White v. Advocate Condell Medical Center

2026 IL App (1st) 240450 Nos. 1-24-0450 and 1-24-0451 (consolidated) SIXTH DIVISION March 31, 2026 Modified Upon Denial of Rehearing July 10, 2026 ______________________________________________________________________________ IN THE APPELLATE COURT OF ILLINOIS FIRST DISTRICT ______________________________________________________________________________ MICHAEL WHITE, Individually and as Independent ) Appeal from the Circuit Court Administrator of the Estate of Darci White, Deceased, ) of Cook County. ) Plaintiff-Appellee, ) ) v. ) No. 18 L 8040 ) ADVOCATE CONDELL MEDICAL CENTER; ) RONALD SHENFELD, M.D.; and INFINITY ) HEALTHCARE PHYSICIANS, LLC, ) Honorable ) Bridget Hughes, Defendants-Appellants. ) Judge presiding. JUSTICE PUCINSKI delivered the judgment of the court, with opinion. Justices Hyman and Gamrath concurred in the judgment and opinion. OPINION ¶1 This is a medical negligence case brought by Michael White (plaintiff), individually and as independent administrator of the estate of his late wife, Darci White (Darci). ¶2 On August 13, 2016, Darci passed away approximately four hours after she was taken to the emergency room at Advocate Condell Medical Center (Advocate) and treated by Dr.  Nos. 1-24-0450 and 1-24-0451 (consolidated) Ronald Shenfeld. Dr. Shenfield is employed by Infinity Healthcare Physicians. LLC, who is also a named defendant. 1 ¶3 Following trial in October 2023, the jury returned a verdict in favor of plaintiff in the amount of $25 million. That amount included itemized awards of $3 million for plaintiff’s “grief and sorrow” and $5 million for plaintiff’s “loss of society.” ¶4 After the trial court denied posttrial motions by Advocate and Dr. Shenfeld, in February 2024, the trial court entered judgment on the verdict, specifying that plaintiff could also recover prejudgment interest. Advocate and Dr. Shenfeld filed separate appeals, which have been consolidated. ¶5 On appeal, Advocate and Dr. Shenfeld assert they were entitled to a directed verdict or judgment notwithstanding the verdict (JNOV) because plaintiff’s expert testimony was insufficient to prove negligence and causation. They otherwise urge they are entitled to a new trial because the verdict was against the manifest weight of the evidence, the trial court erred with respect to certain evidentiary rulings, the trial court erred in denying a requested jury instruction, and because the verdict was excessive. In the alternative to a new trial, defendants seek reduction of the verdict. Finally, defendants challenge the prejudgment interest award pursuant to section 2-1303(c) of the Code of Civil Procedure. 735 ILCS 5/2-1303(c) (West 2022). ¶6 For the following reasons, we reject all of defendants’ arguments and affirm the judgment entered on the jury’s verdict. ¶7 BACKGROUND 1 Dr. Shenfeld and Infinity Healthcare Physicians, LLC, are represented by the same counsel in this appeal. For ease of reference, we use “Dr. Shenfeld” to refer to both defendants. -2-  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶8 Darci and plaintiff were married in 1993. Together, they had one son, Ryan, born in 2003. ¶9 The allegations in this case pertain only to care rendered on August 13, 2016, the date of Darci’s death. The record reflects that three weeks earlier, July 23, 2016, Darci went to an urgent care facility affiliated with Advocate complaining of chest pain and shortness of breath. After a chest X-ray, Darci was discharged and prescribed an antibiotic. She had a follow-up appointment with her primary care physician two days later, July 25, 2016. The note from that visit reflects that she was assessed with hiatal hernia, gastroesophageal reflux disease, and atelectasis. 