However, Dr. Fisk opined that the failure to personally examine plaintiff's foot on the evening of January 13, 1995, resulted in lost time and caused plaintiff to lose his right foot. Dr. Fisk testified that the clinical signs before surgery indicated compartment syndrome and that, upon operating on the foot, he made the diagnosis of compartment syndrome. He stated that the bulging of the muscle out of the compartment after cutting the tissue is indicative of the pressure that existed in the compartments of the foot and, therefore, indicated that plaintiff's foot suffered from compartment syndrome. He continued to explain that compartment syndrome is a condition whose seriousness is determined by time.
After the trial, plaintiff obtained new counsel, and on March 27, 1998, the trial court granted plaintiff an extension of time to file his posttrial motion so his new counsel could review the proceedings. On May 18, 1998, the parties agreed to grant plaintiff an additional two-week extension to file his posttrial motion. An extension was again granted on May 29, 1998, until June 30, 1998, because plaintiff made a motion to interview the jurors.
At this point, defendant requested a Doppler study, a test that checks the circulation of the arteries and veins, and he also requested that Dr. Inder Khokha, a vascular surgeon, see plaintiff. Nurse Werner informed defendant that the Doppler technician was not present at the hospital and that Dr. Khokha was in his car en route to Chicago. Defendant then requested that plaintiff be transferred to a hospital with a vascular surgeon; however, before the transfer order went through, a technician arrived, and the Doppler study was conducted. Defendant asked for the technician to call him when the results of the Doppler study were known. On cross-examination Nurse Werner stated that she listed plaintiff's pain as a six on a one-to-ten scale and that plaintiff could move his toes.
While conceding that vascular damage may coexist and even cause compartment syndrome, he stated that the records indicate that plaintiff had adequate circulation to his toes immediately following the initial trauma. Only over a period of days did circulation to plaintiff's toes show signs of decreasing. In fact, Dr. Fisk notes that plaintiff could move his toes when leaving St. Anthony's, could not move his great toe when Dr. Mansour examined him upon arriving at St. John's, and could not move any toes before surgery at Memorial. Dr. Fisk opined that this demonstrates that the pressures were increasing in the foot compartments and slowly cutting off circulation. Dr. Fisk also conceded that the dead skin on the top of plaintiff's foot is usually indicative of vascular injuries but that when compartment syndrome advances to a certain point, this can occur because the pressure has cut off all circulation.
However, plaintiff had good circulation immediately following the accident on January 10, 1995, and only developed decreased circulation on January 13, 1995. The evidence shows that plaintiff suffered from compartment syndrome that could have been diagnosed in the late afternoon or early evening on January 13, 1995. Dr. Myerson testified that he believed that defendant followed the applicable standard of care in ordering vascular studies for plaintiff on January 13, 1995. He also agreed with defendant's decision to transfer plaintiff to a hospital with a vascular surgeon.
The jury may have concluded that Dr. Pierron was correct, which would reconcile all the physician testimony. If plaintiff suffered a vascular injury that developed into compartment syndrome, then the testimony of Dr. Lang and Dr. Myerson could be reconciled.
Dr. Mansour received a history from plaintiff and conducted a physical examination of plaintiff's foot. Dr. Mansour stated that plaintiff's ankle was receiving circulation but that his toes were not.
After his examination of plaintiff, Dr. Lang contacted Dr. Fisk to discuss the case. Dr. Lang relayed the results of the physical exam and stated his diagnosis of compartment syndrome. He told Dr. Fisk that the diagnosis was from the physical evaluation. Dr. Fisk agreed with Dr. Lang's diagnosis, and he agreed that surgery was needed to relieve the pressure. Dr. Fisk believed that plaintiff's foot would benefit from increased oxygen immediately after surgery, and he recommended that plaintiff be put in a hyperbaric oxygen chamber.
Dr. Fisk testified that plaintiff suffered from compartment syndrome. He based this diagnosis on the state of the muscles within the foot that he observed during surgery. This diagnosis was supported by Dr. Mansour, who clinically diagnosed plaintiff with compartment syndrome, and Drs.
