Lessons From Ophthalmology Malpractice Claims: Managing Patients’ Expectations With Informed Consent and Shared Decision Making

Patients may experience a variety of complications from ophthalmologic procedures. The Doctors Company examined closed ophthalmology malpractice claims to gain insights into patient safety issues and strategies to mitigate risk.

Study Design

This was a retrospective, exploratory study, using an evidence-based taxonomy,¹ of The Doctors Company’s medical professional liability closed claims from the loss years 2010 through 2024. Inclusion criteria included the major responsible service of ophthalmology, major allegation, location of the event, service role involved, major injury, the patient’s gender and age, injury severity (using the National Association of Insurance Commissioners Severity of Injury Scale), average indemnity paid (if any), disposition of claim (indemnity or no indemnity), medications involved (if any), and contributing factors.

Study Results

The study findings included:

• Injury severity: Among claimants, 20 percent experienced a high-severity injury, or disabling injury (including death).
• Major allegations: The top major allegation was improper performance of surgery. The second most common major allegation was improper management of a surgical patient, which includes preoperative care (such as consent), intraoperative decisions, and postoperative care.
• Location: The overwhelming majority of claims, 97 percent, derived from care provided in ambulatory settings, with 52 percent originating in ambulatory surgery centers and 45 percent in practitioner offices or clinics.
• Major injuries: The two major injuries found most frequently were sensory impairment and aggravated condition.
• Indemnity: A paid indemnity resulted from 22 percent of the claims. The average indemnity was $250,000, with the median indemnity at $144,000.
• Contributing factors: Malpractice claims often have multiple contributing factors. The three most frequently occurring contributing factors involved technical performance, patient factors (meaning patients’ degree of adherence to their plan of care), and communication between patients/family and practitioners.

Risk Mitigation Strategies

• Prevent wrong-site and wrong-intraocular-lens (wrong-IOL) procedures. This analysis discovered ongoing issues with preventable errors involving wrong-site surgery and wrong-IOL implants.
• Participate in simulation training. Consider the use of simulation to sharpen technical skills.
• Educate patients about known complications. A known complication was the main reason, or primary driver, that many claims were pursued, consistent with similar findings in other studies.
• Manage patient expectations with informed consent. Study findings suggest that practitioners may not adequately explain the potential risks and outcomes of procedures. This may cause patient dissatisfaction and frustration, leading to the eventual filing of a malpractice claim.

Conclusion

This analysis provides insights into ophthalmology medical malpractice claims, including issues with technical skill and clinical judgment and the need to manage patients’ expectations with informed consent and shared decision making. Examining contributing factors enables the development and implementation of risk reduction and loss prevention strategies. Lessons from the closed ophthalmology claims data can assist in mitigating practice risks by improving patient care, patient safety, and patient satisfaction.

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