Risk Management

Patient Slip and Fall Following Dilation

By Stacey Meyer
OMIC Assistant Claims Manager

Digest, Spring 2001

ALLEGATION  Failure to provide sunglasses following dilation led patient to fall and hip fracture.

DISPOSITION  Case settled on behalf of insured ophthalmic group.

Case Summary

A 72-year-old male patient was seen by the insured for a routine eye exam during which his eyes were dilated with Neo-Synephrine 2.5% and Mydriacyl 0.5%. Afterwards, as the patient was leaving the office and walking towards his son’s waiting car, he stepped off the curb outside the building and fell down on his right side. He sustained a transverse fracture through the mid-right femoral neck and eventually underwent a bipolar hip replacement. After numerous physical therapy sessions, the patient was ambulating with minimal difficulty.

Analysis

The patient alleged that the insured ophthalmologist was negligent in not providing him with sunglasses or advising him to wear sunglasses after dilating his eyes. He stated that when he left the insured’s office, his eyes were unprotected and blinded by the sun’s glare, which impaired his vision so that he did not see the step from the curb. The plaintiff’s expert opined that it was below the standard of care to allow the patient to leave without providing sunglass protection before the effects of dilation had dissipated.

The insured countered that the technicians in his office who instill dilating drops routinely warn patients that they can cause blurry vision and heightened sensitivity to light, and they keep sunshades at the front desk for patients who request them. However, there was no written office policy or procedure in place regarding this issue. Although the office administrator maintained that she offered the patient sunglasses, there was no documentation to support this, and neither the insured nor other office staff could remember specifically warning the patient of the potential problems associated with dilation. Furthermore, the OMIC Publication Archives advise physicians who administer dilating drops to instruct patients to wear sunglasses and avoid driving or operating dangerous machinery afterwards. In light of this, the defense team and insured agreed it would be difficult to defend the case and settled on behalf of the insured ophthalmic group.

Risk Management Principles
Failure to provide for a patient’s safety has been the basis of many “slip and fall” suits against ophthalmologists. Oftentimes, a slip and fall claim will cross over both a physician’s general liability and professional liability coverage, depending on whether the treatment rendered to the patient contributed to or caused the incident in question. Responsibility for patient safety does not begin and end in the exam chair, but extends to the entire premises, regardless of whether the physician owns or controls the property outside the office

Visual impairment following dilation raises questions of patient safety and establishes a duty on the part of the caregiver to provide for the patient’s safe transport out of the office. Settlements and judgments involving patient falls post-dilation can range a few thousand to tens of thousands of dollars, particularly if the ophthalmologist or office staff are found negligent in supervising an elderly or visually impaired patient.

Providing a safe environment for patients should be a priority in all practices. Conduct periodic audits of the office premises and safety policies. Develop written procedures establishing safety guidelines and practices to be followed by office staff. A routine checklist or mechanism to record that a patient has been warned of potential glare problems and instructed to wear sunglasses can serve to protect the physician and staff from failure to warn allegations.