Wheeler v. Durrani

[Cite as Wheeler v. Durrani, 2026-Ohio-2475.] IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO DEBRA ANN WHEELER and : APPEAL NO. C-250095 RICHARD J. BROREIN, TRIAL NO. A-1706556 Successor Coexecutors of the Estate of : Richard and Eileen Brorein, : Plaintiffs-Appellees, : vs. ABUBAKAR ATIQ DURRANI, M.D., : and : CENTER FOR ADVANCED SPINE : TECHNOLOGIES, : Defendants-Appellants. KYRA MCCLENDON, : APPEAL NO. C-250206 TRIAL NO. A-1506695 Plaintiff-Appellee, : vs. : JUDGMENT ENTRY ABUBAKAR ATIQ DURRANI, M.D., : and : CENTER FOR ADVANCED SPINE TECHNOLOGIES, : Defendants-Appellants. : This cause was heard upon the appeals, the records, the briefs, and arguments. For the reasons set forth in the Opinion filed this date, the judgments of the trial court are reversed and the cause is remanded.  OHIO FIRST DISTRICT COURT OF APPEALS Further, the court holds that there were reasonable grounds for these appeals, allows no penalty, and orders that costs be taxed under App.R. 24. The court further orders that (1) a copy of this Judgment with a copy of the Opinion attached constitutes the mandate, and (2) the mandate be sent to the trial court for execution under App.R. 27. To the clerk: Enter upon the journal of the court on 6/30/2026 per order of the court. By:_______________________ Administrative Judge [Cite as Wheeler v. Durrani, 2026-Ohio-2475.] IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO DEBRA ANN WHEELER and : APPEAL NO. C-250095 RICHARD J. BROREIN, TRIAL NO. A-1706556 Successor Coexecutors of the Estate of : Richard and Eileen Brorein, : Plaintiffs-Appellees, : vs. ABUBAKAR ATIQ DURRANI, M.D., : and : CENTER FOR ADVANCED SPINE : TECHNOLOGIES, : Defendants-Appellants. KYRA MCCLENDON, : APPEAL NO. C-250206 TRIAL NO. A-1506695 Plaintiff-Appellee, : vs. : OPINION ABUBAKAR ATIQ DURRANI, M.D., : and : CENTER FOR ADVANCED SPINE TECHNOLOGIES, : Defendants-Appellants. : Civil Appeals From: Hamilton County Court of Common Pleas Judgments Appealed From Are: Reversed and Cause Remanded Date of Judgment Entry on Appeal: June 30, 2026  OHIO FIRST DISTRICT COURT OF APPEALS Statman Harris, LLC, Alan J. Statman and Benjamin M. Maraan II, for Plaintiffs- Appellees, Taft Stettinius & Hollister LLP, Philip D. Williamson, Aaron M. Herzig and Russell S. Sayre, for Defendants-Appellants. [Cite as Wheeler v. Durrani, 2026-Ohio-2475.] CROUSE, Judge. {¶1} In these consolidated appeals, we are again confronted with the issue of whether the trial court erred in joining for trial two medical-malpractice actions against defendants-appellants Dr. Abubakar Atiq Durrani and the Center for Advanced Spine Technologies, Inc., (“CAST”) (collectively referred to as “Appellants”).1 {¶2} Following our review of the record, we hold that the claims brought by plaintiffs-appellees Debra Ann Wheeler and Richard J. Brorein, Successor Coexecutors of the Estate of Richard and Eileen Brorein, and Kyra McClendon (collectively referred to as “Appellees”) did not share common questions of law or fact and that the trial court erred in joining them for trial. We further hold that the trial court erred in admitting testimony about a surgery performed by Durrani on McClendon that was not the basis of the medical-malpractice action; in allowing Dr. Ranjiv Saini, an expert witness for Appellees, to testify outside the bounds of his expertise; and in allowing the jury to see a slide in Dr. Saini’s PowerPoint presentation that referred to unrelated surgeries performed by Durrani. {¶3} Collectively, these errors cannot be found harmless. We accordingly reverse the trial court’s judgments and remand this cause for new, separate trials for the plaintiffs.2 1 We sua sponte consolidate these separate appeals into a single opinion and judgment. 2 Appellees filed motions to dismiss their fraud claims, which were denied by a motions panel of this court because the motions failed to state with particularity the grounds upon which they were based and because they appeared to request relief that this court cannot afford. Both Appellants and Appellees filed supplemental briefs on the issues raised in the motions. Appellees also filed “notice[s] of withdrawal” of their motions to dismiss the fraud claim, which were struck by a motions panel of this court. We decline to revisit our denial of the motions. If Appellees wish to withdraw their fraud claims, they may do so in the trial court.  