Jones v. Defendant Internist/Pulmonologist

  • Circuit Court of Cook County (Judge Allen Goldberg)11/14/2012
    Counsel: Sherri M. Arrigo
    Client: Defendant Internist/Pulmonologist
    Outcome: Verdict in Favor of the Defendant

Synopsis:

On November 14, 2012, a Cook County jury returned a verdict in favor of the firm's client, an internist/pulmonologist represented by DBMS.

The plaintiff, age 57, underwent cervical spine surgery at Ingalls Memorial Hospital on February 6, 2008 by a neurosurgeon. The neurosurgeon consulted the defendant, a board certified pulmonologist/ internal medicine physician, when the patient developed pulmonary and blood pressure issues in the recovery room following the surgery. The defendant continued to follow the patient regarding medical issues.

On February 10, the defendant ordered laxative medication and enemas due to lack of any bowel movement since surgery. The nurses documented a bowel movement that evening. On February 11, the patient's abdomen was distended and the defendant ordered an upper GI and KUB x-rays. The x-rays were interpreted by the radiologist as showing non-specific air in a distended colon and small bowel. The defendant ordered more enemas and nurses documented a bowel movement on that date.

On February 12, the defendant ordered a gastroenterology consult and the gastroenterologist saw the patient that day. The gastroenterologist felt the patient had a resolving ileus (decreased colon motility) and recommended continued conservative management and planned a colonoscopy when the patient could tolerate the necessary prep for the procedure. The defendant left town that afternoon for a pre-planned trip after signing out to another internist. Late that night the patient suffered a bowel perforation and underwent emergency surgery resulting in a permanent ileostomy to drain stool from an opening in his abdomen. He was given a 10% chance of surviving but he did recover and was discharged from the hospital to a rehabilitation facility about one month later.

The plaintiffs alleged that the defendant negligently failed to obtain a proper history and physical exam, failed to appreciate the seriousness of the patient's gastrointestinal condition, failed to communicate properly with other physicians involved in the treatment, and failed to diagnose and treat Olgilvie's syndrome (an acute massive distention of the bowel without mechanical obstruction which can result in bowel perforation).

The plaintiffs testified that the defendant never examined or "laid hands on" the patient despite their pleas that he do so. The plaintiffs expert testified that the standard of care required that the defendant place a nasogastric tube, which would have relieved the colon distention and prevented the perforation. The plaintiffs also claimed that the defendant, as the attending physician, remained responsible for the overall care even after consulting the gastroenterologist.

The defense argued that decreased colon motility and constipation are common after surgery, the defendant appropriately monitored the patient and ordered standard interventions after the patient had no bowel movements for 5 days. Further, the defendant appropriately ordered x-rays to evaluate the abdominal distention and requested a gastroenterology consult in a timely manner after standard interventions within the purview of an internal medicine physician did not relieve the problem.

The defense argued that the standard of care did not require a nasogastric tube and a nasogastric tube would not have been effective to reduce colon distention or to prevent the colon perforation. Furthermore, the defense contended that the defendant appropriately relied on and deferred to his gastroenterology consultant regarding management of the abdominal situation.

In closing argument, plaintiffs' counsel asked the jury to award nearly $5 million. After two and one half hours of thoughtful deliberation, the jury returned a verdict for the defendant.