Optometrist given suspended sentence

RE: Optometrist given suspended sentence

vetbl.locum — Wed, 07 Sep 2016 16:10:14 GMT

Got to love the Police ..........they just retire early when they screw up

Surely this little boy must have had persistent & progressive signs?

Tragic nevertheless

RE: Optometrist given suspended sentence

Gareth C. — Mon, 05 Sep 2016 17:57:38 GMT

quite a good summary from an online opticians magazine

If this case makes the optometry profession reflect on their practices and review their policies to prevent it happening to anyone again, or encourages other parents to take their children to get their eyes tested with the knowledge that any serious issues would be picked up, then it will be worthwhile.’

These were the words of Suffolk Police senior investigating officer Detective Superintendent Tonya Antonis outside Ipswich Crown court 20 minutes after locum optometrist Honey Rose was found guilty of manslaughter by gross negligence last week (July 15).

Regardless what verdict was reached, a criminal trial of an optometrist for manslaughter through negligence was always going to have huge ramifications on not just optometry, but the wider medical profession too. It was the first time an eye care professional had faced such charges.

The case had naturally caught the attention of local and national news, but it was also on the radar of The Spectator. Writing in a blog at the start of the trial, Ross Clark said there would be very serious repercussions if doctors and scientists were going to be dragged into the courts over alleged misjudgements.

He said: ‘Doctors, terrified of failing to spot lurking conditions, are never going to let a case go without referring the patient for further examination. Any spot, any shadow, any abnormality which could conceivably indicate a serious condition will be seized upon. Hospitals and consulting rooms will fill up with patients called in to have further examinations on what are almost certainly benign conditions but which no doctor or nurse will dare to dismiss as such.’

With the guilty verdict returned by a jury of eight men and four women in a little over three hours, optometry must now assess whether its practices need to be changed or whether the tragic death of Vincent Barker is solely down to a failure in duty of care by Rose during his examination.

Associations were quick to offer their condolences to Barker’s family, but did not offer much more because Rose was still the subject to a fitness to practice suspension. The Association of Optometrists (AOP), of which Rose is a member, did say it was disappointed with the outcome of the case. The College of Optometrists explained the role and scope of the optometrist in practice and in a member bulletin, made it clear that Rose was not a member.

Simon Kelly, a consultant ophthalmologist at Royal Bolton Hospitals NHS Foundation Trust, Beaumont Hospital, Bolton, said the verdict would have an impact on not just high street optometry, but ophthalmology too. ‘This conviction is not in my opinion the way forward to improve the diagnosis of papilloedema in the community or indeed patient safety,’ he said.

In the short to medium term it’s likely that more optometrists are going to refer patients to eye hospitals, which are already overstretched, because of a fear of missing pathology.

Practitioner-level reaction has been mixed. BBR Optometry chairman Nick Rumney moved quickly to allay fears among patients: ‘I know people will have concerns following this court case and, firstly, I want patients to know that papilloedema is rare and eye examinations carried out by all optometrists, including particularly stringent guidelines applied to every child’s examination, is designed to provide peace of mind.

‘BBR is regulated by the General Optical Council (GOC) and all of our optometrists are members or fellows of the College of Optometrists which issues such guidance. This is to ensure we are capable of detecting disease, injury or abnormality in the eye or elsewhere.

‘These standards also cover how to conduct a routine eye exam, how to examine children, the review of clinical images taken by an assistant, how an optometrist should safely and correctly keep patient records and when a patient should be referred.’

Online optometry forum theoptom.com has highlighted a feeling of uncertainty over the verdict, and some members have considered a crowd funding project to help Rose get a new defence team in the event of any appeal.

Police investigation

Detective Superintendent Antonis said the case had been a complex enquiry that was initially submitted to police as the sudden unexplained death of a child, but as investigations went on, it started to become clear that Barker had been subjected to a number of failures during his trip to Boots Opticians, Upper Brook Stret, Ipswich, in February 2012.

‘In these circumstances we start a full investigation to understand why that child has died and if we believe there are criminal acts involved we aim to put the facts before a court to bring those responsible to justice.

‘During the course of this enquiry we discovered that, in our view, there was a criminal case to answer, leading to Honey Rose being charged. However, this case was about much more than justice for Vinnie’s family.

