Holton v. Memorial Hosp., No. 79957

CourtSupreme Court of Illinois
Writing for the CourtMcMORROW
Citation679 N.E.2d 1202,176 Ill.2d 95
Decision Date17 April 1997
Docket NumberNo. 79957
Parties, 223 Ill.Dec. 429, 65 USLW 2686 Patricia HOLTON et al., Appellees, v. MEMORIAL HOSPITAL, Appellant.

Page 1202

679 N.E.2d 1202
176 Ill.2d 95, 223 Ill.Dec. 429, 65
USLW 2686
Patricia HOLTON et al., Appellees,
v.
MEMORIAL HOSPITAL, Appellant.
No. 79957.
Supreme Court of Illinois.
April 17, 1997.

Page 1203

[176 Ill.2d 98] [223 Ill.Dec. 430] Hugh C. Griffin, Lord, Bissell & Brook, Chicago, Edward S. Bott, Jr., Thompson Coburn, Belleville, for Memorial Hosp.

Bruce N. Cook, Cook, Shevlin, Ysursa, Bauer & Bartholomew, Belleville, for Patricia Holton.

Thaddeus J. Nodzenski, IL Hospital & Health Systems Assn., Naperville, for Illinois Hospital & Health Systems Association.

JUSTICE McMORROW delivered the opinion of the court:

In this appeal we are asked to resolve whether application of the "loss of chance" doctrine in medical malpractice cases lessens the plaintiff's burden of proving proximate cause. This question has caused conflicting opinions among the Illinois appellate court panels. The loss of chance concept refers to the harm resulting to a patient when negligent medical treatment is alleged to have

Page 1204

[223 Ill.Dec. 431] damaged or decreased the patient's chance of survival or recovery, or to have subjected the patient to an increased risk of harm.

Defendant, Memorial Hospital, requests this court to reverse the judgment entered upon the jury's verdict in favor of plaintiffs, Patricia and Frank Holton. Defendant argues that plaintiffs failed to establish that any acts or omissions of defendant's staff proximately caused [176 Ill.2d 99] plaintiffs' injuries. Alternatively, defendant contends that if the judgment is not reversed outright it must be reversed and a new trial ordered because defendant was prejudiced by conduct of plaintiffs' attorney and by the failure of the trial court to maintain impartiality. In addition, defendant challenges certain jury instructions, and also argues that it is entitled to a setoff in the amount of Mrs. Holton's past medical expenses which were reimbursed by insurance.

We allowed defendant's petition for leave to appeal. 155 Ill.2d R. 315. For the reasons that follow, we reverse the judgment of the appellate court and remand for new trial.

Background

In 1991, Patricia Holton and her husband Frank filed suit in the circuit court of St. Clair County against Memorial Hospital, Radiological Associates, Limited, and William G. Doubek, M.D., seeking damages for Patricia Holton's personal injuries and for Frank Holton's loss of consortium, which allegedly resulted from the defendants' negligence. Subsequently, plaintiffs settled their claims against William Doubek, Radiological Associates, and three other defendants named in a companion case. The trial court found that the $2,950,000 settlement was made in good faith and subsequently dismissed Doubek and Radiological Associates from the case at bar, leaving Memorial Hospital as the sole remaining defendant.

Testimony at trial revealed that Patricia Holton began to suffer severe back pain in late November or early December 1990. Her primary care physician, Dr. Doubek, ordered an X ray and a bone scan. These procedures indicated that the patient suffered from a degenerative process or compression fracture to a vertebra in her thoracic spine. Dr. Doubek scheduled Mrs. Holton to undergo a magnetic resonance imaging [176 Ill.2d 100] (MRI) on January 4, 1991, the earliest available date for nonemergencies. He also told her to go to the emergency room if her pain worsened.

At approximately 9:30 p.m. on December 26, 1990, Mrs. Holton went to the emergency room of Memorial Hospital in Belleville, Illinois, complaining of numbness below the waist and a tingling sensation in her left leg. Dr. Mark Jergens, an emergency room physician, examined Mrs. Holton. He found evidence of a low fever and an elevated white blood count, which indicated the presence of an infection. At this time, according to the trial testimony of Dr. Jergens, Mrs. Holton had not lost any motor skills. The doctor ordered a blood culture and a CAT scan. On the medical records Dr. Jergens noted that a thoracic epidural abscess was a possible explanation for Mrs. Holton's symptoms. An epidural abscess is a collection of pus in the epidural area adjacent to the membrane which covers the spinal cord. Because emergency room physicians at the hospital did not have admitting privileges, Dr. Jergens called Mrs. Holton's primary care physicians to order her admission to Memorial Hospital.

