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Docket No. 91093-Agenda 33-September 2001.

JENNIFER SIMMONS et al., Appellants, v. ROLANDO M.GARCES, M.D., Appellee.

Opinion filed January 25, 2002.

JUSTICE McMORROW delivered the opinion of the court:

In this appeal we are asked to determine whether the jury'sanswer to a special interrogatory is incompatible with the jury'sgeneral verdict, and, if so, whether the special interrogatorycontrols. A jury returned a general verdict in the amount of$675,000 against defendant Dr. Rolando M. Garces and in favorof plaintiffs Jennifer Simmons (Jennifer) and Harold King(Harold), who had brought a medical malpractice action againstDr. Garces following the death of their infant daughter, LaTonyaKing. The jury also answered "No" to the special interrogatory:"Did dehydration contribute to cause the death of LaTonya King?"As a result, in response to Dr. Garces' post-trial motion, the circuitcourt of Cook County entered judgment in favor of Dr. Garces onthe special interrogatory. 735 ILCS 5/2-1108 (West 2000). Adivided appellate court affirmed, concluding that the jury's answerto the special interrogatory was "absolutely irreconcilable with thegeneral verdict" and the trial court therefore "properly enteredjudgment in favor of defendant." 319 Ill. App. 3d 308, 322. Weallowed plaintiffs' petition for leave to appeal. 188 Ill. 2d R. 315.For the reasons set forth below, we affirm the judgment of theappellate court.

BACKGROUND

LaTonya King⁽¹⁾ was born prematurely to Jennifer onDecember 28, 1993, and was hospitalized for two weeksthereafter. On January 21, 1994, Jennifer brought LaTonya to Dr.Garces' clinic for a checkup. The child's weight was five pounds,12 ounces, and Dr. Garces pronounced her a perfectly healthybaby.

Dr. Garces practiced in a clinic at 7106 South Jeffery inChicago, about a block and a half from Jennifer and Harold'sresidence at 7234 South Jeffery. The clinic operated on a first-come, first-served basis. Patients would sign in when they enteredthe clinic, and would be seen by the doctor in that order. Dr.Garces had two assistants, Sharon Robinson (Sharon), a certifiedmedical assistant, and Shalonda Sloan (Shalonda), an 18-year-oldwith no formal training in patient care. One of the responsibilitiesof the assistants was to notify the doctor if a patient presented anemergency. If that were the case, the doctor would see the patientout of turn.

Jennifer testified that LaTonya took her normal feeding offour ounces of formula on the night of January 23, 1994. The nextmorning, January 24, Jennifer noticed loose stool in LaTonya'sdiaper when the child awoke for her feeding. Jennifer denied attrial that LaTonya took four ounces of formula at this 6 a.m.feeding, but was impeached with her deposition testimony to thecontrary. At 8:30 a.m. LaTonya took two ounces of water.However, she would not take her 10 a.m. feeding, and Jenniferbecame concerned. She called Dr. Garces' clinic and spoke to thedoctor, informing him of the situation, and he told her to switch toa formula called Pedialyte. Jennifer tried to feed LaTonya thePedialyte, but the child would take only half an ounce.

At 12:30 p.m. Jennifer again telephoned the clinic and spoketo Sharon, who told her she should keep trying to get LaTonya totake the Pedialyte. Jennifer's subsequent attempts to feed LaTonyathe formula were unsuccessful. At that point Jennifer dressed thebaby warmly and walked to the clinic, arriving at about 1 p.m.After about 15 minutes, Shalonda called Jennifer's name and theywent to a waiting area, where Jennifer told Shalonda that LaTonyawas not sucking the bottle. Shalonda testified that she weighed andmeasured LaTonya, and wrote the child's height, weight,temperature and head circumference in a temporary chart. Sheused a temporary chart because she was unable to retrieveLaTonya's permanent chart. Shalonda then left the waiting areaand went to speak to the doctor. According to Jennifer, whenShalonda returned, she told Jennifer that Dr. Garces wanted her toget some Pedialyte from a drug store. Jennifer then left the clinicand went across the street to the drug store, picked up thePedialyte, and went home. She stated that she left the officebecause she was following the doctor's orders to obtain thePedialyte.

