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Clinical negligence
Author(s) -
Woodward E. G.
Publication year - 2006
Publication title -
ophthalmic and physiological optics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.147
H-Index - 66
eISSN - 1475-1313
pISSN - 0275-5408
DOI - 10.1111/j.1475-1313.2006.00402_9.x
Subject(s) - medicine , optometry , glaucoma , expert witness , ophthalmology , medical negligence , witness , law , political science
Purpose: In an increasingly litigious society a growing number of optometrists are being arraigned in the civil courts and by the Disciplinary Committee of the General Optical Council for clinical negligence. This study analysed the main grounds for these charges and considered future implications. Methods: 50 cases where optometrists were either defendants in a civil court or appearing before the GOC Disciplinary Committee and where the author had provided an expert witness report were examined. These cases occurred between 1999 and 2004. The author was instructed in 19 cases by solicitors acting for the defendant and in 31 cases by the claimants’ solicitors. Results: The most frequent complaint was failing to detect glaucoma (15 cases), followed by failure to detect retinal detachments (13). Five of the glaucoma cases were relatively young contact lens wearers (40–60 years of age). There were six cases where failure to detect papilloedema was alleged and in every case the patients were young adults or children with migrainous symptoms referred to the optometrist for refraction. Of the five cases involving ocular neoplasms, four were choroidal melanomas all of which were eventually detected by a second optometrist. In the fifth case, where a melanoma of the iris was not detected the optometrist did record some changes and a difference in IOP between the two eyes, but took no action. In all, 12 different ocular and systemic conditions were the cause of civil litigation or disciplinary proceedings. Conclusion: The two most frequent charges against optometrists related to the glaucomas and retinal detachment, and optometrists must practice ‘defensive optometry’ in every case where these might be a possibility. The number of cases relating to intra‐cranial neoplasms was surprising, as an optometrist has no legal obligation to diagnose such conditions. However, they are obliged to detect any consequent papilloedema and this was the issue in every case. Also, in the last few years there has been a tendency to sue both the general medical practitioner and the optometrist in such cases. This occurred in all six of the cases in this series and also in the one case involving diabetic retinopathy. With an increasing role for the optometrist in primary health care more optometrists are liable to find themselves as co‐defendants in actions for clinical negligence.