Vision Lost Through Medical Malpractice Results In Large Verdicts
27 Jul 2007
Sight is so precious that everyone would agree that special efforts are required when vision is at risk in medical care.
In two recent medical journal articles the responsibilities of physicians in different settings in regard to potential loss of sight are detailed.
The first involves the obligations of emergency room doctors:
Excerpts from Emergency Medicine Clinics of North America,Volume 16 ? Number 4 ? November 1998
Complaints of changes in vision or loss of vision are common in the emergency department (ED). This complaint may represent a simple problem related to recent trauma or may be early evidence of systemic disease. Some causes require urgent recognition and management, whereas others require minimal outpatient treatment. Key to the diagnosis and recognition of the more significant causes is a logical and organized approach to the history and the physical examination of the patient with eye complaints. The important issues for the emergency physician are: 1) recognition of visual changes; 2) general localization of the lesion through an orderly and structured manner; and 3) appropriate referral if the diagnosis is not apparent or the treatment indicated requires specialized techniques.
The emergency medicine physician can have a dramatic effect by early recognition and aggressive treatment of patients that present with central retinal artery occlusion, central retinal vein occlusion, retinal detachments, acute angle-closure glaucoma, ischemic optic neuropathy, and retrobulbar hemorrhage. Early diagnosis and treatment of these complications may save the vision of the patient.
The second involves two reported cases in which patients received treatment alleged to be below the accepted standard of care with blindness and partial loss of vision the result:
Excerpts From Neurologic Clinics, Volume 16 ? Number 1 ? February 1998
Iatrogenic illness is defined as any illness that results from a diagnostic procedure or therapy, so-called physicians as a cause of illness. Routine review of the medical literature suggests that up to 14% of patients experience iatrogenic neurologic complications, which is reflected in morbidity, mortality, and increased health care costs. From a legal perspective, these untoward events and hazards of medical care are called a tort, with allegations of negligence (i.e., medical malpractice ). A strict legal definition is that "malpractice is professional negligence and medical malpractice is the negligence of a doctor. Negligence is the failure to use reasonable care under the circumstances; doing something which a reasonably prudent doctor would not do under the circumstances or failing to do something which a reasonably prudent doctor would do under the circumstances; it is a deviation or departure from accepted practice."
The courts have recognized that "in performing a medical service, the doctor is obligated to use his or her best judgement and to use reasonable care." By undertaking to perform a medical service, a physician does not guarantee a good result. In fact, mistakes are an inevitable part of being human, even among physicians who practice high-quality medicine. The challenge physicians face is how to communicate errors to patients and reduce the risk of punitive action. The fact that there was a bad result to the patient, by itself, does not make the physician liable, only whether the physician was negligent. A physician is not liable for an error in judgment after a careful examination, if it is a judgment that a reasonably prudent physician could make under the circumstances.
Case 1
Failure to monitor intracranial pressure was alleged by a woman with a 4-day history of headache, nausea, behavioral changes, and spots before the eyes. The neurologist performed a lumbar puncture with elevated opening pressure of 380 mm of H2 O. She received sporadic mannitol treatment but no further lumbar puncture, and in 1 month she became blind. A subsequent magnetic resonance (MR) imaging scan revealed sagittal sinus thrombosis. The plaintiff's blindness was later diagnosed as permanent optic atrophy caused by raised intracranial pressure. The jury found the neurologist liable for $2.4 million in compensatory damages.
Case 2
A 36-year-old-woman was evaluated by a neurologist for convulsions and sickle cell anemia. There was no computed tomography (CT) scan ordered, and therefore the neurologist failed to diagnose a sphenoid ridge meningioma. The patient subsequently developed right visual loss and proptosis with subsequent blindness. The plaintiff claimed that a CT scan was a routine part of a complete workup for seizure disorder, whereas the defendant contended that he advised the patient to have a CT scan but she was afraid. This was not documented in the office notes. Neurologists testified for both sides, with plaintiff verdict $1.25 million.
