Ophthalmology opinions for a blind neurosurgeon

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There are differing ophthalmology opinions for this neurosurgeon who is blind in one eye

“Two ophthalmologists examined Greenberg: one hired by Greenberg, and one hired by the lawyer for the person suing Greenberg.

Though on opposing sides, the doctors both concluded that Greenberg is essentially blind in his right eye because of a childhood accident in which he was poked in the eye with a sharp wire. They also agreed that Greenberg completely failed the standard test for colorblindness, known as the Ishihara test.

But the two doctors clashed on whether this posed a risk to Greenberg’s patients.”

Comments

Anonymous
Did you read the sidebar in the linked article about Dr Goldberg’s color-blindedness? It lists SOME of the TWENTY FOUR times he was sued for malpractice, resulting in nine payments to patients ‘or their survivors.’ Some of the brief descriptions of fact in the cases noted might relate to his color-blindness, but the ones that are clearly not so related are eyepoppers: referring a man with a pacemaker for an MRI, resulting in an ‘explosion’ and death; leaving a sponge in a patient (I thought these got counted routinely before closing); and this one, resulting in a $350,000 settlement:
“Failure to test or recommend treatment for high school athlete with excruciating head pain. The patient was discharged after five days without any diagnosis, died of intracranial pressure. Greenberg diagnosed psychiatric problems, but he did not refer Martin for a psychiatric consultation. Patient had undiagnosed brain tumor.”
I have to tell you, it’s this kind of situation that concerns me when I read the sneering comments of MDs in this blog and elsewhere about all the ‘unnecessary’ testing that gets done. Just because someone statistically isn’t likely to have a brain tumor doesn’t mean he doesn’t have a brain tumor.
So how come Dr Greenburg is still practicing? Huh?
Kevin
Anon,
If we test everybody for everything, who pays for the testing? Already our health care system is buckling under the costs. Can you suggest a solution to pay for indiscriminate, blanket testing?
Thanks,
Kevin
Rich, MD
I don’t think the high-school athlete falls under blanket testing. It would be interesting to know if this athlete ever had any imaging studies done, and what was the state of his neurological exam. It’s hard to believe he was hospitalized for headache for 5 days and no imaging was done.
It also strikes me as odd that this patient was under the care of a neurosurgeon – there would usually be someone else involved if he was admitted to the hospital, such as an Internist, Neurologist, or family practitioner.
It’s also worth noting that this case was settled – there was no award – and yet the anonymous poster above concludes that malpractice MUST have occurred in this case (the article sort of suggests it, too). I’m not defending this case at all (because as I note above, we really don’t have any facts), but settlements are not supposed to imply negligence. It’s possible that his insurer does not require his consent to settle or that the doctor did not want to pursue a lengthy legal battle. Of the size cases listed on the website, only was was a judgement, the rest were settled.
Rich, MD
Oops –
Of the six cases listed on the website, only one was a judgement, the rest were settled.
Anonymous
Uh, settlement means the possibility (and even some level of likelihood) of culpability — $350,000 is not paid out to get rid of a nuisance [or as the docs like to say -- 'frivolous'] suit.
So just because a case settles rather than going to judgment does not necessarily mean the MD had no culpability, tho Rich MD seems to assume such.
And Kevin, given the description of brain tumor case, I find it hard to believe you don’t think any further testing was indiscriminate and blanket given the facts as presented. Would you really not have tested any further on this kid? Is dropping dead the only symptom that indicates testing is medically indicated?
Anonymous
I’m glad I can post this anonymously: I believe with the chaos I walk into every day in the emergency room (EVERY day), and the “vagueness” of so many patient complaints, I could be sued 24 times, and never actually make a mistake. Every day I leave work, I have the sinking feeling I missed something. It’s impossible not to; there is such a high volume of patients, so much responsibility, and so many of them are angry. Eventually I’ll land up in court, having some med school reject tell me what a bad doctor I am. I just hope they can’t take my house.
Anonymous
To preceding anon:
Question #1: What leads you to believe ‘so many’ of the patients you treat to be angry? Are they actually angry, and if so why do you think they have become angry? Are you misconstruing patient anxiety as anger?
Question #2: Why do you assume attorneys are ‘med school rejects’? Do you think this attitude gets in your way?
I hope you don’t lose your house either. Even more, I hope your patients don’t lose their lives and health.
General question: how many MDs each year ‘lose’ their houses due to med mal awards? I keep reading this allegation on many medblog postings, but no one has presented any statistics. Are cases not generally settled within the coverage limits of the insurance?
Rich, MD
So just because a case settles rather than going to judgment does not necessarily mean the MD had no culpability, tho Rich MD seems to assume such.
This is not as assumption on my part. A settlement does not mean there was necessarily no culpability, but you cannot assume there was. Settlement may have been a financial decision made by the insurer or the insured. According to the NJ web site that lists all settlements made (even confidential one):
Settlement of a claim and, in particular, the dollar amount of the settlement may occur for a variety of reasons, which do not necessarily reflect negatively on the professional competence or conduct of the physician (or podiatrist). A payment in settlement of a medical malpractice action or claim should not be construed as creating a presumption that medical malpractice has occurred.
(njdoctorlist.com)
