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One in the eye for spurious litigation

01 November 2003

Miss T was three years old when she injured her right eye whilst playing with a stick. Six hours after the injury she was seen by Mr F, consultant ophthalmologist.

He found a superficial laceration of the cornea containing purulent slough in its floor and margin. There was oedema, conjunctival congestion and evidence of pus in the anterior chamber.

Mr F felt that the globe was perforated and contained a foreign body. In the presence of infection, his preferred course was to treat with oral and topical antibiotics, with a view to later surgical exploration. Miss T’s mum, a medical practitioner, attended with Miss T, and Mr F explained his opinion and plan to her.

Mr F reviewed Miss T the next day, about 15 hours after the original injury and arranged to examine Miss T’s eye under general anaesthetic, after she had been starved. At operation he found a perforating conjunctivalscleral tear and removed a 2cm splinter from the eye.

He repaired the tear and applied conjunctival gentamicin. Miss T did well and by the seventh postoperative day all inflammation had resolved and the tear had healed nicely.

To Mr F’s surprise, a claim alleging negligence was brought by Miss T’s family. He was accused of ‘examining the eye roughly with a torch, when he knew this to be inadequate’, of failing to examine the eye in theatre under general anaesthesia, subjecting Miss T to unnecessary ‘torture’ by directing torchlight at the eye, failing to diagnose a perforation and foreign body, giving the wrong treatment and delaying removal of the splinter for 22 hours.

Expert opinion

We sought expert ophthalmological advice. The expert agreed with all of Mr F’s management and found it ‘perfectly reasonable, on his part, to administer intensive antibiotic treatment … before attempting exploration’. The expert asserted that a more forceful examination at first presentation was contraindicated, with a risk of worsening the degree of trauma and spreading infection.

The expert noted, ‘Mr F’s management succeeded in saving an eye which, at the outset, was in grave danger of being lost … I do not see any evidence that his management in any way added to the patient’s pain or distress. ’We resolved to defend the case to trial.

The claimants failed to attend the court and the claim was dismissed.

Learning points

Dissatisfaction with unpleasant aspects of therapy seems to have been the motivation for this litigation, which is surprising given that a medically-qualified family member was present, receiving full explanation, at the time of the treatment. The failure of the claimants to attend the trial suggests that they realised there was no genuine basis to their claim.

Unless a patient can prove both a breach of duty of care and a causal link to an injury resulting from this, they cannot successfully pursue a claim. Simply being unhappy with some aspects of an inevitably distressing treatment is not enough.

We defend such frivolous claims, even where this involves significant expenditure, in order to discourage the continuing rise in the frequency of unfounded litigation.