To Sue or Not To Sue

[Beth_yu]

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I worked for an opthalmologist for a year in a clinic in southeast asia country.

This is a country where doctors are considered sacred profession and should not be sued for any malpractice..etc

However, the Association of Physician and Surgeons in that country allow a malpractice..etc case to be brought to the court for lawsuit if :

a) A licensed doctor/surgeon is willing to testify for any malpractice, accident, etc..


b)It is evident that something not correct has been done on the patient....misdiagnosed...etc

So, there was this man about 53 years old who has 5 children aged 3, 7, 14 and a very ill wife. Initially, he was supposed to have a simple cataract surgery on the left eye and then later on the right eye (Both eyes have cataract and vision was blurred)

However, due to a young doctor's fault, this simple surgery somehow had caused him his eye. There was infection. Clearly, the surgical instruments weren't sterilized properly. (Note: in this country, doctors have to do everything including sterilizing the surgical instruments)

The man came to this clinic and the opthalmologist whom I worked for told him that he needed to get his eye replaced with an artificial one (He lost his one eye). When the man left, he told me that there was infection due to the earlier doctor's fault.

This poor man is not rich and work all his life to support his family.

The opthalmologist told me that a lawsuit could be filed for his case but he was unwilling to testify for that man. He said that he didn't want to cost another young doctor's bright future and that testifying would only angered other doctors and his ruined his business.

So, since this poor man lives in the district where my parents live, I know that he didn't file for lawsuit or get any compensation. I doubt that he even knows that he should be filing for compensation. Now, he is working and living with only one eye and a job which pays him barely enough for his kids' education.

Note:In a country where doctors are protected and there was never a lawsuit against any doctors or medical institution.

My question:
If you are the opthalmologist, will you testify for that poor man?

If you have all the evidence that it is the young doctor's fault, would you help that poor man and cause this young doctor's his license, future, and career?
And again, do you really care how other doctors perceive you if you are willing to do what is right or what is justice for the people?

I realise this is a long post.
I apologize for the spelling, grammatical mistakes and etc for English is not my first language and I have tried hard to improve.

 

[Andrew_Doan]

Originally posted by Beth_yu

However, the Association of Physician and Surgeons in that country allow a malpractice..etc case to be brought to the court for lawsuit if :

a) A licensed doctor/surgeon is willing to testify for any malpractice, accident, etc..


b)It is evident that something not correct has been done on the patient....misdiagnosed...etc

However, due to a young doctor's fault, this simple surgery somehow had caused him his eye. There was infection. Clearly, the surgical instruments weren't sterilized properly. (Note: in this country, doctors have to do everything including sterilizing the surgical instruments)

Beth,

Welcome to the ophthalmology forum. These ethical issues are interesting.

The following was obtained from:
http://www.themedicalexpert.com/malpractice.htm

To demonstrate malpractice, four critera must be met:

1) Duty is the notion that the doctor has a legal obligation to care for the patient. In general if the doctor treats a patient, duty is present. Sometimes, duty goes beyond the patient. For instance, a doctor?s duty goes to an unborn child while he treats the mother. In some circumstances, the duty may extend to close family members as well (see case discussion). At other times, Good Samaritan laws protect the physician who volunteers services.

2) Breach of duty is the second component. This is usually understood as substandard care. The doctor did something he wasn?t supposed to do, like give the wrong medicine or do the wrong operation. Or he overlooked an important item. Perhaps he didn't give a treatment or didn't do a test that was needed to meet the standard of care. In most cases this can only be determined by a medical expert.

3) Causation is the concept that the doctor?s action or lack of action caused the damages. Causation in fact, foreseeability and proximate cause may be referred to when discussing causation. The ?but for? test may be applied to causation in fact. The test is satisfied if, the injury would not have occurred but for the doctor?s action. If the damages were foreseeable by a reasonable physician, then causation may be proven. Proximate cause may be shown if considering all other factors, the defendant?s action is the main cause of the injury. Causation may be the most complex and difficult part of a case. Because, the law of causation varies between jurisdictions a superb medical expert and an excellent lawyer are essential.

4) Finally, damages must be documented. The patient has to suffer some pain, suffering, disability or death caused by the breach. Although damages may be emotional, physical or financial, they are expressed in terms of a monetary award. Punitive damages may be awarded in unusual cases where the defendant willfully caused harm. The dollar amount that can be recovered depends on the specific legal theory and jurisdiction the case is brought under.


In your case, post-cataract surgery endophthalmitis is a known complication, even in the best of hands. A recent study at Bascom Palmer estimates that 1:1000 intraocular surgeries result in endophthalmitis (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9627649&dopt=Abstract). Statistically, ~50% of those that develop endophthalmitis will develop less than 20/200 vision. Although cataract surgery may be a "simple" procedure, infection may occur even if everything was done properly. I make this point very clear to all the patients consented for intraocular surgery. I even consent them for the slim chance of death because the stress of surgery may result in a cardiac issue leading to morbidity or mortality.

In this case, it is clear that harm was done to the patient and there was duty to the patient. However, I think the burden of proof is to demontrate causality and breach of duty.

You stated that "Clearly, the surgical instruments weren't sterilized properly." Is this conclusion made because the patient developed infection or is there proof that the physician's sterilization methods are sub-standard? As discussed above, infection after intra-ocular sugery is a real and known complication even in the absence of medical negligence. However, if the sterilization methods are sub-standard, then there is a case for malpractice.

To answer your question, testifying in this case depends on if the physician in question demonstrated a clear breach of duty and delivery of sub-standard care. It is not enough to have the patient develop endophthalmitis to make a case for malpractice. One must demonstrate that the physician did not sterilize instruments or failed to use aseptic techniques.

If there was proof that sub-standard care was given, then I would testify and report the physician to the appropriate governing entities. Otherwise, if all standard surgical procedures and techniques were performed, then the patient had an unfortunate outcome to surgery, but this is not malpractice.