Opinion ID: 869450
Heading Depth: 2
Heading Rank: 3

Heading: September 11, 2007 Surgery on Right Eye

Text: On September 11, 2007, Dr. Leder performed the surgery on Harris’s right eye and successfully removed a “[p]artially dislocated traumatic cataract.” 2 Harris’s affidavit stated that, when he arrived for the surgery, he “informed Dr. Leder that [his] vision in [his] right eye had started to return. Dr. Leder assured [him] that the surgery was needed to replace the damaged lens.” Dr. Leder, however, did not insert a lens implant on Harris’s right eye, as he had intended. Dr. Leder’s affidavit explained that he “did not replace the right lens due to the severity of ocular damage in . . . Harris’[s] right eye as well as the risk 1 It is not disputed that “iol implant” means intraocular lens implant. 2 In his complaint, Harris alleged that Dr. Leder performed the surgery on September 10, 2007. However, Harris’s medical records show that the surgery actually occurred on September 11, 2007. 4 Case: 12-12098 Date Filed: 05/24/2013 Page: 5 of 15 for future complications.” Dr. Leder noted that his medical judgment was based not only on the “traumatized right eye” but also on the fact that “Harris had lost vision in his left eye from previous trauma and lens dislocation.” Dr. Leder added that he “prescribed prescription safety glasses for . . . Harris, which if used, would correct the vision to his right eye and would provide some physical protection for his solely functioning right eye given his current environment.” Similarly, in a written report prepared immediately after the surgery, Dr. Leder explained why it was not safe to implant a lens in the right eye: [i]t was apparent that it would not be safe to put in the intraocular lens at this time and due to the patient having had problems with his left eye and being blind in his left eye from the trauma six years ago, it appeared to be safer to not put in an anterior chamber lens, since the patient could be subjected to future trauma in the right eye. It was felt that at this point, either the patient would be best rehabilitated with either a contact or even a pair of glasses with safety glass to protect the right eye from the future possibility of trauma. In his affidavit, Harris averred that Dr. Leder never informed him that he did not replace the lens in his right eye during the surgery. D. September 26, 2007 Post-Surgical Follow-Up Examination On September 26, 2007, Dr. Leder performed a routine follow-up examination of Harris’s right eye. Dr. Leder’s contemporaneous report stated that he: (1) found that Harris had 20/40+ vision in his right eye with +10 correction; and (2) wrote Harris a prescription for polycarbonate safety lenses. 5 Case: 12-12098 Date Filed: 05/24/2013 Page: 6 of 15 In his affidavit, Harris contested these facts, stating that: (1) “[d]uring this time, [he] had no vision”; and (2) “Dr. Leder did not prescribe those glasses to . . . Harris as he claimed.” In any event, a Florida Department of Corrections document, submitted by Harris, indicates that Harris actually received prescription eye glasses on February 6, 2008. The eye glasses: (1) were bifocal type “FT28”; (2) had “distance” spheres of +0.50 for the right eye and “Balance” for the left eye; (3) had “add” spheres of +2.50 for both eyes; (4) had cylinders of -0.50 for the right eye and “Balance” for the left eye; and (5) had an axis of 180. Harris’s prescription form for these glasses included the following special instruction: “Tint Grey solid #2.” E. December 5, 2007 Examination On December 5, 2007, Dr. Patrick Brennan, a doctor at the prison, examined Harris’s eyes. The prison medical records from this examination indicate that Harris told Dr. Brennan that his “VA in OD is worse after cat[aract] sx on 9/11/07.” Dr. Brennan noted that Harris met “DOC criteria for contact lens,” and that “glasses [were] already ordered.” In his affidavit, Harris stated it was not until this appointment with Dr. Brennan that he learned that Dr. Leder had not implanted a lens in his right eye. According to Harris, Dr. Brennan informed him that “no future surgery can be 6 Case: 12-12098 Date Filed: 05/24/2013 Page: 7 of 15 performed.” Harris further stated that “the missing lens in the right eye . . . is the reason for [his] blindness.” F. Prison Administrative Grievances About Right Lens Implant On January 30, 2008, Harris filed an “informal grievance” stating he was promised a lens replacement in his right eye and had not received