Jennifer tried repeatedly that afternoon to feed LaTonya theformula but to no avail. She called the clinic at 2:29 p.m. and at2:53 p.m., each time speaking to Sharon, who told her to continueher efforts. During the second of these calls, Jennifer told Sharonthat LaTonya was sleeping more. At 3:56 p.m. Jennifer called theclinic again and spoke to Dr. Garces, who told her to try a differentformula and if that did not work, to take LaTonya to theemergency room. Dr. Garces said he was concerned that LaTonyamight become dehydrated. Soon after, at about 4:13 p.m., Jennifercalled a cab. She testified that she waited inside her apartment forit to arrive, dressed the baby warmly, and then took the cab toSouth Shore Hospital.

Dr. Thomas Bahk, an emergency room physician at SouthShore, testified that LaTonya was dead when she arrived at theemergency room at about 4:40 p.m. She had no respiration, noblood pressure, and no pulse. He and the emergency room nursesperformed cardiopulmonary resuscitation but were unable torevive her. She was pronounced dead at 5:06 p.m. on January 24,1994.

Marcel Parungao, an emergency room nurse, testified that thebaby's rectal temperature at that time was 93.2 degrees Fahrenheit,and her weight was five pounds, eight ounces. He also found loosestool in her diaper. Myrna Carating, another nurse, testified thatLaTonya was wearing a diaper and pajamas, and was wrapped intwo receiving blankets that were "quite thin." According toCarating, Jennifer told her that LaTonya had been active at 2:30p.m. Carating also recorded that just prior to Jennifer's andLaTonya's arrival at the emergency room, LaTonya had stiffened,her arms had stretched, and her neck was hyperextended.

Chicago Police Officers Charles Howard and Paul Andersonwent to the hospital on January 24 after receiving a call aboutLaTonya's death. Anderson testified that Jennifer indicated shewalked to the hospital. Howard gave essentially the sametestimony, stating that a report prepared after they had gone to thescene indicated that Jennifer walked to the hospital on January 24.Under cross-examination, Howard and Anderson conceded thatthis report was not signed by a supervisor.

Between 5 and 6 p.m., Chicago police department DetectivesJohn McMurray and David Friel were assigned to investigateLaTonya's death. After arriving at the hospital, they interviewedhospital staff members as well as Jennifer and Harold. Friel statedthat they learned from Jennifer that she arrived at the hospital bytaxi. Friel and McMurray closed their investigation afterdetermining that there had been no criminal wrongdoing.

Dr. Tae Lyong An, a forensic pathologist with the CookCounty medical examiner's office, conducted an autopsy.According to Dr. An, LaTonya's death was caused by"dehydration due to gastroenteritis." LaTonya had sunken eyeballsand poor skin turgor,⁽²⁾ or tension, both of which, according to Dr.An, are consistent with dehydration. Under cross-examination, Dr.An conceded that premature babies can be born without fullydeveloped subcutaneous tissue and fat, and thus could have sunkeneyeballs without being dehydrated. In addition, premature infantscan have excess skin that would appear wrinkly and have lesstension. Dr. An also acknowledged that there was just a four-ounce difference between the weight recorded for LaTonya onJanuary 21 (5 pounds, 12 ounces), and her weight on January 24in the emergency room (5 pounds, 8 ounces). That is a weight lossof 4.4%, which Dr. An conceded would be unlikely to cause deathby dehydration. He also acknowledged that his report included nofinding of tubular necrosis in the kidneys, a condition that isconsistent with death by severe dehydration, nor did he find anyanatomic or pathologic evidence of inflammation in the stomachor small intestine, a condition that constitutes the definition ofgastroenteritis. Dr. An explained that there is such a thing as"functional change of the intestine" which, though notanatomically found, can cause diarrhea. "We call itgastroenteritis," he said. "That is nothing unusual."

