Failure to monitor cardiac patient on medical floor.

ON JUNE 1, 1995, JESSE JOHNSON SUFFERED CARDIOPULMONARY ARREST AT HIS HOME AND WAS TRANSPORTED TO LOYOLA UNIVERSITY MEDICAL CENTER. He was admitted to the cardiac care unit under the primary care of Dr. Diane Wallis, a board-certified cardiologist and critical-care specialist. Dr. Wallis maintained that tests revealed evidence of renal compromise, but the patient had not suffered a recent myocardial infarction. The patient was removed from the ventilator on June 2, 1995. That same day, Dr. Wallis scheduled a cardiac catheterization for Monday, June 5. Dr. Wallis maintained that her policy was to explain to the patient the risks of an angiogram, including renal failure, which would require dialysis. Medical records showed that the patient said he would rather die that be on dialysis. In addition, Dr. Wallis maintained that an angiogram was not done before the patient was transferred to the medical floor because they wanted to let him stabilize and to look into the kidney situation. On June 4, 1995, Dr. Wallis ordered the patient's admission to a general medical floor, without continuous telemetry or oxygen monitoring. Dr. Richard Carroll, a board-certified cardiologist, became the patient's attending physician. Dr. Wallis maintained that she decided that the patient could be transferred to a medical floor because he had been monitored for four days and did not have any heart arrhythmia. Furthermore, his oxygen saturation had been monitored and did not waver. Her plan at the time of the transfer was to have a renal consultant talk to him to reassure him that the tear behind his failure to give consent to dialysis was not well founded. Dr. Carroll saw the patient on the morning of June 5, 1995. He ordered a doubutamine stress test to evaluate the patient's cardiac status. The stress test would allow doctors to determine whether an angiogram was necessary. That night, the patient suffered a cardiopulmonary arrest. Although the patient was resuscitated, it was only after some time had passed. He survived with brain damage as a result of oxygen deprivation, He died several months later. Rhodoris Johnson, individually and as Special Administrator of the patient's estate, brought suit against the hospital and Drs. Carroll and Wallis. After a jury trial the jury returned a verdict for the plaintiff against the hospital and Drs. Carroll and Wallis. However, the trial judge granted the defendants' motion to enter Judgment Notwithstanding the Verdict (JNOV) for thedefendanta The plaintiff appealed.

THE APPELLATE COURT OF ILLINOIS REVERSED THE TRIAL COURT'S ORDER GRANTING JNOV FOR THE DEFENDANTS AND REINSTATED THE JURY VERDICT FOR THE PATIENT. The court held, inter alia, that the defendants were not entitled to JNOV where the only question presented to the jury was whether the defendants were negligent when they failed to adequately monitor the patient and when the plaintiff's expert testified that such a failure was the proximate cause of the patient's injuries.

THE COURT REJECTED THE DEFENDANTS' CONTENTION THAT THE TRIAL COURT PROPERLY GRANTED JNOV BECAUSE THE PLAINTIFF FAILED TO PRESENT ANY COMPETENT EVIDENCE THAT DR. CARROLL'S FAILURE TO MONITOR THE PATIENT CAUSED HARM. The evidence presented to the jury was whether the defendants were negligent when they "Jailed to maintain the patient in a Cardiac Care Unit or telemetry unit with continuous EKG and 02 Sat. monitoring." The court noted that there was testimony that with adequate monitoring, changes in the patient's heart rate, cardiac status, or oxygen level would have resulted in earlier intervention, "and 1 think that he would have been treated for his impending cardiac arrest in a much quicker time and, therefore, wouldn't have had the brain damage from the cardiac arrest, ... "However, by the time staff had intervened, "at that point it took so long to get the circulation back up that he had a lack of oxygen to the brain and had severe, irreversible brain damage which ultimately led to his death ..." The defendants' expert, Dr. Arnsdorf, opined that monitoring would not have made a difference because the second cardiac arrest occurred in the presence of a nurse. However, this issue was in controversy, since two physicians' reports indicated that the patient was found "unresponsive in chair." In the lace of this conflicting evidence, the court concluded that the jury was entitled to reject Dr. Arnsdorf's conclusion that monitoring of the patient would not have made a difference. Obviously, had the patient been properly monitored, whether by telemetry or other appropriate means, he would not have been found "unconscious in chair." It is almost inconceivable that Dr. Arnsdorf could make such a statement. Johnson v. Loyola Univ. Med. Ctr., 2008 IL-Iw080404185 (03/31/2008)--IL

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's Nursing Law's & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achivements as an attorney and lecturer, have won his recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's in America and Who's Who in the World.