Brems v. Trinity Medical Center

No. 3--97-0426
________________________________________________________________

IN THE

APPELLATE COURT OF ILLINOIS

THIRD DISTRICT

A.D., 1998
_________________________________________________________________

JUDITH BREMS, as next friend ) Appeal from the Circuit Court
of SUE-ANN BREMS, a minor, ) of the 14th Judicial Circuit,
) Rock Island County, Illinois
Plaintiff-Appellant, )
)
v. ) No. 95--L--174
)
TRINITY MEDICAL CENTER, et al., )
)
Defendants, and )
)
THOMAS CARTER, M.D., and )
K. TRIPUNANENI, M.D. )
) Honorable Ronald Taber,
Defendants-Appellees. ) Judge Presiding
_________________________________________________________________

JUSTICE HOMER delivered the opinion of the court:
_________________________________________________________________

The plaintiff filed a medical malpractice action naming
Trinity Medical Center and four physicians as defendants. The
trial court dismissed with prejudice the counts containing claims
against two of the physicians in the plaintiff's fourth amended
complaint. The trial court found the plaintiff failed to file an
adequate physician's report. The plaintiff appeals the dismissal
of those two counts. For the reasons that follow, we reverse the
trial court's judgment.
FACTS
In July of 1993, Sue-Ann Brems, the minor child of the
plaintiff Judith Brems, was examined and treated at Trinity
Medical Center by Thomas Carter, M.D., K. Tripunaneni, M.D.,
Margery Franklin, M.D., and Rao Movva, M.D.
After a gastric feeding tube inserted into Sue-Ann became
infected, she was transferred to another medical facility where
an abscess was discovered in her abdomen. The plaintiff, as next
friend of her minor child, filed a medical malpractice complaint
against Trinity Medical Center and the four physicians.
The original complaint grouped all four of the physician
defendants into one count. In addition, the physician's report,
which is required by section 2-622 of the Code of Civil Procedure
(735 ILCS 5/2-622 (West 1994)), grouped five physicians including
the four physician defendants into one paragraph.
Defendant Carter filed a motion to dismiss, asserting that
the plaintiff failed to allege in her complaint separate counts
against each defendant. The plaintiff was granted leave to amend
and filed an amended complaint with separate counts against each
defendant.
When the plaintiff failed to attach a physician's report to
her amended complaint, defendants Carter and Tripunaneni each
filed motions to dismiss the amended complaint for failure to
comply with section 2-622. Agreed orders were entered by the
trial court allowing the plaintiff 28 days to file a second
amended complaint.
Two months later, the second amended complaint was filed.
Four substantially identical physician's reports were attached to
the complaint which contained separate counts against the four
defendant physicians.
The trial court dismissed the second amended complaint in
its entirety in response to motions by the defendants Carter and
Trinity Medical Center. The court's order stated that the
physician's report was insufficient under section 2-622. The
trial court allowed the plaintiff an additional 60 days to obtain
an amended section 2-622 report and 30 days thereafter to file
her amended complaint.
The plaintiff filed late her third amended complaint with an
attached physician's report. The trial court dismissed counts I
and IV against the defendants Carter and Tripunaneni in the
plaintiff's third amended complaint pursuant to those defendants'
earlier motions. In two separate orders, the court ruled the
physician's report did not comply with section 2-622. The order
dismissing count I stated the report was insufficient because it
was conclusory and because it failed to identify the specific
conduct of defendant Carter as distinguished from the conduct of
the other physicians. The order dismissing count IV simply
stated the report was insufficient. The trial court granted the
plaintiff one last chance to file an amended report and a fourth
amended complaint.
Attached to the plaintiff's fourth amended complaint, was a
physician's report containing the following:

"I am a physician and surgeon licensed
to practice medicine in all of its branches.
I have reviewed the records, facts and other
relevant material pertaining to the above
entitled matter. I am knowledgeable in the
relevant issues involved in this matter and
have practiced in this area of medicine
within the last six (6) years. The act(s) to
follow reasonably caused or contributed to
the chain of events which, in my opinion,
ultimately led to plaintiff's injuries. For
the reasons to follow below I find that there
is a reasonable and meritorious basis for
filing an action in medical malpractice
against the above named defendant(s).
Minor plaintiff was cared for by all of
the defendants in July, 1993. This child was
a triplet who suffered from multiple organ
system congenital errors. In pertinent part
the child suffered from esophageal atresia
and other errors of the gut which required
direct line gastric feeding. This tube
became infected and misplaced and an abscess
formed in the abdomen. The child became
septic, dehydrated, malnourished and actually
went into septic shock. After about a month
of the foregoing the child was transferred to
another health care facility, at the behest
of the family only, where the abscess was
identified and drained, appropriate
antibiotic treatment was instituted and the
gastric feeding tube was properly positioned.

* * *

As a direct and proximate result of all
the foregoing this child suffered a prolonged
course of serious illness and suffered damage
to all of her organ systems from the sepsis,
dehydration and malnutrition.
The term 'failure' (or any of its
grammatical forms) as used in this report
means that there was a violation of the
appropriate standard of care with regard to
the individual issue being described."

