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July 13, 2001

PRESIDING JUSTICE STEIGMANN delivered the opinion of thecourt:

In December 1997, plaintiff, Lynne K. Jackson (Jackson),personal representative of the estate of Curtis W. Jackson(Curtis), filed an amended complaint against defendant, David L.Graham, M.D., for medical malpractice, alleging that Graham failedto diagnose and treat Curtis' deep vein thrombophlebitis andthrombosis. In November 1999, Graham filed a motion for summaryjudgment. In December 1999, Jackson filed a response to thatmotion, attaching the affidavits of two physicians. In January2000, Graham filed a motion to strike those affidavits, and inAugust 2000, the trial court granted Graham's motion to strike aswell as his motion for summary judgment.

Jackson appeals, arguing that the trial court erred by(1) striking the affidavits and (2) granting Graham's motion forsummary judgment. We reverse and remand for further proceedings.

The following facts appear from the complaint, affidavits, attached documents, and depositions. On July 19, 1995,Jackson brought her husband, Curtis, to Carle Clinic in Urbana, tosee Graham, who was Curtis' primary care physician and was boardcertified in internal medicine. Curtis told Graham that his rightcalf was swollen and had been painful for a couple of days. Inaddition, Jackson asked Graham to check Curtis' ears because shethought he might have an ear infection. Graham examined Curtis'leg and noted on Curtis' medical chart that (1) Curtis' right calfwas larger than his left calf, (2) Curtis was experiencing sometenderness in his right calf, and (3) his "gait and ambulation"were different than usual. Graham then sent Curtis for anultrasound doppler test on his right leg.

Later on July 19, 1995, Dr. Robert Twohey, a cardiologist, read the ultrasound test results as showing "[n]o evidence ofdeep or superficial venous thrombosis" and "no ancillary soft[-]tissue pathology." Graham did not schedule Curtis for a follow-upappointment, leaving further evaluation of Curtis' calf to Dr.Kenneth S. Aronson, who was then treating Curtis for a seizuredisorder. (Curtis had an August 3, 1995, appointment scheduledwith Aronson.) Graham also diagnosed Curtis as having otitis media(inflammation of the middle ear) and prescribed an antibiotic.

On July 26, 1995, Jackson called Aronson's office becauseCurtis' symptoms worsened. At around 6 a.m. the next day, Curtiswas taken by ambulance to the emergency room at Union Hospital inTerre Haute, Indiana. He died about an hour later. Later thatday, Dr. Roland Kohr conducted an autopsy, which showed thefollowing: (1) Curtis had a large saddle embolus in his pulmonaryartery and additional thrombi within his inferior vena cava; and(2) the cause of his death was "acute pulmonary embolization."

In December 1997, Jackson filed an amended complaintagainst Graham, alleging that Graham was negligent in that he (1)failed to diagnose and treat the deep vein thrombophlebitis andthrombosis in Curtis' inferior vena cava and lower right leg, (2)misdiagnosed Curtis' medical condition as otitis media, (3) failedto properly monitor Curtis' medical condition, (4) failed toconduct or order proper diagnostic tests, (5) failed to provide anappropriate follow-up evaluation of Curtis, and (6) failed toprovide any diagnosis and treatment of the medical condition Curtiscomplained of on July 19, 1995.

In November 1999, Graham filed a motion for summaryjudgment, arguing that Jackson could not establish medicalnegligence or proximate cause. Graham attached to the summaryjudgment motion his own affidavit, in which he averred as follows: (1) he is a physician licensed in Illinois; (2) he had reviewed hisnotes and medical records regarding Curtis; and (3) based on hisexperience, examination, and testing of Curtis on July 19, 1995, aswell as his review of the notes and medical records pertaining toCurtis, (a) his care and treatment of Curtis were appropriate andwithin the standard of care, and (b) on July 19, 1995, no evidenceexisted that Curtis had deep vein thrombosis or thrombophlebitis. Graham also attached Kohr's affidavit, in which Kohr averred that,without speculating, he could not determine when the saddle embolushad developed.

