The Illinois Appellate Court affirmed a Cook County jury’s $2.7 million verdict for institutional negligence against Loyola Medical Center in a Chicago transplant error case. Longnecker v. Loyola University Medical Center, 2008 WL 2550686 (1st Dist., June 25).
The issue in Longnecker was whether Loyola University Medical Center was negligent when they transplanted the decedent with a severely hypertrophic replacement heart. The harvested heart was severely diseased and was only considered for transplantation because the harvesting doctors did not examine it. Despite the diseased state of the new heart, the decedent’s heart surgeon went ahead with the transplant. The decedent died without ever waking up from the surgery.
Most times we think of medical negligence cases as those caused by doctors or medical personnel individually. But a hospital or institution is held to the same standard of care as a doctor or a physician. So when evaluating a case for institutional negligence one asks what a reasonably careful hospital would and should do under similar circumstances. Illinois Pattern Jury Instructions, Civil, No. 105.03.01 (1995). Jones v. Chicago HMO Limited of Illinois, 191 Ill. 2d 278 (2000).
Various types of evidence can be utilized to establish a hospital’s standard of care, including expert testimony, statutes, hospital bylaws, custom and community practice, and accreditation standards. And while expert testimony is typically required in Illinois medical malpractice cases, sometimes institutional negligence can be established without expert testimony. Jones, 191 Ill.2d at 298.
There are two different theories of liability a hospital can face under medical malpractice. A hospital can be held liable for the medical negligence conducted by its agents or employees, or can be liable for its own institutional negligence. And according to the Illinois Appellate Court, a hospital owes its patients a duty to exercise a reasonable degree of care when dealing with an apparent risk.
In Longnecker, the apparent risk was that a significantly diseased donor heart would be deemed acceptable for transplantation. Plaintiff held that Loyola had a duty to avoid this risk by ensuring that all members of the transplant team were aware of their role in evaluating the donor heart prior to transplantation. But the defendant doctor argued that he was not aware that he was responsible for evaluating the heart before harvesting and approving it. And while he was found guilty of negligence, plaintiff argued that his failings were partly the result of Loyola’s failure, too.
Loyola had a duty to inform the harvesting doctor that part of his role on the transplant team was to evaluate the heart for transplantation after it was harvested. Instead the harvesting doctor only evaluated the heart while it was in the donor and missed the severe hypertrophy. Yet if he had simply observed the heart after it was harvested the hypertrophy would have been easily identified.
The other members of the transplant team had certain expectations of the harvesting doctor’s role, which he did not fulfill. The heart surgeon who placed the transplant in Longnecker acted on the assumption that the harvesting physician had performed his role of evaluating the harvested heart. Based on this assumption, the transplant surgeon removed Longnecker’s heart in preparation for the new heart. If the transplanted heart had been deemed severely diseased and unacceptable for transplant by the harvesting physician, then Longnecker’s heart would never have been removed and the surgery wouldn’t have taken place. So Loyola was negligent by not requiring that the harvesting doctor be aware of his role on the transplant team.
This case establishes an additional obligation on a transplantation team that may have been absent before this decision was passed down. Longnecker clarifies that institutional negligence occurs if a professional link in the chain of command deviates from the standard of care. Here the surgeon accepting the harvested heart had a duty to examine it prior to its delivery to the heart surgeon for transplantation.
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