Spyrka v. County of Cook

851 N.E.2d 800, 366 Ill. App. 3d 156
CourtAppellate Court of Illinois
DecidedJune 8, 2006
Docket1-05-1338
StatusPublished
Cited by29 cases

This text of 851 N.E.2d 800 (Spyrka 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
Spyrka v. County of Cook, 851 N.E.2d 800, 366 Ill. App. 3d 156 (Ill. Ct. App. 2006).

Opinion

JUSTICE CAMPBELL

delivered the opinion of the court:

Defendants County of Cook and Dr. Chi Du appeal a judgment of the circuit court of Cook County finding them liable in a medical malpractice case brought by plaintiff Stanley Spyrka, individually and as independent administrator of the estate of Dorota Spyrka. The trial court entered the judgment on a jury verdict of $16,957,310. The trial court denied defendants’ posttrial motion. Defendants now appeal.

The record on appeal discloses the following facts. Dr. Robert J. Toltzis testified regarding the medical records of the treatment of Do-rota Spyrka at Cook County Hospital. Dorota was admitted to the hospital on June 1, 2000, with difficulty in breathing, a fever and an abnormal X ray. The saturation of oxygen in her blood was found to be reduced. Dorota was given supplemental oxygen and antibiotics for several days. On June 6, 2000, Dorota had been stable or improving over the previous two days when she screamed out that she could not breathe. Her oxygen saturation, normally 98% or 99%, had fallen to 67%. Her heart rate had increased. Dr. Toltzis testified that “it’s pretty well described that she had a pulmonary embolism at that point.” According to Dr. Toltzis, a person having a pulmonary embolism will feel like he or she is suffocating and it will feel painful to breathe, causing anxiety and distress.

Dr. David M. Systrom, a pulmonary and critical care specialist, testified that a pulmonary embolism occurs when a blood clot that forms in the big veins of the legs, pelvis or abdomen (also known as a deep vein thrombosis or DVT) breaks loose and migrates north to the pulmonary arteries, where it can have a number of effects. As the pulmonary arteries carry blood to the lungs to be oxygenated, a blood clot large enough to block the main artery or its branches can cause low blood pressure, shock and death. Dr. Systrom demonstrated this testimony with a model.

Dr. Systrom explained that cases causing low blood pressure and shock are called massive pulmonary emboli. People can die from a massive pulmonary embolism that is either an acute or recurrent pulmonary embolism. An acute pulmonary embolism generally refers to the first such embolism; an estimated 10% of people die from an acute pulmonary embolism before it can be treated. According to Dr. Systrom, the vast majority of patients appropriately treated do well. Patients that are inappropriately treated may suffer from a recurrent pulmonary embolism, with a high mortality rate. Dr. Systrom explained that a second shower or second single clot can occlude enough of the blood flow to causing low blood pressure, shock and death.

Dorota was put on a ventilator in the intensive care unit (ICU). Cardiac echo testing suggested a pulmonary embolism.

Dorota was given TPA, which Dr. Toltzis testified was a thrombolytic agent that dissolves blood clots. Afterward, Dorota’s oxygen saturation improved. Her heart rate was able to come down. On June 7, 2000, with oxygen supplementation, her saturation level returned to 98%. Dr. Systrom opined that this was a clear-cut, incontrovertible index of the patient’s improvement. Dr. Systrom testified that this shows “[t]he blood clot is being dissolved actively by the TPA. It’s shrinking in size. May or may not totally disappear but it’s shrinking in size.”

Dr. Systrom testified that the administration of TPA was completed at 9 p.m. on June 6, 2000. The team at Cook County Hospital began administering Heparin at about 2:30 a.m. on June 7, 2000.

Dr. William Haire, a physician and hematologist, testified that Heparin is an anticoagulant. Heparin slows blood clot formation and prevents the addition of material to preexisting clots. Dr. Haire testified that Heparin “doesn’t really do anything for clots that are already there.”

Dr. Systrom testified that there is a laboratory measure of the partial thromboplastin time called the APTT, or PTT for short, which indirectly measures the level of Heparin in the blood. Dr. Systrom testified that Cook County Hospital had a protocol stating that during the first 24 hours, the PTT test should be repeated every six hours, and once every morning thereafter, unless it is out of the therapeutic range. Dr. Systrom explained that the effects of Heparin vary in different patients, requiring frequent checks at first. Dr. Systrom testified that APTT levels should have been checked at 8 a.m., 2 p.m. and 8 p.m. on June 7, 2000, and 2 a.m. and 8 a.m on June 8, 2000, but were not. Dr. Systrom testified that PTT tests were done when the TPA was started and ended (both of which were appropriate), but the result for the second test was not in the therapeutic range. Dr. Systrom testified that as there was no PTT record for the period Dorota was on Heparin, there was no way to be certain that she had enough Heparin to prevent a recurrent pulmonary embolism.

Dr. Haire testified that the records show that Heparin was discontinued at approximately 12 a.m. on June 8, 2000.

Dr. Gordon Fall, a family practice physician, testified that defendant Dr. Chi Du — then a first-year family practice intern — wrote the order to discontinue Heparin, prior to an angiogram that was supposedly going to be performed that day. Dr. Fall, having reviewed the deposition testimony of other doctors involved with Dorota’s treatment, testified that Dr. Du would not have the authority to write an order discontinuing Heparin without first checking with a superior.

Dr. Du testified that she wrote the order discontinuing Heparin. Dr. Du testified that she was told by a member of the team that the attending physician had talked to the radiologist during the round and that the recommendation was to go forward with an angiogram. Dr. Du explained that Heparin would be held to prevent the risk of bleeding when the procedure was performed. Dr. Du stated that she would not make that decision. Dr. Du testified that a Dr. Gupta told her to discontinue Heparin at midnight because an angiogram was going to be done in the early morning.

The jury was read deposition testimony from other doctors involved with Dorota’s case. Dr. Muthuswamy, retired former chair of the pulmonary division at Cook County Hospital, testified that he did not tell Dr. Du to stop the Heparin and that no one contacted him about it. Dr. Gupta, the ICU resident, did not think that he gave such an order because he was not present at the hospital; he had previously testified that he did not tell her to discontinue Heparin. Dr. Kenneth Cruz, who assisted the ICU residents and interns, did not recall Drs. Muthuswamy or Gupta saying anything about discontinuing Heparin. Dr. Ramakrishna stated that he did not advise Dr. Du to discontinue Heparin and did not hear anyone else do so.

Dr. Arthur Waltman, a radiologist, testified that an angiogram to rule out a pulmonary embolism was not necessary. Dr. Waltman testified that a reasonable radiologist would not have ordered Heparin stopped without a procedure scheduled. Dr. Waltman testified that a reasonable amount of time for a patient to go without Heparin in anticipation of a procedure would be about two hours and that the anticoagulant effects of Heparin will continue for about 2V2 hours after it is stopped. Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
851 N.E.2d 800, 366 Ill. App. 3d 156, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spyrka-v-county-of-cook-illappct-2006.