Risk Management

Making Your Office Safe

By Monica L. Monica, MD, PhD

Argus, December, 1992

An ophthalmologist’s liability regarding patient care extends to general liability as well as to medical liability. Most general liability claims made against physicians involve “slips and falls” experienced by patients while in the office or on office property. The fact that the physician may not own or control the property does not preclude being named as a co-defendant in lawsuits involving general liability accidents.

As with most medical malpractice insurance carriers, less than 20% of OMIC’s claims are of the “slip and fall” variety. Still, settlements and judgments of such claims may range from a few thousand to tens of thousands of dollars, particularly if the ophthalmologist or office staff was negligent in supervising an elderly or visually impaired patient. Visual impairment following dilation can also raise questions of liability and be the basis of many “slip and fall” suits against ophthalmologists.

What can we do as ophthalmologists to limit our exposure to general liability claims? How can we insure the safety of our patients while they are in our office or on our office property?

Providing a safe environment for patients should be a routine followed by all office staff. Responsibility for the patient does not begin and end in the exam chair, but when the patient walks in and out of the office. Conducting an audit of your premises and safety policies using these common sense safety tips may minimize the likelihood of a general liability claim:

• Make sure that office floor coverings are easily traversed by patients on foot, on walkers or in wheelchairs. Discourage the use of area rugs, especially in patient pathways. Too often the corners of these rugs dislodge and catch the patient’s footing.
• Watch and assist patients when seating them on stools. Make sure the rollers of the stool do not easily slide, carrying the stool out from under the patient. Stools with locking devices are preferable, especially when performing office laser procedures.
• Patients with mobility problems should be supervised and assisted at all times when being moved in and out of exam rooms or on and off chairs. This is especially important for individuals who are blind or have low vision.
• Do not leave elderly patients unattended in exam or treatment rooms.
• Make sure hallways are well lighted and easily traversed by patients on foot, on walkers or in wheelchairs.
• Pathways leading to the office and parking lot areas should be well lighted and free of obstacles. If lighting is a problem in your building, discuss it with your landlord.
• Ramps are extremely helpful in entrance and exit areas.
• Patients whose pupils have been dilated should not be allowed to leave the office until they are comfortable with their vision. Provide mydriatic spectacles or drops to reverse dilation. Suggest that patients take a taxi home or arrange for a family member or friend to drive them.
• If toy chests or play areas are provided for children, make sure there are no tiny toy parts that could easily be swallowed. Examine toys for sharp edges that could cut a child.
• Routinely check equipment and office furnishings for loose fittings and unstable tables or chairs.

When conducting an audit of your office, keep in mind that the Americans with Disabilities Act (ADA) requires that public accommodations, which include physicians’ offices, must be constructed and altered to comply with the law’s accessibility standards. Some of the recommended alterations to your office not only will reduce your risk of liability, but also may be required by law.