Snelson v. Kamm

• Decision Date: 28 February 2001
• Docket Number: No. 4-00-0418, No. 4-00-0419, No. 4-00-0432.
• Court: United States Appellate Court of Illinois
• Parties: Robert SNELSON, Plaintiff-Appellant, v. Dr. Donald KAMM and St. Mary's Hospital of Decatur, A Corporation, Defendants-Appellees. Robert Snelson, Plaintiff-Appellee, v. Dr. Donald Kamm, Defendant-Appellant (St. Mary's Hospital of Decatur, a Corporation, Defendant). Robert L. Snelson, Plaintiff-Appellant, v. Dr. Donald Kamm and St. Mary's Hospital of Decatur, a Corporation, Defendants-Appellees.

745 N.E.2d 128

319 Ill. App.3d 116

253 Ill.Dec. 354

Robert SNELSON, Plaintiff-Appellant, v. Dr. Donald KAMM and St. Mary's Hospital of Decatur, A Corporation, Defendants-Appellees.

Robert Snelson, Plaintiff-Appellee, v. Dr. Donald Kamm, Defendant-Appellant (St. Mary's Hospital of Decatur, a Corporation, Defendant).

Robert L. Snelson, Plaintiff-Appellant, v. Dr. Donald Kamm and St. Mary's Hospital of Decatur, a Corporation, Defendants-Appellees.

Nos. 4-00-0418, 4-00-0419, 4-00-0432.

Appellate Court of Illinois, Fourth District.

February 28, 2001.

Patrick S. O'Shaughnessy (argued), Christopher R. Doscotch, The Janssen Law Center, Peoria, for Robert Snelson.

Michael J. Kehart (argued), Albert G. Webber, Kehart Shafter Webber & Campbell Robinson, Decatur, for Dr. Donald Kamm. Richard J. Wilderson, April G. Troemper, Graham & Graham, Ltd., Springfield, Hugh C. Griffin (argued), Stevie A. Kish, Chicago, for St. Mary's Hospital of Decatur.

Presiding Justice STEIGMANN delivered the opinion of the court:

In January 1996, plaintiff, Robert L. Snelson, sued defendants, Dr. Donald Kamm and St. Mary's Hospital of Decatur (St.Mary's), for medical malpractice. Following a June 1999 jury trial, the jury returned a verdict in favor of Snelson and against Kamm and St. Mary's and awarded Snelson $7 million.

Following an April 2000 hearing on defendants' posttrial motions, the trial court entered an order (1) granting St. Mary's motion for judgment notwithstanding the verdict (judgment n.o.v.) and (2) setting aside the $7 million damage award against Kamm and granting a retrial on the issue of damages.

This court granted separate petitions for leave to appeal by Snelson (Nos. 4-00-0418, 4-00-0432) and Kamm (No. 4-00-0419). See 166 Ill.2d R. 306(a)(1). On appeal, Snelson argues that the trial court erred by (1) granting Kamm a new trial on the issue of damages and (2) granting St. Mary's motion for judgment n.o.v. Kamm argues in his appeal that (1) the trial court erred by (a) allowing the testimony of Snelson's medical expert because it lacked foundation, (b) ruling that Kamm could not cross-examine Snelson's medical expert regarding his potential bias, (c) giving certain instructions to the jury, and (d) admitting into evidence all of Snelson's medical bills incurred since the unsuccessful aortogram; (2) the jury (a) considered extraneous information and (b) demonstrated impropriety in conducting its duties; and (3) the jury's verdict was against the manifest weight of the evidence. We affirm and remand with directions for a new trial on the issue of damages.

I. BACKGROUND

In Snelson's January 1996 complaint, he alleged that following an unsuccessful translumbar aortogram that another physician had performed on him on March 2, 1994, Kamm negligently (1) failed to diagnose "the acute mesenteric occlusion and infarction," (2) delayed diagnosis of the acute mesenteric occlusion and infarction, (3) failed to perform sufficient diagnostic tests immediately following the unsuccessful aortogram, despite "incidents of abdominal pain," (4) failed to monitor Snelson closely, and (5) failed to perform serial physical examinations of Snelson. Snelson also alleged that St. Mary's, through its nursing staff, negligently (1) failed to inform Kamm of Snelson's symptoms immediately following the unsuccessful aortogram, (2) failed to adequately monitor Snelson, and (3) failed to perform sufficient diagnostic tests immediately following the unsuccessful procedure, despite incidents of abdominal pain.

At the June 1999 jury trial, the evidence showed the following.

A. Snelson's Hospitalization

In March 1994, Snelson, who was then 58 years old, was suffering from severe peripheral vascular insufficiency (poor blood circulation) in his legs, which was caused by arteriosclerosis (commonly referred to as hardening of the arteries). Snelson's family doctor had referred him to Kamm, a general surgeon, for treatment. Kamm suggested that Snelson undergo an aortogram to determine the exact locations of the arterial blockages. On March 2, 1994, Snelson and his son, James, arrived at St. Mary's so that Snelson could undergo a translumbar aortogram, a procedure in which dye is introduced through the patient's back into the aorta to study the aorta itself and its branches. (An aortogram is also referred to as an arteriogram.) Possible complications from such a procedure include (1) bleeding from the puncture site; (2) the breaking off of a clot from the aorta, which then blocks a blood vessel; (3) an allergic reaction to the dye; (4) infection; and (5) kidney damage.

