Grant A Justin1,2, Fasika A Woreta3, Marcus H Colyer4,5, James D Auran6, Ron W Pelton7, Christopher J Rapuano8, Anne M Menke9. 1. Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA. grant.a.justin@gmail.com. 2. Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed, Bethesda, MD, USA. grant.a.justin@gmail.com. 3. Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA. 4. Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed, Bethesda, MD, USA. 5. Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA. 6. Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. 7. Pinnacle Eye Center, Colorado Springs, CO, USA. 8. Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA. 9. Ophthalmic Mutual Insurance Company, San Francisco, CA, USA.
Abstract
PURPOSE: To review ophthalmic trauma malpractice claims in the Ophthalmic Mutual Insurance Company (OMIC) database to determine the frequency and causes of litigation. METHODS: A retrospective case series analysis of ophthalmic trauma claims from 2009 to 2019 was completed. Cases were selected only if the injury was secondary to trauma (e.g., fall, gunshot wound, paintball injury, etc.); iatrogenic traumatic surgical injuries were excluded. RESULTS: 31 closed cases associated with 40 total claims related to ophthalmic trauma out of 2565 claims (1.56%) in the OMIC database were analysed. 13 of the 31 cases (41.9%) were decided for the plaintiff. In decisions for the plaintiff, the median settlement amount was $330,000 (range $125,000-$1,000,000). The most frequent initial diagnoses were corneal abrasion (n = 10), hyphema (n = 5) and open-globe injury (n = 5), and the most common final diagnoses were endophthalmitis (n = 8), intraocular foreign body (n = 7) and retinal detachment (n = 7). The most common causes of malpractice litigation were a delay in referral or follow-up (n = 11) and failure to get appropriate imaging (n = 8). In the 13 cases decided for the plaintiff, experts concluded nine did not meet standard of care. CONCLUSIONS: Ophthalmic trauma malpractice claims are very uncommon in the United States, however, the payout is higher than non-trauma settlements, and approximately 40% of cases were decided for the plaintiff. Care could be improved with a careful history and complete ophthalmic examination (with dilated fundoscopy), imaging in appropriate patients, meticulous documentation, and early sub-specialist referral when the diagnosis or management plan was unclear.
PURPOSE: To review ophthalmic trauma malpractice claims in the Ophthalmic Mutual Insurance Company (OMIC) database to determine the frequency and causes of litigation. METHODS: A retrospective case series analysis of ophthalmic trauma claims from 2009 to 2019 was completed. Cases were selected only if the injury was secondary to trauma (e.g., fall, gunshot wound, paintball injury, etc.); iatrogenic traumatic surgical injuries were excluded. RESULTS: 31 closed cases associated with 40 total claims related to ophthalmic trauma out of 2565 claims (1.56%) in the OMIC database were analysed. 13 of the 31 cases (41.9%) were decided for the plaintiff. In decisions for the plaintiff, the median settlement amount was $330,000 (range $125,000-$1,000,000). The most frequent initial diagnoses were corneal abrasion (n = 10), hyphema (n = 5) and open-globe injury (n = 5), and the most common final diagnoses were endophthalmitis (n = 8), intraocular foreign body (n = 7) and retinal detachment (n = 7). The most common causes of malpractice litigation were a delay in referral or follow-up (n = 11) and failure to get appropriate imaging (n = 8). In the 13 cases decided for the plaintiff, experts concluded nine did not meet standard of care. CONCLUSIONS: Ophthalmic trauma malpractice claims are very uncommon in the United States, however, the payout is higher than non-trauma settlements, and approximately 40% of cases were decided for the plaintiff. Care could be improved with a careful history and complete ophthalmic examination (with dilated fundoscopy), imaging in appropriate patients, meticulous documentation, and early sub-specialist referral when the diagnosis or management plan was unclear.