Amniocentesis and Eye Injury

Was amniocentesis cause of eye injury to newborn?(Legal Focus on Hospital Law Issues)(Jackson v. Tulane Medical Centre Hospital

By A. David Tammelleo   |   Hospital Law’s Regan Report  –  Dec, 2006

 

CASE ON POINT: Jackson v. Tulane Medical Ctr. Hospital & Clinic, No. 2005-C-1594 (LA 10/17/2006) So.2d -LA

CASE FACTS: On March 26, 1990, Yata Jackson’s obstetrician, Dr. Max Pailet, referred her to Tulane Medical Center Hospital (Tulane) for evaluation of her preeclampsia. Once admitted, she was evaluated by Dr. Dabney Hammer, a second-year obstetrics and gynecology resident. Dr. Hammer performed an ultrasound to ascertain, inter alia, the fetus’s gestational age, which was approximately 37 weeks. Dr. Hammer discussed his examination and findings with Dr. Pailet, who instructed him to perform amniocentesis to determine the maturity of the fetus’s lungs. Jackson signed a consent form, which stated that “Dr. Pailet and resident” would perform the amniocentesis. No risk to the fetus was mentioned. Dr. Hammer performed the amniocentesis without Dr. Pailet. On March 30, 1990, Jackson’s son, Troy, was born by C-Section. Jackson and Troy were discharged on April 4, 1990. Once Jackson and Troy got home, Jackson noted a white dot in his left eye. When Jackson took Troy to the Well Baby Clinic about two weeks after, she was discharged, she was told that it was probably just pigment that had not formed yet. Approximately two weeks after that appointment, Jackson took Troy to the emergency room at Tulane because of a skin rash. When she inquired about the white dot in the eye, she was instructed to take Troy to Charity Hospital (Charity) to have his eye examined. On May 18, Troy was seen in the ophthalmology department and found to have a traumatic cataract, a peaked iris, and a corneal scar in his left eye. On May 22, Troy underwent cataract removal surgery, which revealed a “penetrating-type injury” to the eye. A second surgery to relieve pressure in the eye was performed on September 25, 1990. After the surgeries, it was determined that Troy had no vision in his left eye. Jackson and Troy’s lather, individually and on behalf of Troy, filed a complaint with the Patient’s Compensation Fund alleging that the hospital and its employees were liable for damages sustained to Troy’s left eye during amniocentesis. They alleged that the hospital’s negligence was a direct cause of the injuries and damages. The Medical Review Panel concluded “there is a material issue of fact, not requiring expert opinion, bearing on liability for consideration by a court namely, insufficient information documenting the ultrasound and amniocentesis procedures versus the complaints of the plaintiffs. However, the Panel conclluded there was no causal relationship between the amniocentesis and trauma to Troy because the nursing notes and lack of statements by plaintiff during her hospitalization, as well as plaintiff’s subsequent statement in the emergency room at the hospital on April 29, 1990, evidence that there was no abnormality in Troy’s left eye, until after his discharge. Troy’s parents brought suit against the hospital individually and on behalf of Troy. The trial court entered judgment on a jury verdict denying and dismissing the plaintiffs’ claims with prejudice. The plaintiffs appealed. On appeal, a five-judge panel of the Fourth Circuit reversed the trial court’s judgment. The hospital appealed.

COURT’S OPINION: The Supreme Court of Louisiana reversed the judgment of Court of Appeals and remanded the case back to the trial court, which had entered judgment on a jury verdict in favor of the plaintiffs. The court held, inter alia, that the Court of Appeals erred in ruling that the jury was clearly wrong in finding no negligence on part of the hospital and Dr. Hammer. The court found that in light of the evidence in the case, the Court of Appeals could have reasonably concluded that the defendants did not breach the standard of care in their treatment of Troy or that Troy’s eye was not injured during the amniocentesis. Consequently, the judgment of the trial court was reinstated.

LEGAL COMMENTARY: After reviewing all the testimony in the record, the court concluded that the jury could have reasonably determined that the defendants did not breach the standard of care in their treatment of Ms. Jackson or that Troy’s eye was injured during amniocentesis. The Court of Appeals’ conclusion that the jury was clearly wrong to find no negligence on the part of Dr. Hammer and the hospital was erroneous. The court held that the Court of Appeals’ decision was clearly wrong to find no negligence on the part of Dr. Hammer and the hospital was clearly erroneous and suggested that the Court of Appeals improperly susbstituted its factual finding for those of the jury. While the evidence detailed by the Court of Appeals could have supported a jury determination that Dr. Hammer and the hospital were negligent, the jury heard that same evidence, made credibility determinations, and decided to the contrary. The court found nothing in the jury’s determinations to justify the Court of Appeals overturning the jury’s verdict. Further, the Court of Appeals also determined that the trial court erred when it refused to allow the plaintiffs to expand their pleadings to include lack of informed consent as a cause of action. The consent form omitted any reference of risk to the fetus. The court found this issue, even if resolved in favor of the plaintiffs, would be irrelevant in light of the court’s determination that the jury was not manifestly in error in reaching a verdict for the plaintiffs.

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