Lang and Wottowa, who not only clinically diagnosed plaintiff with compartment syndrome but also observed the muscles during the fasciotomy. Plaintiff also presented an expert, Dr. Grear, who, based upon a review of depositions and medical records, testified that he believed that plaintiff suffered from compartment syndrome. Dr. Fisk first saw plaintiff in the operating room at Memorial, where Dr. Wottowa and Dr. Crickard were present to assist in the procedure. Multiple incisions were made on the compartments in plaintiff's foot. Dr. Fisk testified that upon incising the compartments, the muscles bulged out and appeared grayish-red in color.
However, he testified that defendant deviated from the standard of care by neglecting to personally examine plaintiff that evening. Dr. Grear stated that if defendant had visited and properly diagnosed plaintiff with compartment syndrome, then the chances of saving plaintiff's foot would have been considerably higher, because the determinant of whether compartment syndrome results in muscle death is the swiftness with which a physician can relieve the pressure in the compartments. Defendant's first expert was Dr. Robert Pierron, an orthopaedic surgeon and associate professor of orthopaedics at St. Louis University. Dr. Pierron opined that plaintiff suffered an arterial or vascular injury.
Dr. Lang did concede that arterial or vascular trauma could eventually develop into compartment syndrome but stated that he did not believe that to be the case here. He testified that the fact that plaintiff had circulation to his toes immediately following the initial trauma on January 10, 1995, indicates that blood flow was compromised only after the compartment syndrome worsened and not vice-versa.
388, 663 N.E.2d at 147. However, the jury cannot accept expert testimony arbitrarily.
On July 26, 1995, plaintiff filed a four-count complaint against Bonutti Orthopaedic Services, , St. Anthony's Memorial Hospital in Effingham (St. Anthony's), Peter Bonutti, M.D., and Timothy Gray, M.D. (defendant). St. Anthony's filed an answer on August 21, 1995, and the remaining defendants filed their answers on September 22, 1995.
The evidence at the trial indicates that it was compartment syndrome. Every physician, save two, testified within a reasonable degree of medical certainty that plaintiff suffered from compartment syndrome.
Sarah Bush Lincoln President and CEO Jerry Esker, said, “This is an exciting time for us. The Bonutti physicians and mid-level providers are very talented and we are thrilled to work with them to create a regional presence in orthopedic care. Additionally, Effingham County residents have access to the orthopedic surgery-neurosurgery team that is already in place at Sarah Bush Lincoln’s main campus in Mattoon. It consists of orthopedic surgeons Eric Brewer, DO, Michael Chioffe, MD, James Kohlmann, MD, Louis Mendella, DO, Donald M. Sandercock II, DO, FAOAO, Jeremy Stevens, MD, and Neurosurgeon Emilio Nardone, MD, FAANS. All are board certified except for Dr. Brewer, who is board-prepared and finishing requirements for board certification.
On April 11, 1997, St. Anthony's filed a motion for summary judgment as to counts II and III. Plaintiff responded by filing a motion to voluntarily dismiss, without prejudice, counts II and III on May 1, 1997, which the trial court granted. On February 24 through 26, 1998, a trial was held against Dr. Gray and Bonutti Orthopaedic Services, The jury returned a verdict in favor of those defendants and against plaintiff. The trial court entered the judgment on February 27, 1998.
Dr. Lang testified that from the onset of compartment syndrome, a patient has a six- to eight-hour window for a realistic chance of saving the muscles. In this case, that window had passed by the time surgery was performed. From a review of St. Anthony's records, as well as the testimony of the nurses at St. Anthony's, Dr. Lang opined that only defendant, as plaintiff's physician during the crucial time period, could have diagnosed the compartment syndrome and saved the muscles in plaintiff's foot. Therefore, defendant deviated from the standard of care owed to plaintiff.
The jury must consider the facts and the evidence upon which the experts base their opinions. In this case, all the physicians had access to the same records. Defendant's expert, Dr. Myerson, had less personal knowledge to base his opinion than Drs.