‘Whatever the outcome of the trial it was never going to bring Vinnie back and it was never their aim to see Honey Rose imprisoned, they only want to raise awareness of the issue so that something positive can come from his death,’ she said.

Trying to find a positive aspect from Barker’s death was also the main concern for parents, Ian and Joanne Barker: ‘Our main concern has always been the accountability of those we entrust with our own health and the health of those we love.

‘It is the responsibility of individuals and the organisation they work for to perform their duties to the expected levels of good practice without exception. The actions of professionals or their failure to act to a standard at which they are required to perform should not go without consequence.

‘It is not our intention to damage the reputation of optometrists, but actually to raise awareness and promote the health benefits and value of good optometry. Because, we believe, without doubt, that if our son had received the duty of care he was owed on February 15 2012, he would still be with us today.’

The hearing

The nine-day hearing heard how Vincent Barker died in July 2012 after fluid built up in his brain. A post-mortem examination revealed that he had died from previously undiagnosed hydrocephalus – a build-up of fluid on his brain – which led to an increase in pressure in his skull. Five months earlier he attended an eye examination performed by Rose in the Boots Opticians.

Addressing the jury at the start of the trial, prosecutor Jonathan Rees QC said retinal images taken during his eye test had showed he was suffering from bilateral papilloedema. But the condition was not noticed by Rose during her examination, even though the images were clearly ‘abnormal’.

Rees said that any competent optometrist would have noticed the symptoms and referred him to hospital for urgent treatment, but he was instead allowed to return to his home in Ipswich with his mother.

The court head that his life could have been saved if the condition had been recognised and he had undergone surgery by a neurosurgeon to relieve the pressure of fluid on his brain.

Rees added: ‘This procedure would have prevented him from dying on July 13 2013, and he would have continued to enjoy a normal life as a young boy. Put another way, the defendant’s failure to detect the swelling of Vinnie’s optic discs was a significant contributory factor to his premature death. She either simply didn’t bother to examine the back of his eyes, or carried out such a slapdash examination that she did not focus on his optic discs.’

The court heard that Barker had retinal photographs taken by an ‘optical consultant’ before the eye examination with Rose. She told police that she believed the staff member had accidentally shown her the retinal images from Vinnie’s previous eye test in 2011 which showed no signs of ill health.

Rose also claimed that she had used an ophthalmoscope to look into the back of his eyes, but he was showing pain and aversion to light so she stopped using the instrument and had to rely on the retinal images.

But Vincent’s mother, who took him for the eye test with his sister Amber, said he had shown no signs of being sensitive to light during the test and nothing was mentioned by Rose at the time or indeed recorded on patient notes.

In her testimony, Rose recalled a voluntary police interview in which she had said that she had worked four times previously at the Boots branch and had based her assessment of the patient on retinal photographs which showed his optic discs were healthy. But she said she did not know how to operate the screen on the camera and asked one of her colleagues to display it.

She claimed that it appeared she had accidentally been shown the images form his earlier eye test and she had never previously seen the ones which showed a ‘completely pathological problem.’

Optical consultant Carol Cocker, who was working at the Upper Brook Street practice at the time, appeared in court to explain her role in practice, which included taking retinal images. Cocker said she received no formal training on interpretation of the images, but would still pre-warn the optometrists about things like shadows on the retina.

Cocker was not able to recall whether she took Vincent Barker’s retinal photos, but did speak about technical problems with the systems at the Boots practice. These included a malfunctioning shutter and a faulty display. This was relayed to the practice manager, but no logs or reports were filed by her. The jury also heard that there had been a power cut at the practice on the day in question, but the technology and innovations witness for Boots Opticians, Martin Donoghue, said this would only have affected the practice management systems.

In an agreed statement to police Rose also claimed she may not have had sufficient instructions from the multiple in the workings of its IT systems. During her time there, she said that help with systems was requested but not always given. The statement also included details of Rose’s approach to children’s eye examinations and her preference for use of fundus images instead of a slit lamp and ophthalmoscope. This was because she preferred to work further away from the young patient.

