This case involved a 68-year-old man who suffered worsening eyesight stemming from developing cataracts in both eyes. When his vision decreased to a certain point (20/100), his optometrist referred him to an ophthalmologist in the community who, as part of his practice, performed cataract surgery. The defendant ophthalmologist was a member of a large practice that included, among others, ophthalmologists specializing in retinal problems and others specializing in eye-pressure issues such as glaucoma.
After being evaluated by the defendant ophthalmologist, the plaintiff was found to be a good candidate for cataract extraction. His retinas were healthy, the blood vessels in his eyes were normal, and his intraocular pressures were fine. Because the cataract in his left eye was worse than the cataract in his right eye, it was decided to remove this one first. As such, defendant ophthalmologist scheduled plaintiff for surgery on his left eye two weeks in the future.
Plaintiff arrived on the date of the surgery and was taken back to the operating suite. During the procedure, the defendant ophthalmologist inadvertently tore a hole in the posterior aspect of the plaintiff’s lens capsule and noted that a small choroidal detachment developed during the procedure. Despite this, he removed the old lens, replaced it with an intraocular implant and closed the eye. The defendant recorded that with the exception of the small choroidal detachment, the procedure was a success.
Plaintiff returned to defendant ophthalmologist the next day for his postoperative follow-up examination. As opposed to the other patients in the waiting room – who were exclaiming the wonders of their improved vision – plaintiff still could not see out of his left eye. When he was examined by the defendant ophthalmologist, plaintiff’s vision was “count fingers” and he still had a choroidal effusion. Rather than refer plaintiff to a retinal specialist, defendant ophthalmologist scheduled the plaintiff to come back to his office in three days.
Over the next two weeks, plaintiff returned three times to defendant ophthalmologist to be evaluated. Plaintiff’s vision did not improve and on each visit, defendant ophthalmologist noted that he continued to suffer from a choroidal effusion. Noting that the intraocular lens was becoming decentered, defendant ophthalmologist scheduled plaintiff for a second surgery to reposition the lens.
Two weeks after the first cataract surgery, plaintiff underwent a second surgery on his left eye to reposition the intraocular lens. According to the medical chart, plaintiff’s eye was red, puffy and tender to touch and there was no change in the choroidal effusion that had been present since the time of the first surgery. Despite this, defendant ophthalmologist moved forward with the operation. According to the defendant ophthalmologist, he opened the eye without problem, but when he tried to reposition the lens implant, it was adhered to the vitreous. As the defendant ophthalmologist pulled on the lens to move it back into position, blood started to leak into the vitreous. Faced with this complication, defendant ophthalmologist removed (rather than repositioned) the lens entirely and closed the eye.
When plaintiff returned the next day for his postoperative visit, he was not told about the complications that had occurred during the surgery. Defendant ophthalmologist noted in the chart, however, that he could not see the plaintiff’s retina due to the amount of blood in the eye. The problem this created was that without an ability to visualize the retina, defendant ophthalmologist could not determine whether plaintiff had suffered a retinal detachment. Despite this, defendant ophthalmologist did not send plaintiff to a retinal specialist, but instead, scheduled him for follow up visits in his own office.
Over the next three weeks, plaintiff returned to be evaluated by defendant ophthalmologist four times. On each visit, plaintiff continued to have so much blood in his eye that the defendant ophthalmologist could not visualize plaintiff’s retina. At this point, defendant ophthalmologist finally scheduled plaintiff for an ultrasound of his left eye. (B scan ultrasounds are used to determine, among other things, whether someone has suffered a retinal detachment.)
The ultrasound that was taken appeared to show a retinal detachment. Rather than forwarding the scan to a retinal specialist for evaluation, defendant ophthalmologist reviewed it himself, but did not chart his conclusions. When asked about this at his deposition, defendant ophthalmologist admitted that he was unable to interpret the scan to determine whether there was a retinal detachment.
At this juncture, not only was plaintiff’s eye still filled with blood, but the pressure in his left eye began to decrease. Over the next six weeks, plaintiff’s pressure dropped from his preoperative value of 22 (in the normal range) down to 6 and then 3. Still, defendant ophthalmologist did not refer plaintiff to either a retinal specialist (to determine whether he had suffered a retinal detachment) or a glaucoma specialist (to address his rapidly decreasing eye pressure). When asked about this in his deposition, defendant ophthalmologist testified that he was hoping that plaintiff’s eye would get better.
After three months without improvement or explanation, plaintiff sought a second opinion from a specialist at one of the major medical centers in North Carolina. It was only after plaintiff told defendant ophthalmologist that he was going to be evaluated by someone outside the practice that defendant ophthalmologist finally scheduled an evaluation with his partner the retinal specialist. By that time, it was too late. As plaintiff learned (from both the defendant’s partner and the outside ophthalmologist), too much time had passed for anything to be done to restore his vision. Accordingly, plaintiff is blind in his left eye. Plaintiff also learned that the untreated postoperative complications were causing his eye to collapse and that it was very likely that he would eventually lose his left eye.
Negligence, causation and damages were heavily contested in the litigation. The defendant claimed that retinal detachment is a risk of cataract surgery. Defendant also tried to characterize the intraoperative bleed during the second surgery as an expulsive choroidal hemorrhage – a catastrophic complication that oftentimes results in total loss of vision in the surgical eye. The difficulty with this defense, however, was that nowhere did the defendant ophthalmologist contemporaneously note that plaintiff suffered an expulsive choroidal hemorrhage and, instead, minimized throughout his chart the extent of the bleed. It was only after plaintiff notified defendant ophthalmologist that he was going outside the practice for a second opinion that defendant suggested, in an “introductory letter” to the medical center ophthalmologist, that plaintiff had suffered a catastrophic expulsive choroidal hemorrhage at the time of the second surgery.
On the damages side, defendant argued that the problems plaintiff was experiencing post-injury were not attributed to his loss of vision, but instead, were attributable to his multitude of other health problems, including his obesity, heart problems and need for 24-hour supplemental oxygen.
The case settled after plaintiff had designated his experts but before they were deposed.
Type of action: Medical malpractice
Injuries alleged: Total loss of vision in left eye after cataract surgery
Case name: Confidential
Case number: Confidential
Verdict or settlement: Settlement
Date: July 2010
Plaintiff’s attorney: John Jensen of Jensen McGrath Podgorny (Research Triangle Park)
Editor’s note: The information in Lawyers Weekly’s verdicts and settlements reports was submitted by the counsel for the prevailing party and represents the attorney’s characterization of the case.