Beard v. Barron

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Beard v. Barron

State: Illinois

Court: 1st District Appellate

Docket No: 1-05-1006 Rel

Case Date: 01/22/2008

Preview:FIRST DIVISION January 22, 2008

No. 1-05-1006 DEVONNA BEARD, Special Administrator of the Estate of Vernestine Hudgins Deceased, ) Appeal from the ) Circuit Court of ) Cook County. ) Plaintiff-Appellant, ) ) v. ) ) JOHN T. BARRON and RUSH) PRESBYTERIAN-ST. LUKE'S MEDICAL CENTER, ) No. 01 L 014065 ) Defendants-Appellees ) ) ) (Hesham Hassaballa, ) The Honorable ) Deborah Mary Dooling, Defendant). ) Judge Presiding. JUSTICE GARCIA delivered the opinion of the court. On November 4, 1999, Vernestine Hudgins died of renal failure associated with Stevens-Johnson syndrome, a painful condition where large blisters form on the skin caused by a hypersensitive reaction to medication. Her daughter, the

plaintiff Devonna Beard, filed suit against Hudgins's cardiologist, Dr. John T. Barron, and Rush-Presbyterian-St. Luke's Medical Center (Rush)1 through its agents, Dr. Hesham
1

Rush-Presbyterian-St. Luke's Medical Center is now known

1-05-1006 Hassaballa and Dr. Barron, alleging medical negligence. The

plaintiff's theory was that Drs. Barron and Hassaballa failed to timely detect a bleed in Hudgins's brain, a subdural hematoma, that caused Hudgins to fall into a state of constant seizures, status epilepticus, that in turn required the administration of Dilantin, an antiseizure medication. According to the plaintiff,

Dilantin caused Hudgins's Stevens-Johnson syndrome, which eventually led to renal failure, causing her death. returned a verdict in favor of the defendants. The plaintiff contends on appeal that the circuit court committed three reversible errors: (1) the trial court misapplied the Dead-Man's Act (735 ILCS 5/8-201 (West 2004)) when it reserved ruling on the plaintiff's motion in limine seeking to bar Dr. Barron from testifying about claimed conversations he had with Hudgins regarding prior headaches; (2) the trial court overruled the plaintiff's objection to the defendants' crossexamination of Dr. William Greenlee as beyond the scope of direct examination; and (3) the trial court refused to give instructions pursuant to Illinois Pattern Jury Instructions, Civil, Nos. 30.21 (aggravation of preexisting condition) and 30.23 (injury from subsequent treatment) (2005). The plaintiff argues that the The jury

as Rush University Medical Center. 2

1-05-1006 errors could have affected the jury's verdict. BACKGROUND In early July of 1999, Vernestine Hudgins was an active 65year-old woman. She enjoyed cooking for her several adult We affirm.

children, attending church outings, shopping, and traveling. Hudgins also suffered from numerous cardiac conditions, some of which required that she be hospitalized several times a year. Hudgins had congestive heart failure and severe pulmonary hypertension, both of which were progressing. She also had

massive edema (swelling in her legs and abdomen), and fluid on her lungs. Hudgins had an irregular heartbeat attributed to She was taking several medications,

atrial fibrillation.

including the diuretics Lasix and Zaraxolyn, and blood pressure medications, including Digoxin and Lisinopril. Hudgins also had been receiving anticoagulation therapy (blood thinners) since 1983, when the mitral valve of her heart was replaced with a mechanical one. Because blood can clot

around mechanical valves, Hudgins took blood thinners to help reduce her chances of a stroke. In July 1999, her life

expectancy was three to five years. On July 6, 1999, Hudgins was admitted to Rush for a scheduled cardiac catheterization procedure to evaluate her aortic valve that had started leaking. 3 Rush, a teaching

1-05-1006 hospital, uses an approach where a supervising doctor, the attending physician, oversees fellows, residents, and interns. The attending physician during Hudgins's July 6 admission was Dr. Barron, a cardiologist who had been Hudgins's physician since 1988. Hudgins was also treated by Dr. Ajay Baddi, a cardiac

fellow, and Dr. Hassaballa, an intern. Because the cardiac procedure involved inserting a catheter into the artery near her groin, the anticoagulation therapy had to be halted before the procedure was performed. At the time of

her admission, Hudgins was taking the blood thinner Coumadin, which remained active in her system for several days. to ensure that Hudgins's blood remained adequately anticoagulated, Coumadin was stopped and Heparin, a blood thinner that would remain in Hudgins's system for only a few hours, was introduced. The idea was that Heparin would be stopped a few In order

