Court Opinion

ID: 9520453
Source: CourtListenerOpinion
Date Created: 2023-08-07 01:40:06.238566+00
Date Added: 2024-06-11T12:46:16.108699
License: Public Domain

JUSTICE LUND, concurring in part and dissenting in part: I concur with the majority opinion as to reversal because of the directed verdict as to count I, the res ipsa loquitur count. I do not agree that the testimony of Dr. Scommengna must be stricken. I do not find that it was based merely on speculation. The record clearly indicates the injury to the plaintiff resulted from the result of a stitch being placed through the adventitia of the left ureter. This happened when the defendant put a stitch in the peritoneum, following the removal of the left fallopian tube and left ovary, which were adherent to the posterior leaf of the left broad ligament. To adequately understand what was being said by the medical experts, we define the terminology used. Peritoneum is defined as follows: “The membrane which lines the inner surface of the abdomen and the pelvis. The pelvis may be regarded as the lowest part of the abdomen. The peritoneum also covers the organs and structures located within the abdomen and the pelvis. To understand the relationship of the parts, it is useful to visualize the interior of the abdomen and pelvis as the interior of a room whose walls, ceiling, and floor are covered or ‘papered’ with a continuous sheet of rubber. The peritoneum corresponding to this rubber sheet is known as the parietal peritoneum. We must conceive now that the various organs of abdomen and pelvis originate outside the peritoneum or rubber sheets, or between the rubber sheet and the wall proper [sic]. As the organ grows in the space between the rubber sheet (peritoneum) and the wall, they push the rubber before them, thus becoming covered or surrounded by the rubber sheet (peritoneum). Where no organ is pushing its way in, the rubber sheet (peritoneum) remains attached to the wall. The peritoneum which covers or surrounds the intruding organs is called visceral peritoneum. Among the organs which thus push their way into the abdomen, or the abdominal cavity (also called peritoneal cavity), are the stomach, the intestine, the liver, the bladder (in the pelvis), etc. In some instances the peritoneum (rubber sheet) closes behind the intruding organ, forming a fold between the organ and the wall. Such a fold of peritoneum is known as a mesentery. Some folds are called ligaments, as the broad ligament.” (2 J. E. Schmidt, Attorneys’ Dictionary of Medicine and Word Finder P—110 (Matthew Bender 1983).) See 2 J. E. Schmidt, Attorneys’ Dictionary of Medicine and Word Finder P—110 (illustration, peritoneum 1) (Matthew Bender 1983). A ureter comes from each of the two kidneys and goes to the bladder. (See 2 J. E. Schmidt, Attorneys’ Dictionary of Medicine and Word Finder Fig. P—61 (illustration) (Matthew Bender 1983).) The ureters are near the fallopian tubes and ovaries. See 2 Attorneys’ Dictionary of Medicine and Word Finder Fig. P—61 (illustration) (Matthew Bender 1983). The adventitia of the ureter is the outermost of the three layers of tissue forming the wall of the ureter. As indicated, the broad ligament is a fold of the peritoneum. In the present case, the left fallopian tube and left ovary had become attached to the broad ligament (peritoneum), and the left ureter was near or attached to the opposite side of the peritoneum. Defendant testified he found the left fallopian tube and ovary adherent to the posterior leaf of the left broad ligament. Plaintiff’s expert, Dr. Zatuchni, testified the operating report did not mention the thickening of the peritoneum and if it was present, it should be noted in the report. He did say adhesions found at the left ovary and fallopian tube could cause the peritoneum to thicken. Defendant’s expert, Dr. Scommengna, stated that the adherence to the broad ligament was probably a result of an inflammatory process. He stated that when there is such adherence, “in general, there is an inflammatory process.” It appears that both doctors find inflammation as a cause of adhesions and a cause of thickening, or lack of pliability, of the peritoneum. Dr. Scommengna indicated that the tube and ovary are usually free, and when they are attached, in general, there is an inflammatory process. He further states the “inflammation does not go toward the tube and ovary. It may go toward the inside, toward the ureter, and if it does that, it makes the tissue less pliable * * * ff Dr. Scommengna testified, within a reasonable degree of medical certainty, that the defendant did not deviate from the necessary standard of care. The medical expert is called for his opinion based on a reasonable degree of medical certainty. The medical expert, using this standard, may give an opinion as to the ultimate issue if the testimony will aid the jury’s understanding. (Perschall v. Metropolitan Life Insurance Co. (1983), 113 Ill. App. 3d 233, 237, 446 N.E.2d 570, 573.) The reasonable degree of medical certainty standard is not an absolute standard but is acceptable because of the complexities of the science of medicine. Assumptions in a hypothetical medical expert opinion are proper as long as they are within the realm of direct or circumstantial evidence, or are reasonable inferences from established facts. Smith v. Perlmutter (1986), 145 Ill. App. 3d 783, 787, 496 N.E.2d 358, 360. Dr. Scommengna used the terms “probable” and “may“ which, according to plaintiff, makes his testimony concerning the pliability and thickness of the peritoneum mere speculation. I do not agree. We must remember that some doctors who testify as witnesses are not legal experts. They know that their testimony necessarily lacks exactness because of the uncertainties resulting from the complexities of the human body. They should not be discredited for their failure to use the words required by legal niceties if their overall meaning is within the legal boundaries. Dr. Scommengna stated adherence was generally caused by inflammation, and inflammation causes thickness or lack of pliability in the peritoneum. The plaintiff’s expert agrees with this. Viewing Dr. Scommengna’s testimony most favorable to the defendant, he is saying, considering all of the facts known to him, it is his opinion, based upon a reasonable degree of medical certainty, the injury resulted from the condition of the peritoneum. Regardless of the surgery reports, the opinion is within the realm of the direct and circumstantial evidence. In addition, there are reasonable inferences from the established facts which justify his opinion. The left fallopian tube and ovary were adherent to the peritoneum. Inflammation is the general cause of this condition, and inflammation causes thickness and lack of pliability. The plaintiff required the surgery because of medical problems which would infer inflammation. The ureter is usually free of the peritoneum unless the peritoneum has been affected by inflammation. The result of the surgery, with the placement of the stitch, can be considered. All of these facts justify the trial judge’s ruling allowing Dr. Scommengna’s opinion to stand. The facts brought out on cross-examination of Dr. Scommengna go to the weight of the testimony not to its admissibility. I would affirm the judgment for the defendant as to count II.