Dr. Doubek examined Mrs. Holton early on the morning of December 27, 1990, and discovered that she had tingling, numbness, and weakness in her lower extremities. He was aware that her symptoms were consistent with either a bone infection called osteomyelitis or a tumor in her spine. Dr. Doubek ordered a neurological consultation.

Dr. Murphy, a neurosurgeon, examined Mrs. Holton in the late afternoon of December 27, 1990. She complained of numbness in her abdomen and legs but could still move her extremities. The CAT scan confirmed the existence of a compression fracture. The radiologist who interpreted the CAT scan was of the opinion that Mrs. Holton's pain was caused by a cancerous tumor.

[176 Ill.2d 101] Mrs. Holton testified that during the day of December 27, 1990, she noticed increasing difficulty in moving her left leg. She informed her attending nurses of this condition. However, the nurses' notes state only that the patient did not experience any significant

Page 1205

[223 Ill.Dec. 432] change in her condition during the day. Between 6 and 7 p.m. on December 27, 1990, Mrs. Holton walked to the bathroom unassisted. After a few moments she attempted to rise and return to her bed. However, she could not move her legs or stand up and noticed a particular problem with numbness in her left leg. She rang the bell for help. Two nurses aides helped her into a wheelchair and from there, into her bed. Although she remarked when the nurses aides helped her from the toilet that her legs "didn't want to work," neither aide reported this incident to a supervisor, a nurse, or a doctor.

Registered nurse Barbara Ford cared for Mrs. Holton during the shift between 11 p.m. on December 27, 1990, and 7 a.m. on December 28, 1990. At some time between 1 a.m. and 5 a.m. on December 28, Nurse Ford determined that Mrs. Holton was having difficulties moving her left leg, but she did not believe that this was a significant change of condition.

After the next change in nursing shifts, between 8 and 9 a.m. on December 28, Mrs. Holton complained of numbness from the waist down and an inability to move her legs except for very slight movement in her right foot. She also lost bowel and bladder control. The nurse then on duty, Susan Schindler, informed Dr. Doubek and the neurosurgeon on call of these developments. Dr. Doubek came immediately and confirmed that Mrs. Holton had suffered a complete loss of motor control below the waist. Dr. Sprich, the neurosurgeon on call for Dr. Murphy, ordered tests to determine where the pressure on the spinal cord was located.

Dr. Doubek testified at trial that at the time of his [176 Ill.2d 102] diagnosis he was operating under the assumption that Mrs. Holton had suffered a sudden onset of paralysis because he had not been informed otherwise by the hospital staff or the charts and records. Accordingly, he initially thought it likely that her condition was caused by a tumor-caused infarct of the blood supply to the spinal cord, which would be consistent with sudden and complete loss of motor function. Defendant's nursing staff did not tell Dr. Doubek that Mrs. Holton's numbness and other symptoms of sensory deficits had been progressing over several hours to a state of motor impairment or partial paralysis. According to the neurological evidence adduced at trial, this escalation from tingling and numbness to paresis, or partial loss of motor function, indicates spinal cord compression caused by osteomyelitis (infection of the bone). Osteomyelitis can cause either an inflammation or an abscess that puts pressure on the spine, resulting in the progression of paralysis. Because Dr. Doubek was unaware that Mrs. Holton's apparently sudden paralysis had been preceded by a more gradual onset of declining motor function, Dr. Doubek determined that the most likely cause of plaintiff's condition was a cancerous tumor, requiring radiation.

Similarly, Dr. Sprich, the neurosurgeon on call for Dr. Murphy, testified that he would have come to the hospital immediately if he had been informed that Mrs. Holton was beginning to have trouble walking and moving her legs. By the time she lost bowel and bladder function, according to Dr. Sprich, her condition was irreversible. He further testified that patients suffering from neurological conditions whose symptoms are consistent with an epidural abscess can usually be beneficially treated because there is sufficient time to confirm the diagnosis and perform surgery to ease the pressure on the spinal cord. Dr. Sprich testified that if cord [176 Ill.2d 103] compression caused by an epidural abscess is diagnosed within 24 hours of the occurrence of paresis, patients often have "an excellent neurological recovery" and, if caught at an early enough point in the paresis, such patients will be able to "move their legs."

