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Crawford v. Anagnostopoulos





APPEAL from the Circuit Court of Cook County; the Hon. JAMES C. MURRAY, Judge, presiding.


Plaintiff June Crawford brought a medical malpractice action against Dr. Irvin H. Strub and Dr. Lampis D. Anagnostopoulos in the circuit court of Cook County. Dr. Strub was dismissed as a defendant before trial, and plaintiff's motion to rejoin him as a defendant was denied. Following a bench trial, judgment was entered in favor of defendant Anagnostopoulos on the issue of informed consent but against him on the malpractice issue. Plaintiff was awarded a $6,000 verdict.

Defendant appeals that portion of the order finding him guilty of malpractice and contends that plaintiff failed to establish by expert testimony that he deviated from an accepted standard of medical care in his post-catheterization treatment of plaintiff. Plaintiff cross-appeals on the issue of damages only, contending they were inadequate as a matter of law.

In her amended complaint, plaintiff alleged defendant failed to exercise the degree of care and skill ordinarily possessed by other surgeons, particularly cardiovascular surgeons, in one or more of the following ways: failure to afford suitable post-operative care; failure to follow the advice of a consulting cardiovascular surgeon who recommended a brachial thrombectomy; failure to follow the advice of a consulting physician who advised a stellate ganglion block; failure to recommend an angiogram to determine the cause of plaintiff's symptomatology; failure to entrust plaintiff to the care of a physician skilled in surgical cardiology while defendant was on vacation; failure to diagnose an occlusion in plaintiff's right brachial artery which precluded tests ordinarily performed to determine the existence of a right brachial artery occlusion; and after being advised in writing on September 1, 1973, that plaintiff had a lack of blood supply to her lower right arm and hand, failure to insure that plaintiff received sufficient treatment to bring her condition to a successful conclusion.

The record indicates that in June 1973, plaintiff, while undergoing X rays, experienced chest pains and was hospitalized at the direction of Dr. Irvin Strub. Dr. Strub, an internist with a subspecialty in gastro-enterology, testified that he was plaintiff's attending physician. In evaluating plaintiff's symptoms, Dr. Strub suspected heart disease and recommended that a cardiac catheterization be performed. Dr. Strub testified that he did not perform catheterizations and recommended to plaintiff several cardiologists at the hospital who did perform that procedure. Plaintiff, a hospital employee from 1969 to 1974, chose the defendant, a board certified internist and cardiologist. Dr. Strub testified that he consulted with defendant who advised that a catheterization be performed.

On July 2, 1973, defendant performed the cardiac catheterization on plaintiff. An incision was made in plaintiff's right arm above the elbow, and a hollow, wirelike, tubular instrument called a catheter was inserted up plaintiff's right brachial artery to her heart. Dye was then injected into the catheter which entered the coronary arteries providing visualization of the arteries and heart chambers. During the catheterization, plaintiff's right brachial artery began to contract spasmodically. Defendant testified that although infrequent, this does occur. As a result, defendant testified the procedure took longer than usual and before closing the brachial artery, he made certain no clot was present.

After the procedure was completed and later that same day, defendant examined the plaintiff and noted that plaintiff's right radial pulse was intermittent, indicative of a spasm. Defendant ordered the drug, heparin, an anticoagulant to prevent formation of blood clots, be administered to plaintiff. Defendant was notified that the attempted administration of heparin was unsuccessful and defendant prescribed other orders. He also gave plaintiff a sedative and ordered hot packs for her arm.

The next day, July 3, 1973, defendant examined plaintiff's arm. He noted the right radial pulse was weaker than the left pulse and plaintiff's right hand was slightly cooler than her left hand. Defendant ordered continuous warm soaks for the right arm.

On July 4, 1973, defendant again examined plaintiff's arm and noted the right radial pulse was good. He discussed plaintiff's condition with Dr. Strub and both agreed to discharge her on that day.

Plaintiff was to return on July 9, 1973, so that defendant could take out her stitches. However, before that date, on July 7, 1973, plaintiff went to see defendant complaining of pain in her arm above the site of the incision and difficulty in extending her arm. Defendant examined the arm and found the right arm somewhat cooler than the left and the right pulse weaker than the left. Defendant testified that he told plaintiff there was still a spasm in the brachial artery. He extended her arm, prescribed aspirin for the pain, certain finger exercises, and told her to continue with the warm soaks.

On July 9, 1973, plaintiff was examined by Dr. Strub and told him of the pain, coolness, and trouble extending her arm. He told her to see the defendant. Plaintiff went to defendant's office that same day for removal of the stitches. Plaintiff testified that she was in pain, her fingers were stiff, her arm was cold, and she could hardly move it. She stated that defendant took out the stitches, tried to extend her arm, took her pulse, and told her to take aspirin for the pain and continue with the exercises. Plaintiff testified that defendant told her the pain would go away and she was to contact him if her problems persisted.

Defendant talked with Dr. Strub about plaintiff's symptoms and they agreed that plaintiff should be examined by Dr. Peter Nennhaus, a cardiovascular surgeon. Plaintiff testified that it was the defendant who sent her to Dr. Nennhaus.

Dr. Nennhaus examined plaintiff and recommended that she have a brachial thrombectomy, a procedure to remove a clot from the artery. According to defendant, he advised Drs. Nennhaus and Strub not to perform the procedure. He thought that since plaintiff had a prolonged spasm of the brachial artery, a thrombectomy would only result in additional spasm and could be harmful. Plaintiff testified that she asked defendant his opinion as to Dr. Nennhaus's recommendation, and defendant disagreed and recommended she see Dr. Spiegler, a physiatrist.

Plaintiff saw Dr. Spiegler on July 13 and again on July 16, 1973. Dr. Spiegler concluded that plaintiff had an arterial spasm of the blood vessels in her right arm. Contrary to Nennhaus's findings, Spiegler found plaintiff's artery constricted but not blocked. He recommended plaintiff have a stellate ganglion block. The stellate ganglion is a nerve junction located in one's neck which controls the nerve fibers which go down into arteries of the arm and cause arteries to constrict. Blockage of the stellate ganglion causes the arteries to open up. This procedure could be performed by a physiatrist, an anesthesiologist or a neurosurgeon. Spiegler explained to plaintiff that the risks were slight with little or no potential for serious injury, ...

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