Adams v. Sarah Bush Lincoln Health Center

• Decision Date: 23 January 2007
• Docket Number: No. 4-06-0284.,4-06-0284.
• Citation: 369 Ill. App.3d 988,874 N.E.2d 100
• Parties: Katherine ADAMS, Plaintiff-Appellee, v. SARAH BUSH LINCOLN HEALTH CENTER, and Kellie Jones-Monahan, M.D., Defendants-Appellants.
• Court: United States Appellate Court of Illinois

874 N.E.2d 100

369 Ill. App.3d 988

Katherine ADAMS, Plaintiff-Appellee, v. SARAH BUSH LINCOLN HEALTH CENTER, and Kellie Jones-Monahan, M.D., Defendants-Appellants.

No. 4-06-0284.

Appellate Court of Illinois, Fourth District.

January 23, 2007.

Justice MYERSCOUGH delivered the opinion of the court:

Plaintiff, Katherine Adams, sued defendants, Dr. Kellie Jones-Monahan and Sarah Bush Lincoln Health Center, alleging that Dr. Jones-Monahan was negligent in removing Adams's gallbladder. The jury returned a verdict in Adams's favor and assessed damages against defendants in the amount of $561,389.90. The trial court denied defendants' motion for a new trial. On appeal, defendants argue that the trial court abused its discretion when it refused to allow defendants to present certain portions of Dr. Steven Strasberg's testimony during cross-examination or in their case in chief and that the trial court abused its discretion by allowing plaintiff to question defendants' expert Dr. Mark Kadowaki regarding his knowledge of Dr. Strasberg's views of Dr. Kadowaki's preferred surgical technique. We affirm.

I. BACKGROUND

Plaintiff went to Sarah Bush Lincoln Health Center on November 15, 2002, for routine laparoscopic gallbladder-removal surgery, also known as cholecystectomy. The surgery was performed by Dr. Kellie Jones-Monahan. Prior to the surgery, Dr. Jones-Monahan warned plaintiff of possible complications that could result from the surgery, including injury to the common bile duct. Dr. Jones-Monahan also informed plaintiff of the possibility that she may have to convert the surgery from a laparoscopic procedure to open surgery if she encountered any problems. Plaintiff consented.

During the surgery, Dr. Jones-Monahan noted the gallbladder was intrahepatic, meaning it was almost completely encased by the liver. Dr. Jones-Monahan also noticed chronic scarring in the area of the bile ducts. During the surgery plaintiff's gallbladder was removed. However, Dr. Jones-Monahan also divided plaintiff's common bile duct, which is not supposed to be severed during this type of surgery. This created a serious injury to plaintiff's remaining biliary system. While still in the operating room after the surgery, Dr. Jones-Monahan conducted an X-ray, called a cholangiogram. The cholangiogram allowed Dr. Jones-Monahan to discover plaintiff had been injured. Also while still in the operating room, Dr. Jones-Monahan contacted Dr. Steven Strasberg, who was a surgeon specializing in hepatobiliary surgery at Barnes-Jewish Hospital in St. Louis, Missouri (Barnes). The injury to plaintiff's common bile duct required her to be transported to Barnes via ambulance. At Barnes, Dr. Strasberg became plaintiff's treating physician. In February 2003, Dr. Strasberg performed surgery to repair the injury to plaintiff's common bile duct.

At trial, plaintiff presented Dr. Richard Vasquez as an expert witness. Dr. Vasquez testified that it was his opinion that Dr. Jones-Monahan did not comport with the standard of care in performing plaintiff's cholecystectomy. Dr. Vasquez explained the relevant anatomy and fundamentals of the surgery to the court. First, he explained that the liver creates bile and that the gallbladder acts as a reservoir for bile created by the liver. Its function is to break down the fats in food. Dr. Vasquez explained that the bile is carried through the liver by the right and left hepatic ducts. These two ducts join to form the common hepatic duct. The cystic duct from the gallbladder joins the common hepatic duct. Above this junction, the duct is referred to as the hepatic duct. Below this junction, it is called the common bile duct. The common bile duct empties bile into the opening of the small intestine, which is called the duodenum.

To remove the gallbladder, a doctor must identify and cut the cystic duct and the cystic artery. Nothing else need be cut to remove the gallbladder. Doctors may use what is called the triangle of Calot to identify the structures properly. The triangle of Calot is an area bordered by the cystic artery, the cystic duct, and the common hepatic duct. If the doctor is uncertain whether she has identified the right structures, she may perform a cholangiogram, which is an X-ray conducted in the operating room that uses dye to show the doctor the location of the ducts. The doctor may also choose to open the patient's abdomen and perform open surgery.

