delivered the opinion of the court:
Defendants, Snow Valley Health Resources, Inc. (Snow Valley), and Rakeesh Marwaha, M.D., appeal a decision of the circuit court of Du Page County granting plaintiff, Robin A. Prairie, a new trial. Following a jury trial, a verdict was returned in favor of both defendants. Plaintiff filed a posttrial motion seeking, among other things, a new trial. The trial court granted that request, relying on three errors it found to have occurred in the course of the trial. Primarily, the trial
Defendant Snow Valley operates a residential facility where it provides long-term care for its patients. Plaintiffs decedent was a 103-year-old woman and resident of Snow Valley. Plaintiffs decedent died on June 12, 1994, while a resident there. Defendant Marwaha is a physician who provided care to the decedent during the period in which she resided at Snow Valley. Plaintiff filed the current action, alleging several breaches by both defendants. Pertinent to this appeal is plaintiffs allegation that defendants failed to adequately monitor the decedent’s vital signs and that this omission led to her death.
•1 Because this appeal comes to us following the grant of a new trial, we will disturb the decision of the trial court only if “it is affirmatively shown that it clearly abused its discretion.” Maple v. Gustafson,
The primary basis for the trial court’s decision to grant a new trial was its determination that Marwaha’s testimony deviated from that disclosed pursuant to Supreme Court Rule 213. See 177 Ill. 2d R. 213. Defendants raise four distinct arguments as to why this ruling was an abuse of discretion. First, defendants assert that plaintiff waived any claim of error by failing to interpose a timely objection. Second, defendants contend that Marwaha’s testimony was properly disclosed. Third, defendant Snow Valley argues that the testimony in question was not opinion testimony and therefore not within the scope of the rule. Finally, defendants postulate that plaintiff could have and should have impeached Marwaha if she felt that his testimony diverged from his previously disclosed testimony.
The testimony at issue here concerns the steps that should have been taken to monitor plaintiff’s decedent’s vital signs in the days before her death. In his deposition, Marwaha was asked whether “[decedent’s] vitals should be taken on each shift,” and he replied, “In each shift, right.” He also referred to a standing order regarding the decedent, part of which he stated was to “[m]onitor her vital signs.” When asked how many times a day they should be monitored, he replied three.
At trial, Marwaha first testified when called as an adverse witness by plaintiff. When asked by plaintiffs counsel whether there was a standing order that the nursing staff at Snow Valley take the decedent’s vital signs three times daily, he stated “I think you are confusing the standing order with the patient assessment.” When asked whether the decedent
“An assessment of the patient is just basically you walk into a patient’s room and see whether — all her mental status, is she awake or is she sleeping. So — then they look at the — make sure that she has eaten good today or slept well, she had a bowel movement or she’s urinating okay and she’s moving all her limbs, she’s breathing okay. Check her color, feel her and see what her temperature is.
This is called a quick assessment of the patient, which all nurses are supposed to do. This takes only 30 to — 30 seconds to a minute. And they’re supposed to do it on everybody every shift.”
Plaintiff did not object to this testimony or attempt to impeach Marwaha with the statement he made during his deposition.
Later, during his own case, Marwaha first stated that decedent was “monitored pretty good.” He then testified that there was no written standard stating a patient’s vital signs had to be monitored three times each day. His attorney next asked whether patients were to be “assessed” three times per day. At this point, plaintiff interposed a Rule 213 objection, arguing that the assessments that Marwaha was speaking about were different from the monitoring of vital signs that he had testified about in his discovery deposition. The trial court overruled this objection. Marwaha then stated that he wanted the decedent monitored and assessed three times each day. Thereafter, during cross-examination, the following colloquy ensued:
“Q. So, Doctor, you expected the nursing home to take her vital signs three times daily at a minimum, is that correct?
A. I expected them to do assessment [sic] three times a day. Vital signs is [sic] a little bit, part of the total assessment of the patient.
Q. But you would agree with Dr. Fintel and Dr. Breall, that three times daily on the vitals was what should be done, correct?
A. The patient should be assessed at least three times a day, yes.
Q. The vital signs should be taken three times a day, isn’t that correct?
A. Vitals is [sic] a part of the assessment. It should be done three times a day.”
In ruling on plaintiffs posttrial motion, the trial court found Marwaha’s testimony to be “markedly different and not consistent” with his deposition testimony.
