eye injuries outside the workplace role of the optometrist and legal responsibilities.pdf

Eye Injuries Outside the Workplace: The Role of the Optometrist and Legal Responsibilities Mark Rosenfield MCOptom., PhD., FAAO Georgina Tsakrios Esq. DISCLOSURES Neither of the speakers have any financial interest in any of the items described here. Point: Secondary font for bullet point Bullet P...

Eye Injuries Outside the Workplace: The Role of the Optometrist and Legal Responsibilities Mark Rosenfield MCOptom., PhD., FAAO Georgina Tsakrios Esq. DISCLOSURES Neither of the speakers have any financial interest in any of the items described here. Point: Secondary font for bullet point Bullet Point: Secondary font for bullet point Bullet Point: Secondary font for bullet point Case scenario 1 John is a healthy 26-year old accountant. His Rx is: OD +2.50sph OS +3.50sph. What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with Case scenario 2 John is a healthy 26-year old accountant. His hobbies include computer gaming and cooking. His Rx is: OD +2.50sph OS +3.50sph. What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with Case scenario 3 John is a healthy 26-year old accountant. His hobbies include computer gaming, cooking and fishing. His Rx is: OD +2.50sph OS +3.50sph. What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with Case scenario 4 John is a healthy 26-year old accountant. His hobbies include computer gaming, cooking, fishing and yardwork. His Rx is: OD +2.50sph OS +3.50sph. What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with Case scenario 5 John is a healthy 26-year old amblyopic accountant. His hobbies include computer gaming, cooking, fishing and yardwork. His Rx is: OD +2.50sph (20/15) OS +3.50sph (20/60). What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with Case scenario 6 John is a healthy 6-year old. His Rx is: OD +2.50sph OS +3.50sph. What Rx material would you order? a. Crown glass b. CR-39 c. Polycarbonate d. 1.67 high index lens e. Whatever the patient is happy with In 2014, more than 193,000 adults and children were treated in hospital emergency rooms in the United States for eye injuries sustained within the home, according to the Consumer Product Safety Commission’s National Electronic Injury Surveillance System. More than a third of injuries in the home happened in the kitchen, bedroom, bathroom, living room or family room. ER visits Highest proportion of eye injury visits to ER: • Chemicals for ages 0-4 years, and > 65. • Household items in 5-9 year-olds, • Sports products in 10-24 year-olds, • Cutting and construction tools in 25-64 year-olds. Chen et al. RI Medical J. 2014 (1); 44-48. Sports eye injuries Sports Related Eye Injuries by Age - 2019 Activity * Estimated Injuries Ages 0 - 14 Ages 15+ Basketball 4,597 965 3,632 Pools & Water Sports 4,565 2.367 2,198 Non-Powder Guns, Darts, Arrows, Slingshots 3,612 1,632 1,980 Bicycles 2,495 668 1,827 Exercise, Weight Lifting 2,385 222 2,164 Baseball / Softball 2,109 1,121 988 Soccer 1,618 404 1,214 * Totals may not be equal because the injuries are not mutually exclusive 2020 Prevent Blindness Isn’t basketball a non-contact sport? Sports injuries Football (aka Soccer) definitely isn’t Injuries from household products: • • • • • • Oven cleaners Glue Disinfectants (ammonia, bleach) Hair sprays Paint Cooking foods that can splatter hot grease or oil Injuries from household products: Accidents involving common household products cause 125,000 eye injuries each year. Other dangerous common sources of injuriesactivities: at home: Other domestic • • • • • • • Lawn mowers Car repair DIY (nail guns, power tools, etc). Yard work Champagne corks Trauma from sharp objects Using hot objects such as curling irons around the face. Pesticides Pesticides can be absorbed quickly and easily into the blood vessels that lie close to the surface of the eye. Corrosive products can cause severe eye damage or blindness. Pesticides can get into the eyes as airborne dust or particles, splashes or spills, broken hoses, spray mists or from rubbing the eyes with contaminated hands or clothing. Injury Risks Garage/Workshop • Power or hand tools • Solvents or other chemicals • Tasks producing fragments, dust particles or other eye irritants • Securing equipment with bungee cords • Soldering equipment Special care should be taken with:risk: Think about those patients at greatest • • • • • Children A one-eyed patient Amblyopes Patients