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York v. El-Ganzouri9/27/2004
placed through the same insertion point, but short of the subarachnoid space, allowing for ongoing administration of anesthesia as needed.
Something happened during Dr. York's combined spinal epidural. Twice, as Dr. El-Ganzouri inserted needles into his back, Dr. York expressed feeling pain. According to Dr. El-Ganzouri, they were fairly mild expressions; but, according to Dr. Miller, they were screams the likes of which he had never heard before. During one of the needle insertions, Dr. York's right thigh cramped and his right calf swelled. Dr. York subsequently went numb as the anesthetic took effect and underwent surgery.
After the knee surgery, Dr. York could not feel or move his right leg. He had lost bowel and bladder control, and experienced sexual dysfunction. Dr. York underwent an extensive course of rehabilitation, but only with partial success. His caregivers anticipated that his deficits would increase with age.
Dr. York and his wife filed a complaint against Dr. El-Ganzouri and University Anesthesiologists. They later amended the complaint to include Rush on the theory that Dr. El-Ganzouri was Rush's apparent agent at the time of his combined spinal epidural. Both defendants answered the complaints and discovery ensued.
The plaintiffs charged that Dr. El-Ganzouri breached the standard of care for anesthesiologists by inserting the spinal needles too high on Dr. York's spine, which allowed him to then pierce and directly insert anesthesia into Dr. York's spinal cord, killing nerves and causing his injuries. Plaintiffs claimed that Dr. El-Ganzouri erroneously injected anesthetic even as he was on notice of improper needle placement by Dr. York's screams. Plaintiffs contended that the error came about because Dr. El-Ganzouri felt pressure to perform the procedure quickly, and because he lost track of the proper disc space between which to insert the needles. Dr. El-Ganzouri had marked the insertion point by making an impression with his thumbnail, but he subsequently turned away to prepare more of the instruments needed for the procedure. The Yorks argued that Rush was accountable for Dr. El-Ganzouri's negligence because nobody informed Dr. York that he was an independent contractor, because he appeared to be a hospital employee based on the language in the consent form Dr. York signed and by his wearing scrubs with Rush's name and insignia on them, and because Dr. York relied on the hospital to provide the anesthesiologist for the procedure. Dr. El-Ganzouri countered that he met the standard of care in performing the combined spinal epidural and that Dr. York's injuries actually resulted from a spinal infarction, meaning a deprivation of blood to the spine, that resulted from a drop in blood pressure during the surgery. He contended that Dr. York's expressions of pain resulted from needles striking nerves in the cauda equina, which would not have produced his severe injuries, nor been a deviation from the standard of care. Dr. El-Ganzouri denied that he ever injected anesthesia while Dr. York expressed pain, instead, withdrawing and reinserting the needle until there were no expressions of pain from Dr. York. Rush, in turn, denied that Dr. York relied on it to provide an anesthesiologist, claiming that Dr. York relied on his son Jeff, who was an anesthesiology resident at Rush and fully aware that University Anesthesiologists was a group of independent contractors, to choose a specific anesthesiologist for the procedure. Rush further denied that Dr. York could reasonably have believed that Dr. El-Ganzouri was a Rush employee because he had previously received a bill from University Anesthesiologists for one of his prior surgeries, and because, based on his own
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