HHS Vulnerability Disclosure, Help The site is secure. Ali N, Little BC. Teo L, Chee SP. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. Why do people sue doctors? 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. The retina successfully reattached with a final visual acuity of 20/25. 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. Total cost of defense for all 108 claims was $3,312,688. The estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Previous studies have shown that the incidence of posterior capsule rupture and posterior dislocation of lens material is higher in cases with residents in training than with cataract surgeons who are experienced at phacoemulsification.94 Although none of the cases in this study resulted from a resident case, one case did involve a cataract surgeon who was overseeing a cataract surgery being performed by his colleague in the transition phase. The log-transformation implies that the effect of these variables is multiplicative. 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. Bethesda, MD 20894, Web Policies 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. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Smiddy WE, Flynn HW, Jr, Kim JE. CI, confidence interval; OR, odds ratio; SE, standard error. 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. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. 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. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. 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. There was additional $103,000 in legal expenses. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Two cases went on to trial and ended with a verdict in favor of the plaintiff. As noted already, the majority of claims are dropped, dismissed, or closed without payment. What helps? Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Risk factors for and management of dropped nucleus during phacoemulsification. 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. Accessibility Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Socioeconomic Characteristics of Medical Practice 1990/1991. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. Two weeks later, visual acuity was hand motions. The term claim was used in this study to include suits, unless specified. Although these findings may cause fear and increased practice of defensive medicine by physicians, better understanding of the incidence, associated factors, and outcomes of medical malpractice claims may result in increased knowledge to the physicians and more effective and improved care to the patients. 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. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Created for people with ongoing healthcare needs but benefits everyone. May M, Stengel B. More than one of these complications was noted in 31 cases. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. During the surgery, the new lens was too small due to a CF, counting fingers; HM, hand motion; NLP, no light perception. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. Even when an IOL has been inserted by the cataract surgeon, the retinal surgeon should be prepared to manage subsequent complications of dislocated or malpositioned IOL, as was the case in some of the claims in this study. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. The attorney listings on this site are paid attorney advertising. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Managing a dropped nucleus during the phacoemulsification learning curve. Merani R, Hunyor AP, Playfair TJ, et al. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Can I sue a doctor for a botched cataract surgery? Bohigian GM, Wexler SA. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. 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. Regan JJ, Regan WM. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. 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. Kraushar MF, Robb JH. 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 What is the recovery after cataract or lens replacement surgery? The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. 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. Among 108 patient claimants, 54 were men and 54 were women. The management of dislocated lens material after phacoemulsification. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. Characteristics of physicians with obstetric malpractice claims experience. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. 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 The number of policyholders doubled between years 2000 and 2009. When the complication of a retained lens fragment has been encountered, the cataract surgeon should closely follow the patient and monitor for complications associated with retained lens fragment and consider timely referral to a specialist for management of further complications that may contribute to poor visual acuity outcomes. 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. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. National Library of Medicine Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. Cheney FW, Posner K, Caplan RA, Ward RJ. 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. 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. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. 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. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. He was referred to a retina specialist, who saw him the next day. 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. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. Yet three or four years ago, UCLA surgeons My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. Claims, errors, and compensation payments in medical malpractice litigation. The costs including indemnity payments and defense costs are summarized in Table 5. Gonzalez ML. Postoperatively, the patient developed hypotony and fibrin reaction. 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. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. 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. Each claim was counted separately as a unique case. 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. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. Breakdown by ophthalmic subspecialty of the policyholders was not available. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Bettman JW. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. The patient was released to a general ophthalmologist. 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. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Those with valid cataract surgery malpractice 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. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). 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. Careers. 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. Management of retained lens fragments in complicated cataract surgery. .I have macular degeneration in the left eye so a technical lens would not have made a difference. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). 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