Gulino v. Zurawski

CourtUnited States Appellate Court of Illinois
Citation43 N.E.3d 1102
Docket NumberNo. 1–13–1587.,1–13–1587.
PartiesJoanne GULINO, Individually and as Independent Administrator of the Estate of Matthew Gulino, Deceased, Plaintiff–Appellee, v. Maria ZURAWSKI, R.N., and Acute Extracorporeal Services, L.L.C., Defendants–Appellants.
Decision Date21 October 2015

43 N.E.3d 1102

Joanne GULINO, Individually and as Independent Administrator of the Estate of Matthew Gulino, Deceased, Plaintiff–Appellee
Maria ZURAWSKI, R.N., and Acute Extracorporeal Services, L.L.C., Defendants–Appellants.

No. 1–13–1587.

Appellate Court of Illinois, First District, Third Division.

Oct. 21, 2015.

43 N.E.3d 1106

Hinshaw & Culbertson, LLP, Chicago (Stephen R. Swofford and Nancy G. Lischer, of counsel), for appellants.

Pfaff, Gill & Ports, Ltd., Chicago (Michael W. Rathsack, of counsel), for appellee.


Justice PUCINSKI delivered the judgment of the court with opinion.

¶ 1 Plaintiff Joanne Gulino (Joanne or plaintiff), individually and as the independent administrator of the estate of her husband Matthew Gulino (Matthew) filed a medical malpractice action against defendants Maria Zurawski, R.N., and her employer, Acute Extracorporeal Services, L.L.C. (AES), in which she alleged that Zurawski was negligent in her treatment of Matthew and that her negligence proximately caused his death. The cause proceeded to trial, where the jury ultimately returned with a verdict finding defendants guilty of negligence and awarded plaintiff damages in the amount of $12,261,131. On appeal, defendants challenge the verdict

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arguing: (1) the circuit court erred in denying their motion for a judgment notwithstanding the verdict; (2) the verdict is against the manifest weight of the evidence; and (3) the circuit court made several erroneous rulings concerning the permissible scope of expert witness testimony. For the reasons set forth herein, we affirm the judgment of the circuit court.


¶ 3 Overview of Thrombotic Thrombocytopenic Purpura

¶ 4 Matthew died on October 25, 2009, from complications of Thrombotic Thrombocytopenic Purpura (TTP), a rare blood disease. In a TTP patient, a protein in the patient's plasma cause the platelets in his body to clump together, which then clog his blood vessels. As a result, the patient's red blood cells, the cells responsible for carrying oxygen throughout the body, cannot effectively pass through the blood vessels and his organs become damaged due to lack of oxygen. TTP is universally fatal without prompt diagnosis and treatment. Patients with TTP typically present with nonspecific symptoms such as fatigue, shortness of breath, bruising, and possible neurological symptoms like confusion or headaches. Patients are typically diagnosed following a series of blood tests including a Complete Blood Count (CBC) and blood smear. A CBC measures the number of red blood cells, white blood cells and platelets in a person's body and the results of a CBC performed on a TTP patient will reveal a lower than normal level of platelets and red blood cells. A blood smear, in turn, will reveal abnormally shaped red blood cells. Although TTP can result from an auto-immune disease, in more than 50 percent of TTP patients, the cause of the disease is unknown. The only effective treatment for TTP is plasmapheresis,1 a treatment that involves the use of a large machine to remove the patient's blood from his body in order to separate the plasma from the rest of the blood. The patient's blood is then combined with plasma from a donor and ultimately reintroduced into the patient's body. Each plasmapheresis treatment takes two to three hours to complete and the treatments are done on a daily basis until the TTP patient begins to improve. Absent plasmapheresis treatments, a TTP patient will die.

¶ 5 Events Preceding Matthew's TTP diagnosis and Death

¶ 6 At the start of 2009, Matthew was a healthy 49–year–old married father of three children. He had his annual checkup in June 2009 with his primary care physician, Doctor Gregory Rausch, and aside from having high cholesterol, Matthew was otherwise healthy. Beginning around October 12, 2009, however, Matthew began experiencing various unusual symptoms including nausea, fatigue, shortness of breath, chills and lightheadedness. When the symptoms did not dissipate over the next few days, he sought treatment from his primary care physician. On October 19, 2009, Doctor Rausch ordered an electrocardiogram (EKG) and a stress test to determine whether Matthew had a potential cardiac issue. He also ordered a partial blood test to check Matthew's cholesterol level since it had been high during his recent annual exam. Based on the results of his tests as well as a physical exam, Doctor Rausch diagnosed Matthew with anxiety and prescribed him Xanax, an anti-anxiety medication. Matthew, however, returned to Doctor Rausch's office two days later on October 21, 2009, because he was not experiencing significant relief

