Carter v. Johnson

617 N.E.2d 260, 247 Ill. App. 3d 291, 187 Ill. Dec. 52, 1993 Ill. App. LEXIS 698
CourtAppellate Court of Illinois
DecidedMay 18, 1993
Docket1-91-1355
StatusPublished
Cited by12 cases

This text of 617 N.E.2d 260 (Carter v. Johnson) 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
Carter v. Johnson, 617 N.E.2d 260, 247 Ill. App. 3d 291, 187 Ill. Dec. 52, 1993 Ill. App. LEXIS 698 (Ill. Ct. App. 1993).

Opinion

JUSTICE SCARIANO

delivered the opinion of the court;

On September 23, 1978, plaintiff Anna Carter consulted defendant Walter Johnson, M.D., regarding abnormal menstrual bleeding accompanied by abdominal pain which she had been experiencing for some time. After examination, defendant diagnosed her as suffering from a degenerating fibroid tumor approximately as large as a three-month pregnancy inside her uterus. Defendant decided that the proper treatment was simply to track the development of the tumor.

Defendant saw plaintiff again in April 1979, and in October 1980, and each time he found that the tumor was still growing. Since defendant was fairly certain that the growth was benign, he determined that surgery was not yet indicated. However, when plaintiff visited defendant on February 4, 1982, he recommended that she have a hysterectomy because the tumor had grown to a size approximating that of a five-month-old fetus.

On February 22, 1982, plaintiff was admitted to the University of Chicago’s Lying-in-Hospital, where defendant had surgical privileges. She was prepared for surgery that night, and the next morning defendant, assisted by a resident, Dr. Mitchell, performed the hysterectomy. Defendant’s post-operative notes indicated that the 1-hour-and-45-minute operation was routine and that no complications had developed.

After plaintiff regained consciousness on the day of the surgery, she was experiencing some pain and running a low-grade fever of 38 degrees celcius (100.4 degrees fahrenheit). Although the fever persisted for the next couple of days, it was not until February 27 that an infection was suspected, and she was given antibiotics in an effort to combat it.

On March 2, defendant left for a planned vacation, leaving plaintiff in the primary care of Dr. Jones, another physician at the hospital. At about 4:30 p.m. that day, a resident noticed a foul-smelling discharge emanating from plaintiff’s vagina. 1 After examination, it was determined that her vagina contained bowel contents which most likely were the cause of her infection and fever. On March 3, a large amount of foul-smelling drainage, which later proved to be bowel contents as well, was also discovered at the incision site. The incision was thus reopened and cleaned with hydrogen peroxide.

It was determined soon thereafter that plaintiff had a fistula (tract) between her rectum and her vagina which was funneling bowel contents out of her rectum and into her vagina. Consequently, a bowel surgeon, A.R. Moosa, M.D., was consulted, and plaintiff was transferred to Billings Memorial Hospital. Dr. Moosa’s prognosis was that surgery was necessary to repair the hole in the bowel wall, but first he had to wait until the wound which had been reopened healed sufficiently. When Dr. Moosa performed the necessary reparative operation on April 12, he discovered that there were two fistulae, one between the rectum and the vagina, and one between the sigmoid colon and the vagina. He repaired the holes, but since the wounds had to be allowed to heal, he preformed a temporary diverting colostomy in order to reroute bowel contents to prevent them from reaching the colon.

Plaintiff was released from the hospital on April 25, 1982, and was readmitted for 11 days in October 1982 to have the colostomy bag removed. Additionally, she was hospitalized on four occasions between July 1982 and December 1989 to clear small bowel obstructions.

On December 2, 1986, plaintiff filed a three-count complaint against defendant, alleging specific negligence in count I, res ipsa loquitur in count II, and failure to obtain informed consent in count III. Plaintiff ultimately dismissed count III of the complaint, and the case went on to be tried before a jury beginning in November 1990.

Defendant testified first for plaintiff as an adverse witness. He admitted that he was the surgeon in charge of the operation and that it was his responsibility throughout the entire procedure. He also admitted that the fistulae and the infections which plaintiff sustained after the surgery were the direct result of the hysterectomy which he performed, and that obviously had the surgery proceeded “smooth as usual,” plaintiff would not have suffered the aftereffects described above.

Defendant reaffirmed what he had noted in the post-operative report, namely, that there were no major complications during the surgery, that he noticed no visible adhesions (scar tissue) during the operation, and that plaintiff tolerated the procedure well. Defendant also stated, however, that there was “an abnormal attachment, possibly due to some previous infection,” between her uterus and her sigmoid colon.

Defendant hypothesized that there were several possibly negligent ways in which the fistulae could have been caused. First, fistulae will form if the tissue wall of the bowel or the sigmoid colon is damaged by the unskilled use of a scalpel, scissors, or clamp, all of which he utilized. He denied, however, that either he or Dr. Mitchell damaged plaintiff’s bowel wall in such a fashion during the surgery. Defendant also opined that a fistula could result if a surgeon placed an errant stitch in the bowel wall, as bowel contents would then run along the thread into the vaginal area, causing the tissue around the thread to become infected and ultimately to collapse, thus causing a larger schism. He denied, however, that he stitched the wall between plaintiff’s rectum and the vagina.

Dr. Moosa, called by plaintiff, testified next through the medium of a videotaped deposition. He stated that plaintiff’s complications, primarily the resulting fistulae, were unquestionably a direct result of her hysterectomy. He further stated that while such complications are rare and that a hysterectomy generally can be performed safely, the organs adjacent to the uterus occasionally can be damaged during surgery without negligent conduct. He testified, however, that it was impossible to determine which of the many possible causes actually occasioned plaintiff’s injuries.

Plaintiff’s expert witness, Julian Ullman, M.D., who is board-certified in obstetrics and gynecology, next took the stand and testified that plaintiff’s fistulae were a direct result of the hysterectomy performed by defendant. He stated that in his opinion, to a reasonable degree of medical certainty, defendant deviated from the applicable standard of care in causing those complications to occur, because fistulae should not result from a routine hysterectomy, which was how the post-operative report characterized the instant procedure. He also testified that there was no evidence in the post-operative notes of adhesions or any other mitigating factors which could have caused defendant any problems during the procedure; in any event, Dr. Ullman opined, a skilled surgeon would instantly see such adhesions and deal with them accordingly. He concluded that the fistulae were possibly caused by the careless use of a clamp, scalpel, scissors, or suture, any of which would be an obvious breach of the standard of care.

David Zbaraz, M.D., a board-certified obstetrician-gynecologist and associate professor at Northwestern University, testified as an expert witness on behalf of defendant.

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Cite This Page — Counsel Stack

Bluebook (online)
617 N.E.2d 260, 247 Ill. App. 3d 291, 187 Ill. Dec. 52, 1993 Ill. App. LEXIS 698, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carter-v-johnson-illappct-1993.