one. Harris stated: “[i]t ha[s] been ‘5 months’ and my vision [has not] returned.” Subsequently, Dr. Fernando Caravallo, at the prison, replied, “you were treated about your eye injury by a professional and you have been approved for new glasses on 02/06/07.” On February 13, 2008, Harris filed a “Request for Administrative Remedy or Appeal” with the MCI warden. In his grievance form, Harris stated that “Dr. Leder assured [him] . . . that [he] would receive [a lens implant] during the operation. Yet [he] wasn’t giv[en] it.” On February 27, 2008, Dr. Caravallo, Dr. Sanchez, and the assistant warden signed the denial of Harris’s request, giving this reason: “You have been done with eye surgery since 09/2007. You have to be provided with glasses as recommended by the eye surgeon. You are soon to be seen by the optometrist again for a Follow up evaluation.” On March 7, 2008, Harris appealed the denial of his grievance to the Secretary of the Florida Department of Corrections. In his appeal form, Harris 7 Case: 12-12098 Date Filed: 05/24/2013 Page: 8 of 15 repeated his allegations regarding the lens implant in his right eye. On May 12, 2008, Harris’s appeal was denied. On May 14, 2008, Harris filed a “Reasonable Modification or Accommodation Request” form with the MCI warden. Harris requested that he be allowed to sleep on a lower bunk as he was “legally blind in both eyes.” An MCI form, dated May 19, 2008, indicated that Harris’s request for a tape recorder was granted because of “lack of sight for reading.” G. State Court Complaint Harris then filed a complaint in state court against Dr. Leder, the MCI assistant warden, and four MCI physicians, asserting claims for medical malpractice and fraud. On March 18, 2010, the state court dismissed Harris’s complaint after determining that Harris had not complied with the statutory prerequisites for bringing a medical malpractice claim and had failed to state a claim for fraud. H. Federal § 1983 Complaint and Discovery On September 16, 2010, Harris filed his federal § 1983 complaint against Dr. Leder, asserting that Dr. Leder’s “intentional failure to replace . . . Harris’[s] lens [in] his right eye . . . constitute[d] deliberate indifference to [Harris’s] serious 8 Case: 12-12098 Date Filed: 05/24/2013 Page: 9 of 15 medical needs in violation of the Eighth Amendment.” 3 The district court denied Dr. Leder’s motion to dismiss for failure to state a claim, and the parties engaged in some discovery. During discovery, Dr. Leder filed an expert affidavit of Dr. Clifford Salinger, a board-certified ophthalmologist licensed in Florida. Dr. Salinger reviewed: (1) Harris’s state court filings; (2) Harris’s § 1983 complaint and the attached documents; (3) Harris’s medical records prepared by Dr. Leder; and (4) other medical records pertaining to Harris’s treatment at St. Mary’s. Based on this review, Dr. Salinger opined “that the care rendered by Dr. Leder was commensurate with that level of care, skill, and treatment recognized by reasonably prudent, similar healthcare providers as acceptable and appropriate under the same or similar conditions and circumstances.” Dr. Salinger explained that Dr. Leder exercised sound medical and professional judgment in not implanting a lens in Harris right eye: the decisions made by Dr. Leder, during surgery . . . did not constitute a deliberate indifference to . . . Harris’[s] medical needs, but rather, demonstrated an exercise of professional judgment based upon discoveries made during surgery and upon . . . Harris’[s] anatomy, which were intended to preserve . . . Harris’[s] right eye. Given the circumstances, that . . . Harris had already lost vision in his left eye due to unrelated events, Dr. Leder exercised sound medical judgment 3 Harris’s § 1983 complaint also named the Florida Department of Insurance as a defendant. Service was never made and the complaint did not contain any claim or allegation pertaining to this defendant. Accordingly, the district court dismissed the Florida Department of Insurance from the case. Harris does not appeal this dismissal. 9 Case: 12-12098 Date Filed: 05/24/2013 Page: 10 of 15 not to replace the lens in the right eye which, based upon . . . Harris’[s] anatomy, would have left him at higher risk for more serious complications. Dr. Salinger concluded that Harris’s injuries were not permanent. Rather, “[t]he serious medical need of which . . . Harris complains [could] be ameliorated via alternatives that [were] available to . . . Harris.”