Friday, October 29, 2004

Jury Duty--Part II

The case in which I served as a juror was one that was, in theory, sad, gross, and confusing. Let me explain...

It was a medical malpractice case with the estate of a deceased man suing an anesthesiologist because the man aspirated during surgery. If you don't know, aspiration is when material from the stomach goes into the lungs, and it's an incident with an 80% mortality/morbidity rate. Now, you'd think that the plaintiff would be suing the anesthesiologist because the aspiration killed the man. Surprisingly, that's not true.

The incident happened back in December of 1994. The man in question had dementia and early Alzheimer's and was in his mid to late 70's. In November of 1994, he had a VP Shunt put into his head to remove some of the excess fluid in his skull and keep his intercranial pressure (the pressure inside the skull) at a normal rate. However, in December of 1994, the shunt started to malfunction. It was revealed that there was a blockage in the shunt and it needed to be revised. The man was sent to the hospital to have that procedure done. When the man was being put under general anesthesia, he vomited. Some of what he vomited ended up going into his lungs.

There is a disgusting twist to this incident that probably lead to the lawsuit in the first place. You see, before the surgery, the man had a small bowel obstruction. The man didn't vomit up food, but material that had been in his bowels so long that it became fecal. He vomited and aspirated feculent material. It's unclear how much actually went into his lungs, but about half a liter (500cc) of material was taken out of the man's stomach after the aspiration happened.

The plaintiff's case was basically that the anesthesiologist was negligent by not properly assessing the risks of aspiration, not delaying the surgery, using the wrong kind of induction (that is, not putting the patient under the right kind of anesthesia), and not continuing to apply cricoid pressure (I'll explain that one later). The defense argued that the anesthesiologist took into account the risks of vomiting and aspiration as well as the possibility of injury to the brain (because of increased intercranial pressure). The anesthesiologist prioritized the risk of injury to the brain versus the risks from a small bowel obstruction that may (or may not) have been resolving.

Now, I said earlier that the man didn't die from the aspiration. In reality, he got very very sick from it. He was put into a medically induced coma and spent nearly three months in the hospital. He got several types of infections, but despite that, he made what could subjectively be called a very good recovery. Despite that, the dementia and Alzheimer's caused him to get sicker and the man died in January of 1997. The lawsuit against the anesthesiologist was actually filed while the man was still living, and the law in Illinois allows a pending lawsuit to continue even if the plaintiff passes away.

About cricoid pressure as I mentioned above...well, when the anesthesiologist put the man under anesthesia, there is a technique used to try and prevent aspiration. It's called the "Selleck maneuver" or something like that. It basically involves pushing the trachea against the back of the neck, pinching the esophagus and (hopefully) keeping things from being regurgitated. In this case, the maneuver was used but didn't work.

During the case, I saw virtually every way a witness could testify. Three witnesses actually testified in court: the defendant and two expert witnesses, both anesthesiologists, one for each side. Two witnesses testified via videotaped depositions. Both of them were expert witnesses for the defense, one a neurosurgeon and the other an anesthesiologist. One witness was not in court, but gave testimony in a unique way. The testimony from a companion of the late plaintiff was read in a way not unlike a radio play. The lawyers read their questions that they asked her while a woman sat in the witness box and read the responses verbatim. One thing I learned is that watching a taped deposition is very boring compared to in-court testimony. It's like watching paint dry in a humid room.

I also learned how even experts can say ridiculous things. The lone expert witness for the plaintiff was one of the least credible (and the also the only black witness of the trial). He got a crucial fact in the case completely wrong on the stand. Another expert witness, the neurosurgeon who testified for the defense, actually said that the man went into a coma because of problems with his brain. As I stated earlier, he was put into a coma on purpose so he could heal from infections that came about because of the aspiration.

Only one day after we started the trial, one of our jurors had to be excused. She was a teacher with a young child. She found out the child was very sick and was excused by the court. We had one alternate juror (the FBI guy) and he became a full-fledged juror after that.

Over the course of the trial, we were shown a large variety of evidence. Most of the evidence consisted of various types of medical documents. They included PGY1 notes (notes from 1st Year Post-Grad Residents), progress notes (notes from other physicians that track a patient's progress), nursing notes (notes that document various aspects of a patient), pre-operative notes, pre-anesthesia records, anesthesia records, CT scans, and other things that I can't remember. These things were presented either as overheads (on an overhead projector) or on very large boards that made them easy for us to read. However, that didn't necessarily help as the doctors' handwriting on these documents was at times completely illegible. The most legible documents were still only half-readable. I wonder why doctors' handwriting always looks so bad. Is it because they have to write so much?