Dr. Jones-Monahan did conduct a cholangiogram on plaintiff but not until after she had divided structures inside of her. Dr. Vasquez testified that Dr. Jones-Monahan should have used a cholangiogram prior to cutting any structures. Dr. Vasquez stated that Dr. Jones-Monahan was not operating within the triangle of Calot. He stated that failure to dissect within the triangle of Calot was a deviation from the standard of care. Dr. Vasquez said that Dr. Jones-Monahan's notes from the operation indicate that the cystic duct, which was the intended duct to dissect, was isolated. However, Dr. Vasquez points out that her notes never indicate that she had identified that duct or the cystic artery. Instead, Dr. Vasquez surmises that she was looking at the common bile duct, which she eventually cut. Dr. Vasquez said that the cholangiogram, if performed prior to cutting, would have shown Dr. Jones-Monahan that she was wrong. He also testified that Dr. Jones-Monahan's failure to convert the surgery into an open procedure violated the standard of care.

Dr. Vasquez stated that variations in anatomy do not excuse injury. Any variations or abnormalities encountered by the doctor can be clarified by X-ray or by converting the procedure into an open surgery rather than laparoscopic. Dr. Vasquez agreed that telling a patient of the risks inherent in cholecystectomy surgery does not allow a doctor to injure the duct.

Dr. Jones-Monahan's testimony agreed with Dr. Vasquez's account of how the injury to plaintiff's common bile duct occurred. Dr. Jones-Monahan admitted a misidentification occurred and that the common bile duct had been mistakenly dissected. She said that at the conclusion of the procedure it appeared to her that plaintiff's hepatic duct had been divided. Dr. Jones-Monahan said that she would not refer to plaintiff's anatomy as abnormal. She said there was inflammation of the gallbladder, but that is to be expected of a patient who is having her gallbladder removed.

Dr. Jones-Monahan testified that she believed the hepatic duct may have been hiding or looped behind the cystic duct. She then said that it was possible that she put a clip on both and subsequently divided both structures. She testified that her theory about the ducts being looped around each other occurred to her after surgery and that she had no evidence that this was, in fact, what happened. She agreed that she still was unsure of how plaintiff's injury occurred.

Dr. Jones-Monahan testified that she used the critical-view technique to identify the structures. This technique involves finding the cystic duct and cystic artery and isolating them before cutting. She agreed that the failure to achieve a critical view of these structures is an indication that the surgery should be converted to an open procedure. Based on the fact that the wrong structures were ultimately cut, Dr. Jones-Monahan stated that she had not obtained a critical view of the proper structures.

Dr. Jones-Monahan testified that at the time of the surgery she believed that her dissection of all the tissues to expose the ducts and arteries was complete and only realized that she had performed an incomplete dissection after the surgery. She agreed that an incomplete dissection was a deviation from the standard of care. Although she thought she divided the cystic duct, she admitted she instead cut the hepatic duct.

Dr. Strasberg was the treating physician who subsequently performed surgery on plaintiff to repair her injury. Plaintiff conducted an evidence deposition of Dr. Strasberg. To expedite the deposition, defendants and plaintiff agreed to reserve all objections except those based on form. Plaintiff's counsel questioned Dr. Strasberg. Defendants' counsel cross-examined. Plaintiff's counsel then conducted his redirect, stating that he was conducting his redirect subject to an objection he intended to make at trial regarding the scope of some of defense counsel's questions on cross-examination.

During the evidence deposition of Dr. Strasberg, which was taken prior to trial, plaintiff's attorney indicated he intended to object to portions of defense counsel's cross-examination of Dr. Strasberg. At trial, plaintiff's attorney moved to strike portions of defendants' cross-examination of Dr. Strasberg for being beyond the scope of his direct examination. Plaintiff argued that he had not questioned Dr. Strasberg regarding standard of care and that defendants' cross-examination questioned Dr. Strasberg on the applicable standard of care. Defendants argue that plaintiff's counsel opened the door to cross-examination regarding the applicable standard of care during direct examination. Defendants contend that during direct examination, plaintiff's counsel referenced articles that Dr. Strasberg had written and that these articles discuss the standard of care.

During direct examination, plaintiff's attorney asked Dr. Strasberg whether his articles were authoritative. Dr. Strasberg said that they were. Defendants argue that this opened the door for questions about a specific article on cross-examination. Plaintiff never introduced any articles at trial. Defendants' questions on cross-examination included questions such as:

"Q. First of all, is it true that in a lap-coli, a laparoscopic cholecystectomy[,] there are several accepted ways of identifying the cystic bile?

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Q. And secondly, regardless of which method is used to identify the cystic duct, not one single method has proven to be infallible; would you agree with that?

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