2 ¶ 10 Dr. Shenfeld was not involved in her care at that time. Darci was discharged the following day. ¶ 10 Separately, on July 29, 2016, (approximately two weeks before her death), Darci went to the emergency room at Advocate stating that she had suffered from diarrhea and abdominal pain since the prior evening. ¶ 11 On the evening of August 13, 2016, Darci experienced an episode of syncope (temporary loss of consciousness) while she and Ryan were going to a store. An ambulance transported her to Advocate’s emergency department. ¶ 12 In the ambulance on the way to the hospital, Darci experienced further brief syncopal episodes. At one point in the ambulance, Darci was given supplemental oxygen. ¶ 13 At approximately 6:30 p.m., Darci arrived at the emergency department at Advocate. Shortly thereafter, she was seen by an emergency room nurse, Amy Spaid, RN (Nurse Spaid). Darci was examined by Dr. Shenfeld, an emergency physician. 2 “Atelectasis happens when lung sacs (alveoli) can’t inflate properly, which means blood, tissue and organs may not get oxygen. It can be caused by pressure outside of your lung, a blockage, low airflow or scarring.” Atelectasis, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17699- atelectasis (Nov. 10, 2022) [https://perma.cc/2RZK-ZL5G]. -3-  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 14 Medical records reflect that Darci experienced three additional brief syncopal episodes at 6:40 p.m., 7:10 p.m., and 7:28 p.m. Around 8:15 p.m., Darci complained of shortness of breath and chest pain. Minutes later, at 8:19 p.m., Dr. Shenfeld ordered a computed tomography angiogram (CTA). 3 ¶ 15 Around 8:50 p.m., Darci went into full cardiopulmonary arrest, or “code blue.” At 9:37, a critical care physician, Dr. Kutty, was consulted. 4 Darci passed away at 10:41 p.m., approximately four hours after arriving in the emergency room. An autopsy found that she had “massive acute pulmonary thromboemboli within each of the mainstem bilateral pulmonary arteries.” ¶ 16 Plaintiff commenced this lawsuit by filing a complaint in July 2018. Plaintiff alleged that although Darci had “known risk factors for pulmonary embolism,” defendants deviated from the standard of care in various ways, including alleged failures by Nurse Spaid and Dr. Shenfeld, and that such negligence resulted in Darci’s death. 5 ¶ 17 Rulings on Motions in Limine ¶ 18 The parties conducted numerous depositions of fact and expert witnesses. In plaintiff’s deposition, he testified that he was in a romantic relationship with another woman, Megan Markowski. The relationship began in “late 2016,” after Darci’s death in August 2016. Markowski was deposed and likewise indicated that she and plaintiff were in a committed 3 “A computed tomography (CT) angiogram is a test that makes detailed pictures of your blood vessels and nearby tissues. The most common reason to have a CT angiogram is to see if you have narrowed or blocked coronary arteries ***.” See CT Angiogram, Cleveland Clinic, https://my.clevelandclinic.org/health/diagnostics/ct-angiogram (May 15, 2025) [https://perma.cc/LC3T- EPWT]. 4 There is no allegation of negligence regarding Dr. Kutty. 5 Plaintiff initially made claims against additional parties, but those claims were dismissed and are not at issue in this appeal. -4-  Nos. 1-24-0450 and 1-24-0451 (consolidated) romantic relationship since late 2016. They began cohabiting in December 2020 in a home owned by plaintiff, and Markowski contributed to expenses such as utilities. ¶ 19 Before trial, plaintiff filed a motion in limine to bar introduction of evidence of his relationship with Markowski. The court granted that motion. ¶ 20 Certain other pretrial rulings are relevant to this appeal. Among these, the court denied Dr. Shenfeld’s and Advocate’s motions to bar plaintiff from presenting expert testimony from two experts in emergency medicine on the ground that their testimony would be identical and unduly cumulative. In a separate ruling, the court granted Advocate’s motion in limine to bar any opinions or testimony regarding “alleged documentation or charting deficiencies” or errors in medical documentation. ¶ 21 Trial ¶ 22 The case proceeded to a jury trial, where plaintiff argued that both Advocate and Dr. Shenfeld were liable because Dr. Shenfeld deviated from the standard of care in three respects. Specifically, plaintiff claimed that Dr. Shenfeld (1) failed to consider a pulmonary embolism earlier, (2) failed to perform a point-of-care