Dr. Carlos Capati, a radiologist, testified that around noon on March 2, he attempted to perform a translumbar aortogram on Snelson. However, he had difficulty navigating the guide wire into the thoracic aorta, and it appeared that the guide wire was instead going into the superior mesenteric artery, which supplies blood to the intestine. Capati took out the translumbar needle and the guide wire and attempted to reinsert the guide wire into the aorta; however, he again had problems doing so. During the second attempt, Snelson's blood pressure began dropping and he complained of abdominal and back pain. Capati stopped the procedure and Snelson's blood pressure returned to normal. Snelson then expressed an urge to have a bowel movement and a portable commode was brought in. Capati examined Snelson's stool but did not see any discoloration. At that point, Capati decided to stop the aortogram. He then informed Kamm that he had been unable to complete the aortogram and Snelson was complaining of back and abdominal pain.

Snelson's son, James, testified that following the unsuccessful aortogram, he saw his father being brought back to his hospital room on a stretcher. James stated that his father was "screaming and yelling." Once in Snelson's room, James assisted the nurses in getting his father back in bed. At that point, Snelson began complaining about "a lot of pain in his stomach." He also complained of "pressure" in his stomach and the need to urinate. Snelson asked that the nurses insert a catheter to empty his bladder, and around 3 or 3:30 p.m. they did so. James left the hospital that afternoon before Kamm checked in on Snelson. Around 8 p.m., James spoke with his father, who was still complaining of pain and talking like he "didn't know who, what, when or where was going on."

None of the nurses who testified at the trial had any independent memory of the events of March 2 or 3, 1994. However, the nurses on staff during that time recorded notes on Snelson's condition. Those notes indicated that, following the unsuccessful aortogram, Snelson returned to his hospital room around 12:40 p.m. At that time, he was complaining of abdominal pain and cramping and insisted that he needed to have a bowel movement. A 12:44 p.m. shift assessment showed that Snelson was alert and complaining of pain that he rated as a "7" on a scale of 1 to 10. At 12:45 p.m., he had a large bowel movement and continued to complain of severe pain across the middle of his abdomen with pain radiating to his back. At that point, the nurses notified Kamm of Snelson's condition. Kamm gave verbal orders that Snelson receive a hemoglobin and hematocrit test and be given pain medication (50 milligrams (mg) of Demerol by muscular injection) every three hours as needed. Kamm also ordered that Snelson's vital signs be taken every 15 minutes for two hours and then hourly thereafter.

From 12:45 p.m. until 2:30 p.m. on March 2, Snelson's vital signs were as follows: (1) his temperature stayed below normal, (2) his respirations were normal, (3) his pulse rose from 80 to 164 during the first hour then dropped to 88 during the second hour, and (4) his blood pressure varied from a low of 120/70 at 1 p.m. to a high of 164/76 at 2:30 p.m.

At 3 p.m., Snelson's temperature had risen slightly to 95.6 degrees Fahrenheit and his blood pressure had dropped to 160/80. The nurses' flow sheet indicated that a nurse inserted a catheter in Snelson's bladder around 3 p.m. At 3:35 p.m., a second shift assessment indicated that Snelson's bowel sounds were normal, but he continued to complain of abdominal pain. At 4 p.m., Snelson's temperature was 96.2 degrees, his pulse was 116, and his blood pressure was 186/98. Around that same time, he had a bowel movement that appeared to contain bloody mucous. The nurses paged Kamm, who was in surgery, and left a message. At 4:30 p.m., Kamm telephoned and spoke with a nurse about Snelson's condition. Kamm testified that at that point, he believed that the bloody bowel movement was due to a mild hemorrhoid. Kamm told the nurse that he would examine Snelson as soon as he could.

At 6 p.m., Kamm arrived at St. Mary's and examined Snelson. At that time, the nurses' notes, shift assessment, flow sheets, and vital sign records were all available to Kamm. During the examination, Kamm noted that Snelson was complaining of mid-abdominal pain and had difficulty urinating. Kamm found that Snelson's lower abdomen was tender and distended, that his bowel sounds were hypoactive (less than normal), and that he had passed several small blood-tinged stools. In his notes, Kamm recorded a concern "about mesenteric insufficiency or thrombo-embolus with ischemia" (essentially, a blockage of blood flow to the intestine). Kamm testified, however, that at that time, he believed that the most likely cause of Snelson's pain was bleeding into his retroperitoneal area as a result of his aorta being punctured during the unsuccessful aortogram.

Kamm further testified that, based on his 6 p.m. assessment, he believed Snelson's condition had stabilized "considerably" from earlier in the afternoon. He thus ordered that the nurses check Snelson's vital signs only every four hours. Because he was concerned about Snelson's abdominal distention, he ordered that Snelson have no food or liquids by mouth. He also increased Snelson's pain...