I did not used the words frivolous or nuisance. I was sued. I did not in my opinion do anything wrong. The jury agreed. Insurer wanted to settle, because the case was “worth” less than the cost of a defense. Fortunately, I have a “consent” clause – they cannot settle without my consent. Not every policy has a consent clause. By your logic, Anon, anyone who has been sued should have a reasonable assumption that there is culpability.
Anonymous
Is it possible someone could conclude his poor eyesight is a disability. Once labled as such what would the American’s with Disabilities Act require of his employer. Since he is likely an independent contractor (self employed) as most physicians are, his ‘employer’ as it were is the patient who has contracted with Dr. Goldberg for services. If not a legal duty, does the patient have a ethical duty to ‘accomodate’ Dr. Goldberg’s disability.
Anonymous
I don’t think ADA applies here — more important in my mind is whether Goldberg had a duty to disclose his condition/disability to his patients.
The words quoted above by Rich MD about not construing settlements as admission of culpability — these are nice logical words on a legal level, but one is nevertheless left free to decide for him/herself whether they would entrust themselves to Dr Goldberg’s ministrations based on his track record. Anyone who settles for $350,000 is almost certainly IMHO not settling to avoid the costs of defending against the litigation.
Another good reason Dr’s track records should be freely available to the public….
Anonymous
“how many MDs each year ‘lose’ their houses due to med mal awards?”
I don’t know what you do for a living, but how would you like that as a RISK of doing business, just because of what you do for A LIVING? Most physicians are pretty conservative; I personally don’t know too many who go on extravagant vacations, gambling jaunts. I don’t know too many physicians who would have sex with a prostitute, or have sex with a prostitute without wearing a condom. Why should we risk our personal assets every day just by going to work?
The patients are angry. They don’t understand why they have to wait an hour or two (or 8, or 10)to be seen, especially if they took an ambulance to the ED for their sore throat. They don’t understand why we can’t afford to give them a “taxi voucher” to go home afterwards. They also seem to believe the hospital has unlimited funds.
Anonymous
The reason I said alot of lawyers are “med school rejects” is because where I went to college, 800/3200 of the freshman class were pre-med. Most got “weeded out”. The majority of those who got weeded out became “pre-law”.
Rich, MD
Anon 1123:
Another good reason Dr’s track records should be freely available to the public…
Why is it that the same people who say that Doctors should be held to the same liability standards as any other business also wish to deny the same doctors from settling confidentially, just like any other business?
Anyone who settles for $350,000 is almost certainly IMHO not settling to avoid the costs of defending against the litigation.
Maybe not. Maybe he doesn’t want to have a heart atack like he did the first time he went to court (this actually happened to someone I know). There are lots of reasons to settle, not just because you might lose in court or are admitting negligence.
Personally, since setlements are now public in my state, I see no reason to ever settle a case that is likely not to exceed my policy limit. The public (as demonstrated by posts in this thread) regards them as admissions of negligence anyway, I might as well take the risk at trial. As mentioned elsewhere in this blog, awards in excess of policy limits are usually settled for the policy limit (I believe this is true but not universal) so it’s a wonder with public settlement records, why anyone would settle anymore (This went into effect in 2004 in NJ). Perhaps with public “track records” what you say will become true.
What about track records for people who file suit?
Curious JD
“If we test everybody for everything, who pays for the testing? Already our health care system is buckling under the costs. Can you suggest a solution to pay for indiscriminate, blanket testing?”
How about you produce a reliable study showing that it exists and what its causes are. How can we address a problem when we don’t konw the scope or the cause? All we have now are physician “surveys” where they say “yes, we do defensive medicine.”
Curious JD
“Maybe not. Maybe he doesn’t want to have a heart atack like he did the first time he went to court (this actually happened to someone I know). There are lots of reasons to settle, not just because you might lose in court or are admitting negligence.”
There are lots of reasons to settle, but it’s more likely than not it’s because of the culpability of the physician. Insurers don’t settle weak cases as a general rule. They don’t want to be seen as a mark.
Physicians ought to know how hard it is to get money out of an insurer, as many times as they’ve had to sue them to get money out of them.
Curious JD
“I don’t know what you do for a living, but how would you like that as a RISK of doing business, just because of what you do for A LIVING?”
Anyone who drives a car takes that risk.
Save us the “lose my house” cry. Is there a state in the union that doesn’t protect the house from judgment creditors? I’d be shocked if there were.
Kevin
CJD,
How would you propose we study the scope of defensive medicine that meet your standards?
I guess we can have two groups of doctors – one practicing “defensive” medicine and another practicing “non-defensive”, evidence-based medicine – and then compare costs and malpractice outcomes.
But realistically, how is something like that going to be done? This isn’t an issue that lends itself to controlled trials.
I’d be interested in hearing your suggestions.
Thanks,
Kevin
drdarcy
Hi CJD,
Well, actually, in CA the homestead law does not protect the full value of the home, particularly if the home is expensive. Some dear friends moved to TX (gotta love TX!!) a few years ago when their non-medical business failed, to better protect their assets in the event that lawsuits against their business turned vicious and creditors went after them personally. They made this move on the advice of their atty.
