Bugno v. Mt. Sinai Hospital Medical Center

559 N.E.2d 1, 201 Ill. App. 3d 245, 147 Ill. Dec. 1, 1990 Ill. App. LEXIS 673
CourtAppellate Court of Illinois
DecidedMay 14, 1990
Docket1-88-3406
StatusPublished
Cited by5 cases

This text of 559 N.E.2d 1 (Bugno v. Mt. Sinai Hospital Medical Center) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bugno v. Mt. Sinai Hospital Medical Center, 559 N.E.2d 1, 201 Ill. App. 3d 245, 147 Ill. Dec. 1, 1990 Ill. App. LEXIS 673 (Ill. Ct. App. 1990).

Opinion

PRESIDING JUSTICE BUCKLEY

delivered the opinion of the court:

Stanley and Elaine Bugno (plaintiffs) brought a medical malpractice action against Mt. Sinai Hospital Medical Center (Mt. Sinai) and Dr. Prahled Pyati for injuries sustained by Stanley as a result of Mt. Sinai’s and Dr. Pyati’s negligent treatment of his leg fracture. Prior to trial, Dr. Pyati settled plaintiffs’ claims for $375,000. Following a jury trial, the jury returned a verdict against Mt. Sinai and awarded plaintiffs $3,500,000 in damages. The judgment was thereafter reduced to $3,084,035.38 by the $375,000 settlement amount tendered to plaintiffs by Dr. Pyati and by the additional sum of $40,964.62, pursuant to the Code of Civil Procedure (Ill. Rev. Stat. 1987, ch. 110, par. 2 — 1205), which represented 50% of the unreimbursed medical, hospital and lost-time benefits paid to plaintiffs by others. Mt. Sinai appeals from this judgment and seeks a new trial. Mt. Sinai presents the following issues on appeal: (1) whether the trial court erred in admitting an exhibit as demonstrative evidence; (2) whether the trial court erred in explaining the plaintiffs’ burden of proof to the jury; (3) whether Mt. Sinai was denied a fair trial where the trial court limited a witness’ testimony; and (4) whether the trial court erred in its instructions to the jury. We affirm.

On October 2, 1980, Stanley was treated at Mt. Sinai for a fractured left ankle. Because Stanley’s ankle was swollen, a molded “temporary cast,” which did not completely encircle the leg was applied to the ankle. The exposed portion of the leg was wrapped in an “Ace” bandage. At the emergency room doctor’s request, Stanley returned to Mt. Sinai on October 6, 1980, at which time he was examined by Dr. Pyati, an orthopedic surgeon, and Dr. Brian Wood. Dr. Pyati ordered that Stanley remain in the “temporary cast” because his ankle was still swollen and that he return to Mt. Sinai’s Cast Clinic on October 10, 1980. On October 10, 1980, Stanley returned to Mt. Sinai, at which time Dr. Pyati ordered that a short walking cast be applied to Stanley’s lower left leg and that he return to the hospital in four weeks.

Stanley returned to Mt. Sinai on October 17, 1980, complaining that he suffered discomfort in his left leg and foot and that the heel of his cast had “crumbled.” Casting room technician Luis Leonardo trimmed Stanley’s cast at the top near his calf, at the bottom near his toes, and repaired the cast’s crumbled heel.

After continued discomfort in his left leg and foot, Stanley telephoned Dr. Pyati on October 20, 1980. Dr. Pyati requested that Stanley return to Mt. Sinai’s Cast Clinic on its next business day, October 22, 1980. After examining Stanley’s leg on October 22, Doctors Pyati and Wood diagnosed Stanley as suffering from deep vein thrombosis (DVT), a blood clotting condition in his left calf directly underneath the cast. Stanley was subsequently admitted to Mt. Sinai, and his cast was removed. To avoid blood clotting, Dr. Pyati prescribed Heparin, an anticoagulant, and ordered a venogram test, which evidenced no blood clots. On November 1, 1980, Stanley suffered a stroke.

