Appeal from the Circuit Court of St. Clair County; the Hon.
Stephen Kernan, Judge, presiding.
JUSTICE WELCH DELIVERED THE OPINION OF THE COURT:
Plaintiff, Herbert Boey, brought this action in medical malpractice as father and next friend for Herbert Boey IV, against Dr. Robert L. Quaas. The jury returned a verdict for defendant, and plaintiff appeals. The pertinent facts adduced at trial are as follows:
Herbert (Jaron) Boey IV, was born to Herbert and Emma Boey on December 28, 1980. Dr. Quaas was Jaron Boey's pediatrician from December 28, 1980, through October 29, 1981.
Mrs. Boey testified that a few days prior to October 21, 1981, her child developed an intermittent fever. On October 21, 1981, she took him to the emergency room of St. Mary's Hospital and told the emergency room personnel that Jaron had a fever and that he was experiencing intermittent neck pain. The neck pain had begun approximately two days earlier. Jaron Boey was then examined by Dr. Sana Ullah. Dr. Ullah diagnosed Jaron Boey's condition as an ear infection and an elevated temperature. Dr. Ullah stated he telephoned Dr. Quaas, told him the condition of Jaron, and the drugs amoxicillin and tylenol were prescribed. Dr. Ullah stated that Jaron was also given a shot of ampicillin at this time. Jaron returned home with his parents.
On October 23, 1981, Mrs. Boey telephoned Dr. Quaas and informed him that Jaron was not improving. She was advised that the antibiotics took 48 hours to be effective. Mrs. Boey stopped giving the antibiotics to her son on October 26, 1981, because he was throwing them up. On October 27, 1981, Mrs. Boey again telephoned defendant and told him that her son was experiencing diarrhea, fever, and neck pulling. Dr. Quaas prescribed Donnagel PG and Pedialyte. Mrs. Boey took her son to Dr. Quaas' office on October 29, 1981. Dr. Quaas' notes in Jaron's medical records indicate that Mrs. Boey stated her son's condition had improved, but Mrs. Boey denied that she told Dr. Quaas that her son's condition had improved. She further stated she complained about the child's rigid neck.
Dr. Quaas testified that he examined Jaron's neck on October 29, 1981, but did not note any abnormalities at that time. He further stated that if he had found any stiffness in Jaron's neck, he would not have ignored the symptoms. His temperature was taken during the office visit, and it was 37.5 degrees centigrade. (On previous "well baby" examinations, Jaron's temperature had ranged between 37 degrees centigrade and 37.6 degrees centigrade.)
Testimony indicated Jaron's condition worsened on October 31, 1981; he was noticeably ill, had an elevated temperature, and his neck stiffness was constant rather than intermittent. Mr. Boey arranged for an appointment with Dr. Pothen Jacob. Dr. Jacob examined Jaron in his office on October 31, 1981, and hospitalized him in St. Mary's Hospital. His initial diagnosis was bacterial meningitis. The child was admitted to the hospital that same day, and a spinal tap was performed. This procedure confirmed Dr. Jacob's diagnosis. The spinal fluid was cloudy and contained 490 white blood cells. Dr. Jacob immediately began treating Jaron with the oral and intravenous administration of ampicillin. The ampicillin was ineffective. On November 2, 1981, chloramphenicol was added to Jaron's antibiotic therapy, and it caused a temporary improvement in his condition.
However, Jaron's condition did worsen. During his hospitalization Jaron was given fluids by mouth and intravenously. (Testimony indicated the restriction of fluid intake is essential in the treatment of bacterial meningitis because too much fluid in the body causes an increase in fluid pressure on the brain, which can cause brain damage and seizures.) During the first 24 hours, Jaron received a total of 1,570 cc of fluid, and received 1,200 cc during the next 24 hours. During the third 24-hour period, Jaron received 1,750 cc of fluid. There was testimony that the recommended amount of fluid intake in bacterial meningitis is 400 to 1,000 cc each day. Also, no tests were performed to determine if Jaron was experiencing an inappropriate secretion of antidiuretic hormone. Testimony indicated that bacterial meningitis can cause the inappropriate secretion of antidiuretic hormone, which increases the fluid pressure on the brain.
On November 4, 1981, Jaron suffered seizures and was transferred to Cardinal Glennon Memorial Hospital for Children in St. Louis, Missouri. Subsequent evaluation confirmed that the child suffered brain damage.