Hell, I’d be beyond pissed if I had to sell my home of 25 years and move to a different state, away from my kids.
I understand you enjoy stirring the pot and increasing Kevin’s hits, and I, for one, find your comments thought-provoking.
But, I think the real issue here is this …. Lawsuits are 100% your game, with your rules. And, both docs and attys being control freaks, I don’t want to play your game (In all fairness, you don’t really want to play my game, either). I’m trying to do my best at a job I love and to take care of my family. I’ve spoken with many lawyers (I’ve got a pack my family), and for them, their cases are an interesting intellectual exercise. Getting sued isn’t *personal*. There is a “no hard feelings” mentality. They understand the rules of the legal game, and it doesn’t scare them.
For me, the threat of a suit is very personal, every time. I’m a pretty level-headed person, but angry patients with potential bad outcomes freak me out, and have me wasting time double and triple and quadruple checking everything, probably making me more likely to make errors, rather than less. I have no trouble believing RichMD’s colleague had a MI in the course of a lawsuit.
Just like you, as a smart person but a non-physician, have a hard time calculating the cost/benefit ratios associated with various medical tests (speaking only in terms of medical outcome, not costs), I have no idea how much risk there would be for me of losing my home. But, it feels like any risk is too much.
We can’t prevent every injury, disease, or death.
But, I think we can change the legal system to provide more security for health care providers, so we don’t all just say “screw it” and go work for Big Pharma, without unduly hampering the rights of those who have been truly harmed.
I like the idea of the “no fault” system.
Curious JD
“But, I think we can change the legal system to provide more security for health care providers, so we don’t all just say “screw it” and go work for Big Pharma, without unduly hampering the rights of those who have been truly harmed. I like the idea of the “no fault” system.”
Provide more security for health care providers? How so? How much more security do health care providers need? Maybe you just mean physicians? How much more security does the nation’s highest paid profession need?
As for California, what’s that limit? $500,000? That’s still a pretty fine place, wouldn’t you say? You drive a car every day – do you think about a judgment ruining your home? Does that keep you from driving? The truth is, the chance of having a judgment that goes past your insurance limits is miniscule.
My cases are far more than an intellectual exercise. I don’t know how many individuals your family members represent, but anytime you’re dealing with people, especially people who have been injured at the hands of another, it’s far more than idle thoughts. I’m generally their lifeline. They are trying to deal with two insurance companies, being inundated with medical bills and phone calls from collection companies, trying to make their payments on every other bill they have, AND having to deal with the physical and psychological impact of being in pain often every moment of every day. Most have my cell and home phone and use it. I feel a tremendous responsibility toward them, much like you feel toward your patients.
For a contract case or something like that, yeah, it’s a little more of an intellectual exercise. But that’s nothing like a PI case.
Anonymous
Rich MD says above: “As mentioned elsewhere in this blog, awards in excess of policy limits are usually settled for the policy limit (I believe this is true but not universal)….”
Yo! Again the question: how many docs have lost their houses? If this is more than an urban legend to stir the troops, please give us the ‘evidence-based’ facts.
Curious JD
Kevin,
How do we do it? Not being a statistician, I don’t know if I can offer a good answer. But I would think it would have to begin with developing a standard protocol for treatment of certain ailments. Is such a thing even possible? I don’t know, that’s for a physician to answer.
The next question is – how do you reduce “defensive medicine”? There have been no comprehensive studies done of states with tort reform v. those without. That to me is surprising, but it also leads me to think that the answer may well be known but it is not favorable to the insurer’s side.
After all, the cost of health care does not change as a result of tort reform.
Elliott
It might be possible to look at Kaiser records vs. BCBS records in California. Randomize and anonimize charts in some way and review. Kaiser isn’t suit proof, but I believe that there are some higher hurdles to filing than there would be with a standard insurance policy. I absolutely believe that bad, costly medicine exists under the rubric of defensive medicine. We see evidence in Kevin’s blog entries and the comments. You can’t have doctors harboring such a wide range of irrational, overhyped fears without having problems as a result.
Anonymous
I agree with Curious JD. Thank God for all the Plaintiff’s attorney’s out there protecting patients from reckless physicians. How do they do it in less litigous societies? Maybe you can start “lawyers without borders”, so you can protect patients in Somalia, Canada, and other health-care systems less fortunate.
Curious JD
When doctors are prepared to get paid the same as their counterparts in Somalia, Canada, etc., then we can talk about giving them the same amount of restricted liability.
Oops, what’s that? You don’t want that? Didn’t think so.
Anonymous
I (and I suspect most physicians in high-risk specialties) would be thrilled to take a pay cut to remove your liability from our profession. I could make more than my parents ever did at 70% of my current salary (in Canada, etc.)and treat patients, instead of lawyers. And you don’t need to respond, “well go to Canada”. Because I am. You may need to come visit yourself someday when there are no OB-GYns left in the US.
Curious JD
I’m holding my breath. Enjoy Canada.

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