The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. Bettman JW. 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. Management of dislocated lens fragments after phacoemulsification surgery. National costs of the medical liability system. The mean payment was $117,688, and the median payment was $90,000. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. 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. 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. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. What helps? The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. 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. 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Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Learn more Kachalia A, Kaufman SR, Boothman R, et al. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. 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. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. In some cases, the cause of capsular tear and resulting complication of retained lens fragment was due to circumstances other than the surgeons surgical technique. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of 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. 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. 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.). The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. The mean age was 69 years (range, 4090 years). Start here to find personal injury lawyers near you. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. Bethesda, MD 20894, Web Policies Ho SF, Zaman A. 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. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. Cheney FW, Posner K, Caplan RA, Ward RJ. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. 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). Holak sued Tyson and Eye Associates. The remaining 76 claims (70%) closed without any payments. Professional liability insurance: II The legal environment. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Tackling the dropped nucleus. 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. The technical lens was suppose to give me even better vision in the right eye. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy 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. 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. 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. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Physician-patient communication. Physicians Insurers Association of America . When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. 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? Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. official website and that any information you provide is encrypted Endophthalmitis in patients with retained lens fragments after phacoemulsification. Those with valid cataract surgery malpractice Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. The defendant prevailed in 83% of trials. Each claim was counted separately as a unique case. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. 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. 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.). Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. 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. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. 19851989. 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. After the trial, the jurors were polled. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. 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. 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. 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. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. 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. sharing sensitive information, make sure youre on a federal Socioeconomic Characteristics of Medical Practice 1990/1991. Rofagha S, Bhisitkul RB. Wilkinson CP, Green WR. Can I sue a doctor for a botched cataract surgery? In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. 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%. 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. 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. Causes of cataract surgery malpractice claims in England 19952008. Management of retained intravitreal lens fragments after phacoemulsification surgery. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Retained lens fragments after phacoemulsification. The number of policyholders doubled between years 2000 and 2009. 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. Claims, errors, and compensation payments in medical malpractice litigation. Vincent C, Young M, Phillips A. Liability claims and costs before and after implementation of a medical error disclosure program. Ross WH. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Medical professional liability claims and premiums, 19861996. Management of dislocated lens material. The median time to referral was 1 week in this study. Total cost of defense for all 108 claims was $3,312,688. 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. 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. National Library of Medicine Gilliland GD, Hutton WL, Fuller DG. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Hickson GB, Clayton EW, Entman SS, et al. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). However, the majority of the claims were dismissed and did not result in an indemnity payment. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. A steroid drop prescribed by your ophthalmologist can help. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Ross WH. Mello MM, Chandra A, Gawande AA, Studdert DM. 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. The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. 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. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. Levinson W, Roter DL, Mullooly JP, et al. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. In these early referral cases, the claim was more likely to be dismissed. 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. 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. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Studdert DM, Mello MM, Gawande AA, et al. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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. 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. Before Beckman HB, Markakis KM, Suchman AL, Frankel RM. Spicer J. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Ho LY, Doft BH, Wang L, Bunker CH. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. 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). 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). Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. Medical malpractice and respondeat superior. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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. 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. Both of these were defined as glaucoma, and there were a total of 31 cases. He was referred to a retina specialist, who saw him the next day. 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. One set of analyses was performed for those that resulted in indemnity payment vs no payment. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. 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. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. 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 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. government site. 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. 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