All members of the seven-physician medical group will continue to serve the orthopedic needs of Effingham-area residents in the new clinic, SBL Bonutti Clinic. They include Peter Bonutti, MD, FACS, FAAOS, FAANA, (hip, knee and shoulder arthroscopy and arthroplasty), Timothy Gray, MD, FAAOS, (trauma surgery), Frank Lee, MD, FAAOS, (hand, shoulder and upper extremity), Didi Omiyi, MD, (joint replacement and robotic surgery), Karl Rudert, DO, FACEP, (emergency medicine and occupational medicine), Joseph Ajdinovich, MD, (sports medicine), and Jonathan Workman, DO, (spine surgery). All are board certified except for Dr. Ajdinovich and Dr. Workman, who are board-prepared and completing requirements for board certification. Mid-level providers at the clinic include Kayla Deters, APN, Stacia Fallert, APN, Jennifer Hess, APN, Nickolas Williams, PA-C, Thomas Williams, PA-C, and Lucas Zumbahlen, APN.
Written by Mary Rechtoris | September 11, 2015 |Print|Email Peter Bonutti, MD, is an orthopedic surgeon practicing at The Bonutti Clinic in Effingham, Ill. Dr. Bonutti founded the clinic in 1989, and the clinic provides innovative musculoskeletal care for its national and international patients. Dr. Bonutti devised several products including an arthroscopic introduction system, bone buttons for rotator cuff repairs and minimally invasive fracture fixation buttons among several others. Dr. Bonutti said that since he is free of the business responsibilities of operating a large medical practice, he has more time for patient care innovation and research to enhance the quality of care.
He based this conclusion on a CT scan of plaintiff's foot, which had been taken in the emergency room at St. Anthony's. He testified that the records did not indicate pain out of proportion with a calcaneus fracture on the level of severity as that suffered by plaintiff. He testified that defendant did not deviate from the standard of care by not personally examining plaintiff on the evening of January 13, 1995. He stated that it is not inappropriate for a physician to rely on the physical examination conducted by a nurse and that a physical examination would not have resulted in a different report of the findings of the foot.
Dr. Fisk opined that defendant deviated from the standard of care owed to plaintiff by failing to personally examine plaintiff on the evening of January 13, 1995. Dr. Fisk believes that the reports that the nurses were giving defendant should have alerted him that something was happening and that a physical examination by a physician was necessary. Dr. Fisk did not have a problem with anything else that defendant did or did not do. He agreed that consulting a vascular surgeon was appropriate and the prudent thing to do.
Muscles are surrounded by tissue that keeps them in compartments, and when the pressure inside these compartments increases to a certain level, the expansion begins to pinch the arteries. When the pressure is great enough, the arteries can close, causing blood flow to stop. Eventually, if not relieved, compartment syndrome leads to muscle necrosis or death.
Hajian, 273 Ill.App.3d at 937, 210 Ill.Dec. 156, 652 N.E.2d at 1136-37; Chambers v. Rush-Presbyterian-St. Luke's Medical Center, 155 Ill.App.3d 458, 108 Ill.Dec.
He founded the Bonutti Clinic in 1989 and continues an active surgical practice specializing in minimally invasive shoulder, hip and knee surgery pioneering numerous minimally invasive instruments, implants and techniques. Dr. Bonutti has authored over 100 clinical research papers and over 500 patents / applications in areas including medical device technology, rehabilitation, and biologics. Bonutti Technologies was founded in 1990 focusing on early stage medical device innovation and design. He started several medical companies including Joint Active Systems, Axiosonic, Osteoweld and has licensed technology to over 20 US and international Medical Device Companies. Reliance on the “five Ps”-pain out of proportion, pallor, pulselessness, paresthesia, and pain with passive motion-is useless according to Dr. Myerson.
He did not believe that defendant's care for plaintiff contributed to the amputation of plaintiff's right foot. However, Dr. Myerson did criticize the sending of plaintiff to a vascular surgeon, because the injury was at a level of the circulatory system where a microvascular surgeon was required. The final expert to testify was Dr. Mark Myerson, a board-certified surgeon. Dr. Myerson opined that plaintiff never suffered from compartment syndrome and that all the physicians who testified that he did were incorrect. Dr. Myerson noted a “spike” of bone protruding into plaintiff's neurovascular bundle of the right foot.
