November 7, 2008

Chicago Hospital's Negligence Clarified by Illinois Appellate Court

The Illinois Appellate Court affirmed a Cook County jury's $2.7 million verdict for institutional negligence against Loyola Medical Center in a Chicago transplant error case. Longnecker v. Loyola University Medical Center, 2008 WL 2550686 (1st Dist., June 25).

Transplant%20cooler%201.jpgThe issue in Longnecker was whether Loyola University Medical Center was negligent when they transplanted the decedent with a severely hypertrophic replacement heart. The harvested heart was severely diseased and was only considered for transplantation because the harvesting doctors did not examine it. Despite the diseased state of the new heart, the decedent's heart surgeon went ahead with the transplant. The decedent died without ever waking up from the surgery.

Most times we think of medical negligence cases as those caused by doctors or medical personnel individually. But a hospital or institution is held to the same standard of care as a doctor or a physician. So when evaluating a case for institutional negligence one asks what a reasonably careful hospital would and should do under similar circumstances. Illinois Pattern Jury Instructions, Civil, No. 105.03.01 (1995). Jones v. Chicago HMO Limited of Illinois, 191 Ill. 2d 278 (2000).

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October 27, 2008

Are All FDA Approved Devices Safe?

The U.S. Food and Drug Association is responsible for ensuring that new medical devices are safe enough to be put on the market. As a federal agency, the FDA controls regulation nationwide and within Illinois and Chicago. But what most consumers don't know is that the process for approving these medical devices doesn't always ensure that they are effective alternatives to already established medical treatments.

Approved%20Stamp.jpgThe majority of newly approved medical devices undergo a 501(k) review. Under this review process the manufacturer needs to prove that their device is substantially similar to another device that has already been approved for the market. Once they have done that, the manufacturer just needs to show that the device does what it claims. Yet in the field of medicine, just performing a function is different than guaranteeing the supposed outcome.

For example, let's suppose that Elaine, an Illinois woman, was trying to decide between which type of radiation she should get to treat her breast cancer. Her options range from conventional radiation, which would irradiate her whole breast five times per week for a total of five weeks, to a newly-FDA approved radiation therapy method called MammoSite brachytherapy. This new method only requires radiation for five days and uses radioactive 'seeds' to treat the cancer.

All things being equal, the MammoSite option is much more appealing because it gets the job done in a fraction of the time and is Elaine's first choice. Her doctor recommends it and she decides to go with the newer treatment option. However, what Elaine doesn't know is that even though MammoSite is FDA-approved, the long-term effectiveness of the treatment is not yet proven. While early studies have come back with promising results, it will be years before there is enough data to determine whether it is as effective as conventional radiation. Yet many of the women undergoing this form of treatment are unaware that it is still in an experimental state and are trusting the FDA-approval and their doctors' recommendation.

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October 20, 2008

Medical Records Falsified In Birth Injury Case

In the many years that I have practiced medical malpractice in Cook County and Illinois, my clients have warned me that the pertinant medical records in their case had been falsified, changed, deleted or simply removed from the hospital and medical charts.

Medical%20Records%201.jpgIn Illinois, the “intentional destruction, mutilation, alteration or concealment of evidence” is called spoliation of evidence. If medical records were to be destroyed or altered, the Illinois Supreme Court can impose a sanction upon any party who unreasonably refuses to comply with any discovery rule or order entered pursuant to the Illinois Supreme Court Rules. The court has the power to stay the proceedings pending compliance; default the case, barring further pleading related to the issue; dismiss a claim or counterclaim related to that issue; exclude testimony related to the issue; to strike any relevant portion of the offending party’s pleadings and enter judgment on the issue; and to enter a default judgment or dismissal against the offending party.

In 1995, the Illinois Supreme Court recognized a separate cause of action for negligent spoliation of evidence. So if your medical records in a medical malpractice case were altered by the medical staff, then you could file a separate lawsuit regarding the altered evidence. And because adequate remedies for the destruction of evidence already exists under Illinois Supreme Court Rule 219, a new tort wasn't created. Instead, the Supreme Court held that an action for negligent spoliation could be brought under existing negligence law.

