When the ophthalmologists turn blind.

The cost of technology is high in ophthalmology but given the increasingly competitive environment and the social demand, there is a pressure to progressively lower the costs to the consumer. To keep costs down there is a tendency to do as many surgeries as possible in an assembly line fashion both in hospitals as well as in the charitable camps. This article provides ophthalmologists an insight into the legal pitfalls in practice of ophthalmology in India and the dangers of the constant lowering of costs of surgery as well as of free service. This lowering of costs would have been ideal in a Utopian world, but times have now changed and there is cost to be paid even for providing free service. In India the prevalent tradition of providing free service, has also resulted in a lowering of guard by the eye surgeons. These mass eye surgery assembly popularly called "free eye camps" has seen millions of people benefited. But recently there is an increase in number of cases where exorbitant penalty has been imposed by the courts, on these philanthropic surgeons for any deficiency in service, and this has destroyed the careers of many ophthalmologists. Time has now come to introspect and to factor the cost of litigation and compensations into the cost of surgeries so that we not only benefit the patients but also safeguard the ophthalmologists and help them fulfill their responsibilities towards their own dependents.

El término nakkapti en el Código de Hammurabi / The term nakkapti in Code of Hammurabi

No disponible

Malpractice Litigation in Cornea and Refractive Surgery: A Review of the WestLaw Database.

PURPOSE: To report and analyze the causes and outcomes of malpractice litigation in cornea and refractive surgery. METHODS: The WestLaw database was reviewed for all malpractice litigation related to ophthalmology in the United States between 1930 and 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved results. All cases involving cornea and refractive surgery were included in this analysis, and results were compared with ophthalmology as a whole. RESULTS: One hundred fifty-nine cornea and refractive surgery cases between the years 1964 and 2014 were included. Ninety-three cases (58.5%) were resolved through a jury trial, 21.5% of which were associated with plaintiff verdicts with a median adjusted jury award of $588,896 (mean $1,518,686). Nineteen cases (11.9%) resulted in settlements with a median adjusted indemnity of $782,533 (mean $761,963). Commonly litigated scenarios included laser-assisted in situ keratomileusis (74.2%) and corneal transplantation (8.2%). Overall, 88.7% of cases involved surgical or procedural claims, 8.8% involved noninterventional claims, and 2.5% involved medical claims only. CONCLUSIONS: Cornea and refractive surgery is a high-risk subspecialty of ophthalmology. Laser-assisted in situ keratomileusis and corneal transplant claims were the most commonly litigated entities in this series. Many cases focus on failure to achieve patients' desired expectations after elective refractive procedures or the negligent performance of refractive surgery on patients with contraindications to surgery, both highlighting the importance of detailed informed consent discussions, realistic goal setting with patients, and thorough examinations and preoperative evaluation.

Civil liability of the ophthalmologist in the São Paulo Court of Appeals.

Objective: To conduct a data survey on the subject of medical claims involving civil liability in ophthalmology at the São Paulo Court of Appeals. Methods: A case law research was carried out on the São Paulo Court of Appeals website searching for the keyword "ophthalmologist" for all years until 2016. Results: Of the 65 cases found, 29 were selected. There has been an increase in the number of claims in ophthalmology, especially in surgical procedures on the anterior chamber of the eye. Most lower court judgments were for defendant. Conclusion: The study suggested the need for specialists to exercise the required amount of care when treating the patients, so that they may understand the risks inherent to the procedure. Despite the increase in claims, most decisions were favorable for the physician.

Objetivo: Realizar um levantamento de dados sobre a temática dos processos envolvendo responsabilidade civil em sede da Oftalmologia no Tribunal de Justiça do Estado de São Paulo. Métodos: Foi realizada uma pesquisa jurisprudencial por palavra-chave no site do Tribunal de Justiça do Estado de São Paulo com o seguinte termo de pesquisa "oftalmologista" para todos os anos até 2016. Resultados: Foram encontrados 65 processos, dos quais 29 foram selecionados. Observou-se tendência ao aumento de processos na área, e predominância de processos em procedimentos oftalmológicos cirúrgicos em câmara anterior do olho. A maioria das sentenças de primeira instância foi improcedente. Conclusão: O estudo aponta para a necessidade de atenção dos especialistas para com o paciente, no sentido de que ele compreenda os riscos inerentes ao procedimento. Apesar do aumento de processos, a maioria permanece favorável ao médico.