Dr. An also testified that he did not think there was anyevidence of hypothermia as a possible cause of death. He said hehad information that Jennifer took LaTonya to the hospital by taxi.He did not remember that Jennifer walked to the hospital.

Jennifer and Harold, acting individually and as co-specialadministrators of LaTonya's estate, brought a wrongful-deathaction against Dr. Garces, alleging that LaTonya's death was aproximate result of Dr. Garces' negligence. Attached to thecomplaint was a physician's report asserting that LaTonya "diedfrom dehydration."

Plaintiffs presented the expert testimony of Dr. Gilbert Given,a board-certified pediatrician, to establish that Dr. Garces deviatedfrom the applicable standard of care and that his negligent conductresulted in LaTonya's death from dehydration. Dr. Given testifiedthat, in his opinion, LaTonya "was severely dehydrated and thiscontributed to her death." He said dehydration, which he definedas a loss of body fluids,⁽³⁾ is determined by the percent of weightloss. A loss in body weight of more than 10% or 12% usuallyindicates severe dehydration. In such instances, the child'scirculation becomes involved, and the child may have lower bloodpressure. According to Dr. Given, LaTonya was 12% to 14%dehydrated, based on a comparison of her weight on January 21,1994 (5 pounds, 12 ounces), and her weight at autopsy, which Dr.Given said was about 5 pounds. The appropriate treatment inLaTonya's case would have been "hospitalization and IV fluids." Dr. Given opined that Dr. Garces' failure to see LaTonya andintervene on January 24 amounted to negligence which contributedto the child's death. According to Dr. Given, "more likely thannot, if Dr. Garces had intervened with appropriate IV fluids[LaTonya] would not have died."

On direct examination, Dr. Given was asked aboutinconsistencies in evidence he had reviewed. He responded thatthere were "numerous" inconsistencies, "[e]ven to the point ofhow the baby got to the hospital. It was noted by one officer thatthe mom took a cab. Someone else noted that the mom walked."

Dr. Given conceded on cross-examination that the medicalexaminer's report included no findings of tubular necrosis of thekidneys, nor did it include any findings of inflammation of thestomach, the large intestine or the small intestine. The report alsodid not mention the exact number of times LaTonya had diarrhea,nor did it describe LaTonya's input of fluid prior to her death. Asfar as Dr. Given knew, no one made any determination as to theamount of fluids LaTonya took in or expelled "during this illness."

He also acknowledged that he did not know to a reasonabledegree of medical certainty the exact extent of the dehydration thatLaTonya suffered. "How dehydrated the child, the baby, was, Idon't know," Dr. Given said.

Dr. Garces denied that he was negligent, and denied that anyclaimed act or omission on his part was a proximate cause ofplaintiffs' claimed injuries. He presented expert testimony toestablish that LaTonya's death was not caused by dehydration butrather that it resulted from hypothermia, or possibly fromsuffocation.

Dr. Michael Kaufman, who was certified in anatomicpathology and cytopathology, testified that he found no significantevidence in the medical records or the autopsy report to indicatethat LaTonya died from dehydration. He opined instead that thecause of death was hypothermia, or possibly suffocation. He notedthat LaTonya's weight had changed by only 4.4% from January 21until the time she was weighed in the emergency room on January24 "just at the point of death." Such a weight loss, he said, is"insignificant" and insufficient to cause or contribute to causedeath by dehydration.

Dr. Kaufman also noted that there was no indication of anyelevation in the levels of blood urea nitrogen, sodium orcreatinine. This, he said, was inconsistent with death due todehydration. In addition, the gross and microscopic findings in theautopsy report showed no evidence of gastroenteritis. The autopsyreport also included no reference to any findings of acute tubularnecrosis, which Dr. Kaufman said was inconsistent with severedehydration.

According to Dr. Kaufman, the most likely cause of death washypothermia. He noted that LaTonya's temperature as recorded inthe emergency room on January 24 was 93.2 degrees, which hetermed "markedly depressed." In order for death to result fromhypothermia, which is defined as a subnormal body temperature,it must be of a significant enough degree that it alters the normalbody metabolism and creates an abnormal heart rhythm. Dr.Kaufman said he found nothing in LaTonya's autopsy report thatwas inconsistent with a death by hypothermia.

