Insight: Consequences of Delayed Follow-Up

Specialties: Ophthalmology and Neonatology

Category: Diagnosis and Communication

Defendants: Three Neonatologists, one Ophthalmologist, and an ophthalmology group

Plaintiffs: Newborn and mother

Result: Settled in high range

When an advised follow-up does not occur within the recommended time frame and there is no system in place to prevent that failure, the result can be unfortunate, with long-term impact on the patient and the provider. It can also present problems for the defense of the case.

The patient in this case was a premature infant born at 25 weeks gestation in 10/99 and transferred to the NICU. An ophthalmology consult was ordered for 40 days after delivery to check for the possibility of retinopathy of prematurity. In early 12/99, the infant was seen by an ophthalmologist, whose note indicated that he would re-examine the infant in 2 to 3 weeks. The neonatologist noted 3 1/2 weeks later that follow-up was needed by an ophthalmologist. The patient was not seen by the ophthalmologist until 2 weeks later, when the physician diagnosed the infant with retinopathy of prematurity and permanent blindness. Laser treatment was done, with no improvement.

The plaintiff alleged that the patient should have been seen every one to two weeks after four to six weeks of life, to monitor development of the retina. The ophthalmologist stated that he was out ill when the NICU called for follow-up and that he told them that he would see the patient the following week. When he saw the patient the following week, he diagnosed retinopathy of prematurity. The defense team explored the possibility that the outcome would have been the same, even if the infant had been examined earlier. However, experts who reviewed the case could not support this theory. They were critical of the untimely follow-up exam, which clearly impeded any possible early intervention.

Based on the likelihood of an adverse jury finding, we negotiated a settlement of the case, with a portion of the proceeds purchasing an annuity to provide guaranteed tax-free monthly payments for the care of the child. Because both the ophthalmologist and the ophthalmology group received unfavorable reviews by experts, the settlement was apportioned to those two parties.