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Outline
I.
Introduction
A. Malpractice lawsuits against optometrists
B. Expanding standard of care
II.
Cases
A. Jones v. Green
1. Facts
a) Rigid lens wearer presents to optometrist with severe ocular
discomfort from overwear
b) Optometrist correctly diagnoses corneal abrasion
c) Optometrist patches patient's eye without applying topical antibiotic
d) Patient develop pseudomonas corneal ulcer and suffers permanent
vision loss
2. Issue -- standard of care for corneal abrasion
3. Lessons
a) Don’t patch corneal abrasion without antibiotic
b) May be best not to patch corneal abrasion at all
c) Don’t practice beyond the limits of your licenses or your expertise
B. Johnson v. Black
1. Facts
a) Monocular patient who lost one eye to glaucoma seeks
orthokeratology to eliminate need for glasses
b) High myope currently under treatment for glaucoma in remaining
eye
2. Issue -- orthok for monocular glaucoma patient
3. Lessons
a) Be cautious with monocular patients
b) Be cautious with patients with ocular disease
c) Take complete health history
d) Consult primary care practitioner
e) Perform thorough slit lamp examination
f) Diagnosis and prescribe based on all information available, including
history and observations
g) Advise of potential risks when fitting contact lenses, especially with
at-risk patients
h) Provide proper follow-up care
i) Don’t perform orthokeratology on inappropriate patients
j) Advise patients of likely prognosis
C. Williams v. Brown
1. Facts
a) Receptionist orders replacement EWCL for patient without review of
patient record or consultation with optometrist
b) At dispensing visit, patient has corneal ulcer which leads to
permanent vision loss
2. Issue -- responsibilities of staff
3. Lessons
a) Train staff thoroughly
b) Consult with optometrist regarding any at risk patient
c) Take thorough history before reordering lenses
d) Document phone conversation with patient
e) Triage all patients who call or visit office
D. Grant v. Black
1. Facts
a) Optometrist measures intraocular pressure at 30 mm for 35 year old
patient but does not do visual fields, gonioscopy, slit lamp
biomicroscopy or any other ocular health testing
b) Patient returns one year later with intraocular pressures over 40 mm;
at this time visual fields show significant field loss
2. Issue -- appropriate testing and advice with borderline or suspicious findings
3. Lessons
a) Routine primary care examination should include all appropriate
ocular health tests
b) Suspicious or borderline findings should indicate need for further
testing, consultation and/or referral
c) Borderline findings require advising patient so that patient can
determine whether additional testing should be done
E. Wilson v. Gold
1. Facts
a) 53 year old patient complains that he woke up this morning and saw
a "spider web" in front of his left eye for the first time
b) Optometrist does no testing and advises patient that this is a normal
change for a 53 year individual, but ten days later patient experiences
flashes of light and suffers a retinal detachment
2. Issue -- testing and warning when patient has symptoms
3. Lessons
a) Regardless of circumstance, patient symptoms must be taken
seriously
b) Any new symptom must be evaluated in detail, including detailed
history and appropriate testing
c) Advice should be given concerning warning signs of retinal
detachment when patients complains of precursor symptoms, such as
floaters
d) Document all visits including dispensing visits
F. Jackson v. Blue
1. Facts
a) Patient complains of headaches
b) Optometrist performs ophthalmoscopy without dilation and nine
months later patient is diagnosed with ocular tumor which lead to the
loss of that eye
2. Issue -- dilated fundus examination
3. Lessons
a) Do not assume headaches related to binocular vision as they can be
due to systemic causes
b) Dilated fundus examination is appropriate with all patients at annual
examinations and when presenting with symptoms
G. Smith v. White
1. Facts
a) Optometrist claims to have referred patient with IOP = 28 mm to
ophthalmologist by giving patient one of MD's business cards
b) Referral not documented in record
2. Issue -- standard of care in making referral
3.
Lessons
a)
b)
c)
d)
III.
Mitigating Malpractice Claims
A.
B.
C.
D.
E.
IV.
Reasonable and prudent referral methods
Communication between OD & MD
Follow-up with MD and/or patient on referral appointments
Proper record documentation
Standard of care
Informed consent
Vicarious liability
Communication
Record keeping
Summary and conclusions