Mello MM, Chandra A, Gawande AA, Studdert DM. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. 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. Among these, the patients sought a second opinion and referred themselves in 3 cases. Posterior-assisted levitation in cataract surgery. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The case was closed with an indemnity payment of $215,000. Interestingly, this physician had another case brought against him 6 years later. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Risk factors for and management of dropped nucleus during phacoemulsification. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Factors associated with these claims and claims outcomes were analyzed. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. Among 108 patient claimants, 54 were men and 54 were women. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. 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. 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. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Claims were separated into regions of the United States as seen in Figure 4. Studdert DM, Mello MM, Gawande AA, et al. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. The The site is secure. The median time to referral was 1 week in this study. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Both of these were defined as glaucoma, and there were a total of 31 cases. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. 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. 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 WebUltrasound: The predominant technology for cataract removal is ultrasound. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. The remaining 76 claims (70%) closed without any payments. Physician age ranged from 31 to 72 years (mean, 49 years). These transformed variables were used in further analyses. Kwok AK, Li KK, Lai TY, Lam DS. Schaal S, Barr CC. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Jena AB, Seabury S, Lakdawalla D, Chandra A. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. 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. Abbott RL. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. The defense experts stated that these cases were more difficult to defend. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. Other studies also found that good visual outcomes do not prevent legal actions.10,92. 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. Start here to find personal injury lawyers near you. In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. The management of dislocated lens material after phacoemulsification. Distribution of closed claims related to retained lens fragments by region in the United States. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Rofagha S, Bhisitkul RB. 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. 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. The needle impaled the lens and tore the lens capsule. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. Finally, the patient must have suffered actual damage or injury as a result of negligence. Total cost of defense for all 108 claims was $3,312,688. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. The The new PMC design is here! Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. 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. Those with valid cataract surgery malpractice The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. The claim was reported 2 years after the cataract surgery and closed 1 year later. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Socioeconomic Characteristics of Medical Practice 1997/98. If a physician had multiple claims from separate cataract surgeries, each was counted separately. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. What is the recovery after cataract or lens replacement surgery? Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. An anterior vitrectomy was performed. FOIA Breakdown by ophthalmic subspecialty of the policyholders was not available. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. 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. 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. Physicians Insurers Association of America . 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. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. 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. 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. In: Gonzalez ML, Zhang P, editors. The patient claimed that the physician should have 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. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. OMIC underwriting applications and claims records were reviewed. Regan JJ, Regan WM. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. Who sues their doctors? Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. On average, a claim took 28.8 21.2 months to close. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Management of dislocated lens fragments following phacoemulsification surgery. Tackling the dropped nucleus. The retina successfully reattached with a final visual acuity of 20/25. 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. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Medical professional liability claims and premiums, 19861996. In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. 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. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. Characteristics of physicians with obstetric malpractice claims experience. However, the majority of the claims were dismissed and did not result in an indemnity payment. He was referred to a retina specialist, who saw him the next day. 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). 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. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Kane CK. Claims, errors, and compensation payments in medical malpractice litigation. Seven hundred medicolegal cases in ophthalmology. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. Brick DC. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. In 94 cases, a referral was made to a subspecialist. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). For statistical purposes, only the data from the primary surgeon was analyzed in the study. 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. This study is limited to those claims from a single insurer, which may not be nationally representative, although it is one of the largest insurers of ophthalmologists in the United States. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. 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. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. However, these numbers may reflect the states in which OMIC has a major presence, since these are also states in which OMIC has the highest number of insured ophthalmologists. Margherio RR, Margherio AR, Pendergast SD, et al. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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. There was additional $103,000 in legal expenses. The costs including indemnity payments and defense costs are summarized in Table 5. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). The number of policyholders doubled between years 2000 and 2009. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. Baldwin LM, Larson EH, Hart LG, et al. He also damaged the film over the The relationship between physicians malpractice claims history and later claims: does the past predict the future? The attorney listings on this site are paid attorney advertising. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. 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 were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Vincent C, Young M, Phillips A. PMC legacy view 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. These manipulations included use of a lens loop, an attempt at impaling the lens with a microvitreoretinal blade, irrigation to float the lens, and pars plana vitrectomy by the cataract surgeon. sharing sensitive information, make sure youre on a federal Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. 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. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Liability claims and costs before and after implementation of a medical error disclosure program. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto WebCataract Symfony Lawsuits? There was another 29 months on average until the closure of a claim. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Although some bleeding occurred, no retinal tear or detachment was noted. The issue of malpractice has wide-ranging stakeholders, including our society. In some cases, the cause of capsular tear and resulting complication of retained lens fragment was due to circumstances other than the surgeons surgical technique. Ross WH. Yet three or four years ago, UCLA surgeons A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. Leaming DV. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. 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. The mean defense costs per claim were $30,692. 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. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Before 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. Vanner EA, Stewart MW. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 The estimated effects of each predictor are shown in Table 8. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. Causes of cataract surgery malpractice claims in England 19952008. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. 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. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. This grouping was done to compare the findings of this study to other published data. Socioeconomic Characteristics of Medical Practice 1990/1991. WebCataract surgery injury occurs in approximately 12% of cases. Dr. did correction surgery (for free) after finding and admitting his error. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. 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. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Among the 3 claims involving retina surgeons, one claim alleged negligent surgery to remove the dropped nucleus and dislocated IOL, which allegedly led to a subsequent retinal detachment. HHS Vulnerability Disclosure, Help CF, counting fingers; HM, hand motion; NLP, no light perception. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. 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.

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