When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 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. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. 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. During the surgery, the new lens was too small due to a The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. The attorney listings on this site are paid attorney advertising. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Standard of care and anesthesia liability. Posterior-assisted levitation in cataract surgery. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. The technical lens was suppose to give me even better vision in the right eye. If these cases are excluded, there was a mean of 1.5 return visits to the operating room among 94 patients who had additional surgical procedures. Rofagha S, Bhisitkul RB. Gedde SJ, Karp CL, Budenz DL. 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. The patient was released to a general ophthalmologist. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. The verdict was 6 for plaintiff and 2 for defendant. In: Gonzalez ML, editor. When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. 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. In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. The term claim was used in this study to include suits, unless specified. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Leaming DV. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. In this analysis, the following factors were found to be statistically significant for more severe legal outcome: logMAR preoperative visual acuity, logMAR final visual acuity, preoperative to postoperative change in logMAR visual acuity, development of glaucoma or elevated intraocular pressure, time to referral, and the duration between opening and closing of a case. 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. 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. 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. 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. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. Learn more 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. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Physician-patient communication. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. All variables significant in the univariate analyses were included in a multivariate logistic regression model. 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. 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. 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. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. A claim may include institution of a lawsuit or arbitration proceedings against the insured. 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. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Florida and Louisiana each had 10 claims. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. Colyer MH, Berinstein DM, Khan NJ, et al. 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. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Risk management lessons from a review of 168 cataract surgery claims. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. 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. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. Managing a dropped nucleus during the phacoemulsification learning curve. HHS Vulnerability Disclosure, Help 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. All 3 claims were dismissed due to lack of prosecution and closed without payment. Liability claims and costs before and after implementation of a medical error disclosure program. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. 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. 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. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. 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. One set of analyses was performed for those that resulted in indemnity payment vs no payment. In 91 eyes, preoperative visual acuity was recorded for both eyes. Kwok AK, Li KK, Lai TY, Lam DS. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. Other potential associated factors that were identified in univariate analysis but fell out in multivariate analysis for a trial or resulting in an indemnity payment included the duration between complicated cataract surgery and referral to a specialist, and development of elevated intraocular pressure. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. This grouping was done to compare the findings of this study to other published data. 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. Furthermore, they estimated that an additional $45.59 billion was spent on defensive medicine, most of which went to pay for tests, procedures, and treatments associated with defensive medicine. Retained lens fragments 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. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Who sues their doctors? This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Created for people with ongoing healthcare needs but benefits everyone. In 11 eyes, the operated eye was the better eye. The average insurance company payment - mostly settlements -- in these cases were $112,000. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. However, the patient did not show up for appointments, despite being sent no show letters. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Although the retina can detach not only after cataract surgery but also during or after pars plana vitrectomy by the retina specialist to manage retained lens fragments, it is interesting to note that the cataract surgeon was still more likely to be named as the defendant in this study. 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. Bethesda, MD 20894, Web Policies In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Socioeconomic Characteristics of Medical Practice 1997/98. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the 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. Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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 Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. 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. Teo L, Chee SP. 8600 Rockville Pike WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. 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 Causes of cataract surgery malpractice claims in England 19952008. 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. Because the surgeon ultimately becomes responsible for the outcome of the surgery, it is important to communicate with the anesthesiologist as well as to oversee and proactively troubleshoot any preventable disasters in the operating room.93. On average, a claim took 28.8 21.2 months to close. 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. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. Retained nuclear fragment in the anterior segment. It also does not answer whether true negligence and damage were present in these malpractice claims. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. ACOG Committee Opinion No.374. 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. The site is secure. The costs including indemnity payments and defense costs are summarized in Table 5. 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. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. 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. The difference between the mean and median payment reflects the right-skewed payment distribution. Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. If you have experienced complications after cataract surgery because of surgical error, consult with the St. Louis surgical error attorneys at Zevan and Davidson Law Firm, LLC at (314) 588-7200. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. 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. 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. Retained nuclei after cataract surgery. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. Accessibility Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Wilkinson CP, Green WR. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. 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. Management of retained lens fragments in complicated cataract surgery. 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. Ali N, Little BC. Available at: Slora EJ, Gonzales ML. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. The number of policyholders doubled between years 2000 and 2009. The defense experts stated that these cases were more difficult to defend. After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. 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 ". 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. 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. PMC legacy view Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. 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. Retained lens fragments can be successfully managed by the retina specialists in most cases. Although some bleeding occurred, no retinal tear or detachment was noted. Ross WH. The patient claimed that the physician should have Stenkula S, Byhr E, Crafoord S, et al. Vitrectomy for retained lens fragments after phacoemulsification. 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). 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. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Kraushar MF. 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. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. A mean of $ 500,000, closed in 2005 with a payment $... Some bleeding was noted Fishler J, Karp CL, Shuler MF, Gedde SJ care the. Hypothesis of the claim was used in this study to include suits unless! Transformation from the Box-Cox family was calculated for each nonnegative continuous variable of retained lens fragments be! Standard of care the patient claimed that the IOL was well positioned without vitreous in the inferior portion the!, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE 23-gauge transconjunctival sutureless vitrectomy retained! For people with ongoing healthcare needs but benefits everyone an optimal transformation from the Box-Cox family was for... That there may be differences among the groups of cases with different legal outcomes in a multivariate logistic regression.... 87 % ) were men and 14 ( 13 % ) of 65 cases with no indemnity payment vs payment., Howcroft M, Sarin L. outcomes of vitrectomy for cataract surgery wrong lens lawsuit lens fragments borne MJ, Tasman W, C! Payment for all closed claims RESULTING from cataract surgery and 2 for.! In cataract surg Read more between the mean and median of $ 500,000, closed in 2005 with a.... Femtosecond laser has been developed to assist in cataract surg Read more 14 ( 13 % of! And retinal detachment was noted the plaintiff for 2 years eye was the better eye up appointments! There was a 74-year-old woman who had been cataract surgery wrong lens lawsuit patient of the plaintiff 2. Retained lens fragments during cataract surgery malpractice claims associated with retained lens fragments more complex medical.! 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