Ophthalmologist can testify as to ER Dr.'s negligence: case on point: Hodgdon v. Frisbie Memorial Hospital, 2001 WL 1568408 N.E.2d - NH (Hospital Law Case of the Month).

ISSUE: One of the issues in this New Hampshire case was whether or not an ophthalmologist could testify as to the negligence of an emergency room physician relative to his diagnosis and treatment of a patient with serious damage to his vision. The court responded with resounding "yes." Ophthalmologist might not ordinarily treat their patients on an emergency basis as an ER physician does. Nevertheless, an ophthalmologist is so highly trained and skilled in his specialty that he is more than qualified to render an expert opinion as to the propriety of emergency room care and treatment relative to an eye injury.

CASE FACTS: On Sunday, October 11, 1998, Agnes Hodgdon was brought to the emergency room at Frisbie Memorial Hospital for treatment of a blunt trauma injury to her right eye. Her eye was bruised and swollen shut. She was examined by Robbie Corriss, a physician's assistant and then by the emergency room physician, Geoffrey Stein. Dr. Stein diagnosed the injury as a subconjunctival hemorrhage with a differential diagnosis of hyphema. Dr. Stein discharged the patient instructing her to apply ice, to take Tylenol, and to see her primary care physician, and, if necessary, an ophthalmologist. When the patient saw the ophthalmologist, he diagnosed a retrobulbar hemorrhage. Eventually, the patient lost her vision in her right eye. The patient brought suit against Frisbie Memorial Hospital and others. At trial, the patient claimed that Dr. Stein was negligent when he failed to properly diagnose and treat her condition, thereby causing her to lose her vision, which otherwise would not have lost. Following a jury verdict for the plaintiff, the defendants appealed.

COURT'S OPINION: The Supreme Court of New Hampshire affirmed the judgment of the lower court. The court held, inter alia, that the hospital could be liable only for Dr. Stein's alleged negligence but could not be held liable for any allegedly negligent conduct by Corriss. Therefore, the court concluded that any implication that the defendants might be liable based on Corriss' negligence was cured by the court's instruction. Accordingly, the court concluded that under the circumstances, any error or prejudice was harmless, and there fore, the court would not disturb the jury's verdict for the plaintiff. The court noted that the plaintiffs only expert, Dr. Kuldip Vaid testified that the patient's lost vision was the result of optic atrophy, which indicated a loss of functioning in her optic nerve. The emergency room records indicated that an examination of the patient's eye revealed a "large subconjunctival hemorrhage, which means there was blood in the white part of the eye and it extended medially and laterally, so it was found on both sides of the pupil. Dr. Vaid testified that with most such hemorrhages, you can see the limit of the hemorrhage." In this case, however, the emergency room records indicated that the edge of the hemorrhage was not visible. The examination of an ophthalmologist two day later, revealed "the hemorrhage went all the way around pupil and a lot of the nerve was already gone." While the patient was in the emergency room, the pupil in the affected eye "was rather reactive to light and equal to the opposite pupil." Therefore, Dr. Vaid concluded, "chances are, her nerve was functioning and there was vision ... pretty decent vision" at the time of the ER visit. He further testified, "it's hard to quantify exactly how much, but by all means at least 50 percent of her nerve was ... working and probably more." When Dr. Vaid examined the patient three weeks later, her optic nerve had suffered significant damage and was no longer functioning properly. Finally, Dr. Vaid testified that had Dr. Stein properly diagnosed the patient's condition as a retrobulbar hemorrhage and immediately sought treatment to reduce the pressure caused by the hemorrhage," she probably would have retained whatever vision" she had when she arrived at the ER.

LEGAL COMMENTARY: In viewing all of the evidence in the light most favorable to the plaintiff, the court could not say that the sole reasonable inference that could be drawn form the evidence failed to establish that the defendants' negligence was the proximate cause of the damage to the patient's optic nerve that resulted in her loss of sight. Because the evidence did not so overwhelmingly favor the defendants such that no verdict for the plaintiff could stand, the court concluded that the trial court did not err in denying the defendants motion for directed verdict.

A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as weel as his achievements as an attorney and lecturer, have won him recognition in Martindale_Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American Law.