ultrasound (POCUS), and (3) failed to administer anticoagulant drugs, namely heparin or tissue plasminogen activator (tPA). Plaintiff also asserted that Advocate was liable due to Nurse Spaid’s failure to communicate certain information to Dr. Shenfeld. ¶ 23 Ryan White ¶ 24 Ryan White, plaintiff and Darci’s son, testified that he was 13 years old on August 13, 2016. Around 6 p.m., he was walking with his mother toward a store entrance when she said that she was not feeling well and collapsed. She was briefly unconscious, for “under a minute.” -5-  Nos. 1-24-0450 and 1-24-0451 (consolidated) Ryan stayed with his mother until an ambulance arrived. He spoke with her as she was placed into an ambulance. Ryan’s father (plaintiff) arrived, and they drove to the hospital. ¶ 25 At the hospital, Ryan and his father spent hours with Darci in her room. They tried to comfort her, and she spoke with them. He recalled that his mother had additional brief episodes of losing consciousness, and it each time it “seemed to worsen and become more violent.” At one point, his mother stopped breathing, and he and his father were asked to leave the room. Sometime later, he was asked to come back to his mother’s room and say goodbye. ¶ 26 Plaintiff Mike White ¶ 27 Plaintiff testified that shortly before 6 p.m., Darci called him and told him that she had collapsed. Plaintiff drove to Darci’s location, where he saw Ryan as well as an ambulance with paramedics speaking to Darci. He and Ryan followed the ambulance in his car, and they arrived at the hospital around 6:30 p.m. ¶ 28 Plaintiff and Ryan had to wait for some time before they were allowed to go into Darci’s room. Plaintiff was in the room for the next three or four hours, during which time various medical personnel (whose names he did not recall) spoke to Darci and gave her tests. ¶ 29 Plaintiff recalled at one point, Darci was in the midst of talking to a medical person when she gasped and looked surprised, “mouth open, eyes open,” and “not breathing not talking.” That episode lasted about 20 or 30 seconds, after which Darci asked, “[D]id I pass out again?” After that event, plaintiff continued to speak with Darci, who “seemed completely normal.” Later, plaintiff witnessed a similar episode while only he, Ryan, and Darci were in the room. Darci said she thought she was going to pass out and then “froze” with her mouth and eyes open. Plaintiff flagged down someone outside the room, after which a nurse arrived and asked Darci several questions. -6-  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 30 Plaintiff also recalled a third event when Darci stopped talking for about 20 to 30 seconds. Plaintiff again went out for help. After that third event, medical personnel “put some tubes up [Darci’s] nose for oxygen,” and he did not speak to her as much, although Darci remained lucid. ¶ 31 Plaintiff recalled that later, Darci complained of a “crushing feeling in [her] chest,” so Ryan left the room and brought back medical personnel. A short time later, he and Ryan were asked to leave and they were directed to a waiting room. ¶ 32 Sometime later, plaintiff spoke with Dr. Kutty as well as a nurse. He and Ryan were then allowed to see Darci, who was deceased. ¶ 33 Plaintiff’s counsel asked if plaintiff missed her, and he answered affirmatively. When asked if his life was different, he answered: “Yes, a hundred percent.” Asked if he tried to “pick up the responsibilities” that Darci had handled with respect to Ryan, plaintiff testified: “I pledged to [Ryan] at the moment we stood over her that it was going to be him and I, and I said I’m not going — it’s just going to be the two of us, and I’m not going to let you down.” Plaintiff testified that “I got [Ryan] through his grade school and high school years as best as I could.” ¶ 34 Andrew Katzner ¶ 35 Andrew Katzner, a paramedic, testified that he and his partner responded to the scene after Darci passed out. He was in the ambulance with Darci for approximately 30 minutes as they transported her. According to his records, Darci denied that she had chest pain or shortness of breath. Katzner