Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. More than one of these complications was noted in 31 cases. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). Stenkula S, Byhr E, Crafoord S, et al. 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. Socioeconomic Characteristics of Medical Practice 1990/1991. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. He was referred to a retina specialist, who saw him the next day. OMIC underwriting applications and claims records were reviewed. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. If a physician had multiple claims from separate cataract surgeries, each was counted separately. Ho SF, Zaman A. Schutz JS, Mavrakanas NA. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. Levinson W, Roter DL, Mullooly JP, et al. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. When a claim is associated with preventable causes such as insertion of a wrong IOL, in addition to the complication of retained lens fragments, the claim may be more difficult to defend. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. The patient claimed that the physician should have The relationship between physicians malpractice claims history and later claims: does the past predict the future? Whether the findings of this study are representative depends on whether physicians who were covered by the insurance carrier of this study were more or less likely to be sued than physicians who were insured elsewhere. 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. Medical professional liability claims and premiums. 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. 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. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. 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). Yang CS, Lee FL, Hsu WM, Liu JH. 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. 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. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. 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. They ranged from a low of $7,500 to a high of $500,000. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. 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. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Some cases that opened in more recent years are still open and are not a part of this study. Final visual acuity was the last recorded visual acuity. Scott IU, Flynn HW, Jr, Smiddy WE, et al. 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. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. 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 Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. However, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. American College of Obstetricians and Gynecologists. 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. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. PMC legacy view Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. 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. 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. Kachalia A, Kaufman SR, Boothman R, et al. FOIA 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. 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. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. 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. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. Florida and Louisiana each had 10 claims. Standard of care is what a reasonable physician would do in similar circumstances. 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. Kane CK. ACOG Committee Opinion No.374. The The patient refused laser treatment for vitreolysis. 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. For this study, a P value <.05 was considered significant. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. 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. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. A steroid drop prescribed by your ophthalmologist can help. 19851989. 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. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. There 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 be written on this topic.1978 The incidence of retained or dropped lens fragments during cataract surgery is estimated to be between 0.1% and 1.6% of cataract surgeries.18,19,23,29,45,54,64 There are numerous articles to indicate that a capsular tear with retained lens fragment is a well-known complication of cataract surgery.2049 Studies show that reasonably favorable visual outcome can be obtained with intervention usually in the form of pars plana vitrectomy.2049,7477 Therefore, encountering this complication in itself would not be a malpractice. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and WebCataract Symfony Lawsuits? Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. Spicer J. Start here to find personal injury lawyers near you. 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. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Bovbjerg RR, Petronis KR. Medical liability claim frequency: a 20072008 snapshot of physicians. The technical lens was suppose to give me even better vision in the right eye. 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. Management of retained intravitreal lens fragments after phacoemulsification surgery. Vanner EA, Stewart MW. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. Baker PS, Spirn MJ, Chiang A, et al. Bethesda, MD 20894, Web Policies Gedde SJ, Karp CL, Budenz DL. The claim was reported 2 years after the cataract surgery and closed 1 year later. Gonzalez ML. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. 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? Can I sue a doctor for a botched cataract surgery? Ross WH. 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. 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.). If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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. 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. 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