Locum optom charged with manslaughter - Optometry Today

[ODwire.org NewsBot]

Optometry Today​

Locum optom charged with manslaughter
Optometry Today
A locum optometrist has been charged with manslaughter following the death of an eight-year-old patient in 2013. Honey Rose, 34, from Newham in east London, was charged with manslaughter caused by negligence after failing to diagnose a papilloedema ...

and more »

Continue reading...

 

[Jeff Kiener]

Bizarre.

 

[Troy Cassidy]

Yes, I was going to comment on this. Google tells me that it's not unknown for doctors to be charged with manslaughter due to negligence in the UK, although I'm sure this is the first optometrist to be so charged. I don't think optometrists in NZ can be charged with manslaughter in such a situation. It seems to me to be an odd use of the charge.

The article says that his eye examination was in February, and he unfortunately died in July. I imagine the key for the prosecution will be in proving that papilloedema was present 5 months earlier, which doesn't seem straight-forward to me. A terrible situation for everyone involved.

Interesting fodder for the"What kind of eye exams are being done" thread.

 

[Lloyd Pate]

Yes, I was going to comment on this. Google tells me that it's not unknown for doctors to be charged with manslaughter due to negligence in the UK, although I'm sure this is the first optometrist to be so charged. I don't think optometrists in NZ can be charged with manslaughter in such a situation. It seems to me to be an odd use of the charge.

The article says that his eye examination was in February, and he unfortunately died in July. I imagine the key for the prosecution will be in proving that papilloedema was present 5 months earlier, which doesn't seem straight-forward to me. A terrible situation for everyone involved.

Interesting fodder for the"What kind of eye exams are being done" thread.

I was a professional reviewer for a case that involved an OD killing a patient by mismanaging papilledema here in the US.

 

[Jeff Kiener]

What's the bottom line?

Swollen-looking nerves = MRI?

= spinal tap?

 

[Lloyd Pate]

What's the bottom line?

Swollen-looking nerves = MRI?

Or 30 degree b scan that day to confirm subtle papilledema.. If you diagnose papilledema, you have 24 hours to get an MRI or CT.

 

[Michael Molamphy]

Tragic, indeed. I'm wondering what her education was, and if a qualified optometrist as we understand the term. I think some referred to as "opticians". Did the parents take the boy to a physician at any time?

 

[Michael Molamphy]

Or 30 degree b scan that day to confirm subtle papilledema.. If you diagnose papilledema, you have 24 hours to get an MRI or CT.

Will there always be headaches , and of constant intensity?

 

[h.c. jang]

I was a professional reviewer for a case that involved an OD killing a patient by mismanaging papilledema here in the US.

What happened?

 

[Troy Cassidy]

I was a professional reviewer for a case that involved an OD killing a patient by mismanaging papilledema here in the US.

Interesting. Was that a criminal case?

 

[Jonathan Warner]

I was a professional reviewer for a case that involved an OD killing a patient by mismanaging papilledema here in the US.

I know I'll get flamed for this, but papilledema is a neurological condition with ophthalmic manifestations. ODs should not be "managing" this. They should be referring it out to a neurologist or neuro-ophthalmologist.

 

[Troy Cassidy]

Tragic, indeed. I'm wondering what her education was, and if a qualified optometrist as we understand the term. I think some referred to as "opticians". Did the parents take the boy to a physician at any time?

Optometrists in the UK were traditionally known as ophthalmic opticians (as distinct from dispensing opticians), but I believe the profession uses optometrist now. The average Briton would generally still say "optician" to refer to optometrists, I think. This lady is/was a registered optometrist.

I was also wondering if any other medical care was sought.

 

[h.c. jang]

I know I'll get flamed for this, but papilledema is a neurological condition with ophthalmic manifestations. ODs should not be "managing" this. They should be referring it out to a neurologist or neuro-ophthalmologist.

I think the managing means referring out; initially for an MRI.

 

[Jonathan Warner]

I think the managing means referring out; initially for an MRI.

If the only thing the OD did was refer out in Lloyd's case, I can't imagine why the OD would be sued.

 

[Lloyd Pate]

I know I'll get flamed for this, but papilledema is a neurological condition with ophthalmic manifestations. ODs should not be "managing" this. They should be referring it out to a neurologist or neuro-ophthalmologist.

