Risk Management

Failure to Prove Negligence in Treatment of Macular Degeneration

Digest, Spring, 1993

ALLEGATION  Insured ophthalmologist allegedly failed to properly assess and treat a subretinal bleed. In addition, there were allegations that the insured negligently performed laser surgery, and failed to warn patient of the potential risks and complications of surgery.

DISPOSITION  Charges were dismissed by the plaintiff during trial.

Background

To prevail in a medical malpractice suit, the plaintiff has the burden of proof of demonstrating the following four elements for a finding of negligence:

• That a physician-patient relationship existed (i.e., a legal duty existed);
• That the physician breached the relationship by rendering treatment which did not fall within the standard of care;
• That it was the physician’s treatment which caused the patient’s injury;
• That the patient did indeed suffer damages as a result of the physician’s care.
• Failure by the plaintiff to prove any one of these four elements usually results in a finding in favor of the defendant.

Case Summary

The patient was an elderly female who saw the insured, a general ophthalmologist, with the complaints of decreased vision in the left eye of three weeks’ duration. Vision was hand motion only. The patient had suffered from poor vision in the other eye for many years as a result of a perforating injury. The ophthalmologist noted age related maculopathy in both eyes, and performed laser treatment.

Four months later, the patient presented with an active blood vessel membrane that appeared to extend through the center of the fovea of the left eye, and a subretinal hemorrhage of the left eye. The patient was treated for conjunctivitis and referred to a macular photocoagulation study group; however, the blood vessel membrane was too large to place the patient in the study. A month later, a retinal specialist diagnosed macular degeneration and referred the patient to a vision rehabilitation center. The patient sued the general ophthalmologist.

Outcome

During the trial, it was the plaintiff’s contention that the ophthalmologist had misdiagnosed macular degeneration and had incorrectly performed laser surgery without the patient’s informed consent. The defense countered that the diagnosis was correct, that the treatment was appropriate, and that the ophthalmologist had informed the patient of the potential risks and complications of laser surgery. As the trial progressed into its fifth day, and it appeared that the testimony was favoring the defense, the plaintiff was informed by her attorney and the judge that she would be responsible for trial and mediation costs if her case was lost. The plaintiff agreed to dismiss all charges.

Risk Management Principlesand Commentary

Had a verdict been rendered in this case, it is unlikely there would have been a finding of negligence. Of the four elements necessary to establish medical malpractice, the plaintiff was able to demonstrate only that a physician-patient relationship, a legal duty, existed.

The defense, on the other hand, was able to demonstrate that there was no breach in the standard of care because the diagnosis was correct and because the laser surgery was acceptable treatment falling within the standard of care for subretinal neovascularization. Furthermore, the defendant-ophthalmologist testified convincingly that the patient was informed of the risks of surgery.

Finally, the defense was able to show that the patient’s vision loss was caused by macular degeneration and subretinal neovascularization, not by the ophthalmologist’s treatment. Since the plaintiff could not demonstrate that the ophthalmologist’s treatment was what caused her alleged injury, she thereby failed to prove another of the essential four elements for a finding of negligence.