Claims of alleged medical negligence in refractive surgery: causes and avoidance.
OBJECTIVE
To identify the issues cited in claims for alleged medical negligence in cases of refractive surgery.


METHODS
One hundred and one cases of alleged medical negligence following refractive surgery were analysed by a single expert witness. Valid features of the statement of claim and issues identified by the expert as being relevant to the outcome were assessed.


RESULTS
Sixty-five percentage of claims included issues of consent. In one third of these cases the Claimant had particular risk factors for which especially careful counselling was warranted. For 29% of claims there were contraindications to surgery. In 24% there was surgical error resulting in a compromised outcome. In 23% there was avoidable delay in instituting medical management for post-operative complications. Four percentage of cases were precipitated by a second opinion where the clinician giving the opinion was not fully conversant with the facts.


CONCLUSIONS
The number of claims could be substantially reduced by: (1) Instituting proper policies for consent with full documentation throughout the process; (2) Ensuring that surgeons are adequately trained in evaluating pre-operative tests and allowing surgeons adequate time to assess patients prior to surgery; (3) Moderating the case-load for surgery; (4) Ensuring that patients have easy access to medical care post-operatively; (5) Keeping comprehensive and accurate records.
Steven Bailey
C
C
Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, United Kingdom. csbailey@mac.com
Bailey
Jennifer A
JA
D000075202:Contraindications; D003316:Corneal Diseases / Q000209:etiology; D004108:Dilatation, Pathologic / Q000209:etiology; D006801:Humans; D007258:Informed Consent; D008318:Malpractice; D019300:Medical Errors; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D011182:Postoperative Care; D012017:Referral and Consultation; D054140:Refractive Surgical Procedures; D013997:Time Factors