Beard v. Barron, 1-05-1006.

• Decision Date: 22 January 2008
• Docket Number: No. 1-05-1006.,1-05-1006.
• Citation: 882 N.E.2d 1062
• Parties: Devonna BEARD, Special Administrator of the Estate of Vernestine Hudgins Deceased, Plaintiff-Appellant, v. John T. BARRON and Rush-Presbyterian-St. Luke's Medical Center, Defendants-Appellees (Hesham Hassaballa, Defendant).
• Court: United States Appellate Court of Illinois

882 N.E.2d 1062

Devonna BEARD, Special Administrator of the Estate of Vernestine Hudgins Deceased, Plaintiff-Appellant, v. John T. BARRON and Rush-Presbyterian-St. Luke's Medical Center, Defendants-Appellees (Hesham Hassaballa, Defendant).

No. 1-05-1006.

Appellate Court of Illinois, First District, First Division.

January 22, 2008.

Justice GARCIA delivered the opinion of the court:

On November 4, 1999, Vernestine Hudgins died of renal failure associated with Stevens-Johnson syndrome, a painful condition where large blisters form on the skin caused by a hypersensitive reaction to medication. Her daughter, the plaintiff Devonna Beard, filed suit against Hudgins's cardiologist, Dr. John T. Barron, and Rush-Presbyterian-St. Luke's Medical Center (Rush)¹ through its agents, Dr. Hesham Hassaballa and Dr. Barron, alleging medical negligence. The plaintiff's theory was that Drs. Barron and Hassaballa failed to timely detect a bleed in Hudgins's brain, a subdural hematoma, that caused Hudgins to fall into a state of constant seizures, status epilepticus, that in turn required the administration of Dilantin, an antiseizure medication. According to the plaintiff, Dilantin caused Hudgins's Stevens-Johnson syndrome, which eventually led to renal failure, causing her death. The jury returned a verdict in favor of the defendants.

The plaintiff contends on appeal that the circuit court committed three reversible errors: (1) the trial court misapplied the Dead-Man's Act (735 ILCS 5/8-201 (West 2004)) when it reserved ruling on the plaintiff's motion in limine seeking to bar Dr. Barron from testifying about claimed conversations he had with Hudgins regarding prior headaches; (2) the trial court overruled the plaintiff's objection to the defendants' cross-examination of Dr. William Greenlee as beyond the scope of direct examination; and (3) the trial court refused to give instructions pursuant to Illinois Pattern Jury Instructions, Civil, Nos. 30.21 (aggravation of preexisting condition) and 30.23 (injury from subsequent treatment) (2005). The plaintiff argues that the errors could have affected the jury's verdict. We affirm.

BACKGROUND

In early July of 1999, Vernestine Hudgins was an active 65-year-old woman. She enjoyed cooking for her several adult children, attending church outings, shopping, and traveling. Hudgins also suffered from numerous cardiac conditions, some of which required that she be hospitalized several times a year. Hudgins had congestive heart failure and severe pulmonary hypertension, both of which were progressing. She also had massive edema (swelling in her legs and abdomen), and fluid on her lungs. Hudgins had an irregular heartbeat attributed to atrial fibrillation. She was taking several medications, including the diuretics Lasix and Zaraxolyn, and blood pressure medications, including Digoxin and Lisinopril.

Hudgins also had been receiving anticoagulation therapy (blood thinners) since 1983, when the mitral valve of her heart was replaced with a mechanical one. Because blood can clot around mechanical valves, Hudgins took blood thinners to help reduce her chances of a stroke. In July 1999, her life expectancy was three to five years.

On July 6, 1999, Hudgins was admitted to Rush for a scheduled cardiac catheterization procedure to evaluate her aortic valve that had started leaking. Rush, a teaching hospital, uses an approach where a supervising doctor, the attending physician, oversees fellows, residents, and interns. The attending physician during Hudgins's July 6 admission was Dr. Barron, a cardiologist who had been Hudgins's physician since 1988. Hudgins was also treated by Dr. Ajay Baddi, a cardiac fellow, and Dr. Hassaballa, an intern.

Because the cardiac procedure involved inserting a catheter into the artery near her groin, the anticoagulation therapy had to be halted before the procedure was performed. At the time of her admission, Hudgins was taking the blood thinner Coumadin, which remained active in her system for several days. In order to ensure that Hudgins's blood remained adequately anticoagulated, Coumadin was stopped and Heparin, a blood thinner that would remain in Hudgins's system for only a few hours, was introduced. The idea was that Heparin would be stopped a few hours before the cardiac catheterization procedure began and restarted once the procedure was over. Hudgins would later transition back to Coumadin.

Hudgins also received a drug called Norvasc, used to treat high blood pressure.

