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Locum optom charged with manslaughter - Optometry Today

Invest Ophthalmol Vis Sci. 2015 Sep 1;56(10):5670-80. doi: 10.1167/iovs.15-17459.
Retinal and Choroidal Folds in Papilledema.
Sibony PA1, Kupersmith MJ2, Feldon SE3, Wang JK4, Garvin M4; OCT Substudy Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial.
Author information
  • 1Department of Ophthalmology State University of New York at Stony Brook, Stony Brook, New York, United States.
  • 2Hyman-Newman Institute for Neurosurgery, Roosevelt Hospital, New York, New York, United States; and the New York Eye and Ear Infirmary, New York, New York, United States.
  • 3Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States.
  • 4Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States.
Abstract
PURPOSE:
To determine the frequency, patterns, associations, and biomechanical implications of retinal and choroidal folds in papilledema due to idiopathic intracranial hypertension (IIH).

METHODS:
Retinal and choroidal folds were studied in patients enrolled in the IIH Treatment Trial using fundus photography (n = 165 study eyes) and spectral-domain optical coherence tomography (SD-OCT; n = 125). We examined the association between folds and peripapillary shape, retinal nerve fiber layer (RNFL) thickness, disc volume, Frisén grade, acuity, perimetric mean deviation, intraocular pressure, intracranial pressure, and refractive error.

RESULTS:
We identified three types of folds in IIH patients with papilledema: peripapillary wrinkles (PPW), retinal folds (RF), and choroidal folds (CF). Frequency, with photos, was 26%, 19%, and 1%, respectively; SD-OCT frequency was 46%, 47%, and 10%. At least one type of fold was present in 41% of patients with photos and 73% with SD-OCT. Spectral-domain OCT was more sensitive. Structural parameters related to the severity of papilledema were associated with PPW and RF, whereas anterior deformation of the peripapillary RPE/basement membrane layer was associated with CF and RF. Folds were not associated with vision loss at baseline.

CONCLUSIONS:
Folds in papilledema are biomechanical signs of stress/strain on the optic nerve head and load-bearing structures induced by intracranial hypertension. Folds are best imaged with SD-OCT. The patterns of retinal and choroidal folds are the products of a complex interplay between the degree of papilledema and anterior deformation of the load-bearing structures (sclera and possibly the lamina cribrosa), both modulated by structural geometry and material properties of the optic nerve head. (ClinicalTrials.gov number, NCT01003639.).

This article is available free at http://iovs.org
 
AdminWolf said:
Indeed, if you see papilledema, the case should be referred out in a hurry -- i think everyone knows this. Or should know this.

As I recall during my medicine rotations there were certain key signs that if seen meant an immediate trip to the ER (or even certain key phrases -- if you ever say to an ER doc or even a good primary care doc "I am having the worst headache i've ever had in my life", it means you are getting a CT scan....)

Is anything like that taught during optometry school -- the signs that one absolutely should not miss during an exam, and should refer to an ER (or available specialist) immediately?
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yes, and repeated in CE.
 
I am all set for subtle papilledema now. Our UBM - B-scan is up and working, and I can now do the 30 degree test.
 
We're writing a story about this. Anyone interested in offering a comment about how/why it happened, what the optom could have done, anything?

Thanks!
 
Gretchyn Bailey said:
We're writing a story about this. Anyone interested in offering a comment about how/why it happened, what the optom could have done, anything?

Thanks!
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Gretchyn -- this is one instance where high-tech instrumentation and documentation is dooming clinicians who overlook basic pathologic findings.

With the advent of OCT, high-resolution photography, etc -- the documentation speaks for itself. You miss something like this at your own peril.
 
AdminWolf said:
Gretchyn -- this is one instance where high-tech instrumentation and documentation is dooming clinicians who overlook basic pathologic findings.

With the advent of OCT, high-resolution photography, etc -- the documentation speaks for itself. You miss something like this at your own peril.
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I saw one malpractice case where the OD used an OPTOS that he upsold the patient into getting to document the papilledema that he did not diagnose. It makes a lawyer's job a lot easier when you document the missed pathology for him.
 
AdminWolf said:
Gretchyn -- this is one instance where high-tech instrumentation and documentation is dooming clinicians who overlook basic pathologic findings.

With the advent of OCT, high-resolution photography, etc -- the documentation speaks for itself. You miss something like this at your own peril.
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Is that what happened here? Was there a retinal photo or some other documentation that shows that the papilledema was present at the time of the exam? Or are you just speculating?
 
Anyone willing to comment?
 
Mike Alvarez said:
Is that what happened here? Was there a retinal photo or some other documentation that shows that the papilledema was present at the time of the exam? Or are you just speculating?
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I am speculating -- I do not know all the facts of the case. But i'd be surprised if a prosecutor brought manslaughter charges in the absence of any hard evidence. Maybe she documented in big, red letters "PAPILLEDEMA - I'LL JUST WATCH AND WAIT" but i doubt it.

Then again, maybe the law in the UK is different...
 
