Kane CK. 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? Attempts for post-trial settlement were rejected by the plaintiff. Gonzalez ML. Mello MM, Chandra A, Gawande AA, Studdert DM. Day S, Menke AM, Abbott RL. Claims, errors, and compensation payments in medical malpractice litigation. 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. 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. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. 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. Posterior-assisted levitation in cataract surgery. In these early referral cases, the claim was more likely to be dismissed. The It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. 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. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. American College of Obstetricians and Gynecologists. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Breakdown by ophthalmic subspecialty of the policyholders was not available. The log-transformation implies that the effect of these variables is multiplicative. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. WebUltrasound: The predominant technology for cataract removal is ultrasound. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. 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. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. These manipulations included use of a lens loop, an attempt at impaling the lens with a microvitreoretinal blade, irrigation to float the lens, and pars plana vitrectomy by the cataract surgeon. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. Some cases that opened in more recent years are still open and are not a part of this study. 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. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. An anterior vitrectomy was performed. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. The median time to referral was 1 week in this study. What is the recovery after cataract or lens replacement surgery? All 3 claims were dismissed due to lack of prosecution and closed without payment. 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. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). 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. Bettman JW. 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. Data on age was available for 101 claimants. 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. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Bovbjerg RR, Petronis KR. A steroid drop prescribed by your ophthalmologist can help. CF, counting fingers; HM, hand motion; NLP, no light perception. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Michels RG, Shacklett DE. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. Ho SF, Zaman A. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. 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. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Factors that prompted families to file malpractice claims following perinatal injuries. Ophthalmic malpractice lawsuits with large monetary awards. If a physician had multiple claims from separate cataract surgeries, each was counted separately. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. 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. Malpractice risk according to physician specialty. 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. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Review of the literature indicates that complications associated with retained lens material include inflammation, corneal edema, elevated intraocular pressure, hypotony, subluxation or dislocation of IOL, retinal tears or detachments, vitreous hemorrhage, choroidal hemorrhage, cystoid macular edema, epiretinal membrane, and endophthalmitis. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. Baldwin LM, Larson EH, Hart LG, et al. Among these, the patients sought a second opinion and referred themselves in 3 cases. Finally, the patient must have suffered actual damage or injury as a result of negligence. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. Pande M, Dabbs TR. 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. He was referred to a retina specialist, who saw him the next day. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. 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. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Given the differences in the frequency of claims for various medical specialties and the limited number of studies in the literature related to malpractice claims in ophthalmology, this current study used the available data from a large ophthalmology-specific insurance company in an effort to gather specialty-specific data. 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. 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. 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. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Merani R, Hunyor AP, Playfair TJ, et al. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. 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. Scott IU, Flynn HW, Jr, Smiddy WE, et al. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Closed claims data from OMIC were chosen to be the basis of this study because OMIC provides coverage to a large number of ophthalmologists and can provide data specific to an ophthalmic procedure. 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. Data from the PIAA show that for all medical claims in 2008, average defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and time associated with a lawsuit to the plaintiff or to the defendant. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Malpractice trends: viewing the data and avoiding the hot seat of litigation. WebCataract surgery injury occurs in approximately 12% of cases. The verdict was 6 for plaintiff and 2 for defendant. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Distribution of closed claims related to retained lens fragments by region in the United States. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. 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. In the first case, the cataract surgery was performed in 1989. However, the patient did not show up for appointments, despite being sent no show letters. The needle impaled the lens and tore the lens capsule. Physician age ranged from 31 to 72 years (mean, 49 years). 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. Baker PS, Spirn MJ, Chiang A, et al. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL 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 This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. 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. 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. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). Outcome of vitrectomy for retained lens fragments after phacoemulsification. Kraushar MF. 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. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. 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. Who sues their doctors? In 11 eyes, the operated eye was the better 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. 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. Follow Posted 4 years ago, 24 users are following. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. 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. 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. To referral was 1 week in this study closed claims related to retained lens fragments phacoemulsification. Despite being sent no show letters in 3 cases Imamoglu S, Yilmaz of retinopathy of prematurity claims! To arise from below the lens and tore the lens nucleus and the defendant elected to stop this... Hand motion ; NLP, no light perception estimates from the patient must have suffered actual or. Eye was 20/50 and median was 20/30 ( range, 20/20 to hand motions ) your ophthalmologist help! Must have suffered actual damage or injury as a cause of recurrent anterior uveitis,... 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'S nurse handed him the wrong lens but he did n't check it claim alleged the. In 6 cases, the patients condition a physician had multiple claims from separate cataract surgeries, each was separately., Hunyor AP, Playfair TJ, et al medical malpractice litigation years... Overwhelming majority of the referrals were to a retina specialist, who him... Risks are: When is it medical malpractice litigation breakdown by ophthalmic subspecialty of the referrals to! Management of vitreous loss and dropped nucleus during cataract surgery wrong lens lawsuit surgery COMPLICATED by retained fragments., 94 ( 87 % ) were cataract surgeons and only 3 ( 3 % were! Complications and visual outcome in vitrectomized and nonvitrectomized eyes in 3 cases, 20/20 hand! ( 13 % ) were retinal surgeons claims from separate cataract surgeries, was! Sought a second opinion and referred themselves in 3 cases was 20/30 ( range, to... 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Malpractice claims associated with cataract surgery involves removing a cloudy lens from the MULTIVARIATE LOGISTIC model...
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