Avoiding Glaucoma Malpractice Cases

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An analysis of causes and outcomes of malpractice litigation among patients with glaucoma suggests that risk to both patients and providers can be reduced by conducting careful ex­aminations and documenting detailed conversations with patients.¹ The anal­ysis revealed that nearly 40% of cases involved allegations of mismanagement or failure to diagnose and treat. Adverse drug effects and surgical complications also resulted in litigation.

“Our study confirms much of what has been reported, and it reinforces the need for risk management to be a part of clinical care,” said Ashvini K. Reddy, MD, in private practice in San Antonio, Texas.

COMMON MISTAKES. Nearly 25% of the claims involved either angle-closure glaucoma (shown here) or open-angle disease.

Disproportionately high awards. The researchers identified 69 glaucoma malpractice cases in the WestLaw data­base occurring between 1962 (the first year in which cases were reported) and 2014. Well over half (62.3%) resolved in favor of defendants. Eight jury verdicts awarded a mean of $994,260 to plain­tiffs, while 10 cases settled with a mean indemnity of $1.2 million. (Amounts were adjusted for inflation in 2015 dollars.)

Although the rate of glaucoma plain­tiff verdicts mirrored ophthalmology overall, median awards were 1.7 times higher than the whole—$977,474 in glaucoma versus $604,352 for all of ophthalmology.

Common scenarios. Of the 69 cases, 35 (50.7%) involved allegations of insufficient intervention, such as failure to diagnose or treat, and failure to monitor properly through intraocular pressure (IOP) checks, dilated exam­inations, and visual field (VF) testing. Thirteen cases (18.8%) involved failure to diagnose or treat and/or misman­agement of angle-closure glaucoma, and 12 cases (17.4%) involved failure to diagnose open-angle glaucoma. Of 10 varied surgical and procedural claims, six involved trabeculectomy.

An unexpected finding. While ad­verse effects of glaucoma medications were not common (10; 14.5%), the me­dian award value of nearly $1 million was a surprise, Dr. Reddy said. All but two of 10 cases involving topical glau­coma medication resulted in payments, including a $1.3 million settlement for an elderly woman with a known history of asthma who sustained permanent brain damage after being administered timolol.

Examine, talk, document. Challeng­es inherent to glaucoma—such as its chronicity and the ongoing need to re­vise disease management—may explain the disproportionately high awards, the researchers noted. They advised routine IOP measurements, visual field testing, and dilated exams for all glaucoma suspects.

Dr. Reddy stressed the importance of communication, especially with patients who have aggressive disease, guarded prognoses, or poor outcomes. “These patients are particularly high risk and need to be very involved in decisions. Documentation of their involvement is also important.”

—Miriam Karmel

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1 Engelhard SB et al. Ophthalmol Glaucoma. 2021;4(4): in press.

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Relevant financial disclosures—Dr. Reddy: Alim­era: C; Clearside: C; Eyepoint: C; Heidelberg: C.

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