Legal Rights

If you’ve suffered vision loss or been diagnosed with Plaquenil (hydroxychloroquine) toxicity, you may be wondering whether your injury could have been prevented – and whether you have a legal right to pursue compensation.
In many cases, the answer is yes.

Vision loss from Plaquenil toxicity is often the result of preventable medical error – most commonly a doctor’s failure to follow established safety guidelines around dosage and eye screening. When this happens, the law may recognize it as medical malpractice.

What Is Medical Malpractice?

In Maryland and other states, medical malpractice occurs when a healthcare provider:

1. Owes a duty of care to a patient,
2. Breaches that duty by failing to meet the accepted medical standard, and
3. Causes injury as a direct result of that failure.

In the context of Plaquenil use, that “standard of care” includes:

• Prescribing the drug at or below the recommended dose (≤5.0 mg/kg of actual body weight per day)
• Ordering baseline and annual eye screenings after 5 years of continuous use – or earlier if the patient has risk factors
• Recognizing and acting upon early signs of retinal damage if they appear on imaging or visual field tests

Failure to meet these standards – especially when it results in irreversible eye damage – may form the basis of a malpractice claim.

Duty of Care in Prescribing and Monitoring Plaquenil

Hydroxychloroquine is not a casual prescription. It’s a long-term medication with a known risk of retinal toxicity and clearly established guidelines for safe use, supported by:

• The American Academy of Ophthalmology (AAO)
• The American College of Rheumatology (ACR)
• The 2020 Joint Statement by AAO, ACR, AAD, and RDS

Because this information is well-documented and widely accepted in the medical community, physicians are expected to know it and apply it when managing patients on Plaquenil.
That means a doctor who prescribes Plaquenil has a legal duty to:

• Calculate dosage based on the patient’s actual body weight
• Recalculate dosage as needed if the patient gains or loses weight
• Coordinate care with an ophthalmologist for proper retinal screening
• Respond appropriately to any early signs of toxicity

When a provider fails to uphold these responsibilities, they may be held accountable under Maryland medical negligence laws.

Potential Negligence in Plaquenil Toxicity Cases
Some of the most common forms of medical negligence associated with Plaquenil-related eye damage include:

1. Overprescribing Plaquenil (Excessive Dosage)

Despite clear warnings from multiple medical societies, some providers still calculate Plaquenil doses using ideal body weight or prescribe routine 400 mg/day doses without adjusting for smaller patients.

This can expose underweight patients – especially women – to toxic levels of the drug over time, dramatically increasing their risk of retinopathy.

• Negligence may occur when:
• The prescribing physician fails to calculate dose based on actual weight
• There is no documentation of weight-based dosing
• The patient remains on a known excessive dose for years

2. Failure to Order Regular Eye Exams
Screening is not optional – it’s the recognized standard of care. Current guidelines require:

• A baseline retinal exam within 1 year of starting Plaquenil
• Annual screenings after 5 years, or sooner if the patient has high-risk factors (e.g., kidney disease, tamoxifen use)

Negligence may occur when:

• The doctor never informs the patient of the need for screening
• There’s no referral to an eye care provider
• Annual screenings are not scheduled or followed up on, despite long-term use
• The physician continues to refill Plaquenil prescriptions without verifying screening compliance

3. Ignoring or Misinterpreting Early Signs of Damage
In some cases, early signs of retinal stress are present on:

• OCT scans
• Visual field tests
• mfERG or fundus autofluorescence

But because these signs can be subtle, failure to interpret or respond appropriately may lead to permanent damage.

Negligence may include:

• Misreading abnormal test results as “normal”
• Failing to repeat or confirm suspicious findings
• Delaying discontinuation of Plaquenil even after definitive evidence of toxicity

By the time advanced symptoms such as bull’s-eye maculopathy appear, the window for intervention has usually closed – and permanent visual loss has occurred.

What Can You Do If You’ve Been Harmed?

If you’ve suffered vision loss and suspect it may be due to Plaquenil toxicity, the next step is to consult an experienced medical malpractice attorney – ideally one who understands the unique medical standards involved in these cases.

An attorney can:

• Review your medical and ophthalmologic records
• Determine whether your physician followed the recognized standard of care
• Consult with expert witnesses to evaluate diagnostic and treatment decisions
• Help you pursue compensation for:
  • Permanent vision loss
  • Pain and suffering
  • Loss of earning capacity
  • Medical expenses

In Maryland, medical malpractice cases must be filed within a specific time frame, and typically require a certificate of merit from a qualified medical expert. Early action is essential.