Closing statements from the prosecution said that throughout the case, Rose had attempted to shift blame away from herself. Defence argued there was simply not enough evidence to return a guilty verdict and the tests performed on the child would have to have been a departure from her usual routine. The only unusual aspect was the element of photophobia and lack of co-operation, which the defence said had been adequately explained by Rose. The jury did not agree.

The coming months are likely to see optometry regulation and retailing asking itself some tough questions.

A statement from Ian and Joanne Barker added: ‘The outcome of this case does not change our life sentence; we will never be able to fully accept that our special little boy is never coming home. The void left in our lives will never heal and the ripple effect to those around us is immense.

‘As parents the distress of witnessing your child’s life from start to end in just eight short years is excruciatingly hard and nonsensical. The decision of a jury or judge cannot bring Vinnie back or undo the devastation of his death. A guilty verdict would never make us winners; our loss is simply too great.’

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Fri, 02 Sep 2016 17:39:10 GMT

I simply can't believe a child who had obvious bilateral papilloedaema could be asyptomatic. The court reports could be misleading if the parents committed perjury

Wynne

RE: Optometrist given suspended sentence

vetbl.locum — Thu, 01 Sep 2016 23:02:48 GMT

Good question.......

Guess you need to access the court report to find out as newspapers as somewhat unreliable

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Tue, 30 Aug 2016 12:01:34 GMT

Was the child asymptomatic?

Wynne

RE: Optometrist given suspended sentence

Bob Russell — Tue, 30 Aug 2016 11:30:25 GMT

The case is a real disgrace!

An optometrist has the primary role as someone responsible for primary vision care. They should be able to identify that certain pathologies are present but is it really realistic that a High Street Boots employee is going to pick up every case?

How much experience of swollen optic discs will she have seen?

She may have been a pretty cr+p optometrist or she may not have been. The Judge accepted this was a 'single lapse'.

Perhaps Boots should have a review process where photographs are assessed by someone else. Human X-rays often get a second look!

I also find it hard to understand why the child remained asymptomatic for so many months!

The whole legal exercise strikes me as being a crazy overreaction. A disciplinary process (only starting now) would have lead to striking off where appropriate.

The tax payer has paid an arm and a leg for vengeance and the impact of this is likely to reverberate throughout the semi-medical world. Not sure this will benefit anybody but will create such a defensive culture.

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Tue, 30 Aug 2016 08:08:23 GMT

Definitely not. It would be necessary to totally rewrite both anatomy and pharmacology textbooks to fall for that one. Simply not scientifically feasible. He was murdered for telling the inconvenient truth.

Wynne

RE: Optometrist given suspended sentence

vetbl.locum — Tue, 30 Aug 2016 02:44:32 GMT

'Dr David Kelly's murder.'

You don't believe the suicide theory then!!!!!!!

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Mon, 29 Aug 2016 11:22:08 GMT

It's the most scientifically improbable explanation for a death I've heard since Dr David Kelly's murder. I wonder whether the coroner was a doctor, or a lawyer.............I suspect the latter.

Wynne

RE: Optometrist given suspended sentence

grumpyoldman — Sun, 28 Aug 2016 12:36:38 GMT

Its is true that crap parents rarely get directly blamed for anything unless they are obviously chavtastic Sun readers.

Madelaine McCann springs to mind immediately, that was, at the very least abandonment and neglect. Sitting on the beach in Anglesea a few weeks a go ,watched some people sea canoeing? kayaking very nervously with 1-2ft waves, on reaching the beach the boat produced a very upset toddler and a 3 month old baby with two adults ,one of whom, the mother was clearly not happy with the whole expedition. You do wonder want goes no in some peoples minds sometimes . The overwhelming desire to carry on with their old ways inspire of the kids appearance undoubtedly puts them at needless risk. Should these people be having kids at all if they are not prepared to have their style cramped for a bit ?.

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Sun, 28 Aug 2016 10:02:30 GMT

Glen , let me get this absolutely straight.

Are you saying the child had headaches, the parents took him to an optometrist, but not a doctor. There was bilateral papilloedaema. The headaches miraculously disappeared for 5 months, then the child suddenly deteriorated in the last 24 hours of his life!

Now, why why why do I find that difficult to believe?