recorded that Darci experienced two brief syncopal episodes in the ambulance, during which she was unresponsive. His report reflected that, at one point, she was provided supplemental oxygen. -7-  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 36 Katzner testified that when he brings patients to a hospital, his practice is to call the hospital’s emergency communication registered nurse (ECRN) and communicate information about the patient before they arrive. Katzner identified an audio recording of his call to the ECRN regarding Darci. That recording was played before the jury. Katzner agreed that the audio recording of that call reflected that Darci’s oxygen saturation level (sometimes referred to as “SPO2”) had been measured at 88%. ¶ 37 Katzner testified that, consistent with his practice as a paramedic, he drafted a written report of his observations and the treatment provided to Darci. Katzner acknowledged that his written report did not specify an 88% oxygen measurement, although he recorded that she was given supplemental oxygen at 6:27 p.m. The report indicated that her oxygen level subsequently improved to 94% before she arrived at the hospital. ¶ 38 Katzner testified that when he transported a patient to a hospital, his practice was to provide the ECRN “with everything that I had” regarding information about the patient. ¶ 39 Stephanie Nelson, RN ¶ 40 Stephanie Nelson, RN (Nurse Nelson), acknowledged that she was the ECRN who received a call from paramedics before Darci arrived at the hospital. Nurse Nelson had no independent recollection of Darci. She acknowledged that as ECRN, it was her responsibility to communicate information from the paramedics to the nurse to whom the patient was assigned. As was her practice, she documented the information in a radio call log. ¶ 41 Nelson agreed that the audio recording of the call she received from paramedics indicated that Darci’s SPO2 dropped to 88% before supplemental oxygen was given, after which it increased to 94%. She agreed that the normal range for SPO2 is 95% to 100%. Nelson agreed -8-  Nos. 1-24-0450 and 1-24-0451 (consolidated) that the audio recording indicated Darci had two syncopal episodes in the ambulance. However, in her radio call log, Nelson “just wrote syncope once.” ¶ 42 Nurse Nelson assigned Darci to Nurse Spaid. Nurse Nelson never spoke to Dr. Shenfeld about Darci. ¶ 43 Amy Spaid, RN ¶ 44 Nurse Spaid testified she had no independent recollection of Darci, but hospital records indicated that Darci arrived at 6:30 p.m. and that Nurse Spaid spoke to her shortly thereafter. Nurse Spaid’s corresponding triage note from 6:40 p.m. stated that “Patient brought in by EMS for episode of syncope while walking into store. Patient complains of left ankle pain.” The note reflected that Darci was alert and oriented, and she stated that she had been in the hospital “two weeks ago.” Nurse Spaid’s 6:40 p.m. note recorded that Darci stated “she feels like it is going to happen again” and had a brief episode where she made “grunting noises” and her “eyelids flickered,” but Darci regained alertness and was “immediately able to tell me her medications.” According to the note, Darci denied chest pain or shortness of breath. Darci’s oxygen level was recorded at 96% at 6:44 p.m. ¶ 45 Nurse Spaid testified that when she saw Darci, she was unaware that Darci had additional syncopal episodes in the ambulance, nor did she know that Darci’s oxygen saturation level had dropped to 88 percent in the ambulance. She indicated that she would have communicated that information to Dr. Shenfeld, had she known about it. ¶ 46 Nurse Spaid acknowledged that medical records showed Darci experienced three syncopal episodes after arrival at the hospital, at 6:40 p.m., 7:10 p.m., and 7:28 p.m. Although she did not have a specific recollection, Nurse Spaid testified that she would have informed Dr. -9-  Nos. 1-24-0450 and 1-24-0451 (consolidated) Shenfeld about those episodes because “I would not expect him to know what happened with the patient unless I told him.” ¶ 47 Elsewhere, Nurse Spaid acknowledged that Darci had