They ranged from a low of $7,500 to a high of $500,000. Causes of cataract surgery malpractice claims in England 19952008. 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 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<.001). The model was simplified using backward selection keeping all predictors with a P value of .25 or less. More than one of these complications was noted in 31 cases. Distribution of closed claims related to retained lens fragments by region in the United States. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Ali N, Little BC. Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. 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. 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. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. 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. Michels RG, Shacklett DE. In: Gonzalez ML, Zhang P, editors. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. The patient claimed that the physician should have Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. will also be available for a limited time. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. Management of dislocated nuclear fragments after phacoemulsification. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. 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. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. A study based on a survey of retina specialists recommended that vitreoretinal surgeons should place an increased importance on the informed consent process and the patient/doctor relationship in order to improve risk management.16 Informed consent is a process rather than a form. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. about navigating our updated article layout. 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. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. WebCataract Symfony Lawsuits? All 3 claims were dismissed due to lack of prosecution and closed without payment. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. 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. Postoperatively, the patient developed hypotony and fibrin reaction. 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. Aasuri MK, Kompella VB, Majji AB. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. This article discusses the most common risks of cataract surgeries, how to prove medical malpractice, and the challenges you will face in a cataract surgery medical malpractice lawsuit. Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). In 94 cases, a referral was made to a subspecialist. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. 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. Obstetricians prior malpractice experience and patients satisfaction with care. 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. Available at: Slora EJ, Gonzales ML. There was another 29 months on average until the closure of a claim. Ophthalmic malpractice lawsuits with large monetary awards. Ross WH. Moore JK, Scott IU, Flynn HW, Jr, et al. 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. government site. The average cataract surgery settlement was for $192,865. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. 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. 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 number of policyholders doubled between years 2000 and 2009. Learn more However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. Vitrectomy for removal of retained lens material. Retained lens fragments after phacoemulsification. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for 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. Medical malpractice and respondeat superior. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. Bethesda, MD 20894, Web Policies Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Gedde SJ, Karp CL, Budenz DL. Bovbjerg RR, Petronis KR. 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Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. 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. 5.3k views Reviewed >2 years ago. 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. 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. What is the recovery after cataract or lens replacement surgery? The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). 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. Attempts for post-trial settlement were rejected by the plaintiff. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Vitrectomy for retained lens fragments after phacoemulsification. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Who sues their doctors? 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. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. 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. 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. 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.). The attorney listings on this site are paid attorney advertising. 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. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. The mean defense costs per claim were $30,692. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. 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). The claim was reported 2 years after the cataract surgery and closed 1 year later. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. Kraushar MF. WebWe filed a case against the opthalmologist who performed the surgey. Oruc S, Kaplan HJ. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. Data on age was available for 101 claimants. Regan JJ, Regan WM. 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. 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. CF, counting fingers; HM, hand motion; NLP, no light perception. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Management of dislocated lens fragments following phacoemulsification surgery. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. 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. 8600 Rockville Pike This is without adjustment for potential differences in dollar amount due to inflationary changes. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Socioeconomic Characteristics of Medical Practice 1997/98. The Benson JS, Coogan CL. Each claim was counted separately as a unique case. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Before Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. The verdict was 6 for plaintiff and 2 for defendant. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. In the first case, the cataract surgery was performed in 1989. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. The case was closed with an indemnity payment of $215,000. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. The median payment was $90,000. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. 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). 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. 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. The mean payment was $117,688, and the median payment was $90,000. 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. It appeared that the nucleus was resting on the optic nerve. 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. 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. Expert testimony. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. 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. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. Retained lens fragments in resident-performed cataract extractions. Kane CK. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. 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. Because the surgeon ultimately becomes responsible for the outcome of the surgery, it is important to communicate with the anesthesiologist as well as to oversee and proactively troubleshoot any preventable disasters in the operating room.93. National costs of the medical liability system. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. 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.

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