Hudgins's cardiac catheterization procedure was performed on July 9, 1999. She remained at Rush for several days thereafter while doctors adjusted her blood thinners to a therapeutic level. On July 10, Dr. Baddi performed a brief neurological exam that was normal and reported in Hudgins's chart that she had no new complaints. Dr. Baddi made similar entries in her chart for July 11 and 12.

On July 12, 1999, Hudgins suffered a nosebleed and a headache. On July 13, she had another nosebleed and headache. She was given Tylenol and a medication called Ultram. On the evening of July 13, Hudgins declined further pain medication, but requested an ice pack for her headache.

On July 14, 1999, Hudgins vomited twice. As a result, she was given the drug Compazine. She also experienced a 47-point drop in her systolic blood pressure and a 23-point drop in her diastolic blood pressure. A nurse's note entered at 4:40 p.m. indicated that Hudgins denied any complaints, was oriented to person, place, and time, opened her eyes to sound, had clear and appropriate speech, and obeyed commands.

On July 17, 1999, Hudgins's headache returned. As a result, Dr. Barron stopped the medication Norvasc. Hudgins did not report a headache for the rest of the day on July 17 or on July 18 or 19.

Although her blood-thinning levels were not quite where Dr. Barron wanted them to be, Hudgins was discharged from Rush on July 19, 1999. Prior to being discharged, she was instructed on giving herself an injection of a fast-acting anticoagulant called Lovenox. She was also placed back on Coumadin. According to members of Hudgins's family, she complained of a headache and appeared groggy upon discharge.

Hudgins was taken to the emergency room (ER) at Rush on the morning of July 20, 1999, because her groin wound from the cardiac catheterization procedure began bleeding. Dr. Barron met Hudgins in the ER and applied pressure to the wound. Hudgins was readmitted so an ultrasound could be performed on the groin area to detect whether she had a pseudoaneurysm. Coumadin was briefly stopped. Once the ultrasound came back negative, Coumadin was restarted. Hudgins was seen by Dr. Hassaballa, who noted that Hudgins was not experiencing any chest pain, dizziness, or double vision, but that she was "[p]ositive for headache started in house on last admission." She was again given Ultram.

On the morning of July 21, 1999, while still at Rush, Hudgins continued to report a headache, was nauseated, and vomited twice. At 7:20 a.m., Dr. Hassaballa ordered Compazine to relieve the nausea and vomiting. When Hudgins was discharged from Rush at 5 p.m. on July 21, she had a "mild" headache and was drowsy. Hudgins declined Tylenol for her headache. Her drowsiness was attributed to Compazine.

Hudgins returned home, where she continued to experience a headache. In the early morning of July 23, 1999, one of Hudgins's daughters called 911 because she began turning her head from side to side and appeared groggy. When the paramedics arrived, Hudgins's eyes were rolled back, indicative of a seizure. She was taken to Westlake Hospital (Westlake), where a computed tomography (CT) scan was performed upon her admission. The CT scan showed a subdural hematoma and indicated she was in status epilepticus. Additional CT scans were performed during her hospitalization at Westlake.

Doctors at Westlake treated Hudgins intravenously with Dilantin, used to control seizures. She remained in status epilepticus for about four days and fell into a coma. On July 28, 1999, Hudgins was transferred to Rush, where Dilantin was continued. Hudgins's seizures eventually stopped, allowing her to be sent to rehabilitation. However, the seizures soon returned. In early September, Hudgins developed a rash that soon turned into open, oozing sores on her back, buttocks and thighs. The sores, about the size of apples would fill with fluid and burst. It was evident to Hudgins's children, who frequently visited, that she was in pain. Hudgins's daughters took turns staying with her through the night.

It was determined that Hudgins had developed Stevens-Johnson syndrome. She also developed pneumonia and her kidneys began to fail. Hudgins died on November 4, 1999, at the age of 66.

The plaintiff filed suit against Dr. Barron, Dr. Hassaballa, and Rush,² alleging medical malpractice. Dr. Hassaballa was later dropped as an individually named defendant.

A jury trial commenced on September 23, 2004. The plaintiff's theory was that the standard of care required the defendants to order a neurological consult of Hudgins on July 17, 1999, as well as a CT scan by July 20 or 21. According to the plaintiff, Hudgins's nausea, nosebleeds and headaches, combined with her anticoagulation therapy, should have placed the doctors on notice that she was experiencing bleeding in her brain. According to the plaintiff, if the bleeding had been detected prior to status epilepticus setting in, it could have been controlled without the administration of Dilantin, which she contended, caused the Stevens-Johnson syndrome. The plaintiff's experts opined at trial that had the subdural hematoma been treated before the seizures developed, the subsequent complications would not have arisen and Hudgins would not have died when she did.

As her initial witness, the plaintiff called Dr. Barron to testify as an adverse witness. The medical charts of Hudgins's July 6, 1999, admission were also admitted into evidence. To...