A claim may include institution of a lawsuit or arbitration proceedings against the insured. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. 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 For this study, a P value <.05 was considered significant. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. 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. On average, a claim took 28.8 21.2 months to close. The negligent act must be a proximate cause of the plaintiffs injuries, which means the act was necessary for the injury when and in the manner it occurred, and the injury must be a foreseeable consequence of the negligent act. 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. Kwok AK, Li KK, Lai TY, Lam DS. 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. 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. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. All variables significant in the univariate analyses were included in a multivariate logistic regression model. 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. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Those with valid cataract surgery malpractice The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. The average cataract surgery settlement was for $192,865. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Management of retained intravitreal lens fragments after phacoemulsification surgery. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. Schaal S, Barr CC. Claims were separated into regions of the United States as seen in Figure 4. 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. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. 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 ". Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. 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. Leaming DV. 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. Stenkula S, Byhr E, Crafoord S, et al. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. 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. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Intermittent corneal edema due to anterior segment retained lens fragments. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Hickson GB, Clayton EW, Entman SS, et al. Management of retained lens fragments in complicated cataract surgery. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. In the first case, the cataract surgery was performed in 1989. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. Ho SF, Zaman A. However, the cataract surgeon did not document having made this call and the case was settled. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. 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. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. 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. Physician-patient communication. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. about navigating our updated article layout. This gender spread was compared with OMIC data on demographics. 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). There was another 29 months on average until the closure of a claim. The possible outcomes are assumed to be ordered: Trial with a verdict > Settled > Dismissed and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Florida and Louisiana each had 10 claims. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. Retained intravitreal lens fragments after cataract surgery. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract 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. 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. 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. 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. Ophthalmic malpractice lawsuits with large monetary awards. Bettman JW. 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 another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. Although these findings may cause fear and increased practice of defensive medicine by physicians, better understanding of the incidence, associated factors, and outcomes of medical malpractice claims may result in increased knowledge to the physicians and more effective and improved care to the patients. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of retinal detachment. This grouping was done to compare the findings of this study to other published data. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. The The model was simplified using backward selection keeping all predictors with a P value of .25 or less. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. CF, counting fingers; HM, hand motions; NLP, no light perception. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. 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 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. 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. For statistical purposes, only the data from the primary surgeon was analyzed in the study. Continuous irrigation was performed, but the nuclear fragment could not be elevated. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. Posterior-assisted levitation in cataract surgery. An anterior vitrectomy was performed. If a physician had multiple claims from separate cataract surgeries, each was counted separately. 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. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. The 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). To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. 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. Data on age was available for 101 claimants. 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). Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. PMC legacy view In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Practice styles and preferences of ASCRS members1994 survey. National costs of the medical liability system. 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). Even when an IOL has been inserted by the cataract surgeon, the retinal surgeon should be prepared to manage subsequent complications of dislocated or malpositioned IOL, as was the case in some of the claims in this study. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. 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. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. 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. Data from the PIAA show that for all medical claims in 2008, average defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and time associated with a lawsuit to the plaintiff or to the defendant. The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. Who sues their doctors? More than one of these complications was noted in 31 cases. Spicer J. Only the claims that closed by December 2009 were included. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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