The opinion of the court was delivered by: Presiding Justice Quinn
Appeal from the Circuit Court of Cook County Honorable James S. Quinlan, Jr., Judge Presiding.
This appeal concerns a medical malpractice action brought on behalf of plaintiff, Taylor Susnis, a minor, by her parents, plaintiffs, Brian and Jami Susnis. Plaintiffs sought recovery for injuries Taylor allegedly sustained days after her birth due to the negligence of defendants. Taylor suffered from cardiorespiratory arrest due to a congenital heart condition and during resuscitation, an interosseous line was inserted that subsequently resulted in damage to the growth plate in her left leg.
At the close of plaintiffs' case, the trial court granted a directed verdict in favor of defendants Dr. Mark Jundanian and Blue Island Radiology Associates (Blue Island). At the conclusion of the trial, the jury rendered a verdict in favor of defendants Dr. Jeffrey Lin and Pronger-Smith Medical Associates (Pronger-Smith). The trial court entered an order of mistrial as to defendants Dr. Baroukh Radfar and St. Francis Hospital and Health Center (St. Francis) when the jury was unable to arrive at a verdict. On appeal, plaintiffs contend that: (1) the trial court erred in granting a directed verdict for Dr. Jundanian and Blue Island on the issue of proximate cause where plaintiffs produced sufficient evidence that Dr. Jundanian breached the standard of care; and (2) pursuant to Supreme Court Rule 213 (177 Ill. 2d R. 213), the trial court erred in barring plaintiffs' expert from testifying that the actions of Dr. Lin and Pronger-Smith caused or contributed to Taylor's injuries. For the reasons that follow, we affirm.
The following facts were adduced at trial. Taylor Susnis was born on August 22, 1992, at St. Francis. On August 23, 1992, Dr. Radfar, a pediatrician on staff at St. Francis, examined Taylor and found her to be a normal newborn. On August 24, 1992, at approximately 6:30 a.m., a nurse observed that Taylor's heart rate was rapid, her lips were blue, and she was hypoactive or unresponsive when moved. The nurse moved Taylor to a special care nursery for further observation and contacted Dr. Radfar at approximately 7:30 a.m. to inform him of her condition. Based on Taylor's condition, Dr. Radfar ordered several tests, including an electrocardiogram (EKG), which is used to evaluate heart rate and rhythm, and a chest X ray. A nurse contacted Dr. Radfar again at approximately 1 p.m. on August 24, 1992, and informed him that Taylor was stable and active and that she was not having any more problems. Dr. Radfar testified that after he examined Taylor at approximately 6:30 p.m. the same day, he evaluated her chest X ray and found it be normal. Dr. Radfar also testified that he customarily relied on the expertise of radiologists to interpret X rays and that he relied on the expertise of Dr. Jundanian in this case to interpret Taylor's chest X ray.
Dr. Radfar stated that Taylor's condition on August 24, 1992, was due to fluid in the lungs, which is a normal and temporary condition in a newborn, and was not due to cardiac problems. However, Dr. Radfar testified in an earlier deposition that Taylor did not have fluid in her lungs. The record indicates that this condition was not mentioned in Taylor's medical charts. Dr. Radfar also admitted that he did not order an echocardiogram, which is the definitive test for diagnosing cardiac problems. Dr. Radfar indicated that, in his opinion, the echocardiogram was unnecessary because Taylor did not have any persistent problems. Dr. Radfar further testified that he did not order a consultation with a pediatric cardiologist for the same reason. In 1992, the standard of care would have required a pediatric consult if the doctor saw a cardiac anomaly or an enlarged heart.
Dr. Jundanian testified that he read Taylor's chest X ray on August 24, 1992, but did not recall if he actually spoke with Dr. Radfar about her condition. Dr. Jundanian stated in his report that Taylor's pulmonary vascularity was slightly prominent, which, among other things, could have been a cardiac abnormality. Dr. Jundanian further testified that he thought Taylor's heart size was within normal limits and not enlarged. However, Dr. Jundanian also testified that if Dr. Radfar had called and asked whether Taylor's chest X ray was normal or abnormal he would have told him that it was abnormal.
On August 25, 1992, Dr. Radfar examined Taylor again prior to her discharge from the hospital. Dr. Radfar testified that his examination indicated that she was doing well, her heart was beating with a regular rhythm, and she had no fluid in her lungs. Taylor was discharged from St. Francis on August 25, 1992, and Dr. Radfar arranged to see her two days later to ensure that she continued to do well.
On August 26, 1992, Jami Susnis brought Taylor to Dr. Jeffrey Lin's office for a checkup. Jami Susnis informed Dr. Lin of Taylor's problems at the hospital. After a complete examination, Dr. Lin determined that Taylor was doing well; she was alert and active, her skin color was normal and her heart sounds were regular. Dr. Lin also discovered that a chest X ray had been taken but did not order or examine the X-ray charts. Although Dr. Lin contacted St. Francis and noted that Taylor's chest X ray stated that there was "increased lung marking," he did not order a second chest X ray.
On August 28, 1992, Dr. Lin examined Taylor again because she had gained more weight than average for a newborn of her age. Dr. Lin testified that the baby appeared normal at the exam and he arranged for another checkup a week later.
