Bucks Montgomery Physician Fall 2020 - 14

FEATURE

Avoiding Malpractice
Action in Pediatrics
and Ophthalmology

O

by Harold P. Koller, M.D., FACS, FAAP
ne of the most serious occurrences during
the years a physician practices medicine is the
initiation of a malpractice law suit against the
doctor. Often the reason for the action is the physician's
lack of thinking "out of the box." Often doctors assume
the most common and obvious cause of a diagnosis is
the most likely. This is not always a wise decision. The
sine qua non is to consider all the other possibilities
that could have caused the illness and not only the most
common and obvious. Missing the real cause, however
remote, could result in a poor or even disastrous
outcome and lead to significant harm to the patient and
a subsequent malpractice action. I will cite numerous
examples of such cases from infancy to senior citizens
that exemplify such narrow-minded misdiagnoses.
The first example is the diagnosis and delayed treatment
of "micro-premature infants" in a hospital NICU
involving the timely diagnosis and treatment of
threshold Retinopathy of Prematurity [ROP]. By not
adhering to the published guidelines of the American
Academy of Pediatrics [AAP], the American Academy
of Ophthalmology [AAO] and the American Association
of Pediatric Ophthalmology and Strabismus [AAPOS],
severe harm to vision and eventual blindness can occur.
Identifying the stages of ROP and their location in a
timely manner can prevent untoward outcomes. An MD
or DO pediatric ophthalmologist observer trained in ROP
identification can avoid catastrophic results. However, it is
the responsibility of the attending neonatologist to make
sure that the re-exams are performed in a timely manner as
recommended by the examining pediatric ophthalmologist.
Another serious omission by a pediatrician and pediatric
ophthalmologist is the delay and inappropriate treatment
of a newborn infant with a congenital dacryocele, a
reddish or flesh colored lump just adjacent to the nasal

12 BUCKS/MONTGOMERY PHYSICIAN

fall 2020

bridge and inner canthal area of the eye. If after digital
message and antibiotic eyedrops the mass is not reduced,
an immediate lacrimal probing should be done, either
in the office or in the OR. By delaying appropriate
surgical treatment, the infection spread to the orbit and
subsequently to the brain, causing marked pathological
damage including diminished mental capacity. Probing
treatment and systemic IV antibiotics occurred too
late in this case after brain injury had happened.
Seeing an infant with symptomatic epiphora [tearing] is
quite common. The treatment is tear duct massage and
antibiotic eyedrops if a discharge exists. If, however,
there is pure tearing accompanied by photophobia and
blepharospasm with and without enlarged corneas,
congenital glaucoma should be suspected and a
measurement of the infant's intraocular pressure [IOP]
and observing the degree of optic nerve cupping
should be performed. Congenital glaucoma is treated
surgically and a delay in diagnosis will result in decreased
visual fields and poor visual acuity. The IOP should
be measured promptly in cases described above.
Bucks Montgomery Physician Fall 2020

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