Loss of Vision Lawsuit Against P.G. Hospital

Proctor v. Prince George's Hospital/Dimensions Healthcare Associates

This is a medical malpractice case filed by a woman residing in Prince George's County who alleges partial blindness because the doctors failed to realize she was at risk for suffering from an ischemic injury due to low hemoglobin levels and low blood pressure. The woman is now partially blind in one eye.

This case was filed in Health Claims Arbitration on January 5, 2017. It is the sixth medical malpractice case filed in Maryland in 2016.

Summary of Plaintiff's Allegations

Plaintiff falls off a step ladder in her home and is taken by an ambulance to Prince George's Hospital Center. She has groin pain, pain in her upper left leg, and decreased sensation in her left foot. Defendant physician evaluates her and orders lab tests and CT scans of her head and hip. No question this is a serious orthopedic injury.

A CT scan of her hip shows an acute fracture of her left femur with medial displacement. Importantly, her lab results reveal a low hemoglobin level. It was not wildly low. Her hemoglobin was 12.9. A normal range of hemoglobin in red blood cells should be between 13.5 g/dl to 17.5 g/dl.

The following day, defendant orthopedist is consulted. Defendant orthopedist concludes that plaintiff needs surgery. The woman's hemoglobin level is low once again. She remains in the emergency room for the day, until she is admitted to the medical-surgical unit.

Plaintiff needs to obtain cardiac clearance before surgery due to her cardiac history. She is evaluated and cleared. The next day, defendant surgeon performs an intramedullary nailing of the left sub-trochanteric femur fracture with interlocking screws. In other words, they need to put in a rod to stabilize her leg.

During this procedure, plaintiff loses blood. She is placed in the critical care unit to recover following the surgery. That evening, when her blood is tested, and she was found to have an even lower hemoglobin level (8.9). This level dropped again the morning following surgery (8.2). Her blood pressure was also dropping. It is understood that the combination of prolonged hypotension and anemia can cause an ischemic injury to the optic nerves. In this case, the ischemic injury ultimately causes a condition known as bilateral posterior ischemic optic neuropathy (PION) and resulted in loss of vision.

The day after her surgery, defendant physician noted that the woman was suffering from post-hemorrhagic anemia and that she was weak. One more day passed, and her hemoglobin level was re-checked, and found to be continually decreasing. At this point, plaintiff also has a fever and increased pain. Defendant physician notes anemia again.

A physical therapist examined plaintiff, and found that her left lower extremity was extremity swollen and to be demonstrating orthostatic hypotension in addition to dizziness. Defendant physician evaluates her again, but maintains his diagnosis of post-op hemorrhagic anemia. He orders labs to be done as her blood levels continue to drop and she begins to have blurry.

After evaluation by another physician assistant, a blood transfusion was recommended. Plaintiff received two transfusions. After the transfusions, plaintiff's hemoglobin level rises, but she continues to have poor visual and has lost a portion of her eyesight in her left eye. An MRI is done to rule out a neurological issue as causing this vision loss. Incredibly, she is discharged from the hospital without follow-up regarding the cause of her loss of vision.

Plaintiff follows-up with a doctor a Kaiser who diagnoses her posterior ischemic optic neuropathy.

Plaintiff files a medical malpractice lawsuit alleging that her hypotension and anemia should have lead the doctors to rule out an ischemic injury. Plaintiff allege that the doctors should have known that she was at risk for an ischemic injury to the optic nerve that can cause posterior ischemic optic neuropathy and permanent blindness. Plaintiff's expert, Dr. David M. Katz, will likely testify that prolonged hypotension and anemia was a substantial contributing cause of the ischemic injury to the optic nerves of the Plaintiff, resulting in permanent vision loss. Dr. Katz will contend that if the patient had gotten an earlier blood transfusion, the injury would have been avoided.

Additional Comments
  • This combination of prolonged hypotension and anemia meant that both the delivery of oxygenated blood (perfusion) and the amount of oxygenated blood available for delivery to organs and tissue was compromised. This places the organs and tissue at substantial risk for ischemic injury.
  • Causation may be a battle in this case, particularly the plaintiff has diabetes, hypertension or atherosclerotic disease.
  • This injury can cause the victim to become completely blind. The economic damages in such a case can be significant because the patient needs to change jobs and requires rehabilitation learn how to ambulate safely, read Braille, and perform daily life activities and keep safe from harm. Here the value of the case may be different because there is generally not a great deal of economic damages with a partial vision injury in one eye.
  • The median verdict or settlement for the loss of vision in one eye in Maryland is $231,000. That statistic is a little old but it probably has not changed a great deal in recent years.
  • The woman's oxygenation levels are important but are not referenced in the lawsuit.
  • PION is resulting from damage to the optic nerve due to a decrease in the oxygenation levels of the blood in conjunction with restriction of the blood supply to the nerve. A PION diagnosis is from poor oxygen delivery through the blood to the posterior optic nerve. This causes the damage to the optic nerve.
Jurisdiction
  • Prince George's County
Defendants
  • An orthopedic surgeon
  • A general surgeon
  • Dimensions Health Corporation
  • Dimensions Healthcare Associates, Inc.
  • Dimensions Healthcare System/Prince George's Hospital Center
Hospitals Where Patient was Treated
  • Prince George's Hospital Center
Negligence
  • Failure to properly evaluate and diagnose plaintiff
  • Failure to recognize the signs, symptoms, and complaints of developing posterior ischemic optic neuropathy
  • Failure to interpret and respond to plaintiff's laboratory results, low blood pressures, dizziness, and anemia
  • Failure to order appropriate blood transfusion
  • Failure to manage plaintiff as a high-risk patient
  • Failure to manage plaintiff as a developing hypotensive event
Specific Counts Pled
  • Medical Negligence
  • Respondeat Superior
Plaintiff's Experts and Areas of Specialty
  • David M. Katz, M.D.: Dr. Katz is board certified in neurology. His subspecialty is neuro-ophthalmology. His practice is in Bethesda.
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