Blind trust: Don’t assume you’re seeing a doctor — even at the Mayo Clinic

They had been to enough appointments to know the routine at Mayo: fill out paperwork, get escorted by nurse to exam room, wait for doctor in a suit and tie, get diagnosis and/or treatment, and leave.

Phillips was soon called back by a nurse. The nurse asked Phillips to read the letters on an eye chart. Phillips couldn't read them with his left eye, he says. He answered some initial questions and then sat with LuWanna, waiting to see the doctor.

The next and last person to enter the exam room was Paul Hughes. (Mayo's records confirm that.) In his deposition, Hughes says he introduced himself simply as "Paul Hughes" and told Phillips that Dr. McPhee wasn't available.

According to the depositions of both Hughes and Phillips, here's what happened next:

Hughes tugged the sliding doctor's stool over to Phillips, took a seat and rolled within a few inches of Phillips. Then he examined both eyes. In addition to Phillips' medical records, Hughes held a form labeled Executive Glaucoma Screening.

Phillips and his wife assumed Hughes was a doctor because he replaced Dr. McPhee, dressed like McPhee, and performed an examination. Hughes then wrote a diagnosis of "K. sicca" and treatment of "tears." He explained that the problem was simply dry eyes. Records show no ophthalmologist or eye doctor saw Phillips at Mayo that day.

"Thank you, doctor," LuWanna Phillips told Hughes on the way out. Hughes, she testified, did not correct her.

In court, Mayo Clinic attorneys argued that Hughes only "assessed" Phillips. But medical records show Hughes wrote "K.  sicca," the diagnosis for inflamed eyes, where the form indicates "Present Rx," the Latin abbreviation for prescription. With that, Hughes sent Phillips home.

Despite Phillips' complaints of severe blurriness and flashes of light, Hughes didn't dilate the problematic eye. Not that he should have known to; he isn't a doctor.

Hughes said he didn't dilate the eye because he thought Phillips was only in for a standard eye exam. But given the written diagnosis (in Hughes' handwriting), the documented complaint of symptoms, and the form that reads "Executive Glaucoma Screening," the jurors didn't buy Hughes' story. Even if Phillips had come for a standard eyeglasses exam, Hughes wasn't licensed to give one (and he documented the exam on a glaucoma screening form).

Two weeks after Phillips asked the Mayo Clinic to examine his eye, his retina detached completely. Doctors hired as expert witnesses for Phillips testified in court that Phillips' retina could have been fixed had it been diagnosed during his Mayo appointment.

The same doctors said the two weeks of additional scar tissue buildup made repair by surgery nearly impossible. That's why Phillips is blind in his left eye today.

Scottsdale attorney Mark Wesbrooks represented Phillips. He says his client's case against the Mayo Clinic is one of the most outrageous medical malpractice cases he's ever seen.

"This guy was a two-time felon. They actually created a separate schedule for him. Mayo tried to keep it hush-hush," Wesbrooks says. "It was a non-doctor who was allowed to practice medicine. He testified that he learned all about the eye while in Texas prison."

These days, it's common to go to the doctor and not see an actual doctor. That's not necessarily a problem. Many non-doctor practitioners are trained and licensed to diagnose patients. For example, physician assistants (P.A.s) and nurse practitioners (P.R.N.s) routinely see and treat patients. Both P.A.s and P.R.N.s receive years of medical training and residency before diagnosing patients in their area of specialty. They're also licensed and disciplined by state boards.

Even without any such training or certification, it's possible to legally work with patients, under Arizona law. There's a state law on the books that allows doctors to name anybody a "medical assistant." Medical assistants aren't allowed by law to see patients alone or to diagnose them.

Sometimes, however, they do. The state trusts physicians to be honest about the duties they give medical assistants, says Roger Downey, spokesman for the Arizona Medical Board.

For this reason, Downey says, medical care in this state is a swim-at-your-own-risk situation. "Patients may be offered a quicker appointment if they wish to see a physician assistant or a nurse practitioner at the doctor's office. Otherwise, patients should not assume the unfamiliar practitioner is a doctor. They should ask if they don't know. That's part of being an informed patient," Downey says.

"For elderly patients, most healthcare professionals recommend that an 'advocate' accompany them when they visit the doctor. An advocate in this sense is a relative or friend who can ask questions the patient doesn't think of asking. The advocate can also take note of the healthcare provider's instructions and information that the patient may not remember later."

That didn't help Paul Phillips.

Medical assistants sometimes go by the name "technician" in ophthalmology departments. The American Academy of Ophthalmology says technicians and assistants should never diagnose patients. Spokeswoman Christina Curas says ophthalmic assistants "are not licensed to practice medicine." Curas adds that it's a violation of the Academy's bylaws and ethics to let technicians diagnose patients alone.