In June 1996, Robert E. Donáis sued the United States pursuant to the Federal Tort Claims Act, 28 U.S.C. §§ 2671-2680, alleging that a third-year resident at the Edward Hines Veterans Administration Hospital (the “VA”) in Hines, Illinois, committed medical malpractice in treating Do-náis for cataracts by negligently fitting and implanting an intra-ocular lens in Do-nais’s right eye, causing the eyesight to deteriorate and requiring further surgery to correct the problem. Following a bench trial, the district court entered judgment for the United States. Donáis appeals.
I. BACKGROUND
. Donáis was an accountant who specialized in tax preparation. Donáis, who had never worn glasses, began to experiеnce difficulties with his vision in late 1991/early 1992. He first went to a private ophthalmologist, where he was diagnosed with cataracts. Surgery was discussed. Do-náis contacted the local VA hospital, where, as a veteran, he would be covered for cataract surgery. In June 1992, Do-náis sought an eye examination and evaluation at the VA eye clinic. At that time, where a refraction of 0 diopters is equivalent to 2%o vision, Donais’s right eye had a myopic refraction of -6.0 diopters and his left eye had a myopic refraction of -4.0 diopters. Although he had cataracts in both eyes, he was told that he nеeded surgery on his right eye but not on the left. He was referred to Dr. George Yan-ik, a third-year ophthalmology resident, for cataract surgery.
The surgery would replace Donais’s natural lens with an artificial lens placed in the capsular bag. Yanik’s target was to give Donáis a myopic refraction lеvel of - 4.5 to -4.6 diopters. 1 Refraction of -4.6 was a spherical equivalent measurement, which reflects a combination of the eye’s myopic refraction and the degree of astigmatism (misshaping of the cornea) occurring. Astigmatism can often occur as a consequence of cataract surgery. Yanik chose this refraction level so Donais’s right eye would be balanced with his left. Generally, when the two eyes are not balanced, the imbalance may cause a condition called “anisometropia,” which makes vision difficult. Yanik also chose the -4.5 to -4.6 target because Donáis indicated that he did not want to wear reading glasses, and with this myopic refraction reading glasses would be unnecessary.
In order to determine the appropriate power of the implanted lens, two measurements were used. The first was a K read
In July 1992, Yanik performed the surgery without any complications. Soon after, however, it was discoverеd that the right eye was providing a greater degree of myopic refraction than the intended -4.6 diopters. Such a difference is referred to as a “power overshoot.” Six weeks after the surgery, the post-operative spherical equivalent was -6.63 diopters. Between August and December 1992, the power overshoot in Donais’s right eye was measured six more times, and remained in the -6 diopter range. In December, Do-náis was informed that he needed surgery for the cataracts in his left eye. Due to the work demands of the tax season, Do-náis did not return to the VA clinic until May 1993. At that time, a trial framing (which uses а series of loose lenses until the patient arrives at the most accurate correction for him) was done to determine the refraction as opposed to an automated machine refraction which had been used for the first seven readings. The refraction in the right eye was -9.5 (myopic reading) +2.75 (astigmatism), or a spherical equivalent of -8.12 diopters, as compared to the December reading of -7.25 + 1.0.
Donáis continued to have problems but waited until November 1993, after he turned 65 and was eligible for Medicare coverage, to schedule an appointment with Dr. Manus Kraff, a privаte ophthalmologist who is a well-known expert in the treatment of cataracts and co-creator of the SRK formula used by Yanik. Kraff proposed a 'two-step surgical procedure. First, he would perform cataract surgery on the left eye to make the refraction 0 diopters (20/20). After Donais’s recovery, Kraff would then exchange the too powerful 29 diopter lens in Donais’s right eye with a 23 diopter lens to make the right eye 0 diopters as well. Kraff performed the operations in December 1993 and March 1994, respectively.
Several months after Kraff s second surgery, Donáis began to experience blurred vision in his right eye due to increased astigmatism. Kraff testified that the increased astigmatism resulted from the multiple surgeries and the compromised ability to heal. Donáis has had no problems with his left eye. However, because of the resulting differ enees between the two eyes, Donáis cannot tolerate a prescription for the right eye. Kraff recommended additional procedures for the right eye to reduce the astigmatism, but Donáis declined to undergo further surgery. During the trial, Donáis testified that he continues to suffer from blurry vision, but is able to read, drive, and watch television for approximately one to two hours at a time.