Wynne

RE: Optometrist given suspended sentence

David Mills — Sun, 28 Aug 2016 01:06:05 GMT

Usual owner/parent guilt, looking for someone to blame, typical innocent model parent spiel when they feel bad about neglecting their child's health. Disgraceful prosecution.

RE: Optometrist given suspended sentence

Michael Woodhouse — Sat, 27 Aug 2016 21:58:06 GMT

[quote user="Glen McIntosh"]But an optometrist working at Boots is not a medical doctor, and certainly not a specialist, and their caseload consists almost entirely of people wanting prescriptions for their spectacles and contact lenses. [/quote]

They have spent 3 or 4 years studying eyes. I know when I got my eyes tested they examined my retina and optic disc and took photographs - that they showed me. What the hell is the point of this screening if it doesn't pick up such things?

Optometrists are registered healthcare providers. It's unlucky, but I feel just in this case. I suspect if more of a generalists (such as a GP who maybe only looks in a few eyes each week) had missed the changes the outcome wouldn't be the same.

RE: Optometrist given suspended sentence

Glen McIntosh — Sat, 27 Aug 2016 18:00:41 GMT

[quote user="Hannah Wynne Richards"]My understanding of the law has always been that manslaughter was the unintentional killing of a human whilst committing another crime.[/quote]

No, that is the rule of felony murder, which says that you are guilty of murder if you kill someone in the course of committing some other felony. This rule is abolished in England, however there is still the "joint enterprise" doctrine which holds that if more that if someone is killed during the course of a criminal enterprise, all of the people involved in committing the crime may be culpable for the homicide (either as murder or manslaughter), not just the person who committed the homicide.

Manslaughter is the legal term for a homicide where the circumstances give rise to culpability that is less than murder. Another way of putting it is that manslaughter is unlawful homicide without malice aforethought, and murder is unlawful homicide with malice aforethought.

[quote user="Evelyn Barbour-Hill"]my suspicion is that they say that, but what they really want is revenge and with a bit of luck some money too.[/quote]

Yes, quite. And a criminal conviction will certainly increase the likelihood of success of any civil action, which is sure to follow.

But it isn't the victim or their family that decide to pursue the criminal case, it is the CPS who base their decision on the following questions: Is there sufficient evidence for a realistic prospect of conviction? and Is a prosecution required in the public interest?

[quote user="Hannah Wynne Richards"]Maybe there's some information missing, such as the fact that the boy collapsed shortly after the examination, but survived for months in a coma. Unless this is the case, then , if the condition was that obvious, surely the boy would have shown some symptoms in the intervening period, so why didn't his parents take him to a doctor earlier?[/quote]

He saw the optometrist on 12 Feb 2012 and there is no mention of any illness until the early hours of the morning on the day he died. From the Daily mail:

"In the early hours of July 13 2012 the day of Vinnie's death he went to his parent's bedroom complaining of headache.

His father, Ian Barker, gave him Calpol and he went back to bed and the following morning he ate a breakfast and went to school and he seemed fine.

However around 2.50pm the school called Mrs Barker to report Vinnie was sick.

She collected him and took him home where he deteriorated.

By 8pm Mr Barker discovered Vinnie was cold to the touch and very sick so he called 999 and paramedics came to resuscitate him before taking him to the A&E department at Ipswich Hospital.

At 9.27pm Vinnie was formally pronounced dead after 40 minutes of attempts to resuscitate him."

Makes me wonder if parental guilt may be a driving factor here.

5 months is along time for a child to have hydrocephalus that was already causing pappiloedema. Surely there must have been other symptoms during that time that might also have prompted more serious medical intervention other than a routine trip to the optometrist?

If this was an ophthalmologist who had misdiagnosed, then yes, I could more easily understand the attachment of a higher degree of responsibility for identifying papilloedema, because they are specialist medical practitioners with years of advanced training and a caseload that provides high exposure to serious pathologies.

But an optometrist working at Boots is not a medical doctor, and certainly not a specialist, and their caseload consists almost entirely of people wanting prescriptions for their spectacles and contact lenses. How many times in the normal course of a career might an optometrist see papilloedema - once or twice?, never? Yep, there is apparently irrefutable documented evidence that she missed an obvious diagnosis. But if that evidence wasn't available, would anybody even consider looking at an optometrist as being responsible for a death that occurred 5 months after the consultation?

