Several years ago, an article published in the Ophthalmic Mutual Insurance Company Digest reported that the size and amounts of malpractice judgments were discouraging ophthalmologists from doing screenings for retinopathy of prematurity (ROP).
The issue was addressed over twenty years ago in a letter from an ophthalmologist to the administration of the hospital where he was employed as well as the state medical board. The letter outlined the reasons for his decision to no longer perform ROP screenings:
“Guidelines from the Cryotherapy of Prematurity Study must be followed exactly. The timing of the evaluation and follow-up visits are critical. This is often not under the physician’s control (i.e., patient’s family compliance to follow-up visit requests is at times marginal). The risk of liability in these cases is high. The emotional trauma of dealing with any kind of litigation is great.”
A few years later, a study published in Transactions of the American Ophthalmological Society indicated that doctor errors in ROP examinations are fairly common. One of the problems addressed in that piece is inconsistency.
While the standard of care for specialists is national, it does not necessarily apply to general practitioners. When it comes to primary care physicians or pediatricians, the standard of care is determined on a local or regional basis, and can differ from one jurisdiction to the next.
It also comes down to the question of who bears the most responsibility when it comes to diagnosing and treating ROP. Obviously, the pediatricians or neonatologist is part of the equation. However, because this is an eye and vision issue, input from an experienced ophthalmologist is also necessary. This is especially important because this professional is held to a higher standard of care and has dedicated his/her career to the study of vision issues.
This said, the majority of ROP cases that generate lawsuits found the failure occurred when it came to transferring care of the patient after being discharged from the hospital. In a study of 13 legal actions involving ROP, three were found to be due to delayed follow-up examinations. In another case, there was failure on the part of the screening facility to refer the outpatient case to the ophthalmologist, while one case centered around an unsupervised resident physician who was charged with care of the patient. In the remaining eight cases, the hospital did not transfer the case at all once the patient had been discharged.
The main point is that most cases of ROP are treatable and even preventable. However, this requires communication and coordination between the pediatrician, the neonatologist, the ophthalmologist and the family affected. All involved parties should also have access to knowledge of the latest guidelines for screening and treatment. In an age of cost-cutting and belt-tightening, however, this does not always occur; and unfortunately it’s the family and child who end up suffering an immeasurable loss.