In the course of ruling, the trial court also noted the testimony of Dr. Ida Androwich, an opinion witness called by Snow Valley. Androwich defined an “assessment” as a skilled observation where one takes whatever information is available and forms an opinion about something. She opined that the decedent’s activities in the days before her death indicated her vitals were normal and that the staff of Snow Valley made appropriate assessments of the decedent during her stay at the facility. She also stated that an assessment does not require the taking of vital signs and that doing so is but one form of an assessment. Androwich believed that the standard of care did not require the decedent’s vital signs to be taken on June 12, 1994, which was the day of her death.
•2 We agree with defendants that plaintiff did not interpose a timely objection to Marwaha’s testimony. The complained-of testimony was first introduced into the trial during plaintiffs case in chief, when Marwaha was called as an adverse witness. Later, during defendants’ case, this testimony was again introduced. Plaintiff did not object until the second time this testimony was presented. Such an objection is not timely. See Gillespie v. Chrysler Motors Corp.,
•3 While it is true that, under such circumstances, plaintiff waived any objection she had to the admission of this testimony, the error may be addressed if it constituted plain error. While the plain-error doctrine finds greater application in criminal cases, it is recognized in civil cases. Cunningham v. Millers General Insurance Co.,
•4 In ruling on plaintiff’s posttrial motion, the trial court acknowledged defendants’ argument that plaintiff had waived this issue by failing to object. After explaining the basis for its determination that it was error to allow Marwaha to testify in the manner that he did, the trial court went on to state “it was an error of such import to allow the case to proceed in this way, that plaintiff has not really had a fair opportunity to present her case.” While the trial court did not use the term “plain error,” its finding comports with the plain-error standard. See Dowell,
Further, this error was one of the type that the supreme court identified in Gillespie, 135 Il. 2d at 377, as falling within the class of errors that have been held to constitute plain error. In that case, the supreme court noted that “blatant mischaracterizations of fact” have been found to be plain error. In the present case, we are dealing with an opinion; however, the opinion was blatantly mischaracterized. Whether something of importance to the trial was blatantly mischaracterized would seem to be the important part of the supreme court’s holding. The trial court observed that, in his deposition, Marwaha flatly stated that the decedent’s vital signs were to be taken three times per day. At trial, Marwaha instead spoke in terms of assessments and would not acknowledge what he testified to in his deposition. The trial court noted that this tied in with Androwich’s testimony, where she defined assessment as a skilled observation that did not require the taking of vital signs. The court found that, as a result, the jury was left with a skewed impression regarding the adequacy of defendants’ actions. We find no error in the trial court’s reasoning. The shift in Marwaha’s testimony, reinforced by the testimony of Androwich, resulted in Marwaha’s opinion, as set forth in his deposition, being blatantly mischaracterized.
Plaintiff asserts that this shift in testimony was a deliberate plot by defendants to avoid the effect of Marwaha’s deposition testimony. Plaintiff contends that “assessment” is a nebulous term designed to give defendants “wriggle room” with which to escape the effect of Marwaha’s earlier statements. The trial court made no finding regarding whether this was a deliberate strategy by defendants, and we need not pass upon this question here. We merely note that plaintiff’s suspicions do not appear to be completely unfounded. In support, one could point to the fact that Marwaha never used the term “assessment” in his deposition, while at trial he was reluctant to answer questions regarding vital signs using any other term. This conveniently coincided with Androwich’s testimony, which defined “assessment.” Plaintiff moved for sanctions for what she perceived as a deliberate plot to circumvent Rule 213. The trial court deferred ruling on this request. Plaintiff asks that we sanction defendants for this alleged conduct; however, as the trial court deferred ruling and because we are remanding, we will exercise our discretion and not address this issue. See Turner v. Commonwealth Edison Co.,
