An Ethical Problem

[azzathejunglist]

Hi guys. Just thought i might share a little issue i am having at the moment with a patient that is giving me the worst headache.



Patient comes in 2 weeks ago, 7 years old. Never had an eye test before. Complaining that things "look funny" and headaches every day. I do the refraction and comes out OD -2.00/-13.75x70 OS -1.00/-8.00x80 . When I explained to the mother (who is a herion addict) that this could explain why her child is having visual issues and keeps failing at school and having great learning problems (as you would expect!!!) I get abused and told to mind my own business and stop trying to sell her things she didn't need.

Mother has zero intrest in buying glasses for her child.


Now i am thinking i might just make the specs up myself for the child from my own pocket. - IF i can find a lab that can even make that 13.75cyl

Or i was thinking of reporting to Child Services.

Things like this make me so angry and sad that the mother cannot and will not care bejond her next fix.


Sorry for the little rant but i needed to get that off my chest.

[ChrisW]

Try CR Surfacing

[pknsbeans]

Is that a refraction or an auto refraction? I don't know of a phoropter over 6cyl, so I can't imagine one going up to 13cyl. If it's an auto, you can't trust it in young ones when you see scripts like that cause he could be accommodating and skewing the results. And if you're giving him 13cyl and he doesn't have it, you could be doing more harm than good. The road to hell is paved with....

[azzathejunglist]

Refraction. Took awile to get it nailed down as yeah, my refractor head only goes to -8.00 cyl. Refract, trial frame, autorefract when wearing trial frame. Add more cyl into trial, and keep going. Normally my tests are 20-30 mins......this took an hour. Highest cyl i have seen personally

[pknsbeans]

Wow. I've never seen that much before even in keratoconus cases. I still wouldn't give all of it to him/her.

Good luck.

[COMEINPEACE]

Pachometer reading?

[HarryChiling]

Now i am thinking i might just make the specs up myself for the child from my own pocket. - IF i can find a lab that can even make that 13.75cyl

What's your email address I can PayPal $50 USD toward the pair.

[Dustin.B]

That's a tough case for sure, but it sounds like that child needs some glasses. I don't think I would go calling CPS just yet, at least not without some more solid information to give them, though I think legally this would constitute neglect at least. Best of luck to you.

[other_bill_fea]

We may be able to do something to get you a pair. I'm not actually sure until I try it, as I think the most I've done is -12. But I'm certainly willing to try and run the pair if you give me the specifics.

[pknsbeans]

I think I saw a post before it was edited stating acuity was 6/7.5. Does that convert to about 20/70ish American? How much of the cyl do you think you'll put in the Rx?

[rbaker]

The problem here is not the Rx or the fabrication of a pair of glasses nor the cost involved. As we have seen by the previous posts all that can be taken care of by the caring members of OptiBoard.

The issue is the environment in which the child is living. If the child's environment poses a risk you are legally and morally obligated to report the situation to the appropriate authorities.

The child needs glasses. The mother is sick. She need help.

[Craig]

The problem here is not the Rx or the fabrication of a pair of glasses nor the cost involved. As we have seen by the previous posts all that can be taken care of by the caring members of OptiBoard.

The issue is the environment in which the child is living. If the child's environment poses a risk you are legally and morally obligated to report the situation to the appropriate authorities.

The child needs glasses. The mother is sick. She need help.

I would do as legally obligated as a health care provider in the state of Florida and report the neglect while also making the glasses for the child.
My obligation is to do what is right and imho that is the only option.

I suggest you take up Bill from FEA in making up the lenses; he is a high-minus himself so he understands the patients view, literally.

I have many frame to donate; just tell me what size and style to get to Bill.

[Lelarep]

Can not buying glasses be considered "neglect"? If confronted by CPS she'd likely say she just didn't want to pay their prices and planned to get them somewhere else. etc... Unless you can truly demonstrate neglect (marks on the child, severely underweight, etc...) you could be striking a hornets nest

[pknsbeans]

I agree with lelarep on this. School is just around the corner and they're in a much better position to not only assess the situation, but also address it. If you can get them glasses, great.

