$1.67 Million Illinois Jury Verdict in Knee Replacement Surgery Gone Very Bad

Virginia Moraites, a 77-year-old retiree, underwent a total left knee replacement at Vista Medical Center East in Waukegan, Ill., on Oct. 13, 2009. The inpatient procedure was done by the defendant orthopedic surgeon, Dr. Gerard Goshgarian. On the morning after the surgery, Oct. 14, 2009, a nurse found that Moraites was unable to move her left foot. The foot felt cold and there were no detectable pulses in her foot.

The hospital’s nurse immediately called both Moraites’ internist and Dr. Goshgarian to report these findings. The internist responded first and ordered a STAT left leg arterial Doppler study as well as a vascular surgery consultation.

Vascular surgeon Dr. David Onsager sent his physician’s assistant to examine Moraites and also ordered ultrasound testing of the blood flow in her feet. Dr. Goshgarian came to bedside to examine Moraites, but he did not issue any additional orders and left to perform surgery on a different patient.

The physician’s assistant examined Moraites that morning noting signs and symptoms of left foot ischemia and recommended an arteriogram of the left leg.

Dr. Onsager testified at this jury trial that he also examined Moraites that morning, but he made no note of this in her chart. The original morning STAT orders were not completed until the middle of the day. At 2 p.m., Dr. Onsager agreed with his physician assistant that an arteriogram was needed, but a STAT arteriogram was not ordered until 3:30 p.m. and was not completed until 6:00 p.m.

The arteriogram revealed an arteriovenous fistula behind the recently operated left knee, which was interrupting the blood flow down to the leg and causing the ischemia, or blood flow blockage, in Moraites’s foot.

Dr. Onsager then decided to transfer Moraites to Northwestern Memorial Hospital. Once she arrived there around midnight, she was diagnosed with severe left leg ischemia; it was noted that her leg was likely non-salvageable.Surgery was performed early the next morning, which was Oct. 15, 2009, to bypass the fistula, restore blood flow and complete fasciotomies.

A fasciotomy is a surgical procedure in which the fascia of the skin is cut to relieve tension or pressure to treat the resulting loss of circulation to an area of tissue or muscle. As in this case, a fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. Moraites’s leg was saved and she subsequently underwent several additional surgeries, including debridements.

Moraites now has a non-functioning lower left leg with drop foot and pain requiring her to use a walker to move. At trial, it was proved that Moraites had $535,806 in past medical expenses, which were stipulated to but was contested by the defendants as to the negligence element of causation. In addition, there was proof of $230,680 of future nursing care costs.

Moraites was unable to appear at this jury trial due to other medical problems. She testified by way of a video evidence deposition that she had been living a full and active life prior to the knee replacement, including caring for her disabled husband, helping to take care of her grandchildren and volunteering at her church. She is now housebound and unable to fully care for herself due to her disabled and painful leg.

It was argued under the res ipsa loquitur doctrine that Dr. Goshgarian chose not to protect the artery behind the knee when cutting the tibia to install the knee prosthesis during the total knee replacement, that he cut or injured the popliteal artery during the surgery which led to the fistula, chose not to conduct a complete exam on the first morning after the surgery, failed to make a differential diagnosis of arterial injury, chose not to emergently address acute ischemia or lack of blood flow to the low leg, failed to establish a treatment plan and improperly continued to rely on Dr. Onsager, the vascular surgeon, to manage the ischemia.

The defendants’ counsel denied negligence and denied the artery was injured during the surgery because (1) no bleeding or hemorrhage was seen during the surgery or found after it, and (2) the knee ligament in front of the artery was not cut or injured.

The defense further maintained that the fistula was an unexpected result of manipulating the knee during surgery, tests ordered by Dr. Onsager and the internist were reassuring because the results showed reduced, but continued blood flow to the left foot and thus Dr. Goshgarian was entitled to rely on the vascular surgeon’s treatment plan.

Vista Medical Center East, the hospital where this surgery took place, settled before trial for $100,000. Also before the trial, the plaintiff and Dr. Goshgarian agreed to limit any judgment to the doctor’s $1 million insurance policy limit and to waive a set-off for the hospital’s settlement payment.

The attorneys that successfully handled this tragic medical malpractice lawsuit were Sean C. Burke and Stephen S. Phalen.

The jury’s verdict of $1,671,000 was made up of the following damages:
• $450,000 for pain and suffering;
• $400,000 for loss of normal life;
• $50,000 for disfigurement;
• $535,806 for past medical expenses; and
• $235,194 for future caretaking expenses.

Before trial and during trial there was no offer made by the remaining defendants to settle the case.

The Moraites attorneys presented experts in orthopedics, vascular surgery and medical billing. The defendants presented experts in orthopedics and vascular surgery. In addition, the defendant presented treating physicians who specialized in both radiology and vascular surgery. In fact, Dr. Onsager did testify as a witness for the defendants.

Attorneys Phalen and Burke made a demand before trial of $1 million which was the policy limits and asked the jury to return a verdict of $1,841,486.

Virginia Moraites v. Dr. Gerard M. Goshgarian, No. 11 L 827 (Lake County, Ill.).

Kreisman Law Offices has been handling hospital negligence lawsuits, medical negligence cases, birth injury lawsuits, birth trauma brain injury lawsuits and physician negligence lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of a medical provider for more than 40 years in and around Chicago, Cook County and its surrounding areas, including Lincolnwood, Harwood Heights, Park Ridge, Northfield, Winfield, Addison, Villa Park, Palatine, Palos Heights, Chicago Ridge, Burr Ridge, Western Springs, Oakbrook Terrace, Yorkfield, Hillside, Maywood, Forest Park, Elmwood Park, Chicago (Marquette Park, Gresham, Washington Heights, Roseland, Woodlawn, Grand Crossing, Avalon Park, Pill Hill, South Deering, Lake Calumet, Burnside, Back of the Yards, Canaryville, Bronzeville, Oakland, West Loop, Goose Island), Oak Park, and Park Forest, Ill.

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