Justia Lawyer Rating for Robert D. Kreisman

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The U.S. Department of Labor reports that in 2008 only 12% of doctors were self-employed. With the implementation of the Affordable Care Act (ACA) and other healthcare reforms, the future of employment by physicians in hospitals will be overtaking the past trends. Hospital employment of doctors is expected to increase between 10 and 25% over the next five years. 

At the same time that employment of doctors is increasing in hospitals, the numbers of physicians practicing on their own is declining. This data comes from the Physician Compensation and Production Survey from the Medical Group Management Association (2003-2009) report. According to that report, physician-owned practices declined from 70% in 2002 to just under 50% by the year 2008.  In contrast, by 2008, hospital ownership of physician practices exceeded the percentage of physician practice sowned by physicians.  Hospital ownership of physician practices in 2002 was only slightly more than 20%.

Back in the 1990s, hospitals and health systems were employing primary care physicians more so than medical specialists because it was thought that the healthcare model of the future would ensure that primary care physicians would be gatekeepers to health care. Because of reform and the ACA, that trend has changed.  The rate of increase in employment of primary care physicians by hospitals and specialists is about equal now.  That is because the ACA does not promote a primary care gatekeeper model. The lowest cost resource at the earliest point of medical care means that specialists will be directed to the patient instead of through the primary care physician.

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Jennifer, a 25-year-old student, began experiencing severe headaches and visual disturbances. Several days later she went to a hospital emergency room. She told the ER staff  she was not prone to headaches and that she was currently taking oral contraception. Jennifer was diagnosed with a complex migraine headache.

Several hours later however, she developed slurred speech, tingling and paralysis in her arm along with low blood pressure. An attending physician ordered a CT scan of Jennifer’s head, which was interpreted by a radiologist showing no evidence of acute hemorrhage. Jennifer’s condition continued to deteriorate, and she began experiencing seizures. 

Finally, she was transferred to another hospital, where a second CT scan showed bilateral intracranial hemorrhages caused by thrombosis or a stroke. The doctors ordered brain surgery, which required a long and extensive rehabilitation program. She now has right-sided weakness and speech problems and requires lifetime medications.

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Bozena Smith filed a medical negligence complaint against two doctors who were residents in 2006 when she claims she was injured in postsurgical treatment.

After the fact discovery was done by each of the parties, and the trial judge entered a deadline of Sept. 13, 2010 for the plaintiff to disclose any experts and opinions. Bozena disclosed one expert she had hired to render an opinion. In the Rule 213(f)(3) disclosures, the plaintiff stated that the doctor retained as an expert would provide expert opinions that both the residents, Drs. Murphy and McFadden, deviated from the standard of care in treating Smith, which caused her injuries. 

However, on Nov. 8, 2010, when the plaintiff’s expert doctor appeared for his deposition, he testified that he was withdrawing his adverse opinions against the residents and then testified that he held no opinions that implicated the residents in any substandard medical care of the plaintiff. In fact, the plaintiff’s expert testified as follows:

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Joseph Farias, age 29, began treatment with the defendant internist, Yolanda Co, M.D., in February 2002. He came to the doctor with complaints of constipation for three years and rectal bleeding. Dr. Co performed a rectal exam and ordered a colonoscopy, which came back negative. There was no cause determined as to why Farias had rectal bleeding.

In October 2003, Farias returned to Dr. Co with new complaints of rectal bleeding. That visit was a cause of what became a medical malpractice lawsuit. This time Dr. Co did a digital rectal exam and diagnosed internal hemorrhoids. In Farias’s Cook County complaint, it was alleged that the internal hemorrhoids could not be diagnosed through digital examination unless the internal hemorrhoids were visualized outside the anus. The standard of care as contended required Dr. Co to perform an anoscopy to properly visualize the hemorrhoids. It was also asserted that should Dr. Co not have the facility to do the anoscopy,  she should have referred Farias to another physician such as a gastroenterologist. 

Dr. Co defended the case by saying that she did observe prolapsing internal hemorrhoids (protruding out of the rectum), even though her chart  stated only internal hemorrhoids. Dr. Co testified that the standard of care required a treating internist such as herself to grade and chart the severity of an internal hemorrhoid, but she admittedly didn’t do that in October 2003.

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In November 2006, the defendant surgeon, Dr. Hodgett, performed a laparoscopic biopsy on a 72-year-old woman, Mary Backes.  The purpose was to diagnose a suspected lymphoma in her retroperitoneal area, which is behind the abdomen. The biopsy was done at Provena Nursing Medical Center in Aurora, Ill. 