[Craig]

Are we trying to protect the child, parent or ourself from what is not occurring in her life?

[Lelarep]

My PoV is based on the 3rd choice. We have to pick and choose our fights. This is one is a very long shot with regard to involving a government agency.

[harry888]

Call school nurse and tell her kid needs glasses for classroom. She will know what to do from there.

[Craig]

As a man who does work with teenage mom's that are wards of the state and young men who where incarcerated for most of their youth until they get put in an adult jail; TIME TO STAND UP FOR THE VOICE THAT CANNOT SPEAK!

I am appalled at the "ostrich" response to a real-life situation the posters are taking; if you where to ask anyone of the kids if they wanted help, the answer would be finally.

Florida law mandates that any professional reports neglect or abuse; same as any OD is supposed to or anyone else who really cares.

What would you want someone to do it is was your kid and you where not there to protect them? That is what I always think of when getting involved to let someone know it is not ok to abuse or neglect kids.

[Craig]

Call school nurse and tell her kid needs glasses for classroom. She will know what to do from there.

The school nurse calls us to help. Should the nurse call the OD or you call the nurse? Sounds like the OD as the doctor should take the lead in getting the child the help needed.

[Craig]

The problem here is not the Rx or the fabrication of a pair of glasses nor the cost involved. As we have seen by the previous posts all that can be taken care of by the caring members of OptiBoard.

The issue is the environment in which the child is living. If the child's environment poses a risk you are legally and morally obligated to report the situation to the appropriate authorities.

The child needs glasses. The mother is sick. She need help.

Why do people defend the mother and ignore the neglect when they both need help.

You made my morning reading your response.

[other_bill_fea]

This also comes down to what the OP can actually do about it. Assuming he has enough information, calling CPS would be a great start. I mean, the worst case there is that they check into it and deem that nothing needs to be done. But at least, at that point, it's been officially looked in to.

The fact that the mother thought there was enough wrong to bring the child in, but then refuse any help is really...strange. Probably enough of an indication to show 'erratic behavior'. And it's not like the child has a small prescription. There should really be no question here that not having corrective eyewear is having a direct impact on the child's quality of life. There's also nothing saying both can't be done - give the child a pair of eyewear (assuming you can get them back in) while also letting CPS know what's up.

[Craig]

We had a scenario a few years ago where the school nurse actually kept a pair of glasses in her office so the sisters would have them at school. Mom did not think they needed them and they where very high rx's in a marginal situation to say the least. The pairs from home kept getting broken or vanishing so we worked with the nurse and she made sure the kids had glasses.

The kids needed help from the mother and this was after it was deemed by CPS that there was nothing they could do but they where aware of the situation.

[fjpod]

So, I assume the mom brought the child in....why?, if she was not at least going to listen to the potential results. Here in NY, we have a school form on which to report eye exams. If you have this over there, I would do this at the very least.

I've had the experience of trying to go over the head of a parent with mental or drug issues. I would suggest NOT tangling with her. As an alternative, maybe you could report to your version of the Child Protectivd Services.

BTW, what was the best corrected VA?

[mervinek]

The problem here is not the Rx or the fabrication of a pair of glasses nor the cost involved. As we have seen by the previous posts all that can be taken care of by the caring members of OptiBoard.

The issue is the environment in which the child is living. If the child's environment poses a risk you are legally and morally obligated to report the situation to the appropriate authorities.

The child needs glasses. The mother is sick. She need help.

Agreed. I think you are better off making that phone call... Let CPS check it out. If it's not an issue than it's not an issue. At least you did what you could to help that poor kid. My heart aches for a child in that environment. Also work with the school nurse. They can be a great resource. I've worked with nurses in the past also with spare glasses etc. Here, Lion's Club with you with no problems.

By the way... this high cyl is common with American Indian patients in the south west US. Not sure if anyone else has run into this, but I had several when working in the Phoenix area years ago.

[drk]

This is in Australia, right?