In December 1999, Jackson filed a response to Graham'ssummary judgment motion, attaching the affidavits of two physicians, John T. Philbrick, M.D., and W. Welby Cox, M.D. In hisaffidavit, Philbrick averred, in pertinent part, as follows: (1)if called as a witness in the case, he could competently testify tothe matters set forth in his affidavit; (2) he received his medicaldegree from Harvard Medical School; (3) he was a licensed physicianin Virginia, was board certified in internal medicine, and devoted60% of his internal medicine practice to treating patients; (3)since 1980, he had taught and supervised University of Virginiamedical students and residents in the practice of internal medicineand treatment of patients (Philbrick also attached his curriculumvitae to his affidavit); (4) "the examination, diagnosis, care[,]and treatment of patients with a history and symptoms similar to[Curtis] when treated by [Graham] is a national standard for[b]oard[-][c]ertified [i]nternal [m]edicine physicians, such as[Graham]"; (5) he was "familiar with the standard of care exercisedby [b]oard[-][c]ertified [i]nternal [m]edicine [p]hysicianspracticing in private physicians groups of more than 300 physiciansin clinics in cities the size of Champaign-Urbana, Illinois, withpopulations of approximately 100,000, and Champaign County,Illinois, with populations of approximately 170,000, or in similarcommunities," during July 1995, when Graham treated Curtis; (6) hehad reviewed medical records and other materials related to Curtis'treatment, including Curtis' medical records from Carle Clinic, theultrasound test report, and the autopsy report; and (7) inPhilbrick's opinion, to a reasonable degree of medical certainty,Graham's treatment and care of Curtis was "below, and did notconform with, the appropriate standard of care, and caused[Curtis'] death."

In his affidavit, Philbrick also set forth the specificways in which Graham's care and treatment of Curtis fell below theappropriate standard of care, as follows: (a) on July 19, 1995,Curtis, who was at an increased risk for deep vein thrombosis dueto his obesity, showed signs and symptoms consistent with deep veinthrombosis in his lower right leg; (b) in 1995, the minimumstandard of care for patients like Curtis required that thetreating physician reevaluate the patient "within several days ofinitial presentation," and Graham had failed to conduct a timelyfollow-up of Curtis; (c) in 1995, the minimum standard of careincluded instructing the patient that if his symptoms worsened orif he experienced symptoms of pulmonary embolism, he should seekimmediate medical attention, and Graham failed to properly instructCurtis regarding when to seek medical attention; and (d) Graham'sfailure to diagnose and treat Curtis' thromboembolism resulted inCurtis' death.

Philbrick's affidavit also set forth the followingparticular facts upon which his opinions were based: (1) Curtiswas 39 years old and suffered from a seizure disorder and obesity;(2) during his July 19, 1995, appointment with Graham, Curtiscomplained of swelling and pain in his right calf, which had beenpresent for several days; (3) Curtis had no history of similarcomplaints; (4) Graham's examination of Curtis revealed thatCurtis' right calf was swollen and tender; (5) Curtis was at"increased risk for deep venous thrombosis due to his obesity"; (6)on July 19, 1995, Curtis showed signs and symptoms consistent withdeep vein thrombosis of his right lower leg; (7) Graham scheduledan ultrasound test of Curtis' right calf but did not schedule afollow-up appointment for Curtis; (8) because an ultrasound of apatient's lower extremity "is limited in its ability to visualizedeep veins of the calf," a negative ultrasound does not rule outdeep vein thrombosis; (9) a "significant portion of calf[-]deepvenous thrombosis (approximately 20%) extend to the thigh duringthe 10 to 14 days following presentation of a patient with thisproblem to a physician for evaluation"; and (10) once a thrombosisis in the deep veins of the thigh, a significant risk (approximately 50%) exists that it will embolize to the lungs.

In his affidavit, Cox averred, in pertinent part, asfollows: (1) if called as a witness in the case, he couldcompetently testify to the matters set forth in his affidavit; (2)he received his medical degree from the University of MissouriMedical School and completed both his internship and residency ininternal medicine; (3) he was a licensed physician in Missouri andWashington and was board certified in internal medicine; (3) he wascurrently in private practice in Everett, Washington, and from 1995until 1999, he specialized in internal medicine at the SpringfieldClinic Cancer and Hematology Center in Springfield, Missouri (Coxalso attached his curriculum vitae to his affidavit); (4) "theexamination, diagnosis, care[,] and treatment of patients with ahistory and symptoms similar to [Curtis] when treated by [Graham]is a national standard for [b]oard[-][c]ertified [i]nternal[m]edicine physicians, such as [Graham]"; (5) he was "familiar withthe standard of care exercised by [b]oard[-][c]ertified [i]nternal[m]edicine [p]hysicians practicing in private physicians groups ofmore than 300 physicians in clinics in cities the size ofChampaign-Urbana, Illinois, with populations of approximately100,000, and Champaign County, Illinois, with populations ofapproximately 170,000, or in similar communities," during July1995, when Graham treated Curtis; (6) he had reviewed medicalrecords and other materials related to Curtis' treatment, includingCurtis' medical records from Carle Clinic, the ultrasound testreport, and the autopsy report; and (7) in Cox's opinion, to areasonable degree of medical certainty, Graham's treatment and careof Curtis was "below and did not conform with, the appropriatestandard of care, and caused [Curtis'] death."

