Ординатура / Офтальмология / Английские материалы / Risk Prevention in Ophthalmology_Kraushar_2008

A

AAO (American Academy of Ophthalmology), 103, 132, 209, 213

Abandonment, pediatric ophthalmology relating to, 203

Acanthamoeba, 126, 129 Accidental injection

intra-arterial, 97 intravenous, 97 Acetazolamide, 133, 176

Acquired immunodeficiency syndrome. See AIDS

Administration

of anesthesia, for ophthalmic plastic surgery, 198–199

of medication, update of, 133 Adverse events, revelation of, conundrum

of apology and apology

inadequate, 88

structure and effect of, 87 behavior, modification of, 85 conclusion to, 88 introduction to, 85

offense, gravity of, 86

ordinary courtesies relating to, 86 risk, prevention of, 86–87

Advice

for medical expert, 45–46

to patient, regarding uveitis, 241

Agency for Healthcare Research and Quality. See AHRQ

Age-related macular degeneration, laser and medical treatment for, 231

AHRQ (Agency for Healthcare Research and Quality), 143

AIDS (acquired immunodeficiency syndrome), 181

Allegations, 5

Allergies, drugs for, 133 Amaurosis, 95

American Academy of Ophthalmology.

See AAO

American Board of Ophthalmology, 55 American Glaucoma Society, 144 Ancillary tests, emergencies relating to, 152 Anesthesia, 91–101

accidental intra-arterial injection, 97 accidental intravenous injection, 97 amaurosis, 95

brainstem, 96–97 complications of, 91 general

complications of, 98 IOP, 93, 94, 99 MH, 99

for globe penetration or perforation, 93–95, 159

issues of, in cataract surgery, 115–116 local, general considerations of

complications of, 92–93 risk factors, 92 systemic toxicity, 93

myotoxicity, 97–98 oculocardiac reflex, 97

for ophthalmic plastic surgery, 198–199 optic nerve, atrophy of, 95–96

optic nerve sheath, penetration of, 96 retrobulbar hemorrhage, 93, 94, 95, 96 summary about, 99–100

topical, 92 Anesthesiologists, 91

Angle closure and other glaucomas, 159 Anterior vitrectomy, 119, 123 Antibiotics, 132

intracameral steroids and antibiotics, 112 topical, 141

Anticholinergic drugs, 141

270

Anticoagulation, cataract surgery and, 112

Aphakic bullous keratopathy, 119 Apology

conundrum of, 85–88 inadequate, 88

structure and effect of, 87 Appeal, trial relating to, 62

Areas of control, identified by physician/ defendant, 254–255

Arterial and venous retinal vascular diseases, laser treatment of, 231

Arteritis, giant cell, 154–155 Assumption, of risk, 167 Atrophy

optic, 172–174

of optic nerve, 95–96 Attendance, at trial, 57–58 Attorney. See also Defense attorney;

Plaintiff’s attorney selection of, 50

Attorney-physician-insurance company relationship, 50

Avastin, 138

B

Battery, 66

Behavior, modification of, 85 Benefits, alternatives and, of informed

consent, 70–71 Bilateral cataract surgery, 113

Bilateral optic disc edema, 174–176 Billing records, 33

Bioequivalent drug products, 136 Biopsy, 181

Bleeding

corneal transplant relating to, 123 ophthalmic plastic surgery associated

with, 199 Blephamide drops, 128 Blepharitis, 181 Blepharoplasty, 189, 197 Brainstem anesthesia, 96–97 Bupivacaine, 92

Burns, chemical, 153

C

Cancer, 193

Carcinoma, squamous cell, 181 Cardozo, Benjamin, 65

Case analysis, plaintiff’s attorney relating to, 29–32

Index

Cataract surgery

anesthetic issues in, 115–116 anticoagulation and, 112 complications of, 103–104 conclusions about, 116–117 considerations specific to, 107–109 elective refractive surgical procedures,

involving lens extraction, 110–111 endophthalmitis, 107–109

general risk management issues about, 105–107

high expectations relating to, 103 infection relating to, 108 informed consent for, 106 introduction to, 103–104

new technology for, general considerations for adoption of, 114–115

OMIC relating to, 105, 111, 116 pharmacologic agents, off-label use of,

relating to, 111 postoperative treatment of, 108

in presence, of ocular and systemic diseases, 113–114

refractive surgery claims v., 210 risk prevention relating to, 104–105 second eye, monocular patient,

and same-day bilateral, 113 specific drugs used off-label during, 112 volume of, 103

