Ramos v. Pyati

534 N.E.2d 472, 179 Ill. App. 3d 214, 128 Ill. Dec. 290, 1989 Ill. App. LEXIS 78
CourtAppellate Court of Illinois
DecidedJanuary 27, 1989
Docket87-1709
StatusPublished
Cited by16 cases

This text of 534 N.E.2d 472 (Ramos v. Pyati) 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
Ramos v. Pyati, 534 N.E.2d 472, 179 Ill. App. 3d 214, 128 Ill. Dec. 290, 1989 Ill. App. LEXIS 78 (Ill. Ct. App. 1989).

Opinion

PRESIDING JUSTICE MURRAY

delivered the opinion of the court:

Defendant, Prahlad Pyati, M.D., appeals from several rulings of the trial court in a medical malpractice suit filed by plaintiff, Carlos Ramos, in which he alleged that defendant performed surgery on his hand outside the scope of the surgery to which he had consented. Specifically, defendant contends that: (1) the trial court erred in denying his motion for a directed verdict because plaintiff failed to prove a prima facie case of medical malpractice; (2) the court erred in directing a verdict in favor of plaintiff based on its conclusion that plaintiff did not consent to the use of the ring finger tendon as a donor tendon; and (3) the court abused its discretion in limiting his expert’s opinion testimony. For the reasons set forth below, we affirm.

The record discloses that in November 1977 plaintiff injured his thumb while at work. He was referred to defendant, after seeing three other doctors, in February 1978. Defendant subsequently diagnosed plaintiff’s injury as a ruptured thumb tendon and, after obtaining plaintiff’s consent to surgically repair the tendon, he operated on the thumb. During the course of the operation, defendant was unable to join the two ends of the ruptured tendon because of scar tissue which had formed and caused the ends to retract. He then examined plaintiff’s palmaris longus (wrist) tendon and found it unsuitable as a donor to bridge the gap between the ends of the ruptured tendon. Defendant proceeded to examine '“the already exposed area for another available, suitable tendon” and chose the digitorum sublimis superfieialis (ring finger) tendon. After the surgery, plaintiff continued to see defendant for approximately one month.

In July 1979, plaintiff filed an action against defendant for medical malpractice, alleging that his hand was “rendered unusable for his customary mode of employment” 1 and that defendant had breached his duty by not: (1) advising him of the serious nature of the proposed operations; (2) exercising a proper degree of care in the performance of the operation; and (3) discontinuing the surgery when he knew or should have known that the “required surgery” would probably cause a greater disability than the already injured condition of his thumb.

At trial, plaintiff testified that although he signed a written consent form authorizing surgery on his thumb, he did not consent to a graft of his ring finger tendon or any other tendon. Plaintiff further stated that defendant only told him that he would have “two small operations” in his wrist to repair his thumb injury; that after the surgery and a cast that had been placed on his hand was removed, he experienced stiffness in his hand and discovered five scars from incisions made by defendant; and that as a result of the surgery he cannot bend his ring finger independently of his other fingers, he has trouble picking up nuts and bolts and handling his tools which he uses in his occupation as a mechanic, and he does not have the same grip strength that he had prior to the surgery.

Defendant testified that due to the passage of time and the number of patients he had seen since treating plaintiff (nine years), he could not remember the specifics of the conversations he had with plaintiff concerning his surgery. Based on his custom and practice, however, he stated that he would have explained the surgical procedure to plaintiff and the consequences of treatment. Specifically, defendant would have explained to plaintiff that he would attempt to rejoin the ends of the ruptured tendon or, if he could not do so, he would graft his wrist tendon to do so. He also would have advised plaintiff that if the wrist tendon was unsuitable, he would use a tendon from another source. Defendant further stated, however, that it was likely since he had not planned to use the ring finger tendon, he would not have told plaintiff that he was planning to use it. Additionally, defendant testified that he did not consider using plaintiff’s calf tendon as a donor tendon because its use might require getting another consent from plaintiff.

With respect to the preferred choice of donor tendons, Dr. Donald Miller, plaintiff’s expert witness, testified that the ring finger tendon is the last choice of four other tendons based upon medical texts relied on at trial. Dr. Miller described the order of use of the preferred donor tendons as (1) the wrist tendon, (2) the calf tendon, (3) toe ex-tensor tendons, (4) small or index finger tendons, and (5) the ring finger tendon. He further explained that the ring finger tendon is the last choice because it, unlike the other tendons that are “fine” and nonfunctional, does not have as much elasticity as the nonfunctional tendons to provide the greatest amount of flexion, and it has a function — “serves a purpose.” Additionally, Dr. Miller stated that removal of the ring finger tendon results in a little weakening of that finger and loss of “some of the elasticity and strength of the hand.” He also stated that he had used the ring finger tendon in two instances — accident cases — only because the other preferred tendons were unavailable. It was Dr. Miller’s opinion that had defendant used a tendon other than the ring finger tendon, plaintiff’s flexion in his thumb would be greater than it is and his ring finger, unimpaired, would be normal, and plaintiff would have greater strength in his hand. Accordingly, it was Dr. Miller’s opinion that defendant therefore deviated from the standard of care. Lastly, Dr. Miller stated, in response to a question on direct examination whether failure to tell plaintiff prior to surgery about the possible use of the ring finger tendon was a deviation from the standard of disclosure, “that in [the] form of consent telling the patient exactly what is to be done is very important, specifically spell it out and define it so that there was a breach of care.”

The testimony of Dr. John Bell, defendant’s expert witness, was limited to his opinion given in a deposition taken by plaintiff based on defendant’s failure to answer in writing interrogatories submitted to him pursuant to Supreme Court Rule 220 (107 Ill. 2d R. 220), i.e., that the operative procedure was in conformity with acceptable medical practice.

During the trial, defendant moved for a directed verdict at the close of plaintiff’s case on the grounds that plaintiff failed to present evidence that defendant’s alleged failure to obtain an informed consent from plaintiff proximately caused his injury, there was no evidence showing that the operation had caused loss of flexion or other injury, plaintiff’s claim that his hand was “unusable” for his customary employment was disproved since he had testified that he had continued working at his former job after the surgery, and plaintiff had failed to prove a prima facie case for medical malpractice. The court denied defendant’s motion. At the close of all the evidence, plaintiff moved for a directed verdict on the issues of consent, absence of consent, and proximate cause “between the performance of the surgery and the resultant injury.” The court granted the motion as to the absence of consent for the use of the ring finger tendon as a donor, but denied it as to proximate cause and did not direct a verdict as to the thumb surgery. Prior to closing statements, the court instructed the jury on the directed verdict as follows:

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Cite This Page — Counsel Stack

Bluebook (online)
534 N.E.2d 472, 179 Ill. App. 3d 214, 128 Ill. Dec. 290, 1989 Ill. App. LEXIS 78, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramos-v-pyati-illappct-1989.