COA: jury should have had access to images

The Indiana Court of Appeals today reversed and remanded a jury verdict in favor of medical care providers in a medical-malpractice case involving a permanent eye injury following laser eye surgery. The appellate court concluded the trial court’s evidentiary and instructional rulings constituted reversible error.

In Paul Arlton v. Gary Schraut, M.D., and Lafayette Retina Clinic, No. 79A02-0906-CV-541, Paul Arlton presented three issues: whether the trial court abused its discretion when it sustained Dr. Gary Schraut’s objections to Arlton’s proffer of printed, enlarged copies of angiograms depicting Arlton’s retina; whether the trial court abused its discretion when it refused to provide the jury with access to digital evidence during deliberations; and whether the trial court abused its discretion in refusing Arlton’s tendered instruction informing the jury that they could review the digital evidence during deliberations.

In the late 1980s, Arlton was diagnosed with a condition known as choroidal neovascularization, an abnormal growth of blood vessels near the retina. If untreated, this condition can cause loss of vision and possibly blindness.

He was treated for the illness in 1987 and again in 1989. He noted no new problems until 2002, when he visited an emergency room and was referred to Dr. Schraut.

The doctor then ordered a fluorescein angiogram, where fluorescent dye was injected into his blood, and a series of photos were taken of his retina. While photos in September 2002 didn’t show a recurrence, photos taken in October 2002 revealed choroidal neovascularization had recurred.

On Nov. 5, 2002, Dr. Schraut performed laser photocoagulation surgery on Arlton’s left eye. Dr. Schraut claimed that during that surgery, Arlton jumped and a shape on his retina reflected that he had moved.

The two disagreed over whether the doctor admitted to further damaging a scar Arlton already had during surgery. An angiogram taken Nov. 27, 2002, showed the condition had been treated and swelling had decreased, but the blind spot remained.

Experts also had different takes on whether the doctor made the blind spot worse or if he had any impact after examining the angiograms and/or Arlton.

On Nov. 4, 2004, Arlton filed a proposed complaint against Dr. Schraut and the Lafayette Retina Clinic with the Indiana Department of Insurance. A Medical Review Panel found in favor of the medical care providers on March 28, 2007, and a jury trial took place May 11-14, 2009.

At trial, jurors had access to color copies of images taken from the angiograms from Sept. 24, 2002, Oct. 31, 2002, and Nov. 27, 2002 – nine images of each angiogram were printed on 8.5 x 11 inch paper. Three CD-ROM discs of the digital images were also admitted. Enlarged photos were shown to the jury using a projector and a screen.

However, following objections from the medical care providers, enlargements Arlton personally made of the images were not made available to the jurors, and the discs were also not available to jurors because of concerns from the medical care providers that the images might be enlarged or focused by the jurors.

The Court of Appeals found that there was no reason to believe the enlargements by Arlton were not authentic; that the jurors should have somehow had access to the digital evidence – “ideally … before deliberations begin … so that the trial court does not have to scramble just before deliberations trying to find a way to let the jury access admitted digital evidence”; and that a jury instruction Arlton suggested regarding the digital evidence, “informing the jury that, if they so desired, they could review the digital evidence during deliberations,” was proper, wrote Court of Appeals Judge Paul D. Mathias.

He added the case came down to an issue of credibility.

“Even Dr. Schraut admitted that placing a laser burn within a pre-existing retinal scar was below his personal standards and below the standard of care. … Dr. Schraut simply denied that he had placed a laser burn within Arlton’s pre-existing scar, whereas (a professor of ophthalmology at the Johns Hopkins University who specializes in retinal and macular diseases and treatment) testified that the angiograms contained evidence that Dr. Schraut did indeed place a laser burn within the pre-existing scar,” he wrote.

“We conclude that the trial court’s evidentiary and instructional rulings constitute reversible error because the end result of these decisions was to deny the jury access to evidence which directly implicated the heart of the matter the jury was asked to decide,” Judge Mathias wrote. “We therefore reverse the judgment of the trial court and remand this cause for a new trial consistent with this opinion.”