Opinion ID: 1890528
Heading Depth: 2
Heading Rank: 1

Heading: Initial Response of Dr. Kardesch to Mrs. Mitchell's Call

Text: On October 11, 2001, Ruben Mitchell awoke in the middle of the night clutching his chest after having a nightmare about death. After Mr. Mitchell left for work the following morning, Mr. Mitchell's wife, Elizabeth Mitchell, called the office of Dr. Milton Kardesch, who was Mr. Mitchell's general internist. Speaking with Dr. Kardesch's medical assistant, Mrs. Mitchell relayed the previous night's episode. In her note documenting her conversation with Mrs. Mitchell, the medical assistant wrote: October 11, 2001, Ruben Mitchell, diet; eats anything, night; sleep, nightmare, grabs chest, sleeps after work, never used to nap. The medical assistant did testify she made a note of the Mitchells' telephone number and drew a line on the message slip, later explaining at trial, That line means that I went back to talk to Dr. Kardesch about this phone call. The parties dispute what occurred next. Because Dr. Kardesch raises a sufficiency of the evidence issue, the evidence is set out in detail. Dr. Kardesch's medical assistant testified she had no specific recollection of Mrs. Mitchell's call. Neither she nor Mrs. Mitchell could recall if Mrs. Mitchell also had mentioned chest pain, but the medical assistant said that even had Mrs. Mitchell so indicated, her practice was not to write down such complaints. Instead, she said it was her general practice to speak to the patient, get a phone number, go back and talk to Dr. Kardesch, and I would write down whatever Dr. Kardesch would tell me the patient should do. Reviewing her own notes documenting both her call with Mrs. Mitchell and her related conversation with Dr. Kardesch, the medical assistant indicated the doctor believed Mr. Mitchell's symptoms might have been related to one of Mr. Mitchell's heart medications. This was corroborated by Dr. Kardesch's testimony that he told his assistant that a side effect of a beta-blocker taken by Mr. Mitchell included bad dreams and nightmares. The assistant's notes also stated Dr. Kardesch's diagnosis was arteriosclerotic heart disease and to rule out angina. The assistant said she did not recall Dr. Kardesch directly speaking on the telephone with Mrs. Mitchell. Dr. Kardesch later testified that he remembered Mrs. Mitchell's telephone call regarding her husband because of the unique nature of a phone call that involved grabbing at the chest and having a nightmare. Dr. Kardesch confirmed both that he did not speak directly with Mrs. Mitchell on the telephone on October 11, 2001, and that his diagnoses had been arteriosclerosis and to [r]ule out angina. He further stated that at the time of the call he believed Mr. Mitchell's symptoms simply pointed to a nightmare. Regardless, not wanting to waste time and feeling it was important that a patient with Mr. Mitchell's past history seek immediate medical care, Dr. Kardesch testified that he instructed his assistant to tell Ms. Mitchell to get Mr. Mitchell over to the emergency room. Dr. Kardesch's assistant conceded at trial that she had no recollection of telling Mrs. Mitchell to take her husband to the emergency room, and her note of the conversation does not contain that advice. She said she nonetheless thought she told Mrs. Mitchell to go to the emergency room because, It was automatic that if a patient was having chest pain, they needed to go to the emergency room, and it was never written. It was just verbal. Mrs. Mitchell flatly contradicted the medical assistant's assumption that she must have said to take Mr. Mitchell to the emergency room. Mrs. Mitchell said that she never was instructed to take her husband to the emergency room: That did not happen. If they would have told me to take him anywhere, I would have taken him immediately. Mrs. Mitchell further testified that as her husband was a journeyman plumber with 28 years seniority, he was allowed to leave work for medical purposes and that he would have done so immediately if Dr. Kardesch's office had so directed. No one disputes that Mr. Mitchell did not go to the emergency room on October 11, 2001. Dr. Donald Singer, a cardiologist and professor of medicine at the University of Illinois in Chicago, testified that Dr. Kardesch deviated from the standard of care in his management of Mr. Mitchell's medical treatment. Specifically, Dr. Singer testified that Dr. Kardesch should have spoken directly with Mrs. Mitchell to better understand Mr. Mitchell's symptoms, and, importantly to the facts of this case, Dr. Kardesch should have shipped the patient off to the emergency room. Further, Dr. Singer testified that Dr. Kardesch needed to get on this patient and immediately order a series of tests, some of which were possible to complete within Dr. Kardesch's office. To a reasonable degree of medical certainty, Dr. Singer testified, Dr. Kardesch breached the standard of care in not following these procedures.