Varela v. St. Elizabeth's Hospital of Chicago, Inc.

867 N.E.2d 1, 372 Ill. App. 3d 714, 310 Ill. Dec. 688, 2006 Ill. App. LEXIS 689
CourtAppellate Court of Illinois
DecidedAugust 7, 2006
Docket1-05-3718
StatusPublished
Cited by9 cases

This text of 867 N.E.2d 1 (Varela v. St. Elizabeth's Hospital of Chicago, Inc.) 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
Varela v. St. Elizabeth's Hospital of Chicago, Inc., 867 N.E.2d 1, 372 Ill. App. 3d 714, 310 Ill. Dec. 688, 2006 Ill. App. LEXIS 689 (Ill. Ct. App. 2006).

Opinion

JUSTICE McBRIDE

delivered the opinion of the court:

In this medical negligence suit, the plaintiffs, Raynoldo Varela, a minor, and his mother Rachel A. Nelson, appeal from an order of the circuit court granting summary judgment to the defendants, emergency room physician Dr. Luis E. Gomez, his employer Mesa EmCare, S.C. (Mesa EmCare), and the hospital where Dr. Gomez treated Raynoldo on June 8, 1997, St. Elizabeth’s Hospital of Chicago, Inc. (St. Elizabeth’s). 1 The summary judgment ruling was based on the court’s determination that the emergency room physician and St. Elizabeth’s nurses did not owe a common law duty of care to their minor patient to discover a past injury and report it as suspected child abuse to his mother and the Illinois Department of Children and Family Services (DCFS), and that the health-care personnel’s conduct was not the proximate cause of physical abuse subsequently inflicted by Raynoldo’s father. The court also denied the plaintiffs leave to file a proposed third amended complaint, which alleged Raynoldo’s injuries were attributable in part to the negligence of unnamed physicians and nurses on a subsequent work shift at the hospital who did not follow up when a radiologist’s report about Raynoldo’s chest X ray noted the presence of healed rib fractures. The court characterized the new allegations as a new theory that was untimely and would not cure the deficient allegations of duty and proximate cause. In their appeal, Raynoldo and Rachel contend the court’s misapprehension of Illinois law regarding duty and proximate cause led the court to erroneously enter summary judgment for the defense and abuse its discretion by denying leave to file the proposed amended pleading.

The record on appeal discloses the following. Raynoldo was born prematurely on March 31, 1997, to Rachel and her boyfriend Kikole Varela. At the time, Rachel was 17 years old and Kikole was 18 years old. Out of concern that Raynoldo was experiencing seizures, he was placed on a phenobarbital regimen. During a “well baby” checkup on April 18, 1997, Rachel reported that Raynoldo was sometimes gasping for air and breathing fast. The doctor’s notes reflect that Raynoldo was a healthy 18-day-old boy and that he was experiencing “periodic breathing,” which was a normal condition that he would probably outgrow. On the morning of June 8, 1997, when Raynoldo was nine weeks old, his parents brought him to the emergency room at St. Elizabeth’s, with complaints of difficulty breathing and increased crying since noon the previous day, when Rachel started him on a new infant formula, Similac with iron. According to Rachel, she also told “the emergency room nurse and doctor” about a “clicking feeling in [her] baby’s back.” The medical records indicate Rachel denied Raynoldo experienced a fever, vomiting, lethargy, or recent seizures. Dr. Gomez examined Raynoldo and noted he was an active infant with a strong grasp. Raynoldo moved all his extremities and his crying was consolable. His chest was clear, his lungs were working well, and his oxygen saturation was 100%. His pupils were equal, round, and reactive to light. Raynoldo drank Pedialyte while in the emergency room and Dr. Gomez ruled out the need to hydrate the child with a saline solution. The doctor noted that Raynoldo’s abdomen was soft and that there were active bowel sounds. However, he also noted that Raynoldo’s abdomen was moderately distended and that there was some initial voluntary guarding of the abdomen when the doctor started his exam. Dr. Gomez found no evidence of blood in the stool, and blood testing he ordered showed a normal white blood count, normal hemoglobin, and normal blood sugar. Dr. Gomez also ordered a chest X ray because of the initial complaint of difficulty breathing. He wanted to assure Rachel that Raynoldo was breathing normally and was not suffering from an acute or “significant process such as pneumonia or some other cause for an inability to breathe.” According to Dr. Gomez’s deposition testimony, he studied the X-ray film for pneumonia, a dropped lung, or anything that would have suggested abnormal lung tissue, and he saw no evidence of an explanation for difficulty breathing. He did not see any indication of the healed fractures on Raynoldo’s lower left ribs, but if he had, Dr. Gomez stated he would have asked about prior injuries, because absent some other explanation, rib fractures in an infant are indicative of abuse. According to the doctor, his expertise was in emergency medical intervention, meaning he could diagnose obvious features in X rays and stabilize patients but was not proficient in discerning subtle features in X rays. Dr. Gomez took into account that Raynoldo’s crying began shortly after being started on the Similac formula with iron a day earlier and that iron is “notorious for slowing the gut and distending the gut.” Also, “It’s very common for a child to cry if the child has [intestinal] colic and to be perceived by a parent [or other observer] as perhaps having difficulty breathing.” In addition, a child and even an adult will “tend to hyperventilate” when his or her “abdomen is uncomfortable.” After considering Raynoldo’s history and the results of the physical exam and diagnostic tests, Dr. Gomez concluded that Raynoldo was suffering from intestinal colic. Dr. Gomez discharged Raynoldo with instructions to discontinue the new Similac formula, to give Pedialyte, to return immediately if there was fever or vomiting, and to follow up with a pediatrician in the morning.

The written discharge instructions informed Raynoldo’s parents that a radiologist would perform an official interpretation of the chest X ray the following morning and that they should have the child’s doctor call for a copy of the radiologist’s report. The discharge instructions also said either Raynoldo’s parents or his doctor would be notified if there was a discrepancy between the findings of the emergency department physician and the radiologist.

Raynoldo was seen by a pediatrician the following day. The pediatrician’s notes describe Raynoldo as a healthy two-month-old. He was alert and active during the examination, his lungs were clear, and his abdomen was soft and not distended. The notes do not reflect whether the doctor was advised of the previous day’s emergency room visit.

On the morning of June 9, 1997, Dr. Ahmad Judar, a board-certified radiologist at St. Elizabeth’s, reviewed Raynoldo’s X ray and made a written report. Dr. Judar documented:

“The heart is normal in size. There appears to be hyperinflated lungs. No evidence of pneumonia or edema. There is evidence of old healed fracture at the left lower ribs involving 7th, 8th and 9th ribs.
Conclusion: Hyperinflated lungs, bronchiolitis should be considered. Old healed fracture at the left lower ribs appears to be involving the 7th, 8th and 9th ribs at the axillary area.”

When Dr. Judar was deposed on July 12, 2004, he no longer recalled this particular report. However, he described the usual procedure. He indicated a “flash card” or preliminary written report of the emergency room doctor accompanies X-ray film sent to the radiology department. If a discrepancy is seen, the radiologist authors a report, makes a handwritten note on the flash card, and returns the documents to the emergency room. Due to the close proximity of Dr. Judar’s office and the emergency room, Dr.

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Bluebook (online)
867 N.E.2d 1, 372 Ill. App. 3d 714, 310 Ill. Dec. 688, 2006 Ill. App. LEXIS 689, Counsel Stack Legal Research, https://law.counselstack.com/opinion/varela-v-st-elizabeths-hospital-of-chicago-inc-illappct-2006.