Legal Review & Commentary: Failure to review contact lens solution instructions leads to $3.5M NY settlement
Legal Review & Commentary
Failure to review contact lens solution instructions leads to $3.5M NY settlement
By Radha V. Bachman, Esq.
Buchanan Ingersoll & Rooney PC
Tampa, FL
and Leilani Kicklighter, RN, ARM, MBA, CPHRM, LHRM
The Kicklighter Group
Tamarac, FL
News: A man went to the eye clinic at a local hospital complaining of chronic blurry vision in his left eye. The man was seen by a resident who removed the man's left eye contact lens and placed it in a contact lens case containing contact lens solution. When the contact lens was placed back into the man's left eye, the man felt a burning sensation. The resident removed the contact lens, but the man was thereafter diagnosed with corneal damage and superficial punctate keratitis. Within a few months, the man went completely blind. A jury found in favor of the man and awarded $4 million.
Background: A 33-year-old actor and part-time teacher of dramatic arts and movement went to the eye clinic of a local hospital, affiliated with well-known medical schools in the area, complaining of chronic blurry vision in his left eye. The man was seen by a fourth-year ophthalmology resident who removed the man's left contact lens and placed it in a contact lens case filled with a contact lens cleaning and disinfecting solution. When the man reinserted the contact lens into his left eye, he felt a burning sensation. The resident removed the contact lens immediately. The contact lens had been in the solution for two hours, and the resident had not used the contact lens case that had come with the solution.
At the time of the visit, the man had been diagnosed with complete blindness in his right eye and legal blindness in his left eye and had been legally blind his whole life. The man had been diagnosed with uveitus, an inflammation of the iris, which affected the man's retina and optic nerve. Additionally, the man's left eye suffered from other ailments, including low eye pressure, substantial shrinkage and shape abnormalities, removal of the lens, and a partially detached retina.
The next day, the man visited his ophthalmologist, who diagnosed him with corneal damage in his left eye. Five days later, his doctor diagnosed him with superficial punctate keratitis. Nine days after his initial visit to the hospital, the man's doctor informed him that the superficial punctate keratitis had diminished, but that he should prepare for eventual blindness nevertheless. Within just a few months, the man became completely blind.
The man sued the hospital, the resident's attending physician, and the resident physician, claiming that their negligence accelerated his blindness. The case against the resident physician was dismissed. The man argued that the resident failed to read the warning labels on the contact lens solution and, in doing so, failed to understand the instructions that required contact lenses to stay in the solution for six hours. The man also claimed negligence as a result of the resident's failure to realize that the solution instructions required it to be used only with the contact lens case that came with the solution in order to allow for neutralization of the acidic solution.
The man further asserted that the resident failed to timely remove the contact lens from his eye after he complained of the burning sensation, and that this failure caused his left eye to get burned by the solution.
The man's treating ophthalmologist testified that the man would have gone blind within about five years had the incident not occurred and that, therefore, the incident accelerated the man's blindness. Another expert testifying on behalf of the man dealt his case a blow when stating that the man's left eye was massively damaged, that he would have gone blind with or without the incident, and that an exact time frame was impossible to pinpoint.
While counsel for the defense apologized for the occurrence, they maintained that the damage actually was the superficial punctate keratitis and that this had healed within nine days after the incident. Defendant's expert opined that the man would have gone completely blind within a year even if the incident in question had not happened, and that the contact lens solution did not play a role in the accelerated blindness. Additionally, the resident asserted that she removed the painful contact lens within seconds.
Counsel for the man stated that the plaintiff had led a full life with the use of magnifying equipment despite his limited sight. He focused his career on making commercials and independent films and had acting roles on various television programs. The plaintiff sought damages for loss of earnings and pain and suffering.
Ultimately, the jury found in favor of the plaintiff and awarded him $4,085,436. The case settled after the verdict pursuant to a high/low agreement for $3.5 million, which was paid by the local hospital.
What this means to you: This case raises many issues and several questions from a risk management and patient safety view. The eye clinic is a part of the hospital that is affiliated with several medical schools in the area. We do not have the information here to tell us who the resident and supervising physician "belong" to. Is the ophthalmology residency based in the hospital or one of the medical schools? Is the resident an employee of the hospital or the university? Is the supervising physician an agent of the hospital or the university when serving as the supervisor of the resident? Depending on state laws, in addition to how contracts of affiliation are designed, the answers to those questions may influence how the insurance and contracts are set up. In all instances, one always would work for a cooperative defense.
One of the underlying principles of medications and use of solutions that go in or on the body are to know the indications, contraindications, expected outcome, and complications of each drug or solution. Nurses, physicians, physician extenders, and medical assistants, including ophthalmology assistants, are all held to these standards. Compliance with those standards of practice would have included the knowledge of use of a specific container with this particular solution and the time frame for soaking the lens. When a solution is poured into a container or drawn up in a syringe for later use, the container or syringe should be labeled with the content and the date.
From the information we have here, we do not know if the eye was flushed upon removal of the contact lens or if the attending physician was readily available, was called, and came to examine the patient. A fourth-year resident should have some level of autonomy when seeing patients, but still is in training and should have ready access to the attending especially when there is an unexpected event.
Additionally, we do not know if the resident selected this particular solution to store the contact lens or if this is the standard storage solution and method used in all examination rooms in that clinic. Regardless, the resident should have known the particulars of the solution and storage container. Steps should be taken to conduct competency assessments in all areas of the hospital, including clinics, to verify that all staff are knowledgeable about practices and standards in their respective areas. Risk managers and other support staff should verify that ready and easy access to reference material is available in all patient care areas.
In this case, the patient was a relatively young person with training in the arts. While he was legally blind and had been for some years, he was not yet totally blind, even if the prognosis of his underlying condition would have rendered him totally blind in the next five to 10 years. Those of us who have correctable vision may not be able to appreciate how much it means to be able to read or see with special lenses, magnifiers, and other specific equipment or to differentiate between light and dark.
Reference
Supreme Court, Kings County, Civil Div., Case No. 0035013/2005.
A man went to the eye clinic at a local hospital complaining of chronic blurry vision in his left eye. The man was seen by a resident who removed the man's left eye contact lens and placed it in a contact lens case containing contact lens solution. When the contact lens was placed back into the man's left eye, the man felt a burning sensation. The resident removed the contact lens, but the man was thereafter diagnosed with corneal damage and superficial punctate keratitis. Within a few months, the man went completely blind.Subscribe Now for Access
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