WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. Bohigian GM, Wexler SA. Management of retained lens fragments in complicated cataract surgery. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Why do people sue doctors? 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. It also does not answer whether true negligence and damage were present in these malpractice claims. 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. Postoperatively, the patient developed hypotony and fibrin reaction. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. and transmitted securely. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. However, the majority of the claims were dismissed and did not result in an indemnity payment. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. All 3 claims were dismissed due to lack of prosecution and closed without payment. May M, Stengel B. The technical lens was suppose to give me even better vision in the right eye. 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 In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. The estimated effects of each predictor are shown in Table 8. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. The term claim was used in this study to include suits, unless specified. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. The mean defense costs per claim were $30,692. 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. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. 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. 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. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. 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. Postoperative complications with significant inflammation causing corneal edema or corneal decompensation were found to be a potential risk factor for increasing the odds of an indemnity payment by more than threefold (P=.037). In 9 cases, the retained lens material was managed without additional surgery and patients were observed. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Some cases that opened in more recent years are still open and are not a part of this study. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Breakdown by ophthalmic subspecialty of the policyholders was not available. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. 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. 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. 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. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Characteristics of physicians with obstetric malpractice claims experience. Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. HHS Vulnerability Disclosure, Help Endophthalmitis in patients with retained lens fragments after phacoemulsification. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). The patient was informed of the complication. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. 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. 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. All variables significant in the univariate analyses were included in a multivariate logistic regression model. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. .I have macular degeneration in the left eye so a technical lens would not have made a difference. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Dr made larger incision & needed stitches. Final visual acuity was the last recorded visual acuity. 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. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Ali N, Little BC. Two cases went on to trial and ended with a verdict in favor of the plaintiff. After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. 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. 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. 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. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. Margherio RR, Margherio AR, Pendergast SD, et al. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. 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. In some states, the information on this website may be considered a lawyer referral service. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Risk management lessons from a review of 168 cataract surgery claims. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Attempts for post-trial settlement were rejected by the plaintiff. 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. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Available at: Slora EJ, Gonzales ML. Levinson W, Roter DL, Mullooly JP, et al. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the The costs including indemnity payments and defense costs are summarized in Table 5. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Moore JK, Scott IU, Flynn HW, Jr, et al. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. 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. Socioeconomic Characteristics of Medical Practice 1990/1991. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. Medical malpractice and respondeat superior. 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 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. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. 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. Retained lens fragments after phacoemulsification. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. 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. Tackling the dropped nucleus. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. The issue of malpractice has wide-ranging stakeholders, including our society. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. 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. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Conservative management could be considered for eyes with good baseline visual acuity. Gedde SJ, Karp CL, Budenz DL. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Baldwin LM, Larson EH, Hart LG, et al. von Lany H, Mahmood S, James CR, et al. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Since corneal edema is a common finding in eyes with retained lens fragments, close postoperative monitoring and appropriate treatment are advised.2022,27 Furthermore, the cataract surgeon should minimize significant trauma to the cornea intraoperatively during an effort to handle posterior dislocation of the lens material. The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. The management of dislocated lens material after phacoemulsification. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Two weeks later, visual acuity was hand motions. 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. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. PMC legacy view Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. 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. 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. Causes of cataract surgery malpractice claims in England 19952008. The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. 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. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. Standard of care and anesthesia liability. 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. 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