•5 We conclude that the trial court acted within its discretion when it decided to address plaintiffs allegation of error. In a related argument, defendants contend that plaintiff interjected this testimony into the trial because it first came out when plaintiff called Marwaha
as an adverse witness. Defendants assert that “[a] party cannot complain of error which he induced the court to make or to which he consented.” McMath v. Katholi,
•6 Defendants contend that the trial court abused its discretion in granting a new trial because Marwaha’s opinion was adequately disclosed. Regarding opinion testimony, Supreme Court Rule 213 requires that parties disclose “the conclusions and opinions of the opinion witness and the bases therefor.” 177 Ill. 2d R. 213(g). The rule further requires that parties supplement their disclosures as new information becomes available. 177 Ill. 2d R. 213(i). A witness may elaborate on a properly disclosed opinion. Becht v. Palac,
•7 In the present case, the resolution of this question turns upon whether Marwaha’s testimony regarding “assessments” was encompassed by his opinion set forth in his discovery deposition that vital signs were to be taken three times each day. A reasonable person could conclude that his deposition testimony, where he answered affirmatively when asked whether the decedent’s vital signs should be “taken” three times per day, entailed using medical instruments to ascertain an objective measurement of decedent’s vital signs. A reasonable person could further conclude that Marwaha’s trial testimony, particularly his statements regarding a “quick assessment” that could be performed in less than one minute, indicated a procedure much less rigorous than that to which he testified in his deposition. Marwaha points out that at one point during the trial he did state that checking vital signs was a part of an assessment and should have been performed three times per day. However, this testimony was preceded by his testimony that taking vital signs was a small part of an assessment. Given this statement and Marwaha’s testimony regarding “quick assessments,” a reasonable person could conclude that this statement did not change the tenor of his trial testimony or bring it within the scope of his deposition testimony. Since a reasonable person could come to the same conclusion as the trial court, the trial court did not abuse its discretion in finding that Rule 213 had been violated. Defendants’ contention that Marwaha was merely testifying in a more precise manner at trial, consistent with his deposition, must therefore be rejected, and their reliance on Becht,
Defendants attempt to frame this issue as whether witnesses may change the terminology in which they speak or must
•8 Snow Valley also argues that Marwaha’s testimony was not opinion testimony and thus does not fall within the scope of Rule 213(g). Snow Valley asserts that Marwaha was testifying to the facts of the decedent’s treatment rather than offering an opinion as to how she should have been cared for. Opinion testimony concerns what a witness “ ‘thinks, believes, or infers in regard to facts in dispute, as distinguished from his personal knowledge of the facts themselves.’ ” Mittelman v. Witous,
•9 Finally, defendants contend that if Marwaha’s testimony differed from that set forth in his deposition, the proper remedy would have been to impeach him. Plaintiff did not attempt to do so. Defendants cite a number of cases affirming the efficacy of impeachment as a safeguard against errant testimony. See, e.g., Boland v. Kawasaki Motors Manufacturing Corp., USA,
The First District’s decision in Suttle v. Lake Forest Hospital,
We decline to announce a rule that a failure to attempt impeachment waives a Rule 213 objection here. This rule would eviscerate Rule 213. The proponent of an opinion would be free to disregard the rule, knowing that the only sanction for a violation would be the possibility of impeachment. Such a rule would thwart the primary purpose of discovery rules, which is “to avoid surprise and discourage tactical gamesmanship.” Schuler v. Mid-Central Cardiology,
•10 The trial court based its decision to grant plaintiffs request for a new trial on the variance in Marwaha’s testimony. Because we conclude that the trial court did not abuse its discretion in determining that Rule 213 was violated and that this violation was severely prejudicial to plaintiff, we also conclude that the trial court did not abuse its discretion in ordering a new trial.