Civil liability of the ophthalmologist in the São Paulo Court of Appeals / Responsabilidade civil do médico oftalmologista no Tribunal de Justiça do Estado de São Paulo

ABSTRACT Objective To conduct a data survey on the subject of medical claims involving civil liability in ophthalmology at the São Paulo Court of Appeals. Methods A case law research was carried out on the São Paulo Court of Appeals website searching for the keyword “ophthalmologist” for all years until 2016. Results Of the 65 cases found, 29 were selected. There has been an increase in the number of claims in ophthalmology, especially in surgical procedures on the anterior chamber of the eye. Most lower court judgments were for defendant. Conclusion The study suggested the need for specialists to exercise the required amount of care when treating the patients, so that they may understand the risks inherent to the procedure. Despite the increase in claims, most decisions were favorable for the physician.

RESUMO Objetivo Realizar um levantamento de dados sobre a temática dos processos envolvendo responsabilidade civil em sede da Oftalmologia no Tribunal de Justiça do Estado de São Paulo. Métodos Foi realizada uma pesquisa jurisprudencial por palavra-chave no site do Tribunal de Justiça do Estado de São Paulo com o seguinte termo de pesquisa “oftalmologista” para todos os anos até 2016. Resultados Foram encontrados 65 processos, dos quais 29 foram selecionados. Observou-se tendência ao aumento de processos na área, e predominância de processos em procedimentos oftalmológicos cirúrgicos em câmara anterior do olho. A maioria das sentenças de primeira instância foi improcedente. Conclusão O estudo aponta para a necessidade de atenção dos especialistas para com o paciente, no sentido de que ele compreenda os riscos inerentes ao procedimento. Apesar do aumento de processos, a maioria permanece favorável ao médico.

Video recording of ophthalmic surgery--ethical and legal considerations.

Video documenting is increasingly used in ophthalmic training and research, with many ophthalmologists routinely recording their surgical cases. Although this modality represents an excellent means of improving technique and advancing knowledge, there are major ethical and legal considerations with its use. Informed consent to record is required in most situations. Patients should be advised of any risk of identification and the purpose of the recording. Systems should be in place to deal with issues such as data storage, withdrawal of consent, and patients requesting copies of their recording. Privacy and security of neither patients nor health care professionals should be compromised. Ownership and distribution of video recordings, the potential for their use in medical litigation, the ethics and legality of editing and the impact on surgeon performance are other factors to consider. Although video recording of ophthalmic surgery is useful and technically simple to accomplish, patient safety and welfare must always remain paramount.

In the eyes of the law: malpractice litigation in oculoplastic surgery.

PURPOSE: To assess characteristics associated with various outcomes of malpractice litigation, resulting from injuries sustained during oculoplastic procedures. METHODS: The Westlaw legal database (Thomson Reuters, New York, NY, U.S.A.) was used to obtain jury verdicts and settlements. Pertinent data were extracted from 69 malpractice cases litigated from 1988 to 2012 involving oculoplastic procedures, including alleged cause of malpractice, outcome, and defendant specialty. RESULTS: The most commonly litigated surgical procedures were blepharoplasty (63.8% of total) and brow lift surgery (11.6%). The most commonly alleged complications included excessive scarring (24.6%), lagophthalmos (24.6%), visual defects (23.2%), and exposure keratitis (21.7%). Plastic surgeons were the most commonly named defendants (46.4%), followed by both comprehensive ophthalmologists and fellowship-trained ophthalmic plastic surgeons (17.3% each). A defense verdict was held in 60.9% of cases, a plaintiff verdict in 31.9% of cases, and a settlement was reached in 7.2% of cases. Blindness, cranial nerve injury, and the allegation of a permanent deficit increased the likelihood of a case being resolved with payment to the plaintiff (Fisher exact tests, p < 0.05). CONCLUSIONS: Most litigated oculoplastic malpractice cases were resolved in favor of the defendant, while settlements and plaintiff decisions averaged $455,703. Blepharoplasty constituted two-thirds of cases, with the most frequently cited associated complications being unsightly scarring, lagophthalmos, and visual deficits. An alleged lack of informed consent (30.4%) or the need for additional surgery (39.1%) was present in a considerable proportion of cases, emphasizing the importance of a detailed informed consent and clear communication preoperatively regarding patient expectations.

