Gorman v. Shu-Fang Chen, M.D., Ltd.

Citations: 231 Ill. App. 3d 982; 596 N.E.2d 1350Docket: No. 5—91—0250

Court: Appellate Court of Illinois; July 29, 1992; Illinois; State Appellate Court

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Victoria Gorman filed a medical malpractice lawsuit against Dr. Shu-Fang Chen and his medical practice following alleged negligence in treating her injuries from a bicycle accident. Gorman claimed that Dr. Chen failed to conduct a proper examination of her temporomandibular joint (TMJ) or consult a specialist, resulting in a missed diagnosis of a fracture in her right temporomandibular condyle. This oversight led to her undergoing a total right TMJ reconstruction with condylectomy. A jury awarded Gorman $816,900 after a trial in Madison County. 

On appeal, defendants challenged the trial court's decisions, arguing: 1) the admissibility of expert testimony from plastic surgeon Dr. Alvin Zook regarding the orthopedic standard of care; 2) modifications made to an Illinois Pattern Jury Instruction related to the standard of care; and 3) the allowance of certain testimony from Dr. Maurice Miller, another witness for the plaintiff.

The incident occurred on March 31, 1986, when Gorman, then 18, lost control of her bicycle and sustained multiple injuries, including a laceration to her chin and a dislocated right hip. She was treated at Oliver-Anderson Hospital, where emergency physician Dr. Michael Wade noted her injuries and ordered various X-rays. Dr. Chen, who was the on-call physician, examined Gorman and identified her major injuries but did not address her jaw swelling, which Gorman's mother observed over several days. Witness testimonies noted significant facial swelling and other complications that persisted during her hospital stay.

Larry Ashlock observed that the plaintiff had significant jaw swelling during his hospital visit in early April, resembling a 'giant jaw breaker' near her cheek. John Sworm, the plaintiff's stepfather, noted a pronounced lump on the plaintiff's right side that diminished over a week. The plaintiff herself reported a golf ball-sized swelling that lasted four to five days. However, Dr. Chen, who attended to the plaintiff daily, reported no complaints of jaw swelling or TMJ issues from either the plaintiff or her mother, and no swelling was noted in her hospital chart, nor were any X-rays taken of her jaw. Dr. Maurice Miller, consulted for the plaintiff's hip issues, also made no mention of jaw problems during his assessment on April 12. 

After her discharge on April 14, Dr. Harry Stadnyke, the plaintiff's dentist, discovered a jaw movement discrepancy and diagnosed a fracture after taking X-rays on April 17, leading to a referral to oral surgeon Dr. Mark Travis. Dr. Travis treated the fracture with non-surgical methods and later performed a total joint implant surgery on July 21, 1986, due to insufficient progress from conservative treatment. 

The defendants argued that allowing the plaintiff's plastic surgeon expert to testify about the standard of care for Dr. Chen, an orthopedic surgeon, was erroneous. To establish a case of medical malpractice, the plaintiff must demonstrate the relevant standard of care, a breach of that standard, and resulting injury. Expert testimony is generally required to establish this standard unless the negligence is obvious to a layperson. Section 8.2501 of the Code of Civil Procedure outlines the qualifications for expert witnesses in medical malpractice cases, specifying the criteria for determining whether a witness can testify regarding the standard of care.

Key factors for determining the qualifications of a medical expert witness in malpractice cases include the relationship of the witness’s medical specialty to the case’s medical issues (a), the extent of the witness’s relevant practice, teaching, or research experience (b), whether the witness holds a license in the same profession as the defendant (c), and in cases against nonspecialists, the witness's familiarity with state standards of care (d). The trial court has discretion in deciding a physician's qualification as a medical expert (Smock v. Hale, 1990).

In this case, defendants concede that plaintiff’s expert, Dr. Zook, satisfies criteria (b) and (c), while (d) is deemed irrelevant. They contend Dr. Zook lacks qualifications under (a) to opine on whether Dr. Chen, an orthopedic surgeon, deviated from acceptable practice. However, this argument is rejected. Citing *Petkus v. Girzadas* (1988), the court emphasizes that the expert’s testimony on general medical standards is sufficient, regardless of their specific specialty, as the alleged negligence relates to general post-operative care, not specialized orthopedic treatment. Thus, the competency of an expert to testify about minimum care standards applicable to any physician is upheld. Similarly, in *Smock*, the court allowed a gastrointestinal surgeon to testify on issues related to a family practitioner’s care despite his unfamiliarity with family practice standards, focusing on the expert's relevant medical knowledge. The current case mirrors these precedents, concentrating on general medical practice standards rather than specialized orthopedic care.

Dr. Zook, a qualified physician and expert in various surgical fields, was permitted to testify about the standard of care related to the case. However, his testimony was deemed unnecessary because Dr. Chen, the defendant and attending physician, provided sufficient evidence to establish both the standard of care and a breach of that standard. The jury was instructed to recognize Dr. Chen as the attending physician from the initial examination of Victoria Gorman until her discharge. Dr. Chen confirmed that as the attending physician, he was responsible for coordinating care and should call a specialist if he suspected an issue, which he failed to do when he acknowledged his lack of expertise regarding TMJ fractures but suspected a possible fracture. Consequently, Dr. Chen's admissions indicated a breach of his duty. Additionally, the defendants contended that the trial court improperly modified the Illinois Pattern Jury Instructions regarding jury guidance, asserting that the court must use the standard instructions unless they do not accurately reflect the law.

A violation of Rule 239(a) does not constitute reversible error if the instruction provided is accurate, non-prejudicial, and not misleading or argumentative. The court affirmed that the modified jury instruction regarding the standard of care for an attending physician was appropriate, as it remained consistent with established legal standards and did not imply a special duty. The trial court found that the term "attending physician" clarified the instruction without altering the legal duty. Defendants argued that this modification was prejudicial, but the court concluded that it was impartial and based on uncontroverted facts, thus rendering any error harmless. Additionally, defendants contested the admission of Dr. Maurice Miller's testimony but faced a waiver issue since this argument was not included in their post-trial motion. The court noted the importance of post-trial motions in allowing trial judges to review their decisions, emphasizing that raising new arguments on appeal undermines this purpose.

In Brown v. Decatur Memorial Hospital and Centracchio v. Rossi Construction Co., the court emphasized that a post-trial motion must specify the points relied upon and the grounds for those points as mandated by Section 2.1202(b) of the Illinois statute. The defendants' post-trial motion failed to meet this requirement, lacking sufficient specificity regarding the grounds for the alleged error, thereby precluding the issue from being preserved for review. Consequently, the court did not address the admissibility of Dr. Miller's testimony. Additionally, the plaintiff's request for attorney fees and costs was denied, as the court found that the defendants' appeal—challenging a trial court's modification of a jury instruction—was not frivolous. The judgment of the circuit court of Madison County was affirmed.