Delayed Diagnosis and Treatment Leads to Permanent Blindness


Internal Medicine Expert WitnessThis visual impairment case takes place in Pennsylvania and involves a male patient who suffered episodes of nausea and vomiting over the course of several months. On one occasion, the patient presented to the hospital with nausea, vomiting, abdominal pain, and a range of other gastrointestinal symptoms. He was given over the counter nausea medication by the ER physician and was sent home. Over the next few days, the patient’s symptoms became progressively worse, and the patient returned to the same hospital ER. He presented to the ER with cold and numbness in arms, as well as significant weight loss, in addition to his original symptoms. Despite the increasing severity of his symptoms he was discharged a few days later. Some time after being discharged from the hospital, the patient developed severe eye pain and blurry vision. He was seen by ophthalmology then and was diagnosed with bacterial conjunctivitis, and prescribed Moxifloxacin eye drops. A few days after this diagnosis, the patient lost all vision in both eyes. He presented to the ER and received treatment, however his condition did not improve. Eventually, he was diagnosed with a rare, but treatable, autoimmune disease.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients similar to the one described in the case? Please explain.
  • 2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
  • 3. Do you believe this patient may have had a better outcome if the care rendered had been different?
  • 4. Are you able to review the records on behalf of the plaintiff and opine on your findings? Potentially testify?
  • 5. Have you ever served as an expert witness and testified on a case similar to the one described above?

Expert Witness Response E-006953

This disease is a rare relapsing autoimmune disorder that preferentially causes inflammation in the optic nerve and spinal cord. I have seen a few patients who have been diagnosed with this condition. The patient’s symptoms on his original visit to the hospital required a thorough evaluation to determine the underlying cause. Depending on the results of the labs and imaging studies, there may have been an opportunity to diagnose the autoimmune condition earlier with a better outcome.

Expert Witness Response E-006954

This case description and all the earlier symptoms do not match the final diagnosis; so, it appears very unclear what was missed and what other conditions she had. NMO is a rare autoimmune disease that most doctors never see; it’s often mistaken as MS. However, it does not involve the brain (unlike MS) and therefore, the earlier symptom of ‘seizure’ doesn’t fit at all with this diagnosis.

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