Dr. William Wittert, a board-certified pediatrician, alsotestified for the defense. Dr. Wittert opined that LaTonya did notdie of dehydration. He noted that, according to the recordtestimony, LaTonya took four ounces of fluid between 9 and 10p.m. on January 23, another four ounces at 6 a.m. on January 24,and two ounces at 8:30 a.m., plus a half ounce of Pedialyte later inthe morning. At the same time, there were only two references tooutput in terms of stool: the loose stool that Jennifer said shefound in the diaper at 6 a.m., and the loose stool found inLaTonya's diaper at the emergency room. According to Dr.Wittert, these inputs and outputs of fluid are inconsistent withdehydration. He noted, in addition, that LaTonya's weight lossfrom January 21 to January 24 was only four ounces, or about4.34%. Such a weight loss could represent mild dehydration but isnot life-threatening. Even if the weight loss were as high as 10%,"babies should not die from that level of dehydration."

As to other possible causes of LaTonya's death, Dr. Wittertsaid he did not have an opinion to a reasonable degree of medicalcertainty as to what caused her death. However, he pointed to thechild's 93.2 degree temperature, which he described as "very low."Most babies, he said, would probably survive that temperature, butLaTonya was small and preterm, and in her case this temperaturemight have contributed to or caused her death. He also said thechild might have suffocated.

Dr. Wittert also opined that Dr. Garces and his staff possessedthe requisite skill and met the applicable standard of care in thiscase. According to Dr. Wittert, nothing that Dr. Garces did causedharm to LaTonya.

The instructions to the jury stated plaintiffs' claims asfollows: Dr. Garces was negligent on the day of LaTonya's deathby (a) failing to examine LaTonya after Jennifer brought her to theclinic when he should have known that the child was experiencingdiarrhea, drowsiness, and the inability to suck;⁽⁴⁾ (b) failing tofollow up by taking phone calls from Jennifer, when he shouldhave known of LaTonya's symptoms; (c) failing to refer LaTonyato a physician or hospital for examination, diagnosis, or IVtreatment when he knew or should have known of her symptoms;or (d) permitting his staff to provide inappropriate medical adviceor decisions over the phone. The jury was instructed that it mustnot decide the question of professional negligence based onpersonal experience but only from expert testimony.

The parties disagreed as to which instruction should be givenfor proximate cause, with plaintiffs arguing for the long form ofIllinois pattern instruction No. 15.01, and defendant urging theshort form. See Illinois Pattern Jury Instructions, Civil, No. 15.01(2000). The trial court agreed to give the long form, which statedthat:

"When I use the expression 'proximate cause,' I meanany cause which, in natural or probable sequence,produced the injury complained of. It need not be the onlycause, nor the last or nearest cause. It is sufficient if itconcurs with some other cause acting at the same time,which in combination with it, causes the injury." IllinoisPattern Jury Instructions, Civil, No. 15.01 (2000).

Once the court agreed to give the long-form instruction,defendant argued that a special interrogatory was needed in orderfor the jury to determine specifically whether dehydration causedLaTonya's death. According to defendant's counsel, if the jurydetermined that dehydration was not involved in LaTonya's death,then Dr. Garces could not be liable because "[t]hat's their wholecase."

Plaintiffs' counsel objected, arguing that the jury had heardevidence of a variety of causes of death, and that it would beprejudicial to plaintiffs to "make it very narrow" with this specialinterrogatory. According to counsel, the jury might think thatLaTonya's death was the result of a combination of causes. Thecourt asked, "What if they think it's suffocation?" Plaintiffs'counsel answered: "[I]f [the jurors] think it's suffocation, there'sbeen no testimony from the plaintiffs that suffocation would makethe doctor responsible, so they wouldn't even get to this. Theywould be on Verdict Form B [in favor of Dr. Garces]."

