A 79-year-old woman presented to an ophthalmology ASC for a right eye cataract extraction with intraocular lens implant.

She had the left eye done previously and she had received fentanyl 20mcg and midazolam 1mg.

For this second case her anesthetic was administered by CRNA V and anesthesiologist Dr. B.

She initially received 2.5mg versed.

Unfortunately during the case she squeezed the speculum in her eye so hard it caused the intraocular lens and anterior vitreous to herniate through her pupil.

After this complication she received fentanyl 50mcg twice.

The lens and vitreous were removed from the anterior chamber and the ophthalmologist placed an anterior lens instead of a posterior chamber lens.

She unfortunately went on to lose vision in the eye.

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The CRNA claims she never complained of pain until after the complication.

The ophtho says she never complained of pain at all.

The plaintiff claims there was anesthesiology malpractice as the sedation was not adequate.

They requested $3.5 million to settle the case.

The defense hired an anesthesiology expert

Arguments were made in front of the judge that the anesthesiologist should be dismissed.

The judge responds;

The judge is saying the patient chose the facility, not necessarily the doctors.

Therefore there are questions of vicarious liability.

The anesthesiologist, CRNA, ophtho will not be dismissed, and liability will be up to a jury.

Outcome

The case did not settle and instead went to trial

The trial concluded and the jury ruled in favor of the defendants.

The defense filed a motion for the plaintiff to reimburse them for the costs of the trial totaling $70,719.59.

It seems they did not think the plaintiff’s side gave them reasonable settlement offers, as they go out of their way to mention the $3.5 million.

Because of this request we are able to get a look at some of the itemized costs. Here is the anesthesiology expert’s bill for trial.

Costs were awarded, but only a very small amount, with the following cited.

So the defense was awarded $700 in recovered costs.

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MedMalReviewer/Anesthesiologist Analysis

1. The distinction here between sedation and anesthesia is true in some regards but also a bit artificial. Balancing pain control with sedation is a shared responsibility. Naturally, when a lawsuit arises, finger pointing starts. It seems that the patient’s reaction may have been sudden and without warning, although her recollection is different.

2. Experts can make out pretty well. Additionally, gaining any amount of court room experience can be very valuable in learning how to communicate effectively while under duress. It’s possible to end up in a courtroom yourself one day, whether it’s for med mal or otherwise. Having some degree of comfort and understanding of procedure and the legal system is a beneficial life skill. However, to do this sort of work you do have to actually enjoy it, and many doctors quickly realize they don’t enjoy the antagonistic nature of depositions and cross-examination.

3. Bringing a case to trial isn’t cheap, here are some of the other charges.

The insurance company is, of course, also getting bills from the defense attorney separately, which are almost certainly much higher than the expenses shown here.

On the plaintiff’s side, most attorneys operate on contingency and front their costs.

4. I get the sense there was some animosity in this case. Unreasonable settlement offers can do that. We don’t know if the defense tried to negotiate a settlement at all here, but they were certainly taken back by the $3.5 million offer. Blindness is a debilitating and sympathetic injury, and a trial could be risky for the defense. That being said, monocular blindness has drastically reduced liability compared to complete bilateral blindness. I’ve had plaintiff attorneys tell me there are some states in which it’s not even worth bringing a unilateral blindness lawsuit because the awards are so it’s not enough to cover their expenses, even if it was obvious malpractice.