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Payne v. United States

September 29, 2006


The opinion of the court was delivered by: Rodriguez, Senior District Judge.


Plaintiff Frederick R. Payne ("Plaintiff") filed the Complaint in this matter alleging that Defendant United States of America ("Defendant"), through its doctors at the Veterans Medical Center ("VA Hospital") in Wilmington, Delaware, committed medical malpractice resulting from cataract surgery. Plaintiff has contended that the treating physician (1) failed to properly handle/manipulate the artificial lense, thereby allowing it to fall into the back of Plaintiff's eye; (2) malpositioned a second artificial lens, an anterior chamber intraocular lens ("ACIOL"), thereby causing severe damage, inflammation, and "iris tuck"; and (3) failed to detect a causally related retinal detachment.*fn1 Plaintiff's expert described the surgery as follows:

[T]he intent of the cataract surgery was to remove the cataract from its natural location, which is behind the iris and in front of the vitreous cavity. The way this is performed, the lens, . . . which is oval-shaped and has some depth to it. And one can think of this almost like a fruit. The fruit has a skin called the capsule. The capsule can be divided into what we call the anterior capsule which sits in the front portion of the lens and this is the part that faces out, and then the posterior capsule which is the back skin of the lens. In fact, this is one continuous skin, but since we manipulate the capsule during surgery, we break it into what's called the anterior capsule and the posterior capsule. And then the substance of the lens, which is the fleshy part of the lens, we call the cortex, and the nucleus is contained within.

[T]he type of surgery that was performed, what is known as a Phaco emulsification procedure, which is the dissolving of the natural lens using an ultrasonic probe and the removal of the dissolved lens, having liquefied it by an instrument called an aspirating device. This is done by tearing a circular opening in the anterior capsule, and this procedure is known as a capsule orexis, which is just Greek for tearing of the capsule. This leaves behind this sac containing the cataract. And when the cataract is dissolved and subsequently removed, there is what's known as the capsular bag, which is at this point a deflated sac consisting of the remaining posterior capsule of the lens. The goal is to implant an artificial lens, an IOL . . . into this sac, this capsular bag which is the natural space of a lens inside the eye.

In order for this to be successfully performed, the sac has to be intact. The lens that is used consists of an optical part known as the optic and then two expandable hooks known as the haptics. And the purpose of this is to secure the lens in place and allow the lens to be inserted through a relatively small incision. The capsular sac is much larger than the optical portion of the lens, it's really only important that the optical portion of the lens be centered in the center of the sac so that the light coming through the pupil will also go through the lens.

The way this particular lens is secured is by having these bendable haptics, which when they are inserted into the sac then expand to secure the lens. And in order for this to secure itself, the capsular bag has to be reasonably intact. The way this lens is put in the eye -- there are different lenses these days. When this lens used to be a one piece lens where the optic was a firm material, it had to be inserted through an incision of a size at least big enough to accept the optic. These days more commonly a lens is inserted made of a foldable material, either silicon or acrylic, which allows the lens to be either folded in half and inserted or folded and rolled and then inserted through a shooter device, an insertion device, so it allows the incision to be half the size of the previous incision because the lens can be folded in half. And what typically occurs is that the lens is folded in half with an instrument called a folder. In this case, the lens was not injected into the eye through an injector, but it was placed into the eye with folding forceps. There are two forceps that are used. One is used to fold the optical portion in half.

Now, if we look at this picture, here is one haptic and here is the other haptic. The way the lens is folded in half is along this direction and the folding forceps will grab the optical portion of the lens. It will not grab either of these haptics. So, once the lens is folded in half, you have one haptic in front, which I believe in this case has been referred to as the leading haptic, and then you have a haptic behind where the forceps is and we can call it, using the terminology that was introduced in this case, as the lagging haptic, even though neither of those are really medical terms.

So, once that is folded, the lens contained in the forceps is inserted into the anterior chamber in an attempt to insert this into the capsular bag. Now, in order to achieve this, the lens has to be tilted because we have the incision here and the capsular bag sits below the incision, so it needs to be inserted on an angle.

Now, the haptic is flexible, so these can bend, these can bend both in the plane of the optic, they can also bend up and down. So when the lens is inserted in the incision, the leading haptic, which is not attached to the forceps but is in fact in front of it, is first inserted through the wound. And so that's free in the wound. And then this is followed by the folding forceps holding the intraocular lens.

Now, while this insertion is occurring, what was known as the lagging haptic is actually still outside of the eye because as the forceps is inserted, the forceps is holding the optical part and then the other haptic is sitting behind. Once the forceps holding the optic is inserted within the anterior chamber with the haptic still outside of it, the forceps will then release the lens and then the optical part of the lens will then unfurl like a sail.

At this point the haptic is in the capsular bag, the optic is angling down into the capsular bag and the surgeon then takes the lagging haptic, which is outside the eye, picks it up with the forceps and then in a sense compresses the haptic and pushes down on the lens so that the lens will then be contained within this capsular bag.

(Tr. 38:21-42:19.)

Pursuant to 28 U.S.C. § 2402, this action was tried non-jury on April 19, 20, and 24, 2006. See 28 U.S.C. § 2402 (1996) (stating that ". . . any action against the United States under § 1346 shall be tried by the court without a jury . . ."). The following are the Court's findings of fact and conclusions of law.


1. Prior to undergoing cataract surgery, Plaintiff experienced blurred vision. Other than requiring glasses, no other problems, i.e., double vision, flashing lights, string-like objects, light sensitivity, and left eye weeping, were reflected in the record. (Tr. 38:4-9.)

2. Plaintiff underwent cataract surgery at the VA Hospital in Wilmington, Delaware on November 20, 2000, (Joint Final Pre-Trial Order, Stipulated Fact No. 1), to remove a cataract from his left eye, (Tr. 38:5-6).

3. Plaintiff's surgery was performed by Drs. Peter Bzik and Gagan Singh. (Joint Final Pre-Trial ...

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