October 1, 2026 by matray

A divided Illinois Appellate Court upheld a ruling barring a medical malpractice plaintiff’s sole expert from testifying about causation and damages because he had offered opinions only on the standard of care. But the court reversed the dismissal of the lawsuit, finding that the evidentiary ruling alone did not establish that the plaintiff could not present other competent evidence of causation.

Case: Spies v. Amine, No. 1-25-1630, 09/18/2026, published.

Facts: Kathleen Spies suffered from chronic back pain. In 2015, after a work-related injury, Dr. Abdul Amine implanted an intrathecal morphine pump to help manage her pain.

In May 2017, Spies went to Advocate Christ Medical Center with symptoms attributed to opiate withdrawal. After it was determined that her morphine pump was malfunctioning, Amine performed surgery to remove the old pump, implant a new one and insert a new catheter.

Amine’s operative report initially stated that the old tubing was attached to the new pump but was later edited to indicate that new tubing had been attached. The discrepancy between the two versions of the operative report eventually became a point of contention during expert discovery.

Amine maintained that the original reference to “old tubing” was a typographical error and that the new catheter had been connected to the new pump. Spies alleged that Amine left the old catheter tubing in place, leaving a segment through which cerebrospinal fluid could escape.

After the May 2017 surgery, Spies experienced a cerebrospinal fluid leak from her intrathecal catheter, leading to a second surgery by Amine to locate and repair the leak.

Amine’s operative report from the second surgery stated that he observed cerebrospinal fluid leaking from the “old tubing,” which he knotted, ligated and buried.

Spies last saw Amine in June 2017 for suture removal. Over the next three years, she experienced severe headaches and recurrent blackouts.

In November 2017, Dr. Brendan Gaynor performed surgery to remove the pain pump. His operative note stated that the pump was removed because Spies was not tolerating the therapy due to medication side effects and discomfort from the pump beneath her skin. Gaynor also reported observing no cerebrospinal fluid leak from the tubing. The remaining intrathecal catheters were not removed.

Spies’ headaches worsened after the pump was removed. In April 2020, she saw Dr. Ryan Trombly, who determined that she had severe stenosis at L4-L5 and L5-S1 and required treatment for spinal headaches and lumbar decompression.

In May 2020, Trombly removed Spies’ spinal cord stimulators and retained intrathecal pain-pump catheters. His operative report stated that cerebrospinal fluid leaked after a catheter was removed but did not identify the location of the leak.

Procedural history: Spies sued Amine, alleging that he deviated from the standard of care during and after the May 2017 surgery to replace the first pump.

She also filed a certificate of merit and reviewing health professional’s report from Dr. Ryan Zengou, a board-certified neurosurgeon practicing in Tulsa, Oklahoma.

Zengou opined that Amine’s failure to investigate and correct a potential cerebrospinal fluid leak between May 2017 and May 2020 “was outside the standard of care.” But he said his “whole basis” for that criticism was Amine’s original operative note indicating that the old catheter had been connected to the new pump. If new tubing had been attached, as the edited report stated, Zengou said the procedure complied with the standard of care.

Zengou also repeatedly testified that he was not offering opinions on the sequelae or injuries Spies allegedly sustained.

The trial judge granted Amine’s motion to bar Zengou from offering causation and damages testimony, then dismissed Spies’ claim because she lacked expert testimony linking the alleged breach of the standard of care to her claimed injuries.

Analysis: The Illinois Appellate Court said the trial judge did not abuse his discretion in barring Zengou’s causation and damages testimony.

Zengou identified alleged deviations from the standard of care during the first surgery, but he did not offer an opinion that those deviations proximately caused Spies’ injuries, the court said.

Although Zengou testified that headaches can be a symptom of an ongoing cerebrospinal fluid leak and that Spies experienced headaches, the court said those statements established only a general medical association. They did not amount to an opinion that Spies’ headaches were proximately caused by a leak attributable to Amine’s alleged negligence.

Zengou also repeatedly and affirmatively declined to offer an opinion on the sequelae of the alleged cerebrospinal fluid leak.

The court therefore concluded that Zengou was prepared to testify about Amine’s alleged deviation from the standard of care, but not whether that deviation caused Spies’ injuries. Because Zengou had declined to offer a causation opinion, the trial judge properly barred him from doing so.

The court also rejected Spies’ argument that a causation opinion was a natural and logical corollary to Zengou’s disclosed opinions.

“The logical-corollary doctrine permits an expert to elaborate upon a disclosed opinion; it does not permit a party to supply, for the first time at trial, an opinion that was never disclosed at all,” the court said.

The court added that a causation opinion “that the expert expressly declined to offer, cannot be the logical corollary of a disclosed causation opinion because no such opinion existed to elaborate upon.”

In a medical malpractice action, the court said, a plaintiff must establish the applicable standard of care, a negligent deviation from that standard and an injury proximately caused by the deviation.

“[D]eviation from the standard of care, standing alone, does not establish proximate cause,” the court said.

But while the trial judge properly barred Zengou from offering causation and damages testimony, the appellate court said that evidentiary ruling did not provide a proper procedural basis for terminating Spies’ entire action before trial.

Pretrial motions addressing evidentiary issues are not a substitute for the procedures governing dispositive motions, the court said.

The court acknowledged that the lack of those procedural protections may be harmless when the record establishes that a plaintiff lacks the evidence necessary to sustain a claim. But it found that the record in this case did not establish that Spies could not present competent evidence of causation without Zengou’s testimony.

“We therefore reverse the judgment entered for defendants and remand for further proceedings consistent with this order,” the court said.

Dissent: Judge Raymond Mitchell disagreed with the majority’s decision to permit the case to continue “despite the absence of expert testimony on an indispensable element of plaintiffs’ claim.”

Mitchell said a jury may draw reasonable inferences from the evidence, but “it may not supply evidence that a plaintiff’s own expert has affirmatively declined to provide.”

With no admissible expert testimony establishing the necessary link between the alleged breach and Spies’ injuries, Mitchell said he believed entry of judgment for Amine was appropriate.

Disposition: Reversed in part and remanded.

To read the court’s decision, click here.