Cefazolin, 120

Cellulitis, orbital, 157–158

Central or branch retinal artery occlusions, 154. See also CRAO

Central retinal artery compression or occlusion. See CRAO

Certified Registered Nurse Anesthetist. See CRNA

Charge

to jury, 62

of negligence, reactions to, 253 Charts, 35

medical records and, drugs relating to, 134 Chemical burns, 153

Childbearing potential, women with, drugs for, 139–140

Choroidal hemorrhage, after surgery, 122–124 Choroidal melanoma, 229–230

Chronic uveitis, 114 Ciprofloxacine eye drops, 136 Claims-made policy, 259–261 Client intake

by paralegal, 29

by plaintiff’s attorney, 29–30 Cocaine, 92

272

Defense attorney (cont.) physician-patient relationship relating

to, 22–23

physician’s testifying questions relating to, 9

plaintiff’s case relating to, 13–14 settlement negotiations relating to, 19 statute of limitations relating to, 19–21 summations relating to, 19

Defense expert, testimony of, 18–19 Denial, as emotional reaction, 252 Deponent, 53–54

Deposition

examination before trial as, 53–56 preparation for, 7–8, 34 transcript of, 55

videotape of, 34

Deposition testimony and trial testimony, differences between, 9–10

Descemetocele, 159

Diabetic retinopathy, laser treatment for, 231

Diagnosis, uveitis relating to, 240, 241, 242 Diagnostic problems, with retina and vitreous,

227–230 Diclofenac, 136

Differential diagnosis, uveitis relating to, 240 Dilantin, 29

Discovery rule, 20–21 Discovery, the process of

examination before trial (depositions), 53–56 expert’s report, 53

interrogatories, 53 records, review of, 52–53

Discussant and discussion, informed consent regarding, 70

Discussion

discussant and, informed consent relating to, 70

of potential risks and complications of uveitis, 241

of risks, 79 Diseases

arterial and venous retinal vascular, 231 external and contact lenses, cornea relating

to. See Cornea: external disease and contact lenses

Graves’, 193–194 orbital, 157 prostate, 114

systemic and ocular, cataract surgery in presence of, 113–114

Documentation

drug prescriptions relating to, 133–134 of emergencies, 152

Index

of informed consent, 73 medical records and, 79–82

after poor outcome regarding uveitis, 215, 237–238

Documents, 35

Double life, of physician/defendant, 249, 251, 252, 254

Doubt, as emotional reaction, 253 Dramatic questioner, 17–18

Drug interaction, awareness of, 133 Drug Price Competition and Patent Term

Restoration Act of 1984, 136 Drugs. See also FDA; INDs; Medication;

Off-label drugs anticholinergic, 141

avoiding medication errors or claims in prescribing of, 131–132

for allergies, 133

charts and medical records relating to, 134 drug interaction, awareness of, 133

in handling drug samples, 135–136 medication administration, update

of, 133

in medication refills, 135

necessary documentation relating to, 133–134

for needle to eye, 142–143 for pupil dilation, 145

in written prescriptions, 134–135 conclusions about, 145–146

generic eye medication, use of, 136–137 in lawsuits against ophthalmologists, 132 off-label use, during cataract surgery, 111, 112 OMIC relating to, 138, 145

patient counseling regarding, 144–145 patient’s compliance with, improvement

of, 144 in PDR, 132

prescribed by ophthalmologists investigational, 138 marijuana, 139

for nursing women, 140–141 off-label, 137–138

for pediatric populations, 141–142 when comanaging patients with other

specialists, 137

for women with childbearing potential and pregnant women, 139–140

prescriptions for, documentation relating to, 133–134

problem, magnitude of, 131

samples of, errors in handling of, 135–136 use of, legal affect’s on one’s practice,

143–144 Dysmorphia, 196

Index

E

Ectasia. See Refractive corneal surgery claims

Edema

bilateral optic disc, 174–176 of optic nerve heads, 155

Effect, of apology, 87

Elective refractive surgical procedures, involving lens extraction, 110–111

Emergencies

ancillary tests relating to, 152

angle closure and other glaucomas, 159 central or branch retinal artery

occlusions, 154 chemical burns, 153 communication relating to, 151 conclusions about, 160 corneal ulcer, descemetocele,

or perforation, 159 cranial nerve palsies, 158 documentation regarding, 152

emotional issues relating to, 150–151 endophthalmitis, 157

examination, 151

giant cell arteritis, 154–155 globe, rupture of, 156 history relating to, 151

immunocompromised patients, problems with, 160

intraocular foreign bodies, 156–157, 195 introduction to, 149

iridocyclitis, 159–160 lacerations

corneoscleral, 156 lid, 155

light and floaters, flashes of, 159 optic nerve heads, edema of, 155 orbital cellulitis, 157–158 orbital disease, 157