Cox's affidavit also set forth the specific ways in whichGraham's care and treatment of Curtis fell below the appropriatestandard of care, as follows: (a) when Graham examined Curtis onJuly 19, 1995, Curtis had a deep vein thrombophlebitis andthrombosis in his lower right leg; (b) Graham deviated from theappropriate standard of care by failing to conduct an appropriatefollow-up evaluation of Curtis; and (c) on July 19, 1995, Grahamfailed to fully address Curtis' chief complaint of a swollen rightcalf.

Cox's affidavit also set forth the following particularfacts upon which his opinions were based: (1) Curtis was a 39-year-old man who had been monitored by Carle Clinic physicians forseveral years; (2) Curtis suffered from a convulsive disorder,which was caused by a previous head injury; (3) prior to his death,Curtis "had experienced some difficulty with breakthrough seizuresand changes in his anticonvulsant program became necessary"; (4)during his July 19, 1995, appointment with Graham, Curtis complained of swelling and pain in his right calf; (5) Curtis' medicalchart indicated that Curtis and Jackson had noticed the swellingfor a "couple of days"; however, the chart also indicated thatJackson thought that Curtis' right lower leg had been swollen "fora number of weeks"; (6) Graham's examination of Curtis revealedthat Curtis' right calf was swollen and tender; (7) Grahamscheduled an ultrasound test of Curtis' right calf but did notschedule a follow-up appointment for Curtis and instead leftfurther evaluation to Aronson; (8) because the swelling and pain inCurtis' right leg had not improved, Graham should have orderedanother ultrasound test; and (10) a repeat ultrasound test"probably would have shown the development of a diagnosable deepvenous thromboph[]lebitis and thrombosis in the inferior vena cavaand more importantly in the right lower extremity."

In January 2000, Graham filed a motion to strike Cox'sand Philbrick's affidavits, claiming that they were insufficientunder Supreme Court Rule 191(a) (145 Ill. 2d R. 191(a)). In April2000, the trial court conducted a hearing on all pending motionsand took the matter under advisement.

In August 2000, the trial court entered a written ordergranting both Graham's motion to strike the physicians' affidavitsand his motion for summary judgment. In striking Cox's andPhilbrick's affidavits, the court found as follows: (1) Cox's andPhilbrick's averments that a national standard of care governs theconduct of board-certified internal medicine physicians when theyexamine, diagnose, care for, and treat patients with a history andsymptoms similar to Curtis' "fail[] to identify the source of anysuch standard. Such assertion amounts to an unsupported conclusion, would not be competent testimony at trial, and therefore,does not meet the requirements of *** Rule 191(a)"; (2) Cox's andPhilbrick's averments that they were familiar with the standard ofcare in clinics such as Carle Clinic, which are located in citiesthe same size as Champaign-Urbana, or in similar communities, were"unsupported by any foundational facts which would identifyaffiant's source of knowledge as to the standard of care described,would not be competent testimony at trial, and therefore, do[] notmeet the requirements of Supreme Court Rule 191(a)"; and (3) "[i]nthe absence of any foundational facts establishing the standard ofcare governing the interaction between [Curtis] and [Graham], whichis necessary to establish the duty owed by [Graham], any testimonyby [Cox or Philbrick] at trial in regard to acts or omissions of[Graham] that would constitute a breach of any such duty would beincompetent."

In granting Graham's motion for summary judgment, thetrial court stated, in pertinent part, as follows:

"After reviewing the pleadings, depositions[,]and admissions on file and the affidavit of[Graham], the [c]ourt has determined there isno triable issue of fact as [to] any breach ofthe duty owed by [Graham] to [Curtis] as histreating physician and that [Graham] is entitled, as a matter of law, to entry of judgmentin his favor on the issue of liability. The[c]ourt specifically finds that, absent theaffidavits of [Cox and Philbrick], which havebeen ordered stricken, there is no evidence tocontravene the verified statement in [Graham's] affidavit and testimony in his deposition that his care, treatment, testing, diagnosis[,] and instructions rendered for and to[Curtis] were appropriate, proper, and withinthe standard of care."