The court suggested that a more appropriate interrogatory totest the jury's verdict would be: "Did dehydration contribute tocause the death of LaTonya King?" The court gave thisinterrogatory over plaintiffs' objection.

During their deliberations, the jury sent out a note asking threequestions:

"(1) If we have already decided on Form A or Form B,what is the purpose of the dehydration form?

(2) Is the dehydration form mandatory?

(3) Do we have to be unanimous on the dehydrationform?"

The court's response to the first question was: "It is the law."The court answered "Yes" to both the second and third questions.

A short time later, the jury returned its verdict, finding infavor of plaintiffs in the amount of $675,000. The jury answeredthe special interrogatory in the negative. Defense counsel movedfor entry of judgment in favor of Dr. Garces on the basis of theinconsistency.

After allowing the parties to brief the issue, the court enteredjudgment on the special finding in favor of defendant, rejectingplaintiffs' argument that the jury's special finding was notabsolutely irreconcilable with the general verdict. The court stated:

"[P]laintiffs concede their liability expert determined thatdehydration at least contributed to LaTonya's death. Theplaintiffs during the trial presented only one causationexpert and no other theory or mechanism for death thatwas independent of dehydration. This Court finds that thespecial finding was absolutely irreconcilable with thegeneral verdict."

Plaintiffs appealed, and the appellate court affirmed. Inreaching this decision, the appellate court stated:

"Plaintiffs presented no expert testimony to establishany other causation of death but dehydration. ***

When the jury was asked to focus its attention on theparticularized question of whether dehydrationcontributed to cause LaTonya's death, it answered 'No.'Plaintiffs' attempt to establish a causal connectionbetween defendant's negligence and LaTonya's death thenfailed for lack of expert testimony.

*** [T]here is no reasonable hypothesis remaining onwhich to reconcile the jury's answer to the specialinterrogatory with the general verdict. The trial courtproperly entered judgment on the special interrogatory."319 Ill. App. 3d at 317-18.

We allowed plaintiffs' petition for leave to appeal. 188 Ill. 2dR. 315.

ANALYSIS

Plaintiffs' main argument before this court is that the jury'sspecial finding was not irreconcilable with the general verdict, andtherefore the trial court should have entered judgment on thegeneral verdict and not on the special finding. According toplaintiffs, the central issue here is not whether LaTonya died ofdehydration, but rather whether Dr. Garces was negligent andwhether his negligence was a proximate cause of LaTonya's death.Plaintiffs contend that regardless of the medical cause of death,LaTonya would be alive today were it not for Dr. Garces'negligence in failing to examine LaTonya and refer her to anemergency room in the early afternoon on January 24. Thus it wasnot inconsistent for the jury to find Dr. Garces liable forLaTonya's death and at the same time conclude that dehydrationdid not contribute to cause her death. Plaintiffs argue in thealternative that the jury's special finding was against the manifestweight of the evidence. They also contend that the specialinterrogatory should not have been given because it was confusingand not in proper form.

Plaintiffs additionally point to various instances of allegedmisconduct on the part of defense counsel that they assert deprivedthem of a fair trial. They also claim that the trial court erred inadmitting certain evidence and barring other evidence, and inrefusing to give a missing-evidence instruction.

Special interrogatories are governed by section 2-1108 of theCode of Civil Procedure, which states:

"Unless the nature of the case requires otherwise, thejury shall render a general verdict. The jury may berequired by the court, and must be required on request ofany party, to find specially upon any material question orquestions of fact submitted to the jury in writing. Specialinterrogatories shall be tendered, objected to, ruled uponand submitted to the jury as in the case of instructions.Submitting or refusing to submit a question of fact to thejury may be reviewed on appeal, as a ruling on a questionof law. When the special finding of fact is inconsistentwith the general verdict, the former controls the latter andthe court may enter judgment accordingly." 735 ILCS5/2-1108 (West 2000).