OHIO FIRST DISTRICT COURT OF APPEALS I. Factual and Procedural History {¶4} On December 9, 2015, McClendon, along with her parents Tonya and Tony McClendon, filed a medical-malpractice action against Durrani and CAST.3 The complaint alleged that Durrani performed a stapling procedure on McClendon’s thoracic spine to correct her scoliosis, and that when the curvature of her spine subsequently worsened, he performed a spinal fusion on her. It further alleged that the surgeries were medically unnecessary and improperly performed. {¶5} On December 7, 2017, an amended complaint was filed by Richard Brorein, as Executor of the Estate of Eileen Brorein, against Durrani and CAST.4 The complaint alleged that Durrani performed a thoracic spinal fusion on Eileen5 that was medically unnecessary and that the surgery was improperly performed, requiring Durrani to perform a revision surgery to correct the deficiencies. {¶6} In October 2018, following the death of Richard Brorein, Debra Ann Wheeler and Richard J. Brorein were substituted as the coexecutors of the estate of Richard and Eileen Brorein. A. Consolidation and Pretrial Filings {¶7} Over Durrani and CAST’s objection, the claims asserted by Eileen’s estate and McClendon were joined for trial. {¶8} Prior to trial, Durrani and CAST filed a motion in limine to preclude, as relevant to this appeal, the admission of (1) evidence of other malpractice lawsuits against Durrani, as well as evidence of Durrani’s treatment of other patients, (2) 3 The complaint also asserted claims against Cincinnati Children’s Hospital Medical Center, UC Health, and West Chester Hospital, LLC, but McClendon settled with these defendants and the claims against them were dismissed. 4 Claims were also filed against UC Health and West Chester Hospital, LLC, but a settlement was reached with these defendants and the claims against them were dismissed. 5 Because there are multiple persons involved in the action with the surname Brorein, we refer to Eileen Brorein by her first name to avoid confusion. 6  OHIO FIRST DISTRICT COURT OF APPEALS surgical-standard-of-care testimony from Dr. Saini, (3) evidence of Durrani’s flight to Pakistan and his absence from trial, and (4) evidence about the medical criminal action against Durrani. They filed a second motion in limine to preclude the McClendons from presenting the testimony of Dr. Charles Mehlman because he had only been identified as an expert “on all Children’s cases” and McClendon’s treatment at Cincinnati Children’s Hospital Medical Center (“CCHMC”) was no longer at issue, as the claims against CCHMC had been dismissed. {¶9} The trial court orally ruled on the motions in limine at the beginning of trial. It granted the first motion in limine with respect to the admissibility of evidence regarding Durrani’s treatment of other patients, other malpractice lawsuits, and the medical criminal action against Durrani. But the trial court denied the motion in limine with respect to Dr. Saini’s testimony on surgical standards of care and Durrani’s absence from trial. With respect to Dr. Saini, it stated, “Well, pursuant to the Court of Appeals’ decision stating that based upon Dr. Saini’s background and his training of orthopedic surgeons, he was qualified to testify as to surgical standards to a certain degree. And the Court will allow him to so testify.” {¶10} The trial court heard further arguments from the parties on the motion in limine regarding the testimony of Dr. Mehlman, and it held that it would allow Dr. Mehlman to testify. The court also denied Durrani and CAST’s renewed objection to the joinder of the two cases for trial. A jury trial was then held on the claims of McClendon and Eileen’s estate for negligence, fraudulent misrepresentation, battery, and lack of informed consent. B. Trial Testimony 1. Eileen Brorein {¶11} The evidence presented at trial established Eileen had suffered back 7  OHIO FIRST DISTRICT COURT OF APPEALS pain for well over a decade before being referred to Durrani. She had already seen multiple doctors for this pain and had treated it with conservative care, including medication, physical therapy, and steroid injections. Eileen was able to obtain only temporary relief from these treatments. At the time she presented to Durrani, she suffered pain in her back and her right shoulder. Her ability to enjoy life was good, but she needed assistance with many household tasks. {¶12} The evidence established that