Longnecker v. Loyola University Med. Ctr.

• Decision Date: 25 June 2008
• Docket Number: No. 1-06-1536.,1-06-1536.
• Citation: 891 N.E.2d 954
• Parties: Connie LONGNECKER, Individually and as Special Administrator of the Estate of Carl Longnecker, Deceased, Plaintiff-Appellant, v. LOYOLA UNIVERSITY MEDICAL CENTER, and Sirish Parvathaneni, M.D., Defendants-Appellees.
• Court: United States Appellate Court of Illinois

891 N.E.2d 954

Connie LONGNECKER, Individually and as Special Administrator of the Estate of Carl Longnecker, Deceased, Plaintiff-Appellant, v. LOYOLA UNIVERSITY MEDICAL CENTER, and Sirish Parvathaneni, M.D., Defendants-Appellees.

No. 1-06-1536.

Appellate Court of Illinois, First District, First Division.

June 25, 2008.

Michael W. Rathsack, Tom Leahy, Peter D. Hoste, Chicago, IL, for Plaintiff-Appellant.

Krista R. Frick, John M. Stalmack, Bollinger, Ruberry & Garvey, Chicago, IL, for Defendant-Appellee, Sirish Parvathaneni, M.D.

Thomas J. Burke, Jr. Ben Patterson, Hall Prangle & Schoonveld, LLC, Eugene A. Schoon, Sherry A. Knutson, Sidley Austin, LLP, Chicago, IL, for Defendant-Appellee, Loyola University Medical Center.

Justice GARCIA delivered the opinion of the court.

Connie Longnecker, individually and as special administrator of the estate of her husband Carl Longnecker, filed suit against Dr. Sirish Parvathaneni and Loyola Medical Center, after Mr. Longnecker died following an unsuccessful heart transplant. During the procedure, Mr. Longnecker received a diseased "hypertrophic heart." He died four days later, never regaining consciousness.

Dr. Parvathaneni acted as the "procuring" or "harvesting" surgeon during the transplant. At trial, the plaintiff presented two theories of liability: (1) Dr. Parvathaneni, as an agent of Loyola, committed professional negligence where he failed to properly test and visually inspect the donor heart, and failed to diagnose it as having significant left ventricular hypertrophy and coronary artery disease; and, (2) Loyola committed institutional negligence by failing to ensure that Dr. Parvathaneni understood his role as a procuring surgeon. The jury found in favor of Dr. Parvathaneni and Loyola on the professional negligence claim. The jury found against Loyola on the institutional negligence claim and awarded the plaintiff $2.7 million.

Loyola filed a posttrial motion in which it argued it was entitled to judgment notwithstanding the verdict (judgment n.o.v.), or, in the alternative, a new trial, because (1) the plaintiff failed to plead institutional negligence, (2) the plaintiff failed to produce expert testimony to support institutional negligence, (3) the plaintiff failed to establish breach, (4) the plaintiff failed to establish causation, and (5) the verdicts were inconsistent. The circuit court found the verdict in favor of Dr. Parvathaneni to be irreconcilable with the verdict against Loyola, reasoning if Dr. Parvathaneni had not been negligent, Loyola's failure to ensure he understood his role could not have been the proximate cause of Mr. Longnecker's death. Therefore, the court decided the verdicts were inconsistent. The court vacated the verdict against Loyola and entered judgment for Loyola.

The plaintiff contends on appeal that the jury's verdicts are not inconsistent. She alternatively argues that if the verdicts are inconsistent, the proper remedy is to order a new trial on both causes of action.

Dr. Parvathaneni agrees the verdicts are not inconsistent. In his brief, he points to the "wholly separate theories of liability against Loyola as principal of Dr. Parvathaneni and [liability against] Loyola for institutional negligence," to which two separate standards of care apply.

Loyola's brief intimates that we need not determine whether the verdicts are inconsistent if the circuit court's grant of judgment n.o.v. is proper for other reasons. Loyola focuses on the circuit court's finding that proximate cause was precluded based on the verdict in favor of Dr. Parvathaneni to contend the judgment n.o.v. was proper. Loyola also argues the judgment n.o.v. was proper because the plaintiff failed to establish the element of breach, and because the institutional negligence claim was barred by the statute of limitations. In the alternative, Loyola argues the circuit court correctly found the verdicts to be inconsistent. Loyola concedes that if the verdicts are inconsistent, the proper remedy is to order a new trial on both claims.

For the reasons that follow, we hold the verdicts in this case are not inconsistent, and that no other basis supports the grant of judgment n.o.v. We therefore reverse the decision of the circuit court of Cook County, and remand for further proceedings.

BACKGROUND

Carl Longnecker suffered from numerous coronary ailments, and, by age 58, had suffered three heart attacks.

In 2000, Mr. Longnecker became a patient of Dr. George Mullen, a cardiologist at Loyola. Dr. Mullen told Mr. Longnecker he needed a heart transplant, and placed his name on a donation waiting list.

