Risk Management

Failure to Diagnose Retinal Detachment

By Stacey Meyer

OMIC Claims/Litigation Associate

Digest, Spring 2000

ALLEGATION Failure to provide a prompt examination resulting in delayed diagnosis and treatment of retinal detachment.

DISPOSITION  Case settled on behalf of insured ophthalmic group.

Case Summary

A 53-year-old female patient who had been seen by the insured ophthalmologist for a number of years called the insured’s office with complaints of seeing streaks and black spots. She was given an appointment in three weeks even though she later claimed that she told the receptionist it was an emergency and she needed to be seen immediately. Three days later, the patient called the insured’s office to report seeing spots and showers of stars and asked to be contacted if any appointments became available before her scheduled appointment in three weeks. Five days later, she again contacted the insured’s office to report seeing black over one-third of her vision in the affected eye. She was given an appointment in seven days. The patient presented to the insured’s office one day before her scheduled appointment and was diagnosed with a retinal detachment. She was immediately referred to a retinal specialist to reattach the retina. The surgery was successful but the patient had a minor loss of vision and diplopia.

Analysis

This case centered around a factual dispute between the plaintiff and the receptionist who took the telephone calls regarding the urgency of the plaintiff’s medical complaints. The plaintiff alleged that the office staff ignored her complaints and thus did not treat the situation as an emergency. She also maintained that had the staff brought her complaints to the ophthalmologist’s attention, an appointment would have been obtained in a timelier manner, and she would not have suffered a retinal detachment with subsequent diplopia and vision loss.

In depositions, the insured’s office staff all testified that if the patient reported the symptoms she claimed, they would have scheduled her for an immediate appointment. Although the practice had a written protocol for scheduling office visits based upon patient symptomology, the staff had not documented their conversations with this patient. The receptionist who fielded the plaintiff’s calls stated that it was his practice to ask patients who were experiencing severe symptoms, such as floaters or loss of vision, to come in immediately. Given the symptom described by the patient (blurry vision), the receptionist did not feel the situation presented an emergency.

Our experts contended that if a patient calls with complaints of blurry vision, setting an appointment at a later date is within the standard of care; however, a patient complaining of showers should be seen immediately. Phone records confirming the plaintiff’s calls to the insured’s office on three separate occasions indicated that she was concerned about her condition. On one occasion, the insured’s staff had recorded the symptoms reported as blurred vision but had not recorded any other information, ruling out any additional problems such as loss of vision, black spots, etc. Thus, the only information available to the defense to work with was the staff’s memory of the events weeks later. Lacking the benefit of documentation of the phone conversations between the patient and office staff, a jury would have been likely to base its decision solely on the credibility of the parties involved. In light of this, the defense team and the insured agreed it would be difficult to argue with the plaintiff’s contention that the sooner one seeks and receives medical attention, the better the outcome.

Risk Management Principles

Improper triage is a source of potential malpractice claims, which is why it is critical that individuals answering the telephone be trained to recognize possible emergencies and schedule such patients appropriately. Documenting the details of a telephone conversation with a patient is as important as documenting the findings of an office examination. Recollections of what was discussed weeks and months later are unreliable and open to dispute without notations in the patient’s record to back them up. There are many products available to assist ophthalmologists and office staff record information from telephone conversations and transfer it to the chart, such as OMIC’s Patient Care Phone Call Record pads. Please contact the Risk Management Department to order.