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Houston appellate court: Ophthalmologist qualified to diagnose ganglioglioma tumor

Expert report was critical of ophthalmologist failure to perform dilated eye exam

There’s probably not a more dreaded word to hear a doctor say than “cancer.” When it is uttered about a child, though, it’s even more heart wrenching.

This was the topic addressed in an opinion entered today by Houston’s 14th Court of Appeals, in a case styled Charlise Gunderson, M.D. and Coastal Eye Associates, P.L.L.C. v. Wade, No. 14-20-00795-CV. You can read the opinion here.

In that case, a pediatrician noticed that the seven-year-old patient’s left eye was looking outward. That’s a medical condition called strabismus. The pediatrician referred the patient and his parents to an ophthalmologist, Dr. Gunderson.

The ophthalmologist performed strabismus surgery on both of the patient’s eyes. That’s a procedure where the tension of the eye muscles is adjusted to realign the eyes to the correct position. About eight months after the surgery, the patient returned to his pediatrician because of headaches and vomiting.

After two pediatrician visits, the patient went to an emergency room for evaluation. A CT scan was performed, which revealed a left occipital tumor in his brain. The young patient was taken to the operating room for surgical removal of the tumor, which turned out to be a slow-growing ganglioglioma. Unfortunately, after the surgery, the patient had lost about one-fourth of the visual field in each of his eyes.

The boy’s family filed a medical malpractice lawsuit against the ophthalmologist and eye clinic, alleging that Dr. Gunderson violated the standard of care by failing to perform a complete eye exam with pupil dilation.

As with all Texas medical malpractice cases, the plaintiffs were required to produce a medical expert report within 120 days of each defendant filing an original answer in the lawsuit. To satisfy this tort reform requirement, the plaintiffs in this case timely produced a report and curriculum vitae (CV or resume) from a board-certified ophthalmologist with four decades of experience.

The ophthalmology expert shared his opinion that if the treating ophthalmologist, Dr. Gunderson, had performed a complete eye exam with pupil dilation, she would have seen the ganglioglioma and referred the patient to a neuro-ophthalmologist specialist for surgical removal of the tumor.

If this diagnosis and referral had been timely accomplished, then the tumor would have been removed before it had grown enough to cause damage in the adjoining structures. Thus, the expert felt that the delayed diagnosis by the treating ophthalmologist caused the patient to experience significant loss of visual fields in both eyes, which will render the individual handicapped for life.

Here at Painter Law Firm, we’ve handled numerous optometry and ophthalmology cases. Many of them involve a delay in diagnosis caused by the doctor’s failure to perform a fundal (dilated) exam.

Texas law allows medical malpractice defendants to challenge or object to the sufficiency of an expert report within 21 days. That’s exactly what the defendants in this lawsuit did. Specifically, the defendants alleged that the board-certified ophthalmology expert supportive of the plaintiffs’ medical malpractice allegations was not qualified to write an expert report.

The crux of the defense objection was that an ophthalmologist does not treat cancers such as the ganglioglioma that this patient had. The appellate court agreed with the trial court that the objection was unfounded.

The plaintiffs’ ophthalmology expert explained that he was familiar with the standard of care for treating patients with similar conditions and that, in fact, he had seen similar patients during his clinical career.

The appellate court discussed a prior case in which a defendant argued that an emergency physician and internist wasn’t qualified to give an opinion dealing with oncology issues. In that opinion, the court noted that, “The conduct causing [the plaintiffs’] injuries related to the ability of an emergency room physician to interpret a routine chest x-ray and identify an abnormality, not the diagnosis and treatment for cancer.”

That’s precisely the issue confronting the defendant ophthalmologist. No one argued that the ophthalmologist was obligated to surgically remove the tumor herself. Rather, the expert simply explained that the standard of care required an ophthalmologist to perform a complete exam, identify the tumor, and make the appropriate referral to a specialist for treatment.

If you have been seriously injured because of poor care from an optometrist or ophthalmologist in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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