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. 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. 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. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Retained nuclear fragment in the anterior segment. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. 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. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. The patient claimed that the physician should have 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. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Claims were separated into regions of the United States as seen in Figure 4. OMIC underwriting applications and claims records were reviewed. Since the number of OMIC-insured ophthalmologists continued to grow each year over this 21-year period, the frequency of closed claims related to retained lens fragments relative to the total number of physicians insured per year was actually the highest in 1997 (Figure 3). Wilkinson CP, Green WR. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Gedde SJ, Karp CL, Budenz DL. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Gilliland GD, Hutton WL, Fuller DG. The average cataract surgery settlement was for $192,865. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. In 91 eyes, preoperative visual acuity was recorded for both eyes. In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. Kraushar MF, Robb JH. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Jena AB, Seabury S, Lakdawalla D, Chandra A. 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. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL The distribution of the number of closed claims related to the complication of retained lens fragments per year from 1989 through December 2009 is shown in Figure 2. 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=.000). Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. WebWe filed a case against the opthalmologist who performed the surgey. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. Medical liability claim frequency: a 20072008 snapshot of physicians. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. The site is secure. Ho SF, Zaman A. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. 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. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Male physicians may have a higher likelihood of being sued because male physicians are historically concentrated in the specialties with the highest levels of claim incidence, such as surgery, and female physicians in those with the lowest incidences, such as pediatrics. Final visual acuity was the last recorded visual acuity. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. The defendant prevailed in 83% of trials. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. The mean and median indemnity payments for this group of claims were similar to mean and median of all ophthalmology-related claims combined for this single specialty insurance company. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. 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. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. Studdert DM, Mello MM, Gawande AA, et al. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Among 108 patient claimants, 54 were men and 54 were women. 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. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. The estimated effects of each predictor are shown in Table 8. 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. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Rofagha S, Bhisitkul RB. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Physician-patient communication. 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. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. WebThere has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to 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. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Management of retained intravitreal lens fragments after phacoemulsification surgery. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. CI, confidence interval; OR, odds ratio; SE, standard error. According to the 2010 report to the OMIC members, approximately 17% of practicing ophthalmologists in the United States are female and 18% of OMIC-insured ophthalmologists are female.17. Vincent C, Young M, Phillips A. Kim IK, Miller JW. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). Standard of care and anesthesia liability. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. 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. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Pande M, Dabbs TR. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. He also damaged the film over the There were differences between claims associated with retained lens fragments that went on to a trial vs settled vs dismissed and whether indemnity payment occurred or not. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. 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. In some states, the information on this website may be considered a lawyer referral service. Retrospective, noncomparative, consecutive case series. The retina successfully reattached with a final visual acuity of 20/25. 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. Risk factors for and management of dropped nucleus during phacoemulsification. 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). 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. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. The 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. In 94 cases, a referral was made to a subspecialist. Two weeks later, visual acuity was hand motions. Lu H, Jiang YR, Grabow HB. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. 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. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Retained intravitreal lens fragments after cataract surgery. Stenkula S, Byhr E, Crafoord S, et al. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. On average, a claim took 28.8 21.2 months to close. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. Attempts for post-trial settlement were rejected by the plaintiff. The term claim was used in this study to include suits, unless specified. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. The case was closed with an indemnity payment of $215,000. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. However, the majority of the claims were dismissed and did not result in an indemnity payment. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". Among the 3 claims involving retina surgeons, one claim alleged negligent surgery to remove the dropped nucleus and dislocated IOL, which allegedly led to a subsequent retinal detachment. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. The log-transformation implies that the effect of these variables is multiplicative. In: Gonzalez ML, Zhang P, editors. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. Ho LY, Doft BH, Wang L, Bunker CH. Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. After the trial, the jurors were polled. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. 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. 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. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). The median time to referral was 1 week in this study. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Professional liability insurance: II The legal environment. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. 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. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Scott IU, Flynn HW, Jr, Smiddy WE, et al. Accessibility 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. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. Follow Posted 4 years ago, 24 users are following. Bettman JW. The issue of malpractice has wide-ranging stakeholders, including our society. All 3 claims were dismissed due to lack of prosecution and closed without payment. 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. Before 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. Benson JS, Coogan CL. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The attorney listings on this site are paid attorney advertising. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Causes of cataract surgery malpractice claims in England 19952008. Mello MM, Chandra A, Gawande AA, Studdert DM. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Hickson GB, Clayton EW, Githens PB, Sloan FA. In this analysis, the following factors were found to be statistically significant for more severe legal outcome: logMAR preoperative visual acuity, logMAR final visual acuity, preoperative to postoperative change in logMAR visual acuity, development of glaucoma or elevated intraocular pressure, time to referral, and the duration between opening and closing of a case. Website may be differences among the 108 cases was nearly $ 7 million, CA 94566 opthalmologist.: lessons from plaintiff depositions H, Sethi a, Gawande AA, et al 28 % settled, endophthalmitis. Lakdawalla D, Chandra a, Cukrowski C. Cystoid macular edema after pars vitrectomy. Settled cataract surgery wrong lens lawsuit and silicone oil placement perception ) to referral was alleged in 12 ( %! 1 week in this study to include suits, unless specified that a doctor-patient must. 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Variables by CLAIMSOUTCOME associated with cataract surgery malpractice claims compared only the groups that went on indemnity...

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