Several expert medical witnesses were called by the parties to testify at trial:
Plaintiff called Dr. Pothen Jacob as a witness. Dr. Jacob testified that he saw the child on October 31, 1981. He stated that at that time Mr. Boey gave him a history indicating, among other things, that the child had a fever and loose stool for a period of two weeks and had pain in his neck for one week. In response to a hypothetical question setting forth the important facts in the instant case, Dr. Jacob stated that a delay in the diagnosis of bacterial meningitis can cause a delay in appropriate treatment and in turn result in neurological damage. Dr. Jacob testified that he believed there had been a deviation from community standards in Dr. Quaas' treatment of Jaron and stated that in his opinion a spinal tap should have been ordered on October 29, 1981. However, he admitted that he has only treated approximately 10 cases of bacterial meningitis and does not consider himself to be an expert in the diagnosis and treatment of the disease. He further stated that he failed to begin the administration of chloramphenicol on October 31, 1981, that he did not do so until November 2, 1981, and that this delay could have caused Jaron's brain damage. Dr. Jacob also testified about the amount of fluid Jaron received. He admitted that he did not restrict Jaron's intake of fluids and admitted that if Jaron were receiving up to four times the amount of recommended fluids, the excessive fluid was a likely cause of his brain damage and seizure. Dr. Jacob further stated that he failed to monitor Jaron Boey for the inappropriate secretion of antidiuretic hormone.
Dr. Arnold Soslow was called as a witness by plaintiff. Dr. Soslow is a physician who practices in the emergency room of Worchester Memorial Hospital in Worchester, Massachusetts. He stated that he has seen approximately 18 to 20 cases of bacterial meningitis in his career. In Dr. Soslow's opinion, the child had early signs of bacterial meningitis on October 29, 1981, the date on which Dr. Quaas examined the child. He testified that Dr. Quaas deviated from community standards and should have immediately accomplished a lumbar puncture. He further stated that Dr. Quaas' failure to perform the lumbar puncture led to the serious adverse effects. However, on cross-examination, Dr. Soslow admitted that, based on Dr. Quaas' office records for the October 29, 1981, examination of Jaron, he could not find any fault.
Dr. Granoff was called as a witness by defendant. Dr. Granoff is director of pediatrics and infectious disease at St. Louis Children's Hospital in St. Louis, Missouri, and is a member of the faculty of Washington University School of Medicine. He stated he is board certified in pediatrics and further specializes in the diagnosis and treatment of infectious diseases. He has conducted research and has published approximately 50 articles concerning the organism that caused Jaron Boey's bacterial meningitis, hemophilus influenae. Dr. Granoff stated he has treated more than 500 cases of bacterial meningitis in his career. He testified that defendant's care of Jaron met all accepted standards of medical care. He further stated that in his opinion Jaron was not suffering from bacterial meningitis on October 29, 1981. He said that Dr. Quaas' records indicated that Jaron's condition had improved, and Dr. Granoff testified that the condition of a person afflicted with bacterial meningitis does not improve in the absence of treatment but continues to rapidly deteriorate. Dr. Granoff further stated that Jaron was not exhibiting any symptoms of bacterial meningitis on October 29, 1981. Jaron did not have an abnormally elevated temperature, and almost all children suffering from bacterial meningitis experience an elevated temperature. Dr. Quaas' records show that there was no neck stiffness at that time. Dr. Granoff elaborated that bacterial meningitis does not produce intermittent neck stiffness. Finally, he stated the results of the spinal tap indicated that Jaron developed bacterial meningitis after October 29, 1981. It was Dr. Granoff's opinion that if the disease had developed before October 29, 1981, the number of white blood cells in the spinal fluid would have been much higher.
• 1, 2 Plaintiff first contends that the verdict was against the manifest weight of the evidence. In determining whether a jury's verdict is against the manifest weight of the evidence, the inquiry on appeal is whether the result reached is reasonable on the facts and evidence, not whether other conclusions are possible. (Nunley v. Village of Cahokia (1983), 115 Ill. App.3d 208, 214, 450 N.E.2d 363, 367.) In a malpractice case, the plaintiff, by the use of expert testimony, must establish the standards of care against which the defendant doctor's conduct is measured. The plaintiff must further prove by affirmative evidence that, judged in light of these standards, the doctor ...