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October 15, 2008

Illinois Erb's Palsy Medical Malpractice Case Turns on Engineering Expert's Testimony

Erb’s palsy is a injury to a child's brachial plexus nerves caused by an abnormal or difficult child birth. The brachial plexus is a cluster of nerves in your neck that control all arm movements. Erb’s palsy can be caused by excessive pulling on the shoulders of the infant by the medical staff during delivery. The resulting paralysis affecting the movement of the child's shoulders, arms or hands can be partial or complete. And while sometimes the paralysis can resolve on its own, it could also necessitate physical therapy or surgery.

Baby%201.jpgIn a recent Illinois case, baby Tanisha Ruffin’s shoulder became impacted on her mother’s pelvic bone during delivery, which put stress on Tanisha's shoulders. In order to free up her shoulders from her mother’s pelvic bone, the defendant obstetrician testified that he used a vacuum extractor cup and a gentle traction on the baby’s head to manipulate her out. Nonetheless, Tanisha was born with Erb’s palsy because of the damage to the brachial plexus nerve network in her shoulder area.

The big issue at trial was whether the Illinois birth injury was caused by excessive traction with the extractor cup, or by the natural propulsive forces of labor.

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October 14, 2008

Are MRI Scans To Be Relied On By Chicago and Illinois Doctors?

When you go for an MRI at a local Chicago hospital you expect that the technician interpreting it will give a clear and correct diagnosis. However, oftentimes the MRI and other scans that are the basis for the medical treatment and care prescribed by our doctors are simply not reliable because of radiology errors.

xray%201.jpgIn one of our cases, a treating radiologist viewing an MRI scan noted certain changes in her lumbar spine. But later, this same patient was re-examined by another orthopedic surgeon who ordered new scans. And this time around the radiology report found none of those subtle changes. The meaning of all of that is that the treatment plan laid out by our client's first treating physician relied on scans that were flawed. The images seen were different on the second set of MRI scans.

Did the radiologist make a mistake? Not really, according the second doctor. But the scans themselves can be different. What's sobering to know is that some MRI scans and other scans, X-Ray and CT can appear different because of the quality of the images. Even academic radiologists say that different scans of the same part of the body can reveal very different findings.

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October 6, 2008

Infected Pressure Sores from Malnutrition and Other Nursing Home Abuse Results in Illinois Legislation

Illinois has enacted legislation to protect nursing home residents because of past instances of nursing home abuse. For example, like many nursing home residents, Fred was admitted to a nursing home when his health declined to the point that his daughter was no longer able to continue caring for him at home. At the time of his admission the 84 year-old male was confined to his bed, needed a feeding tube, and had a Stage II pressure sore on his left hip.

Hospital%20Bed1.jpgMaking the decision to entrust an elderly relative to receiving care at a nursing home is a hard one. Laws like the Illinois Nursing Home Care Act seek to alleviate some of the anxiety of the nursing home decision by addressing concerns of inadequate, improper and degrading treatment of patients in nursing homes. The Act provides residents with a wide range of rights, including the retention of a person’s own personal physician at their own expense. Chicago Mayor Richard M. Daley, then a State Senator for the 23rd District, was one of the chief sponsors of the Act when it was passed in 1979.

In addition to Illinois law, there is also the federal statute called the Omnibus Budget Reconciliation Act of 1987 (OBRA). This statute sets up requirements for long-term care facilities throughout the country. What’s most important about the two statutes is that they demonstrate that the elderly need advocates.

Because even with these legal safeguards in place, residents still suffer nursing home neglect and abuse in Illinois. Unfortunately, Fred's story is very typical and affects Illinois nursing home residents. During his first month at the nursing home, Fred's pressure sore worsened and became infected from his feces. He was transferred to a local hospital after his bed sores infection spread to his hip bone and new ulcers had developed on his other hip and sacrum. At the same time he also required treatment for malnutrition, dehydration, and a significant weight loss. After only six days in the hospital, Fred passed away.

Fred was survived by his adult daughter, who then sued the nursing home’s owner and operator for negligent care. She alleged that the nursing home had failed to adequately treat and prevent additional bed sores from developing and also failure to properly clean and manage those bed sores.

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September 30, 2008

Nursing Home Abuse And Alzheimer's Residents: Protection Under the Illinois Nursing Home Care Act

The Illinois Nursing Home Care Act was created to protect the rights of nursing home residents and combat Illinios nursing home abuse. In order to ensure a high standard of care for patients with Alzheimer's disease or dementia, the Act requires that each individual providing care to a patient with dementia undergoes proper "training in the care and treatment of such residents".