orbital fractures, 158 orbital hemorrhage, 158

physician-patient relationship, 149–150 responsibility relating to, 150

RRD, 159

special case situations, 152 Emergency room, litigation and, 124–129 Emergent situations, after corneal

transplant, 121

Emotional issues, emergencies relating to, 150–151

Emotional reactions, to serious life events, 250–254

Emotions, medical malpractice charge relating to, 250–251

273

Endophthalmitis, 107–109, 229 as emergency, 157 postoperative, 119–121

Epithelial tumors, 181 Errors

common, in evaluation of giant cell arteritis, 178 optic atrophy, 174 papilledema, 176

toxic optic neuropathy, 179

in handling, of drug samples, 135–136 Evidence-based practice, 132 Examination. See also Cross-examination

before trial (depositions), 53–56 for uveitis, 240

Expert. See also Defense expert, testimony of; Medical expert

medical opinion of, basis of, 42 report of, discovery relating to, 53

Expertise, of defendant physician, 16 Expert witness

credentials of, 35 selection of, 52

trial judge and, 37–39

of unethical plaintiff, retribution for, 63–64

External disease and contact lenses, cornea relating to. See Cornea: external disease and contact lenses

Eye

generic medication for, 136–137 needle to, drug errors in, 142–143 right v. left, in pediatric ophthalmology,

204–205

second, monocular patient, same-day bilateral cataract surgery and, 113

Eye banks, litigation and, 124 Eye drops, ciprofloxacine, 136

Eyelid surgery, functional, 192–193

F

Facial fracture repair, 195

Facial surgery, cosmetic, 196–198 Facial trauma, 195–196

Failure

risk of, to diagnose uveitis, 242

serious life events relating to feelings of, 253–254

FDA (Food and Drug Administration), 111, 212, 215

drugs and, 135, 137, 138, 139, 142 glaucoma and, 168, 169

pediatric ophthalmology and, 205, 206 Fee-for-service arrangement, 191

274

Financial condition, of company issuing policy loss reserves relating to, 266

loss reserves to surplus ratio relating to, 267 misconceptions about, 265 rating bureaus relating to, 266

surplus relating to, 266 Floaters, flashes of, 159 5-fluorouracil, 138

Food and Drug Administration. See FDA Fracture repair, facial, 195

Fractures, orbital, 158

Free tail endorsement, common misconceptions about, 260, 261–262

Frye v. United States, 293 F. 1013 (D.C. Cir. 1923), 37–40

Fuchs’ dystrophy, 122

Functional eyelid surgery, 192–193

G

Gatekeeper role, of trial judge, 37, 42 General anesthesia

complications of, 98 IOP, 93, 94, 99 MH, 99

Generic eye medication, use of, 136–137 Gentamycin, 94, 120

Giant cell arteritis, 154–155, 177 common errors in evaluation of, 178

Glaucoma, 114, 159 FDA and, 168, 169 introduction to, 163

management of, 163–164 noncompliant patient with, 168 options in, 166

as neuropathy, of optic nerve, 163 pediatric, 165–166

primary congenital, 166

research for, physician’s professional interests and, 168

risk factors for, 164–165 treatment of

nontraditional, 167 technology in, 168–170

Globe

penetration or perforation of, 93–95, 159 rupture of, 156

Goldmann perimetry, 172, 178 Good Samaritan Laws, 23–24 Good Samaritans, 28

Graves’ disease, 193–194 Gravity, of offense, 86

Guilt, as emotional reaction, 253

Index

H

Health Insurance Portability and Accountability Act. See HIPAA

Hemorrhage choroidal, 122–124 orbital, 158

retrobulbar, 93, 94, 95, 96

Herpes simplex virus infection, 121, 128 HIPAA (Health Insurance Portability and

Accountability Act), 48 Hippocrates, 65

Hiring

of attorney, 21–22 of jury consultant, 36

HIV (human immunodeficiency virus), 181, 182

Human immunodeficiency virus. See HIV Hyaluronidase, 93

I

Immature retina, 207 Immunocompromised patients,

problems with, 160 Inadequate apology, 88

INDs (investigational new drugs), 138 Infections

cataract surgery relating to, 108 herpes simplex virus, 121, 128

mycobacterium avium intracellulare, 178 pseudomonas, 125, 126

Informed consent, 227

for cataract surgery, 106 conclusion about, 74–75 definition of, 66–67 exceptions to, 68–69 history of, 65–66 indications for, 68 informed refusal, 74

