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. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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). Gonzalez ML. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. 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 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. He also damaged the film over the AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. 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. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. 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. Outcome of vitrectomy for retained lens fragments after phacoemulsification. 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 Furthermore, they estimated that an additional $45.59 billion was spent on defensive medicine, most of which went to pay for tests, procedures, and treatments associated with defensive medicine. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? It appeared that the nucleus was resting on the optic nerve. 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. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. In the first case, the cataract surgery was performed in 1989. Attempts for post-trial settlement were rejected by the plaintiff. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. 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. Four patients declined any further surgery. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Start here to find personal injury lawyers near you. 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. 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. 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. The number of policyholders doubled between years 2000 and 2009. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. 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. 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. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Colyer MH, Berinstein DM, Khan NJ, et al. Only the claims that closed by December 2009 were included. 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. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. 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. The new PMC design is here! The term claim was used in this study to include suits, unless specified. 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. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. 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. 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. 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. Oruc S, Kaplan HJ. 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. Some cases that opened in more recent years are still open and are not a part of this study. As noted already, the majority of claims are dropped, dismissed, or closed without payment. 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. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. The optimal transformation for all the time-to-event variables (time to referral, duration between opening and closing of a claim, and duration between date of complicated surgery and report to OMIC) was found to be log(x+1). ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. The site is secure. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. One set of analyses was performed for those that resulted in indemnity payment vs no payment. After the trial, the jurors were polled. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. The estimated effects of each predictor are shown in Table 8. Retained nuclear fragment in the anterior segment. 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. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. National costs of the medical liability system. 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. Ross WH. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Seven hundred medicolegal cases in ophthalmology. 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. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. An anterior vitrectomy was performed. sharing sensitive information, make sure youre on a federal The costs including indemnity payments and defense costs are summarized in Table 5. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. Can I sue a doctor for a botched cataract surgery? Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. 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. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. 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. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. 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). May M, Stengel B. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. The mean defense costs per claim were $30,692. CF, counting fingers; HM, hand motions; NLP, no light perception. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Management of retained lens fragments in complicated cataract surgery. 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. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. 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. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. WebUltrasound: The predominant technology for cataract removal is ultrasound. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. 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). Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Vitrectomy for retained lens fragments after phacoemulsification. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Kim IK, Miller JW. He was referred to a retina specialist, who saw him the next day. Physicians Insurers Association of America . 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. 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. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Medical professional liability claims and premiums, 19861996. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. Management of dislocated nuclear fragments after phacoemulsification. Claims, errors, and compensation payments in medical malpractice litigation. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. 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. Standard of care is what a reasonable physician would do in similar circumstances. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. 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. Physician-patient communication. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. These transformed variables were used in further analyses. 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. Aasuri MK, Kompella VB, Majji AB. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Brick DC. 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. 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Two weeks later, visual acuity was hand motions. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. The items collected during the review of the claims are listed in Table 1. Wilkinson CP, Green WR. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. Teo L, Chee SP. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. 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. ACOG Committee Opinion No.374. Learn more Stenkula S, Byhr E, Crafoord S, et al. Schutz JS, Mavrakanas NA. 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. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. 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). ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). 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.). If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. 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. Management of nucleus loss into the vitreous: long term follow up in 63 patients. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. 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. They ranged from a low of $7,500 to a high of $500,000. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Standard of care and anesthesia liability. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Smiddy WE, Flynn HW, Jr, Kim JE. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment.
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