I feel bad for this patient, and the miss does seem egregious, as blepharitis should not cause such bad vision loss. However, the estimates of lost income seem absurd. He really couldn’t continue to do his job as a professor due to losing vision in one eye? I had an attending when I did EM residency that was able to keep working as an ER doc even after he lost his eye in a golfing accident. He was still able to do LPs and everything.
I won't comment on the estimates in lost income because if I lost my vision unnecessarily, I'd be supremely upset and you can't put a price on your vision. But, this lesson is what will stick with me..."We need to maintain respectful skepticism of a patient’s ability to accurately describe their problem." Countless times I've had patients who dismiss their symptoms and respectful skepticism is best for both parties in these types of situations.
Ophthalmologist here. An RD presenting with HM vision would not have resulted in functional vision if it was diagnosed correctly at the first visit. This settlement is pretty ridiculous, although not dilating a HM patient is negligent and unheard of.
Both in regard to the clinical aspects of this case as well as the damages.,,
Could not agree more with all of you.
From me...
A comment on the damages...
Many years ago, in my first three years out of residency, I worked as a covering neonatologist at our local Level III NICU...
While there I worked with a delightful young nurse who was tragically killed by a drunk driver at the age of only 23.
The driver was convicted of vehicular manslaughter yet only received a one-year jail sentence.
The nurse's family filed a wrongful death lawsuit against the driver and I was deposed as a friend who was familiar with her and her family relationships.
In the process of that deposition, I was told that one of the damages being asked was on behalf of the mother...
For , literally, 40 years of haircuts once a month because that was a service which the deceased child had provided to her mother.
Med Mal Reviewer is so correct about lawyers including anything they can to "beef up claims"!
I see an ophthalmologist regularly for a condition with my left cornea, and she routinely does dilated eye exams of both eyes at every single visit (even if sometimes I wish she didn't, especially on a sunny day!). So it seemed wild to me that the first ophthalmologist in this case didn't bother with one in the setting of an acute complaint of vision loss (and I see a comment from an ophthalmologist that this was, indeed, negligent).
This is why I dilate every new patient to my clinic if they aren't seeing 20/20 and do IOP/CF/pupils/EOMS every time they come in. Or if there's a sudden vision change from prior visit. Never know what might come up.
That being said...I am really curious at how long the patient waited before calling the clinic in the first place. If he had flashes and floaters for a week prior and didn't call till he was hand motion... waited for the vision to get "really bad"...oof. Pretty much every eye clinic schedules sudden loss of vision or flashes/floaters within 24 hours so if he called and told the staff "I have a bump on my lid and my vision is blurry", they aren't gonna necessarily schedule that within 24 hours unless there happens to be an opening.
And if he was hand motion on the first visit, odds are high the macula was already off. I'm fascinated by the claims for the assistive devices too, I actually wonder how much they will actually be used or if that was an attempt to beef up the claim demand.
The patient is presumably will be legal to drive, so why the demand for a stair lift and talking thermostat? I agree they seem excessive.
As a (now retired) emergency physician, I find this case especially concerning. A sudden change in vision, even with a style, is the equivalent, in my mind, of an ocular stroke, and would mandate not only an ophthalmologist referral, but also a phone discussion directly, including “should I dilate and do a slit lamp exam or will you when you come in today to see the patient?” Also,I would be concerned about vicarious liability about referral of an urgent patient and having the specialist miss the diagnosis. The defense obviously found the ophthalmologist care indefensible and should just write a (reasonable) check.
I feel bad for this patient, and the miss does seem egregious, as blepharitis should not cause such bad vision loss. However, the estimates of lost income seem absurd. He really couldn’t continue to do his job as a professor due to losing vision in one eye? I had an attending when I did EM residency that was able to keep working as an ER doc even after he lost his eye in a golfing accident. He was still able to do LPs and everything.
Looks like a bad miss.
I won't comment on the estimates in lost income because if I lost my vision unnecessarily, I'd be supremely upset and you can't put a price on your vision. But, this lesson is what will stick with me..."We need to maintain respectful skepticism of a patient’s ability to accurately describe their problem." Countless times I've had patients who dismiss their symptoms and respectful skepticism is best for both parties in these types of situations.
Ophthalmologist here. An RD presenting with HM vision would not have resulted in functional vision if it was diagnosed correctly at the first visit. This settlement is pretty ridiculous, although not dilating a HM patient is negligent and unheard of.
Pediatrician here...
EXCELLENT comments all...
Both in regard to the clinical aspects of this case as well as the damages.,,
Could not agree more with all of you.
From me...
A comment on the damages...
Many years ago, in my first three years out of residency, I worked as a covering neonatologist at our local Level III NICU...
While there I worked with a delightful young nurse who was tragically killed by a drunk driver at the age of only 23.
The driver was convicted of vehicular manslaughter yet only received a one-year jail sentence.
The nurse's family filed a wrongful death lawsuit against the driver and I was deposed as a friend who was familiar with her and her family relationships.
In the process of that deposition, I was told that one of the damages being asked was on behalf of the mother...
For , literally, 40 years of haircuts once a month because that was a service which the deceased child had provided to her mother.
Med Mal Reviewer is so correct about lawyers including anything they can to "beef up claims"!
I see an ophthalmologist regularly for a condition with my left cornea, and she routinely does dilated eye exams of both eyes at every single visit (even if sometimes I wish she didn't, especially on a sunny day!). So it seemed wild to me that the first ophthalmologist in this case didn't bother with one in the setting of an acute complaint of vision loss (and I see a comment from an ophthalmologist that this was, indeed, negligent).
This is why I dilate every new patient to my clinic if they aren't seeing 20/20 and do IOP/CF/pupils/EOMS every time they come in. Or if there's a sudden vision change from prior visit. Never know what might come up.
That being said...I am really curious at how long the patient waited before calling the clinic in the first place. If he had flashes and floaters for a week prior and didn't call till he was hand motion... waited for the vision to get "really bad"...oof. Pretty much every eye clinic schedules sudden loss of vision or flashes/floaters within 24 hours so if he called and told the staff "I have a bump on my lid and my vision is blurry", they aren't gonna necessarily schedule that within 24 hours unless there happens to be an opening.
And if he was hand motion on the first visit, odds are high the macula was already off. I'm fascinated by the claims for the assistive devices too, I actually wonder how much they will actually be used or if that was an attempt to beef up the claim demand.
The patient is presumably will be legal to drive, so why the demand for a stair lift and talking thermostat? I agree they seem excessive.
As a (now retired) emergency physician, I find this case especially concerning. A sudden change in vision, even with a style, is the equivalent, in my mind, of an ocular stroke, and would mandate not only an ophthalmologist referral, but also a phone discussion directly, including “should I dilate and do a slit lamp exam or will you when you come in today to see the patient?” Also,I would be concerned about vicarious liability about referral of an urgent patient and having the specialist miss the diagnosis. The defense obviously found the ophthalmologist care indefensible and should just write a (reasonable) check.