A DC told his patient to visit a specialist for her blurred vision four times. It wasn't enough to keep him out of court.
Posted in Case Studies on Tuesday, July 14, 2026
In the fall of 2013, Diane Marsh began suffering from headaches. Her primary care physician suspected sinusitis and prescribed antibiotics, but when the headaches wouldn't let up, he ordered a CT scan. It came back clean.
Then, in mid-December, Diane fell at work and ended up in the ER with headache and neck pain. The examining physician found nothing alarming — her pupils were normal, her eyes showed no signs of trouble — and sent her home with a diagnosis of cervical strain and instructions to follow up with her PCP if things didn't improve.
Instead, a week later, she walked into the office of Mark Reyes, DC. She told him her CT scan was negative, but that her vision had been blurry on and off, she was having trouble focusing, and her hands, especially her left, were tingling and numb. Dr. Reyes examined her neck and upper body, checked her eyes with a funduscope (which looked clear to him), took X-rays, and settled on a diagnosis: cervicocranial syndrome, with a thoracic plexus disorder and radicular neuralgia contributing to her symptoms. He started her on a course of ultrasound therapy, spinal manipulation, and heat.
For a while, it seemed to work. Diane was sleeping better within a couple of visits, and by late January her headaches had disappeared entirely. But Dr. Reyes noticed that her vision kept fluctuating. He urged her to see another doctor about it on four separate occasions. She didn't, at least not right away. After a January 26th appointment, she vanished from his schedule for three weeks.
The Real Diagnosis Emerges
When Diane finally saw an optometrist in mid-February, he found swelling in her optic discs and sent her straight to an ophthalmologist. That doctor suspected pseudotumor cerebri (a buildup of pressure inside the skull) and ordered an MRI and a neurology consult. The neurologist confirmed it: massive papilledema from increased intracranial pressure, with her weight likely a contributing factor. Diane spent two days in the hospital undergoing testing, including a lumbar puncture, before being discharged with medication and orders to lose weight.
A Lawsuit Follows
Nearly two years after her initial visit, Diane sued Dr. Reyes and his practice. Her claim was straightforward: he'd missed a serious, sight-threatening condition, misdiagnosed her with unrelated spinal issues, and failed to get her to a specialist in time. The result? The loss of most of her vision in both eyes, along with mounting medical bills and lost income.
Dr. Reyes carried solid personal malpractice coverage, but had never insured his practice separately. His defense attorney spent months persuading opposing counsel to drop the uninsured corporate entity from the suit, a request that was finally granted after Dr. Reyes's deposition.
Dueling Experts
On Diane's side, Dr. Reyes's records fell under the microscope: no documented vitals, a vague patient history, an unexplained note reading simply "optics clear." A neuro-ophthalmologist argued that the papilledema was likely already present when Dr. Reyes first examined her, and that he should have recognized it and pushed harder for a referral.
The defense came back with its own experts. A neurosurgeon pointed out that papilledema can develop within hours — and that six weeks had passed between Dr. Reyes's exam and the eventual diagnosis, far more time than the condition needed to appear from scratch. He also stressed something the plaintiff's side downplayed: Diane hadn't followed through on the referrals she was given. A defense ophthalmologist added that Diane's vision likely worsened sharply between her January 26th and February 16th visits — the same three-week gap she skipped seeing Dr. Reyes — meaning the damage may have already been done by the time anyone caught it.
Settlement Talks and a Summary Trial
At a pre-trial conference, Diane's attorney asked for $400,000. The defense countered that the case was worth closer to $15,000–$25,000. The judge could see the dispute really came down to one question: did Dr. Reyes actually tell Diane to see another doctor, or didn't he? He proposed a summary jury trial to test the waters, and both sides agreed.
At that hearing, Diane's attorney leaned hard on her credibility — she was now a minister — and on the severity of her outcome, at one point suggesting she was nearly blind in one eye, a claim her own medical records didn't quite support. He also raised a new argument: that Dr. Reyes's referral recommendations weren't written down at the time he supposedly made them. The defense countered with a pattern of noncompliance documented by Diane's other providers over the years, and suggested Dr. Reyes was simply the last doctor standing when the real diagnosis finally came to light.
The Verdict — and What Came After
The jury sided partially with Diane, finding that Dr. Reyes hadn't adequately shown he'd made the referrals he claimed. They proposed $60,000 — $10,000 plus $50,000 in medical costs. Afterward, jurors explained their reasoning: his records just said things like "referred MD," with no name and no date, which left them unconvinced. They also felt a more careful physician would have asked Diane directly why she wasn't following up.
Diane's attorney came back a week later demanding $200,000. The defense held firm, refusing to enter six-figure territory. After several more days of back-and-forth, Dr. Reyes just wanted to wrap up the matter and asked to settle, to the tune of $56,000.
What Can We Learn?
Procedure
In most offices, the DC schedules the referral appointment for the patient. That way, misunderstandings are minimized and compliance is improved. If Dr. Reyes had actually made the appointment, his documentation about the referrals wouldn’t have had to stand on their own. What’s more, even the timing and frequency of seeing a patient can raise questions in a malpractice case. It was unclear why Dr. Reyes took Diane Marsh as a patient, waited five days for her first treatment and then saw her 12 times in 28 days.
Records
Documentation is one of the most critical factors in a malpractice defense, and inconsistencies and omissions in the records are often as significant as the actual findings. In this case:
- Dr. Reyes's records were not sufficiently detailed to substantiate his referral of the patient to other healthcare providers.
- He made no effort to obtain the records from the hospital, the primary care physician, the ophthalmologist or the optometrist.
- It was unusual that Dr. Reyes had time to do a funduscopic examination but not enough time to chart the patient’s vitals or blood pressure in the records.
- Though Dr. Reyes was not solely to blame, his lax recordkeeping created the perception there was merit to the lawsuit.
Credibility
The “credibility factor” is a composite of a person’s presentation, demeanor and personality. In this case, based on Dr. Reyes's lack of credibility, due primarily to his recordkeeping, the summary trial jury panel concluded that he did not refer Diane Marsh to other healthcare providers as he attested.
Coverage
Coverage issues cannot be rectified after the fact, and doctors should be certain that they are thoroughly insured before any allegations are made. In this case, Dr. Reyes was fortunate that Diane Marsh’s attorney agreed to drop his corporation from the case. Otherwise, because the corporation was not insured, Dr. Reyes would have incurred legal expenses to defend it and would have been financially liable for any verdict against it.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.