Your management is referring the patient for imaging in a timely fashion.

 

[Lloyd Pate]

If the only thing the OD did was refer out in Lloyd's case, I can't imagine why the OD would be sued.

You don't make a referral 1 week out. The patient died needlessly from a benign tumor.

 

[AdminWolf]

You don't make a referral 1 week out. The patient died needlessly from a benign tumor.

Indeed, if you see papilledema, the case should be referred out in a hurry -- i think everyone knows this. Or should know this.

As I recall during my medicine rotations there were certain key signs that if seen meant an immediate trip to the ER (or even certain key phrases -- if you ever say to an ER doc or even a good primary care doc "I am having the worst headache i've ever had in my life", it means you are getting a CT scan....)

Is anything like that taught during optometry school -- the signs that one absolutely should not miss during an exam, and should refer to an ER (or available specialist) immediately?

 

[Lloyd Pate]

Indeed, if you see papilledema, the case should be referred out in a hurry -- i think everyone knows this. Or should know this.

As I recall during my medicine rotations there were certain key signs that if seen meant an immediate trip to the ER (or even certain key phrases -- if you ever say to an ER doc or even a good primary care doc "I am having the worst headache i've ever had in my life", it means you are getting a CT scan....)

Is anything like that taught during optometry school -- the signs that one absolutely should not miss during an exam, and should refer to an ER (or available specialist) immediately?

I will be teaching it this weekend to the 3rd year students at UHCO.

 

[Michael Ford]

You don't make a referral 1 week out. The patient died needlessly from a benign tumor.

Few questions, did the charts actually say the patient had papilledema?

If It was Dx a week earlier then the person would have lived, I would think that is a pretty aggressive tumor, how could you say that they would not have died any ways?
Seems unlikely that the typically tumors that cause papilledema (optic chiasm) would lead to death.
I would be interested in reading the case behind this, could you give us a case name.

 

[AdminWolf]

I will be teaching it this weekend to the 3rd year students at UHCO.

I'd like to see a lecture like that at the next CEwire2016... even as a refresher for people who may have grown complacent (or not been taught the first time around -- consider the diagnostics that were available when paul got out of school...)

 

[Lloyd Pate]

Few questions, did the charts actually say the patient had papilledema?

If It was Dx a week earlier then the person would have lived, I would think that is a pretty aggressive tumor, how could you say that they would not have died any ways?
Seems unlikely that the typically tumors that cause papilledema (optic chiasm) would lead to death.
I would be interested in reading the case behind this, could you give us a case name.

Yes

The patient would have lived if they had been referred appropriately. Neurosurgeons and pathologists back me up on that.

Size and intracranial pressure causes papilledema not location at the chiasm.

You can not read about the case. It was settled. A lot of malpractice cases don't see the light of day.

 

[Michael Barris]

Indeed, if you see papilledema, the case should be referred out in a hurry -- i think everyone knows this. Or should know this.

As I recall during my medicine rotations there were certain key signs that if seen meant an immediate trip to the ER (or even certain key phrases -- if you ever say to an ER doc or even a good primary care doc "I am having the worst headache i've ever had in my life", it means you are getting a CT scan....)

Is anything like that taught during optometry school -- the signs that one absolutely should not miss during an exam, and should refer to an ER (or available specialist) immediately?

I taught this annually to optometry students beginning in 1983.

 

[Jeff Guthrie]

there is speculation that the corporate location this optometrist worked at performed routine screening photos, and the photos may have documented the problem...

 

[h.c. jang]

there is speculation that the corporate location this optometrist worked at performed routine screening photos, and the photos may have documented the problem...

That's what I was thinking. Otherwise I'm not sure how one can show papilledema existed 3 months prior.

 

[Allan Panzer]

We are here..Lloyd's Course at UHCO with Ed Makler.

 

[Scott Caughell]

I personally order the stat MRI and if findings significant get them into neuro. Interestingly, the few brain tumors I have caught did not have papilledema. I've had a good number of IIH diagnoses. Personally I feel that if I have an urgent concern I get the ball rolling because the medical machine does not always work efficiently.

Now "worst headache of my life" would get a prompt one way ticket to the ER.

