Nassar v. County of Cook

775 N.E.2d 154, 333 Ill. App. 3d 289, 266 Ill. Dec. 592
CourtAppellate Court of Illinois
DecidedAugust 8, 2002
Docket1-00-3602
StatusPublished
Cited by35 cases

This text of 775 N.E.2d 154 (Nassar v. County of Cook) 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
Nassar v. County of Cook, 775 N.E.2d 154, 333 Ill. App. 3d 289, 266 Ill. Dec. 592 (Ill. Ct. App. 2002).

Opinion

JUSTICE HARTMAN

delivered the opinion of the court:

Plaintiffs, Rana Nassar, a minor; Odaie Nassar, a minor; Luaey Nassar, a minor; and Ckusi Nassar, a minor, by their mother and next friend, Wafieh Jamal Nassar; and Wafieh Jamal Nassar, individually (plaintiffs), appeal from a jury verdict in favor of defendant, County of Cook, a body politic, individually, and d/b/a Cook County Hospital, in a retrial of an obstetrical malpractice action. On appeal plaintiffs contend that the circuit court erred in: (1) giving the long-form proximate cause instmction; (2) refusing to give the missing witness instruction; (3) allowing defendant to present statistical evidence regarding other women’s pregnancies; (4) allowing testimony of previously undisclosed opinions in violation of Supreme Court Rule 213 (177 Ill. 2d R. 213 (Rule 213)); and (5) denying plaintiffs’ motion for a new trial based on prejudicial remarks made during opening statements.

In 1990 Wafieh Nassar became pregnant with quadruplets. On March 18, 1991, during the twenty-second week of her pregnancy, Wafieh presented at Cook County Hospital complaining of symptoms consistent with preterm labor. She was hospitalized and remained there until her babies were born 47 days later at 29V2 weeks gestation. All four babies suffered intraventricular hemorrhages (IVH). Plaintiffs brought this action claiming defendants failed to utilize proper techniques to prevent the premature delivery and that once premature delivery was imminent, defendants failed to administer corticosteroids, causing permanent neurological injuries in all four babies. This case was tried in July 1999, resulting in a hung jury. The case was retried in February 2000. The following relevant evidence was adduced at the retrial.

Dr. James Hawkins, who was called as an adverse witness by plaintiffs, testified that he examined Wafieh on March 18, 1991, when she first presented at the clinic at Cook County Hospital. A monitor indicated that Wafieh was having contractions. Her cervix was long, soft, and closed and she was suffering from an E. coli urinary tract infection (UTI), which can cause preterm contractions. Wafieh was admitted to the complicated obstetrics unit. Dr. Hawkins testified that after high frequency low amplitude contractions were noted on March

27, 1991, Dr. Taheri ordered terbutaline, which was administered on March 28, 1991. 2 She did not receive any tocolytic drugs from March 18 through March 27, 1991. On April 16, 1991, Wafieh was transferred to labor and delivery at 3:30 a.m. to start intravenous ritodrine; but it was not administered until 2 p.m. when her cervix was dilated one or two centimeters. Dr. Ligaya Marasigan explained that intravenous ritodrine was not necessary at 3:30 a.m. because Wafieh’s cervix was still closed at that time.

Dr. James Shepherd was called as an adverse witness by plaintiffs and testified that he treated Wafieh when she was transferred to the labor and deliver unit from April 16 through May 3, 1991. Beginning on April 16, 1991, Wafieh was on continuous fetal monitoring with a few exceptions. Wafieh never had regular uterine contractions that would be characterized as active labor. From April 12 until May 3, 1991, Wafieh’s cervix progressed from one to three centimeters dilated, which was a slow and very gradual change expected in a quadruplet pregnancy.

Dr. Marasigan, who also was called as an adverse witness by plaintiffs, testified that Wafieh did not need tocolytic drugs from March 18 until March 27, 1991. Wafieh had occasional uterine irritability, but not regular contractions. Dr. Marasigan ordered terbutaline on March 28, 1991. From April 21 until May 3, 1991, Wafieh’s cervix remained two centimeters dilated. On May 3, 1991, she progressed to three centimeters. Wafieh’s cervical change was expected because she was carrying quadruplets. Dr. Marasigan wrote a note on May 1, 1991, to consider using steroids. She could not recall why Wafieh was not given steroids.

Dr. John Klutke, one of Wafieh’s treating physicians, was called as an adverse witness by plaintiffs and testified that when Wafieh experienced cervical change it was related to the over-distension of her uterus and unrelated to any contractions she was experiencing because she never had regular contractions. He explained that Wafieh was at risk for preterm labor because her uterus was distended with quadruplets. He stated that it was not possible to have a quiescent uterus in a quadruplet pregnancy because of the over-distension of the uterus. He described the contractions that occur as a result of an over-distended uterus as irregular low amplitude contractions that occur continually, but do not lead to labor. Tocolytics are designed to prevent regular strong contractions that lead to labor, not irregular low amplitude contractions. He further explained that the cervix thins out and dilates due to over-distension. Regular uterine contractions cause rapid dilation of the cervix. Wafieh did not have rapid cervical change from regular contractions. She experienced a slow, gradual change from April 16, 1991, when her cervix was a fingertip closed until May 3, 1991, when it was dilated three centimeters.

Dr. Tyler who was called as an adverse witness by plaintiffs, testified that in 1991 steroids were not shown to be beneficial in multiple gestations. When Dr. Tyler saw Wafieh on May 4, 1991, she told him she felt some moisture in the vaginal area. He performed a digital vaginal examination, which confirmed that the membranes were ruptured and the cervix was dilated to four centimeters. Plaintiffs were delivered by cesarian section by Drs. Tyler and Hosseinian. Dr. Tyler testified that Wafieh had experienced a very slow progression of cervical dilation over weeks, caused by the over-distention of her uterus and not by a regular contraction pattern.

Dr. Felicia Lane was called as an adverse witness by plaintiffs. She testified that there is not one single definition of “active labor.” Contraction activity as well as cervical dilation are taken into account. With multiple gestations, three to four centimeters dilation is considered active labor. She further stated that delaying the delivery of quadruplets when the mother is four centimeters dilated poses the risks of precipitous delivery and cord prolapse. She stated that steroids were not the standard of care in 1991 and it is still unknown whether steroids are beneficial with quadruplets.

Dr. Eddie L. Swift, one of Wafieh’s treating physicians, testified that he would not have recommended that steroids be given to Wafieh because of the potential risk of pulmonary edema and because she had a UTI. Dr. James Young testified that minor plaintiffs’ neurological injuries were caused by IVH and their prematurity.

Plaintiffs’ expert witness, Dr. John Elliott, a perinatologist, testified that defendants deviated from the standard of care by: (1) failing to properly utilize tocolytics; (2) failing to evaluate the change in contraction pattern and check magnesium sulfate levels on May 3, 1991; (3) allowing the magnesium sulfate level to drop to one on May 4, 1991; (4) allowing the fetal monitor to be disconnected on May 3, 1991; (5) Dr.

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Bluebook (online)
775 N.E.2d 154, 333 Ill. App. 3d 289, 266 Ill. Dec. 592, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nassar-v-county-of-cook-illappct-2002.