an oxygen reading of 89% at 8 p.m., after which Darci was placed on a nasal cannula for supplemental oxygen. Nurse Spaid did not have a specific recollection of communicating that 89% reading to Dr. Shenfeld. Nurse Spaid acknowledged that several hours later, she modified the chart to reflect that the reading was 94% instead of 88%. She did not specifically recall why she made that change, although she agreed it possibly reflected that Darci’s oxygen level increased to 94% after receiving supplemental oxygen. ¶ 48 Dr. Shenfeld ¶ 49 Dr. Shenfield testified he had no independent recollection of the treatment he provided to Darci, so he had to rely on the medical records. He explained that he did not personally enter notes when he examined Darci; he treated her in presence of a “scribe” who observed and recorded information into the medical records “in real time.” ¶ 50 Dr. Shenfeld acknowledged that when he saw Darci, he had the ability to access records of her prior visits to Advocate healthcare facilities. Given his custom and practice, he stated that he “probably” reviewed those records. However, Dr. Shenfeld disagreed when plaintiff’s counsel asked if they “raise[d] the index of suspicion” for pulmonary embolism. ¶ 51 The medical records reflected that Dr. Shenfeld first saw Darci at 6:33 p.m. and that her chief complaint was syncope. Darci indicated that she had “felt lightheaded” and “passed out” on her way to a store. Dr. Shenfeld agreed that syncope is an unexpected, transient “loss of consciousness or near loss of consciousness.” - 10 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 52 The records reflected that Darci stated she had an episode of diarrhea the prior day and that two weeks earlier she was treated in the hospital for diarrhea. The medical records stated that Darci’s normal blood pressure was in the “90s/50s.” Darci denied weakness, numbness, dizziness, chest pain, shortness of breath, or headache. ¶ 53 Dr. Shenfeld agreed that syncope is very rarely a sign of pulmonary embolism, whereas dehydration is a common cause of syncope. He testified that after he first met Darci, he engaged in a “differential diagnosis” by which he considered a number of possible causes for Darci’s symptoms. He initially considered dehydration as a possible cause; his treatment plan was to give her fluids and to observe and “reassess.” He agreed that “dehydration was the No. 1 item” in his differential diagnosis until about 8:15 p.m. ¶ 54 Dr. Shenfeld acknowledged Darci had a rapid heart rate (tachycardia), which he believed was attributable to dehydration and bleeding. He ordered an electrocardiogram (ECG), as he “was considering arrythmia.” The corresponding ECG report was time-stamped 7:40 p.m. Dr. Shenfeld interpreted the report as showing an abnormally rapid heart rate. ¶ 55 Dr. Shenfeld testified that he first considered pulmonary embolism at 8:15 p.m., after Darci complained of chest pain and shortness of breath. Before that time, he did not consider pulmonary embolism on his differential diagnosis. Within minutes, at 8:19 p.m., Dr. Shenfeld ordered a CT angiogram to rule out pulmonary embolus. However, that test was never performed, because Darci went into full cardiopulmonary arrest at 8:50 p.m. ¶ 56 Dr. Shenfeld testified that he could not personally perform or interpret a POCUS, but that he could call other physicians to do so. Dr. Shenfield eventually called Dr. Kutty, who performed a bedside echocardiogram. Dr. Shenfeld acknowledged that, in his deposition, he - 11 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) stated that could have called Dr. Kutty earlier. Dr. Shenfield agreed that he is authorized to order tPA, a “clot buster” drug. ¶ 57 Elsewhere, Dr. Shenfeld agreed that nothing in the medical records indicated that he was ever told that Darci’s oxygen level had been 88%. ¶ 58 Dr. Christopher L. Moore ¶ 59 Plaintiff elicited testimony from multiple expert witnesses. Plaintiff called Dr. Christopher L. Moore as an expert in emergency medicine. ¶ 60 Dr. Moore testified that hypoxic means a low oxygen level and is potentially dangerous. He