Malpractice and the quality of care in retinopathy of prematurity (an American Ophthalmological Society thesis).

PURPOSE: A review of retinopathy of prematurity (ROP) malpractice cases will identify specific, repetitive problems in the provision of care and the reasons underlying these problems. Opportunities to improve the quality of care provided to premature infants with ROP will result.
METHODS: A retrospective review of a series of 13 ROP malpractice cases in which the author served as a paid consultant, as well as a review of the literature for additional cases, was conducted. The series of 13 involved a review of the entire medical record as well as testimony and depositions. The characteristics of each case are tabulated, including state, date, allegations, defendants, disposition, award, the medical facts and care issues involved, and the judgment of medical error. In addition, a merit review was performed on the care in each case, and an error assessment was performed.
RESULTS: The quality of care issues included neonatology failure to refer or follow up in 8 of 13, failure to adequately supervise resident care in 2 of 13, ophthalmologic failure to follow up in 6 of 13, and failure to properly diagnose and manage in 9 of 13. The latter included 4 of 13 that hinged on zone III issues and the presence or absence of full nasal vascularization with or without previous zone II disease. Merit review found negligent error by at least one party in 12 of 13. Ophthalmology error was found in 6 of 13. Malpractice, ie, negligent error causing negligent harm, was judged to be present in 9 of 13.
CONCLUSIONS: Negligent errors are common in malpractice cases that proceed to disposition. There are a limited number of repetitive errors that produce malpractice. An explanation of how these errors occur, coupled with the pertinent pathophysiology, afford an excellent opportunity to improve patient care.