 

[Marc Provencher]

You can not read about the case. It was settled. A lot of malpractice cases don't see the light of day.

It may not go to court, but all insurance malpractice payments, by law, have to be reported to the National Provider Data Bank, so there is a public record.

 

[Lloyd Pate]

It may not go to court, but all insurance malpractice payments, by law, have to be reported to the National Provider Data Bank, so there is a public record.

Some times.

http://www.americanjournalofmediation.com/docs/Mediating Med Mal Without The Data Bank Reports.pdf

 

[Marc Provencher]

Some times.

http://www.americanjournalofmediation.com/docs/Mediating Med Mal Without The Data Bank Reports.pdf

Fascinating. There is the old saying, "We don't make the rules, we just play the game.", and this is a perfect example of how the "game" is played. Why have an NPDB if it can be easily circumvented?

I found this interesting:

"Suffice it here to say that rapid changes in the current health care market make possible a significantly greater use of the corporate shield, with the emergence of Accountable Care Organizations, bundled payment arrangements, hospital purchases of physician practices, and other structures that may make it more attractive and appropriate for hospitals and other entities to provide "enterprise liability." To the extent that corporate shield remains permissible, and to the extent it becomes increasingly utilized by complex provider structures, physicians can find expanding opportunities to participate in early mediation of health care disputes without incurring a permanent black mark in the Data Bank."

So ACO physicians can avoid having malpractice claims registered in the NPDB! Something to consider when looking at "quality metrics" such as malpractice payouts.

 

[Jeff Kiener]

The "nudge" is on.

ACOs can be made pretty attractive by the powers that be, and you and I will have "an offer we cannot refuse".

Seriously, are we subject to criminal professional liability in the States?

 

[Lloyd Pate]

Fascinating. There is the old saying, "We don't make the rules, we just play the game.", and this is a perfect example of how the "game" is played. Why have an NPDB if it can be easily circumvented?

I found this interesting:

"Suffice it here to say that rapid changes in the current health care market make possible a significantly greater use of the corporate shield, with the emergence of Accountable Care Organizations, bundled payment arrangements, hospital purchases of physician practices, and other structures that may make it more attractive and appropriate for hospitals and other entities to provide "enterprise liability." To the extent that corporate shield remains permissible, and to the extent it becomes increasingly utilized by complex provider structures, physicians can find expanding opportunities to participate in early mediation of health care disputes without incurring a permanent black mark in the Data Bank."

So ACO physicians can avoid having malpractice claims registered in the NPDB! Something to consider when looking at "quality metrics" such as malpractice payouts.

Now you know why I have participated in malpractice cases which will never see the light of day. Docs make more mistakes than what you think.

 

[Allan Panzer]

Ok everyone..up and exercise....

 

[Michael Ford]

Yes

The patient would have lived if they had been referred appropriately. Neurosurgeons and pathologists back me up on that.

Size and intracranial pressure causes papilledema not location at the chiasm.

You can not read about the case. It was settled. A lot of malpractice cases don't see the light of day.

Where was this lesion located?

Call me skeptical that the MDs did not want to throw a none MD under a bus. If you could talk more about the location and what happen it would be of great benefit to us readers unable to attend your lecture in Texas.

 

[Lloyd Pate]

Where was this lesion located?

Call me skeptical that the MDs did not want to throw a none MD under a bus. If you could talk more about the location and what happen it would be of great benefit to us readers unable to attend your lecture in Texas.

I will have to dig through my closed cases and find the autopsy report. I will post it if I can find it. 2 MDs killed the patient too, so it is not an OD - MD affair.

 

[Michael Barris]

Why have an NPDB [National Provider Data Bank] if it can be easily circumvented?

Many well-designed and important data banks mandated by state and federal laws are incomplete, sometimes by large percentages, because adequate funds have not been authorized to enforce compliance. Similarly, many crimes are not investigated for the same reason. Homicide is a general exception.

On ODwire recently, interest was apparent in http://clinicaltrials.gov . However, when I briefly and recently scanned this registry of clinical trials of pharmaceutical agents, I found that the majority of the trials registered never reported summaries of those specific trials, even six years after scheduled completions of those trials.

