On March 3, 1998, the plaintiff reported to his regular ophthalmologist with an emergency that had begun four days earlier when he developed large floaters in his left eye accompanied by flashing and limited visual acuity. He further complained of having developed a black spot in the left temporal periphery of the left eye which began on March 2, 1998 and continued. The ophthalmologist examined the eye and diagnosed a retinal detachment, which he drew in a fundus drawing of the eye (clock-like) as encompassing an area of 2 clock hours. He also found retinal folds and a possible retinal tear. As a result of his findings that evening, the ophthalmologist immediately called the defendant retinal specialist in his group and advised her of his findings. An appointment was arranged for the very next morning (March 4, 1998 at 9:00 a.m.), and according to the plaintiff, he was advised by his ophthalmologist to prepare himself for emergency retinal surgery. As a result, the plaintiff, accompanied by his wife, consulted the retinal specialist the morning of March 4, 1998 . He had intentionally not eaten so that emergency surgery could take place. By the time he was examined again, his retinal detachment that had more than doubled in size and now encompassed approximately 5 clock hours on the fundus drawing made by the defendant. She also found a 2 clock hour retinal tear with a rolled posterior edge. At the same time, she noted lattice degeneration (a thinning of the retina) in the left eye and made a note that she would have to examine the right eye in due course to determine if a similar condition existed in that eye. In spite of the severe risk of further deterioration to the left eye, the defendant did not perform surgery on March 4, 1998, and instead arranged for surgery the following day, which did not begin until after 2 p.m. Although the defendant alleged that no hospital operative suite was available to do the surgery on March 4, 1998, testimony would have been presented by the plaintiff from a former employee of the hospital that one was available on March 4, 1998. Also, written procedures were in place to allow a physician with an emergency patient to bump other surgeries.
The defendant retinal specialist had determined that plaintiff required a scleral buckle procedure to repair the retinal tear and the retinal detachment in the left eye. This procedure, which also involves the freezing of the retinal tissue with a welding type of procedure to repair the tear, entails the wrapping of a silicone band around the eye to force the retina back against the back of the eye so it can heal. Unfortunately, prior to the procedure beginning, the defendant examined the left eye and found additional pathology: the retinal tear had expanded to a “giant” tear encompassing a full quadrant of the eye, blood was found in the vitreous of the eye, and a second retinal tear had developed in the upper portion of the same eye. This progression of symptoms and pathology indicated severe vitreous traction causing posterior vitreous detachment which was damaging the retina, and could no longer be remedied by a simple scleral buckle procedure. Rather, at that point, the plaintiff required a vitrectomy to remove the entire vitreous in the eye, and replace it with a fluid or a gas, which holds the retina in place, after the retinal tears are repaired, and alleviates the tractional forces pulling at the retina which cause further injury. This procedure should have been combined with the scleral buckle.
In the days following the surgery, the plaintiff continued to have severe vitreous hemorrhage to the point where the retina could not be adequately examined without ultrasound. It was not until March 20, 1998 that the defendant determined that the vitrectomy was necessary to alleviate the plaintiff’s conditions, at which point surgery was scheduled for March 25, 1998. Unfortunately, by that time, the plaintiff had developed a total retinal detachment involving all 12 clock hours of the fundus, and now was detached at the macula, which is the center of fine detailed vision in the eye. Further, the second retinal tear which had been found during the March 5, 1998 surgery at the top of the left eye, had now also become a giant retinal tear. Following the March 25, 1998 surgery, the plaintiff continued to deteriorate and developed a complete deterioration of the eye which caused it to shrink and become useless. A year later, the eye was surgically removed and plaintiff now has a prosthetic eye on the left side.
As previously noted, the defendant also failed to examine the right eye during plaintiff’s first visit on March 4, 1998. This failure continued for several months, and at no time was the right eye examined or treated prophylactically for probable lattice degeneration, a thinning of the retina. Plaintiff’s contended that this thinning was in the superior, or upper, portion of the eye, which went on to suffer a retinal detachment in March of 2000, two years later. This resulted in multiple surgeries on the right eye, which were only modestly successful and have left that eye legally blind.
The defendant contested these allegations and argued that the delay in performing surgery was not meaningful under the circumstances. Further, it was argued that the determination to perform a scleral buckle procedure alone, without a vitrectomy, was a matter of medical judgment, which was justified under the circumstances. The defendant further argued that although it was negligent to fail to examine the right eye both initially and in the months of treatment thereafter, the retinal detachment sustained in the right eye was unrelated to that negligence and not her fault. In support thereof, the defendant would have argued that the new retinal surgeon who treated the right eye performed the combination of a scleral buckle and vitrectomy (as plaintiff contends had been necessary to treat the left eye), and nevertheless, complications resulted in substantial loss of plaintiff’s vision in that eye as well. Lastly, the defendant would have presented a strong Scafidi defense seeking credit for plaintiff’s pre-existing conditions in both eyes, to the extent they were not the defendant’s fault.
Attorneys Amos Gern and John Ratkowitz resolved the case after two days of trial.