This appeal followed.

A. Motion To Strike the Affidavits of Philbrick and Cox

Initially, Graham contends that the trial court'sdecision to grant or deny a motion to strike a Rule 191 affidavitfiled in support of, or in opposition to, a summary judgment motionis a matter of discretion, and this court should not reverse thetrial court's decision absent an abuse of that discretion. Wedisagree.

In support of his argument for an abuse of discretionstandard of review, Graham cites In re Estate of Hoover, 155 Ill.2d 402, 420, 615 N.E.2d 736, 744 (1993), for the proposition thata trial court's decision to strike an affidavit is an evidentiarymatter and thus within that court's discretion. We agree thatgenerally an abuse of discretion standard of review applies whenthis court reviews a trial court's evidentiary rulings. See, e.g.,Poulos v. Lutheran Social Services of Illinois, Inc., 312 Ill. App.3d 731, 745, 728 N.E.2d 547, 559 (2000). However, in this case, weare reviewing the trial court's ruling on a motion to strike anaffidavit, which motion was made in conjunction with the court'sruling on a motion for summary judgment. In such cases, theappropriate standard of review is de novo.

In Employers Insurance v. Ehlco Liquidating Trust, 186Ill. 2d 127, 160, 708 N.E.2d 1122, 1139 (1999), the supreme courtaddressed an analogous situation and held that when the trial courtawards attorney fees and costs (a decision generally reviewed underan abuse of discretion standard) in conjunction with that court'sruling on a motion for judgment on the pleadings, the reviewingcourt must apply the standard of review that is appropriate for agrant of judgment on the pleadings--that is, the de novo standardof review. See also Mobil Oil Corp. v. Maryland Casualty Co., 288Ill. App. 3d 743, 751-55, 681 N.E.2d 552, 558 (1997) (applying denovo standard of review to an award of attorney fees and costs madein a grant of summary judgment; cited approvingly by the supremecourt in Employer's Insurance). Accordingly, when the trial courtrules on a motion to strike a Rule 191 affidavit in conjunctionwith a summary judgment motion, we review de novo the trial court'sruling on the motion to strike.

Applying a de novo standard of review in such situationsis logical, as the following hypothetical illustrates. Assume thatthe trial court had before it this same case, with the sameaffidavits, but that the defendant had not filed a motion to strikethose affidavits. In such a case, the court could have--and shouldhave--engaged in the same analysis as it did here. In other words,the court did not need to have before it a motion to strike inorder to find that the affidavits were insufficient under Rule191(a) (145 Ill. 2d R. 191(a)). Under that circumstance, theappropriate standard of review clearly would be de novo. SeeFerguson v. McKenzie, No. 89144, slip op. at 3 (January 29, 2001),___ Ill. 2d ___, ___, ___ N.E.2d ___, ___; Jones v. Chicago HMOLtd., 191 Ill. 2d 278, 291, 730 N.E.2d 1119, 1127 (2000); OutboardMarine Corp. v. Liberty Mutual Insurance Co., 154 Ill. 2d 90, 102,607 N.E.2d 1204, 1209 (1992) (in which the supreme court held forthe first time that reviewing courts should conduct de novo reviewsof summary judgment rulings); Carroll v. Paddock, 317 Ill. App. 3d985, 990, 741 N.E.2d 326, 330 (2000); Kipnis v. Mandel Metals,Inc., 318 Ill. App. 3d 498, 503, 741 N.E.2d 1033, 1037 (2000);Anderson v. Alberto-Culver USA, Inc., 317 Ill. App. 3d 1104, 1110,740 N.E.2d 819, 824-25 (2000); People v. Select Specialties, Ltd.,317 Ill. App. 3d 538, 542, 740 N.E.2d 543, 547 (2000).

Likewise, in this case, the trial court did not needGraham's motion to strike in order to consider the sufficiency ofCox's and Philbrick's affidavits. It simply would make no sense toconclude that the otherwise applicable standard of review--de novo--can be changed to a deferential standard by a party's unilateraldecision to file a wholly unnecessary motion to strike theaffidavits. Accordingly, we review de novo the trial court'sruling on Graham's motion to strike the affidavits filed inopposition to his summary judgment motion.

