CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. 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 Holak sued Tyson and Eye Associates. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. and transmitted securely. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. The mean defense costs per claim were $30,692. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Vitrectomy for removal of retained lens material. The patient was informed of the complication. Florida and Louisiana each had 10 claims. Hickson GB, Clayton EW, Entman SS, et al. Teo L, Chee SP. The remaining 76 claims (70%) closed without any payments. .I have macular degeneration in the left eye so a technical lens would not have made a difference. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. 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. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a Studdert DM, Mello MM, Gawande AA, et al. The median time to referral was 1 week in this study. WebCataract Symfony Lawsuits? Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. Accessibility 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. In the first case, the cataract surgery was performed in 1989. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. Kraushar MF, Robb JH. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Dr made larger incision & needed stitches. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. He was referred to a retina specialist, who saw him the next day. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. National costs of the medical liability system. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. 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. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Gedde SJ, Karp CL, Budenz DL. Why do people sue doctors? If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). Gilliland GD, Hutton WL, Fuller DG. 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. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. 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. However, the majority of the claims were dismissed and did not result in an indemnity payment. 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. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. In: Gonzalez ML, editor. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). Characteristics of physicians with obstetric malpractice claims experience. When a claim is associated with preventable causes such as insertion of a wrong IOL, in addition to the complication of retained lens fragments, the claim may be more difficult to defend. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. 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. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Management of dislocated lens fragments following phacoemulsification surgery. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. A steroid drop prescribed by your ophthalmologist can help. Margherio RR, Margherio AR, Pendergast SD, et al. 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. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. This grouping was done to compare the findings of this study to other published data. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Obstetricians prior malpractice experience and patients satisfaction with care. 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. Socioeconomic Characteristics of Medical Practice 1997/98. 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. Intermittent corneal edema due to anterior segment retained lens fragments. Levinson W, Roter DL, Mullooly JP, et al. government site. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Can I sue a doctor for a botched cataract surgery? Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. Malpractice, in contrast, requires demonstration of negligence, defined as substandard care that resulted in harm.1 Malpractice suits are usually based on the legal theory of negligence, requiring the presence of the following four elements: (1) duty to treat, (2) breach of duty, (3) cause, and (4) damages. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Ophthalmic malpractice lawsuits with large monetary awards. Careers. 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. 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. 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. 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). Scott IU, Flynn HW, Jr, Smiddy WE, et al. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. 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. 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. Management of dislocated lens fragments after phacoemulsification surgery. This gender spread was compared with OMIC data on demographics. Seven hundred medicolegal cases in ophthalmology. These transformed variables were used in further analyses. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Two cases went on to trial and ended with a verdict in favor of the plaintiff. 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). 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. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. 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. sharing sensitive information, make sure youre on a federal Medical professional liability claims and premiums, 19861996. Miller KP. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. Only the claims that closed by December 2009 were included. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. In 94 cases, a referral was made to a subspecialist. This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. 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. 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. 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. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as trial with a verdict > settled > dismissed, and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Pars plana vitrectomy for the management of retained lens material after cataract surgery. Moore JK, Scott IU, Flynn HW, Jr, et al. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Benson JS, Coogan CL. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. 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. about navigating our updated article layout. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. 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. 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. Previous studies have shown that the incidence of posterior capsule rupture and posterior dislocation of lens material is higher in cases with residents in training than with cataract surgeons who are experienced at phacoemulsification.94 Although none of the cases in this study resulted from a resident case, one case did involve a cataract surgeon who was overseeing a cataract surgery being performed by his colleague in the transition phase. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Physician age ranged from 31 to 72 years (mean, 49 years). Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. 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. Retrospective, noncomparative, consecutive case series. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Abbott RL. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Who sues their doctors? Brick DC. Gonzalez ML. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. I am currently evaluating a similar case in involving a surgeon placing a wrong lens into a patient, however the error was recognized during the su After the trial, the jurors were polled. 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. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. 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. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. If you have experienced complications after cataract surgery because of surgical error, consult with the St. Louis surgical error attorneys at Zevan and Davidson Law Firm, LLC at (314) 588-7200. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. An official website of the United States government. 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. 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 Was made to a retina specialist, who saw him the next day surgery complicated by retained lens fragments satisfaction. Material was in the management of retained lens fragment detachment, 21 cases of cystoid macular after! Case closed in 1992 for $ 125,000, and endophthalmitis ) represent a unique opportunity to examine the medicolegal associated..., scott IU, Flynn HW, Jr, Smiddy WE, Murray,! 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