Whatever you want to say. :)
 
AdminWolf said:
I am speculating -- I do not know all the facts of the case. But i'd be surprised if a prosecutor brought manslaughter charges in the absence of any hard evidence. Maybe she documented in big, red letters "PAPILLEDEMA - I'LL JUST WATCH AND WAIT" but i doubt it.

Then again, maybe the law in the UK is different...
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I have been involved as a witness in numerous cases where the OD documented pathology with OPTOS, fundus cameras, and OCT. They then missed diagnosing the pathology which they documented so well. That is one reason I tell my students to never do "routine" imaging. You only document known pathology. It is too easy to get busy and not review your images well and miss something. That will then bite you big time. Their money making scam then ends up costing them.
 
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Lloyd Pate said:
I have been involved as a witness in numerous cases where the OD documented pathology with OPTOS, fundus cameras, and OCT. They then missed diagnosing the pathology which they documented so well. That is one reason I tell my students to never do "routine" imaging. You only document known pathology. It is too easy to get busy and not review your images well and miss something. That will then bite you big time. Their money making scam then ends up costing them.
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With respect, I don't believe that's the best conclusion to draw from these cases. The optometrists concerned had evidently missed pathology during slit-lamp/funduscopy which was evident on imaging. Their imaging tools gave them a second chance, and possibly a better view, with which to detect and diagnose the problem. A better conclusion, IMO, is that the images from these devices need to be reviewed properly.

I agree that if these instruments are regarded as a revenue-gathering upsell, and never get properly reviewed, there's potential for trouble and the patient is being fleeced. If they are used for good rather than evil, routine fundus images can be useful.
 
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Troy Cassidy said:
With respect, I don't believe that's the best conclusion to draw from these cases. The optometrists concerned had evidently missed pathology during slit-lamp/funduscopy which was evident on imaging. Their imaging tools gave them a second chance, and possibly a better view, with which to detect and diagnose the problem. A better conclusion, IMO, is that the images from these devices need to be reviewed properly.

I agree that if these instruments are regarded as a revenue-gathering upsell, and never get properly reviewed, there's potential for trouble and the patient is being fleeced. If they are used for good rather than evil, routine fundus images can be useful.
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I agree that if you properly review them and find pathology that can be good; HOWEVER, when you charge extra for testing that you do not examine, you are fleecing the patient. I guess we are saying the same thing.
 
Has a malpractice ever resulted in manslaughter charges though, that anyone has heard of before? I can understand losing your license and malpractice insurability but prison time seems a bit roughl.
 
Kristin Bartlett said:
Has a malpractice ever resulted in manslaughter charges though, that anyone has heard of before?
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PubMed, the computerized index of the peer-reviewed medical literature, accessed on 26 September 2015 simultaneously using the search terms "malpractice manslaughter", yields 92 citations, including at least one recent one from Australia.
 
AdminWolf said:
I am speculating -- I do not know all the facts of the case. But i'd be surprised if a prosecutor brought manslaughter charges in the absence of any hard evidence. Maybe she documented in big, red letters "PAPILLEDEMA - I'LL JUST WATCH AND WAIT" but i doubt it.

Then again, maybe the law in the UK is different...
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Adam, I'm also speculating. It is possible that there have been prior instances with this practitioner that something happened. Or it may be a practice of discrimination since the practitioner is "of color" and is just a way to draw attention to this.

Lastly, the rules for malicious prosecution may be different from the US and the UK. In other words, there is always the possibility that you can be arrested and charged and later dropped. That's' what the grand jury system is supposed to avoid that enough evidence is present to justify an arrest warrant.
 
Yes, but a grand jury can indict a ham sandwich.
 
The trial in this tragic case is now underway. As suggested, retinal photos proved the presence of papilloedema at the time of exam. The optometrist claims she was shown older photos of the boy, and couldn't perform ophthalmoscopy because he was extremely photophobic. A snippet from the Telegraph story:

Retinal images taken during his eye test had shown that the optic disc at the back of each eye was swollen, a result of raised pressure in the skull, the court was told.

Any competent optometrist would have noticed the symptoms and referred Vinnie to hospital for urgent treatment, said Mr Rees.

Surgery to relieve the pressure on his brain could then have saved his life, the court heard.

“He would have continued to enjoy a normal life as a young boy,” Mr Rees said. “The defendant’s failure to detect the swelling of Vinnie’s optic discs was a significant contributory factor to his premature death.”

Ms Rose told police that the retinal images had been taken by another member of staff, the court heard. That member of staff had accidentally shown her images from Vinnie’s test the previous year, which showed no sign of ill health, Ms Rose believed.

She claimed she had used an ophthalmoscope to look into the back of his eyes, but Vinnie was showing pain and “aversion to light” so she stopped.

However, Vinnie’s mother, Joanne Barker, 37, of Ipswich, said that he had shown no sign of being sensitive to light during the test and that nothing had been mentioned at the time.
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Troy Cassidy said:
The trial in this tragic case is now underway. As suggested, retinal photos proved the presence of papilloedema at the time of exam. The optometrist claims she was shown older photos of the boy, and couldn't perform ophthalmoscopy because he was extremely photophobic. A snippet from the Telegraph story:
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Any idiot knows photophobia comes from menengial irritation as a result of high ICP. She should have looked into why he was photophobic. I have seen cases here where an OD takes "routine" pictures which document pathology which they don't detect.

