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Scardina v. Nam

May 8, 2002


Appeal from the Circuit Court of Cook County. Honorable James S. Quinlan, Judge Presiding.

The opinion of the court was delivered by: Justice Cerda


In this case, plaintiff, William Scardina, appeals the orders of the circuit court directing a verdict in favor of defendants Shin II Eugene Nam, a radiologist, and his employer, Behnifar Associates in Radiology (Behnifar Associates), and entering summary judgment in favor of defendant Alexian Brothers Medical Center (Alexian Brothers) on his claims of medical negligence stemming from the alleged failure of defendants to properly diagnose and treat a gastrointestinal disease known as diverticulitis. The principal issue raised by plaintiff's appeal is whether the evidence introduced at trial was sufficient to allow the jury to consider the issue of Dr. Nam's purported negligence in failing to diagnose plaintiff's ailment and, specifically, whether Dr. Nam's conduct proximately caused plaintiff's condition to worsen and require further medical attention. For the following reasons, we affirm.


Plaintiff's Medical Condition and Treatment

In the latter part of August 1994, plaintiff experienced chronic stomach pain, diarrhea and fever. On August 31, 1994, plaintiff sought treatment from his family physician, Dr. Carlotta Rinke. Because Dr. Rinke was unavailable at the time, plaintiff met with Dr. Rinke's associate, Dr. Ronald Ledvora. Dr. Ledvora examined plaintiff and diagnosed a possible case of diverticulitis. Dr. Ledvora prescribed an antibiotic, Cipro, and instructed plaintiff to schedule a follow-up visit with Dr. Rinke.

Diverticulitis is a disease of the intestines *fn1 . While diverticulitis may affect the small intestine, the condition occurs most frequently in the large intestine, mainly in the sigmoid colonic region. The disease forms where small, weakened pockets of the intestinal wall become inflamed and eventually perforate, thereby creating a fistula, or pathway, for bacteria to escape and leak out into the abdominal cavity. This bacteria, in turn, can lead to the formation of an abscess, a term generally described as a localized collection of pus in the body's tissues which, itself, commonly causes inflammation.

Plaintiff's condition improved slightly over the few days following his visit with Dr. Ledvora. However, by week's end, his condition had worsened and plaintiff returned to Dr. Rinke's office on September 8, 1994. Following an examination, Dr. Rinke advised plaintiff he needed to be hospitalized and seen by a surgeon immediately.

Plaintiff was transported and admitted to Alexian Brothers on September 8, where he was examined by Dr. Cacioppo, a surgeon, and Dr. Nam. An abdominal CT scan, as interpreted by Dr. Nam, revealed the presence of a large abscess in the left side of plaintiff's abdomen and in front of the mid-portion of the descending colon. A large area of inflammation was present in the surrounding areas of fatty tissues that invest the intestines. Based on his observations, Dr. Nam concluded plaintiff's abscess was "most likely related to a perforated intestine." Dr. Nam attempted to trace the abscess to the sigmoid colon or appendix but was unable to due to positioning of the small bowel loops.

Additional tests, including a gastrografin enema, were conducted to determine the presence of any abnormalities with plaintiff's intestines. In a gastrografin enema, a contrast liquid or dye is injected under pressure into the patient's large intestine via the rectum to determine the presence of fistulas, which may be detected by a visualization of the contrast liquid leaking outside the intestinal walls. A number of spot films, or snapshots of a particular area, were taken by Dr. Nam as the contrast liquid progressed through plaintiff's colon. Dr. Nam further prepared overhead films of plaintiff's entire abdominal region throughout the contrast process.

In his diagnostic report, Dr. Nam noted the free flow of contrast from the rectum up to the cecum and observed an abscess cavity in plaintiff's left mid-abdomen, which confirmed the results of the earlier CT scan. Dr. Nam did not directly observe any leakage of the contrast outside the walls of the colon and, specifically, did not note any indications of an early fill, or a premature filling of the small intestine with the contrast before the contrast has moved completely through the colon. According to plaintiff's experts, where no abnormalities exist in the colonic wall, one would normally expect the contrast liquid to fill the entire colon before it enters the small intestine. The filling of the small intestine with contrast liquid before the contrast has filled the entire colon is, according to the experts, abnormal, suggesting the presence of a fistula in some area of the colonic wall. A determination of an early fill is made when no direct evidence of a fistula is apparent and is predicated on the premise that the contrast liquid could only enter the small bowel prior to the filling of the colon if a fistula was present.

Dr. Nam's gastrografin report additionally noted the presence of diverticula in the sigmoid colon and concluded the presence of "mild sigmoid diverticulitis." Dr. Nam, however, did not observe any direct evidence of bowel perforations.

Upon review of the relevant studies and diagnostics, Dr. Cacioppo diagnosed plaintiff with having a small bowel perforation with an intra-abdominal abscess. On September 12, 1994, following drainage of the abscess and the administration of intensive antibiotics, a sinogram, a process in which a contrast liquid is injected into the drained abscess cavity to ascertain whether the abscess in contact with, for instance, the intestinal walls, was performed. The sinogram revealed, according to Dr. Nam's diagnostic report, a communication, or connection, of the abscess with the small intestine, thus confirming Dr. Cacioppo's belief of a small bowel fistula.

Surgery on plaintiff was ultimately performed by Dr. Cacioppo on September 15, 1994. During this procedure, Dr. Cacioppo found the abscess situated between loops of small bowel and in direct contact with the jejunum. Due to its continuity with the small bowel, the abscess had caused three perforations of the jejunum wall. Dr. Cacioppo additionally observed malrotation, or twisting, of plaintiff's small intestine. Dr. Cacioppo extracted both the abscess and the perforated area of the small bowel and rejoined the exposed ends of the jejunum.

While Dr. Cacioppo did not testify during plaintiff's case, the record indicates Dr. Cacioppo would have stated that: due to concerns about the possibility of perforations in the large intestine, he visualized the sigmoid colon for abnormalities but found nothing unusual. Dr. Cacioppo detected no evidence of an enterocolonic fistula, or an abnormal connection between the small and large intestines. Further, the perforated area of plaintiff's small bowel was not in contact with the colon and, in fact, was found by Dr. Cacioppo to be nowhere near the colon. The September 15 surgery did little to alleviate plaintiff's condition. An additional CT scan conducted on September 19, 1994, revealed the formation of a new abscess in the plaintiff's lower pelvic region, in proximity to the sigmoid colon. The ...

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