Dr. Doubek and Dr. Sprich also explained why they agreed that the apparently sudden onset of Mrs. Holton's paralysis supported the diagnosis of cancerous tumor rather than osteomyelitis. Osteomyelitis is a rare occurrence in the absence of a prior surgical intervention or trauma to the spinal cord, and Mrs. Holton did not have such a history. Also, statistical probabilities favored the existence of cancerous tumor under the perceived suddenness of the paralysis, especially where, as here, there was no involvement of the disc area of the spine. Consequently, the

Page 1206

[223 Ill.Dec. 433] doctors who diagnosed and treated Mrs. Holton concluded that the cause of her condition was a cancerous tumor and proceeded...

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141 practice notes
  • Miranda v. Cnty. of Lake, No. 17-1603
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • August 10, 2018
    ...harm was a diminished chance of survival. See Murrey v. United States , 73 F.3d 1448, 1453–54 (7th Cir. 1996) ; Holton v. Mem'l Hosp. , 176 Ill. 2d 95, 119, 223 Ill.Dec. 429, 679 N.E.2d 1202 (1997) (recognizing the lost chance doctrine in Illinois). While expert testimony could be used as "......
  • McDonnell v. McPartlin, No. 87309.
    • United States
    • Supreme Court of Illinois
    • June 15, 2000
    ...i.e., the element of proximate cause. Plaintiff, however, contends that this court's subsequent decision in Holton v. Memorial Hospital, 176 Ill.2d 95, 223 Ill. Dec. 429, 679 N.E.2d 1202 (1997), requires that there be evidence that the nonparty physician was professionally negligent before ......
  • Murillo v. United States, No. 17-cv-1279
    • United States
    • United States District Courts. 7th Circuit. United States District Court (Northern District of Illinois)
    • December 1, 2020
    ...has lessened the effectiveness of treatment or increased the risk of an unfavorable outcome to the plaintiff. Holton v. Mem'l Hosp. , 176 Ill.2d 95, 223 Ill.Dec. 429, 679 N.E.2d 1202, 1209 (1997). Yet, this immediate suit is not a medical malpractice action, and this doctrine does not apply......
  • Yoder v. Ferguson, No. 1-04-3214.
    • United States
    • United States Appellate Court of Illinois
    • March 6, 2008
    ...only be used when there is evidence showing the conduct of a third person was the sole proximate cause. Holton v. Memorial Hospital, 176 Ill.2d 95, 134, 223 Ill.Dec. 429, 679 N.E.2d 1202 (1997); Ballweg v. City of Springfield, 114 Ill.2d 107, 121, 102 Ill.Dec. 360, 499 N.E.2d 1373 (1986). T......
  • Request a trial to view additional results
138 cases
  • Miranda v. Cnty. of Lake, No. 17-1603
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • August 10, 2018
    ...harm was a diminished chance of survival. See Murrey v. United States , 73 F.3d 1448, 1453–54 (7th Cir. 1996) ; Holton v. Mem'l Hosp. , 176 Ill. 2d 95, 119, 223 Ill.Dec. 429, 679 N.E.2d 1202 (1997) (recognizing the lost chance doctrine in Illinois). While expert testimony could be used as "......
  • McDonnell v. McPartlin, No. 87309.
    • United States
    • Supreme Court of Illinois
    • June 15, 2000
    ...i.e., the element of proximate cause. Plaintiff, however, contends that this court's subsequent decision in Holton v. Memorial Hospital, 176 Ill.2d 95, 223 Ill. Dec. 429, 679 N.E.2d 1202 (1997), requires that there be evidence that the nonparty physician was professionally negligent before ......
  • Murillo v. United States, No. 17-cv-1279
    • United States
    • United States District Courts. 7th Circuit. United States District Court (Northern District of Illinois)
    • December 1, 2020
    ...has lessened the effectiveness of treatment or increased the risk of an unfavorable outcome to the plaintiff. Holton v. Mem'l Hosp. , 176 Ill.2d 95, 223 Ill.Dec. 429, 679 N.E.2d 1202, 1209 (1997). Yet, this immediate suit is not a medical malpractice action, and this doctrine does not apply......
  • Yoder v. Ferguson, No. 1-04-3214.
    • United States
    • United States Appellate Court of Illinois
    • March 6, 2008
    ...only be used when there is evidence showing the conduct of a third person was the sole proximate cause. Holton v. Memorial Hospital, 176 Ill.2d 95, 134, 223 Ill.Dec. 429, 679 N.E.2d 1202 (1997); Ballweg v. City of Springfield, 114 Ill.2d 107, 121, 102 Ill.Dec. 360, 499 N.E.2d 1373 (1986). T......
  • Request a trial to view additional results
2 firm's commentaries
1 books & journal articles

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