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. 2023 Jan;37(1):109-119.
doi: 10.1038/s41433-021-01893-4. Epub 2022 Jan 14.

Ophthalmic Trauma Malpractice in the Ophthalmic Mutual Insurance Company Database

Grant A Justin  1   2 , Fasika A Woreta  3 , Marcus H Colyer  4   5 , James D Auran  6 , Ron W Pelton  7 , Christopher J Rapuano  8 , Anne M Menke  9
Affiliations

Ophthalmic Trauma Malpractice in the Ophthalmic Mutual Insurance Company Database

Grant A Justin et al. Eye (Lond). 2023 Jan.

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.

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Conflict of interest statement

Dr. Pelton is a Board member of Ophthalmic Mutual Insurance Company (OMIC). Dr. Rapuano is a Committee member of OMIC. Dr. Menke is an employee of OMIC. The other authors do not have any conflicts of interests.

Figures

Fig. 1
Fig. 1. Verdict decisions and means of resolution in decisions for the defendant.
A: Verdict. B: Means of resolution in cases for the defendant.
Fig. 2
Fig. 2. Initial and final diagnoses.
A: Initial diagnoses. B: Final diagnoses.
Fig. 3
Fig. 3. Assessment of issues with diagnosis and management, specific causes of malpractice claims and evaluation of standard of care.
A: Diagnosis and management assessment. B: Cause of malpractice claims. C: Standard of care.
See this image and copyright information in PMC

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