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Jones v. Orris6/27/2005
ients who have had a previous infection, such as from pelvic inflammatory disease, or after a surgical procedure to remove a gallbladder or appendix, and she noted that Jones had previously had an appendectomy. She further testified that a patient can develop adhesions in the absence of infection after abdominal surgery based on a natural tendency to develop adhesions. However, an infection associated with an appendectomy will put a patient at higher risk for adhesions. She acknowledged that she could not testify with a reasonable degree of medical certainty whether an earlier or less invasive appendectomy would have prevented Jones's adhesions. She likewise had no opinion about whether earlier intervention would have prevented infection and lowered the likelihood of adhesions.
Dr. Orris testified regarding his care of Jones on her first emergency room visit, from which she was discharged without a diagnosis of appendicitis. He testified that he ordered a CT scan in order to rule out the condition, and the radiologist informed him by telephone that although he did not see Jones's appendix on the CT scans, he saw no evidence of appendicitis because the scan showed no inflammatory changes. According to the radiologist, the CT scan was normal and Jones did not have appendicitis. Dr. Orris decided to discharge her without a surgical consult based on the negative CT scan and a considerable improvement of her symptoms during eight hours of observation at the hospital. He instructed her upon discharge to return to the emergency room if her symptoms worsened and to follow up with her doctor in two days.
Dr. Koralewski testified that when Jones came to him for follow-up care after her visit to the emergency room, she informed him that she had a negative CT scan in the emergency room. She also reported that she had had no nausea, vomiting, fever, or diarrhea in the last 24 hours. She reported a white vaginal discharge for two days and painful urination. Red and white blood cells were found in her urine, and Dr. Koralewski diagnosed a urinary tract infection and prescribed an antibiotic.
Dr. Graham, Jones's expert, testified that Dr. Orris violated the standard of care by failing to rule out appendicitis and call for a surgical consult. He testified that he had previously reviewed portions of Dr. Orris's and Dr. Koralewski's depositions, and Jones's Northside Hospital and Kaiser Permanente medical records. Dr. Graham testified that Dr. Koralewski violated the standard of care by failing to analyze why Jones had an abnormal urinalysis with no urinary tract infection symptoms and by discharging her with the diagnosis of a urinary tract infection. According to Dr. Graham, Dr. Koralewski treated the lab results and not the patient, who had been sick for four days.
Dr. Graham acknowledged that he had no opinion whether Jones suffered any permanent injury as a result of her appendicitis. He further acknowledged that he could not state with a reasonable degree of medical certainty whether any conduct of Dr. Orris caused or contributed to any of Jones's current conditions, that his sole role in the case would be to testify about the standard of care, and that he had no opinion about Jones's alleged damages in the case. Finally, he acknowledged that he had no opinion within a reasonable degree of medical certainty as to when Jones's appendix burst. In his opinion, her appendix had not ruptured before her CT scan in the emergency room because the CT scan would have revealed the rupture. He could not testify whether her appendix had already ruptured by the time she saw Dr. Koralewski. He could not testify to a reasonable degree of medical certainty about the extent of any post-surgical adhesio
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