Hirn v. Edgewater Hospital

Decision Date21 July 1980
Docket NumberNo. 78-976,78-976
Citation86 Ill.App.3d 939,42 Ill.Dec. 261,408 N.E.2d 970
Parties, 42 Ill.Dec. 261 Ilona HIRN, Plaintiff-Appellant, v. EDGEWATER HOSPITAL, a corporation, and Dr. Forough Parsa, Defendants-Appellees.
CourtUnited States Appellate Court of Illinois

John G. Phillips, Chicago, for plaintiff-appellant.

Victor J. Piekarski, Joseph A. Norton, Querrey, Harrow, Gulanick & Kennedy, Chicago, for defendant-appellee Edgewater Hospital.

William V. Johnson, Thomas H. Fegan, Johnson, Cusack & Bell, Chicago, for defendant-appellee Forough Parsa, M. D.

CAMPBELL, Justice:

The plaintiff, Ilona Hirn, filed a medical malpractice action against Edgewater Hospital (hereinafter hospital) and Dr. Forough Parsa for injuries incurred as the result of a renal arteriography 1 performed by Dr. Parsa at defendant hospital. After the jury returned verdicts for both defendants and the trial court denied her post-trial motions for a judgment notwithstanding the verdict and a new trial, the plaintiff filed the present appeal. The following errors are urged on appeal: (1) the trial court erred in failing to direct a verdict for the plaintiff against the hospital; (2) the trial court erred in failing to direct a verdict for the plaintiff against Dr. Parsa; (3) the scope of expert testimony permitted in medical malpractice cases deprived the plaintiff of her right to a trial by jury; (4) numerous evidentiary errors required a new trial of this cause; and (5) conduct of Dr. Parsa's counsel was so prejudicial that it denied plaintiff a fair trial.

We affirm.

While the plaintiff's complaint, filed February 19, 1974, alleges a number of negligent acts or omissions against each defendant, the ultimate issues in the trial are best gleaned from the issue instruction submitted to the jury. There it is alleged that the hospital was negligent in that:

"One of the Hospital nurses only applied pressure at the puncture site for two minutes instead of the five minutes required by accepted practice.

Acting through its staff, the Hospital failed to check for ankle pulses, foot color and circulation to the foot."

Dr. Parsa was negligent, it was alleged, in that:

"She failed to place written follow-up orders in the chart to direct the nursing staff.

She failed to personally perform an adequate follow-up of the Plaintiff.

She failed to take adequate steps to relieve Plaintiff's condition, or secure the consultation of a physician competent to do so, after she was informed of Plaintiff's condition by Dr. Dimitrov.

She attempted to insert the needle before first making certain of the location of the femoral artery, thereby striking the femoral nerve with the needle.

She failed to perform a cutdown procedure or insert the catheter into the artery in the arm when she was unable to locate the femoral artery.

She failed to note in hte (sic) charts that the vein as well as the femoral artery had been punctured with the needle.

She failed to demonstrate skill in the manner in which she performed the arteriogram.

She failed to require or oversee the application of pressure at the puncture site for a longer period than the ususal (sic) five minutes when she knew the Plaintiff had a propensity towards high blood pressure."

The plaintiff was hospitalized by Dr. Dimitrov, her family physician, to determine the cause of her high blood pressure, recurrent chest pain, and frequent headaches. A renal arteriography was ordered to determine whether there was an abnormality of the renal arteries or kidney system. This procedure was performed at Dr. Dimitrov's request, on December 21, 1973, by Dr. Parsa with the assistance of four hospital employees. A renal arteriography is performed by injecting a radio opaque dye into the femoral artery located in the groin and then taking an x-ray of the renal arteries. An initial step in the procedure is the insertion of a needle into the femoral artery. In this case, that step was complicated by the plaintiff's obesity. The plaintiff was informed by Dr. Parsa, prior to surgery, that she might have to perform a "cutdown" procedure on plaintiff because of her weight. Dr. Parsa testified that she encountered difficulty locating the femoral artery and that she made two or three attempts before hitting it. The procedure, however, was completed without further complication.

