Pavnica v. Veguilla

929 N.E.2d 52, 401 Ill. App. 3d 731
CourtAppellate Court of Illinois
DecidedApril 28, 2010
Docket3-09-0065
StatusPublished
Cited by4 cases

This text of 929 N.E.2d 52 (Pavnica v. Veguilla) 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
Pavnica v. Veguilla, 929 N.E.2d 52, 401 Ill. App. 3d 731 (Ill. Ct. App. 2010).

Opinion

JUSTICE SCHMIDT

delivered the opinion of the court:

Plaintiffs, Leonard and Patricia Pavnica, brought this medical malpractice and loss of consortium action against defendants Edwin Veguilla, M.D., Andrew Zwolski, M.D., and Prairie Emergency Services, S.C. Following a trial in the circuit court of Will County, a jury returned a verdict in defendants’ favor. Plaintiffs appeal, arguing that the trial court erred in denying their posttrial motion. In that motion, they argued they were entitled to a new trial based on an erroneous ruling on their motion in limine that allowed defendants to testify to their military service. They further requested that a judgment be entered in their favor, claiming the jury’s verdict was “wholly unwarranted, arbitrary, unreasonable, and was against the manifest weight of the evidence.” We affirm.

FACTS

In October of 2003, Leonard had a pancreas and kidney transplant. Leonard was a diabetic and knew the importance of checking his feet for cuts and injuries. As a result of the transplant, Leonard was also placed on immunosuppressive medication which he knew gave him more reason to be concerned about minor injuries.

On December 19, 2003, Leonard stubbed his toe on a piece of furniture in his home and believed that he may have broken it. From watching the Discovery channel, Leonard knew a technique that involved taping his injured toe to the next toe to help the healing process.

After taping his toes together, Leonard felt that his toe was not healing properly, so he sought medical assistance. He attempted to see his regular physician, Dr. Deborah Freeman, but she was unavailable until January 2 due to the Christmas holiday season. Dr. Freeman’s office instructed Leonard to go to the emergency room so he proceeded to the emergency room at St. Joseph Provena in Joliet on December 22, 2003. Dr. Veguilla treated plaintiff in the emergency room.

Leonard testified that Dr. Veguilla diagnosed cellulitis/ lymphangitis. Leonard stated that Dr. Veguilla drew a red line on Leonard’s leg below the knee and advised him that if the redness went above that line to come back to the emergency room or immediately follow up with his physician. Dr. Veguilla also prescribed Levaquin, an oral antibiotic, and told Leonard to make a follow-up appointment with Dr. Freeman to have his foot rechecked.

Eight days later, on December 30, Leonard returned to the emergency room and was seen by Dr. Zwolski. Leonard returned to the emergency room because he felt the medication was not working and his infection seemed to be getting worse. Dr. Zwolski ordered a battery of tests. This was done, Leonard believed, because Dr. Zwolski suspected a bone infection. After the series of tests that included a blood test and X-rays, Dr. Zwolski concluded the examination and instructed Leonard to follow up with his physician and continue taking the Levaquin.

Leonard testified that he was not admitted to the hospital following his second emergency room visit and no additional antibiotics were added to his course of treatment. He stated that, while in the emergency room, Dr. Zwolski did contact Dr. Freeman to make an appointment for Leonard upon her return.

Leonard went to see Dr. Freeman on January 2. Dr. Freeman examined the foot and the infected area and, believing that there was anaerobic infection, admitted plaintiff to the hospital. Leonard stated that he was told the infection looked gangrenous. At the hospital, Leonard was placed on intravenous antibiotics and Dr. Freeman requested an infectious disease consult. Due to the possible consequences of any rejection of his transplants, Leonard was transported to Northwestern Memorial Hospital, where he came under the care of the transplant team that performed his transplants. Leonard testified that the progression of the gangrene became so serious that an amputation of his toes was necessary. An orthopedic surgeon performed the amputation of his toes; eventually another operation was performed to remove a portion of his forefoot.

Plaintiff argued at trial that the emergency room physicians violated the standard of care by failing to place him on anaerobic antibiotics following his emergency room visits. Defendants argued that their choice of the antibiotic regimen was proper and appropriate. Furthermore, defendants asserted that Leonard’s condition had improved from the first to the second emergency room visit and, therefore, no change was needed to his antibiotic regimen.

Dr. Freeman testified that if she had known that Leonard had previously been to the emergency room, she would have admitted him to the hospital after talking to Dr. Zwolski during Leonard’s second visit.

Dr. Segreti, plaintiffs’ retained infectious disease expert, testified that had the antibiotics been changed to include anaerobic coverage, Leonard would not have suffered the amputation of his toes or foot. Dr. Segreti further testified that the only reason Leonard underwent an amputation was due to the infection. He came to this conclusion given the blood flow studies performed at St. Joseph Provena that indicated Leonard had very good blood flow to his lower extremities, especially in the foot and toes. Dr. Segreti also specifically stated that he was not testifying to the standard of care of emergency room physicians.

Plaintiffs called Dr. Michael Rosenberg, who testified that Dr. Veguilla violated the proper standard of care for emergency room physicians by failing to admit Leonard during his first visit. Dr. Rosenberg also testified that it was a violation of the standard of care for Dr. Zwolski not to admit Leonard on his second visit. Dr. Rosenberg’s opinions were based on the status of the patient as a diabetic, the patient’s recent transplant history, and the fact that Leonard was on antirejection medication. Dr. Rosenberg noted those facts put Leonard at severe risk of infection and rejection.

Dr. Rosenberg further testified that Dr. Veguilla should have taken blood cultures and placed Leonard on an antibiotic that would have covered both aerobic and anaerobic bacteria. Dr. Rosenberg testified that Leonard was not covered for anaerobic bacteria that can develop with injuries of this type to diabetic patients in very tight, closed-off spaces, especially between the webbing of the toes. Dr. Rosenberg opined that the emergency room physicians’ treatment of Leonard violated the applicable standard of care.

Defendant Dr. Veguilla testified that he examined Leonard on December 22, 2003, and took a medical history. The physical examination revealed a relatively small area of minimal swelling on the right foot. There was evidence of infection, as manifested by erythema, induration, warmth and mild tenderness. The affected area was about the size of a quarter or 50-cent piece. The medical history disclosed that Leonard was a diabetic, as well as a multiple-transplant patient. Leonard was taking immunosuppressant medications secondary to the kidney and pancreas transplants.

Dr. Veguilla diagnosed Leonard with cellulitis and lymphangitis. The absence of a note in the medical records measuring the length of the red streak (the lymphangitis) indicates that the streaking did not extend to the mid-foot.

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Cite This Page — Counsel Stack

Bluebook (online)
929 N.E.2d 52, 401 Ill. App. 3d 731, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pavnica-v-veguilla-illappct-2010.