Risk Management

Medication Error Underlines Importance of Informed Consent

Digest, Summer, 1992

ALLEGATION  Insured ophthalmologist was charged with negligence as a result of prescribing Betagan to an asthmatic patient which allegedly resulted in worsening of her asthma.

DISPOSITION  Case was settled prior to instituting a lawsuit.

Background

The practice of ophthalmology calls for the use of very specific ophthalmic medication for the treatment of various eye conditions. However, it is important to consider a patient’s preexisting medical condition before prescribing some of these medications. Several OMIC claims have been identified where the ophthalmologist prescribed a beta-blocker for glaucoma therapy without considering its effect on the patient’s preexisting asthmatic condition. In these cases, the potential for the worsening of the asthma was alleged to have never been discussed with the patient prior to instituting a trial run of the medication.

Case Summary

The patient was an elderly female with a history of asthma which was noted by the OMIC insured on the first visit. On one visit, the insured noted elevated intraocular pressures of 29 OS and 16 OD and prescribed Betagan. The patient returned a month later complaining that her asthma had worsened since using the Betagan. The insured discontinued the medication and the patient improved. Later, the patient claimed she sustained “substantial” lung damage as a result of being on the medication for one month.

Outcome

Although the patient was never able to show “substantial” lung damage from the one-month use of the Betagan, it was believed that the drug aggravated her condition. Because there were no discussions with the patient indicating her asthma might be exacerbated while on this medication, the case was settled for a nominal amount.

Risk Management Principles and Commentary

This case demonstrates two very important principles in medication-error related claims and informed consent:

• Always review a patient’s medical history for preexisting medical conditions prior to prescribing any medication.
• Discuss the risks and adverse reactions associated with any prescribed medication.

If the patient is at least informed of the risks and complications associated with a particular medication and consents to try it, the ophthalmologist’s exposure is diminished.