The Dallas Court of Appeals has reversed a judgment rendered on a jury verdict awarding a plaintiff $300,000 in damages in her lawsuit against an ophthalmologist.
Robert E. Torti, M.D., P.A. d/b/a Retina Specialists & Henry Choi, M.D. v. Rachel Martinez (No. 05-24-00774-CV; August 5, 2026) arose from a medical liability lawsuit. Martinez sued Dr. Choi and his practice group when a vitrectomy procedure developed complications and left her blind in that eye. Plaintiff, who suffered from uncontrolled diabetes, was referred to Defendants when she complained of blurry vision. An exam revealed a proliferative diabetic retinopathy, for which the ophthalmologist prescribed injections of certain medication. After the first injection, the physician recommended that she continue with the injections and wanted to see her back in one week. Plaintiff, however, waited a year to visit the clinic again, where she saw Dr. Choi. By that time, she had progressed from the non-proliferative phase to the proliferative phase in both eyes. Dr. Choi’s plan was to resume injections, now in both eyes, to see how Plaintiff progressed, with the objective of getting her vitreous clear enough to apply a laser. After several months of treatment, Plaintiff’s vision improved.
At that point, Plaintiff had a medical crisis and has to be hospitalized for congestive heart failure and kidney failure. By now, Plaintiff’s vision had deteriorated so that she was blind in both eyes, ruling out laser treatment. Dr. Choi decided, however, to try surgery in hopes of restoring to her left eye and continue medications on the other eye. In May 2020, Dr. Choi did the surgery. The next day, after Plaintiff’s post-operative visit, her vision got worse, and by the following morning she couldn’t see out of her left eye. Dr. Choi’s examination found a rare complication from a vitrectomy, which he attributed to Plaintiff’s poor glycemic control. He used a steroid injecton to treat the inflammation it had caused. After a few more visits, Dr. Choi suggested another operation to repair her retina. She declined and went to a different practice. She got the surgery there, but it didn’t restore her vision. She sued Dr. Choi and his practice. The jury sided with Plaintiff on liability and was instructed in its assessment of damages not to include any amount for any condition existing before the surgery at issue, except to the extent any such condition was aggravated by any injury. The jury awarded $300,000 for past and future physical pain and mental anguish, past and future physical impairment, and past and future medical expenses. Defendants appealed.
In an opinion by Justice Jackson, the court of appeals reversed and rendered judgment for Defendants. They argued that there was legally insufficient evidence of proximate cause and Plaintiff’s medical expenses. The court first looked to the testimony of Plaintiff’s expert, who practiced vitreoretinal surgery. He opined that Dr. Choi breached the standard of care by discontinuing the injections too quickly, failed to check for or treat elevated interocular pressure immediately after Plaintiff’s surgery, and failed to recognize the traditional retinal detachment or recognizing it and not timely treat it. Taken together, these breaches caused Plaintiff’s macular detachment and permanent vision loss. Dr. Choi’s expert testified that when Dr. Choi saw Plaintiff in May 2020, her advancing disease made surgery, rather than continuing the injections, a good option. He further testified that Dr. Choi tested Plaintiff’s eye pressure manually, rather than measuring it, and was justified in waiting a week after surgery to see if she needed treatment for eye pressure. Finally, the expert opined that Dr. Choi’s post-operative care, including not rushing Plaintiff into another operation, did not breach the standard of care.
As noted above, Defendants argued that Plaintiff didn’t present legally sufficient evidence of proximate cause, specifically that she didn’t establish cause-in-fact because she failed to rule out other possible causes of the blindness, such as the progression of her diabetic retinopathy. They further contended that Plaintiff didn’t prove foreseeability. To prevail in her suit, Plaintiff had to “adduce evidence of a reasonable medical probability that the injuries complained of were proximately caused by the negligence of the defendant, meaning it is more likely than not that the ultimate harm or condition resulted from such negligence” (citations omitted). But when Defendants demonstrated that there were other plausible causes of the injury that could be negated, Plaintiff was obliged to offer evidence excluding them with reasonable certainty. In other words, “the expert must provide an analysis of alternate causes that is sufficient for the factfinder to reasonably conclude the defendant’s conduct was a substantial factor in causing the injury.”
Here the alternative plausible cause of Plaintiff’s blindness in her left eye was diabetic retinopathy. First, Plaintiff’s severe and uncontrolled diabetes caused a raft of other health issues and resulted in the very small vessels in her body, including those in the eyes, to become ischemic. Her kidney failure went “hand in hand with diabetic retinopathy.” Without control over her glycemia, Plaintiff, even with the injections, “will still bleed inside the eye and develop complications for diabetic retinopathy. Plaintiff’s expert admitted that diabetes could have caused Plaintiff’s blindness, but he failed to address “the role that progression of Martinez’s diabetic retinopathy may have played in [her] blindness and thus did not exclude it as a cause with reasonable certainty.” He likewise didn’t offer “any explanation as to why his theory that Martinez’s blindness was caused by Dr. Choi’s negligence was superior to a theory that it was caused by progression of Martinez’s diabetic retinopathy.” Plaintiff attempted to argue the “eggshell skull” theory, but to no avail. Her preexisting condition, retinopathy, was the reason she sought treatment in the first place. Without legally sufficient evidence of cause-in-fact, Plaintiff failed to prove proximate causation. The court reversed and rendered judgment in favor of Defendants.