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from his symptoms. Doctor Rausch did not conduct any additional tests at that time, but suggested that Matthew consider making an appointment to see a psychiatrist. The following day, October 22, 2009, Matthew was still experiencing symptoms and sought emergency treatment at Palos Community Hospital where he was attended to by Doctor Brian Crowley. After hearing Matthew describe his symptoms and learning that his primary care physician had recently diagnosed him with anxiety, Doctor Crowley concluded that Matthew was suffering from an acute anxiety reaction and prescribed a stronger anti-anxiety medication. Neither Doctor Rausch nor Doctor Crowley ordered a CBC before making their respective diagnoses.

¶ 7 Three days later, on October 25, 2009, Matthew woke up experiencing slurred speech and mobility problems with his left arm. His wife Joanne called 911 and he was taken to Advocate Christ Medical Center (Advocate). Matthew arrived at Advocate at 8:57 a.m. and underwent several tests including a CBC. Blood tests revealed that Matthew's platelet count was low and that there was evidence of damage to his red blood cells. Further testing revealed that Matthew was experiencing liver and kidney failure as well as significant neurological impairment. Matthew was ultimately diagnosed as having TTP by Doctor Hamad, a hematologist, sometime after 4 p.m. that day. Doctor Hamad directed Doctor Murathanun, the second year resident in charge of Advocate's Medical Intensive Care Unit (MICU), to contact defendant AES, the company with which Advocate had a contract to provide plasmapheresis services, to arrange for a plasmapheresis treatment for Matthew. The call to AES was made at approximately 4:30 p.m. and defendant Zurawski was dispatched to provide Matthew's plasmapheresis treatment at 4:42 p.m. Zurawski, however, did not arrive at Advocate to perform the procedure until approximately 11 p.m. By that time, Matthew had gone into cardiac arrest. He was unable to be resuscitated and he was pronounced dead at 11:40 p.m. The cause of death was multiple organ failure.

¶ 8 Lawsuit

¶ 9 Following her husband's death, plaintiff filed a complaint and an amendment thereto advancing claims of medical negligence against various medical facilities and personnel including Doctor Rausch, Doctor Crowley, Advocate, AES and Zurawski, alleging that the defendants' negligent failure to properly and timely diagnose and treat her husband caused his death. In pertinent part, the second amended complaint alleged that AES and Zurawski were negligent “in one of the following ways: (a) They failed to arrive promptly at Advocate Christ to provide plasmapheresis services to [Matthew]; or (b) They failed to maintain or enforce a reasonable quality control system to verify that nurses called to provide emergency services at Advocate Christ actually arrived and performed the services in a timely manner; or (c) They failed to recognize the need to respond emergently to the call from Advocate Christ for [Matthew]; or (d) * * * [F]ailed to arrange for and provide plasmapheresis equipment and services to Matthew [ ] when plasmapheresis had been ordered by a physician attending to his care.” Defendants, in turn, filed responses denying plaintiff's allegations of negligence and the cause subsequently proceeded to a jury trial.

¶ 10 Trial

¶ 11 Joanne Gulino testified that her husband had been in good health up until October 2009. She recalled that he began experiencing various symptoms around October 12, 2009, including chills, fatigue and

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flu-like symptoms. Thereafter, on the morning of October 19, 2009, her husband complained that his heart was racing and that his sternum hurt. At that point, Joanne called Doctor Rausch, and made an appointment for her husband later that day. During Matthew's appointment, he relayed his symptoms to a nurse who told him that his symptoms “sound[ed] like anxiety.” Joanne recalled that Doctor Rausch ordered an EKG and a stress test once he heard that Matthew had been experiencing symptoms of nausea, lightheadedness, and shortness of breath. Ultimately, Doctor Rausch diagnosed her husband with anxiety and provided him with a prescription for Xanax. Despite receiving the prescription, Joanne testified that Matthew was still feeling poorly a few days later and had noticed some bruising around his elbows. He returned to see Doctor Rausch on October 21, 2009, and was examined for other areas of bruising, but none were found. At the conclusion of that appointment, Doctor Rausch provided...

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