A special interrogatory serves "as guardian of the integrity ofa general verdict in a civil jury trial." O'Connell v. City ofChicago, 285 Ill. App. 3d 459, 460 (1996). It tests the generalverdict against the jury's determination as to one or more specificissues of ultimate fact. Noel v. Jones, 177 Ill. App. 3d 773, 783(1988); Gasbarra v. St. James Hospital, 85 Ill. App. 3d 32, 38(1979). A special interrogatory is in proper form if (1) it relates toan ultimate issue of fact upon which the rights of the partiesdepend, and (2) an answer responsive thereto is inconsistent withsome general verdict that might be returned. Noel, 177 Ill. App. 3dat 783; Gasbarra, 85 Ill. App. 3d at 38. Special findings areinconsistent with a general verdict only where they are "clearlyand absolutely irreconcilable with the general verdict." Powell v.State Farm Fire & Casualty Co., 243 Ill. App. 3d 577, 581 (1993).If a special interrogatory does not cover all the issues submitted tothe jury and a "reasonable hypothesis" exists that allows thespecial finding to be construed consistently with the generalverdict, they are not "absolutely irreconcilable" and the specialfinding will not control. Powell, 243 Ill. App. 3d at 581. Indetermining whether answers to special interrogatories areinconsistent with a general verdict, all reasonable presumptions areexercised in favor of the general verdict. Bilderback v. AdmiralCo., 227 Ill. App. 3d 268, 270 (1992).

We conclude that the jury's special finding in the instant caseis "absolutely irreconcilable" with the general verdict. As noted,the jury answered "No" to the special interrogatory: "Diddehydration contribute to cause the death of LaTonya King?"Plaintiffs based their entire case on the theory that Dr. Garces'negligence caused LaTonya's death by allowing her to becomeseverely dehydrated. If, as the jury concluded, dehydration did notcontribute to cause LaTonya's death, then the necessary linkbetween Dr. Garces' alleged negligence and LaTonya's death ismissing, and he could not be found liable. The special finding thusis irreconcilable with the general verdict in favor of plaintiffs andagainst Dr. Garces.

As in every negligence case, plaintiffs here needed to establishmore than the standard of care and a deviation from that standard.They also were required to show a casual connection between thedeviation and the injury, in this case LaTonya's death. EvanstonHospital v. Crane, 254 Ill. App. 3d 435, 441 (1993). In a medicalmalpractice case, proximate cause must be established by experttestimony to a reasonable degree of medical certainty. Aguilera v.Mount Sinai Hospital Medical Center, 293 Ill. App. 3d 967, 972(1997); accord Townsend v. University of Chicago Hospitals, 318Ill. App. 3d 406, 413 (2000).

Plaintiffs here presented the testimony of one expert, Dr.Given, who opined that LaTonya was severely dehydrated and thatthis contributed to her death. According to Dr. Given, it was morelikely than not that LaTonya would have survived if Dr. Garceshad intervened with appropriate IV fluids.

As the appellate court below correctly noted, plaintiffspresented no expert testimony establishing any cause of deathother than dehydration. In addition, while defendant's experts didsuggest other possible causes, i.e., hypothermia and suffocation,plaintiff's attorney disputed these theories in closing argument.Moreover, the trial record reveals no expert testimony establishingthat Dr. Garces would have been to blame if LaTonya died fromeither of these other causes. Plaintiffs' counsel conceded as muchwhen, in arguing against the giving of the special interrogatory, hestated that if the jury thought LaTonya died of suffocation, "there'sbeen no testimony from the plaintiffs that suffocation would makethe doctor responsible, so [the jurors] wouldn't even get to this.They would be on verdict form B [in favor of Dr. Garces]." Absentexpert testimony linking Dr. Garces' conduct to death byhypothermia or suffocation, and given the jury's rejection ofdehydration as a cause of death, there is no reasonable hypothesisremaining on which to reconcile the jury's special finding with thegeneral verdict.