In so holding, we note that Hoover, 155 Ill. 2d 402, 615N.E.2d 736, does not require a different result. Although theHoover court reviewed the trial court's striking of an affidavit inthat case under an abuse of discretion standard, it did notdirectly address the proper standard of review to be applied whenthe trial court rules on a motion to strike in conjunction with amotion for summary judgment. See Hoover, 155 Ill. 2d at 419, 615N.E.2d at 744. Moreover, Hoover was decided several years beforethe supreme court decided Employer's Insurance.

2. The Trial Court's Grant of Graham's Motion To Strike
Cox's and Philbrick's Affidavits

In determining the appropriate standard of care, Illinoisstill follows the "similar locality" rule, "which requiresphysicians to possess and apply the knowledge, skill[,] and carewhich a reasonably well-qualified physician in the same or similarcommunity would bring to a similar case." Slezak v. Girzadas, 167Ill. App. 3d 1045, 1052, 522 N.E.2d 132, 135 (1988). In Purtill v.Hess, 111 Ill. 2d 229, 246, 489 N.E.2d 867, 874 (1986), the supremecourt recognized that because "there are today relatively uniformstandards for the education and licensing of physicians," courtsshould read the "similar locality" rule broadly. The issue inPurtill was whether a physician's affidavit filed in opposition tothe defendant's summary judgment motion demonstrated the affiant'sfamiliarity with the applicable standard of medical care. Purtill,111 Ill. 2d at 243, 489 N.E.2d at 873. In his affidavit, thephysician admitted a lack of knowledge regarding the standard ofcare applicable to physicians in the same community or similarcommunities in which the defendant practiced medicine. Purtill,111 Ill. 2d at 244, 489 N.E.2d at 873. The trial court struck theaffidavit and granted summary judgment in the defendant's favor,and the appellate court later affirmed that decision. Purtill, 111Ill. 2d at 239, 489 N.E.2d at 871.

On appeal to the supreme court, the plaintiff urged thecourt to reconsider the "similar locality" rule. Purtill, 111 Ill.2d at 246, 489 N.E.2d at 874. Although the supreme court refusedto abolish that rule, it reversed the trial and appellate courts,holding that an expert need not be familiar with the standard ofmedical care in a particular community when a nationally uniform,minimum standard exists and the expert is familiar with thatstandard. Purtill, 111 Ill. 2d at 247, 489 N.E.2d at 874-75. Thus, the Purtill court held that an expert will be qualified totestify as to the standard of care in a medical malpractice case if(1) the expert is familiar with the standards of care applicable toa reasonably well-qualified physician in the same or similarlocality of treatment or (2) certain nationally uniform, minimumstandards exist despite the locality of treatment, and the expertis familiar with those standards. Purtill, 111 Ill. 2d at 246-47,489 N.E.2d at 874-75. The Purtill court further held that only if"conditions and facilities that are available [to the defendantphysician] are relevant" must the expert be "acquainted withaccepted standards of care under similar circumstances." (Emphasisadded.) Purtill, 111 Ill. 2d at 247, 489 N.E.2d at 875. Accordingly, a party may invoke the "similar locality" rule only when aquestion exists regarding the inequality of medical facilities andconditions, such as the availability of facilities for examinationand treatment of the patient or the presence of a specialist, whichwould make it unfair to hold a physician practicing in a small,rural community to the same standard of care as a physicianpracticing in an urban environment where specialized care facilities are readily available.

In this case, no question exists regarding the availability or inequality of medical facilities. In Cassady v.Hendrickson, 138 Ill. App. 3d 925, 936, 486 N.E.2d 1329, 1336(1985), this court rejected the "similar locality" rule as itpertains to board-certified specialists at Carle Clinic, stating, in pertinent part, as follows:

"[Carle] Clinic is a nationally recognizedmedical group practice. In order to achievethis recognition, it had to be nationallyqualified, have facilities approved by anational review group, and have nationallyqualified personnel. It is affiliated with amedical school and is an urban unit. Most ofits physicians are board certified. ***

*** Maintaining that a nationally recognized, urban, physicians' association withaccess to current medical technology shouldbenefit from the protection the same or similar community standard affords the ruralpractitioner disregards the purpose and rationale behind the locality rule."

In light of (1) Carle Clinic's status as a nationally recognized,urban medical group that is affiliated with a medical school and(2) the fact that no dispute exists over whether Carle Clinic hasthe necessary equipment to diagnose and treat deep vein thrombosis,the "similar locality" rule does not apply to this case.