hours before the cardiac catheterization procedure began and restarted once the procedure was over. transition back to Coumadin. Hudgins also received a drug called Norvasc, used to treat high blood pressure. Hudgins's cardiac catheterization procedure was performed on July 9, 1999. She remained at Rush for several days thereafter Hudgins would later

while doctors adjusted her blood thinners to a therapeutic level. 4

1-05-1006 On July 10, Dr. Baddi performed a brief neurological exam that was normal and reported in Hudgins's chart that she had no new complaints. 11 and 12. On July 12, 1999, Hudgins suffered a nosebleed and a headache. On July 13, she had another nosebleed and headache. On the Dr. Baddi made similar entries in her chart for July

She was given Tylenol and a medication called Ultram.

evening of July 13, Hudgins declined further pain medication, but requested an ice pack for her headache. On July 14, 1999, Hudgins vomited twice. was given the drug Compazine. As a result, she

She also experienced a 47-point

drop in her systolic blood pressure and a 23-point drop in her diastolic blood pressure. A nurse's note entered at 4:40 p.m.

indicated that Hudgins denied any complaints, was oriented to person, place, and time, opened her eyes to sound, had clear and appropriate speech, and obeyed commands. On July 17, 1999, Hudgins's headache returned. Dr. Barron stopped the medication Norvasc. As a result,

Hudgins did not

report a headache for the rest of the day on July 17 or on July 18 or 19. Although her blood-thinning levels were not quite where Dr. Barron wanted them to be, Hudgins was discharged from Rush on July 19, 1999. Prior to being discharged, she was instructed on 5

1-05-1006 giving herself an injection of a fast-acting anticoagulant called Lovenox. She was also placed back on Coumadin. According to

members of Hudgins's family, she complained of a headache and appeared groggy upon discharge. Hudgins was taken to the emergency room (ER) at Rush on the morning of July 20, 1999, because her groin wound from the cardiac catheterization procedure began bleeding. Dr. Barron met Hudgins was

Hudgins in the ER and applied pressure to the wound.

readmitted so an ultrasound could be performed on the groin area to detect whether she had a pseudoaneurysm. stopped. restarted. Coumadin was briefly

Once the ultrasound came back negative, Coumadin was Hudgins was seen by Dr. Hassaballa, who noted that

Hudgins was not experiencing any chest pain, dizziness, or double vision, but that she was "[p]ositive for headache started in house on last admission." She was again given Ultram.

On the morning of July 21, 1999, while still at Rush, Hudgins continued to report a headache, was nauseated, and vomited twice. At 7:20 a.m., Dr. Hassaballa ordered Compazine to When Hudgins was discharged

relieve the nausea and vomiting.

from Rush at 5 p.m. on July 21, she had a "mild" headache and was drowsy. Hudgins declined Tylenol for her headache. Her

drowsiness was attributed to Compazine. Hudgins returned home, where she continued to experience a 6

1-05-1006 headache. In the early morning of July 23, 1999, one of

Hudgins's daughters called 911 because she began turning her head from side to side and appeared groggy. When the paramedics

arrived, Hudgins's eyes were rolled back, indicative of a seizure. She was taken to Westlake Hospital (Westlake), where a

computed tomography (CT) scan was performed upon her admission. The CT scan showed a subdural hematoma and indicated she was in status epilepticus. Additional CT scans were performed during

her hospitalization at Westlake. Doctors at Westlake treated Hudgins intravenously with Dilantin, used to control seizures. She remained in status On July

epilepticus for about four days and fell into a coma.

28, 1999, Hudgins was transferred to Rush, where Dilantin was continued. Hudgins's seizures eventually stopped, allowing her However, the seizures soon

to be sent to rehabilitation. returned.

In early September, Hudgins developed a rash that soon

turned into open, oozing sores on her back, buttocks and thighs. The sores, about the size of apples, would fill with fluid and burst. It was evident to Hudgins's children, who frequently Hudgins's daughters took turns

visited, that she was in pain.

staying with her through the night. It was determined that Hudgins had developed Stevens-Johnson syndrome. She also developed pneumonia and her kidneys began to 7

1-05-1006 fail. Hudgins died on November 4, 1999, at the age of 66.

