Garley v. Columbia LaGrange Memorial Hosp.

• Decision Date: 30 June 2004
• Docket Number: No. 1-02-2012.,1-02-2012.
• Citation: 286 Ill.Dec. 337,351 Ill. App.3d 398,813 N.E.2d 1030
• Parties: Stephen GARLEY, as Special Adm'r of the Estate of Pauline Garley, Deceased, and Stephen Garley, Indiv., Plaintiff-Appellee, v. COLUMBIA LaGRANGE MEMORIAL HOSPITAL, Defendant-Appellant (Scott Multack; Advanced Health Care for Women. Ltd.; Carla Mitchell; Joan Cardone; Joseph Reda and Western Springs Family Practice Center, Ltd., Defendants).
• Court: United States Appellate Court of Illinois

813 N.E.2d 1030

351 Ill. App.3d 398

286 Ill.Dec. 337

Stephen GARLEY, as Special Adm'r of the Estate of Pauline Garley, Deceased, and Stephen Garley, Indiv., Plaintiff-Appellee, v. COLUMBIA LaGRANGE MEMORIAL HOSPITAL, Defendant-Appellant (Scott Multack; Advanced Health Care for Women. Ltd.; Carla Mitchell; Joan Cardone; Joseph Reda and Western Springs Family Practice Center, Ltd., Defendants).

No. 1-02-2012.

Appellate Court of Illinois, First District, Fourth Division.

June 30, 2004.

Rehearing Denied August 5, 2004.

Hall, Prangle & Schoonveld (Michael E. Prangle, of counsel) and Lord, Bissell & Brooks (Hugh C. Griffin and Stevie A. Starnes, of counsel), Chicago, for appellant.

Novoselsky Law Offices (David A. Novoselsky and Leslie J. Rosen, of counsel) and Goldberg & Goldberg (Barry D. Goldberg, of counsel), Chicago, for Appellee.

Presiding Justice QUINN delivered the opinion of the court:

Pauline Garley died from a pulmonary embolism three days after undergoing several abdominal surgeries at LaGrange Memorial Hospital (Hospital). Her husband, plaintiff Stephen Garley, filed a wrongful death suit against the Hospital, based upon the conduct of its nursing staff in caring for Mrs. Garley both during and after surgery; numerous doctors involved in her surgery and postsurgical care, including Drs. Scott Multack, Carla Mitchell, Joan Cardone, and Joseph Reda; and two healthcare corporations. Prior to trial, Drs. Cardone and Reda, as well as the healthcare corporations, were voluntarily dismissed as defendants. After a jury trial, the Hospital and Dr. Multack were found liable for Mrs. Garley's death. The Hospital filed a motion for judgment n.o.v., which the circuit court denied. On appeal, the Hospital argues that the circuit court erred in denying its motion for judgment n.o.v. because plaintiff's experts were not competent to testify as to the applicable nursing standard of care. For the following reasons, we reverse and remand with instructions.

BACKGROUND

On the morning of April 28, 1998, Pauline Garley was admitted to the Hospital, where she was to undergo several abdominal surgeries lasting approximately three hours. The surgeries were to be performed by Dr. Scott Multack, who was to be assisted by Dr. Carla Mitchell and Dr. Joan Cardone. At 9:40 a.m., Nurse Nancy Nowak brought Mrs. Garley into the operating room and, pursuant to Dr. Multack's request, positioned her in the lithotomy position (on her back with her legs elevated and separated) with the use of knee crutches. Though the length of the surgery, her weight, and her age placed Mrs. Garley at risk for developing a deep vein thrombus (DVT) or blood clot, no anticlotting device or medication was utilized or suggested during surgery. After surgery was completed at 1:30 p.m., Dr. Multack ordered that Mrs. Garley be "ambulated with assistance" to decrease the risk that a DVT might develop. According to hospital records, Nurse Karol Meier unsuccessfully attempted to walk Mrs. Garley at 4:36 p.m., approximately three hours after surgery. Mrs. Garley was not ambulated on April 28.

At approximately 11 a.m., on April 29, Mrs. Garley was walked for the first time to a chair in her hospital room. Later, at 2:17 p.m., she was walked an undisclosed distance with the use of a walker. At 7:19 p.m., she was walked a distance of 0 to 10 feet, but could not tolerate any further ambulation.

On April 30, at approximately 4 p.m., Mrs. Garley again ambulated from 0 to 10 feet. At 8:33 p.m., while Nurse Linda Trotta was ambulating her, Mrs. Garley collapsed and died shortly thereafter.

At trial, Dr. Mitra Kalelkar, a forensic pathologist and assistant medical examiner for Cook County, testified that Mrs. Garley died of a pulmonary embolism. She testified that Mrs. Garley developed a DVT, which dislodged and traveled through her bloodstream, blocking her pulmonary arteries. Based upon her finding that Mrs. Garley's left thigh and calf were larger than her right thigh and calf, she believed the DVT developed in her lower left extremity. She could not determine, however, when the clot formed or whether the clot formed above or below her knee. She also testified that she did not believe that the DVT formed in Mrs. Garley's pelvis because "no pelvic veins were thrombosed."

