Hilgenberg v. Kazan

711 N.E.2d 1160, 305 Ill. App. 3d 197, 238 Ill. Dec. 499
CourtAppellate Court of Illinois
DecidedMay 10, 1999
Docket1-97-2912
StatusPublished
Cited by29 cases

This text of 711 N.E.2d 1160 (Hilgenberg v. Kazan) 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
Hilgenberg v. Kazan, 711 N.E.2d 1160, 305 Ill. App. 3d 197, 238 Ill. Dec. 499 (Ill. Ct. App. 1999).

Opinion

JUSTICE GALLAGHER

delivered the opinion of the court:

This is a professional negligence action brought by John Hilgenberg and his wife, Joyce Hilgenberg (plaintiffs), against Robert Kazan M.D.; West Suburban Neurosurgical Associates, S.C.; John Garino, M.D.; George Katele, M.D.; and Suburban Anesthesiologists, S.C. West Suburban Neurosurgical Associates, S.C., is the professional corporation of Dr. Kazan, the neurosurgeon who performed John Hilgenberg’s (plaintiffs) surgery. Suburban Anesthesiologists, S.C., is the professional corporation of Drs. Garino and Katele, the anesthesiologists for plaintiffs surgery.

Plaintiff underwent cervical spine surgery (posterior hemilaminectomy) for a herniated intervertebral disk on October 31, 1991. Following the surgery, defendants became aware that plaintiff suffered a spinal cord injury—infarction, “central cord syndrome” or stroke. On November 26, 1996, the jury returned a verdict in favor of all defendants. Plaintiffs timely filed a posttrial motion that was denied on July 18, 1997. This appeal was timely filed against all defendants, but both issues raised by plaintiffs involve defendant Kazan’s defense and not defendants Garino and Katele. We affirm.

At the time of the surgery, plaintiff was a 38-year-old male who had been an insulin-dependent diabetic since early adulthood. He underwent cervical spine surgery (posterior hemilaminectomy) for a herniated intervertebral disk which was performed by Robert Kazan (defendant Kazan), M.D., a neurosurgeon. Anesthesia was administered by John Garino, M.D., and George Katele, M.D. Preoperatively, plaintiff enjoyed normal spinal cord function. The cervical spine surgery was considered low risk and full recovery was anticipated.

During the surgery, plaintiff suffered a vascular insufficiency which caused a discrete part of his spinal cord to die at the level of surgery. Anatomically the damaged spinal cord consisted of two columnar-shaped areas of dead tissue located in the center portion of the "butterfly" -shaped gray matter of the spinal cord, slightly toward the front, one column on each side of the midline. The remainder of the butterfly-shaped spinal cord gray matter, together with the white matter located toward the periphery of the spinal cord, was completely unaffected. Each column of destroyed spinal cord tissue measured approximately 3.8 centimeters (1.5 inches) in length and 2 to 3 millimeters in width. These two dead areas of anterior spinal cord gray matter extended from the level of the fifth to the seventh cervical vertebrae, with the site of surgery, therefore, near the center of the length of each column.

Plaintiffs contended at trial that during the 1991 surgery, defendant Kazan negligently overmanipulated the spinal cord in a direct, mechanical fashion. Plaintiffs argued that the direct spinal cord manipulation by defendant Kazan, combined with a second factor, low intra-operative blood pressure in the patient, proximately caused the spinal cord damage in the plaintiff. Alternatively, plaintiffs argued the theory of res ipsa loquitur. It was undisputed at trial that spinal cord infarction had occurred and that the spinal cord infarction had resulted in severe motor deficits and muscle wasting in both of plaintiff’s hands and forearms.

The defense theorized that plaintiffs insulin-dependent diabetes had put him at high-risk for the development of the spinal cord injury which he in fact suffered. To that end, defendants argued that it was plaintiff’s diabetes, rather than the negligence of the defendants, which offered the best explanation for his damages.

Dr. Charles D’Angelo, an expert witness for defendant Kazan, is a board-certified neurosurgeon at Rush-Presbyterian-St. Luke’s Medical Center. During his career, Dr. D’Angelo has performed between 500 and 1,000 cervical disk surgeries. Dr. D’Angelo’s opinions in this case were based in part on his review of plaintiffs medical records. Dr. D’Angelo testified that defendant Kazan did not strike or retract the spinal cord during the surgery. Based on a myelogram and CT scans done before surgery, Dr. D’Angelo concluded that defendant Kazan had ample room to remove the disk without any increased risk to the spinal cord. He also found no indication from either the operative report or the anesthesia report that defendant Kazan had retracted the spinal cord during surgery. Dr. D’Angelo testified that whenever the spinal cord is struck, there is always a characteristic and dramatic rise in the patient’s blood pressure. Dr. D’Angelo reviewed plaintiffs anesthesia record and noted that nowhere on the record was there a dramatic rise in plaintiffs blood pressure. Based on the absence of a rise in blood pressure on plaintiffs anesthesia record, Dr. D’Angelo concluded that defendant Kazan had not struck or retracted the spinal cord.

