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Cassady v. Hendrickson





Appeal from the Circuit Court of Champaign County; the Hon. Creed D. Tucker, Judge, presiding.


Plaintiff, William Cassady, appeals an order of the circuit court of Champaign County, granting summary judgment in defendants' favor. We reverse and remand.

This cause involves a medical negligence action brought against Dr. Jon Hendrickson, medical office assistant (MOA), Loretta Strode, and their employer, the Carle Clinic Association (Clinic). Plaintiff essentially alleges that: Strode punctured his rectum during the administration of a cleansing enema; Hendrickson, a radiologist, failed to appropriately respond after discovery of the problem, causing a delay in treating plaintiff; the Clinic was responsible for the actions of its employees; and Strode and the Clinic were negligent under a theory of res ipsa loquitur. Plaintiff also alleges that defendants did not adequately inform him about the risks of the procedure. However, on appeal plaintiff concedes this issue. Grievous injury resulted from the puncture and subsequent infection.

On January 9, 1985, the circuit court granted defendants' motion for summary judgment. It found that plaintiff's medical expert was not qualified to render opinion testimony on the appropriate standard of care and that plaintiff could not establish his res ipsa loquitur theory because evidence indicated that the puncture could have been caused by a rectal defect. Therefore, it found no material issues of fact existed, and defendants were entitled to judgment as a matter of law.

We reverse and remand.

The facts are prolix but will be summarized only as necessary to an understanding of our disposition.


On September 21, 1981, plaintiff underwent a physical examination conducted by Dr. John Houseworth, a board certified internist, at the Clinic's offices in Champaign. The Clinic is a physicians' group practice organization. Houseworth stated that plaintiff was a 69-year-old male whose primary complaint was emphysema. Plaintiff did not have any complaints concerning his bowels or rectum. Houseworth did not find any rectal abnormalities. However, hemoglobin test results revealed blood in the stool. Therefore, Houseworth recommended a proctoscopic examination and colon X ray.

Plaintiff stated that he reported to the enema department for a cleansing enema prior to the proctoscopic examination. He did not experience any difficulty during the enema procedure. He was not advised of any risks concerning the procedure. After the cleansing enema, plaintiff reported to Dr. Julius Bonello, a board certified colon and rectal surgeon, who conducted a proctoscopic examination.

Bonello stated that his September 21, proctoscopic examination did not reveal any abnormalities. Bonello inserted the proctoscope approximately 20 centimeters (between seven and eight inches). There were no visible soft or weak spots. The examination would have revealed such areas if they were secondary to visible rectal abnormalities. Bonello did not discover the cause of the positive reaction to the hemoglobin test.

Plaintiff returned to the Clinic on October 1, 1981, for a barium X ray of his colon and other tests. Prior to the barium X ray, plaintiff underwent two cleansing enemas. At the start of the first enema, immediately after insertion of the enema catheter tip, plaintiff felt a sharp pain. He told Strode, the MOA giving the enema, that he was in pain. Strode did not verbally respond. She paused, then pushed the catheter tip in further, causing additional pain. Plaintiff informed her of the additional pain.

Plaintiff further stated that Strode continued the enema. The fluid felt as if it were coming into his abdomen. Plaintiff screamed, telling Strode that she was hurting him. After completion of the first enema, plaintiff had difficulty getting off the table, was in severe pain, was disoriented, and could not evacuate the enema fluid. Plaintiff informed Strode that he was in pain and had difficulty moving. She administered the second enema.

Strode stated that she distinctly remembered administering enemas to plaintiff on October 1, 1981. She visually checked the enema catheter tip, a piece of hard plastic about five inches long, adding additional lubricant to it. She inserted the tip approximately 2 1/2 inches without any difficulty. Nothing unusual happened. Plaintiff did complain of pain after infusion of approximately 200 to 300 cc's of fluid. Strode believed the discomfort was due to cramping. She slowed the infusion rate and administered the balance of the enema. Plaintiff did not complain during the second enema. He did say his rectum felt swollen. When she escorted him to the fluoroscopy department, plaintiff did not seem to be experiencing any discomfort or pain.

Plaintiff stated that after the cleansing enema procedure he was unable to stand straight, walked bent over, held his stomach, was in extreme pain, and was disoriented. Plaintiff also told the barium X-ray technician that he was in pain.

Strode stated that she learned how to administer enemas during nurse's aid training and through on-the-job training at the Clinic and a local hospital. The procedure is routine. She administers several enemas of this type daily.

Jona Franklin, the barium X-ray technologist who assisted plaintiff on October 1, stated that she did not notice any indication that plaintiff was in pain or in distress. She inserted the barium enema catheter tip approximately two to three inches. Hendrickson arrived and started the barium X ray. He switched the barium off almost immediately, ordering Franklin to obtain additional X rays. Although Franklin could not remember specifics about plaintiff's physical appearance or condition on October 1, she remembered that he did not have any difficulty moving. She did not remember blood on the enema catheter tip or Hendrickson saying anything to plaintiff after he turned on the fluoroscope.

Hendrickson stated that he is a board certified radiologist. He started the X-ray procedure at approximately 8 a.m. Because he noted the extravasated barium (barium outside the intestinal tract), Hendrickson turned the barium off almost immediately and took X rays of the area. He ordered additional X rays, telling plaintiff about his findings in Franklin's presence.

Hendrickson further stated that he telephoned Houseworth, who indicated that he would see plaintiff that afternoon and would contact Bonello, a surgeon. Plaintiff appeared stable, without any unusual pain or difficulty in movement. Hendrickson spoke with him approximately four times, before authorizing plaintiff's release from the fluoroscopy department, 80 minutes after the procedure. Normally, patients are released after five minutes. Hendrickson admitted that he did not conduct a physical or take plaintiff's vital signs. He thought his duty was to observe plaintiff and report the problem to Houseworth. Plaintiff stated that Hendrickson did not tell him anything or ask any questions. After he arrived at the cafeteria, he ate some breakfast, then fainted.

Jan Melton, a nurse at the Clinic and Strode's supervisor, stated that she was called to the cafeteria to assist plaintiff, who was awake and sitting at a table when she arrived. Plaintiff was very weak and complained of low abdominal pain. ...

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