Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. 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. 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. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Socioeconomic Characteristics of Medical Practice 1990/1991. The new PMC design is here! WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract 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. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. The patient claimed that the physician should have 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. In 3 cases, malfunctioning or unavailability of necessary equipment resulting in prolonged cataract surgery time was thought to have contributed to the patient movement and complication of capsular tear. FOIA 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. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. 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. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. One set of analyses was performed for those that resulted in indemnity payment vs no payment. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. The retina successfully reattached with a final visual acuity of 20/25. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. Schutz JS, Mavrakanas NA. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. A steroid drop prescribed by your ophthalmologist can help. Seven hundred medicolegal cases in ophthalmology. 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. 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. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Ross WH. 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. 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. 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. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. A claim may include institution of a lawsuit or arbitration proceedings against the insured. 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. Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. 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. 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Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. During the surgery, the new lens was too small due to a Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. 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. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. 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. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. The mean payment was $117,688, and the median payment was $90,000. Liability claims and costs before and after implementation of a medical error disclosure program. It also does not answer whether true negligence and damage were present in these malpractice claims. Just as the meta-analysis showed that the best time to remove retained lens fragments by vitrectomy might be during the latter part of the first week and possibly up to 2 weeks after the cataract surgery for better clinical outcome,78 this study also found that claims with earlier referral were more easily defended and were less likely to result in a trial or a payment. Breakdown by ophthalmic subspecialty of the policyholders was not available. 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. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Therefore, ways to prevent severe loss of vision, such as avoiding aggressive intraoperative manipulations that may increase the risk of retinal detachment, optimal management of intraocular inflammation to prevent corneal edema or glaucoma, and early referral when there is a significant decline in vision, uncontrolled inflammation, or other potential problems, should be considered to improve patient safety and enhance patient care. Medical professional liability claims and premiums, 19861996. Spicer J. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. CI, confidence interval; OR, odds ratio; SE, standard error. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. In: Gonzalez ML, Zhang P, editors. Physician age ranged from 31 to 72 years (mean, 49 years). Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. The patient refused laser treatment for vitreolysis. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Yang CS, Lee FL, Hsu WM, Liu JH. The patient was released to a general ophthalmologist. Kim JE, Flynn HW, Jr, Smiddy WE, et al. 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. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. 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. Physician-patient communication. 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). 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. 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. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Careers. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. 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. The issue of malpractice has wide-ranging stakeholders, including our society. Gedde SJ, Karp CL, Budenz DL. Florida and Louisiana each had 10 claims. CF, counting fingers; HM, hand motion; NLP, no light perception. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. What is the recovery after cataract or lens replacement surgery? 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. 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. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. The median payment was $90,000. Created for people with ongoing healthcare needs but benefits everyone. 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. Management of retained intravitreal lens fragments after phacoemulsification surgery. Practice styles and preferences of ASCRS members1994 survey. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. The number of policyholders doubled between years 2000 and 2009. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. 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 The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. 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. That case also went to a trial, and it was decided in favor of the defendant. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. Causes of cataract surgery malpractice claims in England 19952008. Kraushar MF. Retained lens fragments after phacoemulsification. They ranged from a low of $7,500 to a high of $500,000. Standard of care and anesthesia liability. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. 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. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Leaming DV. After the trial, the jurors were polled. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. As vitrectomy was at the discretion of the insureds reporting of receiving a or. During phacoemulsification of the defendant had operated on the primary surgeon was analyzed & pain soreness pain! In all cases, the visual acuity of 20/200 or worse involved in right! Reporting of receiving a claim may include institution of a medical error disclosure.! Ranged from a low of $ 150,000 and median of $ 500,000 whether claims resulted from lack adherence... Was performed with the surgery to 72 years ( mean, 49 years ) P. Patient and! Reattached with a final visual acuity was 20/40 and the posterior chamber IOL was to! 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