I think the parents might also be guilty of playing the role of amateur diagnosticians (as many parents and pet owners often do). Their child had complained of headaches, yet they took him to an optometrist. You go to an optometrist because you think you might need glasses, not to get a diagnosis for the cause of headaches. You go to a doctor for that, who then refers you to an optometrist if he/she thinks you need glasses.

An optometrist shouldn't have been the only professional in a position to prevent this child's death.

Whose fault is that?

RE: Optometrist given suspended sentence

Robin Grimmer — Sat, 27 Aug 2016 16:20:32 GMT

I would have thought any half decent lawyer could appeal and get this conviction thrown out.

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Sat, 27 Aug 2016 16:16:34 GMT

When did this child 1st show symptoms?

What were those symptoms?

When was the child 1st presented to a doctor?

How many times was he seen by a doctor before further referral?

I can't understand this case at all, because I can't see how the optometrist can be solely responsible. Either the parents were partly responsible in delaying taking their child to a doctor, or the doctor(s) were partly responsible in also failing to diagnose the condition. There's no doubt that the optometrist was partly resonsible, but it beggars belief that she was the sole cause of this death.

Wynne

RE: Optometrist given suspended sentence

Neil Wheadon — Sat, 27 Aug 2016 16:02:58 GMT

[quote user="Martin Atkinson"]The client in question is a GP and you could see litigation in her eyes until I asked her that if I had genuinely missed something which was obvious[/quote]

This is the worst example

Bring something on due to ignorance, but don't throw stones in greenhouses. I hope he/she goes home and was thoroughly ashamed after your reply.

Neil

RE: Optometrist given suspended sentence

grumpyoldman — Sat, 27 Aug 2016 16:00:00 GMT

If the child had papillodema it had raised intracranial pressure ,significantly higher ICP , which would have manifest itself as changed mentation headaches stupor other cranial nerve signs. given a dogs IOP IS 15-20 we rarely see papillodema without lots of other neurology and ICP > 40 ,and its the other neurology that causes the presentation not the papillodema. I would not be happy seeing a vet disciplined for not noticing or missing changes in the optic nerve head of a patient with a single eyed blindness and no other pathology in a basic consult.

Several years ago a friend was repeatedly to and fro to the doctors with their daughter who was experiencing headaches etc , attributed to migraine exam stress etc , an ophthalmologist moved in next door, noticing the girls unhappy expression he examined her and advised an immediate MRI . Unfortunately the girl died 3 months later,

no one was tried convicted reported or disciplined ,sometimes bad things happen and I guess some of us are better at dealing with it than others.

RE: Optometrist given suspended sentence

Evelyn Barbour-Hill — Sat, 27 Aug 2016 14:58:27 GMT

[quote user="Arlo Guthrie"]My suspicion is that in situations like this, what the victims (or their families) actually want is an apology, a recognition that a mistake was made and proof that steps have been taken to prevent them happening again. They pursue justice when that isn't forthcoming. [/quote]

Call me Mr. Cynical but my suspicion is that they say that, but what they really want is revenge and with a bit of luck some money too.

I await vituperation.

[quote user="Arlo Guthrie"] various people made the point that her behaviour fell SO far below the expected professional standard that the charge / sentence was warranted. [/quote]

No. From what is reported, there was apparently negligence; quite probably the behaviour apparently fell so far etc... that a disciplinary hearing was indicated; but it could only be the criminal offence of manslaughter if her actions or inactions were a direct cause of the boy's death. Which, from the brief report here, does not appear to be so.

I wonder if the judge's remarks were actually intended as hints that the verdict was perverse.

RE: Optometrist given suspended sentence

Hannah Wynne Richards — Sat, 27 Aug 2016 12:33:44 GMT

My understanding of the law has always been that manslaughter was the unintentional killing of a human whilst committing another crime.

Therefore if 2 people fight ( other than in a proper boxing match) and 1 is knocked out and dies, that is manslaughter. If a boxer dies, it isn't. That's because referreed boxing isn't illegal..........brawling is.

