Risk Management



Complicated Course of Chronic Iritis

By Randy Morris, JD OMIC Claims Associate

Digest, Fall 2001

ALLEGATION  Failure to timely treat chronic iritis and scleritis.

DISPOSTION  Defense verdict on behalf of OMIC insured.

 

Case Summary

A 50-year old male patient was seen by the insured on a referral from an optometrist for evaluation and treatment of iritis in the right eye. The patient’s history included a prior episode of iritis with a finding of synechia. Examination showed the presence of a cataract, which the insured suspected was caused by chronic iritis. She prescribed Predforte and Mydriacyl. The patient returned for numerous visits with the insured, while at the same time being treated by a primary care physician and an optometrist. On two occasions, when the primary care physician diagnosed conjunctivitis, the insured injected Celestone and the patient seemed to respond favorably.

During a subsequent visit, the insured diagnosed iris bombe related iritis. On two separate occasions, the insured used a YAG laser on an emergent basis to make a hole in the iris and bring down the intraocular pressure. In both instances, the hold closed off within a matter of weeks and prompted the insured to a perform a sector iridectomy. The iridectomy failed within one month. Although the cataract was potentially contributing to the iris bombe, the insured chose not to perform cataract surgery because of ongoing medical issues with the eye.

The insured referred the patient to an iritis specialist for a second opinion. The specialist’s impression was chronic iritis and scleritis, and he ordered a battery of tests to determine whether various diseases might be causing the chronic iritis. Tests for syphilis, tuberculosis, and rheumatoid arthritis were negative, but the patient continued to have problems with the eye. Throughout the course of treatment, the patient was seen by numerous specialists and prescribed various medications, including oral Prednisone. Despite these efforts to diagnose and treat the cause of the iritis, the patient eventually lost all vision in the right eye.

Analysis

The insured, the primary care physician, and a medical group were all named defendants in the patient’s lawsuit. Plaintiff’s expert criticized the insured for not treating the chronic iritis more aggressively, but he was forced to concede that he could not say to a reasonable medical probability that more aggressive therapy would have prevented that patient’s loss of vision. The defense expert felt strongly that the insured had complied with the standard of care at all times and that the patient appeared to have lost vision in the eye despite the best efforts of all the physicians involved. Specifically, the defense expert supported the insured’s decision to get a second opinion when the patient did not respond to treatment with topical steroids.

Risk Management Principles

This case illustrates how an unfortunate result can lead to a lawsuit, even when the best of case is provided. The patient presented with a complicated chronic condition that failed to respond to a multidisciplinary course of treatment. Fortunately, skilled defense counsel and a very effective expert witness convinced the jury that there was no negligence on the part of the OMIC insured in her care of the patient. The insured’s referral to the iritis specialist was a major factor in her defense and underscores the value of a prompt referral when a patient is not responding to treatment. In post-trial interviews, several jurors said they did not like the plaintiff expert’s criticism of the insured ophthalmologist; conversely, they were impressed with OMIC’s defense expert. The codefendants didn’t fare as well, however, and were hit with a plaintiff verdict. In an interesting twist, they appealed the verdict and were granted a judgment in their favor.

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