Risk Management



Free Vision Screening Exams

By Paul Weber, JD

Digest, Fall 1998

Ophthalmologists and their staff often provide free vision screening examinations at health fairs, schools, senior centers and local malls. These screenings are enormously beneficial for discovering and preventing eye health problems in the general population. They also generate good public relations for the ophthalmologist who is able to give something back to the community that supports his or her practice. However, these activities are not without liability risks for the ophthalmologist and steps should be taken to minimize these risks.

Q  What are some of the risks of providing free vision screenings?

A  The major risk is the same as when a patient is examined in the office: failure to detect or warn about an eye disease or other health problem that should have been discovered during the screenings examination.

Q  How do I limit my exposure to a claim since I am only providing a limited service?

A  Exam organizers (school administrators, senior center directors, etc.) should notify prospective participants (the public) that the ophthalmologist’s role will be limited to discussions and advice about eye disease and health and that treatment will not be provided during the exam. At school screenings, it is necessary to secure permission from the parents of minor children before their child is examined. The ophthalmologist should create pre-printed forms (on NCR paper) explaining to participants that this is not a complete eye exam but is limited to specific tests (glaucoma screening, visual acuity, etc.). Record the name of each person who is examined and give each a copy of the pre-printed form.

Q  What should I do if I see an obvious or potential eye problem?

A  Your response to this situation will depend on what is being observed. In all cases where there is a problem, the participant should be given follow-up instructions in writing. These instructions should be part of the same form that explains the limited nature of the exam. Use the pre-printed form to emphasize that follow-up of any abnormal finding is the participant’s (parent’s) responsibility and that failure to seek out further medical treatment could result in a more serious eye or medical problem if left untreated. There should be a section indicating whether the follow-up is an emergency, urgent (24-48 hours), timely (1-2 weeks) or when convenient.

Q  Do I need to keep records of screening exams?

A  It is prudent to keep records of screening exams (particularly if follow up was recommended) so that if a claim or dispute ever arises, there is evidence of the scope and limitations of the exam as well as the problems that were noted and instructions that were given to the patient. Without these records a patient would have the opportunity to misconstrue the nature of the service being provided and the results of the screening.

Does my OMIC professional liability policy cover me when I provide free vision screening examinations?

A  Yes, you and your staff are covered in the event of a claim as a result of providing free vision screening services. The type of coverage and limitations are the same as when providing these services in your office.

Is it proper to allow my staff to provide services at these events as representatives of my office without my presence or direct supervision?

A  At your request, staff may provide services at screening exams within the authorized scope of their employment, licensure and training. These screening services (e.g., basic tonometry, visual acuity testing) should be limited to those provided at the office that do not require the direct supervision of an ophthalmologist or other licensed personnel. Prior to providing these unsupervised services, the ophthalmologist should advise the staff not to render any service or provide any advice beyond their customary office functions. It must be made clear to those being screened that the technicians or assistants providing the services are not physicians. At a minimum, name tags with the appropriate job title should be worn. Pre-printed forms to be given to participants, as discussed above, should be tailored to the more limited scope of what a technician or assistant can provide.

OMIC has developed a form, titled Your Examination Today Was Not a Complete Eye Examination for patients receiving a limited eye examination. This form also may be used when drafting your own form for vision screening activities.

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