lawsuit standard for lack of, 69

for ophthalmic plastic surgery, 188–190 process of

consent form, 72–73

consent material, presentation of, 69–70

discussant and discussion, 70 documentation, 73

patient, questions for and by, 71–72 risks, benefits, alternatives, 70–71 setting during, 70

purposes of, 67–68

for refractive corneal surgery, 221–222 as risk prevention strategies, 79

Informed refusal, 74

Index

Ingratiating questioner, 18 Injection, accidental

intra-arterial, 97 intravenous, 97

Injury, nature and extent of, 29

INR (international normalized ratio), 112 Insurance. See Medical malpractice; OMIC Insurance company-attorney-physician

relationship, 50 International normalized ratio. See INR

International Society of Refractive Surgeons of the AAO. See ISRS/AAO

Interrogatories, 32–34

Intra-arterial injection, accidental, 97 Intracameral lidocaine, 112

Intracameral steroids and antibiotics, 112 Intraocular foreign bodies, 156–157, 195 Intraocular lens exchange, 122 Intraocular lymphoma, 183, 184 Intraocular medications, 230–231 Intraocular pressure. See IOP Intraocular tumors and lesions, 182 Intravenous injection, accidental, 97 Intravitreal triamcinolone acetonide, 137 Investigational new drugs. See INDs IOP (intraocular pressure), 93, 94, 99 Iridocyclitis, 159–160

ISRS/AAO (International Society of Refractive Surgeons of the AAO), 214

J

Joint and several liability, 24–25 Judge

jury and, roles of, 11 jury v., 10

trial, 37–39, 42 Jury

to defendant physician, reaction of, 15–17

deliberations of, verdict and, 62 judge and, roles of, 11

judge v., 10

selection of, 11–12, 58 Jury consultant, hiring of, 36 Justice Department, U.S., 139

K

Keratectomy. See PRK Keratitis, 128

Keratotomy. See Refractive corneal surgery claims

275

L

Laboratory tests, referral, and treatment plan, for uveitis, 240–241

Lacerations, 155, 156

Lacrimal surgery, 187, 193–194

Laser. See LASIK; Retina and vitreous, medical treatment for

Laser-assisted in situ keratomileusis. See LASIK

Laser skin resurfacing techniques, 197–198

Laser trabeculoplasty, 164, 166, 168 LASIK (laser-assisted in situ

keratomileusis), 209, 210, 211, 214, 215–219

Lawsuits. See also Countersuits; Medical malpractice; Prelawsuit activities

informed consent relating to, 69

against ophthalmologists, drugs relating to, 132

Legal effect’s, on practice, drug use relating to, 143–144

Legible medical record, importance of, 105–106

Lens, contact. See Cornea: external disease and contact lenses

Lens exchange, intraocular, 122

Lens extraction, elective refractive surgical procedures involving, 110–111

Lens implantation, 110

Lesions and tumors, intraocular tumors, 182 Liability, 29

joint and several, 24–25 vicarious, 5–6

Lid lacerations, 155 Lidocaine, 92

Light and floaters, flashes of, 159

Literature review, of refractive corneal surgery malpractice claims, 219–220

Litigation

emergency room and, 124–129 eye banks and, 124

Litigious patient, identifying and managing of, 82–83

Local anesthesia, 92–93 Loss reserves, 266

to surplus ratio, 267

M

Macular degeneration, age-related, laser and medical treatment for, 231

Malignant hyperthermia. See MH Maloccurrence, 5

276

Malpractice. See Medical malpractice Malpractice claims, of refractive corneal

surgery, literature of, 219–220 Management, of glaucoma, 163–164

noncompliant patient with, 168 options in, 166

Manage patient expectations, for refractive corneal surgery, 220

Marijuana, 139 Medical expert

advice for, 45–46

basis for expert opinion of, 42 criteria for, 42

introduction to, 41 minefields for, 44–45 needed for, 41 process of, 42–43 testimony of, 43–44

Medical malpractice basic terminology for

allegations, 5 introduction to, 3 maloccurrence, 5 medical misadventure, 5 negligence, 4 proximate cause, 4–5 respected minority, 5 standard of care, 3–4 tort, 4

vicarious liability, 5–6 charges of

assessing meaning of, 250 correcting distortions relevant to,

255–256

emotions associated with, 250–251 environment surrounding, 249–250

claims, outcomes of, 254 insurance for

company issuing policy, financial condition of, 265–267

conclusion to, 267

consent to settle clause, 262–264 cost of, 259

free tail, common misconceptions about, 260, 261–262

introduction to, 259 policy form, 259–261

policy limits, choosing of, 264 suit, sequence of events in

attorney, selection of, 50 complaint, 51 countersuits, 63

discovery, the process of, 52–56 expert witness, selection of, 52

Index

narrative summary, 51–52 patients’ suits relating to, 47

physician-attorney-insurance company relationship, 50

prelawsuit activities, 47–49 settlement, 56–57 summons, 49

trial, 57–62

unethical plaintiff’s expert witness, retribution for, 63–64

Medical misadventure, 5 Medical records, 33

charts and, drugs relating to, 134 collection and review of, 30–31 documentation and, 79–82 legible, importance of, 105–106 request for, 48

