Opinion ID: 1864782
Heading Depth: 1
Heading Rank: 9

Heading: Dr. Thomas C. White, M.D.

Text: Dr. White is an ophthalmologist in Sioux Falls, practicing in the Great Plains Eye Clinic. Dr. Opheim's notes indicate that he referred Foltz to Dr. White. Dr. White gave a deposition and testified at the hearing; his deposition was received as an exhibit at that hearing; his testimony at the deposition and the hearing was essentially the same. Dr. White first saw Foltz in June 1991, approximately sixteen months after the accident. At that time, he noted a slight pallor or paleness to the temporal side of the optic nerve heads in both of Foltz' eyes, indicating that the nerves were not as healthy as they should be. Dr. White acknowledged that this would be a subjective observationthat two competent examiners might not agree on the presence or degree of pallor in the nerve. Dr. White administered a Goldmann test to Foltz, using the target size III-4-e, the target size recommended by the AMA for impairment evaluations. He acknowledged that if a larger size target was used (such as that used by Dr. Wirtschafter) this would be likely to show a larger field of peripheral vision. The results of the Goldmann test administered by Dr. White showed that Foltz had 10 to 12 degree peripheral vision field in the right eye, and 10 degrees peripheral vision in the left eye. Dr. White diagnosed Foltz with a traumatic optic neuropathy meaning that because of the trauma he had a disturbance in his optic nerve, resulting in a loss of peripheral vision. Dr. White's office performed a tangent screen visual field test on Foltz, which is the objective test suggested by Dr. Wirtschafter as having the ability to show whether a patient's claimed peripheral vision loss is real or faked. That test was performed by an ophthalmic technician in February 1992. Dr. White described the test, and acknowledged that in the profession, it is the practice to not tell the patient before the test what the purpose or procedure is, nor is the technician informed of any anticipated results; thus, the test is performed in an unbiased manner. In Dr. White's office, the test was performed at two distances, one meter and two meters. Dr. White testified that the results of this tangent screen visual field test showed that Foltz' peripheral vision loss is organic or real, as opposed to imagined or hysterical. Dr. White further testified that his office tested Foltz' peripheral and central vision fields on multiple dates with at least three different testing devices. Dr. White testified: All of these technicians then, on different instruments, showed the same pattern, consistently, of loss. In order to purposely falsify results, one would have to imagine or suppose that an individual could immediately adjust to each of these different modalities in exactly the same and proper degree, which is, you know, sort of not impossible, but certainly highly improbable, in my opinion.... Difficult to do. It would certainly presuppose a patient's familiarity with those instruments and testing devices. Dr. White was questioned regarding the difference in his opinion with that of Dr. Wirtschafter, and he stated: [Dr. Wirtschafter] would prefer, before he calls the peripheral vision loss organic, to see some loss of central vision or central visual disturbances, which he does not see.... And my point is that it would be nice to have that kind of confirmation, certainly, but it is not necessary for it to exist. We cannot impose what our preferences are upon reality, of the way the patient or the disease is in reality. In summary, Dr. White testified that the peripheral vision loss was real, and that it was caused by damage to the optic nerve.