Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. Outcome of vitrectomy for retained lens fragments after phacoemulsification. 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. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. A claim may include institution of a lawsuit or arbitration proceedings against the insured. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. 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. 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. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). 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. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. Dr. did correction surgery (for free) after finding and admitting his error. As noted already, the majority of claims are dropped, dismissed, or closed without payment. 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. 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. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. 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). Baker PS, Spirn MJ, Chiang A, et al. This gender spread was compared with OMIC data on demographics. These transformed variables were used in further analyses. They ranged from a low of $7,500 to a high of $500,000. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. 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. Seven hundred medicolegal cases in ophthalmology. 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. Hickson GB, Clayton EW, Entman SS, et al. 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. 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. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. 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. WebCataract surgery injury occurs in approximately 12% of cases. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). National costs of the medical liability system. 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. Before Practice styles and preferences of ASCRS members1994 survey. 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. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. 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. 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. In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Gonzalez ML. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. An example of one unit change in visual acuity would be going from 20/20 to 20/200. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Levinson W, Roter DL, Mullooly JP, et al. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. In 91 eyes, preoperative visual acuity was recorded for both eyes. 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. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to Vanner EA, Stewart MW. 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. Two cases went on to trial and ended with a verdict in favor of the plaintiff. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. In 94 cases, a referral was made to a subspecialist. 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. The issue of malpractice has wide-ranging stakeholders, including our society. Miller KP. For this study, a P value <.05 was considered significant. 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. In addition to alleged negligent cataract surgery with retained lens fragments, placement of the wrong IOL was cited as a contributing negligence in 3 cases: (1) placement of wrong-powered IOL handed to the surgeon by a nurse; (2) not having the correct type of IOL to insert in the setting of capsular rupture, resulting in increased likelihood of subsequent dislocation of IOL; and (3) placement of wrong-powered IOL due to incorrect transfer of A-scan data by a technician. 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. Characteristics of physicians with obstetric malpractice claims experience. What helps? von Lany H, Mahmood S, James CR, et al. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. 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.). All 3 claims were dismissed due to lack of prosecution and closed without payment. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. 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. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. Schaal S, Barr CC. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. The claim was reported 2 years after the cataract surgery and closed 1 year later. 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 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. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. In some states, the information on this website may be considered a lawyer referral service. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. 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. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Ali N, Little BC. Retained lens fragments in resident-performed cataract extractions. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. Those with valid cataract surgery malpractice An anterior vitrectomy was performed. The log-transformation implies that the effect of these variables is multiplicative. Accessibility Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. The median payment was $90,000. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. The costs including indemnity payments and defense costs are summarized in Table 5. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. 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. The 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. The mean payment was $117,688, and the median payment was $90,000. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Total cost of defense for all 108 claims was $3,312,688. Merani R, Hunyor AP, Playfair TJ, et al. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. 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 claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. 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. 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. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. 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. 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. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. The estimated effects of each predictor are shown in Table 8. On average, a claim took 28.8 21.2 months to close. In 11 eyes, the operated eye was the better eye. 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). Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. 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. 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. CF, counting fingers; HM, hand motion; NLP, no light perception. 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? PMC legacy view 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. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. 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. However, these numbers may reflect the states in which OMIC has a major presence, since these are also states in which OMIC has the highest number of insured ophthalmologists. Kwok AK, Li KK, Lai TY, Lam DS. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. 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). During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Studdert DM, Mello MM, Gawande AA, et al. 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. In: Gonzalez ML, editor. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. A steroid drop prescribed by your ophthalmologist can help. 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. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. Start here to find personal injury lawyers near you. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. 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The Terms of Use and the Supplemental Terms for specific information related to cataract surgery cataract surgery wrong lens lawsuit an anterior vitrectomy performed...

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cataract surgery wrong lens lawsuit