In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. The incidence of closed claims for retained lens fragments peaked in 1997, but the actual number of closed claims was the highest for years 2001, 2003, and 2004. Factors that prompted families to file malpractice claims following perinatal injuries. Among the 3 claims involving retina surgeons, one claim alleged negligent surgery to remove the dropped nucleus and dislocated IOL, which allegedly led to a subsequent retinal detachment. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Retained intravitreal lens fragments after cataract surgery. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. The median payment was $90,000. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Brick DC. Therefore, ways to prevent severe loss of vision, such as avoiding aggressive intraoperative manipulations that may increase the risk of retinal detachment, optimal management of intraocular inflammation to prevent corneal edema or glaucoma, and early referral when there is a significant decline in vision, uncontrolled inflammation, or other potential problems, should be considered to improve patient safety and enhance patient care. Whether the findings of this study are representative depends on whether physicians who were covered by the insurance carrier of this study were more or less likely to be sued than physicians who were insured elsewhere. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. The patient was informed of the complication. Standard of care is what a reasonable physician would do in similar circumstances. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Learn how we can help. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. HHS Vulnerability Disclosure, Help Mean final visual acuity was 20/200 (range, 20/20 to no light perception). The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. The Studdert DM, Mello MM, Gawande AA, et al. Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. This grouping was done to compare the findings of this study to other published data. Teo L, Chee SP. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. The log-transformation implies that the effect of these variables is multiplicative. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. An anterior vitrectomy was performed. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. Can I sue a doctor for a botched cataract surgery? According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Kraushar MF. Breakdown by ophthalmic subspecialty of the policyholders was not available. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. Causes of cataract surgery malpractice claims in England 19952008. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. Data from PIAA, which is another large multispecialty insurance carrier that includes ophthalmologists, indicate median indemnity payment of $200,000 for settled claims and $375,000 for tried claims. Characteristics of physicians with obstetric malpractice claims experience. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. The new PMC design is here! Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. WebThere has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. Bovbjerg RR, Petronis KR. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. Kane CK. Medical malpractice and respondeat superior. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. This article discusses the most common risks of cataract surgeries, how to prove medical malpractice, and the challenges you will face in a cataract surgery medical malpractice lawsuit. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. Of the 66 claims that were dismissed, Texas had the most claims with 14, followed by Louisiana with 9, California with 8, Illinois with 7, Virginia and Florida each with 4, Kentucky and Colorado each with 3, Arizona, Michigan, and Missouri each with 2, and Alabama, Massachusetts, Nevada, North Carolina, Ohio, Pennsylvania, West Virginia, and Washington, DC, each with one claim. Continuous irrigation was performed, but the nuclear fragment could not be elevated. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Gonzalez ML. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. The verdict was 6 for plaintiff and 2 for defendant. Tackling the dropped nucleus. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Federal government websites often end in .gov or .mil. Start here to find personal injury lawyers near you. On average, a claim took 28.8 21.2 months to close. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Wilkinson CP, Green WR. The term claim was used in this study to include suits, unless specified. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. Follow Posted 4 years ago, 24 users are following. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. This study is limited to those claims from a single insurer, which may not be nationally representative, although it is one of the largest insurers of ophthalmologists in the United States. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. My vision actually was worse after the lens placement. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Rofagha S, Bhisitkul RB. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". The defendant prevailed in 83% of trials. This gender spread was compared with OMIC data on demographics. Retrospective, noncomparative, consecutive case series. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Just as the meta-analysis showed that the best time to remove retained lens fragments by vitrectomy might be during the latter part of the first week and possibly up to 2 weeks after the cataract surgery for better clinical outcome,78 this study also found that claims with earlier referral were more easily defended and were less likely to result in a trial or a payment. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. The remaining 76 claims (70%) closed without any payments. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. Practice styles and preferences of ASCRS members1994 survey. Dr. did correction surgery (for free) after finding and admitting his error. The issue of malpractice has wide-ranging stakeholders, including our society. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. Retained nuclear fragment in the anterior segment. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. The possible outcomes are assumed to be ordered: Trial with a verdict > Settled > Dismissed and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). Colyer MH, Berinstein DM, Khan NJ, et al. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. During the surgery, the new lens was too small due to a There was another 29 months on average until the closure of a claim. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Malpractice, in contrast, requires demonstration of negligence, defined as substandard care that resulted in harm.1 Malpractice suits are usually based on the legal theory of negligence, requiring the presence of the following four elements: (1) duty to treat, (2) breach of duty, (3) cause, and (4) damages. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Careers. Spicer J. Professional liability insurance: II The legal environment. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Learn more Among these, the patients sought a second opinion and referred themselves in 3 cases. Miller KP. Dr made larger incision & needed stitches. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The most common risks are: When Is It Medical Malpractice? WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Merani R, Hunyor AP, Playfair TJ, et al. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. In 91 eyes, preoperative visual acuity was recorded for both eyes. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Managing a dropped nucleus during the phacoemulsification learning curve. In one study that did attempt comparison of observation vs vitrectomy, randomization was not possible because of bias toward vitrectomy for larger lens fragments and more severe inflammation.40. The doctor used a technical lens for my right eye and a standard lens for the left one. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. It appeared that the nucleus was resting on the optic nerve. