editor's perspective

Liability for Patient Lack of Responsibility

BY JOSEPH T. BARR, OD, MS, EDITOR
April 1999

Our liberal legal and court system in the United States has caused most eyecare practitioners to become paranoid. I received a letter last year which stated, "I am concerned about liability issues involving non-compliant contact lens patients, which is a significant problem area in my practice. Patient Jane Doe is a 25-year-old 4.00D myope who was fitted with two-week disposable contact lenses five years ago. She has worn one pair of contact lenses continuously for eight weeks without removal or replacement and uses no disinfecting solution. She refuses to purchase back-up spectacles and does not return for required follow-up. She has been given and has signed our informed consent form outlining risk, proper use, replacement, wearing schedule and follow-up care on several occasions, but continues to be non-compliant, which we document in our chart. Over the past five years, she has had three episodes of marginal corneal ulcers, keratitis and GPC." This practitioner asks, "Am I contributing to this patient's negligence, and am therefore liable by continuing to supply her with disposable contact lenses?"

Even though our society and legal system is wrong for not requiring personal responsibility and trying to find someone to blame or sue, we continue to have to practice in the way we expect patients to behave -- responsibly. It appears that this practitioner has already covered the bases -- he has educated the patient, provided her with care, issued warnings and treats her with a safe modality. What else would you do? Send the patient a registered letter? You'd have some added protection but the behavior may not change. Stop selling lenses to her? She'd get them elsewhere. Show her gory ulcer pictures? Only after positive efforts fail. Write a letter to tell her that you want to refer her to another practitioner but that you're not abandoning her and will see her until she has selected another practitioner? It is a dilemma.

.