The plaintiff filed suit against Dr. Barron, Dr. Hassaballa, and Rush,2 alleging medical malpractice. Dr. Hassaballa was

later dropped as an individually named defendant. A jury trial commenced on September 23, 2004. The

plaintiff's theory was that the standard of care required the defendants to order a neurological consult of Hudgins on July 17, 1999, as well as a CT scan by July 20 or 21. According to the

plaintiff, Hudgins's nausea, nosebleeds and headaches, combined with her anticoagulation therapy, should have placed the doctors on notice that she was experiencing bleeding in her brain. According to the plaintiff, if the bleeding had been detected prior to status epilepticus setting in, it could have been controlled without the administration of Dilantin, which she contended, caused the Stevens-Johnson syndrome. The plaintiff's

experts opined at trial that had the subdural hematoma been treated before the seizures developed, the subsequent complications would not have arisen and Hudgins would not have died when she did. As her initial witness, the plaintiff called Dr. Barron to

2

The plaintiff's original complaint named other defendants

not relevant to this appeal. 8

1-05-1006 testify as an adverse witness. The medical charts of Hudgins's To

July 6, 1999, admission were also admitted into evidence.

support her theory that Hudgins's brain was bleeding while she was still at Rush, the plaintiff presented expert testimony from Dr. Mary Edwards-Brown, a neuroradiologist and professor of radiology at Indiana University. Dr. Edwards-Brown reviewed

several images of Hudgins's brain, including CT scans taken on July 23 and July 28, 1999, at Westlake and a magnetic resonance imaging (MRI) scan taken at Rush on July 29. It was Dr. Edwards-

Brown's opinion that, within a reasonable degree of medical certainty, Hudgins's hematoma was in the early subacute phase, meaning the majority of the bleeding occurred within two days to a week before the July 29 MRI. However, the images also Dr. Edwards-Brown

indicated the bleeding had occurred over time.

concluded that some of the hematoma was in the late subacute phase, meaning it occurred as much as two months prior to the MRI. Because Hudgins's clinical history indicated she was on

anticoagulants, experienced bleeding from her nose and groin wound, and suffered headaches, Dr. Edwards-Brown opined the bleeding likely began when Hudgins reported her first headache on July 12. The plaintiff also presented the jury with the videotaped deposition of Dr. William Greenlee, a neuroradiologist. 9 Dr.

1-05-1006 Greenlee testified that the July 29, 1999, MRI taken at Rush indicated Hudgins's bleed occurred several days to several weeks prior to the scan. On cross-examination, Dr. Greenlee testified

that when looking at the July 29, 1999, MRI and a July 28, 1999, CT scan together, his opinion was that the age of the bleed was in the "several days to a week period." Dr. Robert Heller, a board-certified internist from Los Angeles, and Dr. Omkar Markand, the Professor Emeritus in the neurology department at Indiana University, also testified as experts on behalf of the plaintiff. Both doctors based their

opinions, in part, on the records of Hudgins's 1999 admissions to Rush and Westlake. Dr. Markand testified that the standard of care required Dr. Barron to do more than just take Hudgins off Norvasc on July 17, 1999. Because Hudgins had experienced nosebleeds, headaches,

nausea, and vomiting, Dr. Barron should have requested a neurological consult and probably should have obtained a CT scan of Hudgins's head. Dr. Markand testified that because Hudgins's

symptoms were present during her July 20, 1999, admission to Rush, the standard of care required both a neurological consult and a CT scan on July 20 and no later than the morning of July 21. Dr. Markand also testified that Hudgins developed StevensIn his opinion, had

Johnson syndrome from receiving Dilantin. 10

1-05-1006 Hudgins's subdural hematoma been detected by July 21 and immediately treated, she would not have developed status epilepticus, would not have required Dilantin, and would not have developed Stevens-Johnson syndrome. It was Dr. Heller's opinion that Dr. Barron's treatment fell below the standard of care because he ignored Hudgins's symptoms of headache, nausea and vomiting, and did not properly evaluate those symptoms in light of her anticoagulation therapy by ordering a neurological consult or a CT scan of her head. Dr.

