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10/31/95 CONNIE A. HOLDER v. JUDE CASELTON

October 31, 1995

CONNIE A. HOLDER, AS SPECIAL ADMINISTRATOR OF THE ESTATE OF RICHARD HOLDER, DECEASED, PLAINTIFF-APPELLANT,
v.
JUDE CASELTON, M.D. AND JOSE PARCON, M.D., D/B/A JOSE PARCON, M.D., S.C., A CORPORATION, DEFENDANTS-APPELLEES.



Appeal from Circuit Court of Greene County. No. 92L17. Honorable James W. Day, Judge Presiding.

Released for Publication December 4, 1995. As Corrected December 6, 1995. Petition for Leave to Appeal Denied January 31, 1996.

Justices: Honorable Robert J. Steigmann, J., Honorable James A. Knecht, P.j., Honorable Robert W. Cook, J., Concurring. Justice Steigmann delivered the opinion of the court: Knecht, P.j., and Cook, J., concur.

The opinion of the court was delivered by: Steigmann

JUSTICE STEIGMANN delivered the opinion of the court:

Plaintiff, Connie A. Holder, special administrator of the estate of Richard Holder (Holder), sued defendants, Jude Caselton, M.D., and Jose Parcon, M.D., for medical malpractice, alleging that defendants failed to diagnose and treat Holder's acute appendicitis and sepsis. In May 1994, a jury returned a verdict for defendants. Plaintiff appeals, arguing that (1) the jury verdict was against the manifest weight of the evidence; (2) defendants presented irrelevant and prejudicial testimony and argument which deprived plaintiff of a fair trial; (3) the trial court erred by (a) limiting testimony regarding the effects of a certain drug, and (b) improperly instructing the jury. We affirm.

I. BACKGROUND

On June 23, 1991, Holder went to the emergency room at Boyd Hospital in Carrollton with a sudden onset of epigastric pain. Dr. Caselton examined Holder and, believing he might have acute gastritis, gave him pain medication and told him to return if his pain did not subside. On June 25, 1991, Holder returned to the emergency room, complaining of right lower quadrant abdominal pain, lack of appetite, and slight nausea. Dr. Caselton examined Holder and found that he had diffused abdominal tenderness, mainly in the right lower quadrant. Dr. Caselton admitted Holder to the hospital and ordered lab tests, including a complete blood count and urinalysis. At that time, Holder was 6 feet 4 inches and weighed 344 pounds.

At admission, Holder's white blood cell count was elevated, and his urine was loaded with red blood cells. Holder had a long history of urinary tract problems, including dilated ureters, presence of uric acid stones, and passing of stones, as well as blood in his urine. He also had previously complained of pain in his right flank and right abdomen. On June 25, Dr. Caselton suspected urate calculi and uropathy and intended to observe Holder for acute abdomen with early acute appendicitis. After admitting Holder, Dr. Caselton instructed nurses to strain Holder's urine to monitor for blood and uric acid stones. During his entire hospital stay, Holder passed blood in his urine.

On June 26, 1991, Dr. Caselton asked Dr. Parcon, a general surgeon, to examine Holder. Dr. Parcon did so and found (among other determinations) that Holder showed signs of bowel function and had pain over both lower quadrants. An intravenous pyelogram (IVP) performed that same day showed no complete obstruction of Holder's ureters; nonetheless, Holder's white blood count remained elevated. At the time he examined Holder, Dr. Parcon believed that Holder's abdomen did not require immediate exploratory surgery. Dr. Caselton concurred in Dr. Parcon's opinion.

On June 27, 1991, Dr. Caselton examined Holder and found no tenderness or rigidity in the abdomen. On June 28, Holder's white blood count was within normal limits. On June 29, Holder's white blood count was still within normal limits. Dr. Caselton thought that Holder seemed better and displayed bowel sounds and a soft, less tender abdomen. On June 29, nurses strained Holder's urine and found a "black prickly stone." Late in the evening on June 29, Holder began deteriorating, complaining of lower right quadrant pain, and voiding dark brown and stained urine. He also had decreased blood pressure.

During the morning of June 30, 1991, Holder complained of severe abdominal pain and had rapid respiration. During the afternoon of June 30, Holder denied any pain, and his blood pressure was in the low normal range. At this time, Dr. Caselton thought Holder had renal colic and a decompressing belly that was "throwing off" pulmonary emboli. On July 1, 1991, Dr. Caselton, believing that Holder required the care of a specialist, ordered Holder transferred from Boyd Hospital to Passavant Hospital in Jacksonville. Holder died en route, and an autopsy revealed that his cause of death was peritonitis from a bacterial infection caused by a ruptured acute appendix.

II. ANALYSIS

A. Plaintiff's Claim that the Verdict Was Against the Manifest Weight of the Evidence

Plaintiff first argues that the jury verdict was against the manifest weight of the evidence because plaintiff showed that defendants violated the appropriate standard of care by failing to diagnose and treat Holder's acute appendicitis and sepsis. Plaintiff cites the testimony of Dr. Miedema, one of her experts, that when a patient presents with abdominal pain "out of the blue," a physician must rule out acute appendicitis.

To prove negligence in a medical malpractice case, a plaintiff must show that the treatment received deviated from the appropriate standard of care. ( Witherell v. Weimer (1987), 118 Ill. 2d 321, 333, 515 N.E.2d 68, 74, 113 Ill. Dec. 259.) In order for a verdict to be against the manifest weight of the evidence where the evidence is conflicting, an opposite conclusion must be clearly evident. Flynn v. Edmonds (1992), 236 Ill. App. 3d 770, 794, 602 N.E.2d 880, 895, 176 Ill. Dec. 934.

Plaintiff claims that no credible expert testimony contradicted her evidence that defendants violated the standard of care by failing to rule out acute appendicitis, and she cites Carman v. Dippold (1978), 63 Ill. App. 3d 419, 379 N.E.2d 1365, 20 Ill. Dec. 297, as supporting her claim. We disagree.

In Carman, the defendant doctor did not use or have forceps available during a breech delivery. ( Carman, 63 Ill. App. 3d at 424, 379 N.E.2d at 1368.) All the doctors who testified in Carman said that forceps should have been on the instrument tray and used if other procedures were unsuccessful. ( Carman, 63 Ill. App. 3d at 424, 379 N.E.2d at 1368.) The defendant in Carman presented no expert testimony in support of his continued use of an alternative procedure during the delivery. Carman, 63 Ill. App. 3d at 427, 379 N.E.2d at 1370.

Unlike Carman, defendants in the present case did offer expert testimony that supported their actions and contradicted plaintiff's claim that their conduct deviated from the appropriate standard of care. Dr. Burch, one of defendants' experts, testified that it was very reasonable for Dr. Caselton to assume that Holder's problem was urological in nature and that Dr. Caselton acted appropriately in not diagnosing acute appendicitis. Dr. Burch also stated that Holder's elevated white blood count on June 30, 1991, did not necessarily discount the presence of renal colic, and Holder could have developed an infection in his ureter.

Dr. Petrovich, another defense expert, testified that Dr. Caselton met acceptable medical standards in his care and treatment of Holder and that Dr. Caselton's failure to diagnose acute appendicitis was reasonable and within acceptable medical standards. Dr. Petrovich stated that there is no one test to detect appendicitis, and the coexistence of urinary tract disease and appendicitis makes diagnosis "extraordinarily difficult."

Dr. Wilson, a physician who had previously treated Holder, testified that Holder complained of pain in his right flank and right abdomen in 1983. Dr. Wilson also stated that it would have been negligent to operate on a patient with right lower quadrant pain ...


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