Legal Review & Commentary

$4.875M settlement in eye infection case

News: A middle-aged man was suffering from a fever, facial swelling and redness, and nasal congestion. After consulting with his regular family doctor and two other doctors, the man was diagnosed with viral influenza and a mild drug reaction. When the man's symptoms persisted and his eyes began bleeding, however, the family doctor finally realized that his patient was suffering from an eye infection. Subsequent treatment was unsuccessful, though, and the man lost his eyesight in both eyes. The man sued his family doctor's physician group for negligence, and the parties settled the case for $4,875,000.

Background: A 44-year-old man who was not feeling well asked his wife to call their family physician's office. But because their regular family doctor was not available, the woman was referred to another doctor's office. The wife contacted the second office and told one of the doctors there that her husband had had a fever between 102° and 103° over the last couple of days, that he had swelling on his face and ears (but no itching), that his face was red, and that he had bad nasal congestion and drainage. The doctor instructed the woman to tell her husband to stop taking any over-the-counter medications and to instead try Benadryl. The woman was to call the doctor again if her husband did not begin feeling any better.

Although the woman followed the instructions, her husband's condition did not improve. So the next day, the woman took her husband to the office of their regular family doctor. At the office, the regular family doctor noted that the man had joint and muscle pain, swelling in and around his eyelids, ears, neck, throat, and eyes, and associated discharge. The man also had a fever — which had begun two days earlier — of 101.7°. The doctor suspected that the man was suffering from a viral influenza and a drug reaction, possibly to the dyes in the medications he had been taking. Consequently, the doctor restricted the patient to color-free acetaminophen and sent him home after prescribing a steroid, an antihistamine, and a medication to help with digestion. The doctor, however, failed to consider the possibility of infection, and he did not order any blood work.

The next day, the man's wife called the family doctor's office, but this time was directed to another doctor in the office. The woman reported that her husband's eyes were still swollen and that his symptoms had not changed. The family doctor's associate advised the woman to change the dosage of the steroid medication and to follow up with the regular family doctor later. Yet again, however, the man's condition did not improve, and his eyes remained swollen shut.

Two days later, the woman called the office again and reported that her husband's eyes were matted shut with blood coming out. Although the man had an appointment for later that day, he wanted to come in earlier. But the family doctor's office instructed the man to keep his originally scheduled appointment. At the appointment, the regular family doctor finally recognized that the man had an eye infection — known as orbital cellulitis — and that he required immediate hospitalization. Although hospital staff administered antibiotic medications and performed emergency surgery, the man lost his eyesight in both eyes and was unable to return to his job.

The man sued the family doctor's physician group, claiming that the defendant failed to properly hire, train, and supervise its medical staff, that it failed to timely diagnose and treat the plaintiff's medical condition, and that it failed to perform additional diagnostic tests to determine the cause of the plaintiff's symptoms. The thrust of the man's claim was that the infection should have been part of the doctor's differential diagnosis, and if antibiotics had been administered earlier, the man would not have lost his vision. After all, the man complained, a simple blood test would have disclosed an elevated white blood cell count, which would have confirmed a bacterial process and led to the administration of antibiotics. The physician group denied liability, maintaining that the plaintiff's symptoms were caused by other factors and not by orbital cellulitis. Before trial, the parties settled the case for $4,875,000.

What this means to you: "This case underscores the importance for every health care facility to take all patient complaints seriously until a diagnosis can be made," says Patricia S. Calhoun, Esq., an attorney for Buchanan Ingersoll and a former registered nurse. "Staff often find themselves in the position of filtering telephone complaints from patients and family members, which are sometimes panicked, with overstated complaints. It is critical to avoid the temptation toward malaise when faced with such complaints, and to inform patients of the option to seek alternative medical treatment at the earliest juncture possible at a local emergency room or elsewhere." It presents a potential risk management nightmare when clinical staff become inoculated against the possibility that symptoms described by patients and family members can potentially be very serious. A panicked family member who contacts a health care facility may well have good reason to be panicked.

The physician's office contacted by the patient's wife in this case could have avoided this multimillion-dollar liability in its entirety had it simply informed the patient of the option to present at the nearest hospital emergency department or other facility, and documented such. Instead, the physician's office almost literally advised the patient to "take two aspirin and call me in the morning." The physician's office had no obligation to see the patient on an emergent basis, but it should have advised the wife of the patient to go to the emergency department.

"This case also underscores the danger from a risk management perspective of providing medical advice over the telephone without an examination of the patient," says Calhoun. In retrospect, it was a mistake for the physician to provide medical advice over the telephone without examining the patient at all. Days later, another physician made the same mistake. These physicians could have limited their liability if they had either made an appointment for the patient to come in within a reasonable time, or recommended that the patient seek treatment at a local emergency department or another clinic that could see him sooner. Unfortunately, the clinic paid the price for those individuals taking a more casual approach and underestimating the gravity of symptoms described by a family member over the telephone.

Reference

• Forsyth County (NC) Superior Court, Docket information withheld.