Browsing articles from "April, 2017"

A new logo and brand strategy as OMIC looks forward

We are excited to introduce a new OMIC brand strategy and corporate logo. In anticipation of our 30th anniversary year in 2017, OMIC has placed a renewed emphasis on defining our core missions in order to best serve the needs of our policyholders. In 2012, we also began an exhaustive process of forming a new strategic plan that will prepare OMIC for a rapidly changing environment in both the insurance and eye healthcare communities. Part of that process was to showcase and celebrate our unique identity.

Our new logo features an abstract graphic that suggests the shapes of overlapping eyes and symbolizes a commitment to a forward-looking vision for OMIC. It signifies the common and shared goals of OMIC, the American Academy of Ophthalmology, and our policyholders to support, defend, and enhance the practice of
ophthalmology.

With one eye focused on our past, we reflect on OMIC’s origins. Our founding members and sponsoring organization, the Academy, laid a foundation for what would become the largest and most trusted insurer of ophthalmologists in America. We reaffirm our mission, first articulated by OMIC’s leaders in 1993, to serve the needs of Academy members by providing high quality medical liability insurance products and services.

With another eye looking forward, we will respond to the changing needs of our policyholders and strive to be a leader in the medical liability community by promoting quality ophthalmic care and patient safety.

In the coming months, members of the ophthalmic community will learn more about OMIC’s accomplishments and milestones as we celebrate our 30th year of serving ophthalmology. In addition, our branding strategy will focus on OMIC’s future commitments to our specialty.

Telephone care

Archives, Hotline // No Comments

ANNE M MENKE, RN, Phd, OMIC Patient Safety Manager

Telephone care was the central focus of the case featured in the Closed Claim Study. Our policyholder’s care consisted of just one conversation with a pediatrician who called for advice. This single call determined not only the child’s clinical outcome but also the liability risk for the two physicians who spoke to each other. Telephonic exchanges can occur between the ophthalmologist and other physicians involved in the care, but most physician-to-physician calls come from the Emergency Department (ED). These calls raise a number of concerns.

Q. Do I establish a physician-patient relationship by speaking to another physician about a patient?

A. To many physicians, the only fair and obvious answer is no: one would have to examine or treat a patient to establish a relationship with so many risks and duties. After all, how can you be legally responsible—and potentially liable—if you never even meet or speak to the patient? (Of course, never seeing or speaking to the patient is the norm for specialties such as pathology and still quite common in radiology.) Contrary to this assumption, courts have consistently ruled that telephone advice provided about a specific patient does indeed establish a physician-patient relationship.

Q. Do I have to provide advice on the phone to any physician who calls me?

A. No, there are situations when you may refuse to provide such advice. You may decline the request if the call concerns someone who is not your patient. Before saying no, be sure that you do not have a contractual obligation to accept the call, such as a condition imposed by a health insurance company in order to be on its panel. If you or your group are not accepting any new patients, it might be prudent to tell the caller to contact someone who is available for ongoing care. There are, however, certain times when you do have an obligation to discuss a patient. Other physicians who are part of a current patient’s healthcare team often need to speak to you in order to safely diagnose and treat the patient. You not only receive such calls, but make some yourself and no doubt appreciate the time the other physician takes to answer your questions. You or a physician in your practice must take these calls.

Q. What about calls from the ED?

A. You are required to speak to physicians who call from an ED in two instances. First, whether you are on call for that hospital or not, you are expected to answer questions about your own patients. Be sure to document these conversations and clarify who will provide any needed care. If the patient needs to be examined or treated in the ED, you may—but are not required to—provide that care even if you are not
on call that day for that hospital. Or you could, for example, speak with the ED physician, advise on needed exams, tests, or treatment, and then ask the ED physician to contact the ophthalmologist who is on call to the hospital that day. Document this conversation as well. Second, you must provide telephone advice to an ED physician if you are the on-call ophthalmologist that day for that hospital. And you must examine the patient in person if the ED physician requests it. Review your medical staff bylaws to determine if you are serving on call for just that hospital or any hospital in an affiliated group of hospitals. Remember also that the hospital must accept transfers of patients who need a higher level of care if it has the capacity and capability. By extension, you must respond to calls about these patients. The call may come from the transferring hospital trying to reduce the risks of the transfer as
much as possible. If an ED physician from a hospital that wants to transfer a patient contacts you first, ask the physician to discuss the transfer with an ED physician at your hospital.

