Risk Management
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Responsibilities of a Consulting Ophthalmologist
Digest, Fall, 1991
ALLEGATION Insured consulting ophthalmologist allegedly failed to adequately monitor, order and apply appropriate restraints on a psychiatric patient admitted through the emergency room.
DISPOSITION Settled out of court.
Background
Ophthalmologists are routinely asked to render emergency services and/or surgery to patients admitted through the emergency room. However, often the duties and responsibilities owed the patient seen on consult are not clear, particularly when there is an attending physician involved.
Case Summary
The patient was a 30-year-old female with a history of schizophrenia who presented to the hospital with a ruptured right globe. Upon admission, the parents indicated to the emergency room physician that their daughter had stopped taking her psychotropic medications, had not eaten for the past two days and had fallen in the bathroom. The patient’s attending psychiatrist was notified but did not come in to see the patient. The patient was ultimately admitted under the psychiatrist’s service and the insured was called in to repair the right eye. Postoperative orders included restraints if necessary.
Soft restraints were applied. However, shortly after the patient returned to her room, she self-enucleated her good left eye. She was taken to the OR where the insured again performed surgery. Unfortunately, the patient had avulsed the optic nerve which left her blind in both eyes.
Although the insured did not call or speak to the psychiatrist directly, the medical record revealed that he had ordered the patient’s psychiatrist be contacted for medications if necessary to sedate her. In addition, restraints were ordered “to keep hands from eyes.”
Medical records from past admissions revealed the patient had suicidal tendencies which her psychiatrist was aware of and which should have prompted him to take appropriate measures for her safety during this admission.
Outcome
The hospital settled out of court for $10,000. Although the OMIC insured said he did not suspect that the initial injury to the eye was self-inflicted, the insured and carrier believed the emotional issues and publicity surrounding this incident would compromise defense of the claim. The ophthalmologist agreed to a nominal settlement. The psychiatrist ultimately settled out of court for $250,000.
Risk Management Principlesand Commentary
This case offers a number of suggestions for ophthalmologists who are called in as consultants:
- Familiarize yourself completely with your hospital’s policy for admitting patients under the name of another physician.
- Communicate directly with the attending physician. Do not delegate this responsibility to the ER or nursing staff.
- Thoroughly document all conversations with the attending physician and nursing staff.
- If the emotional or psychiatric status of the patient is at question, take appropriate measures to insure the patient’s safety.
