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

Heading: Cobbs’s Request for Cataract-Removal Surgery

Text: Cobbs’s request for cataract-removal surgery ran this course twice before CMS approved his surgery in early 2008. The Medical Committee, headed by Pramstaller, denied Cobbs’s request for -3- No. 10-2089 Cobbs v. Pramstaller, et al. the surgery in October 2004 and denied a request for an off-site ophthalmology consultation in April 2006. We recount below the repeated requests, denials, and ultimate approval of Cobbs’s cataractremoval surgery in 2008. In August 2004, Dr. Dastgir, Cobbs’s ophthalmologist, removed a cataract from Cobbs’s right eye and recommended that Cobbs undergo surgery on his left eye to remove another, less severe cataract. A month later, Dr. Piper, a physician at the Ryan Correctional Facility, requested that CMS authorize left-eye surgery for Cobbs, noting Dr. Dastgir’s recommendation. The utilization-review unit at CMS “pended” Dr. Piper’s request and forwarded Cobbs’s claim to the Medical Committee. A few weeks later, in October 2004, the Medical Committee met and considered Cobbs’s request for surgery. When the Medical Committee reviewed his claim, Cobbs had 20/70 vision without correction in his right eye and 20/70 vision with correction in his left. When exposed to glare, vision in his left eye was much worse—20/400—and Cobbs’s medical records described a “dense posterior sub-capsular cataract.” Prior to his right-eye surgery, Cobbs complained of double vision. After reviewing Cobbs’s record, the Medical Committee denied his request for surgery, noting that the “decision was based on the documentation that was submitted with this request. Should other information become available, the [Medical Committee] will be happy to re-evaluate.” Both Pramstaller’s and CMS’s denial of the request relied on the medical judgment that, although deteriorated vision in one eye would affect peripheral vision and depth perception, a cataract did not warrant treatment unless it impaired the prisoner’s overall visual acuity. In Pramstaller’s words, -4- No. 10-2089 Cobbs v. Pramstaller, et al. [H]aving monocular vision does not put anybody at a risk for anything. People who have monocular vision are allowed to drive automobiles; the only thing I’m aware of that they cannot do with monocular vision is work as a pilot. Cobbs met with two different optometrists in March and May of 2005. In May 2005, Cobbs met with Dr. Connolly, who noted Cobbs’s left-eye cataract and requested an off-site ophthalmology evaluation as a prerequisite to cataract-removal surgery. CMS denied the request, citing the Medical Committee’s previous denial, and Dr. Connolly did not appeal the decision. In December 2005, Cobbs met with a new optometrist, Dr. McGrath. After examining Cobbs, McGrath also concluded that “cataract surgery [was] needed.” By this time, vision in Cobbs’s left eye deteriorated to 20/600. Notes from McGrath’s December 2005 examination also remark on Cobbs’s “trouble with depth perception” and mention that Cobbs had “walked into objects on his left side.” CMS denied the request, again citing the Medical Committee’s previous denial. McGrath did not appeal the decision to the Medical Committee. In March 2006, Cobbs met with McGrath a second time. Once again, McGrath concluded that Cobbs needed cataract surgery and requested approval for an ophthalmology consultation from CMS, noting that Cobbs suffered from a “dense cataract,” that Cobbs risked developing glaucoma, and that Cobbs had 20/20 vision in his right eye and 20/600 vision in his left eye. Again, CMS denied McGrath’s request, citing the Medical Committee’s previous denial. This time, McGrath appealed his request for an ophthalmology consultation to the Medical Committee. In the form appealing his denied request, McGrath noted that “surgery [was] advised to prevent secondary -5- No. 10-2089 Cobbs v. Pramstaller, et al. glaucoma” and that Cobbs “need[ed] cataract surgery—hypermature cataract surgery is more complicated and there is [a] risk of [secondary] glaucoma.” On April 25, 2006, Pramstaller and the Medical Committee met and deemed an ophthalmology consultation for cataract removal unnecessary. They did, however, respond to McGrath’s concerns regarding glaucoma by issuing a directive to “monitor closely for increase in interocular pressure and resubmit [the request] if pressure increases.” Again, the Medical Committee invited Cobbs’s physician to resubmit his request if Cobbs’s condition changed. After the April 2006 denial, no doctor appealed another denied request to the Medical Committee. Cobbs’s vision continued to deteriorate, and Cobbs continued to send healthcare request forms describing the worsening condition of his left eye. In July 2006, Dr. Piper, Cobbs’s primary care physician, again requested that Cobbs be sent to an ophthalmologist, but CMS again denied his request. Dr. Piper did not appeal the denial to the Medical Committee. In August 2006, Dr. Cook, another optometrist, examined Cobbs, requested surgery, and suggested that Cobbs wear a patch over his left eye to offset the effects of his now-monocular vision. Cook marked the request “urgent”; noted that Cobbs had an “opaque/white pupil”; and warned that the hypermaturity of the cataract could “preclude the use of phacoemulsification,” a technique used in cataract-removal surgery. Cobbs saw optometrists again in December 2006 and April 2007, and both optometrists requested cataract surgery for Cobbs. Relying on the Medical Committee’s denial, CMS denied the doctors’ requests. Despite providing grave descriptions of Cobbs’s condition, none of the doctors appealed CMS’ denials to Pramstaller and the Medical Committee. Throughout this -6- No. 10-2089 Cobbs v. Pramstaller, et al. period, Cobbs continued to file various health care requests and grievances complaining about his condition, to no avail. In October 2007, Cobbs filed this lawsuit. Pramstaller unsuccessfully moved for summary judgment on Cobbs’s claims against him, contending that his only involvement with the denial of Cobbs’s medical requests was attendance at the two Medical Committee meetings at which the Medical Committee denied Cobbs’s requests for surgery. Pramstaller, along with other MDOC defendants, have twice more moved for summary judgment, asserting qualified immunity. Each time, the district court has adopted the magistrate judge’s recommendation to reject the defendants’ claims of qualified immunity. Three months after filing his lawsuit, Cobbs met with another optometrist, the optometrist requested surgery, and CMS approved the request the following week. As Cobbs’s doctor predicted, Cobbs’s cataract-removal required a follow up surgery due to complications caused by the surgery’s delay. Cobbs has since fully recovered his sight; according to the last entry in Cobbs’s medical records, his left-eye vision is now 20/25.