during his initial consultation with Eileen, Durrani recommended surgery. Based on his examination of her medical images, he determined that she suffered a significant kyphotic deformity, thoracic spinal and foraminal stenosis, and a large disc herniation at T5-6, T6-7, and T7-8 that was causing very significant spinal cord compression. Durrani subsequently performed a laminectomy and a fusion of Eileen’s spine from levels T3 to T10. {¶13} Following the surgery, Eileen developed complications related to the hardware that Durrani had placed. She could feel the rods poking into her skin and experienced much discomfort. Imaging studies showed that the screws in her spine were starting to back out. Durrani recommended a revision surgery to correct this issue, which allegedly resulted from osteoporosis in Eileen’s bones. Durrani performed the revision, removing the hardware that had been placed during the first surgery and putting in different screws. Following the second surgery, Eileen experienced pain worse than what she had suffered prior to either surgery. {¶14} Eileen passed away from unrelated causes approximately two years after the second surgery. 2. Kyra McClendon {¶15} The evidence presented at trial established that in 2008, McClendon, then age ten, was referred to CCHMC by her primary-care physician for concerns of 8  OHIO FIRST DISTRICT COURT OF APPEALS scoliosis. She was seen by Durrani at CCHMC, where he worked at the time. {¶16} After ordering and examining an X-ray of McClendon’s spine, Durrani presented the McClendons with three options: (1) ignore the curvature, which would eventually cause McClendon’s spine to collapse her lung, (2) have McClendon wear a back brace nearly 24/7 for the rest of her life, or (3) have McClendon undergo a noninvasive surgery involving the stapling of her spine. The McClendons felt that surgery was their only option. Unbeknownst to them, McClendon’s surgery was the first time that the stapling procedure had been performed at CCHMC. {¶17} After a few post-surgery visits, McClendon did not see Durrani for a two- year period. In 2010, after her primary-care physician noticed that her scoliosis had progressed, McClendon followed up with Durrani at CAST, where he was employed at the time. Durrani viewed updated images of McClendon’s spine and told her that she needed a spinal fusion. He said that she would be able to return to her activities of choice, tumbling and cheerleading, several months after surgery. Durrani performed a spinal fusion on McClendon from levels T3 to L2, although, prior to surgery, he had indicated that the fusion would extend to L3. During the surgery, he fused only six of the 11 impacted segments of McClendon’s spine. He also used a bone morphogenetic protein on McClendon during the surgery, despite not informing McClendon or her parents that he intended to do so. {¶18} After her surgery, McClendon experienced pain in the area around her hip. Durrani believed the pain was caused by an issue with her hips and that it was not related to the fusion surgery. McClendon also treated with two other doctors for this pain. One attributed the pain to her spine, while the other attributed it to the weight of the hardware Durrani had placed in her back. The pain eventually improved after McClendon participated in physical therapy. She was able to return to gymnastics, but 9  OHIO FIRST DISTRICT COURT OF APPEALS not on the competitive level that she had participated in prior to surgery. McClendon, who was 25 at the time of trial, stated that she had “good days and bad days” and that she had experienced pain off and on for the past 15 years. C. Appellees’ Expert Testimony {¶19} Appellees presented expert testimony from three witnesses, Dr. Stephen Bloomfield, Dr. Mehlman, and Dr. Saini. 