Notwithstanding the foregoing, plaintiffs argue that it does notmatter whether LaTonya died of dehydration or some otherspecific medical cause. What is important, they contend, is thatLaTonya was ill and Dr. Garces failed to examine and treat heraccordingly, thus proximately causing her death. Hence there is noinconsistency between the jury's finding that dehydration was nota cause of LaTonya's death, and the general verdict in favor ofplaintiffs and against Dr. Garces. Plaintiffs assert that:

"It is irrefutable that had Dr. Garces seen LaTonya andreferred her to an emergency room for care as he shouldhave in the early afternoon [of January 24], she would bealive today. The hypothermia and suffocation speculationabout the medical cause of death that the defensepresented does not make a difference in a legal causationanalysis; had proper care been given, LaTonya would nothave been in a position to become hypothermic or haveaccidentally suffocated."

The gist of this argument appears to be that, regardless of thespecific cause of death, Dr. Garces had a duty to examine LaTonyaand refer her to an emergency room for care. If LaTonya had beensent to an emergency room in the early afternoon on January 24,she would not have been in a position to become hypothermic orsuffocate on the way to the hospital later that day.

This argument lacks merit. It is well settled that two distinctrequirements must be met in order to establish proximate cause.The defendant's conduct must be shown to be an actual cause ofthe plaintiff's injury, and it must be a legal cause as well. Lee v.Chicago Transit Authority, 152 Ill. 2d 432, 455 (1992); Nelson v.Thomas, 282 Ill. App. 3d 818, 828 (1996). Actual cause, or causein fact, can be established only where "there is a reasonablecertainty that a defendant's acts caused the injury or damage." Lee,152 Ill. 2d at 455. A defendant's acts are a legal cause only if theyare "so closely tied to the plaintiff's injury that he should be heldlegally responsible for it." McCraw v. Cegielski, 287 Ill. App. 3d871, 873 (1996). A determination as to legal cause is "a policydecision that limits how far a defendant's legal responsibilityshould be extended for conduct that, in fact, caused the harm."Lee, 152 Ill. 2d at 455.

In the instant case, even if we were to conclude, which we donot, that Dr. Garces' failure to examine LaTonya and refer her toan emergency room was an actual cause of LaTonya's death, thiswould not establish that his conduct proximately caused her death.It would still have to be shown that Dr. Garces' conduct was alegal cause. However, this cannot be so, given the facts in thiscase. As noted, the only cause of death linked by expert testimonyto Dr. Garces' conduct was dehydration. See Aguilera, 293 Ill.App. 3d at 972; Townsend, 318 Ill. App. 3d at 413. Accordingly,if the cause of death were anything other than dehydration, Dr.Garces could not be held legally responsible. The link to hisconduct would simply be too attenuated to support a judgment ofliability. Cf. Lee, 152 Ill. 2d at 455; McCraw, 287 Ill. App. 3d at873.

Plaintiffs rely upon Cohen v. Sager, 2 Ill. App. 3d 1018(1971), and Bilderback v. Admiral Co., 227 Ill. App. 3d 268(1992), for support of their contention that the specialinterrogatory in the instant case was not irreconcilable with thegeneral verdict. In both Cohen and Bilderback, a general verdictwas found to have addressed issues not covered by specialfindings, and there was thus no inconsistency. Plaintiffs' relianceupon these cases is misplaced.

In Cohen, the plaintiff claimed she suffered injuries when theautomobile in which she was a passenger was struck by thedefendant's vehicle. The jury returned a general verdict in favor ofthe defendant, but found in response to special interrogatories thatinclement weather and icy conditions were not the proximatecause of the accident, and that the defendant was guilty ofnegligence that contributed to cause the accident. The trial courtentered judgment in favor of the plaintiff on the special findings,which it ruled were inconsistent with the general verdict. Theappellate court reversed, holding that the special findings "did notexclude every reasonable hypothesis consistent with the generalverdict" (Cohen, 2 Ill. App. 3d at 1020), and there was thus noinconsistency. According to the court, the jury could have found,consistent with the general verdict, that "while the defendant wasnegligent in causing the collision, no injury was suffered or that[the plaintiff's] injury was not proximately caused by thedefendant's negligence." Cohen, 2 Ill. App. 3d at 1021.