Unless carrying out an eye examination is now illegal, then I'l have to revise my definition of manslaughter.

The other factor I find puzzling was that the boy didn't die until 5 months later. Maybe there's some information missing, such as the fact that the boy collapsed shortly after the examination, but survived for months in a coma. Unless this is the case, then , if the condition was that obvious, surely the boy would have shown some symptoms in the intervening period, so why didn't his parents take him to a doctor earlier?

Very puzzling.

Wynne

RE: Optometrist given suspended sentence

Martin Atkinson — Sat, 27 Aug 2016 11:30:19 GMT

I had a client come in yesterday complaining that I missed a dental condition in her rabbit for which it had to go for emergency dental treatment at another vet a week later and she's going to report me to the RCVS. Quite honestly I couldn't remember the case and to make matters worse I didn't write any clinical notes, it just indicates she was sold some Xenex, however, the appointment reason states: 'check for itchy skin'. Fortunately a student was present in the consultation and she clearly recalls that all the client mentioned was the rabbit was scratching itself and spent as much time asking for advice about getting a companion. I took an acetate strip and looked for mites under the microscope and although the slide showed no mites I suggested she used the Xenex as a precaution as a negative never proves the abscence of anything. She recalls that at no time was anything mentioned about anorexia, dysphagia, salivating, grooming difficulty or anything else that may lead me to suspect a dental problem. I am usually pretty hot on rabbit dental disease and often check the teeth on a routine examination but are we supposed to do a full examination of every body system even when presented with a relatively trivial condition?

The client in question is a GP and you could see litigation in her eyes until I asked her that if I had genuinely missed something which was obvious, which I refute anyway, has this not ever happened to her? Her attitude softened a little after that. I don't recall the average GP even getting from behind their desk when I've gone in with a minor problem let alone given me a full health check. What is the world coming to?

RE: Optometrist given suspended sentence

Arlo Guthrie — Sat, 27 Aug 2016 10:46:05 GMT

[quote user="grumpyoldman"]Seems extremely harsh[/quote]

That was my first reaction too. I mean, she missed something. It happens. People make mistakes. Then again, various people made the point that her behaviour fell SO far below the expected professional standard that the charge / sentence was warranted.

Still, I wonder which serves the public interest better: the creation of a climate of fear amongst practitioners which is inevitably out of proportion to the actual risk of prosecution (I think only 13 practitioners have EVER faced similar charges). Or the delivery of justice for the very small number of cases of this sort.

My suspicion is that in situations like this, what the victims (or their families) actually want is an apology, a recognition that a mistake was made and proof that steps have been taken to prevent them happening again. They pursue justice when that isn't forthcoming.

So for me, the public interest would be far better served if practitioners were immune from prosecution PROVIDED that they could show that these things had been done.

At best, prosecution might cause:

[quote user="grumpyoldman"]ultimately it may generate a none committal communal diagnostic approach involving 3 or more clinicians with a majority report outcome.[/quote]

But I think more likely it will lead to more mistakes being covered up.

RE: Optometrist given suspended sentence

grumpyoldman — Fri, 26 Aug 2016 21:20:33 GMT

Seems extremely harsh , ultimately it may generate a none committal communal diagnostic approach involving 3 or more clinicians with a majority report outcome. This will make things prohibitively expensive delaying diagnosis and rendering subsequent treatment less or ineffective . The only people to gain from this decision will be solicitors and barristers, as usual.

RE: Optometrist given suspended sentence

Robin Grimmer — Fri, 26 Aug 2016 18:12:07 GMT

I'm no lawyer, but manslaughter?? Although she missed the diagnosis, she didn't cause his illness. Maybe a case for a civil action, but not criminal surely.

RE: Optometrist given suspended sentence

Neil Wheadon — Fri, 26 Aug 2016 16:31:45 GMT

Surgeon was prosecuted as well a few years ago. There is a degree of disquiet about this. I think there were 13 cases in the pipeline last year according to BBC news yesterday.

Bland statement from the parents basically saying that the prosecution will keep standards up and if you are competent you have nothing to fear.

The thing is, however hard you try you don't get everything right every time do you? We're not automatons.

Neil