March 23, 1999

Dr. Raymond Stein Accused of Malfeasance by Dr. Jeffery Machat

TLC THE LASER CENTER

March 23, 1999

Mr. Brent Hanson
2007 Teasley Lane #118
Denton, Texas 76205

Dear Mr. Hanson,

RE: Visual Problems in Left Eye

I am the National Medical Director for TLC the Laser Center. As you are well aware, TLC purchased Beacon and has taken over their Toronto facility at BCE Place. Dr. Raymond Stein, who performed your procedures and corresponded with you, now operates from a competing facility, The Bochner Institute, which is co-owned by he and his father.

Dr. Stein, as we had indicated to you previously, had taken all of the original charts of all of the patients that he had treated. However, since his departure, we have been inundated with dozens and dozens of requests from patients who have requested us to take over their care due to the fact Dr. Stein was either unwilling or unable to help them further. He had performed multiple procedures on some of these patients, as in your own case, without resolution of their problems. While we have literally bent over backwards to help each one of those patients that have been turned away by Dr. Stein and we are willing to do so once again, I think that you must also understand our position.

In your particular case, your left eye astigmatism was in the most severe 1% of the most severe 1% of the world. You were also treated with PRK and not LASIK, which would have made it more amenable to resolving your problem. Furthermore, you appear to have a muscle imbalance problem and possible eccentric fixation as well, from the notes I received from Dr. Foley. You currently have mixed astigmatism in your left eye and reduced best corrected vision by only 1 line. That is, you are fortunately correctable in your left eye to within 1 line of your pre-op best-corrected vision. There was also a question if there was a decentration in your right eye although the refractive result, uncorrected and best-corrected vision is quite good.

I am certainly valling to attempt to treat you with further laser refractive surgery in Canada most likely at our TLC Windsor clinic, which is just across the border from Detroit. I would use the Technolas 217 scanning laser utilizing the eyetracking system. I would not charge you a facility fee or a surgeon fee.

Mixed astigmatism is not treatable locally in your area. I would still require a color map to be couriered to me so that I may examine the post-operative findings although I will never have all of the pre-operative data as Dr. Stein has all of that information. Furthermore, you also require a cycloplegic refraction, as the amount of mixed astigmatism is important to determine prior to your visit. That is, while your cornea still has approximately half of the astigmatism that you started with initially, which is approximately is 3 diopters, you are still in the worst 1% of the vorld. You also have other portions of your cornea that are now farsighted. That is, parts of your cornea are farsighted and parts of your cornea are nearsighted in an astigmatism pattern.

Furthermore, I would gather that at least during your last enhancement in August 1997 you had haze formation that Dr. Stein treated as there was a PTK (or therapeutic component) to your retreatment. This is of concern as any further surgery whether PRK or LASIK could induce the haze to recur. While you appear to have an adequate thickness to your cornea for LASIK surgery, you do not have a lot of tissue remaining for further treatments as the thickness of the protective layer increases while the thickness of the actual stroma thins with repeat surgery. Specifically it is important for you to realize that there is a limit as to what we will be able to do and that once again, I cannot live up to the discussions that you and Dr. Stein may have had previously as each doctor has his own comfort zone.

I am currently receiving, along with our Clinical Affairs department, quite a number of referrals per week of patients from across North America. This includes a number of patients of Dr. Stein's. It takes us at least 2-3 hours to manage each one of these cases and it is not surprising that things have not moved forward as quickly as you wished. Once again, I cannot speak for Dr. Stein, as his letter to the College of Physicians and Surgeons in Ontario vhen he requested his original charts had stated that he wanted to continue the care of his former patients. Clearly this is not the case.

In summary, I would ask that you have a cycloplegic refraction completed and sent to TLC Windsor. Please contact Dr. Foley at TLC Arlington at 817-460@ who will arrange a surgical date for you with Carol Meloche at TLC Windsor. I vill tell you that I only treat complex cases on certain days per month and I typically book at least two months ahead. While I certainly appreciate your position and I do know that you are having difficulties with your vision and I absolutely do want to help you, I am simply writing you this letter so you can better understand my position and in what way I may be able to help you best. I have tried to be very detailed in this note and I vill certainly send a copy to the College of Physicians and Surgeons so they may address this issue with Dr. Stein. TLC will certainly do whatever it can to bring you to a point where we have optimized your visual correction in your left eye.

I hope that this letter meets with your satisfaction and you realize the number of people who have been working diligently behind TLC to bring your problem to a successful resolution. I very likely have more laser refractive surgery experience than anyone else in North America does, both in general and in dealing with these difficult cases, as I have performed approximately 24,000 procedures since 1991.

Once again, I will do my very best for you and I hope to see you in the near future.

Warmest personal regards,

Jeffery J. Machat, MD FRCSC DABO
National Medical Director

Mail color topographies and indicate cycloplegic refraction on bottom of page to:

TLC Windsor
3200 Deziel Drive Suite 208
Windsor, Ontario
Canada N8W 5K8
Attn: Carol Meloche

CC:    Elias Vamvakas CEO TLC The Laser Center Inc.
Allan Weisman, OD FAX: 972-416-1270 Linda Foley, OD - TLC Arlington
David Eldridge, OD - TLC Clinical Affairs
Carol Meloche - TLC Windsor
College of Physicians and Surgeons 80 College St.
Toronto, ON Canada
Posted by Admin at March 23, 1999 10:51 AM