Medical-Legal Expertise for Ophthalmologists and Healthcare Professionals: Why the Right Expert Matters
Medical-Legal Expertise for Ophthalmologists and Healthcare Professionals: Why the Right Expert Matters
Medicine is becoming increasingly complex.
Even when a physician has acted appropriately and provided care consistent with accepted medical practice, complaints, College investigations, insurance disputes and lawsuits can still arise.
When they do, the quality of the medical expert reviewing the case can make an important difference.
At Fraser Valley Cataract & Laser (FVCL), our physicians have extensive experience in ophthalmology, refractive surgery, cataract surgery and surgical practice. We have also been involved in College physicians & Surgeons reviews, insurance-related legal reviews, medical-legal opinions and preparation of legal letters.
Our medical-legal consulting service is designed primarily to assist physicians and healthcare professionals with the defence of their practice. In unique circumstances, we will consider assisting with a plaintiff complaint.
Our Primary Focus: Medical-Legal Defence
FVCL’s preference is to work with physicians, clinics, insurers and legal counsel on the defence side of medical-legal matters.
Our goal is not simply to find fault with another physician.
Instead, we ask an important question:
“Was the care provided reasonable and consistent with the accepted standard of practice, based upon the information that was available to the physician at the time?”
That distinction is extremely important.
A medical outcome that is less than ideal does not necessarily mean that a physician provided negligent care.
Medicine involves risk. Even excellent medical care can sometimes result in complications, unexpected outcomes or patient dissatisfaction.
A proper medical-legal assessment therefore requires an understanding of both the medicine and the circumstances in which the medical decisions were made.
Why Ophthalmology Requires Specialized Medical-Legal Expertise
Ophthalmology is a particularly technical and separate area of medicine. If you ask any medical physician, the specialty of ophthalmology is a unique complex area of medicine that has very little overlap with other specialties, especially with the equipment and terminology.
Modern cataract and refractive surgery may involve:
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- Advanced biometry
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- Intraocular lens calculations
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- Toric and presbyopia-correcting lenses
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- LASIK and PRK
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- Implantable contact lenses
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- Refractive lens exchange
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- Corneal topography and tomography
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- Ocular surface disease
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- Complications of cataract surgery
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- Postoperative refractive errors
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- Glare, halos and other visual disturbances
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- Enhancement procedures
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- Eyelid and oculoplastic surgery
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- Glaucoma and other ophthalmic conditions
Understanding whether a complication represents negligence requires more than simply reading a patient’s chart.
It requires someone who understands what the surgeon was trying to accomplish, what information was available and communicated, what risks were reasonably foreseeable, what alternatives existed, and what would normally be considered reasonable practice.
A Poor Outcome Does Not Automatically Mean Poor Care
This is one of the most important principles in medical-legal analysis.
A patient can experience a poor outcome despite appropriate care.
For example, a patient may develop a complication that is recognized as a known risk of surgery. The existence of the complication alone does not establish that the surgeon acted improperly.
Similarly, a patient may be unhappy with their vision after cataract or refractive surgery even though the surgery was performed appropriately and the result falls within a range of recognized outcomes. There may be appropriate remedies for such an acceptable but unexpected outcome.
The expert’s responsibility is to distinguish between:
A complication or unexpected outcome
VS
A departure from an appropriate standard of care.
That requires careful analysis rather than hindsight.
Reviewing the Case From the Physician’s Perspective
When reviewing a medical-legal case, we consider questions such as:
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- What was the patient’s condition before treatment?
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- What information was available to the physician at the time?
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- What was the physician’s diagnosis?
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- What treatment options were reasonably available?
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- Was the chosen treatment reasonable?
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- Were appropriate investigations performed?
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- Was the patient appropriately selected for the procedure?
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- Was informed consent appropriately addressed?
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- Was the procedure performed appropriately?
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- Was the postoperative care reasonable?
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- Was the complication recognized and managed appropriately?
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- Were appropriate referrals or consultations made?
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- Was the patient’s subsequent course consistent with a known complication?
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- Is the patient’s current condition medically explainable?
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- Is there a reasonable causal relationship between the alleged error and the claimed injury?
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- Was there appropriate communication and written documentation of the above?
These questions can be particularly important in ophthalmic surgical cases where a patient’s expectations may differ from what can realistically be achieved medically.
Early Review Can Be Valuable
Not every medical-legal case needs a lengthy expert report.
Sometimes the most valuable service is an early, preliminary review.
