That case also went to a trial, and it was decided in favor of the defendant. 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. Kraushar MF. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. The patient refused laser treatment for vitreolysis. 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. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. However, the cataract surgeon did not document having made this call and the case was settled. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. and transmitted securely. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. If a physician had multiple claims from separate cataract surgeries, each was counted separately. May M, Stengel B. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. HHS Vulnerability Disclosure, Help However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. He was referred to a retina specialist, who saw him the next day. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Medical professional liability claims and premiums. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. 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. 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. Medical professional liability claims and premiums, 19861996. 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. 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. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by 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. The verdict was 6 for plaintiff and 2 for defendant. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. They ranged from a low of $7,500 to a high of $500,000. Two weeks later, visual acuity was hand motions. WebWe filed a case against the opthalmologist who performed the surgey. Standard of care and anesthesia liability. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Claims were separated into regions of the United States as seen in Figure 4. Causes of cataract surgery malpractice claims in England 19952008. 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. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. 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. 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. Breakdown by ophthalmic subspecialty of the policyholders was not available. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as 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. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. 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. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. On average, a claim took 28.8 21.2 months to close. Ho LY, Doft BH, Wang L, Bunker CH. 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. 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. 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. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. 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 Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Of the 30 claims that were settled, there were 6 claims from Illinois; 5 from Florida; 3 from California; 2 claims each from Colorado, Michigan, and New York; and one claim each from Georgia, Louisiana, Missouri, Nevada, Tennessee, Texas, Virginia, Washington, West Virginia, and Wyoming. 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. 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 trial was in favor of the plaintiff with a payment of $231,754. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. 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. Claims that were dismissed, dropped, or closed without compensation were combined as dismissed, and the term dismissed was used interchangeably with closed without compensation, dropped, and withdrawn, unless specified. 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 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<.001). In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. The issue of malpractice has wide-ranging stakeholders, including our society. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Practice styles and preferences of ASCRS members1994 survey. Risk factors for and management of dropped nucleus during phacoemulsification. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. 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. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Socioeconomic Characteristics of Medical Practice 1990/1991. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Schutz JS, Mavrakanas NA. Male physicians may have a higher likelihood of being sued because male physicians are historically concentrated in the specialties with the highest levels of claim incidence, such as surgery, and female physicians in those with the lowest incidences, such as pediatrics. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. 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 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. Por YM, Chee SP. Who sues their doctors? 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. Mello MM, Chandra A, Gawande AA, Studdert DM. Created for people with ongoing healthcare needs but benefits everyone. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. 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. Scott IU, Flynn HW, Jr, Smiddy WE, et al. Kachalia A, Kaufman SR, Boothman R, et al. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. Factors that prompted families to file malpractice claims following perinatal injuries. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Brick DC. Oruc S, Kaplan HJ. Conservative management could be considered for eyes with good baseline visual acuity. Final visual acuity was the last recorded visual acuity. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Careers. 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. Yang CS, Lee FL, Hsu WM, Liu JH. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Attempts for post-trial settlement were rejected by the plaintiff. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Holak sued Tyson and Eye Associates. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Before Retained lens fragments after phacoemulsification. 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. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. 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. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). 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. 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 Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. 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 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 distribution of the number of closed claims related to the complication of retained lens fragments per year from 1989 through December 2009 is shown in Figure 2. In these early referral cases, the claim was more likely to be dismissed. The new PMC design is here! Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Smiddy WE, Flynn HW, Jr, Kim JE. 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 lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Colyer MH, Berinstein DM, Khan NJ, et al. 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. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. von Lany H, Mahmood S, James CR, et al. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Schaal S, Barr CC. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. 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. 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. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. 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. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. 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). Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. Those with valid cataract surgery malpractice The mean age was 69 years (range, 4090 years). But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. 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. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Management of dislocated lens material. 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