At trial, Kraff provided expert testimony on Donais’s behalf. Kraff testified that before the original surgery, Yanik most likely mismeasured Donais’s right eye, and that was the reason Yanik chose a too powerful lens. However, Kraff also testified that a power overshoоt is not always a breach of the standard of care, and that he himself has overshot the lens power. Kraff theorized that the measurements taken by the VA between August and December 1992 were wrong, and therefore the actual overshoot after the surgery was higher than indicated.
The district court found that Donáis failed to provide expert testimony that proved Yanik breached an applicable standard of care, and failed to show that any breach by Yanik proximately caused Do-nais’s injury.
II. ANALYSIS
Following a bench trial, we apply a clearly erroneous standard when reviewing the district court’s findings of fact.
Keller v. United States,
Under Illinois law, in a medical malpractice actiоn, the burden is on the plaintiff to prove (1) the proper standard of care by which a physician’s conduct may be measured, (2) a negligent failure to comply with the applicable standard, and (3) a resulting injury proximately caused by the physician’s lack of skill or care.
Purtill v. Hess,
Kraff did not state a definitive baseline standard of care. Kraff disagreed with Yanik’s plan of treatment, maintaining that “the wrong power of lens was implanted in Mr. Donais’s eye,” and that a target of -4.6 diopters with an end result of -9 diopters was a breach of the standard of care. Kraff believed that Yanik should have targeted the right eye for a 0 diopter correction, because the cataract in the left eye would necessitate surgery and that surgery would correct the left eye to 0 diopter, leaving both eyes balanced. Kraff was unable to determine a specific amount of overshoot which would constitute a breach of care. In his deposition, Kraff stated that an overshoot of 3 diopters would not be a breach but that 5 diopters would. However, he also stated that after surgery where the target was -4.0 to — 4.6, a reading of -7 “is an error, but that would be hard to say breach.” Kraff also testified that a power overshoot is not necessarily a breach of care, and that he himself had on several occasions missed the target refraction and has had to replant a different lens.
Epstein also could nоt state a definitive standard of care which would clearly indicate malpractice. According to Epstein’s deposition testimony, although he personally might have chosen a different diopter target, Yanik was not necessarily wrong in planning a -4.6 diopter target for the right eye to balance with the left eye. Therefore, when Donais’s right eye was measured at -8.12 spherical (-9.25 +2.75) in May 1993 at the VA clinic, the resulting 3.6 overshoot would not be considered a breach of care. Epstein testified, “I don’t think that there is any degree of myopia that would have made Dr. Yanik guilty of breaching the standard of care. [A power overshoot is] just one of those things that happens with cataract surgery.” He stated, “I would say one of the recognized risks of cataract surgery with lens implantation is that a patient may wind up with a lens implant that is the wrong power.”
At trial, while Epstein testified that up until December 1992, the overshoot was caused by mismeasurements, he noted that the additional “spike” in refraction that was first recorded in May 1993 could likely have been a result of the lens repositioning itself due to scarring and the natural healing process and that “[i]t happens not infrequently.” There was evidence in the record to support the fact that the lens had moved into the sulcus. When Donáis was examined in August 1993, a VA doctor recorded that the lens was “well fixated in the ciliary sulcus,” yet Yanik stated that he had inserted the lens into the capsular bag. When Kraff examined Donáis, he recorded that the lens was well-placеd but could not recall if it was in the bag or the sulcus. According to Epstein, if the lens did in fact move forward causing the “spike” six months after surgery, then the overshoot following the first five months of surgery averaged below 3 diopters (spherical equivalent below 2), which would not be considered outside an accеptable standard of care. He also testified that an overshoot of up to 12 diopters would not necessarily be malpractice, and was unable to draw the line as to where an overshoot would be considered a breach of care.
When only conflicting opinions as to whаt they consider the correct technique should have been are presented by testifying physicians, the Illinois Supreme Court has held that “the plaintiff has failed to present sufficient evidence of a standard of care in the medical'community to submit the case to the jury.”
Walski,
III. CONCLUSION
For the above-stated reasons, the judgment of the district court is affirmed.
Affirmed.
Notes
. Yanik testified at trial to these numbers. In his deposition, he had stated the targeted refraction was -4.0 to -4.5 diopters. However, throughout his trial testimony, Yanik most often referred to the -4.6 number.