Opinion ID: 1864782
Heading Depth: 1
Heading Rank: 7

Heading: Dr. Michael Pekas, M.D.

Text: Dr. Michael Pekas is an ophthalmologist, practicing with the Central Plains Clinic in Sioux Falls. Dr. Opheim referred Foltz to Dr. Pekas, and Foltz first visited with Dr. Pekas in May 1990. Dr. Pekas' testimony was presented at the hearing via deposition. At the first appointment on 5/22/90, Dr. Pekas took a history and performed an examination of Foltz, including a number of visual tests. In his deposition, Dr. Pekas testified as to his findings: He [Foltz] did reveal some mild double vision ... the rest of the examination was pretty well normal except for the visual fields, and visual fields showed pretty much a peripheral field loss, kind of a tunnel vision type of field loss in each eye. And I told the patient at that time that he did have some mild abnormalities that I was hoping with time, you know, would clear; that it could be associated with his, you know, with his automobile accident[.]... [H]e had about a 30 degree central field at that time. (Emphasis added.) Thus, it was Dr. Pekas who first informed Foltz that he had suffered a loss of peripheral vision. Dr. Pekas also examined Foltz' optic nerve head, and testified that the color of the nerve appeared normal. Foltz returned for further visual field testing two days later, and Dr. Pekas' tests revealed the same results. In January 1991, Dr. Pekas performed visual field testing on Foltz, revealing twenty degrees central field in each eye. Again, in September 1991, visual field tests revealed no change approximately twenty degrees in each eye. Counsel for Warner/Cigna asked Dr. Pekas: Q. [D]o you have an explanation for Mr. Foltz' 20 degree field of vision? A. No, I don't. Counsel for Warner/Cigna then asked Dr. Pekas for his opinion about the vision problem, giving Dr. Pekas three choices: Q. Do you have an opinion as to whether this is a psychological problem or a malingering problem or an unexplained problem? A. I'd say it's unexplained. I can't really tell whether it's malingering or what, but it's an unexplained problem. I can't correlate it with any pathological process. (Emphasis added). Thus, although Dr. Pekas could not explain the problem, he did not label the source as psychological or malingering. He felt that he should see clear damage to the optic nerve head, such as loss of color. Again, Dr. Pekas was asked: Q. [D]o you believe that he has the 20 degree field of vision? ... A. Well, it gets hard for me to answer that question because, you know, it boils down to his perceptions, you know, his subjective perceptions of what is going on. All I know is that I, again, I cannot explain his field loss due to any known pathological process that I can come up with. Q. So it boils down to Mr. Foltz' honesty in doing these tests; is that fair? A. Yes. Dr. Pekas did say that the types of visual field tests he gave to Foltz could be skewed by a patient. [4] However, Dr. Pekas did not testify to any belief that Foltz was intentionally skewing the exam results, or that Foltz would even know how to do so. The substance of Dr. Pekas' testimony was that he could not explain Foltz' peripheral vision loss; he refused to testify that Foltz did not have the vision loss.