Q. How do I know if I can trust that the physician who calls me has made a competent assessment of the
patient?

A. Your ability to safely provide telephone care depends upon your assessment of the other physician’s knowledge, skill, and judgment. Do not assume that the history and physical examination reported to you are adequate. Make that determination only after asking enough questions to ensure that you, as the specialist in eye conditions, have the information you would gather yourself if you were seeing the patient. Document the conversation. Consider using our telephone contact form as a template. It is available at http:/www.omic.com/after-hours-contact-formand-recommendations/.

Q. Can my technician handle calls from patients that come during office hours?

A. Technicians can help by gathering the information you need and relaying your advice to the patient. Consider using our template in http:/www.omic.com/telephone-screening-of-ophthalmicproblems-sample-contact-formsand-screening-guideline/.

Review the information to determine if you need to speak to or examine the patient. Document your decision and instructions.

Telephone consultation on minor patient with foreign body injury

Articles, Case Studies // No Comments

RYAN BUCSI, OMIC Senior Litigation Analyst

Allegation

Failure to evaluate and treat a minor patient with a foreign body injury.

Disposition

Defense verdict at high-low arbitration. $175,000 paid on behalf of insured.

A minor patient sustained an eye injury when a metal fragment struck him while he was hammering a penny. The parents flushed his eye with water. The following day his pediatrician diagnosed decreased vision and a conjunctival hemorrhage. The pediatrician called the OMIC insured after hours and informed the insured that she did not see any signs consistent with a penetrating injury. The pediatrician stated that the cornea was intact with no abrasion and that the anterior chamber appeared intact as well. The insured specifically asked if this was a high-speed impact injury and the pediatrician responded that it was not. Our insured advised that he could not make a diagnosis over the phone but he suspected a possible conjunctival hemorrhage or an abrasion. The insured recommended antibiotics and follow-up with
the pediatrician or the emergency room if the condition did not improve. The insured informed the pediatrician that he was on call at the local children’s hospital emergency room and could see the patient that evening. The pediatrician did not ask the insured to see the patient nor did she tell him that she would instruct the patient to go to the emergency room. Six days later, the pediatrician informed the insured via telephone that a general ophthalmologist had examined the patient and had diagnosed a foreign body in the eye, confirmed by orbital CT. The patient was referred to a retinal specialist, who immediately performed surgery to remove the foreign body. The patient later developed endophthalmitis and underwent a corneal transplant but ended up with only count fingers vision.

Analysis

Plaintiff’s experts alleged that the insured should have advised the pediatrician to send the patient to an emergency room for a CT scan or MRI to determine whether there was a foreign body in the eye. Plaintiff also alleged that the pediatrician violated the standard of care by not immediately sending the patient to the emergency room. During her deposition testimony, the pediatrician testified, consistent with her records, that the patient’s vision had been drastically affected. The ophthalmologist, however, contended that he was not informed of any drastic vision loss during the initial phone conversation. The defense expert felt that the insured’s care met the standard assuming that his version of the phone call with the pediatrician was accurate. However, if the expert assumed that the pediatrician’s version of the phone call was accurate, then the insured failed to meet the standard. Our defense expert believed that any penetration of the globe by a foreign object should be treated as an emergency situation and that the delay in diagnosis caused the patient to experience significant vision loss. This was a case involving significant loss of vision in a minor and the defense was not comfortable taking the case to trial. Therefore, binding high-low arbitration was agreed upon. The case was heard by an arbitrator with a plaintiff high of $750,000 and a defense low of $175,000. The arbitrator ruled in favor of the defense and OMIC paid $175,000 to the plaintiff. The pediatrician settled her portion of the case for an undisclosed amount.

Risk management principles

The insured admitted that to meet the standard of care an ophthalmologist must examine a child who has experienced a drastic visual decrease following trauma. The defense expert indicated that he routinely examines children with such injuries. The crux of this case then was whether the ophthalmologist was informed that a drastic visual decrease had occurred. The pediatrician documented that she told the insured that vision in the patient’s eye had been drastically affected.

Our insured did not recall being informed of this but had no documentation to support his position. Fortunately for our insured, his lack of documentation did not keep the arbitrator from ruling in his favor. The defense attorney filed a motion challenging the establishment of a physician/patient relationship when the only involvement was a phone call. As in other OMIC claims, the court ruled that this relationship is clearly established when a physician gives advice about a specific patient. The court did note that a relationship is probably not established if a colleague calls and asks general questions, such as how to manage trauma cases. In any event, when consultations on specific patients occur, the best course of action is to document the information presented and the advice given.

Community

Articles // No Comments

Followers of OMIC social media pages and Blog will be alerted to relevant news, updates, and announcements from OMIC, including notification whenever new patient consent documents or loss prevention resources are published. OMIC’s Twitter feed @MyOMIC will link OMIC’s Facebook fans and LinkedIn network with associated content.