By 2001, Mr. Longnecker's condition worsened. His "status" on the donation waiting list went from "2 class" to "1B class," moving his name up the list. His chance of surviving one year without a transplant was 30%.

On June 11, 2001, Mr. Longnecker was informed a potential donor heart had been located. He went to Loyola and was prepared for surgery.

A. Loyola Heart Transplantation Procedures

Loyola uses a team approach to heart transplantations. The Loyola transplant team consists of a nurse coordinator and three doctors: the transplant cardiologist, the procuring surgeon, and the transplant surgeon.

The Regional Organ Bank of Illinois (ROBI) also plays a role in Loyola's heart transplantations. When a potential donor is declared brain dead, ROBI gathers information about the donor, including gender, age, and weight, the cause of death, and whether the donor smoked, drank alcohol, or used narcotics. ROBI may also order diagnostic tests of the donor's heart. ROBI then passes any relevant information to Loyola's nurse coordinator, who briefs the transplant cardiologist.

The transplant cardiologist first makes an evaluation, based on the donor's history and the results of any tests, to preliminarily accept or decline the heart. If the heart is preliminarily accepted, the procuring surgeon goes to the donor hospital, where he or she opens the donor's sternum and visually inspects the heart and feels it for defects. Next, the procuring surgeon makes the "final phone call" where he or she reports the findings to the transplant surgeon, who decides whether to accept or reject the heart. If the heart is accepted, the procuring surgeon "cross-clamps" the donor heart, cutting off the blood supply, and flushes it with a preservative solution. The heart is transported to Loyola, where the transplant surgeon, who has removed the patient's "native" heart, transplants the donor heart.

Time is of the essence in heart transplantations. A preserved heart can remain viable for approximately four hours after being removed from the donor's body. Thus, the removal of the donor heart and its transport to the recipient hospital must be carefully coordinated with the removal of the recipient's native heart.

B. The Heart Transplantation in this Case

In this case, the nurse coordinator was Penny Pearson. Dr. Mullen was the transplant cardiologist. The defendant, Dr. Parvathaneni, was the procuring surgeon, and Dr. Foy, the surgical director of the Loyola transplant team, was the transplant surgeon.

The donor was a 46-year-old male who was declared brain dead at Good Samaritan Hospital. The donor's family informed ROBI he smoked cigarettes and marijuana and drank alcohol regularly, and that he may have used cocaine. The family also revealed the donor was diagnosed with hypertension (high blood pressure) in September 2000. He was "noncompliant" with treatment, meaning he did not take medication regularly.

Based on the donor's history, ROBI ordered diagnostic tests, including an echocardiogram, the "gold standard" test for left ventricle hypertrophy (the enlargement of the heart wall), and an angiogram, the "gold standard" test for coronary artery disease (plaque in the arteries). The donor's level of troponin, a substance that may be indicative of damaged heart muscle, was also measured.

The echocardiogram revealed the donor's left ventricle measured 1.2 centimeters, meaning he suffered from "mild" left ventricle hypertrophy. The angiogram revealed "mild" coronary artery disease. The donor's troponin level was elevated.

ROBI contacted Pearson with the above information. Pearson then contacted Dr. Mullen, who, after evaluating the echocardiogram and angiogram, and after discussing the matter with Dr. Foy, preliminarily accepted the heart. Dr. Parvathaneni then went to Good Samaritan in order to "visualize" the heart, that is, to inspect it for congenital abnormalities and to confirm the findings of the echocardiogram and angiogram. Dr. Parvathaneni did not have any concerns about plaque or hypertrophy in the heart. Dr. Parvathaneni called Dr. Foy and told him the heart "look[ed] good" and was "suitable for transplantation" from a surgical aspect. Dr. Foy accepted the heart.

At 7:10 a.m., Dr. Parvathaneni cross-clamped the donor's heart, and removed it at 7:30 a.m. By 7:40 a.m., the heart was in route to Loyola, where it arrived at 8:10 a.m.

At 7:48 a.m., while the donor heart was on its way to Loyola, Dr. Foy placed Mr. Longnecker on a bypass machine. At 8:28 a.m., Mr. Longnecker's native heart was cross-clamped and removed. When Dr. Foy removed the donor heart from its container, he immediately saw and determined by touch that it suffered from left ventricular hypertrophy and coronary artery disease. Dr. Foy wrote "Hypertrophic heart!" in his operative note because the amount of hypertrophy was more than he expected based on the results of the echocardiogram. Nevertheless, Dr. Foy determined the heart was suitable for transplant, and transplanted it. The heart, however, never functioned, and, on June 15, 2001, Mr. Longnecker died. Had Mr. Longnecker survived, his name would have been placed back on the heart donation waiting list.

An autopsy revealed the donor heart weighed 492 grams, whereas a normal heart weighs 300 grams. The heart's left ventricle measured two...