Berrell v. Hamilton

• Decision Date: 15 April 2003
• Docket Number: No. A03A0556.,A03A0556.
• Citation: 260 Ga. App. 892,581 S.E.2d 398
• Parties: BERRELL v. HAMILTON et al.
• Court: Georgia Court of Appeals

581 S.E.2d 398

260 Ga. App. 892

BERRELL v. HAMILTON et al.

No. A03A0556.

Court of Appeals of Georgia.

April 15, 2003.

Andrea Bennett, Atlanta, for appellant.

Love, Willingham, Peters, Gilleland & Monyak, Robert P. Monyak, Ashley R. Hill, Scott M. Patterson, Atlanta, for appellees.

ADAMS, Judge.

After losing the sight in his right eye as the result of an infection, Lawrence Berrell sued Stephen M. Hamilton, M.D. and Eye Consultants of Atlanta, P.C. for medical malpractice. In a highly detailed and well-reasoned order, the trial court awarded summary judgment to the defendants. Among other findings, the court determined that Berrell failed to offer proof of causation. Although Berrell contends that the trial court erred, we find otherwise and affirm.

On appeal from the grant of summary judgment, this Court conducts a de novo review of the evidence. Entertainment Sales Co. v. SNK, Inc., 232 Ga.App. 669, 502 S.E.2d 263 (1998). In so doing, we must construe the evidence and all reasonable inferences therefrom in favor of the nonmoving party. Chiaka v. Rawles, 240 Ga.App. 792, 525 S.E.2d 162 (1999).

When so considered, the evidence shows that Berrell had a medical history of bilateral glaucoma and underwent several eye surgeries and treatments over a four-year period. Berrell had glaucoma laser treatment of the right eye in July 1994. He also had glaucoma laser treatment of his left eye in August 1994 and again in January 1995. In August 1996, a retinal detachment repair was performed on his right eye. In January 1998, Dr. Hamilton, a board-certified ophthalmologist, removed a cataract, replaced it with an implant lens, and performed a trabeculectomy on his right eye. A trabeculectomy (or "bleb") is an operation in which a hole is created to drain intraocular fluid and relieve intraocular pressure caused by glaucoma. Although alleviating vision-threatening pressure, the bleb leaves a patient more susceptible to infection entering the eye.

After the procedure, Dr. Hamilton checked for leaks in the bleb on January 23, 26 and 30 and February 10 and 16, 1998. Dr. Hamilton also saw Berrell on May 18 and September 30, 1998, and February 2, 1999, but his office notes do not indicate that he checked for leakage on those dates. He testified, however, that he looked for leakage on each subsequent visit regardless of whether his office notations so indicated. Berrell's last office visit with Dr. Hamilton occurred on February 3, 1999, the date on which Berrell's medical expert concluded that Dr. Hamilton committed malpractice by not doing a Seidel test for leakage of the bleb. But, Dr. Hamilton testified that "the bleb was not leaking as of February 3, 1999." On that office visit, Dr. Hamilton did not observe any signs of infection.

More than four months after that office visit and about a year and a half after the bleb procedure, Berrell developed a virulent eye infection while in Panama City, Florida. On June 17, 1999, Berrell sought emergency assistance at the Columbia Gulf Coast Medical Center in Panama City. He told doctors he had been experiencing pain and drainage in his right eye for two days. An ophthalmologic consultation reported "pain, redness, discharge and blurring vision over past 24-36 hrs." Advised that his situation was "extremely serious," Berrell returned to Atlanta where Allen Kozarsky, M.D. examined him at Eye Consultants. Dr. Kozarsky observed "a very red, very ... angry eye." Dr. Kozarsky testified that by that time, there was already a high probability that Berrell would lose his vision. Dr. Kozarsky explained that when an infection is already inside the eyes, "it just grows like wild fire," and "it is pretty much a done deal." Berrell was then admitted for in-patient treatment at Piedmont Hospital. There, Emilio Lacayo, M.D. noted "acute right eye endophthalmitis." Under History of Present Illness, Dr. Lacayo recorded:

On Tuesday [June 15] he had right eye clear discharge with weeping of the right eye. He denies purulent discharge at that time. He noticed increased redness of the right eye with photophobia. He noted progressive worsening of these symptoms with decreased vision in the right eye. He was seen in the emergency room in Panama City where he was given some medication and subsequently discharged. He was then evaluated and diagnosed with endophthalmitis and is now admitted for acute treatment and surgery on his right eye.

Berrell underwent a vitrectomy on his right eye. Despite emergency surgery and other intensive medical efforts to save his sight, by August 1999, Berrell no longer had any vision in his right eye.

Berrell alleged that Dr. Hamilton provided negligent treatment and care by "failing to properly recognize and monitor plaintiff's condition, to warn, instruct and advise plaintiff about the nature of his condition and the potential for complications and how to avoid same, and to intervene on a timely basis to prevent the severe infection that ultimately resulted in the loss of his right eye." Berrell's expert, Joseph Citron, M.D., testified that in his professional opinion, Dr. Hamilton's care fell below the reasonable standard of professional medical care, "when he failed to evaluate the change in the right eye filtering bleb. Specifically, he failed to perform a Seidel test to test for a leak of the bleb." Dr. Citron, a board-certified ophthalmologist, testified, "[i]t is also my opinion with a reasonable degree of medical certainty that the above deviation from the standard of care by Dr. Hamilton, was a direct cause of Mr. Lawrence Berrell's loss of vision of his right eye."

Dr. Citron testified that he based his opinion about a leak in the bleb on the fact that Berrell's eye became infected. But, Dr. Citron admitted that he did not know when, before June 1999, the bleb began to leak and could not say that it was probably leaking on February 3, when Dr. Hamilton last saw Berrell. Dr. Hamilton, however, testified unequivocally that the bleb was not leaking on February 3 and showed no signs of leaking. And, noting that he had "reviewed ... the medical records relating to the diagnosis and treatment of the patient's eye infection," Dr. Hamilton testified that "[n]one of the ophthalmologists who cared for the patient after he contracted the infection ever diagnosed a bleb leak." Defense expert, Reay H. Brown, M.D., who examined Berrell's medical records, testified that "[m]y opinion is that it did not [leak]."

As to Berrell's allegation that Dr. Hamilton breached a duty to provide proper post-operative instructions, Berrell admitted that Dr. Hamilton had given such instructions. When Dr. Hamilton was asked whether he discussed the bleb post-operatively with Berrell, Dr. Hamilton responded, "[a]bsolutely." When asked whether he had informed Berrell about the high risk of infection that could cause...