[Intravitreal injections: AFSSAPS guide to good practice]. / Injections intravitréennes: mise au point de l'AFSSAPS.

Intravitreal injections are very commonly performed in the daily practice of Ophthalmology and become a leading procedure in the management of age-related macular degeneration, diabetic retinopathy, infectious endophthalmitis or retinitis, uveitis and retinal vein occlusions. Based on the comments of a group of experts, including ophthalmologists, pharmacists and hygienists, the French Agency for the Safety of Health Products (AFSSAPS) edited a guide to good practice of intravitreal injections, revisiting those previously published in 2006. The overall experience accumulated during time is a valuable source of information to determine the most appropriate protocol. Therefore, the simplification of the procedure is reasonably proposed even though safety remains a major issue, in order to avoid complications, especially infections.

Processos judiciais em oftalmologia: análise de possíveis fatores desencadeantes / Litigation in ophthalmology: analysis of possible triggers

Objetivo: Analisar os possíveis fatores de desencadeamento de processos judiciais na área de oftalmologia. Método: Estudo retrospectivo de 70 casos de processos judiciais cíveis em oftalmologia. Foram avaliados em cada processo, a anamnese, o exame oftalmológico, os dados do paciente no momento do incidente, sexo, idade, diagnóstico inicial e diagnóstico da causa do processo, número de consultas antes e após o fato desencadeante, a realização de exames pré-operatórios mínimos de acordo com os protocolos da Cooperativa Estadual de Serviços Administrativos em Oftalmologia - COOESO, termo de consentimento informado, as folhas de descrição do procedimento, de enfermagem, de materiais e medicamentos do centro cirúrgico, do anestesista, da alta hospitalar e o valor da indenização. Resultados: Dos 70 casos analisados, com relação à acuidade visual final, 45 (64,3 por cento) apresentavam amaurose. Quanto às condições prévias ao tratamento, os diagnósticos foram: catarata 46 (65,7 por cento), ametropias 12 (17,1 por cento), trauma ocular 8 (11,4 por cento), glaucoma 3 (4,3 por cento) e descolamento de retina 1 (1,4 por cento). Com relação às principais complicações secundárias ao tratamento efetuado que deram motivação à lide, os diagnósticos foram: descolamento de retina 37 (52,8 por cento), acuidade visual insatisfatória pós cirurgia de catarata 12 (17,1 por cento), irregularidades corneanas após cirurgia refrativa 8 (11,4 por cento), endoftalmites 4 (5,7 por cento), desconforto com óculos prescritos 4 (5,7 por cento) e atrofia bulbar 4 (5,7 por cento). O número de consultas antes do início do processo foi de até duas em 67,1 por cento dos casos. Os processos decorrentes de cirurgia representaram 94,3 por cento da amostra. Termo de consentimento informado não foi utilizado em 63 por cento do total de casos cirúrgicos. Os valores de indenização pagos foram menores do que 50 mil reais em 72,7 por cento. Conclusões: Foram fatores importantes relacionados aos processos judiciais oftalmológicos: amaurose, tratamento cirúrgico, descolamento de retina, número reduzido de consultas pré-operatórias e ausência de termo de consentimento.

Purpose: To analyze the possible predisposing factors of lawsuits involving ophthalmologists. Methods: Retrospective study of 70 lawsuits involving the practice of Ophthalmology. The patient's gender, age, medical and ophthalmic history were reviewed. The eye disorder that generated the prosecution, the pre-existing ophthalmic diagnosis, the preoperative exams and the operating room data were also analyzed. The informed consent form, the outcome of the litigation and the value of compensation were recorded. Results: Blindness was reported in 45 (64.3 percent) of the 70 lawsuits and was the principal eye disorder related to litigation. The pre-existing eye diseases associated with legal claims were: cataracts in 46 (65.7 percent) lawsuits, refractive errors in 12 (17.1 percent), ocular trauma in 8 (11.4 percent), glaucoma in 3 (4.3 percent) and retinal detachment in 1 (1.4 percent) lawsuit. The major surgical complications that possibly motivated the patient to sue the ophthalmologist were retinal detachment in 37 (52.8 percent) lawsuits, poor visual acuity after cataract surgery in 12 (17.1 percent), corneal disorders following refractive surgery in 8 (11.4 percent), endophthalmitis in 4 (5.7 percent), discomfort with refractive prescriptions in 4 (5.7 percent) and ocular atrophy in 4 (5.7 percent) lawsuits. Ophthalmic surgery was involved in 94.3 percent of the 70 prosecutions analyzed. Two or less visits to the ophthalmologist preceding the surgical or refractive event leading to legal dispute were recorded in 67.1 percent of the lawsuits. A pre-surgical Informed consent form was not used in 63 percent of the 66 surgical procedures leading to litigation. 62.9 percent of the lawsuits were unfavorable to the Ophthalmologist and the amount of compensation was less than R$ 50,000 in 72.7 percent of these legal claims. Conclusions: Blindness, surgery, retinal detachment, few pre-operative ophthalmic visits and the lack of informed consent forms were possible risk factors associated with lawsuits in the field of Ophthalmology.

