Fox v. Our Lady of Lourdes Regional Medical Center

Citations: 550 So. 2d 379; 1989 La. App. LEXIS 1708; 1989 WL 116225Docket: No. 88-609

Court: Louisiana Court of Appeal; October 4, 1989; Louisiana; State Appellate Court

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Wesley Fox filed a medical malpractice suit after experiencing impaired vision in his left eye following cataract surgery performed by Dr. Barry A. Bohn in 1984. Fox claimed that an incorrect intraocular lens (IOL) was implanted, resulting in his vision problems. Prior to trial, several defendants, including Our Lady of Lourdes Regional Medical Center and Optical Radiation Corporation, were dismissed without opposition. After a bench trial in December 1987, the court ruled in favor of the defendants, dismissing Fox's suit. Fox appealed, arguing that the trial court erred in finding that Dr. Bohn met the accepted standard of care, failed to apply the doctrine of res ipsa loquitur, and did not award damages. 

Key facts include that Dr. Bohn’s technician took essential measurements of Fox's eye before surgery, which were critical for selecting the correct IOL. Post-surgery, Dr. Robert Stewart identified that the implanted IOL had the wrong power (25 instead of the required 33), leading to Fox's vision issues. Fox contended that incorrect measurements were taken, influencing the lens strength calculated. He claims his impaired vision has caused significant personal suffering, early retirement, and financial loss, seeking both general damages and lost wages. In medical malpractice cases, the plaintiff must demonstrate the standard of care, failure of the physician to meet that standard, and a direct causal link between the failure and the injury suffered.

Dr. Bohn, an ophthalmologist, is held to the standard of care and knowledge typical of his specialty when assessing negligence. Evidence of negligence must be provided by specialists in the relevant field. A determination of whether Dr. Bohn breached these standards hinges on his conduct during the cataract procedure. The principle of res ipsa loquitur allows for an inference of negligence when direct evidence is lacking, suggesting that the defendant's negligence is the most plausible cause of the injury, unless other explanations are equally probable. This doctrine does not eliminate the necessity to prove negligence but allows the plaintiff to use circumstantial evidence to shift the burden of proof.

In the case at hand, it is uncontested that Mr. Fox's vision issues stem from an inadequately powered intraocular lens (IOL) implanted by Dr. Bohn. The key issue is whether such an error could occur absent negligence. The standard of care in cataract surgery involves precise measurements of the eye, including the axial length and curvature, which are inputted into a computer to determine the IOL's refractive power. The measurements are taken using an ultrasound device, where improper application of the probe can lead to inaccuracies. Although the machine used was functioning correctly, the evidence suggests that human error could have resulted in the incorrect measurements, rather than a malfunction of the equipment.

The measurement of the left eye's axial length was not compared with that of the right eye, a standard practice recommended in the Jed Med Axisonic II instruction manual. While the defendant’s expert acknowledged this practice among more experienced colleagues, he did not deem it essential. Dr. Bohn’s axial length measurement was inconsistent with those from the Houston Eye Center, leading to incorrect intraocular lens (IOL) power calculations. Expert Dr. Jack Holladay testified that these inaccurate measurements contributed to the insertion of an incorrectly powered lens in Mr. Fox’s left eye.

Additionally, Dr. Bohn failed to follow proper measurement techniques by not averaging multiple readings, instead choosing the longest measurement. Although this alone did not constitute a breach of the standard of care, Dr. Bohn's staff also obtained incorrect K readings. These inaccuracies stemmed from not instructing Mr. Fox to remove his hard contact lenses well before the preoperative visit, which is essential for accurate curvature measurements. The effect of hard contact lenses on eye shape was acknowledged by all experts, noting that the eyes need time to revert to their original shape after lens removal.

Mr. Fox did not remove his contact lenses until arriving at Dr. Bohn’s office, leading to K readings taken immediately afterward. Consequently, Dr. Bohn implanted a 25 diopter IOL instead of the necessary 33 diopter IOL for adequate vision. Three main causes for this error were identified: 1) inaccurate axial length measurement due to human error, 2) the lack of comparison measurements with the right eye, and 3) incorrect K readings resulting from inadequate preoperative instructions regarding contact lens removal. The exact contribution of each factor to the overall error was not specified, though various doctors provided differing percentage estimates. While a physician is not a guarantor of treatment outcomes, they are required to exercise reasonable care and diligent judgment in their specialty.

The defendant displayed negligence by failing to adhere to the standard of care required in his specialty, which is evidenced by multiple failures related to Mr. Fox's cataract surgery. There is no indication that Mr. Fox contributed to his vision issues or that the tools used were faulty. Dr. Bohn's office records show an inaccurate measurement of the anterior chamber depth and an unexplained change in the intraocular lens (IOL) order from 27 to 25. Other physicians were able to determine the correct IOL strength, supporting the conclusion that Dr. Bohn's negligence likely caused Mr. Fox’s vision problems, invoking the doctrine of res ipsa loquitur.

Mr. Fox's left eye vision is currently 20/400 but can be corrected with contact lenses. This significant discrepancy between his eyes affects his daily activities, including watching movies and reading. He is entitled to general damages due to malpractice. However, he is not entitled to lost wages as there is insufficient evidence linking his retirement to his eye condition—testimonies from his superiors indicate no awareness of reading difficulties at work, and his prescription for reading glasses remained unchanged.

In assessing damages, the reviewing court follows established standards, and upon detailed examination of the record, it concludes that a fair award for general damages amounts to Fifty Thousand Dollars ($50,000.00).

The trial court's judgment dismissing Wesley Fox's lawsuit is reversed, and a judgment is rendered in Fox's favor against defendants Barry A. Bohn, Barry A. Bohn, M.D., and the Louisiana Medical Mutual Insurance Company for $50,000, with legal interest from the date of judicial demand until paid, and all costs assessed against the defendants. The case involves complications following cataract surgery performed by Dr. Stewart in November 1984, where an intraocular lens (IOL) was incorrectly calculated due to erroneous anterior chamber depth measurements by Dr. Bohn. Expert testimony highlighted that these inaccurate measurements significantly contributed to Fox’s vision issues. While the formula used for calculating IOL strength was questioned, it was determined that the incorrect measurements were the primary issue, not the formula itself. Dr. Stewart successfully calculated the correct lens strength using a similar formula, indicating that the formula was not fundamentally flawed for Fox’s eye shape.