countervailing evidence the nonmovant might have presented if given notice and time to
sufficiently respond to the dispositive motion.” Okic, 2019 IL App (1st) 181074, ¶ 81 (citing
Peterson, 313 Ill. App. 3d at 10-11). Plaintiffs were never afforded that opportunity, and for the
reasons already discussed, we cannot say that adherence to the proper procedure would have been
a “useless act.” (Internal quotation marks omitted.) Seef, 311 Ill. App. 3d at 20.
¶ 78 Accordingly, although the circuit court did not abuse its discretion in barring Dr. Zengou’s
undisclosed causation testimony, the resulting dispositive judgment on the in limine motion cannot
stand. We therefore reverse the judgment entered for defendants and remand for further
proceedings consistent with this order. We express no opinion as to how the circuit court should
proceed on remand, including whether, in its discretion, it should permit the filing of a formal
dispositive motion or proceed directly to trial.
¶ 79 III. CONCLUSION
¶ 80 For the foregoing reasons, the judgment of the circuit court is affirmed in part and reversed
in part.
¶ 81 Affirmed in part and reversed in part; cause remanded.
¶ 82 JUSTICE MITCHELL, concurring in part and dissenting in part:
¶ 83 The circuit court correctly recognized that this medical malpractice case could not proceed
to a jury trial after plaintiffs’ own expert expressly disclaimed any opinion that the alleged
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deviation from the applicable standard of care caused plaintiffs’ injury. Under Illinois law, proof
of a deviation, standing alone, is not enough. A plaintiff must establish that the deviation
proximately caused the complained-of injury, and in the ordinary medical malpractice case, that
causal connection must be established through competent expert testimony to a reasonable degree
of medical certainty. Simmons v. Garces, 198 Ill. 2d 541, 556 (2002). Indeed, in Lopez v.
Northwestern Memorial Hospital, 375 Ill. App. 3d 637, 646 (2007), this court affirmed the removal
of theories from the jury where the plaintiff failed to present expert testimony connecting the
alleged breach to the injury. That is precisely what occurred here.
¶ 84 My esteemed colleagues in the majority nevertheless reverse, permitting the case to
proceed despite the absence of expert testimony on an indispensable element of plaintiffs’ claim.
While a jury may draw reasonable inferences from evidence, it may not supply evidence that a
plaintiff’s own expert has affirmatively declined to provide. While our cases have recognized that
using a motion in limine as a dispositive motion is improper, it does not constitute reversible error
unless the nonmovant can demonstrate unfair prejudice. See Okic v. Fullerton Surgery Center,
Ltd., 2019 IL App (1st) 181074, ¶¶ 81-85. Here, plaintiffs can show no prejudice because their
counsel, Albert Brooks Friedman, argued the issue extensively, plaintiffs had every opportunity to
come forward with contrary evidence, and the circuit court reviewed the expert’s deposition in its
entirety before making its ruling. Even now, years later, plaintiffs cannot point to any admissible
expert testimony in the record that fills the causation gap. That is fatal to plaintiffs’ case.
¶ 85 The suggestion that the defendant-doctor might supply the missing causation testimony is
pure speculation and is actually contradicted by the record. Illinois courts have consistently held
that a plaintiff cannot rely on speculation that an opponent’s admission might prove her case. See
Shramek v. General Motors Corp., 69 Ill. App. 2d 72, 80-82 (1966); Price v. Lunan Roberts, Inc.,
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2023 IL App (1st) 220742, ¶ 25. Rather, a plaintiff must present evidentiary facts—pleadings,
depositions, admissions on file, or affidavits. In the record before us, in the defendants’ answers
to plaintiffs’ Illinois Supreme Court Rule 213 (eff. Jan. 1, 2018) interrogatories, the defendantdoctor expressly denied plaintiffs’ theory: “Dr. Amine will disagree with each and every criticism
raised within the Complaint, and he will disagree with each allegation of negligence articulated by
plaintiffs’ experts.” He would testify that “any of the injuries the plaintiff sustained following her
surgery are known and recognized risks that occurred in the absence of negligence.”
¶ 86 In short, because no admissible expert testimony established the necessary link between
the alleged breach and plaintiffs’ injury, the circuit court properly entered judgment for defendants.
I would affirm the judgment below in all respects.
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Spies v. Amine, 2026 IL App (1st) 251630
Decision Under Review: Appeal from the Circuit Court of Cook County, No. 2020-L008663; the Hon. Frank J. Andreou, Judge, presiding.
Attorneys William F. Fitzpatrick, of Chicago, for appellants. for
Appellant:
Attorneys Patrick J. O’Connor III and Caroline A. Kernan, of Smith Blake for Hill LLC, of Chicago, for appellees.
Appellee:
31