Claims of alleged medical negligence in refractive surgery: causes and avoidance.

PURPOSE: To identify the issues cited in claims for alleged medical negligence in cases of refractive surgery. METHODS: One hundred and one cases of alleged medical negligence following refractive surgery were analysed by a single expert witness. Valid features of the statement of claim and issues identified by the expert as being relevant to the outcome were assessed. RESULTS: Sixty-five percentage of claims included issues of consent. In one third of these cases the Claimant had particular risk factors for which especially careful counselling was warranted. For 29% of claims there were contraindications to surgery. In 24% there was surgical error resulting in a compromised outcome. In 23% there was avoidable delay in instituting medical management for post-operative complications. Four percentage of cases were precipitated by a second opinion where the clinician giving the opinion was not fully conversant with the facts. CONCLUSIONS: The number of claims could be substantially reduced by: (1) Instituting proper policies for consent with full documentation throughout the process; (2) Ensuring that surgeons are adequately trained in evaluating pre-operative tests and allowing surgeons adequate time to assess patients prior to surgery; (3) Moderating the case-load for surgery; (4) Ensuring that patients have easy access to medical care post-operatively; (5) Keeping comprehensive and accurate records.