Exposing the LASIK Scam

One Surgeon at a Time
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 Post subject: White Wall of Silence
PostPosted: Tue Jan 10, 2006 12:54 pm 
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http://www.revoptom.com/body/articles/9_2001/ro199.htm

A Malpractice Feeding Frenzy

Unscrupulous surgeons may become a trial lawyer?s best friend. Here?s why.

By Arthur B. Epstein, O.D.

I recently reviewed the records of a patient who had LASIK performed by one of our area?s best-known refractive surgeons. Like many surgeons, this doctor?s notoriety comes more through incessant radio ads than surgical skill. His huge ad budget got him several television appearances where he publicly stated that he?s never experienced a complication. Maybe he hasn?t, but I know several patients who would disagree, including the patient whose records lie on the desk in front of me.

LASIK malpractice cases are on the rise. Awards for visual loss can be substantial, and badly damaged patients make compelling witnesses. For a lawyer, that?s a potent combination. We are just now seeing the tip of the refractive surgery litigation iceberg. The American Trial Lawyers Association recently initiated a refractive surgery special interest group.

One attorney I know described the current mood of the legal community as the beginning of a feeding frenzy. Lawyers are increasingly turning to optometrists to review patient records in these cases. Some have discovered that refractive surgeons maintain a ?white wall of silence?; others appreciate the O.D.?s ability to figure out why a patient no longer sees well.

This particular case in front of me is especially troubling. Last year, the patient was a successful doctor. Today, he?s just another casualty of the war on myopia. The poor guy lives with dry eyes so bad that he can barely sleep. When he does it?s only for a few minutes, then severe pain awakens him. He can no longer work and is staring financial ruin in the face. Worse, there isn?t much hope despite his seeing numerous specialists. His records, more than 60 pages of them, chronicle a long and unpleasant journey into the waking nightmare that has become his life.

I read through his records several times, searching for clues of how this tragedy occurred. They weren?t easy to decipher and I got the feeling that some were missing. The preoperative data was of little help. The brief exam appeared routine; nothing of note was recorded.

His surgery was uneventful, but his troubles began soon after. At one day post-op, he returned complaining of discomfort. The examiner noted bilateral epithelial defects over the inferior portion of both flaps. This led to DLK and epithelial in-growth, then dry eye and constant pain. The later portions of the record were a veritable manual of everything that could go wrong with LASIK.

The one clue to the actual cause was in a brief note by one of the consulting specialists. He had scribbled ?exposure.? Finally, it all fit together. When I met with the patient and his attorney, I confirmed that he had lagophthalmos. I asked the patient to hold his lids open while trying to forcibly close both eyes. Sure enough, his Bell?s phenomenon was essentially absent.

I believe happened is that this patient probably had exposure when he was worked up for surgery?only it was somehow missed. The corneal examination had been minimal; no fluorescein or rose bengal, no dry eye test. The microkeratome pass over an area of corneal hypoesthesia and incompetent epithelium were the most likely causes of the non-healing defect that led to his subsequent problems.

I explained my theory, the attorney asked if lagophthalmos and a deficient Bell?s phenomenon were contraindications for LASIK. I opined that exposure keratitis certainly would be.

The patient, who had sat silently up till then, looked straight at me and asked if this should have been caught before the surgery. He asked, ?Would a reasonably competent doctor have caught this?? I responded, ?It should have been caught.? Without hesitation he then asked, ?Then why wasn?t it?? I sat there in silence. It was a question I could not answer.

Vol. No: 138:08 Issue: 9/15/01


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PostPosted: Tue Jan 10, 2006 12:57 pm 
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Does anyone have a link and a date for this article?
<hr>
Should You Take A LASIK Case?
By Diana Digges
Lawyers Weekly USA

Since the cases are costly to prepare, lawyers caution carefully investigating the impact of the disability.

"I don't want to get involved in a case unless there's been a real functional disability to the client. A firefighter comes in and says he can't fight fires, can't go out at night, that's someone who's suffering severe, functional disability," said Knopf. "On the other hand, if someone says they see haloes when they drive, but not all the time, that person obviously has complications, but I wouldn't want to get involved. Frankly, it's a matter of economics. These cases are very expensive." Attorneys maintain that experts cost them between $500 and $1,000 an hour - if you can get them to testify.

"There's a white wall of silence that I have not encountered in too many other med-mal areas," said Keith.


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