The closing arguments were the part of the trial that most resembled what you see on TV. The attorneys were at their most fierce. However, they were still filled with those things that are just unique to reality. For example, the plaintiff's attorney wasted nearly 20 minutes at the beginning of her closing statement to detail the history of our jury system. Then, she had the nerve to say how she had time constraints. At least she did joke about her ability to talk for long periods of time, though. The defendant's attorney put on a closing statement worthy of a courtroom drama. He rattled through the case and went through all his exhibits in a very quick, easy to follow manner. He also appealed to emotion (within the context of the case) by subtly referring to bad experiences in the lives of all the court people including the judge (who still had left-side paralysis resulting from a stroke), the plaintiff's attorney (lost a parent), and even himself (had leukemia, son was very sick and needed CPR to be revived). The rebuttal by the plaintiff's attorney was easily her finest hour in the courtroom. She was actually concise and took direct jabs at the defense and the jabs they took at her. After these statements, we got instructions from the judge and we went to the Jury Room.

In the jury room, we laid out what the plaintiff had to prove. I wrote the four points on the board. We had to pick a foreperson and it was decided that among the people who volunteered (which included me), whoever got the highest card won. Just when I thought I would be the foreperson when I got a queen, another person got a king. Anyway, we went around the room and each of us told everyone how they felt about each point. In order for the anesthesiologist to be found liable, he had to have been negligent in at least one of the four points. The majority of us felt that the anesthesiologist wasn't liable. However, two of us still had issues. It all basically revolved around one piece of evidence that would prove if he was negligent in one of the points. We asked for that piece of evidence in a note to the judge. It took over 20 minutes for us to get a response to that note...only to realize that the note was too vague. We rewrote our request and sent it off again. We got a copy of the piece of evidence back and upon looking at it, it sealed the deal. We found the defendant not liable.

When we went back into the courtroom, in addition to reading the verdict, the judge asked each of us individually if we agreed with that verdict to make sure that it was correct. I'm not sure if this was done all the time, but it certainly made sense given that one of the jurors told a story about how a criminal got off because the jury signed the wrong verdict form. Better safe than sorry, I guess. Afterwards, the judge dismissed us and commended us for our service. The defendant came to the jury box and shook hands with most of us as we filed to the Jury Room to get our stuff, our certificates of Jury Service, and our checks. The foreperson and I elected to visit the judge in his chambers after we got our stuff. I thanked him for a smooth trial and for being so laidback. Honestly, I was kind of worried about being on a trial because of the sometimes overly stern portrayal of judges I've seen. However, the judge for this trial was fair and accommodating without being soft. After I left the chambers, I shook hands with both attorneys who thanked me for my service. As I left the courtroom, I encountered the defendant who also shook my hand. We chatted briefly and he told me that this trial was the second one for this case. The first trial ended with a hung jury that was 11-1 in his favor. He thanked me and wished me good luck on my job hunt. What's funny is that after I left the Daley Center, I went to Marshall Field's on State Street and applied for a position.

In the end, my jury duty was a very interesting experience. On one hand, the jurors we had were diverse, goofy, and a lot of fun to be with. We joked frequently, played cards, and got along very well. On the other hand, serving as a juror on a medical malpractice case is kind of tough. I had many different medical conditions and terms explained to me with definitions that sometimes conflicted. For example, the condition known as normal pressure hydrocephalus was defined in two different ways by the expert witnesses. Then, there was the whirlwind of medical documentation that was put into evidence. And let's not forget that the case was nearly 10 years old and there were many dates to many in fact that the plaintiff's attorney got the date of the man's death wrong in her opening statement. I took well over 10 pages of Legal Pad-sized notes during the trial. I can only imagine what it's like for jurors on long-term trials like the Scott Petersen trial or the O.J. Simpson case. Because I served on a jury, I am exempt from being called again for jury duty for one year. If I am sent another summons, I can call or send a copy of my check stub or jury service certificate to the court and be exempted. Will I try to get out of jury service if I am called in a year or two? Yep. This time was okay, but there is no guarantee I'll have such a nice experience next time. But, after this trial, there are three words I don't want to hear for a looong time: massive, feculent (pronounced fee-cu-lent, feck-u-lent, and foo-cu-lent during the trial), and any word that begins with vomit.

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