1. Dr. Bloomfield {¶20} Dr. Bloomfield opined that Durrani had exaggerated the findings on Eileen’s medical images and that Durrani’s reading of those images was outside of the standard of care. He testified that, contrary to Durrani’s representations, Eileen’s medical images did not show that her spinal cord was compressed. Dr. Bloomfield also opined that it was a violation of the standard of care for Durrani to recommend surgery for Eileen on her first visit. He also testified that Durrani breached the standard of care by performing surgery to decompress a spinal cord that was not significantly compressed, and that Eileen’s pain and suffering was directly and proximately caused by Durrani’s deviation from the standard of care. 2. Dr. Mehlman {¶21} Prior to Dr. Mehlman’s testimony, Durrani and CAST asked the trial court to verify that Dr. Mehlman would not be permitted to testify about whether the stapling procedure that Durrani performed on McClendon at CCHMC met the standard of care, because the claim related to that surgery had been settled with CCHMC and was no longer part of the case. Appellees’ counsel argued that Dr. Mehlman would need to comment on the first surgery to explain why it led to the necessity for the second surgery. {¶22} The trial court instructed Appellees’ counsel not to question Dr. 10  OHIO FIRST DISTRICT COURT OF APPEALS Mehlman about whether the first surgery met the standard of care. {¶23} Dr. Mehlman testified about the curvature of McClendon’s spine upon her initial presentation to Durrani. He stated that she would have been a candidate for bracing and that “[t]he standard of care for the country would be to offer bracing for that child.” Durrani and CAST objected. The trial court sustained the objection and instructed the jury to disregard the previous question and answer. {¶24} Dr. Mehlman testified that when the stapling procedure was performed on McClendon, it was not a procedure that was regularly performed by pediatric orthopedic surgeons. Dr. Mehlman subsequently repeated this sentiment, stating that the stapling procedure never “caught on” and was never regularly performed. Upon objection from Durrani and CAST, the trial court told the jury, “There is a lot of discussion here about the first surgery that was performed on this plaintiff. Testimony is being allowed because it’s necessary to set the basis for the surgery that’s involved in this case, which was the second surgery. So please keep that in mind.” {¶25} Dr. Mehlman testified that Durrani breached the standard of care when performing the fusion surgery on McClendon because he did not fuse all 11 segments in McClendon’s spine and because he used a bone morphogenetic protein off-label on her. He explained that the bone morphogenetic protein had not been approved by the FDA for use on minors, and that it carried side effects such as infertility, cancer, and excessive bone growth in abnormal places. He further testified that the fusion surgery left McClendon at risk for adjacent segment disorder, and that there was a high likelihood she would have future problems and pain associated with the spinal fusion. {¶26} Dr. Mehlman’s testimony addressed the staples that Durrani had used in the stapling procedure on McClendon’s spine. He stated that Durrani’s use of Medtronic staples was “completely off-label.” Dr. Mehlman also opined that the 11  OHIO FIRST DISTRICT COURT OF APPEALS informed-consent form for McClendon’s spinal fusion did not meet the standard of care because it did not list the name of the procedure that was to be performed and did not discuss any risks or complications associated with the procedure. He further stated that a separate form signed by McClendon’s mother, referred to as an “acknowledgement of consent,” also failed to list the risks and benefits of the surgery. 3. Dr. Saini {¶27} Dr. Saini, a neuroradiologist, provided opinions about the surgeries performed on both Eileen and McClendon. He utilized a PowerPoint presentation during his testimony. As the parties agree, one of Dr. Saini’s slides contained statements from a physician not involved in the lawsuit indicating that Durrani had performed unnecessary surgeries and was engaged in criminal activity. When that slide was presented, Appellees’ counsel immediately said, “Let’s take that down for a second, please.” {¶28} At a sidebar, Appellees’ counsel explained that he noticed that the slide had not been redacted and that he needed to “black out the information about [Durrani’s] unnecessary surgeries.” Appellants’ counsel moved for a mistrial, arguing that there was a high likelihood that the jury saw the slide, which counsel represented had stated that “[i]t is noted that since that time he has been charged with criminal activity regarding unnecessary surgeries.” The trial court denied the motion for a mistrial, stating, “Number one, the Court was looking at the exhibit also, and I don’t know what it said. I realize that my reading it, and looking at it, observing it may not be the same as the jurors. But the length of time that it was up and