Alzheimer's disease is a brain disorder that affects over 5 million people throughout the U.S. This tragic disease destroys brain cells and affects the memory, behavior, and thinking processes of those with the disease. The nature of the symptoms, which can range from verbal outbursts, violent tendencies, or hallucinations, health care professionals must be patient and understanding when caring for patients with Alzheimer's.

Nursing%20Home1.jpgHowever, too often we hear about nursing home residents with Alzheimer's who receive substandard care and come to harm because of a lack of understanding regarding their disease. Take for example the case of 87 year-old Melanie, a nursing home resident suffering from the Alzheimer’s disease. One day she became increasingly aggressive and the employees called for nursing assistance to assess the situation. But no one answered the repeated calls for assistance over the next several hours.

When Melanie's Alzheimer's made her so aggressive that the employees were unable to calm her down or control her a nursing home employee finally resorted to calling the local police. They reported that Melanie was extremely aggressive and threatening. The police arrived at the nursing home and subdued Melanie by handcuffing her. None of this would have been necessary had the nursing staff stepped in and diffused Melanie's outburst. Instead the police had to step in and bring this 87 year-old woman to the hospital to receive treatment.

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September 2, 2008

Prisoner's Medical Malpractice Claim Allowed to Go Forward By Chicago's Seventh Circuit Court of Appeals: Reverses District Court Ruling

Chicago's 7th Circuit Court of Appeals reversed a ruling that had dismissed a prisoner's medical malpractice claim against his prison. Inmate Diego Gil brought a suit against the Federal Correctional Institution of Oxford, Wisconsin, claiming negligence and medical malpractice under the Federal Torts Claim Act, along with a violation of his Eighth Amendment rights. Diego Gil v. James Reed, et al., No. 06-1414.

Jail%20Cell%201.jpgIn March 1998 Gil underwent surgical repair of a rectal prolapse. When his condition worsened after the unsuccessful surgery Gil sought medical aid from a physician's assistant at his prison. But the physician assistant refused to give Gil medical attention, stating he was abusing the facility's emergency care.

This refusal of care continued for the next year and a half. During that time Gil developed an infection near the surgical site and was denied antibiotics. Gil's requests to see a specialist were continually denied. When Gil was finally allowed to see a colorectal surgeon he was immediately taken to surgery for rectal prolapse. After his second operation Gil was prescribed specific pain medications and warned against taking Tylenol III as it could cause constipation that would exacerbate his condition. Yet the prison staff refused to give Gil the prescribed pain medications and instead gave him Tylenol III.

At this point Gil filed suit against several of the prison officials for medical negligence and malpractice. He also alleged that the refusal to follow the surgeon's instructions amounted to a deliberate indifference to his serious medical needs as a violation under the Eighth Amendment of the Constitution.

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August 27, 2008

Illinois Appellate Court Upholds Verdict Over Expert Qualifications

A Cook County jury verdict was entered in favor of the University of Chicago Hospitals in a 2005 trial and was upheld on appeal to the Illinois Appellate Court (Kashief Weathers et al. v. University of Chicago Hospitals, et al., No. 1-061726). In the case, several doctors were accused of causing brain damage to an infant born with his umbilical cord wrapped around his neck. The plaintiff child now suffers from cerebral palsy and severe brain damage.

Newborn%20Baby.jpgThe baby's mother brought a birth injury malpractice claim against University of Chicago Hospital alleging that defendant doctors failed to relieve the trauma caused by his umbilical cord during his birth in October 1988. There were also allegations that the doctors didn't timely treat the baby's seizures after his birth.

The plaintiffs’ obstetric expert testified that the defendant doctors deviated from the standard of care by not performing a cesarean section, which would have sped up the delivery. The expert felt that a quick delivery could have changed the child's outcome because the brain damage likely occurred at some time during labor.

But the defense expert, a pediatric neurologist, disagreed. He felt that a cesarean section would not have made a difference because in his opinion the baby was injured at least one day prior to his birth. So by the time his mother was in labor there was nothing the doctors could have done to alter his outcome.

The trial jury sided with the defense and entered a verdict in favor of the University of Chicago Hospitals. The plaintiff brought the case for appeal on several counts.

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July 14, 2008

Apparent Authority: Who is Your Doctor Really Working For?