The evening of the day that the procedure was performed, the plaintiff experienced femoral bleeding and swelling and observed a hematoma 2 in her right upper thigh. Dr. Parsa followed the plaintiff's condition for 24 hours after the renal arteriography finding nothing unusual in the plaintiff's condition during this period of time. Two days after the procedure was performed, the plaintiff reported having a "pins and needles" sensation. By December 27th, the day before she was discharged, the hematoma had grown to a size 20 by 30 centimeters (approximately nine by thirteen inches). On January 8, 1974, the plaintiff was rehospitalized suffering chest pains, difficulty in breathing, weakness, profuse perspiration, and continuing leg pains. Tests disclosed blood clots in her lungs. During her hospitalization the plaintiff also experienced loss of her right knee reflex and paralysis of her quadriceps muscle. Both problems were found to be the result of damage to the femoral nerve.

At the trial the following testimony was received regarding the cause of the plaintiff's nerve injury and embolism. 3 Dr. Neil Allen, a neurologist who treated the plaintiff in consultation after the procedure, testified that the plaintiff's nerve injury was caused either by pressure from the hematoma or by a direct puncture of the femoral nerve during the renal arteriography. Dr. Parsa testified that, while she was not a neurologist, she concluded that the hematoma was the most likely cause of the nerve injury. She also testified, however, that it is not unusual to have a hematoma form after a renal arteriography. This conclusion was confirmed by Drs. Dimitrov and Blazek although the latter noted that he had never seen a hematoma of such great size. Furthermore, Dr. Baker, the plaintiff's expert, testified that the visible size of a hematoma has no bearing on whether pressure is being exerted on a nerve.

When asked whether the plaintiff's embolism was a result of the renal arteriography Dr. Baker initially stated that he would rather not hazard a guess at what caused the plaintiff's embolism. Subsequently, however, he stated that he had an opinion, but not a firm one, that the pulmonary embolism could have resulted from the renal arteriography. He explained that, the near proximity of any operation to the existence of an embolism, would give him that opinion. On cross-examination, he clarified his testimony by stating that he did not say that the embolism was caused by the renal arteriography, but only that it could have been related to it. He explained that there are numerous causes of emboli. Dr. Blazek also testified that the plaintiff's embolism could be related to the arteriography. Dr. Dimitrov never formed an opinion as to the cause of the embolism.

Drs. Parsa, Blazek, and Baker testified concerning the standard of care relevant in this cause and whether that standard had been breached. Dr. Baker, the plaintiff's expert, testified that a physician, who could not locate the femoral artery due to the obesity of a patient or some other complication, had two alternative techniques to utilize. The physician could use a "cutdown" method where an incision is made to clearly expose the artery or, in the alternative, the brachial artery in the arm could be used because it is easier to locate. He noted that, at his institution, it is standard procedure to stop this type of procedure after two unsuccessful attempts to locate the artery. He also testified that, subsequent to the procedure, 10 to 20 minutes of pressure should be applied to the artery for patients with normal blood pressure and as much as 20 to 30 minutes for patients, such as the plaintiff, who suffer from high blood pressure. Dr. Baker, however, stated that it would not be a violation of the prevailing standard of care either to hit the vein two or three times or to use the femoral artery as a site when encountering difficulty hitting the femoral artery. He did outline three post-operative deviations from the standard of care: (1) no post-operative orders were given to the nursing staff to alert them of possible post-operative complications; (2) some medical action should have been taken when pain persisted for 48 hours; and (3) the patient should not have been released with a hematoma the size of the plaintiff's. Dr. Baker would not offer an opinion, however, concerning whether these deviations from the standard of care constituted a breach of Dr. Parsa's duty to the plaintiff because he was not familiar with Dr. Dimitrov's experience and did not know what his agreement was with Dr. Parsa as to post-operative care. He found no other deviations from the required standard of care.

Dr. Blazek, Dr. Parsa's expert and a specialist in cardiology, testified that, to locate a femoral artery in performing a renal arteriography, a physician should palpate the arterial pulse to act as a guideline to insertion of the needle. It is not necessary to call in a consultant when having difficulty finding the artery. After the procedure is performed, pressure should be applied to the blood vessel for five minutes and then an additional five more minutes if bleeding persists. In most instances, hemostasis 4 is achieved after the first five to ten minutes. Because of the close proximity of the femoral artery and vein, Dr. Blazek would not consider it a deviation from the standard of care for a cardiologist performing a renal arteriography to hit the vein two or three times. If the vein is punctured slight pressure on it causes hemostasis. It is not necessary to call in a consultant if the vein is hit. Dr. Blazek also...

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