Opinion ID: 2224042
Heading Depth: 1
Heading Rank: 2

Heading: Plaintiff's Medical Experts

Text: Plaintiff's cardiology expert maintained that at mandatory minimum Mrs. Hinlicky should have had a preoperative stress test. In his view, it was the standard of care to deal with heart problems before undertaking carotid surgery under all reasonable medical conditions. On cross-examination, he acknowledged that the algorithm provided a general approach but a decision about treatment additionally requires consideration of the specifics of a patient's case. The guidelines were never intended to be the standard of practice because it's too simplified, it's a general summary of the general approach. A vascular surgeon testified that [t]he literature is abundant and was in 1996 that ruling out a critical coronary lesion or finding. . . [and] correcting it . . . greatly reduces the cardiac risk [in] subsequent vascular surgery. He opined on cross-examination that guidelines have some usefulness, but don't take in to account all risk factors and all clinical situation[s], so every patient has to be individualized, not cookie-cuttered out. It was not reasonable, in his view, for a surgeon to rely solely on guidelines. Finally, a specialist in anesthesia and pain management agreed that Dr. Ilioff should not have permitted Mrs. Hinlicky to undergo surgery without further cardiac testing. While he was aware of the guidelines, he maintained on cross-examination that they were not published by a recognized anesthesia journal at the time and he had not incorporated them into his practice, as [g]uidelines are guidelines.