Court Opinion

ID: 9718878
Source: CourtListenerOpinion
Date Created: 2023-08-26 07:37:03.630405+00
Date Added: 2024-06-11T12:10:08.675484
License: Public Domain

PRESIDING JUSTICE O’MARA FROSSARD, dissenting: I agree with a remand for new trial but would permit plaintiffs’ case against Ingalls Memorial Hospital to proceed, as I believe the trial court abused its discretion by barring nurse Hall’s expert testimony in its entirety and dismissing Ingalls. A causal relationship between the defendant’s negligence and the injury must be shown by a preponderance of the evidence. Chambers v. Rush-Presbyterian-St. Luke’s Medical Center, 155 Ill. App. 3d 458 (1987). The plaintiff may provide either direct or circumstantial evidence to meet this burden and the weight to be given to evidence that the injury was proximately caused by the defendant’s lack of skill or care is a matter left to the jury to decide. Bombagetti v. Amine, 254 Ill. App. 3d 817, 821 (1993). Plaintiffs demonstrated sufficient evidence of a causal link between Ingalls’ nurses’ deviations from the standard of care and the death of the baby to raise a question of fact for the jury to resolve. Nurse Hall’s testimony established the nursing standard of care: (1) Mrs. Seef be assigned high risk labor status upon her admission to the hospital; (2) Mrs. Seefs condition be assessed every 15 minutes; (3) the fetal monitoring strip be run at three centimeters per minute for ease of interpretation; and (4) Mrs. Seef be positioned on her side during labor. Nurse Hall testified that the standard of care additionally required Ingalls’ nurses to inform Dr. Sutkus of Mrs. Seefs status by 1 a.m. and that if Dr. Sutkus did not take appropriate action, the nurses were required to notify a nursing supervisor. Nurse Hall’s testimony demonstrated Ingalls’ nurses’ deviations from the standard of care. Ingalls’ nurses did not assign Mrs. Seef high risk labor status upon admission and they did not assess her condition with the frequency required. Rather than setting the fetal monitoring strip at a speed of three centimeters per minute, Ingalls’ nurses set it at one centimeter per minute, making the strip more difficult to read and interpret. Nurse Hall testified that, as a result of the nurses’ failure to set the monitor strip at the correct speed and their failure to properly monitor Mrs. Seef, changes on the strip were not identified and acted upon in the manner required by the nursing standards of care. Those failures contributed to the baby’s death. Sometime before 12:30 a.m., panels 94 and 95 on the fetal monitor strip showed signs of hypertonic contractions. Nurse Hall stated that once the monitoring strip revealed hypertonic contractions, Ingalls’ nurses should have notified Dr. Sutkus, but they did not. By 1 a.m. panel 99 indicated a loss of variability, a consistent pattern of extremely hypertonic contractions, another instance in which the attending nurses should have alerted Dr. Sutkus, although they failed to do so. At 2:45 a.m., the monitor strip showed fetal heart arrhythmia. Nurse Hall indicated that the nurses should have contacted Dr. Sutkus and if he failed to either give satisfactory orders or see Mrs. Seef himself, the nurses had an obligation to alert their nursing supervisor. Again they failed to do so. The majority incorrectly concludes that Dr. Lilling did not provide the necessary proximate cause evidence. Dr. Lilling, provided evidence that the nurses’ failures contributed to the baby’s death. In his opinion the nurses failed to properly interpret Mrs. Seefs fetal monitoring strip. Dr. Lilling noted that neither Dr. Sutkus nor Ingalls’ nurses had the appropriate level of concern for Mrs. Seefs condition until 3:05 a.m., nearly an hour after the baby should have been delivered. He offered evidence of a causal link between the nurses’ failure to act and the baby’s death when he indicated that with the proper level of care and concern the baby would have survived if delivered by 2:15 a.m., instead of at 3:45 a.m.. He stated that: “[Mrs. Seef] needed a cesarean section anytime prior to l:45[a.m.] to 2:45[a.mJ and the sooner it was done, the better off this baby would be.” Dr. Lilling’s testimony that Dr. Sutkus should have delivered the baby between 1:45 a.m. and 2:45 a.m., combined with the nurses’ failure to act