•11 The trial court also relied on the admission of a medical treatise as substantive evidence and the impeachment of plaintiff with a misdemeanor conviction in reaching its decision. It found these errors to be of less importance, and we will briefly address them here. Preliminarily, however, we note that Snow Valley has failed to comply with Supreme Court Rule 341 regarding the citation of authorities. See 188 Ill. 2d R. 341. Rule 341(e)(7) requires that arguments be supported with citation to authority. 188 Ill. 2d R. 341(e)(7). Rule 341(d) directs that “[cjitations shall be made as provided in Rule 6.” 188 Ill. 2d R. 341(d). Rule 6 provides that “[cjitations of
The first of the additional two errors the trial court found to contribute to the unfairness of the trial was what it determined was the admission of á medical treatise as substantive evidence. Dr. Breall, one of plaintiffs expert witnesses, testified during his discovery deposition that a medical text, referred to as the Braunwald text, supported his opinion that digoxin and Verapamil would prevent a patient from going into atrial fibrillation. At trial, Breall admitted that he had erred and that the Braunwald text did not support his opinion. Subsequently, Dr. Fintel, one of defendants’ experts, testified that “[t]he textbook states clearly that new information suggests that drugs like digoxin and Verapamil do not prevent the emergence of atrial fibrillation and it gives references.” Defendants argue that the testimony of Fintel constituted proper impeachment of Breall, and they note that medical treatises may be used to impeach experts. See Mielke v. Condell Memorial Hospital,
The trial court, however, found that the use of the text was improper. The trial court noted that Breall admitted that the Braunwald text did not support his opinion; consequently, there was no basis upon which.he needed to be impeached, nor was there any need to perfect impeachment. The trial court found that the text was introduced to establish the accepted method of treatment. Finally, the trial court held that this error was prejudicial in that the jury would likely look to the treatise to resolve the dispute between Breall and Fintel. We find this to be an adequate exercise of the trial court’s discretion.
•12 Initially, we note that the trial court’s determination that Breall admitted that the Braunwald text did not support his opinion is supported by the record. In such circumstances, there was no basis to impeach him. Our supreme court has noted the following:
“A court’s witness, or any witness for that matter, cannot be impeached by prior inconsistent statements unless his testimony has damaged, rather than failed to support the position of the impeaching party. The reason for this is simple: No possible reason exists to impeach a witness who has not contradicted any of the impeaching party’s evidence, except to bring inadmissible hearsay to the attention of the jury.” People v. Weaver,92 Ill. 2d 545 , 563 (1982).
In the present case, Breall did not contradict defendants’ assertion that the Braunwald text did not support his position. Hence, the trial court did not err in determining that defendants’ use of the text did not constitute impeachment. Accordingly, the trial court did not abuse its discretion in finding that the text was introduced for substantive purposes, which is clearly improper. See Mielke,
“Q. Depending on the circumstances and depending on where you’re at you use different names, correct?
A. No, sir.
Q. Well, you’ve used the name Marlene Prairie in the 1990’s, correct?
A. No sir. I did not.
Q. Ma’am, did you appear in the courthouse in Du Page County in February of this year — or February of 1999, and did you give your name as Marlene A. Prairie?
A. I don’t believe so.”
Plaintiffs counsel interposed an objection, which the trial court overruled. The proceedings then continued as follows:
“Q. Ma’am, were you involved in a proceeding in this courthouse in Du Page County back in February of this — of last year?
A. Yes.
Q. And that was a proceeding to remove certain vehicles from your property, correct?”
At this point, the court sustained an objection from plaintiffs counsel.
•13 Defendants argue that this testimony was relevant in that whether a plaintiff is a lineal heir of the decedent is an issue in a wrongful death suit. See Lee v. Chicago Transit Authority,
Marwaha further argues that any error was cured by the trial court’s sustaining plaintiffs objection to this questioning. See American National Bank & Trust Co. of Chicago v. Thompson,
•14 One last issue must be addressed before we conclude. Snow Valley argues that the trial court’s order granting a new trial should be limited to plaintiffs case against Marwaha. Snow Valley points out that the trial court did not find that Snow Valley had violated Rule 213. Additionally, Snow Valley asserts that there was no nexus between the introduction of the Braunwald text and plaintiffs case against Snow Valley. Initially, we note that Snow Valley has provided no authority regarding the propriety of ordering a new trial regarding a defendant when the errors that form the basis of the order were committed by a codefendant. This issue is thus waived. Fuller v. Justice,
In light of the foregoing, we hold that the trial court did not abuse its discretion in ordering a new trial as to both defendants. Plaintiff has raised several other issues that she asserts support the trial court’s order; however, in light of our disposition of this matter, they need not be addressed.
The decision of the circuit court of Du Page County is affirmed and this cause is remanded for further proceedings.
Affirmed and remanded.
McLAREN and BYRNE, JJ., concur.