with developing eye disease. An eye that is already weakened from previous surgery (e.g., refractive surgery) or trauma. What is the Optometrist’s role? Assess risk, advise, educate. A significant part of the optometrist’s role is to evaluate the visual demands of a particular task and to prescribe an appliance so that a patient can meet these demands satisfactorily with minimal risk. How do you find out about the patient’s visual demands at work, at home and elsewhere? ASK THEM!!! What do they do, and where / how do they do it? This should be part of EVERY case history. If you are not including an adequate assessment of patient risk, then there is a possibility that you could be considered negligent in failing to advise the patient properly as an eyecare professional. What do they do, and where / how do they do it? You have a professional responsibility to assess risk, and provide counselling to the patient. They may not understand the level of risk involved in “normal” daily activities. If they are at particular risk (e.g., amblyope, post-LASIK patient), then you have a special responsibility to advise. • “If only the doctor had told me how important it was to do something, then of course I would have done it. But he didn't act like it was that big a deal.” • Malpractice attorneys and insurance risk managers say that this is a classic allegation they hear from plaintiffs when a patient's failure to comply with medical advice is a factor in their illness or injury. Legal Responsibilities **This presentation is not, and is not intended to be construed as legal advice. Please consult with an attorney regarding any questions or issues that may arise. Cause of Action Duty • Is there a doctor/patient relationship? Breach • Did you deviate from the reasonable standard of care? Cause of Action Causation • What you did must be a substantial factor in the patient’s injury. Damages • Was the patient actually injured? Damages Compensatory • Unable to perform normal daily tasks • Current and future medical expenses • Current and future lost earnings Pain and suffering Punitive damages Targeting Questioning Rules! • Foreseeability is key! • When prescribing glasses and contemplating the materials to be used, how the patients intend using their spectacles is of utmost importance. Know Your Patient Ocular health of the patient: • Monocular patient • Amblyopic patient • Previous injury • Significant disease in one or both eyes • Thin cornea • Prone to falls • Prior refractive surgery Cover Your Bases • • • • How old is my patient? Hobbies? Employment? Do they use contact lenses for specific tasks? It is the duty of the optometrist to ask the right questions and elicit the answers necessary to make the best decision for the patient. Cover Your Bases Patient comes in with a prescription for glasses to fill at your office. Do you: • • • • Call the prescribing doctor Take a full case history Refract the patient Obtain medical records from prescribing doctor prior to dispensing lenses When in doubt, type it out! • One of the most important aspects of litigation is what is documented! • If it is not written as part of the patient's record, it did not happen. • Document as if another doctor will examine the patient at their next appointment. • Document as if the patient’s chart will be the only way to exonerate you in a medical malpractice trial. When in doubt, type it out! • Trials are usually 3-5 years after a complaint is filed. With SOL, trial could begin 6-8 years after patient’s injury. • There is a significant amount of time and patients in between, which makes recalling what is absent from your file arduous, and more importantly, less believable to a jury. • Your files will be presented in court. If important facts are missing, you will under oath have to accurately recall your conversations with the plaintiff and their responses. When in doubt, type it out! • It is not only about the facts! If information is not in your file, you must be able to tell your story to the jury in an effective and convincing manner under oath. • Succeeding in court is less about the truth, and more about what you can prove with the facts presented. When in doubt, type it out! Important points to document: • Diagnosis • Treatment options • Treatment plan • Risks and benefits of treatment plan • Prognosis with treatment plan, and prognosis with alternative treatment plans • The patient’s response When in doubt, type it out! Important points to document: • Any follow up measures taken • Phone calls with patient, other doctors • Always update patient charts with records/reports from other providers If you feel concerned about a patient’s compliance, be concerned! • Quickly draft a statement outlining what you’ve discussed/recommended and have patient sign it! • Conduct follow up calls and document! • It is your license on the line, be your own best advocate! When in doubt, type it out! 2007-2016 Data Analysis • 1 in 5 medical malpractice claims had documentation issues. • 70% of documentation issues were insufficient/lack of information. 