Dr. Carla Mitchell testified that she examined Mrs. Garley on April 29, the day after the surgery, and that Mrs. Garley exhibited no symptoms of DVT. Mrs. Garley also did not complain of leg pain during the examination. Dr. Mitchell stated that, per Dr. Multack's order, the nurses were supposed to ambulate Mrs. Garley as soon as possible and, at a minimum, 3 times every 24 hours. The nursing staff did not inform her that Mrs. Garley had not yet been ambulated. Dr. Mitchell testified that had Mrs. Garley exhibited symptoms of DVT, there were methods and treatments available to reduce the risk of an embolism.

Dr. Multack testified that he expected the nurses to ambulate Mrs. Garley a few hours after surgery, as soon as she was "up and alert." He testified that she was to be walked "even if that meant waking her up" and that he expected her to walk unassisted by April 30. When he saw Mrs. Garley on April 30 at 5:10 p.m., she did not complain of leg pain. He stated that he was never informed that Mrs. Garley had complained of leg pain or that she was having difficulty ambulating. He testified that had she been ambulated in accordance with his order, the likelihood of a DVT forming would have decreased and that the failure to do so increased the risk of a pulmonary embolism. He also testified that a number of treatment options were available had he been informed of Mrs. Garley's complaints of leg pain.

Nurse Karol Meier testified that she was working the 3 p.m. to 11 p.m. shift on April 28. She testified that she understood Dr. Multack's order to "ambulate with assist" to mean that Mrs. Garley was to be ambulated as soon as possible, but no later than 12 to 18 hours after surgery, i.e. between 1:30 a.m. and 7:30 a.m. on April 29. She testified that if a doctor's order is not being followed, unclear, or cannot be carried out, the doctor should be notified. However, according to Mrs. Garley's chart, she was not exhibiting any symptoms consistent with the presence of a DVT and had not complained of leg pain. Annette Colbert, a patient care technician, testified that she attended to Mrs. Garley on April 29 and 30. She testified that Mrs. Garley complained of leg pain while she was being ambulated and that she (Ms. Cobert) relayed these complaints to Nurse Mary Kiser.

Plaintiff testified that Ms. Colbert called him at work to tell him that his wife was sick, having trouble walking, and experiencing pain in her legs. When plaintiff arrived at the hospital, his wife complained to him of leg pain. Plaintiff did not remember which day Ms. Colbert called him.

Nurses Mary Kiser, Linda Trotta, Jane Shepski, and Shawndra Ferrell testified that they attended to Mrs. Garley during her three-day stay at the Hospital. They testified that she did not exhibit any signs consistent with the presence of a DVT or complain to them about pain in her legs. While hospital records indicated that Mrs. Garley complained of abdominal pain, there was no record of her complaining of pain in her legs. Nurse Kiser also testified that she did not remember Ms. Colbert telling her that Mrs. Garley had complained of leg pain.

Three experts testified on behalf of plaintiff, none of whom were licensed nurses.

Dr. Charles Bird, a board-certified obstetrician-gynecologist, had practiced medicine for 31 years after graduating from Northwestern University Medical School. Dr. Bird was the chief of gynecology at Evanston Hospital and taught third-year medical students at his alma mater.

He testified that Mrs. Garley died as a result of a blood clot. He characterized Mrs. Garley as having a moderate risk of developing such a clot based upon her age and weight and the length of the surgery. Dr. Bird testified that, based upon his experience working with nurses, he was familiar with "the standard of care applicable to nurses who perform postoperative care on patients who have undergone surgeries" similar to those performed on Mrs. Garley. He stated that, because no anticlotting measures were utilized during surgery, she should have been ambulated within 12 hours of surgery. He testified that the Hospital nursing staff fell below the standard of care when they failed to ambulate Mrs. Garley in a timely fashion and that their failure to do so contributed to her death.

During cross-examination, Dr. Bird stated that he had no opinion as to whether Mrs. Garley would have survived had she been ambulated, but testified on redirect examination that it was more probable than not that anticlotting devices or measures, including ambulation, would have prevented her death. Dr. Bird also testified that the nurses should have followed up Mrs. Garley's complaints of leg pain to Ms. Colbert by examining her legs, but they were not required to inform her doctor of those complaints.

Dr. Fred Duboe, also an obstetrician-gynecologist, performed his residency at Northwestern after receiving his medical degree from the University of Illinois at Chicago (UIC) in 1980. During his 22 years of continuous practice, Dr. Duboe published several scholarly articles relating to blood clots and taught both residents and nurses. Dr. Duboe had also married a nurse and occasionally read her Nursing Spectrums, a nursing periodical.

He testified that Mrs. Garley died as a result of a DVT which developed some time after surgery. He stated that, based upon his experience working with nurses, the nurses' conduct in caring for Mrs. Garley did not meet the requisite standard of care because they failed to appropriately and timely ambulate Mrs. Garley. He testified that the nurses should have walked her a distance of about 60 feet within 12 to 18 hours after surgery. Moreover,...