the opportunity to observe it was, in the Court’s opinion, insignificant.” {¶29} Upon resumption of his testimony, Dr. Saini opined that Durrani breached the standard of care when reading Eileen’s medical images. He testified that 12  OHIO FIRST DISTRICT COURT OF APPEALS Eileen did not have severe central canal stenosis, that her spinal cord had room to move, and that the images did not show that she suffered from severe kyphosis. {¶30} With respect to McClendon, Dr. Saini testified that the stapling procedure Durrani performed on her was experimental at the time it was performed, and that it was the first procedure of that nature performed at CCHMC. He also testified that Durrani used Medtronic staples, rather than Nitinol staples, and that this contributed to the failure of the stapling procedure. Dr. Saini criticized Durrani’s decision to only fuse six of the levels in McClendon’s spine during the fusion surgery. He stated that without pedicle screws at each level, motion between the segments could not be stopped to allow fusion to occur. {¶31} Dr. Saini testified that the informed-consent form signed by McClendon’s mother for the spinal fusion did not meet the standard of care because it did not list the name of the procedure to be performed or the risks and benefits and pros and cons of the surgery. D. Appellants’ Expert Testimony {¶32} Durrani and CAST presented expert testimony from two witnesses, Dr. Michelle Hansman Whiteman and Dr. Paul Kaloostian. 1. Dr. Hansman Whiteman {¶33} Dr. Hansman Whiteman, a neuroradiologist, testified that Durrani’s interpretation of Eileen’s medical images was reasonable and within the standard of care. She stated that Durrani correctly determined that Eileen’s spinal cord was compressed at three levels, and that he did not exaggerate radiographic findings. {¶34} With respect to the stapling procedure that Durrani performed on McClendon, Dr. Hansman Whiteman testified that, at the time that it was performed, stapling was equally as efficacious as bracing. She stated that McClendon’s scoliosis 13  OHIO FIRST DISTRICT COURT OF APPEALS improved significantly after the stapling before it began to progress again two years later. Dr. Hansman Whiteman discussed the fusion surgery performed on McClendon and stated that Durrani had obtained a “very beautiful result” compared to McClendon’s preoperative curvature. 2. Dr. Kaloostian {¶35} Dr. Kaloostian, a neurosurgeon, testified that Durrani met the applicable standard of care in his treatment of both Eileen and McClendon. With respect to Eileen, he stated that it was reasonable to recommend a spinal fusion and that the procedure was medically indicated based on Eileen’s presentation to Durrani, including the facts that she had osteophytes pushing on her spinal cord and significant kyphotic deformity. He further testified that it was not against the standard of care to recommend surgery to Eileen on her first visit, particularly because she had exhausted conservative-care treatment. {¶36} With respect to McClendon, Dr. Kaloostian testified that stapling was a recognized procedure at the time it was performed. As for the spinal fusion Durrani had performed on McClendon, Dr. Kaloostian stated that it was not a breach of the standard of care to use a bone morphogenetic protein on a minor scoliosis patient. Dr. Kaloostian further testified that Durrani’s surgery improved McClendon’s condition and did not proximately cause her any harm. E. Motion for Directed Verdict for Eileen’s Estate {¶37} After Durrani and CAST rested, they moved for a directed verdict on the claims brought by Eileen’s estate. They argued that Debra Ann Wheeler and Richard J. Brorein, the successor coexecutors of Eileen’s estate, were not proper plaintiffs because the estate had been closed. In support, Durrani and CAST introduced a certified copy of a January 2021 judgment entry from an Auglaize County Probate 14  OHIO FIRST DISTRICT COURT OF APPEALS Court closing Eileen’s estate. They also filed a written memorandum arguing that the successor coexecutors lacked standing to maintain the action once the estate was closed. {¶38} The trial court gave Appellees one day to respond. The trial then proceeded with closing arguments and jury instructions. {¶39} When the parties returned to court the following day, Appellees introduced an amended judgment entry from the Auglaize County Probate Court. The entry provided that “[t]he Court