"Photophobia is commonly present and is occasionally the presenting symptom of intracranial hypertension."
http://content.lib.utah.edu:81/cgi-...ROOT=/EHSL-NOVEL&CISOPTR=623&filename=505.pdf
 
Lloyd Pate said:
Any idiot knows photophobia comes from menengial irritation as a result of high ICP. She should have looked into why he was photophobic. I have seen cases here where an OD takes "routine" pictures which document pathology which they don't detect.

"Photophobia is commonly present and is occasionally the presenting symptom of intracranial hypertension."
http://content.lib.utah.edu:81/cgi-...ROOT=/EHSL-NOVEL&CISOPTR=623&filename=505.pdf
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I actually don't remember hearing that one before! Good to know.
 
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Optometrist Honey Rose guilty over Vincent Barker death
An optometrist who failed to spot an eye condition in a boy who later died has been found guilty of gross negligence manslaughter.

Vincent Barker, eight, known as Vinnie, died in July 2012 after fluid built up in his brain.

Honey Rose, 35, from Newham, East London, performed a routine eye test on the child five months earlier. She said she had "done her best" for him.

But jurors at Ipswich Crown Court found her guilty after a 10-day trial.

http://www.bbc.com/news/uk-england-suffolk-36804297
 
What kind of profession is optometry in the U.K.?

Are they like optometrists here about 30-40 years ago?
 
I'd love to see those photos. Was it just a blurred discs or reach out and touch you swollen. I guess this is a bad way of raising awareness.
 
Lloyd Pate said:
Any idiot knows photophobia comes from menengial irritation as a result of high ICP. She should have looked into why he was photophobic. I have seen cases here where an OD takes "routine" pictures which document pathology which they don't detect.

"Photophobia is commonly present and is occasionally the presenting symptom of intracranial hypertension."
http://content.lib.utah.edu:81/cgi-...ROOT=/EHSL-NOVEL&CISOPTR=623&filename=505.pdf
Click to expand...

I hope this comment is tongue-in-cheek. Any "idiot" does not know, "[P]hotophobia comes from menengeal [sic] irritation as a result of high ICP." The point in this matter is not the doctor's failing to connect photophobia with elevated intracranial tension; it is that, allegedly, she did not do her job.

One can advocate either side. It is possible, as many might think, the optometrist plainly neglected her duty: An eight-year-old patient presented; the practitioner refracted him and took photos, then carelessly went about the remainder of her day. She either did not look at the images; glanced at them so briefly as to miss pathology; or reviewed the pictures carefully, but failed to find abnormality. The charge may be neglect, or incompetence.

On the other side, however, it also is possible the optometrist obtained images of the patient, and was in fact accidentally shown old pictures by her technician. Patient-care ultimately remains the doctor's responsibility, but each of us relies heavily on technician staff, and we thus are privy to their errors (as well as, of course, to our own). Further, the doctor may indeed have dilated the patient with execution of good examination, and simply not observed disk oedema. (Grade-I/mild oedema easily can be taken to be physiologic.)

We have only brief pieces of information, and we do not know even how the photographs described actually look. In my opinion, as members of the audience, we haven't enough information to pass judgement on this case. All we may do is make suppositions directed by our existing biases, and offer pontifications thus.
 
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I'm curious to know if the boy received any other care during the interim between the eye exam and his death. If he was that ill, would not other health care workers been involved in diagnosing the etiology of his symptoms. He surely could not have been acting like a normal 12 year old during that time.

If the child was not seen by anyone else, perhaps parental neglect was at play.
 
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Lloyd Pate said:
I have been involved as a witness in numerous cases where the OD documented pathology with OPTOS, fundus cameras, and OCT. They then missed diagnosing the pathology which they documented so well. That is one reason I tell my students to never do "routine" imaging. You only document known pathology. It is too easy to get busy and not review your images well and miss something. That will then bite you big time. Their money making scam then ends up costing them.
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On the flip side, I do routine photos on all my patients. It aids me in noting minute differences when I compare new photos with older images. I had two cases of rat lung worm disease last year, whereby comparisons of old "normal" photos clearly showed differences in the optic nerves.
 
ODwire.org NewsBot said:

Locum optom charged with manslaughter
Optometry Today
A locum optometrist has been charged with manslaughter following the death of an eight-year-old patient in 2013. Honey Rose, 34, from Newham in east London, was charged with manslaughter caused by negligence after failing to diagnose a papilloedema ...

and more »

Continue reading...
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Interesting, now maybe the brits will hold even lawyers and judges to the same standards, maybe even politicians, just thinkin.
 
Angel Adolfo Camblor said:
I'm curious to know if the boy received any other care during the interim between the eye exam and his death. If he was that ill, would not other health care workers been involved in diagnosing the etiology of his symptoms. He surely could not have been acting like a normal 12 year old during that time.

If the child was not seen by anyone else, perhaps parental neglect was at play.
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It did say it was 5 months from eye exam to death. So...
 
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