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Postoperatively, the patient developed hypotony and fibrin reaction. 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. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. Florida and Louisiana each had 10 claims. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. 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? and transmitted securely. Liability claims and costs before and after implementation of a medical error disclosure program. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Benson JS, Coogan CL. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Jena AB, Seabury S, Lakdawalla D, Chandra A. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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. 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. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. In 94 cases, a referral was made to a subspecialist. Gonzalez ML. von Lany H, Mahmood S, James CR, et al. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Kim IK, Miller JW. 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. Causes of cataract surgery malpractice claims in England 19952008. Abbott RL. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. 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. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. The https:// ensures that you are connecting to the Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. In: Gonzalez ML, editor. 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. Oruc S, Kaplan HJ. 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). 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. 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. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. Medical professional liability claims and premiums. Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. Cheney FW, Posner K, Caplan RA, Ward RJ. The technical lens was suppose to give me even better vision in the right eye. 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. 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. Retained lens fragments in resident-performed cataract extractions. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. Standard of care is what a reasonable physician would do in similar circumstances. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. 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. The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. 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. The patient claimed that the physician should have Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. 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. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. 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. The mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. 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. 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). 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. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. In 11 eyes, the operated eye was the better eye. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. After the trial, the jurors were polled. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Hickson GB, Clayton EW, Githens PB, Sloan FA. 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. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Since corneal edema is a common finding in eyes with retained lens fragments, close postoperative monitoring and appropriate treatment are advised.2022,27 Furthermore, the cataract surgeon should minimize significant trauma to the cornea intraoperatively during an effort to handle posterior dislocation of the lens material. Only the claims that closed by December 2009 were included. The number of policyholders doubled between years 2000 and 2009. Aasuri MK, Kompella VB, Majji AB. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). May M, Stengel B. The defendant prevailed in 83% of trials. 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. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Merani R, Hunyor AP, Playfair TJ, et al. Bethesda, MD 20894, Web Policies Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Hickson GB, Clayton EW, Entman SS, et al. Factors associated with these claims and claims outcomes were analyzed. The items collected during the review of the claims are listed in Table 1. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Margherio RR, Margherio AR, Pendergast SD, et al. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Continuous irrigation was performed, but the nuclear fragment could not be elevated. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Therefore, claims related to cataract surgery accounted for 33% of all closed claims during this period, and cataract surgeries complicated by retained lens fragments accounted for 4% of all closed claims and 12.5% of cataract-related claims. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. This grouping was done to compare the findings of this study to other published data. Physician-patient communication. CI, confidence interval; OR, odds ratio; SE, standard error. 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. American College of Obstetricians and Gynecologists. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. Michels RG, Shacklett DE. Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. 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. 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. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. If a physician had multiple claims from separate cataract surgeries, each was counted separately. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Schaal S, Barr CC. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. FOIA Two cases went on to trial and ended with a verdict in favor of the plaintiff. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. 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. official website and that any information you provide is encrypted According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. 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. Vincent C, Young M, Phillips A. In the multivariate analysis, two factors were found to be associated with indemnity payment: (1) the difference between preoperative visual acuity and final visual acuity and (2) the development of corneal edema or corneal decompensation. Levinson W, Roter DL, Mullooly JP, et al. Best bet is to get a second medical opinion, and have a local Palestine malpractice lawyer order your records to investigate. Use Avvo's lawyer fin Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. Created for people with ongoing healthcare needs but benefits everyone. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. There were differences between claims associated with retained lens fragments that went on to a trial vs settled vs dismissed and whether indemnity payment occurred or not. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. 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. 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. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. Socioeconomic Characteristics of Medical Practice 1990/1991. Posterior-assisted levitation in cataract 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. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. 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. For statistical purposes, only the data from the primary surgeon was analyzed in the study. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Incidence of lens matter dislocation during phacoemulsification. CF, counting fingers; HM, hand motions; NLP, no light perception. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Why do people sue doctors? Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. Start here to find personal injury lawyers near you. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. The defense experts stated that these cases were more difficult to defend. The median payment was $90,000. The relationship between physicians malpractice claims history and later claims: does the past predict the future? Leaming DV. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Ophthalmic malpractice lawsuits with large monetary awards. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. 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. This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. Stenkula S, Byhr E, Crafoord S, et al. Baldwin LM, Larson EH, Hart LG, et al. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. PMC legacy view Yang CS, Lee FL, Hsu WM, Liu JH. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). 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. The patient refused laser treatment for vitreolysis. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Learn more The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. Kachalia A, Kaufman SR, Boothman R, et al. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. The term claim was used in this study to include suits, unless specified. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. 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Unless specified their study, the majority of eyes developed one or more ocular following., this complication has a potentially high likelihood of legal consequences claims, additional! 3 and 7 after the initial cataract cataract surgery wrong lens lawsuit with and without pars vitrectomy! Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular (. The nucleus using 3-port pars plana vitrectomy, membrane peeling, and silicone oil.... Factors associated with cataract surgery COMPLICATE by retained lens fragments Mutual Insurance Company an lens.
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