2017 Malpractice Report • Better chart documentation was the number one thing doctors who have been sued would have done differently. What to expect if things go wrong • Claim • Lawsuit • Settlement What to expect if things go wrong: 1. Claim • Plaintiff submits claim to malpractice insurance carrier. • Insurance company/Defendant attorney conducts review. • May be requested to agree to tolling agreement so plaintiff’s time to litigate under statute of limitations does not expire. What to expect if things go wrong: 1. Claim • Insurance company is the main player • Usually denied by malpractice insurance company • Timeframe: 6 months – 1 year What to expect if things go wrong: 1. Claim Result: • No pre-lawsuit settlement • Plaintiff files complaint • Claims representative makes a settlement offer • Mediation What to Expect if things go wrong: 2. Lawsuit Timeframe for patient to sue • Approximately 2-3 years from injury • Varies state by state Path to Trial • • • • • Consultation with experts Notice of Intent File complaint Discovery Interrogatories What to Expect if things go wrong: 2. Lawsuit Depositions • Keep calm and only answer direct questions directly! Settlement Conference Trial Insurance company vs. Optometrist • Insurance company indemnifies doctor up to limit of insurance • If verdict in excess of policy limits, doctor is liable What to Expect if things go wrong: 2. Lawsuit Timeframe to Trial: • 3-5 years from filing of complaint • Appeals can extend the timeframe • COVID-related delays 3. Settlement • • • • It is not admitting malpractice! No admission of guilt No loss of excess time/wages No risk of excess financial or personal responsibility • State-dependent disclosure • Considerations: previous settlements or actions, terms of the settlement, etc. When things went wrong $16 million (2012) • 14 year old beaten at school and left blind in one eye • Significant ocular damage a result of shards from child’s eyeglasses lodging into his eye $8.5 million (2008) • Teacher hit in face with door by kindergartener and lost vision in his right eye. • Jury initially awarded plaintiff $9.4 million, reduced by Appellate Division on appeal When things go wrong $5.5 million (2015) • 8-year-old injured in gym class when an exercise band snapped in his eye • Child suffered substantial loss of vision • Students were not provided with eye protection equipment by the school. • $1 Million (present day value) • Optometrist failed to provide 11-year-old with shatter proof eyeglasses. When things go right Congratulations! You prevailed in court! Here's what it cost: • Hours of reviewing your own files, experts reports and the defendant’s evidence • Hours of preparation for your deposition, as well as the deposition of your staff, if needed • Hours of reviewing your deposition for trial • Hours of preparation with your attorney • Time away from your office, lost wages, time away from your family and friends • Your peace of mind Key Takeaways • You must understand your patients and their needs! • You have a legal duty to your patients! • Communicate clearly to your patients! • Your demeanor matters! Nice doctors are sued less, so be nice! Key Takeaways • Always seek professional legal advice when unsure how to proceed. • When in doubt, type it out! • 5 extra minutes can save you time defending yourself against malpractice claim. What do you do and where do you do it? As an eye care practitioner, you have an ethical, moral and legal obligation to discuss eye safety with every patient you see. There are 2.5 million eye injuries in the USA every Eye Injuries year. • That’s 6,800 a day, OR • 285 per hour, OR • 4 in the next minute. • Or probably at least 2 in the time it took you to read this slide! • It is estimated that at least 90% of them are preventable. Don’t let this happen Your patient You