testified that normal oxygen saturation is 96 percent or higher, “borderline” hypoxia is 93 to 95 percent, and 92 percent or lower is hypoxic. Darci’s recorded 88 percent level on the way to the hospital was hypoxic. ¶ 61 Dr. Moore testified that a pulmonary embolism is typically a blood clot that obstructs circulation to the lung. It usually travels from lower extremities through the heart into the pulmonary artery “where it lodges because it can’t get through the lungs.” ¶ 62 Dr. Moore opined that an emergency room physician should be able to perform a point of care transthoracic ultrasound. He opined that Dr. Shenfeld violated the standard of care in that he did not consider “pulmonary embolus early on in the course given this patient had hemodynamic instability, repeated syncope, hypoxia.” He also opined that Dr. Shenfeld violated the standard of care because he failed to perform a POCUS “soon after the patient’s arrival” or to “immediately” find someone who could. ¶ 63 Dr. Moore also opined that “it was a deviation to not initiate [anticoagulation] therapy sooner including heparin which is a blood thinner” or tPA. - 12 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 64 Dr. Moore testified that if Dr. Shenfield had “considered pulmonary embolism early” and had a POCUS been performed, “he would have realized it was a large pulmonary embolism,” and therapy could have been initiated sooner, including heparin. Had such therapy been initiated, “it would more likely than not have prevented her from dying.” ¶ 65 Dr. Moore also opined that a POCUS performed between 6:33 p.m. and 8:15 p.m. would have shown “very obvious” “right ventricular dilation,” or “right heart strain,” indicating a blockage by pulmonary embolism. Dr. Moore also agreed that had anticoagulant medication been administered around the time of the “code blue” around 8:50 p.m., it was “very likely” to help Darci recover. ¶ 66 Dr. Jeffrey Kline ¶ 67 Following Dr. Moore’s testimony, defendants renewed their motion in limine to bar cumulative testimony from another plaintiff’s expert witness, Dr. Kline. Defendants urged that in light of Dr. Moore’s testimony, there were no further issues to cover with Dr. Kline. Plaintiff’s counsel argued Dr. Kline’s testimony would differ in that it would focus on the development of thromboembolism, and there would only be “slight overlap” with Dr. Moore’s testimony. The court permitted plaintiff to call Dr. Kline. ¶ 68 Dr. Kline testified that the vast majority of pulmonary embolisms occur after deep vein thrombosis (DVT). He described how a clot in a vein can become a pulmonary embolism. He interpreted Darci’s autopsy results as showing a large clot in the pulmonary artery as well as some “distal clots” in the right and left main stem arteries. ¶ 69 Dr. Kline testified that Dr. Shenfeld “should have considered pulmonary embolism as the number one or number two cause of Darci White’s passing out spells and ordered a diagnostic test for pulmonary embolism upon his first encounter” with her. On that point, he explained - 13 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) that Darci “presented with passing out which is a known symptom or occurrence that can happen with blood clots in the lung,” her oxygen level had dipped to 88 percent, she had “heart rate of 110 and a blood pressure of 96,” and she was taking estrogen which was a “risk factor” for pulmonary embolism. ¶ 70 He also opined that Dr. Shenfeld should have used a “cardiac ultrasound at the bedside,” or POCUS, “on his first encounter” or “as soon as possible thereafter.” He opined that an emergency physician should know how to do a POCUS or “should be able to have it arranged quickly.” He also opined that Dr. Shenfeld should have consulted with a critical care pulmonologist “earlier.” ¶ 71 Dr. Kline believed that had a POCUS been ordered earlier, it would have shown the right side of the heart was swollen as a result of clots in the lungs. Then, the next steps should have been to give heparin and “take the patient immediately” for a CT scan, which “is the way we diagnose clots in the lungs.” ¶ 72 