York v. Rush-Presbyterian-St. Luke's

• Decision Date: 22 June 2006
• Docket Number: No. 99507.,99507.
• Citation: 854 N.E.2d 635,222 Ill.2d 147
• Parties: James M. YORK, M.D., et al., Appellees, v. RUSH-PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER et al. (Rush-Presbyterian-St. Luke's Medical Center, Appellant).
• Court: Illinois Supreme Court

854 N.E.2d 635

222 Ill.2d 147

James M. YORK, M.D., et al., Appellees, v. RUSH-PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER et al. (Rush-Presbyterian-St. Luke's Medical Center, Appellant).

No. 99507.

Supreme Court of Illinois.

June 22, 2006.

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R. Dennis Rasor and Diane I. Jennings, of Anderson, Rasor & Partners, L.L.P., and George F. Galland, Jr., of Miner, Barnhill & Galland, P.C., Chicago, for appellant.

Robert A. Clifford, Timothy S. Tomasik, Robert P. Sheridan, David A. Novoselsky and Leslie J. Rosen, Chicago, for appellees.

Hugh C. Griffin and Adam L. Frankel, of Lord Bissell & Brook, L.L.P., Chicago, for amicus curiae Adventist Health System et al.

Michael E. Prangle, of Hall Prangle & Schoonveld, L.L.C., Chicago, for amici curiae Advocate Health Care et al.

Thaddeus J. Nodzenski and Mark D. Deaton, Naperville, for amicus curiae Illinois Hospital Association.

Michael J. Morrissey and Morgan M. Strand, of Cassiday Schade & Gloor, L.L.P., Chicago, for amicus curiae Metropolitan Chicago Healthcare Council.

Todd A. Smith, Chicago, for amicus curiae Association of Trial Lawyers of America.

Bruce R. Pfaff, Chicago, for amicus curiae Illinois Trial Lawyers Association.

Justice McMORROW delivered the judgment of the court, with opinion:

Dr. James M. York suffered a spinal injury during knee replacement surgery performed at defendant Rush-Presbyterian-St. Luke's Medical Center (Rush). As a result, Dr. York (hereinafter, plaintiff) and his wife filed a medical malpractice action in the circuit court of Cook County against the attending anesthesiologist, Dr. Abdel Raouf El-Ganzouri, and Dr. El-Ganzouri's employer, University Anesthesiologists, S.C. Plaintiff alleged that his injuries resulted from the improper administration of a combined spinal epidural anesthesia by Dr. El-Ganzouri prior to the surgery. Specifically, plaintiff alleged that Dr. El-Ganzouri deviated from the standard of care by inserting a needle used to administer anesthesia too high on plaintiff's spine, causing the needle to pierce plaintiff's spinal cord and to result in irreversible spinal injury. Subsequent to the filing of his initial complaint, plaintiff amended his complaint to add Rush as a defendant on the theory that Dr. El-Ganzouri was Rush's apparent agent. After a jury trial, all three defendants were found liable. The jury awarded plaintiff and his wife damages in the amount of $12,598,591.31. The appellate court affirmed the verdict against all defendants. 353 Ill.App.3d 1, 288 Ill.Dec. 529, 817 N.E.2d 1179.

Thereafter, all three defendants filed petitions for leave to appeal with this court. We granted Rush's petition for leave to appeal, but denied the petition for leave to appeal filed by Dr. El-Ganzouri and University Anesthesiologists. Accordingly, this appeal solely addresses plaintiff's apparent agency claim against Rush. For the reasons that follow, we affirm the judgment of the appellate court.

BACKGROUND

As an initial matter, we note that the record in this cause is voluminous, and that we have carefully reviewed the record in its entirety. The appellate court, in its opinion below, set forth with great detail all of the evidence adduced at trial. However, since the instant appeal is limited to reviewing plaintiff's claim that Rush is liable because Dr. El-Ganzouri was Rush's apparent agent, we do not find it necessary to set forth in detail the evidence presented at trial with respect to the underlying medical malpractice claim against Dr. El-Ganzouri and University Anesthesiologists. Accordingly, we provide only a brief overview of the facts of the medical malpractice action in order to set the context for plaintiff's claim of apparent agency against Rush.

Plaintiff is a retired orthopedic surgeon. On February 9, 1998, plaintiff underwent a cemented total left knee arthroplasty at Rush. This was the third knee surgery plaintiff had at Rush since 1997, and all three surgeries were performed by Dr. Aaron Rosenberg, an orthopedic surgeon. Upon his admission to Rush for the February 9, 1998, surgery, plaintiff signed a treatment consent form which stated, in pertinent part:

"I hereby authorize Dr. Rosenberg and such assistants and associates as may be selected by him/her and the Rush-Presbyterian-St. Luke's Medical Center to perform the following procedure(s) upon myself/the patient * * *."

