Latin American ophthalmologists discuss how to protect themselves legally

Norberto Domingo Alfano

BUENOS AIRES — In the increasingly litigious atmosphere of medicine in Latin America, ophthalmologists must know where they stand and how to take the proper steps to protect themselves.

"We are our own worst enemies," Norberto Domingo Alfano, MD, said during the Annual Report of the Argentinean Society of Ophthalmology Annual Course.

In a topic introduced by Ramón R. Grimaldi, MD, a panel of physicians and legal experts discussed the past, present, future and prevention of medical malpractice in ophthalmology.

"It is the obligation of everyone who works in a branch of the art of medicine to respond to justice for damages caused by the exercise of their profession," Dr. Grimaldi said. "It is in response to the general concept of liability."

In 2003, 15.77% of the medical malpractice cases in Argentina involved ophthalmologists. It dropped slightly, he said, to 10.27% in 2007. Of the ophthalmic malpractice cases in 2006, 32.5% were related to cataract, 32.5% were traumatic retina cases, 17.5% were refractive, 7.5% were cornea, and glaucoma and optical nerve cases each made up 5%.

Although the majority of these cases are settled in favor of the physician, there are daily precautions one can take to further protect his or her medical reputation and to avoid "judicial syndrome," in which medicine becomes defensive and less effective, Dr. Grimaldi said.

Alfredo J.A. LaValle

Specifically, the panel discussed cultivating a good patient-physician relationship, maintaining good documentation in the form of a detailed clinical history and consistent informed consent as well as a witness signing the forms, performing the procedure according to standard protocol, and capturing it on audio and video.

Dr. Grimaldi and others also recommended working with other ophthalmologists to ensure the right course of action. He warned that the surgeon is responsible for any equipment or tools used during surgery as well as any substances used during the operation.

"The surgeon is the boss, so he is civilly responsible for everything that happens in the operating room," he explained.

Straying from any of these rules leaves a physician open for criticism, the panel explained.

"The surgical protocol as well as our full documentation must be a true reflection of our neat, serene, detailed and professional procedure," Alfredo J.A. LaValle, MD, said.