Risk Management

Message from the Chairman

My biggest concern as a physician,

and one shared by most clinicians, is that a decision made or a procedure performed results in harm to a patient, leading to pain and suffering, and perhaps adversely affecting quality or length of life. Most patients understand and accept the reality that events occur in the practice

of medicine that fail to salvage vision or restore function. However, patients do not give consent to procedures expecting that they will result in loss of sight, loss of the eye, or injury. Fortunately, such events are rare. After experiencing an adverse outcome, an honest surgeon will ask himself or herself privately, “Did I do something to cause this? Was this my fault? Did I make a mistake? What if I had done things differently?”

Patients who have been harmed, their friends, and family members ask the same questions. Their assessment and answers to those questions are the basis of medical liability claims. It is left to the courts and juries to determine if the complication results from “malpractice” as defined by the courts. All too often, an acceptable complication that occurs in the normal conduct of medical practice results in a claim, particularly when there is observable physical damage, pain and suffering, or financial loss. Physicians may feel cheated if a settlement is paid out when they are certain that everything was done correctly and within acceptable standards of care. However, one can’t escape the reality that a patient lost an eye or vision, suffered a stroke, or passed away in the course of treatment. Even when an adverse outcome is the result of maloccurrence, not malpractice, juries often take the approach that someone has to pay. That “someone” is usually the professional medical liability insurance carrier, which provides protection for physicians both when there is clear evidence of wrongdoing and when there is a settlement in the absence of malpractice. This coverage provides a safety net for patients who have been harmed and protection for the physician’s assets.

When a claim comes in to OMIC, investigation and defense of the claim falls to the claims department headed by Mary Kasher, MSN, JD. Insureds are familiar with OMIC’s outstanding claims history: average indemnity 18% lower than average ophthalmology indemnity reported by other carriers; 79% of cases closed with no indemnity payment; expense per closed claim 30% below industry average; 85% win rate at trial. This remarkable record reflects Mary’s experience and direction and the dedication and skill of senior litigation analysts Ryan Bucsi, Richard Isom, Stacey Meyer, and Randy Morris. This team of claims specialists serves as the intermediary between the attorney and doctor, supervising each claim in their respective geographic jurisdiction and leading each ophthalmologist through the litigation process from beginning to end.

Mary’s biggest challenge has been finding outstanding attorneys in each of the 49 states where OMIC insures ophthalmologists and educating them about the specialty so they could knowledgeably and skillfully defend insureds.

Mary’s approach to claims defense is shared by the OMIC Board and senior leadership: If a doctor is not negligent, provide the best defense possible, and settle those cases that need to be settled early and fairly.

John W. Shore, MD Chairman of the Board