During the February 9, 1998, procedure, Dr. El-Ganzouri was plaintiff's attending anesthesiologist, and Dr. Rodney Miller was the anesthesiology resident. Shortly before plaintiff's surgery, Dr. El-Ganzouri administered a combined spinal epidural anesthesia to plaintiff. In this procedure, the anesthesiologist first inserts a large epidural needle — known as a "Touhy" needle — through the skin and between bones in the spine, but short of the spinal column itself. It is generally accepted that the proper location for the insertion of this needle is below the spinal cord, in the lumbar area of the spine, which is at or below the L2-L3 vertebral interspace. By injecting the patient through the lumbar area, the anesthesiologist greatly reduces the risk of the needle making contact with the spinal cord. Once the Touhy needle is properly placed, the anesthesiologist then inserts a much finer needle — known as a "Whittaker" needle — into the center of the larger Touhy needle. The Whittaker needle is advanced through the Touhy needle until the Whittaker needle pierces the dura, which is a thick skin protecting an area known as the subarachnoid space. The subarachnoid space contains cerebrospinal fluid, as well as the spinal cord itself. Once the anesthesiologist pierces the dura, he or she can confirm access to the subarachnoid space by aspirating cerebrospinal fluid back through the inserted needles. Once the presence of cerebrospinal fluid is confirmed, the anesthesiologist knows that the needles are properly placed and then may inject the anesthesia through the already — inserted needles.

In preparing to insert the Touhy needle into plaintiff's back, Dr. El-Ganzouri located the position on plaintiff's spine where he intended to insert the needle. However, when Dr. El-Ganzouri inserted the first needle into plaintiff's back, plaintiff expressed that he felt excruciating pain in his right hip, knee and leg, and that his right thigh cramped and his right calf swelled. Plaintiff experienced additional severe pain — described as pain radiating down his right leg, resulting in his right leg losing all sensation — when Dr. El-Ganzouri inserted the second needle. Plaintiff then underwent the knee replacement surgery on his left knee.

After the knee surgery, it was discovered that plaintiff had suffered a spinal injury. Plaintiff could neither feel nor move his right leg. In addition, plaintiff had lost bladder and bowel control and also experienced sexual dysfunction. Although plaintiff underwent extensive rehabilitation, he had only partial success in his recovery.

As a result of these events, plaintiff filed a four-count complaint in the circuit court of Cook County on November 17, 1998. Count I of the complaint alleged professional negligence against Dr. El-Ganzouri and University Anesthesiologists, Inc., stating that Dr. El-Ganzouri deviated from the standard of care in administering the combined spinal epidural anesthesia to plaintiff by improperly inserting the needles into plaintiff's spinal cord. Count II of the complaint was filed on behalf of plaintiff's wife, Elizabeth York, and sounded in loss of consortium due to the professional negligence of Dr. El-Ganzouri and his employer, University Anesthesiologists. The remaining two counts of the complaint alleged claims of res ipsa loquitur against Dr. El-Ganzouri and University Anesthesiologists. The two counts sounding in res ipsa loquitur were subsequently dismissed with prejudice by the circuit court at the conclusion of the trial and are not at issue in this appeal.

On February 7, 2000, plaintiff filed an amended complaint. This amended complaint added Rush as a defendant and alleged:

"[Dr. El-Ganzouri was] the actual or apparent agent of Defendant, Rush, was mentoring, directing, instructing and teaching various medical students and/or residents and was acting in said capacity, and upon whom plaintiff justifiably and reasonably relied to properly administer anesthesia to the detriment of plaintiff."

The amended complaint pled in the alternative that "defendant Rush failed to inform plaintiff that defendant, Dr. El-Ganzouri, was an independent contractor." The claim of apparent agency was repeated in count II of the complaint, which alleged loss of consortium on behalf of plaintiff's wife.

The jury trial in this case commenced on May 30, 2002. With respect to the underlying medical malpractice action, plaintiff presented medical experts who opined that Dr. El-Ganzouri deviated from the standard of care for anesthesiologists by inserting the spinal needles too high on plaintiff's spine during the combined spinal epidural procedure. Plaintiff introduced evidence that Dr. El-Ganzouri inserted the anesthesia needles at the T12-L1 spinal interspace rather than at the generally recommended L2-L3 spinal interspace. Plaintiff's experts opined that such improper placement of the needles would allow the spinal cord to be pierced, and that the injection of anesthesia directly into the spinal cord would kill nerves and cause the injuries that plaintiff experienced. In contrast defendants presented medical experts who opined that Dr. El-Ganzouri satisfied the relevant standard of care in performing the combined spinal epidural anesthesia and that plaintiff's injuries were caused by a "spinal infarction"¹ that resulted from a drop in plaintiff's blood pressure during surgery.

With respect to the apparent agency claim brought by plaintiff against Rush, plaintiff argued at trial that Rush was liable for the negligence of Dr. El-Ganzouri. Plaintiff...