Another defendant, Dr. Sayeed, was the patient’s primary care physician. Following the biopsy, Backes experienced blood pressure drops, low urine output and rapid respiration. 

Her family maintained in the lawsuit that Dr. Hodges and Dr. Sayeed chose not to recognize that Backes’s duodenum had been perforated during the biopsy procedure and failed to realize that her post-op symptoms were indicative of developing sepsis. It was also claimed that the doctors chose not to timely return Backes to surgery for exploration and repair of the perforation to attempt to save her life.

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Neal Nuss, age 73, was transported to St. James Hospital in Blue Island, Ill., on Sept. 5, 2006 following an auto accident. Nuss was admitted to the hospital and diagnosed with subdural hematoma; he was evaluated by a neurosurgeon. 

Over the next three days, doctors determined that the subdural hematoma was not big enough to operate on. Nuss was discharged from the hospital on Sept. 8, 2006. The doctors planned to monitor his condition as an outpatient. The monitoring was overseen by the defendant Dr. Cheryl Woodson, the patient’s primary care physician.Dr. Woodson instructed Nuss to return as an outpatient to undergo a CT scan at St. James Hospital for comparison. Nuss followed up as directed and saw Dr. Woodson on September 12 and underwent the CT scan on September 13. The scans were interpreted by radiologist, Dr. Green.

The doctors concluded that Nuss’s condition was stable and his next follow-up visit was planned with the neurosurgeon five days ahead.

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The Illinois Appellate Court reversed a trial judge’s ruling in a medical malpractice case because the judge ruled that the defendants had no right of reduction on the jury’s verdict.  

In this case, Charles Perkey, as administrator of the estate of Leanne Perkey (his wife), sued the doctors and hospital because of a delay in diagnosing Leanne’s pancreatic cancer in a timely manner. 

After a jury trial, the verdict, which included $310,000 for Leanne’s medical expenses, was not reduced when the trial judge refused the defendants’ motion to reduce the judgment under Section 2-1205 of the Illinois Code of Civil Procedure. 

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Fifty-year-old Dan Hebel suffered a rope burn while on a fishing trip in August 2004. Eventually he was referred to an orthopedic surgeon, Dr. Craig Williams, at Illinois Bone & Joint Institute in Morton Grove.He first complained of an infectious process in his hand on August 23, 2004.One week later, Dr. Williams gave Hebel a steroid injection.The injection, however, caused the infection to worsen.

In this lawsuit, Hebel contended that the steroid injection was contraindicated by the underlying infection. Dr. Williams referred Hebel to Dr. Robert Citronberg for infectious disease management. Drs. Williams and Citronberg became co-treating physicians. Sometimes infections like this require antibiotic treatment and/or surgical involvement.

On November 9, 2004, Dr. Williams performed an incision and drainage procedure. Specimens from the surgery were sent for study and cultures. The pathology results were sent to both physicians, but the culture results were sent only to Dr. Williams and never sent to Dr. Citronberg.

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The Illinois Appellate Court for the Fourth District reversed a jury’s verdict for defendants, which included OSF Healthcare System, in the Circuit Court of McLean County.  The case centered around an injury and subsequent death of a 3-year-old boy, Christian Rivera, in 2003. The jury trial was held in July 2011. 

During the trial, the family of Christian offered its expert witness, Dr. Finley Brown, to testify as a medical expert in family practice.

The defendants were allowed by the trial judge to cross-examine Dr. Brown for the issue related to his annual earnings as an expert witness for an 8-year period. Plaintiff’s counsel had argued against the broad timeframe, but the trial judge denied plaintiff’s motion to limit the timeframe. Defense used this testimony to say the jury that Dr. Brown was a “go-to guy for expert opinions.”

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In a May 16, 2013 New York Times opinion page editorial, written by assistant professor of law at the University of California, Los Angeles, Joanna  C. Schwartz, discussed the Affordable Care Act in relation to medical malpractice lawsuits. The article was titled, “Learning from Litigation.” The thrust of the article is that new evidence contradicts the “conventional wisdom that malpractice litigation compromises the patient safety . . .”  Professor Schwartz says that the opposite appears to be occurring;  that with more openness and transparency, hospitals are responding to the risk of litigation in positive ways.

Professor Schwartz interviewed dozens of hospital risk managers who confirmed that a hospital’s approach to lawsuits has begun to change. She says that hospitals have become more open to handling medical errors up front and are apologizing to patients when mistakes do happen in some cases.

The given reason that hospitals are more open to these types of solutions is that in disclosing errors up front, hospitals and patients tend to resolve matters much earlier, reasonably and much more cost effectively. 

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