nun[c] pro tunc reopens the estate at the date it was closed.” (Emphasis in original.) {¶40} Appellants objected to the late filing, arguing that no additional evidence could be introduced because the jury had already begun deliberating. They contended that although Eileen’s estate had standing when the case was initiated, standing had to be maintained throughout the action, and it was not. {¶41} Upon further questioning from the trial court, counsel for Durrani and CAST stated that he had learned of the estate’s closure on August 4, 2022, which was four days prior to trial. The trial court questioned whether defense counsel had invited any error by waiting until the conclusion of trial to raise the issue. {¶42} The court ultimately denied the motion for a directed verdict on the issue of standing. It stated, The issue is whether or not they maintain standing to pursue the action after January of 2021. And the Court is going to rely on its understanding of what a nunc pro tunc entry does. And it relates back to the date that’s stated there, and the judge has stated that it was error or a mistake to dismiss the action in a nunc pro tunc, reinstates the action to the date that was on the initial dismissal or termination entry. 15  OHIO FIRST DISTRICT COURT OF APPEALS F. Jury Instructions {¶43} Included in the jury instructions were both an instruction regarding Durrani’s absence from trial and an instruction regarding the stapling procedure performed on McClendon at CCHMC. {¶44} With respect to Durrani’s absence, the trial court instructed the jury that, The defendant, Dr. Durrani, has not attended these proceedings in person. He is represented here by counsel. You shall not speculate on why he is not present or consider his absence for any purpose except as instructed below. Dr. Durrani has voluntarily left the jurisdiction, removing himself from plaintiffs’ ability to subpoena him for trial. When a party such as Dr. Durrani has relevant evidence or testimony within his or her control, and the party fails to produce that relevant evidence or testimony, that failure give[s] rise to an inference that the evidence or testimony is unfavorable to that party. Regarding its ability, in general, to make an inference, the court instructed the jury, “Whether an inference is made rests entirely with you” and “[t]o infer or make an inference is to reach a reasonable conclusion of facts which you may, but are not required to, make from other facts which you find have been established by direct evidence.” {¶45} And with respect to the stapling procedure performed on McClendon, the following instruction was given to the jury: In Kyra McClendon’s case, you’ve heard some testimony regarding the surgery she underwent at Cincinnati Children’s Hospital Medical Center on May 2nd, 2008. You may not consider that surgery 16  OHIO FIRST DISTRICT COURT OF APPEALS for the award of damages. That testimony was provided to form the basis for the surgery of March 25th, 2011, at West Chester Hospital, which is the cause before you. G. Jury Verdicts {¶46} The jury returned verdicts finding in favor of McClendon on her claims for negligence, lack of informed consent, battery, and fraudulent misrepresentation. It found that Durrani was negligent for recommending and performing the first surgery on McClendon, for having inadequate and inaccurate documentation, for using a bone morphogenetic protein on a minor, and for failing to meet the standard of care in the second surgery. The jury awarded McClendon a total $807,757.67 in both economic and noneconomic damages. {¶47} With respect to Eileen, the jury returned verdicts in favor of her estate on the claims for negligence and fraudulent misrepresentation. It found that Durrani was negligent for exaggerating the amount of compression on Eileen’s spinal cord and exaggerating her pain level during the initial diagnosis to justify surgery. The jury found in favor of Durrani on the claims for lack of informed consent6 and battery. Eileen’s estate was awarded a total of $500,246.04 in economic and noneconomic damages. {¶48} While the jury deliberated on the issue of punitive damages, the parties discussed the jury’s finding that Durrani was negligent in his care and treatment of McClendon for recommending and performing the spinal stapling surgery. Counsel for Durrani and CAST argued that they had objected repeatedly throughout trial to the introduction of evidence about the stapling procedure and that “the jury returned a 6 Because the jury found in favor of Appellants on the informed-consent claim brought by Eileen’s estate, we have omitted testimony pertaining to this claim from the opinion. 