‘Dismissive' ophthalmologist fails to diagnose retinoblastoma, leaving a child blind
Key Takeaways
Industry Buzz
“Retinoblastoma is the most common intraocular tumor in childhood ... The screening for it should start in the neonatal unit, even before the baby leaves the hospital.” — Benjamin Bert, MD, a board-certified ophthalmologist
“It may be very compelling for a jury that a nonclinician parent, using a Facebook post, was able to recognize things missed by multiple trained professionals.” — Lanny Tuchmayer, attorney
A 9-month-old boy’s retinoblastoma was missed by his pediatrician and pediatric ophthalmologist, leading to blindness in both eyes, according to a case breakdown featured on The Expert Witness Newsletter, a medical malpractice blog that supports physicians’ continuing medical education. []
To date, no articles or news sources provide further details about the case, which is still in progress. Redacted court documents are available on the blog.
When the child was seen by his pediatrician, referred to as Dr. E, he appeared healthy, despite his mother’s assertion that he sometimes ran into objects in front of him.
An exam was conducted, but it did not include a red reflex test, which the American Academy of Pediatrics says is essential in neonatal, infant, and child physical examination. []
The child underwent a spot vision screening, which suggested anisometropia—a condition that occurs when the refractive power of the eyes is significantly different.
He was then referred to an ophthalmologist, referred to as Dr. K, who also diagnosed the child with esotropia, a form of strabismus, and blepharitis. []
During follow-up visits, the mother mentioned that her child had a “yellow” right eye and that he was still bumping into things.
She also noticed that her child had an abnormal light reflex in photographs—something that, based on a Facebook post she had seen, she knew could indicate a health concern.
When she presented these concerns to Dr. K, she was dismissed. There was also a language barrier, as the mother primarily spoke Spanish.
At some point, the pediatrician said the child’s issues were insignificant, noting that the mother had nothing to worry about regarding the abnormal light reflex.
Related: 8 outrageous malpractice cases—and what physicians can learn from themThe mother ping-ponged between the ophthalmologist and the pediatrician without being taken seriously before asking to be referred to another ophthalmologist.
Eventually, this ophthalmologist diagnosed the child with a large retinoblastoma in the right eye with retinal detachment, as well as smaller areas of retinoblastoma with retinal detachment in the left eye. The child lost vision in both eyes.
The plaintiff's pediatric expert—a board-certified pediatrician—stated that the healthcare practitioners involved “deviated from the standard of care” in several ways, including by failing to appropriately evaluate and diagnose the child and failing to schedule timely follow-up and urgent referrals.
Some physicians who have commented on the blog post have called the situation “heartbreaking.”
A closer look at retinoblastoma—and where this case went wrong
“Retinoblastoma is the most common intraocular tumor in childhood … The screening for it should start in the neonatal unit, even before the baby leaves the hospital,” says Benjamin Bert, MD, a board-certified ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. “Most of the presentations are younger than 5 years. It is routinely part of the general health checkup with a pediatrician.”
So, what happened? The way retinoblastoma is screened for is testing for the red reflex, Dr. Bert explains. Instead of when you see someone in a photo with a red eye, you get a complete reflection of light off the retina, he says.
“When someone has retinoblastoma, it shows up as white or abnormal in one eye or both eyes," Dr. Bert says. "The expectation is that the pediatrician is screening all kids by using a direct ophthalmoscope to check [for] red reflex. If abnormal, this triggers sending the child to a pediatric ophthalmologist to do a full dilated exam.”
Dr. Bert says that retinoblastoma can show in a multitude of ways, but the red reflex is typically present. It may also appear as strabismus, decreased vision, or even an inflammatory condition, such as blepharitis. Additionally, it can be misdiagnosed as Coats disease.
In many cases, though, retinoblastoma is simply caught by family members taking photos of their child, Dr. Bert says.
Related: Doctor denies life-saving surgery, family alleges: Malpractice or medical judgment?A legal point of view
From a legal point of view, Lanny Tuchmayer, an attorney and general manager at X-Copper, says the case “raises important issues concerning the standard of care, communication, documentation, and diagnostic vigilance.”
He says that in cases like this, there is a “strong basis for malpractice, especially if there are several opportunities to catch a serious diagnosis [and] especially [with] something as well-known and time-sensitive as retinoblastoma. It may be very compelling for a jury that a nonclinician parent, using a Facebook post, was able to recognize things missed by multiple trained professionals.”
Proving negligence in cases like this usually boils down to two elements: whether there was a deviation from the standard of care and, if so, whether that deviation caused harm, Tuchmayer explains.
"Here, the standard of care for pediatricians and pediatric ophthalmologists in seeing visual concerns in infants entails carrying out, or at least documenting, a proper red reflex examination,” Tuchmayer says.