Doctor Patient Relations

Guard Against Malpractice Lawsuits for Medical Eyecare

By Pamela Miller, OD, FAAO,JD

Pro-active steps can protect you from malpractice lawsuits as you provide more medical eyecare services.

Optometrists have exciting opportunities to expand into areas of medical eyecare that includeglaucoma and macular degeneration management, etc., in addition to co-management ofrefractiveand cataract surgery. But first you must take key steps toprotectyour practice from malpractice lawsuits.

Expand Malpractice Insurance Coverage

The first step when expanding medical eyecare services is to think about increasing your malpractice liability umbrella policy. As you increase your practice scope, you are held to a higher level of liability because your standard of care has increased. For that reason, you may want to increase your coverage to as much as $3 million or to your carrier’s maximum level. That level of coverage for an optometric practice usuallycosts no more than $2,000 annually. When you consider that a single successful malpractice lawsuit could potentially cost your practice over $1 million, that is a good deal. If you haven’t done so already, consider bundling your malpractice insurance with your office or homeowner’s insurance to save money.

Stay Within Scope of Licensure

Every state has different laws regulating what services ODs are permitted to provide to their patients and at what point ODs must refer the patient to another optometrist or ophthalmologist for care. For example, in some states ODs areonlypermitted to treat patients with some forms of glaucoma but not others;it depends on the level of severity. Your state law may state that once a disease like glaucoma has reached a certain level of severity, the patient must be referred to an ophthalmologist.

Use Prudent Judgment to Refer

Like most legal issues, there is a huge gray area in the decision on when to refer patients to a specialist. For what is not outlined by state law in the scope of your licensure, you must rely on your own prudent judgment. You may want to come up with your personal protocol for when to refer a patient. For example, one good rule of thumb is to referpatients with conditions that could potentially lead to significant damage to their vision or even blindness to a specialist if they are not improving after a reasonable amount of time under your care. You never want to be the last doctor a patient (literally) sees before heor shegoes blind. ROB editors note: See American Optometric Association’s Clinical Practice Guidelines.

Follow Patient Progress and Document It
You can’t know when to refer unless you follow your patients in their response to your treatments.Carefully document your original diagnosis and treatment plan, and alsomonitor how–if at all–patients are adhering to the treatment plan and how the treatment is affecting them. For example, when you see aglaucoma patient for a follow-up exam, ask them to bring in all of the drugs they are currently taking. It is important to do that because patients often won’t tell you the truth about how well they are following your directions, or they may have misunderstood you. Having the patient’s medicine bottles in front of you can tell you a lot. For example, you might see that a supply of medication that should have lasted three months is nearly gone after one month; or you might find just the opposite: Abottle of pills that should almost be finished is nearly full. A doctor can potentially be held liable on the basis of negligence if a patient misuses the medication that is prescribed for them and then suffers damage to theirhealth or even death, so it is important to track how the patient uses the medication you prescribe and to document your repeated instructions to the patient.

Make Sure Patient Or Caretaker Fully Understands Instructions

It is not enough to simply tell a patient how you would like him or herto take the medications you have prescribed. You must make surethe patient or theircaretaker understands. Have them repeat back to you your instructions, and have it written out for them on a sheet of paper they can take home with them. You can also e-mail them an electronic version. Make it as easy as possible for the patient by pointing out the different cap colors on all the bottles of medication, when possible.Do whatever you can to help them distinguish between all the medications you have prescribed and all the different instructions.

Ask About Other Drugs, Health Conditions, and Consult with Patient’s Other Doctors

In addition to bringing in the medication you prescribed for the patient, have patients bring in, or at least report, anyother medications they take. You can’t always depend on pharmacists to catch possible drug interactions, so it is important for you to check that yourself. Learning about the patient’s other medications also gives you the opportunity to ask about changes to their overall health that may impact their eye condition. It is also important for you to frequently communicate with a patient’s primary care doctor if the patient has a condition like diabetes or high blood pressure that could affect the eye disease you are treating them for.

Provide Patient With Records When They Leave Your Care

Ifa patient to whomyou administered medical eyecare is leaving yourpractice, you have a final responsibilitytoeither hand them the records of their care or ask them for the name of their new optometrist and permission to send the records to the new doctor. Too often, a patient who hasreceived care for an existing condition or disease tells their new doctor they don’t remember what was prescribed for them or what their last doctor’s name was. Do the best you can to ensure your patients receive the care they need even after they leave your practice and be sure to document in the patient’s record that this follow-through to their new doctor has been done.

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Pamela Miller, OD, FAAO, JD, DPNAP,has a solo optometric practice in Highland, Calif. She is an attorney at law, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com

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