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). I am currently evaluating a similar case in involving a surgeon placing a wrong lens into a patient, however the error was recognized during the su Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. According to the 2010 report to the OMIC members, approximately 17% of practicing ophthalmologists in the United States are female and 18% of OMIC-insured ophthalmologists are female.17. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. The .gov means its official. Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. A study based on a survey of retina specialists recommended that vitreoretinal surgeons should place an increased importance on the informed consent process and the patient/doctor relationship in order to improve risk management.16 Informed consent is a process rather than a form. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. The median time to referral was 1 week in this study. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Lu H, Jiang YR, Grabow HB. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. However, the cataract surgeon did not document having made this call and the case was settled. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. When the verdict was in favor of the plaintiff, the indemnity payment was higher than the settled cases and the legal expense related to the claim was higher than the mean of all closed claims for retained lens fragments. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. The costs including indemnity payments and defense costs are summarized in Table 5. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. OMIC underwriting applications and claims records were reviewed. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. Hickson GB, Clayton EW, Entman SS, et al. Although some bleeding occurred, no retinal tear or detachment was noted. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. Ho SF, Zaman A. While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. Abbott RL. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Risk management lessons from a review of 168 cataract surgery claims. The relationship between physicians malpractice claims history and later claims: does the past predict the future? Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. This article discusses the most common risks of cataract surgeries, how to prove medical malpractice, and the challenges you will face in a cataract surgery medical malpractice lawsuit. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). Management of dislocated lens fragments following phacoemulsification surgery. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). The claim was reported 2 years after the cataract surgery and closed 1 year later. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. He also damaged the film over the In the first case, the cataract surgery was performed in 1989. Ross WH. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. After the trial, the jurors were polled. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. 19851989. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. American College of Obstetricians and Gynecologists. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. For this study, a P value <.05 was considered significant. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Half of all claims in this study were referred within 1 week of cataract surgery or the same day as detection of the retinal detachment. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P<.001). To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Each claim was counted separately as a unique case. In the table, the estimates give the odds ratio of an indemnity payment when the predictor is changed by one unit for continuous variable (eg, visual acuity change), whereas for categorical variable (eg, corneal edema or decompensation), it means a change from the unlisted group to the listed one. CI, confidence interval; OR, odds ratio; SE, standard error. sharing sensitive information, make sure youre on a federal Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. More than one of these complications was noted in 31 cases. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. Schutz JS, Mavrakanas NA. The mean and median indemnity payments for this group of claims were similar to mean and median of all ophthalmology-related claims combined for this single specialty insurance company. Vanner EA, Stewart MW. Both of these were defined as glaucoma, and there were a total of 31 cases. Scott IU, Flynn HW, Jr, Smiddy WE, et al. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Moore JK, Scott IU, Flynn HW, Jr, et al. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. Yet three or four years ago, UCLA surgeons Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Retained lens fragments in resident-performed cataract extractions. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Previous studies have shown that the incidence of posterior capsule rupture and posterior dislocation of lens material is higher in cases with residents in training than with cataract surgeons who are experienced at phacoemulsification.94 Although none of the cases in this study resulted from a resident case, one case did involve a cataract surgeon who was overseeing a cataract surgery being performed by his colleague in the transition phase. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. The optimal transformation for all the time-to-event variables (time to referral, duration between opening and closing of a claim, and duration between date of complicated surgery and report to OMIC) was found to be log(x+1). In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. Even when an IOL has been inserted by the cataract surgeon, the retinal surgeon should be prepared to manage subsequent complications of dislocated or malpositioned IOL, as was the case in some of the claims in this study. Why do people sue doctors? WebUltrasound: The predominant technology for cataract removal is ultrasound. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. Final visual acuity was the last recorded visual acuity. Created for people with ongoing healthcare needs but benefits everyone. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. An example of one unit change in visual acuity would be going from 20/20 to 20/200. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Bettman JW. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Aasuri MK, Kompella VB, Majji AB. Physician-patient communication. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. National Library of Medicine Retained lens fragments after phacoemulsification. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Two weeks later, visual acuity was hand motions. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. In 3 cases, malfunctioning or unavailability of necessary equipment resulting in prolonged cataract surgery time was thought to have contributed to the patient movement and complication of capsular tear. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. i'm sorry to read of your troubles and I know enough as a practicing physician for 20 years that your course has deviated from the typical cataract In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. An official website of the United States government. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. It involved a 70-year-old female patient who went from preoperative visual acuity of 20/60 to final visual acuity of no light perception. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Since the number of OMIC-insured ophthalmologists continued to grow each year over this 21-year period, the frequency of closed claims related to retained lens fragments relative to the total number of physicians insured per year was actually the highest in 1997 (Figure 3). Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians and gynecologists than it was for pediatricians and psychiatrists. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. Management of dislocated nuclear fragments after phacoemulsification. CF, counting fingers; HM, hand motion; NLP, no light perception.

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