Malpractice/abandonment scenario's

[Ryan_eyeball]

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I was kinda wondering what people thought about two different hypothetical scenario's.

1) Patient is a -6.00 Sph OU myope (spec only wearer) that was seen at your office a week prior for which you updated his Rx (to the one listed). He is currently wearing his only pair of spectacles, and ordered new glasses a week ago, for which he wanted to pay for in cash/check (when the glasses came in). The patient comes in, and states that he broke his pair of glasses, and would like to get his new ones but is unable to pay til another week. Is it illegal to deny him his glasses since he can't pay for another week? If you do, and he drives home gets in a wreck, and kills someone are you legally responsible? What if the guy picks up the glasses, and refuses to pay, or gave a wrong # and address to hunt him down? Why couldn't more people just refuse payment before getting glasses? Even if you require payment beforehand, and the guy couldn't pay at that time (the original exam date), and he still broke his glasses a week later, what could we do to get him bye (let's say you're not a one hour optical, and the guy lives by himself, no relatives)?

2) Scenario 2 Same Rx as above a -6.00 myope, and a CL wearer (a previous patient that you've seen for the past two CL exams-2 years apart each time). Let's say that he's on his last set of CL's and he rips one of the CL's (CL's are 4 months old). He comes into your office, but he learns that his CL Rx is three months expired. He asks if he can purchase one box, or have a trial pair to get him bye. He doesn't have backup glasses, and he says he can't afford to come in right now because the farm crop hasn't been good this year. Let's say you, as the doctor refuse to give him a trial pair til he updates his CL Rx. He says that this is denying him medical care, because of his ability to pay, and abandoning his eyecare, so is he correct? If so, why can't everyone just say this to get off cheap?

Ok another part, lets say that you do decide to be Mr Nice doctor and decide to give him a trial pair to get him bye. He develops a corneal ulcer (and loses central VA down to 20/60) due to CL overwear , in the next two months. Can a lawyer go back and say that he should not have been given a medical device without a current prescription for that device & without being given an eye examination first.

Just seems like difficult situations, and i was wondering how others would handle these scenarios. Any feedback would be appreciated.

 

[KHE]

I was kinda wondering what people thought about two different hypothetical scenario's.

1) Patient is a -6.00 Sph OU myope (spec only wearer) that was seen at your office a week prior for which you updated his Rx (to the one listed). He is currently wearing his only pair of spectacles, and ordered new glasses a week ago, for which he wanted to pay for in cash/check (when the glasses came in). The patient comes in, and states that he broke his pair of glasses, and would like to get his new ones but is unable to pay til another week. Is it illegal to deny him his glasses since he can't pay for another week? If you do, and he drives home gets in a wreck, and kills someone are you legally responsible? What if the guy picks up the glasses, and refuses to pay, or gave a wrong # and address to hunt him down? Why couldn't more people just refuse payment before getting glasses? Even if you require payment beforehand, and the guy couldn't pay at that time (the original exam date), and he still broke his glasses a week later, what could we do to get him bye (let's say you're not a one hour optical, and the guy lives by himself, no relatives)?

2) Scenario 2 Same Rx as above a -6.00 myope, and a CL wearer (a previous patient that you've seen for the past two CL exams-2 years apart each time). Let's say that he's on his last set of CL's and he rips one of the CL's (CL's are 4 months old). He comes into your office, but he learns that his CL Rx is three months expired. He asks if he can purchase one box, or have a trial pair to get him bye. He doesn't have backup glasses, and he says he can't afford to come in right now because the farm crop hasn't been good this year. Let's say you, as the doctor refuse to give him a trial pair til he updates his CL Rx. He says that this is denying him medical care, because of his ability to pay, and abandoning his eyecare, so is he correct? If so, why can't everyone just say this to get off cheap?

Ok another part, lets say that you do decide to be Mr Nice doctor and decide to give him a trial pair to get him bye. He develops a corneal ulcer (and loses central VA down to 20/60) due to CL overwear , in the next two months. Can a lawyer go back and say that he should not have been given a medical device without a current prescription for that device & without being given an eye examination first.

Just seems like difficult situations, and i was wondering how others would handle these scenarios. Any feedback would be appreciated.

These are all hypothetical but rarely come up, in my experience.

In general, I would not deny glasses to a patient who was a -6.00D myope, even if they could not pay for them. While technically you are not legally bound to provide them the treatment any more than a physician is required to provide a patient with heart medications that they can't afford, morally its the right thing to do. If you were ever to be sued, the plaintiffs lawyer will say "So, DOCTOR! Do you mean to tell this court and this jury that you essentially left a man blind and allowed him to blindly try to find his way home simply because he couldn't pay $200?? Are you to tell this jury that you ruined this mans life over $200?" You would be toasted and roasted.

That being said, it is a good idea to require at least half of the fee up front before starting a job.

For the contact lens patient, I would allow them to buy one box, or I would provide them with a trial because you are much much more likely to have trouble letting them run around without any correction than you are risking the ulcer. As ODs, we recommend yearly follow ups on contact lens patients but there really isn't any evidence that shows that seeing a CL patient in the 12th month prevents an ulcer in the 14th month. How would you want to be treated in this situation? If you were a physician, would you cut someone off of their blood pressure medicine because you wanted to see them yearly and it had been 13 months? Likely not.

I don't think either cases amounts to abandonment because abandonment usually revolves around a patient who is in imminent danger of losing life or limb.

But really, for me, it boils down to this....

I'm not a very religeous man, but when I'm standing before St. Peter and he's got the scale out and he's weighing the deeds of my life, I hope that my generosity and charity in "helping the blind" over the years will tip the scales in my favor a bit.

 

[Ben Chudner]

I'm not a very religeous man, but when I'm standing before St. Peter and he's got the scale out and he's weighing the deeds of my life, I hope that my generosity and charity in "helping the blind" over the years will tip the scales in my favor a bit.

We can be sued for just about anything, but I do not believe there is evidence of either malpractice or abandonment in these cases (I am not a lawyer, however, so that is not legal advice). That being said, I agree with Ken's quote above. I think doing the right thing outweighs doing what is right for your business.