Heller also opined that Dr. Hassaballa's treatment fell below the standard of care because he failed to properly report Hudgins's symptoms of intracranial bleeding to Dr. Barron, his attending physician, and failed to properly evaluate Hudgins with either a neurological consult or a CT scan. The defendants presented expert testimony from Dr. Albert Ehle, a neurologist and professor of neurology at the University of Chicago, Dr. Joel Meyer, a neuroradiologist with Evanston Northwestern Health Care, and Dr. Dan Fintel, a cardiologist at Northwestern. defense. According to Dr. Meyer, the July 23, 1999, CT scan of Hudgins's brain indicated the hematoma was acute, meaning it had occurred within hours or up to one or two days prior to the scan. 11 Drs. Barron and Hassaballa also testified for the

1-05-1006 Dr. Hassaballa and Dr. Barron each testified that his respective care of Hudgins met the applicable standard of care. Dr. Barron testified that Hudgins's nosebleeds and headaches were not significant because she had experienced them before. He also

testified that because Compazine resolved Hudgins's vomiting, this was "strong evidence" that the vomiting was not "cephal in origin." Dr. Ehle testified that the standard of care did not require either a neurological consult or a CT scan on July 17, 1999, when Norvasc was discontinued. In his opinion, there was

"no evidence" that the plaintiff had the kind of "persistent, progressive headaches" that are symptomatic of a subdural bleed during her first admission to Rush. Dr. Ehle also testified that

the standard of care did not require either a neurological consult or a CT scan during Hudgins's second admission to Rush. Dr. Ehle also found it "significant" that Hudgins was "well-known to the service [provider]" and accordingly her doctors, including Drs. Barron and Hassaballa, would be "sensitive to any subtle changes in her behavior that could have been an indication of something going on." According to Dr. Ehle, the Stevens-Johnson

syndrome could have been caused by antibiotics Hudgins received, as well as by Dilantin. Dr. Fintel testified that in his opinion, the standard of 12

1-05-1006 care did not require either a neurological consult or a CT scan during Hudgins's first or second admission to Rush. According to

Dr. Fintel, clinical signs of a subdural hematoma include a persistent change in mental status, the inability to follow commands, clumsiness, neurological abnormalities, and severe persistent headaches that do not respond to drugs and intensify over time. According to Dr. Fintel, Hudgins did not experience Dr. Fintel also testified

any of these symptoms while at Rush.

that the complications Hudgins experienced following the subdural bleed were "inevitable and unavoidable" as well as "not predictable." The jury returned a verdict in favor of the defendants, and the circuit court entered judgment on the verdict. The

plaintiff's posttrial motion was denied, and this timely appeal followed. ANALYSIS I. Dead-Man's Act

In keeping with her theory that Dr. Barron and Dr. Hassaballa failed to recognize Hudgins's headaches as symptomatic of a bleed in her brain, the plaintiff filed two motions in limine seeking to prevent Dr. Barron from testifying that Hudgins had experienced headaches in the past. It was the plaintiff's

theory that such testimony would violate the Dead-Man's Act (the 13

1-05-1006 Act) (735 ILCS 5/8-201 (West 2004)). The trial court ruled it

was required to first determine under Hoem v. Zia, 159 Ill. 2d 193, 636 N.E.2d 479 (1994), whether the plaintiff's experts would "open the door" to any prior conversations or events between Dr. Barron and Hudgins before deciding whether any prior conversations were admissible. The court stood by its ruling

even after being informed Dr. Barron would be the first witness to testify. Although the plaintiff contends otherwise, the issue in this case turns on the nature of the evidence presented regarding any prior conversations between Hudgins and Dr. Barron. It is

therefore an evidentiary issue, not an issue of statutory construction. Accordingly, we review the trial court's ruling In re Estate of Hoover, 155 Ill. 2d

for an abuse of discretion.

402, 420, 615 N.E.2d 736 (1993). The Dead-Man's Act provides, in relevant part: "In the trial of any action in which any party sues or defends as the representative of a deceased person ***, no adverse party or person directly interested in the action shall be allowed to testify on his or her own behalf to any conversation with the deceased *** or to any event which took place in the 14

1-05-1006 presence of the deceased ***, except in the following circumstances: (a) If any person testifies on behalf of the representative to any conversation with the deceased *** or to any event which took place in the presence of the deceased ***, any adverse party or interested person, if otherwise competent, may testify concerning the same conversation or event." 5/8-201(a) (West 2004). Our supreme court has explained that the Act serves two purposes: (1) protecting decedents' estates from fraudulent claims; and (2) equalizing the position of the parties in regard to the giving of testimony. Gunn v. Sobucki, 216 Ill. 2d 602, 735 ILCS

609, 837 N.E.2d 865 (2005), citing Hoem, 159 Ill. 2d at 201; see also M. Graham, Cleary & Graham's Handbook of Illinois Evidence

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