during this time period, provided the necessary causal connection between the nurses’ inaction and the baby’s death. Bombagetti, 254 Ill. App. 3d 817. Nurse Hall testified regarding the nurses’ failure to position Mrs. Seef on her side during labor. She noted that Mrs. Seef was turned from her right side to her back prior to 12:45 a.m. at panel 97 of the strip. She further stated that: “Mrs. Seef was repositioned onto her back *** and remained in that position until 3 a.m. This position increases the likelihood of cord compression and was not a proper position for this mother to labor in.” Dr. Lilling’s testimony paralleled nurse Hall’s when he stated that Mrs. Seef s fetal monitoring strip displayed a “variable with a late component,” indicating cord compression. The cord compression resulted in hypoxic stress, or a lack of oxygen. In Dr. Lilling’s opinion the hypoxia progressed to anoxia, or a complete deprivation of oxygen, which caused the baby’s death. Dr. Lilling’s opinion as to the cause of the baby’s death coincided with Dr. Sutkus’ opinion, where he indicated “anoxia” as the cause of death. The nurses by repositioning Mrs. Seef on to her back increased the cord compression resulting in oxygen deprivation which caused the baby’s death. A defendant is liable for negligent conduct regardless of whether that conduct contributed in whole or in part to the injury. Chambers, 155 Ill. App. 3d at 465. A decision as to causation should be removed from the jury when not just the evidence, but also all the reasonable inferences therefrom, so overwhelmingly favor the defendant that no reasonable jury could find for the plaintiff. Bombagetti, 254 Ill. App. 3d at 820. Although a reasonable jury could have found that the nurses’ deviations from the standard of care contributed to the baby’s death, the trial court erred by eliminating this possibility when it excluded nurse Hall’s testimony and subsequently dismissed Ingalls from the case. Issues regarding standard of care and proximate cause are questions of fact properly to be decided by the jury. Aguilera v. Mount Sinai Hospital Medical Center, 293 Ill. App. 3d 967, 971 (1997). Dr. Sutkus testified that even if he had known of Mrs. Seef s condition prior to 3:05 a.m., he would not have taken any different action. Dr. Lilling, however, discredited Dr. Sutkus’ assertion when he testified that any reasonably qualified obstetrician would have delivered the baby by cesarean section by 2:15 a.m. at the latest to save the baby’s life. Moreover, the nurses had a duty to notify him and to bring his inaction to the attention of their supervisor. Dr. Sutkus speculated about what he would have done had the nurses acted in accordance with the standard of care, whereas Dr. Lilling offered not speculation, but an expert medical opinion as to how an obstetrician meeting the standards of care should have proceeded if properly notified. The weight to be given to Dr. Sutkus’ and Dr. Lilling’s conflicting testimony was a matter for the jury to determine. Suttle v. Lake Forest Hospital, No. 1 — 97—3567 (September 30, 1999). A trial court is not required to accept a defendant’s hypothetical testimony as uncontroverted fact, particularly when the opposing party offers contradictory testimony. See Wodziak v. Kash, 278 Ill. App. 3d 901, 912 (1996) (finding “scant evidentiary value” in a medical malpractice defendant’s self-serving testimony, due to bias). Ingalls’ reliance upon Gill v. Foster, 157 Ill. 2d 304 (1993), is misplaced. In Gill, our supreme court held that a nurse’s failure to notify the treating physician of the plaintiff’s chest pain did not proximately cause the injury, because the physician already knew of the plaintiff’s chest pain. Gill, 157 Ill. 2d at 310-11. In Gill, the doctor’s notes supported the assertion of the defendant hospital that the doctor knew of plaintiffs symptoms and yet took no action. Our supreme court noted that the treating physician had repeated contacts with the plaintiff after his complications arose and his condition worsened, yet the doctor still failed to properly diagnose the condition. Gill, 157 Ill. 2d at 310-11. The court therefore concluded that the nurse’s failure to notify the physician could not have proximately caused the delay in plaintiffs treatment. Gill, 157 Ill. 2d at 310-11. In contrast, here, the