An experienced ophthalmologist may be able to identify relatively quickly whether a case appears to:
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- Have a strong defence;
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- Require additional investigation;
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- Require a detailed expert report; or
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- Contain concerns that should be carefully addressed before proceeding further.
Early expert involvement can potentially prevent unnecessary expense and help legal counsel determine how best to approach a case.
For this reason, FVCL is available to provide preliminary case assessments before proceeding to a full medical-legal opinion when appropriate.
We Can Review Existing Complaints and Lawsuits
FVCL can provide opinions concerning the defence of current complaints and lawsuits within our physicians’ areas of training and experience.
Our physicians have experience providing first, second and third opinions and have worked with insurance-related legal reviews and legal correspondence. Our physicians are familiar with the Canadian and U.S. legal systems and can familiarize themselves with other jurisdictions when appropriate. (FVCL)
Our areas of ophthalmic expertise include cataract surgery, intraocular lenses, refractive surgery, LASIK, PRK, ICL, refractive lens exchange and eyelid surgery, or any other eye conditions.
What About Plaintiff or Critique Opinions?
Our primary interest is medical-legal defence.
However, we recognize that lawyers and insurers may occasionally require an independent ophthalmic opinion regarding the medical issues in a case.
FVCL may consider providing an opinion concerning criticism of medical care when the matter falls within our physicians’ appropriate areas of expertise and when we can provide an objective, professionally supportable opinion.
Our obligation is always to provide an opinion based on the medical evidence and our professional expertise—not simply to support one side of a dispute.
Objectivity Still Matters in Defence Work
Being retained by the defence does not mean that an expert should automatically support the physician.
A strong medical-legal opinion should be able to withstand scrutiny.
If the medical evidence supports the physician’s care, we should be able to explain why.
If there are areas of concern, those should also be identified and addressed honestly.
The most useful expert is not necessarily the person who will say what the retaining lawyer wants to hear.
It is the person who can provide a credible, evidence-based medical opinion that can withstand questioning, and compare it with the reasonable medical standard of peers.
Medical-Legal Examination and Record Review
Depending on the circumstances, FVCL may provide:
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- Medical record review
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- Medical-legal analysis
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- Written expert opinions
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- Medical-legal examinations
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- Second and third ophthalmic opinions
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- Review of existing expert opinions
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- Defence consultation
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- Consultation with legal counsel
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- Assistance with understanding complex ophthalmic issues
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- Expert testimony when appropriate
Our physicians can work directly with legal counsel, insurers or other authorized parties depending upon the requirements of the case.
Why Choose FVCL?
FVCL is not a general medical-legal consulting company.
Our strength is specialized ophthalmic knowledge combined with extensive real-world surgical experience.
Our physicians are active ophthalmologists and surgeons who understand the practical realities of diagnosing and treating patients.
Dr. Gabriel Chu is a Fellow of the Royal College of Physicians and Surgeons of Canada and is a faculty member at the University of British Columbia.
Dr. Joseph King completed his ophthalmology residency in the United States and subsequently completed fellowship training in laser vision correction. Drs. Chu and King founded Fraser Valley Cataract & Laser in 2013. (FVCL)
That combination of clinical experience and medical-legal analysis can be particularly valuable when a case involves technically complex ophthalmic care.
A Medical-Legal Opinion Should Help Clarify the Medicine
Ultimately, the purpose of a medical expert is to make complicated medical issues easier for lawyers, insurers and, when necessary, courts or tribunals to understand.
A good expert opinion should help answer:
What happened?
Why did it happen?
Was it a recognized complication or an avoidable problem?
Was the treatment reasonable based upon the information available at the time?
Was the standard of care met?
What, if anything, could reasonably have been done differently?
At FVCL, our goal is to provide clear, clinically grounded opinions that help legal professionals understand the ophthalmic issues involved in a case.
When the Medicine Is Complex, Choose an Expert Who Understands the Medicine.
If you are a physician, medical clinic, insurer or lawyer involved in an ophthalmic medical-legal matter, FVCL welcomes inquiries regarding potential cases.
Our primary focus is medical-legal defence, while independent ophthalmic opinions and critiques may also be considered when appropriate. And unique circumstances, we could provide opinions for plaintiff complaints, and we will assess on a case by case basis.
All cases are subject to review for appropriate expertise, conflicts and the ability to provide an objective professional opinion.
Fraser Valley Cataract & Laser
Specialized ophthalmic expertise for complex medical-legal matters.