[Litigation in ophthalmology: analysis of possible triggers]. / Processos judiciais em oftalmologia: análise de possíveis fatores desencadeantes.

PURPOSE: To analyze the possible predisposing factors of lawsuits involving ophthalmologists. METHODS: Retrospective study of 70 lawsuits involving the practice of Ophthalmology. The patient's gender, age, medical and ophthalmic history were reviewed. The eye disorder that generated the prosecution, the pre-existing ophthalmic diagnosis, the preoperative exams and the operating room data were also analyzed. The informed consent form, the outcome of the litigation and the value of compensation were recorded. RESULTS: Blindness was reported in 45 (64.3%) of the 70 lawsuits and was the principal eye disorder related to litigation. The pre-existing eye diseases associated with legal claims were: cataracts in 46 (65.7%) lawsuits, refractive errors in 12 (17.1%), ocular trauma in 8 (11.4%), glaucoma in 3 (4.3%) and retinal detachment in 1 (1.4%) lawsuit. The major surgical complications that possibly motivated the patient to sue the ophthalmologist were retinal detachment in 37 (52.8%) lawsuits, poor visual acuity after cataract surgery in 12 (17.1%), corneal disorders following refractive surgery in 8 (11.4%), endophthalmitis in 4 (5.7%), discomfort with refractive prescriptions in 4 (5.7%) and ocular atrophy in 4 (5.7%) lawsuits. Ophthalmic surgery was involved in 94.3% of the 70 prosecutions analyzed. Two or less visits to the ophthalmologist preceding the surgical or refractive event leading to legal dispute were recorded in 67.1% of the lawsuits. A pre-surgical Informed consent form was not used in 63% of the 66 surgical procedures leading to litigation. 62.9% of the lawsuits were unfavorable to the Ophthalmologist and the amount of compensation was less than R$ 50,000 in 72.7% of these legal claims. CONCLUSIONS: Blindness, surgery, retinal detachment, few pre-operative ophthalmic visits and the lack of informed consent forms were possible risk factors associated with lawsuits in the field of Ophthalmology.

[Ophthalmology complaints in Spain]. / Denuncias en oftalmología, en España.

PURPOSE: We reviewed 90 complaints for allegedly incorrect ophthalmic procedures. Most of these complaints (33%) were related to cataract and refractive surgery (18%). In third position in terms of frequency (14%) were complaints concerning oculoplastic surgery and in fourth position were complaints related to retinal detachment (13%). This was followed by a miscellaneous group, which represented 10% of complaints. About 9% of complaints were related to emergency ophthalmic procedures, while just 3% of complaints were related to glaucoma. METHODS: We analysed within each subgroup the characteristics of the claims; the information given to the patient, those cases in which there existed grounds for considering the ophthalmologist's performance as being incorrect, and court orders that were adopted. RESULTS: The most common groups were cataract and refractive surgery, which together represented more than a half of the complaints. We found in 26% of cases, reports from other doctors criticizing the professional performance a posteriori of an accused ophthalmologist, incorrect or incomplete documents of informed consent, as well as patients asserting that their surgeons made them promises of results, or minimized risks about the proposed operation. CONCLUSIONS: In the great majority of cases, the claim was settled due to a characteristic complication inherent in the surgical technique and present in the document of informed consent signed by the patient. We also observed a minority of cases, particularly in refractive surgery, in which a foreseeable and avoidable complication related to incorrectly prescribed surgical techniques was produced. In these exceptional cases, expert evidence is usually unfavorable and charges are typically laid. It is probable that improved information for patients would reduce the number of these claims.