Legal Review & Commentary
Eye treatment leads to vision loss, settlement
News: A man was working with chemicals at his job when a chemical cleaning solution splashed into his eye. He presented to a nearby emergency department, where doctors irrigated his eye to remove the chemical. Upon discharge, he followed up with two ophthalmologists, one of whom determined that a corneal transplant was required. Although the transplant was successful, the man subsequently experienced bleeding behind his eye, which led to total vision loss in his right eye. He sued the hospital for medical malpractice. He argued that his eye was not adequately irrigated at the emergency department and that some chemical remaining his eye caused his cornea to deteriorate, which eventually caused his vision loss. The parties settled the case for $500,000.
Background: A 39-year-old professional stain cleaner was washing a van at his job site. The man was using a cleaning solution with the highest level of alkaline available. During the washing, some of the cleaning solution splashed into the man's right eye.
He rushed to a nearby emergency department, where doctors evaluated him. The patient's right eye was irrigated, and he was given antibiotic creams. He was discharged and instructed to follow up with an ophthalmologist.
The patient followed up daily with the ophthalmologist. After three weeks, the man told the ophthalmologist that his vision was deteriorating. The man was referred to another ophthalmologist, who determined that the patient required a corneal transplant.
The patient's vision returned after the transplant, but he subsequently developed macular edema, which is a condition characterized by bleeding behind the eyes and which is a known risk of corneal transplant surgery. The man subsequently completely lost his vision in his right eye.
The man sued the hospital, the emergency department physician, and the two ophthalmologists for medical malpractice. The doctors were dismissed from the suit, which left the hospital as the only defendant. The man claimed that the hospital irrigated his eye with an inadequate amount of fluid, which allowed the alkaline solution to destroy his corneal tissue; that the hospital staff failed to exercise skill and knowledge necessary to correctly perform the procedure; and that the hospital failed to properly hire, train, and supervise its staff. The man opined that adequate irrigation would have prevented the tissue damage and obviated the need for a transplant. Claiming that he continues to undergo biweekly eye treatment and that he was forced to miss 1½ years of work, the man sought $50,000 in lost wages, $95,000 in past medical expenses, and unspecified pain and suffering damages.
The hospital disputed liability and the amount of claimed damages. It principally argued that the man's eye damage was sustained at the scene of the accident and that no alternative treatment, including more adequate irrigation, would have prevented his vision loss. Prior to the start of trial, though, the parties agreed to a $500,000 settlement.
What this means to you: "To lose one's eyesight is a tragedy regardless of the reason," says Leilani Kicklighter, RN, ARM, MBA, CPHRM, LHRM, consultant/principal of The Kicklighter Group in Tamarac, FL, which focuses on risk management consulting services, and past president of the American Society for Health Care Risk Management, "When the loss of eyesight is preventable, it is even more of a tragedy," she says.
This scenario demonstrates how following directions and using personal protective equipment (PPE) in personal pursuits and professional work plays an important role in prevention of unfortunate situations such as this one. Protective eye equipment is inexpensive and readily available and should be used when using high-powered spray equipment. Using a high-alkaline solution, as in this situation, adds to the need for the protective eye wear. In this situation, the plaintiff was a professional stain cleaner and worked with chemicals as part of his job and should have known better. Familiarity (as with the frequent use of chemicals) often leads to bravado, which can lead to a failure to use PPE.
Being that this was a cleaning company that uses chemicals, emergency eye wash areas should have been accessible in various areas throughout the company's premises, and all employees should have been educated how to flush the eyes in such a situation as described here. Whether this was a job-related accident or not, the cleaning company risk manager should never pass up the opportunity to re-emphasize the need to use PPE, to reorient staff as to the location of the eye wash areas, and education staff as to how to properly flush/irrigate the eye(s).
This plaintiff drove himself to the nearby emergency department. It is not clear how fast he was triaged and taken in to see the physician upon arrival. If there was a delay, it could have contributed to the resultant corneal damage since the irrigation of the eye was not undertaken until after the patient was evaluated by the physician. A review of the triage process, with emphasis on the need for immediate treatment of a patient with an eye injury, including a chemical splash, should have been undertaken by risk management. At the triage stage, it may be appropriate to conduct an immediate irrigation of the eye(s) sustaining the chemical splash with no penetrating injury, especially if no irrigation had been done before arrival at the hospital emergency department. Again, this is an opportunity to re-emphasize to all emergency department personnel on all shifts how to properly irrigate an eye that has sustained a chemical splash using the feedback by demonstration method. Models for virtual training and dyes are an excellent method of assessing clinical competence for such a procedure.
The allegations of this patient were that the corneal damage was the result of improper and inadequate flushing or irrigation of the eye. While there appear to be extenuating circumstances and comparative liability, based on the failure of the plaintiff to follow label directions to wear eye protection, the use of the higher concentration of the solution with a pressure cleaner, and failure to do an immediate eye flush at the job site, this would be a difficult claim for the hospital depending on their process for triaging, the amount of time required to see a doctor, and the subsequent eye flush or irrigation. If records reflecting individual training of all emergency department staff on proper eye irrigation for chemical splashes were not available, that might prove to be troublesome as well.
While this situation raises to the forefront the need to conduct special educational programs relating to eye irrigation and flushing, it is important to include this training in the annual competency evaluations and during new-hire orientation for all employees. Hospital employees are at risk for chemical splashes to the eye as well as contamination or splashes of bodily fluids. It is important that the eye is flushed immediately when such splashes occur. Irrigation of the eyes can be done by anyone and should be done as quickly as possible. A licensed professional is not required to perform such emergency eye flushes.
Reference
- Cook County (IL) Circuit Court, Case No. 00-L-7344.
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