A state appeals panel has upheld a $12 million medical malpractice award to the family of a father of three children who died of a rare blood disease after a chain of misdiagnoses and other problems left him with failing organs, and a nurse who had been specially dispatched to provide a potentially lifesaving specialized emergency treatment took more than six hours to travel to the hospital where he died.
On Oct. 21, a three-justice panel of the Illinois First District Appellate Court ruled in favor of the family of Matthew Gulino, who died in 2009 at Advocate Christ Medical Center in Oak Lawn, as his organs failed shortly after he was diagnosed with Thrombotic Thrombocytopenic Purpura (TTP).
TTP is a rare blood disease in which a protein in the patient’s plasma cause blood platelets to clump, clogging blood vessels and preventing the flow of oxygen through the body. The disease is almost always fatal, unless treated with a procedure known as plasmapheresis. The treatment utilizes a machine to separate the plasma from the rest of the blood, where it is then blended with donor blood. The procedure can take two to three hours at a time, and is required sometimes to be repeated for several days until the condition is corrected.
In this case, Gulino, 49, a married father of three children, who had been to that point considered otherwise healthy, court documents said, had complained to doctors beginning in October 2009 of a range of symptoms, including nausea, fatigue, shortness of breath, chills and lightheadedness. After running an electrocardiogram and other tests, his doctors initially diagnosed “anxiety,” and prescribed him anti-anxiety medications.
However, the symptoms only worsened, and on Oct. 25, 2009, Gulino was rushed to Advocate Christ Medical Center, complaining of slurred speech, mobility problems in his left arm and paralysis in the left side of his face. Blood tests there revealed low platelet counts and kidney and liver failure. At that time, he was diagnosed with TTP and the hospital and its doctors ordered plasmapheresis. The hospital conveyed that order to Acute Extracorporeal Services (AES), a specialized medical contractor the hospital works with to provide plasmapheresis.
According to court documents, the order requesting AES dispatch a nurse to the hospital to treat Gulino on an emergency basis was issued at 4:42 p.m. However, the nurse dispatched to treat Gulino did not arrive at the hospital until about 11 p.m. According to testimony at trial, the nurse had inexplicably first stopped at another hospital in Downers Grove to perform a non-emergency phlebotomy on another patient and went to her home in Willowbrook before traveling to the hospital to treat Gulino.
Gulino was pronounced dead at 11:40 p.m. that night.
Gulino’s family sued all the medical organizations and professionals involved in his treatment and death, alleging the failure to correctly diagnose Gulino and treat him caused his death. Particularly, the family’s complaint cited the failure of the nurse and AES to arrive promptly at Advocate Christ Medical Center to give Gulino a realistic chance at survival.
At trial, in Cook County a jury sided with the family, awarding more than $12 million in damages.
AES appealed the decision, arguing the circuit court erred by not granting their motion for a judgment notwithstanding the verdict, as AES asserted the Gulino family never presented “any competent evidence … AES breached the applicable nursing standard of care” or that the delay in arriving at the hospital is what caused Gulino’s death.
The appellate justices, however, disagreed, saying they found the plaintiffs’ witnesses to be credible enough, and, in this case, expert testimony is not necessarily required, saying the nurse’s delay in traveling to the hospital – particularly when she knew the situation was an emergency – “was so grossly negligent that expert witness testimony regarding the requisite standard of care was not even required” in this case.
The justices also noted the testimony of a doctor who testified on behalf of the plaintiffs, who pegged Gulino’s chances of survival, even in his precarious condition, to “have been greater than 50 percent” had he received “a timely plasmapheresis treatment.”
Justices said this testimony, while it was countered by defendants’ witnesses who said Gulino’s multiple organ failures placed his survival in doubt even with the plasmapheresis treatment, placed the jury’s findings in the realm of reason.
“Given the verdict, the jury evidently found plaintiff’s experts more credible and this court cannot usurp the function of the jury and substitute our judgment for that of the trier of fact,” the appellate justices wrote.
The appellate justices further determined Cook County Circuit Court Judge James P. Flannery did not abuse his discretion in a range of decisions regarding expert medical testimony presented by both sides during the lower court proceedings.
The appellate court opinion was authored by Justice Aurelia Pucinski, with justices Mary Anne Mason and James Fitzgerald Smith concurring.
The Gulino family was represented in the action by attorney Bruce R. Pfaff, of Pfaff, Gill & Ports, of Chicago.
AES was defended by the firm of Hepler Broom, of Chicago.