(Blanching occurs when one applies pressure to the skin and the skin whitens and upon the release of the pressure, the skin returns to its normal color. How swiftly the skin responds to this indicates the level of circulation in that part of the body.) Nurse Niemerg believed that plaintiff could wiggle his toes on January 12, 1995. On January 10, 1995, plaintiff suffered multiple fractures to his right foot. Plaintiff's most severe fracture was of the calcaneus (heel) bone. The fracture was described by all the physicians and nurses who examined plaintiff as highly comminuted, or broken into multiple pieces. The calcaneus does not break along lines as other bones; rather, it shatters when suffering a trauma.
On November 12, 1996, plaintiff filed a voluntary motion to dismiss the claim against Dr. Bonutti, and the trial court granted the motion on December 6, 1996. Plaintiff filed an amended four-count complaint. Drs. Bonutti and Gray and Bonutti Orthopaedic Services filed their answers on January 2, 1997, and St. Anthony's filed its answer on January 9, 1997.
In this case, the weight of expert testimony would lead a reasonable person to the conclusion that plaintiff suffered from compartment syndrome at some point in time. Plaintiff established the time period in which defendant was responsible for the care of plaintiff and that during that period of time defendant could have diagnosed plaintiff's condition. The evidence demonstrates that defendant did not personally come to the hospital to examine plaintiff, even after being requested to by plaintiff's nurses. Plaintiff has proven, at the very least, that the chances of saving his foot would have been greater had defendant physically examined his foot. Therefore, we conclude that the jury's verdict was against the manifest weight of the evidence.
On cross-examination, the defense questioned Dr. Lang as to why he had time to transfer plaintiff but did not have time to check plaintiff's compartment pressures. Dr. Lang explained that the time it takes to prepare an operating room at either hospital is the same and that a transfer by an ambulance would not affect the swiftness with which a patient and facility could be ready for surgery. Number of Founded Organizations 1 CB Rank (Person) 509,590 Peter Bonutti Location Decatur, Illinois, United States Regions Great Lakes, Midwestern US Gender Male LinkedIn View on LinkedIn Peter Bonutti,MD is Founder at Bonutti Technologies. is an orthopedic surgeon and innovator.
He founded the Bonutti Clinic in 1989 and continues an active surgical practice specializing in minimally invasive shoulder, hip and knee surgery pioneering numerous minimally invasive instruments, implants and techniques. Dr. Bonutti has authored over 100 clinical research papers and over 500 patents / applications in areas including medical device technology, rehabilitation, and biologics. Bonutti Technologies was founded in 1990 focusing on early stage medical device innovation and design. He started several medical companies including Joint Active Systems, Axiosonic, Osteoweld and has licensed technology to over 20 US and international Medical Device Companies.
Dr. Myerson explained that the foot has a bundle consisting of nerves, arteries, and veins and that the severe fracture of the calcaneus bone caused a fragment of bone to jut into the bundle. He further testified that the Doppler study conducted on January 13, 1995, illustrates that the tibial artery was not open. He opined that the bone fragment in the neurovascular bundle either cut the artery or pinched it so that the blood flow to the muscles in the foot was decreased. Either way, the problem was a vascular problem suffered from the initial trauma to the calcaneus bone.
He bases this upon the time it takes from the onset of compartment syndrome until muscle death (six to eight hours), as well as the testimony of the nurses at St. Anthony's and the records from St. Anthony's. The first physician to see plaintiff at St. John's was Dr. Ashraf Mansour, a vascular surgeon.
On redirect examination, Nurse Werner stated that plaintiff could wiggle his toes; however, she stated that he did not want to do so because the pain was too intense. Plaintiff did not need to prove that if defendant had come to the hospital and examined plaintiff, that would have prevented plaintiff's foot from being amputated. The Illinois Supreme Court settled the question of whether to use the “loss of chance” doctrine or the “better result” test, in Holton v. Memorial Hospital, 176 Ill.2d 95, 223 Ill.Dec.
The defense correctly asserts that assessing the weight and credibility of testimony is exclusively in the province of the jury. See Wodziak, 278 Ill.App.3d at 913-14, 215 Ill.Dec. 388, 663 N.E.2d at 147. When conflicting testimony exists, it is for the jury to resolve the conflict. See Wodziak, 278 Ill.App.3d at 913-14, 215 Ill.Dec.