At trial, plaintiffs adduced the following additional evidence. Dr. Virginia Ambrosini, an internal medicine specialist, and Stanley’s attending physician at Mt. Sinai, testified that a stroke occurs when an individual’s artificial blood supply to the brain becomes occluded and that Stanley’s treatment rested upon whether his stroke was thrombotic or embolic. A thrombotic stroke occurs when an individual has an arteriosclerotic growth causing a blockage in one of the branches of the left cartoid artery which leads to the brain. No evidence of arteriosclerosis was noted by Dr. Ambrosini from the results of Stanley’s brain flow study performed in November 1980. An embolic stroke occurs when a piece of foreign material, usually a blood clot, “let[s] loose” from somewhere in the body and lodges in a vessel blocking the flow of blood to the brain. Dr. Ambrosini opined that the clot which caused Stanley’s stroke was a paradoxical embolus which originated in Stanley’s left leg and traveled from the venous system through a patent foramen ovale 1 in Stanley’s heart into the arterial left cartoid circulation system and then to the brain.

The testimony of Dr. Norman Kohn, Stanley’s treating neurologist at Mt. Sinai, Dr. David Lubell, Stanley’s treating cardiologist at Mt. Sinai, Dr. Donald Miller, an orthopedic surgeon and plaintiffs’ expert witness, and Dr. Pyati concurred with the above testimony.

Dr. Muhammad M. Ilahi, a neurologist and Stanley’s treating physician, testified that when he performed an ultrasound test on the major arteries of Stanley’s neck in 1986 to determine whether Stanley suffered from an arteriosclerotic condition, or plaque in the arteries, the ultrasound disclosed no arteriosclerosis. He further testified that arteriosclerosis is a progressive disease and that Stanley could not have suffered from the disease in 1980 since there was no evidence of arteriosclerosis in 1986.

Dr. Kohn’s testimony was substantially similar to the testimony given above by Dr. Ilahi.

Dr. James Talano, a cardiologist at Northwestern Memorial Hospital in Chicago, testified that in his expert opinion Stanley did not suffer from cerebral arteriosclerosis, cartoid arteriosclerosis, clots in the heart, or abnormalities in the mitral and aortic valves. He further testified that no pathology or abnormality of the left heart, the left chambers, the aorta or great vessels existed. Dr. Talano opined that the cause of Stanley’s stroke resulted from a “clot that originated in [Stanley’s] leg that paradoxically went across the septum.”

Regarding the cause of the blood clot, Dr. Miller testified that the tightness of Stanley’s cast caused the DVT. Dr. Miller further testified that Stanley had a simple noncomminuted fracture in his left lateral malleolus and that a cast should not place pressure on the blood vessels in an extremity.

Dr. Miller also testified that Dr. Pyati’s and Leonardo’s conduct was below the applicable standard of care because they failed to remove Stanley’s cast after repeated complaints by Stanley of discomfort, swelling and discoloration. Dr. Miller opined that had the cast been removed, Stanley’s stroke would not have occurred.

In order to illustrate the manner in which the cast appeared on October 10, October 12, and October 17, 1980, before and after it was trimmed and repaired, plaintiffs were allowed to utilize as demonstrative evidence group exhibit No. 1, which consisted of exhibits 1A, IB and 1C. Group exhibit No. 1 consisted of a large, poster-size drawing of the lower portion of a leg with overlays depicting different variations of the manner in which the cast and Stanley’s leg appeared over a period of time. Different colors were used to depict swelling and discoloration of Stanley’s leg. The drawings were prepared by a medical artist based upon descriptions given him by Stanley and Elaine Bugno, Mary Ann Bugno, Richard Zolna, and Bernadette and Joseph Jarosz. Zolna and the Jaroszes attended a party with Stanley on October 12, 1980, and were therefore familiar with the condition of his leg. Exhibit 1A depicted discoloration and swelling subsequent to the cast’s application on October 10, 1980.

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Bluebook (online)
559 N.E.2d 1, 201 Ill. App. 3d 245, 147 Ill. Dec. 1, 1990 Ill. App. LEXIS 673, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bugno-v-mt-sinai-hospital-medical-center-illappct-1990.