Dr. Kline acknowledged that on the way to the hospital, Darci had two syncopal episodes and that her oxygen level was measured at 88%. He believed this was caused by the clot blocking blood flow. ¶ 73 Leslie Boyd, RN ¶ 74 Leslie Boyd, RN, testified as plaintiff’s expert in emergency nursing care. She opined that Nurse Spaid deviated from the standard of care by failing to communicate to Dr. Shenfeld that Darci’s prearrival oxygen level had dropped to 88% or that Darci had two additional syncopal episodes en route to the hospital. Further, Nurse Boyd opined that Nurse Spaid failed to timely communicate that Darci had three subsequent syncopal episodes in the emergency room and failed to timely communicate a decrease in her oxygen level at 8 p.m. - 14 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 75 Dr. Gary Salzman ¶ 76 Plaintiff called Gary Salzman, M.D., as an expert in pulmonary and critical care medicine. Dr. Salzman testified to his opinion that from the time she arrived at the hospital at 6:30 p.m., Darci was “hemodynamically unstable,” meaning her heart was not adequately delivering blood to her vital organs. He based this on her elevated heart rate, low blood pressure, and episodes of syncope. ¶ 77 Dr. Salzman opined that Darci had a number of different blood clots from the time she first passed out. Each time she passed out, including the syncopal episodes in the ambulance and in the emergency department, indicated another blood clot. He believed this “recurrent shower of blood clots stack[ed] up one among the other causing more and more obstruction into her lungs,” which in turn strained her heart. After “seven times of passing out and seven episodes of blood clots,” her heart “couldn’t take it anymore,” and she went into cardiopulmonary arrest at 8:50 p.m. Although Dr. Kutty later diagnosed a massive pulmonary embolism and she was given a “clot busting drug,” it was “late” and the drug “didn’t work” to prevent her death. ¶ 78 Dr. Salzman opined that if a POCUS had been performed sometime between 6:30 p.m. and 8:30 p.m., it would show the right ventricle was larger than normal and not pumping adequately. He believed that if a critical care physician had been consulted before 8:50 p.m., he or she would “suspect a blood clot” and perform an ultrasound. He testified that a critical care doctor would initially treat with the anticoagulant heparin to stabilize the clot, and the next step would be to give the “clot buster drug,” tPA, to dissolve the clot. ¶ 79 Dr. Salzman believed that had a POCUS been performed before 8:30 p.m., Darci would have been administered heparin and would have survived. He also believed that she had a chance of survival if tPA had been ordered before 9:10 p.m. - 15 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 80 Denial of Motions for Directed Verdict ¶ 81 After the close of plaintiff’s case, both Dr. Shenfeld and Advocate moved for a directed verdict. The court subsequently denied both motions. ¶ 82 Dr. Mark Cichon ¶ 83 Dr. Shenfeld called Dr. Mark Cichon, who testified as an expert in emergency medicine. ¶ 84 Dr. Cichon opined that Dr. Shenfeld complied with the standard of care and did not contribute to Darci’s death. ¶ 85 Dr. Cichon explained that when Dr. Shenfeld first saw Darci around 6:30 p.m., she did not have symptoms of pulmonary embolism. Darci was alert and communicating. She did not have risk factors for pulmonary embolism such as recent surgery, prior stroke, recent trauma, smoking, or pregnancy. Although she was on oral contraceptives, the records indicated she did not report this to Dr. Shenfeld. ¶ 86 Dr. Cichon testified that Darci showed signs consistent with dehydration, such as low urine output and dry mucus membranes. Dr. Cichon agreed that the ECG performed at 7:40 p.m. did not show heart strain or “evidence of an acute cardiac event that needed immediate intervention.” Dr. Cichon agreed that Darci’s condition changed significantly at 8:15 p.m. and that Dr. Shenfeld acted appropriately by ordering a CT angiogram at 8:19 p.m. ¶ 87 Dr. Jesse Russell Booth Hall ¶ 88 Dr. Jesse Russell Booth Hall