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Play Ball!

GEORGE A. WILLIAMS, MD, OMIC Board of Directors

As a lifelong Chicago Cubs fan, I understand the topic of errors better than most folks. Sometimes errors are the individual’s fault. Sometimes, they are the team’s fault. I can’t count the number of times I’ve seen a routine pop fly drop among three Cubs players in a classic example of “I got it. You
take it.” Similarly, errors in medicine can be the fault of the individual or the fault of the team. The difference is that unlike in baseball, medical errors truly matter.

This issue of the Digest summarizes OMIC’s experience with diagnostic errors in pediatric patients. My thanks to Anne Menke and Bob Wiggins for providing these excellent examples of OMIC’s continuing quest to improve care.

It is a sobering report at multiple levels. First and foremost, it is a story of lost opportunity to prevent visual loss or even death in a child—an always tragic occurrence. Second, it demonstrates the personal consequences to the involved ophthalmologists, who are often devastated by the realization that their care has been judged to be negligent. Finally, and frankly least importantly, we see the substantial financial ramifications of such errors.

When I say the financial costs are the least important part of the story, it is not because the money does not matter. It does. Your Board carefully considers our fiduciary responsibility to our insureds on every settlement. Fortunately, OMIC has the financial strength to provide appropriate and fair compensation when patients have been harmed due to negligence. The most important issue is to understand what went wrong.

Each of these cases presents an opportunity to ask two important questions: How did this happen and what can be done to prevent it from happening again? Sometimes, it is simple physician error. We all make mistakes and in the current era of increasing patient volumes, increasing clinical knowledge to be mastered, and the often maddening regulatory and documentation requirements, I don’t see practice getting any easier. That makes it all the more important that we take the time to ask ourselves how sure we are of a diagnosis and to think what else could this be, particularly when managing an atypical presentation or clinical course. If we are not certain, close follow-up and a second opinion demonstrate to the patient our concern.

As noted by Bob and Anne, sometimes the answer is a systems-based failure. Medicine is transitioning to a future of team-based care in which systems of care will become increasingly critical. Nowhere in ophthalmology is this more apparent than in the management of ROP.

Several years ago, OMIC’s claim experience in retinopathy of prematurity demonstrated the need to approach ROP from a systems-based perspective. As a result, OMIC developed an evidence-based underwriting process that establishes a rigorous educational program involving not only ophthalmologists, but their offices and neonatal intensive care units as well. We call this process our “Safety Net” and if we can catch even one child, everyone wins. The Safety Net is a dynamic, evolving process and OMIC provides it free to everyone whether an OMIC insured or not. Under the direction of pediatric ophthalmologist Robert S. Gold, the OMIC ROP Task Force is continually evaluating
the Safety Net to reflect the best available evidence for the diagnosis and management of ROP. It is another example of the synergy between good medicine and good business.

I am told that this year is different for the Cubs. I hope so. One thing that will not be different is your company’s continuing dedication to patient safety. Baseball players often shrug off their errors with the attitude that they will get the next one. For our patients, there is no next one. I got it, you
take it is no way to play ball or practice medicine.

A new logo and brand strategy as OMIC looks forward

Articles, Eye on OMIC // No Comments

We are excited to introduce a new OMIC brand strategy and corporate logo. In anticipation of our 30th anniversary year in 2017, OMIC has placed a renewed emphasis on defining our core missions in order to best serve the needs of our policyholders. In 2012, we also began an exhaustive process of forming a new strategic plan that will prepare OMIC for a rapidly changing environment in both the insurance and eye healthcare communities. Part of that process was to showcase and celebrate our unique identity.

Our new logo features an abstract graphic that suggests the shapes of overlapping eyes and symbolizes a commitment to a forward-looking vision for OMIC. It signifies the common and shared goals of OMIC, the American Academy of Ophthalmology, and our policyholders to support, defend, and enhance the practice of
ophthalmology.

With one eye focused on our past, we reflect on OMIC’s origins. Our founding members and sponsoring organization, the Academy, laid a foundation for what would become the largest and most trusted insurer of ophthalmologists in America. We reaffirm our mission, first articulated by OMIC’s leaders in 1993, to serve the needs of Academy members by providing high quality medical liability insurance products and services.

