Opinion ID: 1967565
Heading Depth: 1
Heading Rank: 7

Heading: Dr Neil Miller

Text: Dr. Neil Miller, a neuro-ophthalmologist, testified about the standard of care and causation for ION. Dr. Miller testified that the physician assistant's decision not to notify a physician when Dr. Haidak reported the purple disc in his vision did not satisfy the standard of care. He also testified that the seven-hour delay in receiving the ophthalmology consultation was a breach of the standard of care. With respect to causation, Dr. Miller could not testify with a reasonable degree of medical certainty that ION can be prevented, or that there is a reliable treatment for this condition, or that the delay in responding to Dr. Haidak's complaints harmed him. Dr. Miller testified that ION is exactly the same as ischemia anywhere in the body, but he could not state to a reasonable degree of medical certainty that ION can be prevented. On appeal, Dr. Haidak argues that Dr. Miller misconstrued the term reasonable medical certainty, which we have defined as an objectively well founded conviction that the likelihood of one cause is greater than any other; it does not mean the expert is `personally certain' of the cause ... or that the cause is discernible to a certainty. Robinson v. Group Health Ass'n, 691 A.2d 1147, 1150 (D.C.1997) (citation omitted). We find Dr. Haidak's argument questionable and, even if true, irrelevant. Dr. Miller was the only witness proffered as an expert on ION specifically. Dr. Haidak draws our attention to a remark by Dr. Miller about the gold standard for treatment of ION, and suggests that this standard is inconsistent with, and more demanding than, the reasonable degree of medical certainty standard required. Dr. Miller's remarks, however, were in response to Dr. Haidak's question: Now, what would be the gold standard in determining which treatment worked to treat ION? The subsequent exchange did not revolve around that standard: Q: To a reasonable degree of medical certainty can you say that it can be ION can be prevented? A: No, sir, I cannot say that. Q: Is the standard of care ... that ION that it should be treated as soon as possible? ... A: Yes, sir. Q: Did the failure to respond to his vision loss complaint harm him? A: I can't say that to a reasonable degree of medical certainty. There is nothing in the record to support an argument that Dr. Miller meant something other than that he had an objectively well-founded conviction that there was no medical certainty that delayed response to Dr. Haidak's complaint of loss of vision harmed him. While Dr. Miller testified that the applicable standard of care requires the physician to treat ION right away, he also said [w]e don't know [whether earlier treatment is better than later treatment] because people generally don't get better no matter what. The question whether Dr. Miller based his answers on an incorrect understanding of the proper standard is irrelevant, however, because the gold standard question and answer pertained to proper treatment of ION, and thus the standard of care. They did not pertain to the prevention of ION, and thus contribute little, if anything, to a determination of causation. We, therefore, conclude that the trial judge did not abuse his discretion when he subsequently limited Dr. Miller's testimony as to causation of ION.