Dr. D’Angelo also reviewed plaintiffs postoperative MRI scans and testified that it was impossible for defendant Kazan to have injured the spinal cord in the manner plaintiffs alleged. Dr. D’Angelo observed that there was no blood nor any bone chips or fragments of disk in the area of the surgery. In fact, nothing had been disrupted in the area of the surgery that would even hint that the surgery caused an injury to the spinal cord.

Dr. D’Angelo also testified regarding plaintiffs’ res ipsa loquitur allegation, stating that “the problem that [plaintiff] suffered can happen definitely in the absence of negligence and has happened to others, including myself, without any evidence of negligence.” Dr. D’Angelo based his opinion in part on a couple of his patients who suffered similar injuries after surgery.

The 60-day rule of Supreme Court Rule 218(c), requiring completion of discovery 60 days prior to trial, was waived by all parties on April 2, 1996. 166 Ill. 2d R. 218(c). On August 8, 1996, plaintiffs’ counsel received defendant Kazan’s Rule 213 answers identifying Dr. Ducker as a retained opinion witness and disclosing his opinions. 166 Ill. 2d R. 213. Dr. Ducker, a neurosurgeon, entered neurosurgical training in 1965 and was board certified in 1971. At the time of the trial, he practiced and taught at Johns Hopkins University in Baltimore, Maryland. Dr. Ducker has extensive experience in posterior laminectomies, the surgery defendant Kazan performed on plaintiff. Dr. Ducker performs between 15 and 20 posterior laminectomies per year.

The only proximate cause opinion disclosed by Dr. Ducker under Rule 213 was that the conduct of defendant Kazan had not proximately caused plaintiffs damages. On August 13, 1996, prior to Dr. Ducker’s deposition, plaintiffs filed their motion to bar Dr. Ducker from testifying to any affirmative proximate cause opinions at deposition or trial based on defendant Kazan’s Rule 213 disclosure. However, before the motion was heard, defendant Kazan updated Dr. Ducker’s opinions pursuant to Rule 213 disclosing specific and affirmative proximate cause opinions. The update also indicated that Dr. Ducker would base his opinions on the article he co-authored entitled, “Posterior Cervical Laminoforaminotomy for Radiculopathy: Review of 172 Cases,” which appeared in the medical journal, Neurosurgery, Vol. 33, No. 3, September 1993.

This article constituted a review of Dr. Ducker’s experience with posterior hemilaminectomies, which at that time amounted to over 170 cases. Notably, Dr.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Lu v. Stocking
2020 IL App (3d) 190213-U (Appellate Court of Illinois, 2020)
Watson v. West Suburban Medical Center
2018 IL App (1st) 162707 (Appellate Court of Illinois, 2018)
Davis v. The City of Chicago
2014 IL App (1st) 122427 (Appellate Court of Illinois, 2014)
Lovell v. Sarah Bush Lincoln Health Center
931 N.E.2d 246 (Appellate Court of Illinois, 2010)
Petraski v. Thedos
Appellate Court of Illinois, 2008
Sobczak v. General Motors Corp.
Appellate Court of Illinois, 2007
Dowd and Dowd, Ltd. v. Gleason
816 N.E.2d 754 (Appellate Court of Illinois, 2004)
Dowd & Dowd, Ltd. v. Gleason
Appellate Court of Illinois, 2004
Youle v. Ryan
811 N.E.2d 1281 (Appellate Court of Illinois, 2004)
Cress v. Recreation Services, Inc.
795 N.E.2d 817 (Appellate Court of Illinois, 2003)
Smith v. Silver Cross Hospital
Appellate Court of Illinois, 2003
Nassar v. County of Cook
775 N.E.2d 154 (Appellate Court of Illinois, 2002)
Petre v. Kucich
Appellate Court of Illinois, 2002
Tsoukas v. Lapid
733 N.E.2d 823 (Appellate Court of Illinois, 2000)
People v. M.I.
722 N.E.2d 779 (Appellate Court of Illinois, 1999)
People v. Drum
718 N.E.2d 302 (Appellate Court of Illinois, 1999)

Cite This Page — Counsel Stack

Bluebook (online)
711 N.E.2d 1160, 305 Ill. App. 3d 197, 238 Ill. Dec. 499, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hilgenberg-v-kazan-illappct-1999.