17  OHIO FIRST DISTRICT COURT OF APPEALS verdict against the instruction that you’re not to award damages for the first surgery.” {¶49} In response, Appellees’ counsel argued that the jury had been instructed that it could not consider the stapling procedure for purposes of damages, and that the jury’s finding that Durrani was negligent in recommending and performing the stapling procedure did not establish that it had violated that instruction. {¶50} The trial court elected to send the jury a question asking if it had considered the first surgery performed on McClendon when awarding damages. The jury answered that question in the negative. {¶51} With respect to punitive damages, the jury returned verdicts awarding both McClendon and Eileen’s estate $3,000,000 in punitive damages. H. Post-Verdict Motions {¶52} Appellees filed motions for prejudgment interest. Durrani and CAST filed motions for a new trial and/or for judgment notwithstanding the verdict and for remittitur. As relevant to these appeals, the motions argued that the trial court erred by (1) joining the plaintiffs’ cases, (2) denying Durrani and CAST’s motion for a mistrial based on the display of an exhibit mentioning unnecessary surgeries and criminal charges against Durrani, (3) allowing Dr. Mehlman to testify, (4) denying Durrani and CAST’s motion for a directed verdict on the issue of standing and the closure of Eileen’s estate, (5) failing to direct a verdict on McClendon’s claim for future medical expenses, and (6) providing an adverse-inference instruction to the jury. Durrani and CAST also filed post-trial motions for a setoff. {¶53} The trial court denied the motions for a new trial and/or judgment notwithstanding the verdict. With respect to the issue of joinder, it found that there was sufficient commonality of issues and parties to warrant joinder. It noted that the evidence presented in both cases was that Durrani had exaggerated or falsified 18  OHIO FIRST DISTRICT COURT OF APPEALS diagnostic findings and that both cases involved the thoracic spine. It also found that no prejudice had resulted from the joinder because it had instructed the jury to consider each case separately and because the jury’s finding in favor of Durrani and CAST on the claims brought by Eileen’s estate for failure to obtain informed consent and battery demonstrated that the jury was able to parse through the evidence and reach independent conclusions. {¶54} But the trial court found that Durrani and CAST were entitled to a reduction of the jury’s award of noneconomic damages pursuant to R.C. 2323.43(A)(2), as well as a reduction of the award of punitive damages pursuant to R.C. 2315.21(D)(2)(b). The court also denied Durrani and CAST’s motions for a setoff and, following a hearing, granted Appellees’ motions for prejudgment interest. {¶55} The trial court issued “final, appealable, orders” on January 22, 2025. But those orders did not include a final calculation of prejudgment interest, so the trial court issued entries setting forth the amount of prejudgment interest awarded on March 18, 2025. It also issued an order dismissing the claims of Tonya and Tony McClendon on April 2, 2025. {¶56} Durrani and CAST now appeal, raising five assignments of error for our review. We address these assignments out of order. II. Standing/Real Party in Interest {¶57} In their second assignment of error, Appellants argue that the trial court erred in failing to grant their motion for a directed verdict on the claims brought by Eileen’s estate because there was no real party in interest who had standing to bring the claims after January 2021. {¶58} As previously explained, Appellants moved for a directed verdict on the claims brought by Eileen’s estate on the ground that the estate had been closed, so 19  OHIO FIRST DISTRICT COURT OF APPEALS there was no longer a real party in interest to assert the claims. They introduced a document from the Auglaize County Probate Court, dated January 20, 2021, reflecting that Eileen’s estate was closed as of that date. The trial court gave Appellees overnight to respond, and, in the interim, allowed the jury to begin deliberating on all claims, including those brought