Medical Record Retention Guidelines
While ideally medical records should be kept forever, this is not always practical. To ensure that present and future patient needs are adequately met, and that allegations of malpractice can be successfully defended, follow the guidelines in our document. Different rules apply, depending upon the age of the patient, and the reason the record are being requested.
Press “download” to review and print Medical Record Retention.
OMIC policyholders who have additional questions or concerns about record retention are invited to call OMIC’s confidential Risk Management Hotline at (800) 562-6642, option 4, or email us at riskmanagement@omic.com.
Informed Consent for Ophthalmologists
This online course will provide an overview of the doctrine of informed consent as it applies to various ophthalmic practice settings and will illustrate practical ways that ophthalmologists can support the consent ‘process’ so as to foster more effective patient/provider communications as well as improve the defense of malpractice claims.
Completion of this course offers policyholders a discount on their OMIC premium renewal. Contact Linda Nakamura at lnakamura@omic.com or (800) 562-6642, ext. 652, to order course or for additional information.
A Fund for Risk Management Studies
The OMIC Board of Directors has unanimously approved an initial donation of $50,000 toward establishment of the Bruce E. Spivey, MD, Fund for Risk Management Studies. This is the latest collaborative effort between OMIC and the American Academy of Ophthalmology to further their shared goals of risk reduction for ophthalmologists and improved ophthalmic care for patients.
The Spivey Fund will operate within the Academy Foundation’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care. The Hoskins Center will manage funds for projects determined by OMIC and the Academy to be consistent with their risk management and patient safety goals. OMIC will combine its extensive claims database and risk management knowledge with the Hoskins Center’s expertise in issue analysis and outcomes measurements. This potent combination of experience and expertise will be useful in developing evidence-based resources and tools for ophthalmologists that improve patient care and minimize the risk of lawsuits.
A highlight of the fund will be the “Bruce E. Spivey, MD, Lecture in Risk Management and Patient Safety.” This will be an annual lecture at the Academy’s annual meeting co-sponsored by OMIC and the Hoskins Center. Susan H. Day, MD, a pediatric ophthalmologist in San Francisco, CA, will be this year’s guest lecturer. In addition to serving as Academy president in 2005 and holding numerous other Academy leadership positions, Dr. Day was an OMIC board and committee member from 1996 through 2008. She is also past president of the American Association of Pediatric Ophthalmology and Strabismus. Dr. Day is currently Chair and Program Director for the Department of Ophthalmology at California Pacific Medical Center, a position Dr. Spivey held himself for many years.
Message from the Chair/CEO
It was Bruce Spivey in his position as Executive Vice President who led the leadership of the American Academy of Ophthalmology to create its own professional liability insurance company in 1987. Dr. Spivey understood that a company dedicated exclusively to insuring ophthalmologists would be in a better position to provide ophthalmic-specific risk management and claims handling services than multispecialty carriers. It is therefore appropriate that OMIC and the Academy would join forces to recognize and honor Dr. Spivey with the establishment of the Bruce E. Spivey, MD, Fund for Risk Management Studies. The fund’s mission is threefold:
- Assist OMIC in developing innovative risk management and patient safety initiatives, studies, and educational programs that will improve the quality of eye care around the world;
- Explore new ways of bringing risk management and patient safety programs to ophthalmologists who are members of the Academy, including international members;
- Develop tools that measure the effectiveness of risk management and patient safety education initiatives and their impact on physician and institutional behavior.
OMIC has provided $50,000 in seed money to get the fund up and running. There is already a record of several high-value joint Academy/OMIC programs in which OMIC provided not only special expertise but also financial support. Examples include an online informed consent CME course, a “wrong site surgery” patient safety program, and several patient education updates. OMIC funded these projects because they promised to provide ophthalmologists with risk management tools to reduce exposure to lawsuits while, at the same time, improving patient care.
Establishing the Spivey Fund within the Academy Foundation’s Hoskins Center will formalize future initiatives between OMIC and the Academy, streamline administration of these initiatives, and allow a way for others to provide vital philanthropic support for these critical projects and activities. As part of the Academy Foundation, the fund is set up so any individual, corporation, foundation, trust, estate, or legal entity may contribute. A description of the fund and how to donate can be found on the Foundation’s web site at https://secure.aaofoundation.org/onlinedonate_faao/spivey.aspx.