In addition, the report contained a paragraph pertaining to
the medical center and four separate paragraphs pertaining to
each of the defendant physicians which read as follows:

"[Name of the defendant] as a physician who
cared for plaintiff, had a duty to comply
with the standard of care and by virtue of
the following acts of commission and/or
omission; failed to diagnose or cause to be
treated the abdominal abscess and failed to
diagnose or cause to be treated misplacement
of the gastric feeding tube (Doctors are
supposed to monitor tubes and make sure they
are placed properly and they are supposed to
re-position the tube if it becomes
displaced.) These defendants additionally,
by virtue of their failure to observe
appropriate aseptic technique in the handling
of such tubes (i.e. they did not scrub glove
properly thereby contaminating the field)
caused the tube, aforesaid, to become
infected in the first instance."

The defendants Carter and Tripunaneni filed motions to
dismiss counts I and IV of the fourth amended complaint for
failure to comply with section 2-622. We must determine whether
the trial court abused its discretion when it dismissed with
prejudice counts I and IV of the plaintiff's fourth amended
complaint because the section 2-622 report was insufficient.

ANALYSIS
Section 2-622 of the Code of Civil Procedure requires a
plaintiff seeking damages because of medical or other healing art
malpractice to attach to the complaint: (1) an affidavit from the
plaintiff or his attorney that a qualified health professional
has determined in a written report that there is a meritorious
cause of action, and (2) the health professional's written report
indicating the basis for his determination. 735 ILCS 5/2-622
(West 1994). The sufficiency of the health professional's report
is at issue in this appeal.
The report must clearly identify "the reasons for the
reviewing health professional's determination that a reasonable
and meritorious cause for the filing of the action exists ***."
735 ILCS 5/2-622(a)(1) (West 1994). A trial court's dismissal of
an action because the plaintiff has failed to meet the
requirements of section 2-622 will not be disturbed on appeal
unless the trial court has abused its discretion. Winters v.
Podzamsky, 252 Ill. App. 3d 821, 621 N.E.2d 72 (1993).
The defendants Carter and Tripunaneni argue that the report
alleged only in a conclusory fashion that they negligently failed
to diagnose and treat the patient's abdominal abscess. The
defendants assert that the last report was essentially the same
in substance as the reports previously held insufficient by the
trial court. They contend the report failed to identify the
proper standard of care or discuss the reviewer's analysis of the
records of the patient. We disagree.
Section 2-622 should not be so strictly construed that fine
technicalities can be used as a means of stripping plaintiffs of
their substantive rights and their day in court. See Neuman v.
Burstein, 230 Ill. App. 3d 33, 595 N.E.2d 659 (1992). The
statute must be liberally construed so as not to deprive the
plaintiff of her right to seek redress for her injuries (Hagood
v. O'Conner, 165 Ill. App. 3d 367, 519 N.E.2d 66 (1988)). If a
single medical report in a medical malpractice action against
multiple defendants is sufficiently broad to cover each
defendant, adequately discusses deficiencies in the medical care
given by the defendants, and establishes that a reasonable and
meritorious cause exists for filing the action, the report can be
considered sufficient to comply with section 2-622. Neuman v.
Burstein, 230 Ill. App. 3d 33, 595 N.E.2d 659 (1992).
The medical report attached to the fourth amended complaint
is sufficiently broad to cover defendants Carter and Tripunaneni,
adequately discusses deficiencies in the medical care given the
minor by the defendants, and establishes a reasonable and
meritorious cause of action exists in this case.
The report indicates that the reviewing physician was a
qualified health professional meeting the requirements of section
2-622, and that he had reviewed the medical records and other
relevant matters pertaining to this case. The report states that
each of the four physician defendants had responsibility for
providing medical care to the minor.
According to the report, the patient was a triplet who
suffered from esophageal atresia and other congenital defects
which required direct line gastric feeding. An abdominal abscess
resulted from infection and misplacement of the gastric tube,
causing the child to become dehydrated and malnourished, leading
to septic shock. Only when the child was moved to another
facility at the family's request, did she receive the necessary
remedial care. The report charged each of these defendants with
failing to ensure proper placement of the tube, to observe
appropriate aseptic techniques in handling the tube, to properly
monitor and reposition the tube, and to diagnose and treat the
abdominal abscess. Further, the report discusses the applicable
standard of care, opines that the resulting complications
suffered by the child were caused or contributed to by each of
the defendants, and concludes that there exists a reasonable and
meritorious cause of action for medical malpractice against each
of the defendants.
While we offer no opinion whether the plaintiff will or
should ultimately prevail on the merits of her claims against the
defendants, Carter and Tripunaneni, we find the physician's
report is sufficient to meet the requirements of section 2-622 as
to these defendants. We therefore conclude that the trial court
abused its discretion in dismissing counts I and IV of the
plaintiff's fourth amended complaint. The judgment is reversed
and the cause remanded.
The plaintiff also complains that defendant Carter failed to
cite whether he was moving for dismissal under section 2-615 (735
ILCS 5/2-615 (West 1994)) or section 2-619 (735 ILCS 5/2-619
(West 1994)) of the Civil Practice Law. However, in view of our
decision, we find it unnecessary to address this issue.

CONCLUSION
For the foregoing reasons, we reverse the judgment of the
circuit court of Rock Island County and the cause is remanded for
further proceedings consistent with this order.
Reversed and remanded.
BRESLIN and SLATER, JJ., concurred.