Graham does not contend that Carle Clinic should not beheld to a national standard of medical care because it has inferiorfacilities, equipment, or physicians. Indeed, such a contentionwould be disingenuous. Instead, he claims that "there cannot be anational standard of care because [Jackson's] experts disagree" onthat standard of care. Contrary to Graham's claim, Cox's andPhilbrick's affidavits do not show that they disagree on thenational standard of medical care. Rather, both Cox and Philbrickaverred that the national standard of care requires physicians toconduct an adequate and timely follow-up of the patient, whichincludes conducting a repeat ultrasound doppler test. Cox's andPhilbrick's affidavits differed only in that Cox averred thatGraham should have hospitalized Curtis for further observation andevaluation prior to conducting another ultrasound doppler test andPhilbrick did not. Cox and Philbrick both agreed that the minimumnational standard of care required a follow-up ultrasound test.

Having determined that a national standard of medicalcare applies in this case, we must next determine whether Cox's andPhilbrick's affidavits were sufficient under Rule 191(a) (145 Ill.2d R. 191(a)).

Jackson contends that Cox's and Philbrick's affidavitssatisfied Rule 191(a) and the trial court erred when it found thatthe affidavits were insufficient because they failed to identifythe "source" of the national standard. We agree.

Supreme Court Rule 191(a) governs the sufficiency of anaffidavit filed in support of, or in opposition to, a motion forsummary judgment (145 Ill. 2d R. 191(a)). That rule provides, inpertinent part, as follows:

"Affidavits in support of and in opposition toa motion for summary judgment *** shall bemade on the personal knowledge of theaffiants; shall set forth with particularitythe facts upon which the claim, counterclaim,or defense is based; shall have attachedthereto sworn or certified copies of allpapers upon which the affiant relies; shallnot consist of conclusions but of facts admissible in evidence; and shall affirmativelyshow that the affiant, if sworn as a witness,can testify competently thereto." 145 Ill. 2dR. 191(a).

Rule 191(a) is satisfied if "from the document as a whole, itappears the affidavit is based on the personal knowledge of theaffiant and there is a reasonable inference that the affiant couldcompetently testify to its contents at trial." Kugler v. SouthmarkRealty Partners III, 309 Ill. App. 3d 790, 795, 723 N.E.2d 710, 714(1999).

In Woolums v. Huss, No. 4-00-0898, slip op. at 21 (June28, 2001), ___ Ill. App. 3d ___, ___, ___ N.E.2d ___, ___(Steigmann, P.J., specially concurring), Presiding JusticeSteigmann recently questioned the requirements of Rule 191(a) as itpertains to expert opinions and called on the supreme court toaddress the rule in light of the supreme court's holding in Wilsonv. Clark, 84 Ill. 2d 186, 417 N.E.2d 1322 (1981). However, evenleaving aside the concerns expressed in that special concurrence,we conclude that Cox's and Philbrick's affidavits satisfied therequirements of Rule 191(a).

Philbrick's affidavit shows that he (1) has been a board-certified internal medicine physician since 1978, (2) has completedextensive education and training in the field of internal medicine,and (3) has several years of experience in that field. Philbrickalso averred that since 1980, he has taught at the University ofVirginia School of Medicine, and since 1997, he has taught andsupervised University of Virginia medical students and residents inthe practice of internal medicine. In addition, Philbrick'scurriculum vitae shows that he has written several articlesregarding the diagnosis and management of deep vein thrombosis.

Cox's affidavit shows that he (1) has been a board-certified internal medicine physician since 1975, (2) has completed extensive education and training in the field of internalmedicine, and (3) has several years of experience in that field. In addition, Cox's affidavit shows that he completed both hisinternship and medical residency in internal medicine.

