Case Study - Ophthalmology Cataract Surgery: defend!

Timothy R. Bone, President, MedMal Direct Insurance Company // March 29, 2010

The parties to the lawsuit: This lawsuit was filed on behalf of a 62 year old, retired widower with no minor dependents; and was filed solely against a 55 year old board certified Ophthalmologist.

The facts
The patient first presented himself to the Ophthalmologist with complaints of pain and blurred vision in the right eye for the past three months. The Ophthalmologist’s examination of the patient revealed posterior subscapular cataracts involving both eyes, the right eye greater than the left. The patient was treated conservatively for 10 months, at which time the Ophthalmologist noted that the right eye cataract had advanced to a state where cataract extraction and insertion of an intraocular lens were indicated.

At that same office visit the patient received an extremely detailed explanation in lay as well as medical terms concerning what a cataract was, the type of operation anticipated and the possible complications that can occur, including hemorrhage. (Note that other patient records from the Ophthalmologist’s office show extremely detailed informed consent was obtained from these other patients.)

The surgery was performed one month later and was totally uneventful. However, the day after the surgery, during the first post-operative visit by the Ophthalmologist, it was noted that the patient had a large anterior chamber hemorrhage (hyphema). The patient was then seen by the Ophthalmologist about every three days through the next three months in order to closely observe the absorption of the blood from the anterior chamber.

At the end of that three month period, corneal staining was noted and thus removal of the blood was necessary. Note that the Ophthalmologist, since the hyphema was noted, had regularly consulted with another Ophthalmologist, who concurred totally with the treatment plan for this patient. Within three days of noting the hyphema, the Ophthalmologist irrigated the blood from the anterior chamber without complication and saw the patient once a week for the next six months. At the last office visit, the patient’s visual acuity remained at Hand Movements with intraocular tension controlled and no corneal staining present. There was nothing further that could be done to improve the patient’s visual acuity.

Allegations of negligence
The primary allegation of medical malpractice directed against the Ophthalmologist was that the cataract extraction and intraocular lens insertion were negligently performed. Additionally, the patient alleged that the Ophthalmologist did not adequately inform the patient of the possible complications of this cataract surgery; specifically, hemorrhage.

Expert Opinion

The formally retained defense expert was fully supportive of the treatment rendered by the Ophthalmologist. Additionally, the consulting Ophthalmologist – Chief of Ophthalmology at a highly respected medical center – indicated a willingness to testify with full support of the treatment rendered.
The attorney for the patient retained a general surgeon (not board certified) who supported the allegations of negligence.

Damages

The patient does not have a claim for lost wages but does have a claim for approximately $10,000 in medical expenses as well as an undetermined amount for loss of vision and pain in his right eye.
There were no codefendants in this case; thus, there is no possibility of contribution.

Analysis
After careful review by the Litigation Committee in concert with the highly experienced claims staff, the decision was made that the Ophthalmologist did not have significant liability exposure in this matter from the standpoint of the surgical technique nor from the alleged failure to adequately inform the patient of possible complications. The decision was made to pursue a most vigorous defense for the Ophthalmologist.

Result
After a two week trial, the jury returned a verdict in favor of the defendant Ophthalmologist. No appeal was taken.