648494_my_doctor_2.jpg

When you go to the hospital for a surgery you are seen by a bevy of treaters- anesthesiologist, surgeon, attending physician, residents, etc. And all of them are employed by the hospital, right? Wrong. Many of the physicians that practice at a hospital are actually independent contractors and the hospital can argue that it has no liability for medical negligence these individuals commit- even while working on their property.

In order to bring a claim against a hospital for medical negligence in Illinois by a non-hospital employed physician who provided services at the hospital, there needs to be "apparent authority". Apparent authority deals with whether the physician appears to be an agent/employee of the hospital or clinic and has the power to act on their behalf. So if a patient can prove that they thought their physician was employed by the hospital and that it was reasonable for them to do so, then the hospital is liable for the negligent physician.

The current case law relies on the decision in York, M.D. v. Rush Presbyterian St. Luke's Medical Center, et al. (2006 WL 1702529), an Illinois case based locally in Chicago. York established that because a patient relies upon a hospital to provide services during the course of his or her stay then they make hold the hospital liable for negligence by those performing those services, even if they are not employed by the hospital.

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July 11, 2008

Be Your Own Best Advocate: How Being Proactive in Your Own Care Can Improve Your Medical Outcome

Patient responsibility is a common phrase bantered around in medical negligence cases. It refers to the patient's obligation to accurately represent their symptoms and complaints. The main reason this is an issue hinges on the fact that a large part of what a treating physician relies on, at least in the initial contact with a patient, is the patient's subjective telling of his or her complaints.

879205_stethoscope.jpg For example, if a patient presents with a persistent cough but isn't sure for how long this makes a large difference in the initial work-up by the physician. A cough is not a red flag for a serious, life-threatening disease and oftentimes is indicative of nothing more than a common cold. However, when combined with other factors, such as a history of smoking, recent unexplained weight loss, or bloody phlegm, it can be a clue to a more serious problem.

Gone are the days when our local family doctor took care of us from childhood through adulthood and knew all our family's medical history. Nowadays a yearly check-up with your primary physician is comprised of a quick interview with a nurse and then an even quicker visit with the doctor. Most physicians don't spend a lot of time prodding and considering each individual question. They expect that you will tell them concisely what is wrong, give them all the relevant information, and then they will diagnose and treat you. But it really isn't that straightforward. In order to ensure that you get the most out of any physician encounter, and are receiving proper treatment, you need to be your own advocate.

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July 9, 2008

Medical Malpractice Verdict Affirmed by Illinois Appellate Court: Good Samaritan Act Does Not Apply

1028001_helping_hands_4.jpgA Lake County, Illinois circuit court presided over Muno v. Condell Medical Center, et al., (No. 2-06-0587), a medical negligence case where a minor died after the planned surgery failed with respect to the anesthesiology provided. In this case, the anesthesiologist and his group decided not to bill the family after this child died during surgery. When the family brought suit against the anesthesiologist for his anesthesiology error, the physicians argued that he should be immune from any legal action under the Good Samaritan Act because he did not bill for his services.

Good Samaritan Act Regarding Exemption from Civil Liability for Emergency Care

Any [physician] who, in good faith, provides emergency care without fee to a person, shall not, as a result of his or her acts or omissions, except willful or wanton misconduct on the part of the person, in providing the care, be liable for civil damages. (745 ILCS 49/25)

At the bench trial the jury ruled in favor of the child's family . But one of the defendants, an anesthesiologist, appealed the verdict stating that the court should rule in his favor because he didn't bill the family for his services. The appellate court relied on Estate of Heanue v. Edgcomb for the proposition that a doctor cannot simply withhold a bill to the injured patient and stand behind the immunity provided by the Good Samaritan Act each time he/she choses not to diagnose, treat or simply errors causing injury or death to a patient.

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June 26, 2008

Hospital Liability in Cook County Jury Verdict Upheld Against Loyola University Medical Center In Heart Transplant Case

Loyola University Medical Center was held liable by a Cook County jury in 2006 for "institutional negligence" involving the unsuccessful heart transplantation attempt of Carl Longnecker, the plaintiff decedent. The hospital was held liable for not ensuring that a doctor understood his role on the heart transplant team. At the same time the jury found that the same doctor, also named as a defendant, was not guilty of medical negligence.