Viewing Cox's and Philbrick's affidavits as a whole(including their attached curriculum vitae), we conclude that thefacts stated therein support a reasonable inference that the sourceof the national standard of medical care is the education andtraining they have received in the field of internal medicine. Ifthe nationally uniform standard of medical care is the norm, whichit is, then it is axiomatic that the source of that standard is themedical education and training that physicians receive. SeePurtill, 111 Ill. 2d at 246, 489 N.E.2d at 874 (in which thesupreme court recognized that "there are today relatively uniformstandards for the education and licensing of physicians"). We thusfurther conclude that viewing the affidavits as a whole, Cox andPhilbrick could competently testify to the contents of theirrespective affidavits at trial. Accordingly, we hold that thetrial court erred by granting Graham's motion to strike Cox's andPhilbrick's affidavits. See Williams v. Covenant Medical Center,316 Ill. App. 3d 682, 693, 737 N.E.2d 662, 672 (2000) (in whichthis court concluded that the affidavit of the plaintiff's expertsatisfied Rule 191(a), noting that the expert (1) averred that hereviewed the patient's medical records and available depositions,(2) described the patient's conditions that increased her risk offalling, and (3) stated that the hospital's nursing staff failed toraise all of the patient's bed rails and the patient sufferedinjuries after leaving her bed and falling).

Moreover, even if an abuse of discretion standard ofreview applied, we would hold that the trial court abused itsdiscretion by striking Cox's and Philbrick's affidavits.

B. Motion for Summary Judgment

Last, Jackson argues that the trial court erred bygranting Graham's motion for summary judgment. We agree.

Summary judgment is appropriate when the pleadings,affidavits, depositions, admissions, and exhibits on file, whenviewed in the light most favorable to the nonmoving party andstrictly against the moving party, reveal that (1) no genuine issueof material fact exists and (2) the moving party is entitled tojudgment as a matter of law. Jones, 191 Ill. 2d at 291, 730 N.E.2dat 1127; Purtill, 111 Ill. 2d at 250, 489 N.E.2d at 876. Thus, inthe context of a medical malpractice action, summary judgment isproper "only where the plaintiff has failed to demonstrate anability to offer, through competent expert testimony, evidence attrial on the applicable standard of medical care." Purtill, 111Ill. 2d at 250, 489 N.E.2d at 876; see Smock v. Hale, 197 Ill. App.3d 732, 741, 555 N.E.2d 74, 80 (1990). Summary judgment must beawarded with caution to avoid preempting a litigant's right totrial by jury or the right to fully present the factual basis of acase where a material dispute may exist. Anderson, 317 Ill. App.3d at 1110, 740 N.E.2d at 824-25. Thus, summary judgment "shouldbe allowed only when the right of the moving party is clear andfree from doubt" (Jones, 191 Ill. 2d at 291, 730 N.E.2d at 1127),and "[w]here doubt exists, the wiser judicial policy is to permitresolution of the dispute by a trial" (Meck v. Paramedic Services,296 Ill. App. 3d 720, 725, 695 N.E.2d 1321, 1324-25 (1998)). Wereview de novo the trial court's grant of summary judgment. Ferguson, No. 89144, slip op. at 3 (January 29, 2001), ___ Ill. 2dat ___, ___ N.E.2d at ___. Accordingly, we afford no deference tothe trial court's decision and instead, we consider anew thepleadings, affidavits, depositions, admissions, and exhibits onfile to determine whether the trial court's decision was correct. Bank One, Springfield v. Roscetti, 309 Ill. App. 3d 1048, 1054, 723N.E.2d 755, 759 (1999).

Initially, we note that in reviewing a trial court'sgrant of summary judgment, it is not our duty to assess thestrength of the qualifications, credibility, and testimony of Coxand Philbrick against those of Graham and Kohr. Instead, we mustdetermine whether Cox and Philbrick's affidavits were sufficient tocreate issues of fact on whether Graham deviated from the appropriate standard of care and whether that deviation caused Curtis'death. In this case, both Cox's and Philbrick's affidavits statethat Graham's care and treatment of Curtis deviated from thenational standard of medical care. Both Cox and Philbrick opinedthat (1) when Graham examined Curtis on July 19, 1995, Curtisshowed signs and symptoms of deep vein thrombosis in his lowerright leg; (2) Graham deviated from the standard of care by failingto properly diagnose and treat Curtis' deep vein thrombosis; and(3) Graham's deviation from the appropriate standard of care causedCurtis' death. Viewing Cox's and Philbrick's affidavits strictlyagainst Graham and liberally in Jackson's favor, we conclude thatthe affidavits are sufficient to create issues of fact regardingwhether Graham deviated from the appropriate standard of care andwhether that deviation caused Curtis' death. Accordingly, we holdthat the trial court erred by granting Graham's motion for summaryjudgment.

For the reasons stated, we reverse the trial court'sjudgment and remand for further proceedings.

Reversed and remanded.

MYERSCOUGH and KNECHT, JJ., concur.