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Welton v. Ambrose

August 17, 2004


Appeal from Circuit Court of Sangamon County. No. 96L325. Honorable Donald M. Cadagin, Judge Presiding.

The opinion of the court was delivered by: Justice Cook


Plaintiffs, Sanford Welton, Jr., and Adair Ward, are the co-special-representatives for the estate of Sanford Welton, Sr. They appeal from the Sangamon County circuit court's order granting summary judgment in favor of defendants, Dr. James Ambrose and Memorial Medical Center. We affirm in part, reverse in part, and remand for further proceedings.


In 1994, Sanford Welton, Sr. (Welton), went to Memorial Medical Center in Springfield (Memorial) because he noticed that he was becoming excessively fatigued while walking. His doctors determined that surgery could address this problem but that he first needed to undergo a coronary bypass procedure. Dr. William Pyle of Memorial successfully performed the coronary bypass surgery in August 1994.

On the morning of December 7, 1994, Welton returned to Memorial for aorto-bifemoral bypass, left femoral popliteal bypass, and left renal artery bypass surgery to correct the problem with his legs. Pyle conducted this operation as well, and defendant James Ambrose served as the anesthesiologist.

Elayne Whitlock, Welton's wife at the time, accompanied him to Memorial. When they arrived, they spoke first to a nurse, then to an anesthesiologist, whom Whitlock remembered as a dark-complected, apparently Indian man who spoke with an accent. This anesthesiologist suggested that Welton agree to an "epidural" during and after the surgery to control the pain. After first declining, Welton agreed. Neither Whitlock nor Welton remembered seeing Ambrose before the surgery. That morning, Welton signed a form called "Consent to Operative Surgical Procedure." It contained a section that read: "I consent to the administration of anesthesia to be applied by or under the direction of the staff anesthesiologists and to the use of such anesthetics as they may deem advisable."

Before the surgery began, Ambrose placed an epidural catheter in Welton's lumbar region to manage pain during and after the operation. Welton received the drugs fentanyl and bupivacaine, among others, through the epidural. The surgery lasted from 8:40 a.m. until 4:55 p.m., and a few minutes later Welton was taken to a recovery room. He did not see Ambrose again until two days later.

Ambrose is a shareholder of and employed by Associated Anesthesiologists of Springfield (Associated), a corporation that maintains an office at Memorial. Associated maintains a staff of doctors 24 hours a day to provide "pain service" at Memorial. The particular doctor on call ordinarily visits each patient on anesthesia once in the morning and once in the evening.

The morning after the surgery, December 8, Dr. Prasad Kareti of Associated saw Welton and noted that he seemed comfortable and pain-free. At 11:20 a.m. that day, however, two nurses tried to take Welton to use the bathroom and found that he had trouble using his legs. A nurse reported this to Pyle, the surgeon, who determined that it was not abnormal for Welton's legs to be weak so soon after surgery. The same day, Dr. Ramaiah Samala of Associated visited Welton during his evening rounds. Ramaiah found that Welton remained comfortable and free of pain. The epidural remained in place throughout this time.

A nurse recorded on Welton's medical chart that at 7:45 a.m. on December 9, he was having seizure-like activity in his face, arms, and hands, "could only utter words yes, yes, yes," and could not follow commands. Early on December 9, someone turned off the pump attached to the epidural. It is not clear who turned off the pump or exactly when this happened. From December 9 until his death, Welton was paralyzed from the chest down. He was discharged from the hospital in March 1995.

On November 22, 1996, Welton filed a complaint against Ambrose only, alleging that he was negligent in failing to monitor Welton's blood pressure and neurological condition and in failing to discontinue the epidural pump after it was reported that Welton had neurological deficits. A report by Dr. Mervyn Jeffries attached to the complaint offered the opinion that Welton's paraplegia was caused by complications when the epidural anesthesia established during the operation was continued for too long afterward, that the epidural should have been removed after Welton's trouble using his legs on December 8 at 11:20 a.m.

Welton later learned that although Ambrose claimed that he conducted a preanesthetic evaluation on every patient he anesthetized, including Welton, neither he nor Memorial possessed a preanesthetic evaluation form for the December 7, 1994, surgery. Welton then filed a first-amended complaint on November 8, 1999. In addition to raising new allegations to support the negligence claim against Ambrose, Welton added three new claims. Count II alleged lack of informed consent, and count III alleged battery. Finally, count IV added Memorial as a defendant and claimed spoliation of evidence for its loss of the preanesthetic evaluation form.

Welton died of atherosclerotic cardiovascular disease on April 9, 2001. Plaintiffs, Sanford Welton, Jr., and Adair Ward, as representatives of Welton's estate, filed an eight-count, second-amended complaint, in which they continued the previous claims and also realleged them as wrongful-death claims. Ambrose moved for summary judgment as to counts I, II, III, V, VI, and VII. Memorial then moved for summary judgment as to counts IV and VIII. On June 18, 2003, the circuit court granted summary judgment as to all eight counts of the complaint. A docket entry records this event, but the court did not enter a written order.

On July 14, 2003, plaintiffs filed a notice of appeal. The same day, Memorial filed a "Motion for Clarification," seeking to amend certain errors in the docket entry of June 18, 2003. After a hearing on July 25, 2003, the circuit court granted the motion for clarification and issued a written order to that effect on July 31.


A. Preliminary ...

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