Opinion ID: 2994656
Heading Depth: 1
Heading Rank: 2

Heading: analysis

Text: Following a bench trial, we apply a clearly erroneous standard when reviewing the district court’s findings of fact. Keller v. United States, 58 F.3d 1194, 1197 (7th Cir. 1995) (citation omitted). The Federal Tort Claims Act provides a remedy for personal injury caused by the negligent or wrongful act of any government employee acting within the scope of his employment, under circumstances where the United States, if a private person, would be liable to the claimant for the act in accordance with the law of the place where the act occurred. 28 U.S.C. sec. 1346(b); see also Midwest Knitting Mills, Inc. v. United States, 950 F.2d 1295, 1297 (7th Cir. 1991). Therefore, we apply the law of Illinois in this action. Under Illinois law, in a medical malpractice action, 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, 489 N.E.2d 867, 872 (Ill. 1986) (citations omitted). Unless the physician’s negligence is so grossly apparent or the treatment so common as to be within the everyday knowledge of a layperson, expert medical testimony is required to establish the standard of care and the defendant physician’s deviation from that standard. Id. (citations omitted); see also Walski v. Tiesenga, 381 N.E.2d 279, 282 (Ill. 1978). To establish that a doctor is guilty of malpractice, the plaintiff must introduce evidence of the standard of care to which the defendants were bound to adhere. Walski, 381 N.E.2d at 283-84. The only issue in the present case is whether Yanik committed medical malpractice. Therefore, Donais must first establish an accepted standard of care. 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. Kraff acknowledged that the seven measurements taken in the first six months after Yanik’s surgery were all less than a 3 diopter overshoot, which he would not ordinarily consider a breach of care. However, Kraff’s explanation for the spike between December 1992 and May 1993 was that it was nonexistent, that it only appeared because the VA measurements through December 1992 were inaccurate, due to the use of automated refraction, as opposed to the more accurate method of trial framing, which finally revealed the accurate refraction in May 1993. Kraff stated that this was his assumption given the fact that the component measurements (such as the axial length and the corneal curvature) used to arrive at the automated refraction had not been kept in the VA’s records; only the final refractive correction number was recorded. However, there was no evidence presented to support this assumption. Absent a finding that the government willfully destroyed evidence in bad faith, the district court does not abuse its discretion in declining to infer that the evidence would have been unfavorable to that party. Keller, 58 F.3d at 1197. Therefore, the district court did not err in declining to accept this portion of Kraff’s theory. Epstein also could not 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 Donais 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 Donais, he recorded that the lens was well-placed 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 acceptable 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 what 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, 381 N.E.2d at 284 (listing cases). The plaintiff does not establish a prima facie case merely by presenting the testimony of another physician who states that he would have acted differently from the defendant. Id. at 285. Because of the uncertainty of both expert witnesses in determining the applicable standard of care, Donais failed to establish a prima facie case. In addition, the moving party must establish that a judgment cannot be supported by the evidence in order to set aside the district court’s holding. See Keller, 58 F.3d at 1199 (citations omitted). Although Donais raises alternative interpretations of the evidence, these assertions alone are not sufficient to show that the district court’s decision could not be supported by the evidence. The district court carefully and fully considered all aspects of this technical case and did not clearly err in finding for the defendant based upon Donais’s failure to meet his burden of proof.