Longnecker had been waiting for a transplant for 14 months when he was notified that a heart had been found for him. Dr. Parvathaneni was responsible for obtaining that heart and getting it to Loyola, where the transplant would be performed. According to surgeons at Loyola, Parvathaneni played a crucial role in the process in that they relied on his inspection and evaluation when they accepted and used the heart. Dr. Parvathenani testified that he was unaware that he needed to perform a detailed assessment of the heart, but just was responsible for getting it to Loyola quickly. So when it became evident that the heart had significant disease and allegedly never functioned after its removal the question was who was responsible. The transplant surgeons decided to go ahead with the surgery, stating that they needed to go ahead with the transplant of the diseased heart because Longnecker's own heart had already been removed. However, it should also be noted that the doctors could have used an artificial heart in this case. Longnecker never regained consciousness after the surgery and died several days later.

Post trial, the Circuit Court judge, Irwin Solganick granted judgment notwithstanding the verdict in favor of Loyola, even though the jury found the hospital responsible with a verdict in favor the plaintiff-decedent's family in the amount of $2.7 million. So even though the jury found the hospital guilty, Judge Solganick overruled that decision and entered a not-guilty verdict against Loyola. According to Judge Solganick his decision to vacate that jury verdict was premised on inconsistencies in the verdict.

According to Judge Solganick the inconsistencies are that the jury concluded that the defendant doctor, Dr. Parvathaneni, did not do anything to harm Longnecker, but at the same time ruled that the hospital was negligent in not making sure that Dr. Parvathaneni understood that he was to thoroughly inspect the heart before harvesting it. According to Judge Solganick "whether [Dr. Parvathaneni] personally did not understand his role or whether Loyola did not see that he understood his role did not matter" and therefore Loyola shouldn't be held accountable for Longnecker's death.

Illinois' First District Appellate Court, in a 2-1 decision, reversed Judge Solganick's order and remanded the case back to the trial judge for reinstatement of the verdict.

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June 20, 2008

Illinois Supreme Court Interprets Medical Malpractice Law

In a sharply divided decision, 4-3, the Illinois Supreme Court held that plaintiffs who are allowed to refile a case after a voluntary nonsuit, would still be allowed 90 days after the refiling to present the required Section 2-622 affidavit of a physician or other medical provider to certify that a medical negligence complaint has merit.

In Illinois it has been the law that as a prerequisite to filing any medical malpractice case, the plaintiff's attorney must include with the complaint a certificate of merit asserting that the case has merit from a physician or medical provider expert in the area of medicine being complained about. Sometimes lawyers find that although they believe the facts support a case for medical malpractice, no medical certificate was available in advance of the running of the statute of limitations.

In Illinois the statute of limitations is two years for most tort/negligence cases with some exceptions. What the statute of limitations does is act as a complete bar from bringing the action at all, i.e. the court would dismiss the case unless it is filed within the time limit.

In the underlying case decided by the Supreme Court, the plaintiff filed suit without the certificate of merit. Facing dismissal of the case by a McLean County judge, the plaintiff voluntarily dismissed her case, refiled within one year and then asked for another 90 days to obtain the required certificate of merit. The circuit court dismissed plaintiff's case and an appeal ensued to the 4th Appellate District. That appellate court reversed the lower court decision and the case was further appealed to the Illinois Supreme Court.

The Illinois Supreme Court likely took up this issue up is because some appellate court districts in Illinois had differing views on this 90 day rule. While all courts allowed attorneys to file a medical malpractice case without the certificate of merit with the proviso that one must be submitted within 90 days thereafter. And in the absence of the certificate being filed within the time limits, the complaint would be dismissed.

However, some courts also allowed plaintiffs a one time grant of a nonsuit, which is a non-prejudicial dismissal with a right to reinstate the case within one year. What this means is that some judges would allow plaintiff to refile their case after missing the 90-day deadline for filing a certificate of merit, whereas another court might not allow this. There was no consistency between the various courts of Illinois.

Much of the confusion came as a result of the tort reform statute in 1995 that said a certificate of merit needed to be filed within 90 days of the case, which was held to be unconstitutional by our supreme court in 1997. The Illinois legislature amended the statute two months after the supreme court decision. However, this new statute neglected to address the 90-day extension in its then new provisions so that it was at the discretion of individual courts.

In this case the Supreme Court affirmed the appellate court decision, thus clarifying the law on the subject. So as it stands now, a plaintiff who has not submitted the certificate of merit within the initial deadline may dismiss his or her case, refile within one year and have an additional 90 days thereafter to file the professional's certificate of merit. This standard will be applied to all courts throughout Illinois.

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