Risk Management

Monovision misunderstanding leads to health department complaint

RYAN BUCSI, OMIC Senior Litigation Analyst

Allegation

Wrong powered lens placed during cataract surgery OS.

Disposition

Complaint dismissed by state department of health.

A patient presented to an OMIC insured with complaints of poor vision related to cataracts. The patient refused to wear glasses or contact lenses and wanted to explore treatment options that would not require either. The insured discussed monovision with the patient, explaining that an operation would be required on both eyes and if successful, one eye would be used for distance vision and the other for near vision. It was explained that prior to the procedure, the patient would be required to wear a contact lens to determine if she was indeed a candidate for monovision and would be comfortable with the anticipated results. The insured determined that the patient was naturally nearsighted and that the contact lens would be placed in the right eye for distance vision. Following the contact lens trial, the patient reported that she had inserted the contacts on only three occasions, but that on these three occasions, her vision was “just fine” and therefore she believed that undergoing the monovision procedure was a “good solution.” The insured agreed that the patient was a good candidate for monovision, so cataract surgery for distance vision was performed on the right eye. Subsequently, cataract surgery was performed on the left eye for near vision. During the one month postoperative exam, the patient complained of blurred vision in the left eye when looking at items in the distance. The insured reminded the patient that her distance vision in the left eye was not supposed to be similar to her distance vision in the right eye as this was not the intended outcome of the monovision procedure. The insured did note a slight overcorrection in the left eye, for which he recommended a piggy back lens; however, the monovision procedure was successful. Following this examination, the patient did not return to the OMIC insured.

Analysis

Five months after his last contact with the patient, the insured received a letter from his state’s department of health alerting him that the patient had filed a complaint. The patient alleged that the wrong powered lens was placed in the left eye and that she had to undergo a subsequent procedure to correct this error.

The insured promptly contacted OMIC and the case was referred to local defense counsel, which drafted a response letter to the state department of health. In the letter, defense counsel contended that the appropriate lens was placed in the left eye since the patient had agreed to monovision. Defense counsel was able to use informed consent documents and the insured’s medical records to prove that the patient was well aware that her right eye would be corrected for distance vision and her left eye would be corrected for near vision. Furthermore, the letter stated that following the procedure there was a slight overcorrection in the left eye. The exact reason for this overcorrection was unknown to the insured; however, it was possible that the lens itself shifted during the healing process. Defense counsel pointed out that this is a well known complication of the monovision procedure and in no way reflected a deviation from the standard of care. In addition, defense counsel retained a local expert who signed an affidavit stating that the care provided by the OMIC insured was well within the accepted standard of care. The combination of defense counsel’s letter and the supportive expert opinion prompted the state department of health to dismiss the patient’s complaint.

Risk management principles

Complaints from state health departments or medical boards should be referred to the OMIC claims department. No matter how “informal” a request for a response to a patient’s complaint may seem, these matters are serious and require legal representation in order to assure that the proper process is followed. This increases the likelihood that the complaint will be dismissed and may help the insured avoid a related medical malpractice claim or lawsuit. This case also highlights the importance of the informed consent process when discussing a complex treatment plan with a patient. The insured in this case did such a good job documenting his informed consent discussion that it provided defense counsel with enough evidence to convince the medical board that the patient was well aware of the parameters of treatment as well as the risks.