On August 30, 1992, Jami Susnis observed "white stuff" coming out of Taylor's mouth and nose. Jami Susnis attempted to clear Taylor's nose and mouth, but when she remained congested, Jamie Susnis contacted Dr. Lin's office. Another doctor at the office advised that Taylor was probably suffering from a cold. However, when Taylor seemed to worsen, Jami Susnis took her to the emergency room at St. Francis.
Taylor suffered a cardiorespiratory arrest in the St. Francis emergency room. Taylor was resuscitated and then transferred to Christ Hospital. In order to save her life, the doctors at Christ Hospital inserted an interosseous line in her leg to resuscitate her. An interosseous line is a form of emergency vascular access to insert fluids or other medications in cases where a patient's peripheral veins are not easily accessible. A special needle is manually drilled into the hollow center of the bone and then fluid is pumped directly into the center of the bone.
Taylor was treated for multi-organ failure, and on September 18, 1992, she underwent heart surgery to treat an interrupted aortic arch. Although Taylor's heart problems were resolved, she suffered severe damage to the growth plate in her left leg, apparently as a result of the interosseus line.
Dr. Mark Moran testified that he first saw Taylor on March 3, 1997. By this time, Taylor had undergone at least two unsuccessful surgeries in an attempt to repair the damage to the growth plate in her left leg. Dr. Moran observed that Taylor's condition began with partial growth arrest of her tibia and by the time he treated her, the entire proximal tibia had stopped growing. Dr. Moran testified that X rays performed early on in her treatment indicated that the growth plate appeared normal for a child of Taylor's age. However, Dr. Moran further testified that, as Taylor gets older, there will be a leg length discrepancy with the left leg becoming progressively shorter than the right.
Brian and Jami Susnis filed a complaint on Taylor's behalf and individually and alleged that Dr. Radfar, Dr. Lin and Dr. Jundanian each failed to observe abnormal cardiac and pulmonary vascular findings in Taylor's chest X ray. Plaintiffs also sued Pronger-Smith, a multispecialty practice group to which Dr. Lin belongs, and Blue Island, Dr. Jundanian's practice group. While these entities are parties to this appeal, plaintiffs allege only that the doctors are agents of these entities and they make no claims that the entities were independently negligent. Count II of the complaint alleged that St. Francis failed to timely and adequately triage Taylor upon her arrival to the emergency room.
Prior to trial, several motions in limine were filed, including a motion to limit any testimony regarding Dr. Lin's deviations from the standard of care unsupported by testimony or evidence of causation which the trial court granted. The court also granted Dr. Lin's motion in limine barring plaintiffs' opinion witnesses from offering any opinions not previously expressed in depositions or Rule 213 interrogatories. Dr. Jundanian adopted Dr. Lin's motions as they applied to him. The court also granted Dr. Radfar's motion in limine barring plaintiffs' experts from testifying as to causation not previously testified to in discovery.
During trial, Dr. Marilyn Siegel, one of plaintiffs' experts, testified that, in her opinion, Dr. Jundanian did not meet the standard of care. Dr. Siegel opined that Dr. Jundanian should have known from the chest X ray that Taylor's heart was enlarged.
Dr. Robert Lerer provided expert testimony that, in his opinion, Dr. Radfar and Dr. Lin deviated from the standard of care by not requesting a cardiology consult for Taylor based upon the signs and symptoms she exhibited after delivery. In Dr. Lerer's opinion, Taylor's chest X ray was abnormal and her heart was enlarged. Dr. Lerer testified that, based upon these signs, an echocardiogram should have been ordered or a cardiology consult should have occurred. As to Dr. Lin specifically, Dr. Lerer testified that he deviated from the standard of care by failing to obtain all of Taylor's medical records on August 26, 1992, and on August 28, 1992. Dr. Lerer added that Dr. Lin deviated from the standard of care by not examining Taylor's femoral pulses on August 26, 1992, and August 18, 1992. However, on cross-examination, Dr. Lerer testified that there was nothing in the physical examination that would have suggested heart disease to a reasonably well-qualified pediatrician and that it was unreasonable to have expected Dr. Lin to have had Taylor's hospital records by the first time he examined her on August 26, 1992.
Plaintiffs' interrogatories and supplemental interrogatories dated November 5, 1998, named Dr. David C. Schwartz as a witness who would provide testimony that Taylor suffered injury as a result of the interosseous line placed in her leg. In plaintiffs' answers to Rule 213 interrogatories, plaintiffs stated that Dr. Schwartz would render the following opinions: (1) based upon Taylor's symptoms, the EKG and the chest X ray, Taylor should have been examined by a pediatric cardiologist; and (2) if a pediatric cardiologist had examined Taylor, an echocardiogram would have been ordered which would have shown the congenital heart condition.
At Dr. Schwartz's deposition, the following testimony was elicited:
"Q. Do you have any opinions in this case regarding the cause of the left tibial growth arrest for Taylor Susnis in her left leg?
Q. Have you reviewed any records pertaining to the left tibial growth arrest?
Q. When Taylor Susnis was first examined by Dr. Radfar, was it appropriate for Dr. Radfar to order an EKG and x-ray?
*** A. I don't think so, because I believe that exam was the -the day of birth, or at least within 24 hours. And my impression, from the medical record, was that at that point the baby was fine. There were no symptoms being recorded by the ...