 

[Andrew Gore]

Or 30 degree b scan that day to confirm subtle papilledema.. If you diagnose papilledema, you have 24 hours to get an MRI or CT.

I'm thinking this would be a good place for someone like Dr. Pate to review papilledema diagnosis. In other words, there are times when there is no question that the patient is presenting with papilledema. This happened to one of my patient's a year or so ago and I sent her right to the hospital for a scan. However, there are times where someone has a slightly funny looking nerve that is not really papilledema. I'm sure I'm not the only one that would love to have a quick review in this thread that discusses the signs demanding a stat referral. Thank you!

 

[Michael Barris]

I'm thinking this would be a good place for someone like Dr. Pate to review papilledema diagnosis.

J Neuroophthalmol. 2014 Dec;34(4):331-5. doi: 10.1097/WNO.0000000000000150.
Correlation between papilledema grade and diffusion-weighted magnetic resonance imaging in idiopathic intracranial hypertension.

Salvay DM1, Padhye LV, Huecker JB, Gordon MO, Viets R, Sharma A, Van Stavern GP.

Author information
1Department of Ophthalmology and Visual Sciences (DMS, JBH, MOG, GPVS), Washington University, Saint Louis, Missouri; Department of Ophthalmology and Visual Sciences (LVP), Washington University, Saint Louis, Missouri; Department of Radiology (RV, AS), Mallinckrodt Institute of Radiology, Washington University School, Saint Louis, Missouri; and Department of Neurology (GPVS), Washington University, Saint Louis, Missouri.

Abstract
BACKGROUND:
To explore the relationship between diffusion-weighted magnetic resonance imaging (DWI) hyperintensity of the optic nerve head (ONH) and papilledema grade in patients with idiopathic intracranial hypertension (IIH).
METHODS:
A retrospective chart review was conducted of patients with definitively diagnosed IIH by clinical examination and visual field (VF) analysis who underwent orbital magnetic resonance imaging (MRI) within 4 weeks of diagnosis. A neuroradiologist masked to the diagnosis assessed the results of DWI for each eye independently and graded the signal intensity of the ONH into none, mild, and prominent categories. DWI grading was compared with papilledema grade and visual field mean deviation (VFMD) by Spearman rank correlation analysis and t-tests.
RESULTS:
Forty-two patients were included in the study. A statistically significant difference (P = 0.0195) was found between papilledema grade and patients with prominent DWI findings (n = 16; mean papilledema grade 3.75 ± 1.25) vs mild or no ONH hyperintensity (n = 26; mean papilledema grade 2.79 ± 1.24) at the time of initial diagnosis. DWI hyperintensity of the ONH at diagnosis was also found to be significantly correlated with the degree of papilledema at follow-up (ρ = 0.39, P = 0.0183) but not with VFMD.
CONCLUSIONS:
We found a significant correlation between the severity of papilledema and ONH hyperintensity on DWI in patients with IIH but not with VF loss or other visual parameters. These findings may offer insight into the pathophysiology of papilledema in IIH and provide a surrogate marker for the presence and severity of papilledema.

 

[Rahul M. Gupta]

Indeed, if you see papilledema, the case should be referred out in a hurry -- i think everyone knows this. Or should know this.

As I recall during my medicine rotations there were certain key signs that if seen meant an immediate trip to the ER (or even certain key phrases -- if you ever say to an ER doc or even a good primary care doc "I am having the worst headache i've ever had in my life", it means you are getting a CT scan....)

Is anything like that taught during optometry school -- the signs that one absolutely should not miss during an exam, and should refer to an ER (or available specialist) immediately?

They are taught, but one of the great problems in the optometry curriculum is didactic concepts are not, and cannot be, reinforced in the clinical setting. We don't experience general medical care in a hospital. Optometrists don't work with heart attacks or strokes or gunshots or kidney disease, et cetera.

Emergency-medicine concepts are learned in the comfort of a classroom, then one day they might present in the exam lane, and we are deer in the headlights.

 

[Jeff Kiener]

Don't worry Rahul. With all the new schools coming, I'm sure they'll see tons of patients.

 

[Rahul M. Gupta]

Don't worry Rahul. With all the new schools coming, I'm sure they'll see tons of patients.

We harp very much about new schools (and, not wrongly so), but there also is the reality of expansion in the existing institutions.