by Eileen’s estate. The following day, Appellees presented the trial court with an “amended judgment entry” from the Auglaize County Probate Court reflecting that the “[t]he Court nun[c] pro tunc reopens the estate at the date it was closed.” (Emphasis in original.) The trial court denied the motion for a directed verdict, stating that it accepted the nunc pro tunc entry and the representations contained therein and concluding that the plaintiffs had maintained standing. {¶59} We review a trial court’s ruling on a motion for a directed verdict de novo. Lally v. Mukkada, 2011-Ohio-3681, ¶ 5 (1st Dist.). Pursuant to Civ.R. 50(A)(4), where “the trial court, after construing the evidence most strongly in favor of the party against whom the motion is directed, finds that upon any determinative issue reasonable minds could come to but one conclusion upon the evidence submitted and that conclusion is adverse to such party,” the court shall direct a verdict for the moving party. See also Lally at ¶ 5. {¶60} Appellants argue that this was not the proper use of a nunc pro tunc entry by the Auglaize County Probate Court. While we are sympathetic to this argument, we have no jurisdiction to review an entry issued by a lower court in a different county. See R.C. 2501.02(C) (an appellate court has jurisdiction “to review, affirm, modify, set aside, or reverse judgments or final orders of courts of record inferior to the court of appeals within the district” (Emphasis added.)); Ohio Const., art. IV, § 3(B)(2). In our review, we must accept the entry for what it purports to be. The trial court was required to do so as well. 20  OHIO FIRST DISTRICT COURT OF APPEALS {¶61} This assignment of error implicates the concepts of both real party in interest and standing. In McCann v. Durrani, 2023-Ohio-3953 (1st Dist.), this court engaged in a detailed discussion of both concepts. We explained that the party bringing suit must have standing to sue, that standing is a prerequisite to invoking the trial court’s jurisdiction, and that “[s]tanding to sue must be determined at the time the action is filed, and its absence requires that the complaint be dismissed.” Id. at ¶ 20. We further explained, “In addition to the standing necessary to invoke the jurisdiction of the court, the civil rules” require that all actions be prosecuted in the name of the real party in interest. Id. at ¶ 21; see Civ.R. 17(A) (“Every action shall be prosecuted in the name of the real party in interest.”). {¶62} On December 17, 2017, when the complaint pertaining to Eileen was filed, Richard Brorein, as the executor of the estate of Eileen Brorein, had standing to sue, and the jurisdiction of the trial court over the lawsuit was properly invoked. At that time, Richard Brorein was the real party in interest. When Richard Brorein passed away, his children Debra Ann Wheeler and Richard J. Brorein were named as successor coexecutors of the estate. They became the real parties in interest and were substituted as plaintiffs in this action. The estate was subsequently closed on January 20, 2021. Upon the closure of the estate, the former coexecutors of the estate were no longer real parties in interest. See Schmidt v. Hicks, 28 Ohio App. 413, 418 (1st Dist. 1928) (when an estate is closed, the executor is no longer a real party in interest and cannot bring or prosecute an action). So, at the time that the trial began on August 8, 2022, there was no real party in interest to pursue the claims. The question we must resolve is whether Appellees cured the real-party-in-interest issue with the nunc pro tunc entry from the Auglaize County Probate Court. {¶63} Lierenz v. Bowen, 1994 Ohio App. LEXIS 43 (6th Dist. Jan. 14, 1994), 21  OHIO FIRST DISTRICT COURT OF APPEALS addressed a similar situation. In Lierenz, the plaintiff, “in her capacity as the executrix of an estate,” filed a breach-of-contract lawsuit against defendants. Id. at *2. While the litigation was pending, the probate court approved an entry that settled the decedent’s account and discharged plaintiff as the executrix of the estate. Id. at *3. The defendants moved to dismiss the plaintiff’s complaint on the ground that she lacked authority to maintain the action after she was discharged as the executrix of the estate. Id. The trial court denied the motion to dismiss, the case proceeded to trial, and the jury awarded plaintiff damages. Id.7 {¶64} The plaintiff then filed a m