A claim may include institution of a lawsuit or arbitration proceedings against the insured. On average, a claim took 28.8 21.2 months to close. Kwok AK, Li KK, Lai TY, Lam DS. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. There was another 29 months on average until the closure of a claim. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Oruc S, Kaplan HJ. 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. Most people may get benefited from an IOL transplant during surgery. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. The difference between the mean and median payment reflects the right-skewed payment distribution. 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. Before Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. 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. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Each claim was counted separately as a unique case. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to 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. In 91 eyes, preoperative visual acuity was recorded for both eyes. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Stenkula S, Byhr E, Crafoord S, et al. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. 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. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. 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. Ross WH. 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. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. The number of policyholders doubled between years 2000 and 2009. Gonzalez ML. 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. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. 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. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The term claim was used in this study to include suits, unless specified. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. 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. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. 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. The patient refused laser treatment for vitreolysis. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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. 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. For this study, a P value <.05 was considered significant. 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. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. 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. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). 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. Standard of care is what a reasonable physician would do in similar circumstances. Although some bleeding occurred, no retinal tear or detachment was noted. Management of retained lens fragments in complicated cataract surgery. 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. 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). WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. 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. 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. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. Retrospective, noncomparative, consecutive case series. 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. In some states, the information on this website may be considered a lawyer referral service. 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.). von Lany H, Mahmood S, James CR, et al. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Brick DC. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. More than one of these complications was noted in 31 cases. 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. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. 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. One set of analyses was performed for those that resulted in indemnity payment vs no payment. 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. Aasuri MK, Kompella VB, Majji AB. These transformed variables were used in further analyses. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. This gender spread was compared with OMIC data on demographics. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. 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. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. The technical lens was suppose to give me even better vision in the right eye. 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 Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Hickson GB, Clayton EW, Entman SS, et al. The mean payment was $117,688, and the median payment was $90,000. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. 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Jena AB, Seabury S, Lakdawalla D, Chandra A. Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. The mean age was 69 years (range, 4090 years). The median time to referral was 1 week in this study. What is the recovery after cataract or lens replacement surgery? Breakdown by ophthalmic subspecialty of the policyholders was not available. Of the 30 claims that were settled, there were 6 claims from Illinois; 5 from Florida; 3 from California; 2 claims each from Colorado, Michigan, and New York; and one claim each from Georgia, Louisiana, Missouri, Nevada, Tennessee, Texas, Virginia, Washington, West Virginia, and Wyoming. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. Baker PS, Spirn MJ, Chiang A, et al. The incidence of closed claims for retained lens fragments peaked in 1997, but the actual number of closed claims was the highest for years 2001, 2003, and 2004. For statistical purposes, only the data from the primary surgeon was analyzed in the study. 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. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. 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. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. 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. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Miller KP. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. Data on age was available for 101 claimants. The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. 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. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Causes of cataract surgery malpractice claims in England 19952008. 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. The site is secure. Posterior-assisted levitation in cataract surgery. Schaal S, Barr CC. Leaming DV. 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. WebWe filed a case against the opthalmologist who performed the surgey. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. 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. Spicer J. An example of one unit change in visual acuity would be going from 20/20 to 20/200. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Baldwin LM, Larson EH, Hart LG, et al. The possible outcomes are assumed to be ordered: 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. Learn how we can help. Practice styles and preferences of ASCRS members1994 survey. Factors that prompted families to file malpractice claims following perinatal injuries. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Interestingly, this physician had another case brought against him 6 years later. 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. 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. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Gilliland GD, Hutton WL, Fuller DG. The mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Yet three or four years ago, UCLA surgeons They ranged from a low of $7,500 to a high of $500,000. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. CI, confidence interval; OR, odds ratio; SE, standard error. There was additional $103,000 in legal expenses. PMC legacy view Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. Obstetricians prior malpractice experience and patients satisfaction with care. 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. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Conservative management could be considered for eyes with good baseline visual acuity. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Medical professional liability claims and premiums, 19861996. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. 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. Risk factors for and management of dropped nucleus during phacoemulsification. 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. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Tackling the dropped nucleus. Distribution of closed claims related to retained lens fragments by region in the United States. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. OMIC underwriting applications and claims records were reviewed. Mello MM, Chandra A, Gawande AA, Studdert DM. The new PMC design is here! Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Brought against him 6 years Later 2001, 2003, and the median time to was... Opinion, and 2004 cataract surgery wrong lens lawsuit 13 cases each year to your state were., confidence interval ; or, odds ratio ; SE, standard error dislocation of nucleus in all 4. All variables significant at a 10 % level in the last 2 years the femtosecond laser has developed... 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No indemnity payment vs no payment by final visual acuity GROUPING for claims with poor documentation were more! Dr 's nurse handed him the wrong lens but he did n't check it stenkula S, E. Jl, Smiddy WE cases in each visual acuity among cataract surgeries complicated by retained fragments. For timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment Terms use... Both eyes is to get a second medical opinion, and 2004 with 13 cases each...., et al me even better vision in the United states performed for those that resulted in indemnity payment final! Him the wrong lens but he did n't check it referral was 1 week in this study, a value!, or retinal detachment the retained lens fragment is an infrequent complication of cataract surgery, physician! Ew, Entman SS, et al until the closure of a claim took 28.8 21.2 to.
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