nurses were the only medical staff in consistent contact with Mrs. Seef. Dr. Sutkus monitored the fetal monitoring strip for a few minutes around 11:45 p.m. and then did not see Mrs. Seef again until three hours later at 3:05 a.m. Unlike the physician in Gill, Dr. Sutkus was not aware of Mrs. Seef’s worsening condition. The only indication that the nurses’ inaction did not contribute to the resulting death of this baby is Dr. Sutkus’ untested assertion that had he been aware of Mrs. Seef s worsening condition he would not have done anything differently. However, if upon notification Dr. Sutkus did not take the appropriate action, the proper standard of care required the nurses to notify a supervisor. The recent case of Suttle v. Lake Forest Hospital, No. 1 — 97—3567 (September 30, 1999), is instructive. In Suttle, the plaintiff filed suit against the defendant hospital for damages allegedly caused by the hospital personnel’s negligent care of her shortly after her birth. The hospital’s obstetrician observed that the plaintiff’s mother had an abnormal placenta. After delivering the plaintiff, the obstetrician sent the placenta to the pathology lab for testing, but did not inform any other hospital personnel of his observations. As a result, when the plaintiff began to experience difficulty in breathing, the hospital pediatricians failed to diagnose her as suffering from hypovolemic shock and failed to properly treat her causing permanent neurological damage. The defendant hospital argued that the plaintiff could not establish proximate cause, because the pediatrician testified that his treatment of the plaintiff would not have differed even if he had been informed of the plaintiffs abnormal placenta. The trial court agreed, and after a jury verdict in favor of the plaintiff, granted the defendant’s motion for a judgment notwithstanding the verdict. Suttle, slip op. at 6-7. The trial court found that plaintiff could establish negligence on the part of the obstetrician, but based on the pediatrician’s testimony that he would have done nothing differently even if the obstetrician had informed him of the abnormal placenta, the court found the plaintiff could not provide the causal link between the obstetrician’s negligence and the injuries. Suttle, slip op. at 6-7. This court reversed the judgment of the trial court, holding that “whether [the defendant’s] treatment of [the plaintiff] would have remained the same had any of the hospital personnel informed him of [the plaintiffs mother’s] condition was a question *** for the jury to determine.” Suttle, slip op. at 13. Like the pediatrician in Suttle, Dr. Sutkus testified his treatment would not have differed even if the nurses had informed him of Mrs. Seef s worsening condition. The court in Suttle addressed the same issue and noted that evidence which shows that negligent delay in diagnosis or treatment lessened the effectiveness of treatment is sufficient to establish proximate cause. Suttle, slip op. at 13. Here, any reasonably qualified obstetrician would have delivered the baby by 2:15 a.m. at the latest to save the baby’s life. Whether Dr. Sutkus’ delay in delivering the baby and treating Mrs. Seef would have occurred had the nurses informed him of Mrs. Seef’s worsening condition was a question of fact for the jury to determine. Suttle, slip op. at 13. I disagree that the testimony of Dr. Sutkus breaks the causal link between the nurses’ deviations and the death of the Seefs’ baby. There is evidence that the nurses’ deviations from the standard of care proximately caused the baby’s death by failure to assign high risk status, improper positioning’ failure to provide oxygen and fluids, failure to notify a supervisor or other physician, and failure to properly run and interpret the fetal monitor. Proximate cause issues are fact specific and uniquely for the jury’s determination. Holton v. Memorial Hospital, 176 Ill. 2d 95, 107 (1997). I would permit the plaintiffs to proceed against Ingalls and allow the jury to resolve these issues. “To the extent a plaintiffs chance of recovery or survival is lessened by the malpractice, he or she should be able to present evidence to a jury that the defendant’s malpractice *** proximately caused the increased risk of harm or lost chance of recovery.” Holton, 176 Ill. 2d at 119.