Medication. See also Drugs; Retina and vitreous, medical treatment for

administration of, update of, 133 errors in, avoidance of, 131–132

for ophthalmic plastic surgery, 198–199 refills of, avoiding errors in, 135

tests and, for retina and vitreous, 227 for uveitis, 239

Melanomas

choroidal, 229–230 conjunctival, 181 uveal, 183

MH (malignant hyperthermia), 99 Minefields, for medical expert, 44–45 Misconceptions, about free tail endorsement,

260, 261–262 Mitomycin-C, 138 Models, 35

Modification, of behavior, 85 Monocular patient, second eye, same-day

bilateral cataract surgery and, 113 Mortality and Morbidity Rounds on Web.

See Web M&M

Mycobacterium avium intracellulare infection, 178

Mydriacyl, 142 Myotoxicity, 97–98

N

Nadbath block, 92

NAION (nonarteritic anterior ischemic optic neuropathy), 173

Narrative summary, 51–52 Nasolacrimal duct obstruction, 194

National Board of Medical Examiners, 33 National Practitioner Data Bank, 33

Index

National Registry of Drug-Induced Ocular Side Effects, 140

Needle to eye, drug errors in, 142–143 Negligence, 4

charge of, reactions to, 253 comparative, 25 contributory, 25

Negotiations, settlement, 19 Neuroophthalmology

claim types from cases of, 171–179 introduction to, 171

Neuropathy, of optic nerve, 163 Nonarteritic anterior ischemic optic

neuropathy. See NAION Noncompliant patient, with glaucoma, 168 Nonophthalmic laser in situ

keratomileusis, 218–219 Nontraditional glaucoma, treatment of, 167 Novel treatment, for pediatric ophthalmology,

205

Nursing women, drugs prescribed for, 140–141

O

Occlusions. See Central or branch retinal artery occlusions

Occurrence-type policy, 259–261 Ocular

and facial trauma, 195–196

and systemic diseases, cataract surgery in presence of, 113–114

Oculocardiac reflex, 97 Offense, gravity of, 86 Off-label drugs

prescribed by ophthalmologists, 137–138

prescribed for pediatric ophthalmology, 205–206

Off-label pharmacologic agents, used during cataract surgery, 111, 112

OMIC (Ophthalmic Mutual Insurance

Company), 119

cataract surgery relating to, 105, 111, 116

drugs relating to, 138, 145 neuroophthalmology relating to, 171 refractive corneal surgery claims statistics

of, 209–212

statistics of, for refractive corneal surgery claims, 209–212

Oncology, 181–185 Opening statements, 12, 59 Operative report, 106–107

277

Ophthalmic Mutual Insurance Company. See OMIC

Ophthalmic plastic surgery

anesthesia administration and medication for, 198–199

bleeding associated with, 199 conclusions about, 199–200 cosmetic facial surgery, 196–198 functional eyelid surgery, 192–193

handling disappointment with, 190–191 informed consent for, 188–190

ocular and facial trauma, 195–196 orbit and lacrimal surgery, 193–194 paralytic agents used for, 197

risks of, 187

special considerations for, 187–188 Ophthalmic subspecialty

claims by, 210

risk management on, 89 settlement by

average, 211 total, 212

Ophthalmologists. See also Drugs risk prevention strategies of, 83–84 vitreoretinal risk factors for, 225

Optic atrophy, 172–174

common errors in evaluation of, 174 Optic nerve

atrophy of, 95–96 dysfunction of, 182 neuropathy of, 163

Optic nerve heads, edema of, 155 Optic nerve sheath, penetration of, 96 Orbital cellulitis, 157–158

Orbital disease, 157 Orbital fractures, 158 Orbital hemorrhage, 158 Orbital tumefactions, 182

Orbit and lacrimal surgery, 193–194

P

Papilledema, 175, 176

common errors in evaluation of, 176 Paralegal, client intake by, 29

Paralytic agents, 197

Pars plana vitrectomy, for problems other than RRD, 233–234

Patients

comanaging of, drugs relating to, 137, 222

counseling of, regarding drugs, 144–145 drug compliance of, improvement of, 144 immunocompromised, problems with, 160