Potential contributors can feel confident that the Spivery Fund will be well managed. OMIC is an established, financially strong company and is committing its own financial resources to fund joint projects with the Hoskins Center because we believe they will benefit ophthalmology. Furthermore, OMIC will bring its business organizational skills to ensure that clear and measurable goals are set and met.
This new alliance between OMIC and the Academy will make both organizations stronger and better able to cope with the tremendous changes facing healthcare providers in the 21st century.
John W. Shore, MD, Chairman of the Board
Abandonment or Noncompliance?
Ryan Bucsi, OMIC Senior Litigation Analyst
Digest, Winter 2013
Allegation
Failure to follow up with patient after a negligent injection of Kenalog.
Disposition
Defense verdict.
Case summary
A 56-year-old male patient with type II diabetes began to complain of decreased vision OD one month following uncomplicated cataract surgery OD. He was referred to an OMIC-insured retinal specialist, who diagnosed diabetic macular edema and proliferative diabetic retinopathy OD. The insured recommended an intravitreal injection of preservative-free triamcinolone acetate (Kenalog), which was performed without complication. The following day, the patient returned to the retinal specialist with hand motion vision, pain, pressure, and photophobia. The insured diagnosed pseudoendophthalmitis and prescribed antibiotics. Three days later, the patient returned to the insured with hand motion vision. The insured diagnosed pseudo versus infectious endophthalmitis and the patient elected to continue with antibiotics and steroid drops versus injection. Ten days later, the patient’s visual acuity improved to 20/100 OD; however, two weeks later, the patient called to report pain and redness OD. The insured asked the patient to come into a satellite office, but the patient declined due to the increased driving distance. The patient was advised of the risk of not being seen and an appointment was scheduled for two days later. On the following day, the patient telephoned the retinal specialist to report pain and increased blurring. The patient was advised to come into the satellite office, but once again refused citing the increased distance. When the patient finally did return to the office, visual acuity was hand motion OD and intraocular pressure was 66. The insured tapped the right eye on two occasions, which only temporarily decreased the pressure. When the patient declined a third tap, the insured referred the patient for a trabeculectomy, but this was delayed as the patient was admitted to the hospital for dehydration. Following this hospitalization, a trabeculectomy was performed which eventually resolved the increased pressure. A second retinal consultation by a non-OMIC insured was performed, which revealed hand motion vision, no detachment, vitreous opacity, and controlled pressure OD. A pars plana vitrectomy and lens removal were eventually performed which resolved the endophthalmitis, but the vision remained at hand motion.
Analysis
Plaintiff alleged that the Kenalog injection caused glaucoma and endophthalmitis resulting in hand motion vision OD. He also alleged that he was not aware of the off-label use of Kenalog and that the insured “abandoned” him. Plaintiff’s expert testified that the insured had a duty to travel to see the patient. The defense argued that the insured met the standard of care for informed consent by advising the patient of the risks and alternatives and that the patient signed a consent form for the Kenalog injection. The defense refuted the abandonment allegation and argued contributory negligence by the patient when he declined to drive to a satellite office, even though it was no more than 27 additional miles from where he was regularly seen. The defense expert testified at trial that the patient’s noncompliance played a definite role in his outcome. The defense also noted that post-injection, steroid-induced glaucoma and endophthalmitis are known side effects of intravitreal Kenalog injections. Although the discussion about the off-label use of Kenalog was not documented in the patient’s chart, during deposition the office technician explained that the insured “always” explained to patients when drugs were used off-label. The plaintiff demanded $750,000 to settle, but the insured and OMIC agreed that the case was defensible. After a three-day trial and 90 minutes of deliberation, the jury returned with a defense verdict.
Risk management principles
To prove abandonment, the plaintiff must show that there was an established physician-patient relationship and that care was withdrawn without adequate warning. OMIC is not aware of any legal duty during this relationship for a physician to go to a patient’s home, nursing home, or, as in this case, another office. Patients have a legal right to refuse care. On the other hand, physicians have a legal duty to explain the consequences of refused care, which the insured did. OMIC recommends that physicians inform patients of off-label use, especially if the treatment consists primarily of an off-label medication, as in this case (see sample consent form at http://www.omic.com/informed-consent-for-off-label-use-of-a-drug-or-device/).