testified as Dr. Shenfield’s expert in critical care medicine. Dr. Hall testified that syncope has various possible causes, including dehydration. Dr. Hall stated that Darci’s oxygen saturation rate at 6:44 p.m. was 96%, indicating “normal oxygenation.” At that point, she was “hemodynamically stable.” - 16 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) ¶ 89 Dr. Hall believed that around 8:15 p.m., the blood clot, which had “been causing her to pass out,” “finally did travel to the lung and was overwhelming to her heart and lung function.” ¶ 90 He testified that the autopsy report indicated a very large “saddle embolus” that blocked both main branches of the pulmonary arteries leading to right and left lungs. Dr. Hall denied that the autopsy indicated several separate pulmonary embolism events. ¶ 91 Dr. Hall noted that on July 23, 2016 (three weeks before her death), Darci sought medical attention complaining of pain in her chest. Dr. Hall believed that Darci had a relatively small pulmonary embolism at that time that resolved. Dr. Hall believed that in the weeks before Darci’s death, a clot was growing in size that eventually broke off and traveled through her heart over the course of two hours on August 13, 2016. He explained that such a slow-moving “clot-in-transit” is very rare, affecting only “1 in 1,000 or 1 in 10,000” of people with a pulmonary embolism. Dr. Hall opined that this same clot caused each of the seven syncopal episodes and that it entered the lungs between 8:15 p.m. and 8:30 p.m., when Darci complained of shortness of breath and chest pain. ¶ 92 Dr. Hall opined that Darci would have died regardless of the medical treatment provided by Dr. Shenfeld, given the age and size of the clot when she arrived at the hospital. He explained that anticoagulants “work better on fresh clot[s]” than older ones. Even if heparin or tPA had been given earlier, they would not have been able to save Darci. Dr. Hall believed that nothing Dr. Shenfield did or failed to do cause Darci’s death. ¶ 93 Dr. Geoff Crabb ¶ 94 Dr. Geoff Crabb testified as Advocate’s expert in emergency medicine. He explained that there are many possible causes for syncope, including “simple things” like being excited. Dr. Crabb opined that Dr. Shenfeld complied with the standard of care with respect to his initial - 17 -  Nos. 1-24-0450 and 1-24-0451 (consolidated) differential diagnosis. He agreed that Darci showed signs of dehydration and “there was nothing that would go along with a pulmonary embolism” when she arrived in the emergency room. He noted that, on arrival, Darci had no chest pain or shortness of breath, and her oxygen saturation level was 96%. ¶ 95 Dr. Crabb explained that the differential diagnosis evolved at 8:15 p.m., when Darci complained of shortness of breath and chest pain. Dr. Shenfeld complied with the standard of care at that point by changing his differential diagnosis to consider pulmonary embolism and by ordering a CTA. Dr. Crabb did not think the standard of care required an emergency physician to be able to conduct a POCUS, and he opined that no POCUS was warranted when Darci first arrived at the emergency room. As Darci showed no indication of pulmonary embolism before 8:15 p.m., the standard of care did not require heparin or tPA to be given earlier. Nor did he believe that the standard of care required Dr. Shenfeld to contact Dr. Kutty prior to 9:37 p.m. ¶ 96 Julianne Brennan, RN ¶ 97 Advocate called Julianne Brennan, RN, as an emergency room nursing expert. Nurse Brennan testified that she believed Nurse Spaid appropriately communicated with Dr. Shenfeld and complied with the nursing standard of care. ¶ 98 Dr. Jess Mandel ¶ 99 Dr. Jess Mandel testified as Advocate’s expert in critical care medicine. Dr. Mandel disagreed with Dr. Salzman’s theory that there were multiple clots causing the syncopal episodes. In his view, the autopsy indicated one large clot that blocked both main pulmonary arteries. Dr. Mandel opined that Darci suffered a very rare “clot-in-transit.” He believed that the same clot was developing for a number of weeks before Darci’s death.