Opinion ID: 2981044
Heading Depth: 4
Heading Rank: 2

Heading: April 2006 Denial

Text: In April 2006, Pramstaller and the Medical Committee denied Dr. McGrath’s request to schedule Cobbs for a consultation with an ophthalmologist as a prelude to cataract surgery. The record suggests that the Medical Committee denied the ophthalmology consultation after reviewing forms that Dr. McGrath prepared following a March 2006 examination of Cobbs. McGrath’s 2006 request described Cobbs’s deteriorating left eye and the risks of delaying surgery. The request, which McGrath originally submitted to CMS, warned that Cobbs suffered from a “dense cataract” and risked developing glaucoma, and recorded Cobbs’s vision as 20/20 in - 13 - No. 10-2089 Cobbs v. Pramstaller, et al. his right eye and 20/600 in his left eye. After CMS denied McGrath’s request, he appealed to the Medical Committee, noting that “[s]urgery [was] advised to prevent secondary glaucoma. No view of lens/retina possible to check eye health.” McGrath further remarked that Cobbs “need[ed] cataract surgery—hypermature cataract surgery is more complicated.” Finally, McGrath noted that “if [cataract surgery was] denied, monthly [intraocular pressure check] advised.” Pramstaller and the Medical Committee again found cataract removal unnecessary, but heeded McGrath’s warning about glaucoma and the need to monitor pressure. A directive to “monitor closely for [an] increase in interocular pressure and resubmit if pressure increases” accompanied the Medical Committee’s denial of Cobbs’s cataract-removal surgery. Again, the Medical Committee invited Cobbs’s doctors to resubmit his request if his condition changed. Cobbs fails to show that this denial was anything other than the product of considered medical judgment. Before denying the claim, Pramstaller met with the Medical Committee, a group of physicians, and the group discussed the necessity of treatment. According to Pramstaller, the Medical Committee and he believed that delaying cataract-removal surgery—in the absence of conditions like glare or double vision—posed “minimal” risk. Cobbs points out that the difference in acuity between his two eyes—20/20 and 20/600—constituted a “discrepancy” in vision that Pramstaller admits warranted surgery. But a discrepancy in vision is more than a difference in acuity between eyes; rather, a “discrepancy” in vision refers to a difference that “creates a disparity in the visual cortex and makes it difficult for the brain to perceive vision.” The result is double vision, a condition that impairs overall sight. - 14 - No. 10-2089 Cobbs v. Pramstaller, et al. The eye care that Cobbs actually received further belies the notion that Pramstaller acted with deliberate indifference toward Cobbs’s health. During the relevant time period, Cobbs regularly met with ophthalmologists and optometrists. When a doctor did mention a condition that potentially qualified Cobbs for cataract-removal surgery—such as McGrath’s warning about glaucoma in 2006—the Medical Committee responded by ordering that doctors monitor the condition. Finally, both of the Medical Committee’s denials invited doctors to resubmit requests if additional facts came to light, making clear that its denial relied only on documents submitted with the doctors’ requests.