In Bilderback, where the plaintiff alleged that he was fired inretaliation for seeking workers' compensation benefits, the juryreturned a general verdict in favor of the plaintiff, but found inresponse to special interrogatories that his discharge had beenrecommended and authorized on the belief that the plaintiff hadshoved a supervisor and given false information to the companynurse. The trial court agreed with the defendant that the specialfindings were inconsistent with the general verdict, and it thereforeentered judgment in favor of the defendant. The appellate courtreversed, holding that the general verdict addressed an issue thatwas not determined by the special findings, and there was thus noinconsistency. According to the court, the jury found in its generalverdict that the actual reason for the plaintiff's discharge was thathe was pursuing workers' compensation benefits. There were nospecial interrogatories asking this specific question, and theinterrogatories that were given "d[id] not establish that anythingelse was the actual reason" for the discharge. Bilderback, 227 Ill.App. 3d at 271.

In the instant case, unlike Cohen and Bilderback, the issueaddressed by the special interrogatory was not peripheral but ratherwas an ultimate question of fact upon which the rights of theparties depended: "Did dehydration contribute to cause the deathof LaTonya King?" See Noel, 177 Ill. App. 3d at 783. Becausedehydration was the only cause of death linked by experttestimony to Dr. Garces' conduct, the jury's negative answer tothis interrogatory effectively eliminated any other "reasonablehypothesis" that might have reconciled the special finding with thegeneral verdict. See Powell, 243 Ill. App. 3d at 581. The specialfinding removed from consideration the only cause of death that,based on the evidence presented at trial, could be proximatelyconnected to Dr. Garces' conduct. Any other basis for the generalverdict postulating a different cause or causes would lack therequisite causal connection to Dr. Garces. The general verdict andthe special finding in the instant case are absolutely irreconcilable.

Plaintiffs argue in the alternative that the special interrogatoryis against the manifest weight of the evidence. According toplaintiffs, the evidence in support of dehydration as the cause ofdeath was "overwhelming," and "[n]o other legitimateexplanations for LaTonya's death were submitted to the jury." Wedisagree.

" 'A verdict is against the manifest weight of the evidencewhere the opposite conclusion is clearly evident or where thefindings of the jury are unreasonable, arbitrary and not based uponany of the evidence.' " Maple v. Gustafson, 151 Ill. 2d 445, 454(1992), quoting Villa v. Crown Cork & Seal Co., 202 Ill. App. 3d1082, 1089 (1990). In the instant case, contrary to plaintiffs'contentions, there was ample expert testimony to support thespecial finding that dehydration did not contribute to causeLaTonya's death.

Dr. Kaufman, one of defendant's experts, testified that hefound no significant evidence in the medical records or the autopsyreport to indicate that LaTonya died of dehydration. He noted thatLaTonya's weight had dropped by only 4.4% from January 21until the time she was weighed in the hospital emergency room onJanuary 24 "just at the point of death." Such a weight loss, he said,is "insignificant" and insufficient to cause or contribute to causedeath by dehydration. In addition, there was no indication of anyelevation in the levels of blood urea nitrogen, sodium orcreatinine. This, Dr. Kaufman said, was inconsistent with deathdue to dehydration. The gross and microscopic findings in theautopsy report showed no evidence of gastroenteritis, which Dr.An, the medical examiner, asserted had led to dehydration in thiscase. The autopsy report also included no findings of acute tubularnecrosis, which Dr. Kaufman said was inconsistent with severedehydration.

Dr. Kaufman's testimony also provided an alternative causeof death, hypothermia, that was unrelated to defendant's allegednegligence. Dr. Kaufman noted that LaTonya's temperature asrecorded in the emergency room on January 24 was 93.2 degrees,which he described as "markedly depressed." He said he foundnothing in LaTonya's autopsy report that was inconsistent withdeath by hypothermia.

Dr. Wittert, another of defendant's experts, stated that "[t]hischild did not die from dehydration." He noted that, according tothe record testimony, LaTonya took in some 10