With another eye looking forward, we will respond to the changing needs of our policyholders and strive to be a leader in the medical liability community by promoting quality ophthalmic care and patient safety.

In the coming months, members of the ophthalmic community will learn more about OMIC’s accomplishments and milestones as we celebrate our 30th year of serving ophthalmology. In addition, our branding strategy will focus on OMIC’s future commitments to our specialty.

Telephone consultation on minor patient with foreign body injury

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RYAN BUCSI, OMIC Senior Litigation Analyst

Allegation

Failure to evaluate and treat a minor patient with a foreign body injury.

Disposition

Defense verdict at high-low arbitration. $175,000 paid on behalf of insured.

A minor patient sustained an eye injury when a metal fragment struck him while he was hammering a penny. The parents flushed his eye with water. The following day his pediatrician diagnosed decreased vision and a conjunctival hemorrhage. The pediatrician called the OMIC insured after hours and informed the insured that she did not see any signs consistent with a penetrating injury. The pediatrician stated that the cornea was intact with no abrasion and that the anterior chamber appeared intact as well. The insured specifically asked if this was a high-speed impact injury and the pediatrician responded that it was not. Our insured advised that he could not make a diagnosis over the phone but he suspected a possible conjunctival hemorrhage or an abrasion. The insured recommended antibiotics and follow-up with
the pediatrician or the emergency room if the condition did not improve. The insured informed the pediatrician that he was on call at the local children’s hospital emergency room and could see the patient that evening. The pediatrician did not ask the insured to see the patient nor did she tell him that she would instruct the patient to go to the emergency room. Six days later, the pediatrician informed the insured via telephone that a general ophthalmologist had examined the patient and had diagnosed a foreign body in the eye, confirmed by orbital CT. The patient was referred to a retinal specialist, who immediately performed surgery to remove the foreign body. The patient later developed endophthalmitis and underwent a corneal transplant but ended up with only count fingers vision.

Analysis

Plaintiff’s experts alleged that the insured should have advised the pediatrician to send the patient to an emergency room for a CT scan or MRI to determine whether there was a foreign body in the eye. Plaintiff also alleged that the pediatrician violated the standard of care by not immediately sending the patient to the emergency room. During her deposition testimony, the pediatrician testified, consistent with her records, that the patient’s vision had been drastically affected. The ophthalmologist, however, contended that he was not informed of any drastic vision loss during the initial phone conversation. The defense expert felt that the insured’s care met the standard assuming that his version of the phone call with the pediatrician was accurate. However, if the expert assumed that the pediatrician’s version of the phone call was accurate, then the insured failed to meet the standard. Our defense expert believed that any penetration of the globe by a foreign object should be treated as an emergency situation and that the delay in diagnosis caused the patient to experience significant vision loss. This was a case involving significant loss of vision in a minor and the defense was not comfortable taking the case to trial. Therefore, binding high-low arbitration was agreed upon. The case was heard by an arbitrator with a plaintiff high of $750,000 and a defense low of $175,000. The arbitrator ruled in favor of the defense and OMIC paid $175,000 to the plaintiff. The pediatrician settled her portion of the case for an undisclosed amount.

Risk management principles

The insured admitted that to meet the standard of care an ophthalmologist must examine a child who has experienced a drastic visual decrease following trauma. The defense expert indicated that he routinely examines children with such injuries. The crux of this case then was whether the ophthalmologist was informed that a drastic visual decrease had occurred. The pediatrician documented that she told the insured that vision in the patient’s eye had been drastically affected.

Our insured did not recall being informed of this but had no documentation to support his position. Fortunately for our insured, his lack of documentation did not keep the arbitrator from ruling in his favor. The defense attorney filed a motion challenging the establishment of a physician/patient relationship when the only involvement was a phone call. As in other OMIC claims, the court ruled that this relationship is clearly established when a physician gives advice about a specific patient. The court did note that a relationship is probably not established if a colleague calls and asks general questions, such as how to manage trauma cases. In any event, when consultations on specific patients occur, the best course of action is to document the information presented and the advice given.

Community

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