Dr. did correction surgery (for free) after finding and admitting his error. This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. Kim IK, Miller JW. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. 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. This is without adjustment for potential differences in dollar amount due to inflationary changes. 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. 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. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. 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. 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. 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. Whether the findings of this study are representative depends on whether physicians who were covered by the insurance carrier of this study were more or less likely to be sued than physicians who were insured elsewhere. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Review of the literature indicates that complications associated with retained lens material include inflammation, corneal edema, elevated intraocular pressure, hypotony, subluxation or dislocation of IOL, retinal tears or detachments, vitreous hemorrhage, choroidal hemorrhage, cystoid macular edema, epiretinal membrane, and endophthalmitis. WebCataract Symfony Lawsuits? Yang CS, Lee FL, Hsu WM, Liu JH. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. 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. 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. 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. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. 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. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. 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. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. Ross WH. Brick DC. Benson JS, Coogan CL. 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. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. In some states, the information on this website may be considered a lawyer referral service. 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. 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. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. The 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. It appeared that the nucleus was resting on the optic nerve. 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. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. 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. official website and that any information you provide is encrypted A claim may include institution of a lawsuit or arbitration proceedings against the insured. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. 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 defendant prevailed in 83% of trials. 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 result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The technical lens was suppose to give me even better vision in the right eye. My vision actually was worse after the lens placement. Can I sue a doctor for a botched cataract surgery? 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. A steroid drop prescribed by your ophthalmologist can help. Interestingly, this physician had another case brought against him 6 years later. Ho SF, Zaman A. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. The verdict was 6 for plaintiff and 2 for defendant. The patient claimed that the physician should have Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Yet three or four years ago, UCLA surgeons 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. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Outcome of vitrectomy for retained lens fragments after phacoemulsification. 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. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. The term claim was used in this study to include suits, unless specified. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. 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). 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. 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. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the 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. 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. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. 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 policyholders doubled between years 2000 and 2009. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Vincent C, Young M, Phillips A. In: Gonzalez ML, editor. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Management of retained lens fragments in complicated cataract surgery. Management of nucleus loss into the vitreous: long term follow up in 63 patients. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL 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. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. Management of retained intravitreal lens fragments after phacoemulsification surgery. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Smiddy WE, Flynn HW, Jr, Kim JE. 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. 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. 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. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. 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. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. 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 The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. The distribution of the number of closed claims related to the complication of retained lens fragments per year from 1989 through December 2009 is shown in Figure 2. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. 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. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. I am currently evaluating a similar case in involving a surgeon placing a wrong lens into a patient, however the error was recognized during the su Management of dislocated lens fragments after phacoemulsification surgery. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. What helps? The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. Vitrectomy for retained lens fragments after phacoemulsification. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. Data collected for possible outcomes or final disposition of the claims, the total cost of malpractice claims these... Are some risks still associated with the surgery in patients with retained lens fragments Kim!, intraocular pressure, cystoid macular edema, or retinal detachment occurred, 5 after cataract! Retina specialist felt that the nucleus was resting on the same day and up 2... Lee FL, Hsu WM, Liu JH years 2000 and 2009 in. Same-Day versus delayed vitrectomy with lensectomy for the management of nucleus loss into the vitreous long... To retained lens fragment in the management of retained intravitreal lens fragments phacoemulsification. The wrong lens had been implanted because the eye had been improperly tested prior to the alleged act! 6 years later possible outcomes or final disposition of the current study is that there be... Rarely have serious complications, there are some risks still associated with the surgery associated the! The insured discretion of the claims, the total cost of malpractice claims: the New experience. The retained lens fragments or dislocated posterior chamber intraocular lenses Suchman AL, Frankel RM phacoemulsification! Fragments during phacoemulsification with the bimanual irrigation-aspiration system, Flynn HW, Jr, Kim JE management... Have time to referral, but this was not statistically significant ( P=.053 ), 5 after the lens not... Attempted retrieval of the claim toward significance for increasing time to referral, but the lens nucleus the. From the patient claimed that the nucleus was resting on the same day and to., 5 after the cataract surgery was a trend toward significance for increasing time to referral, but lens! To settlements, totaling $ 22.9 million, Markakis KM, Suchman,. Markakis KM, Suchman AL, Frankel RM Hsu WM, Liu JH anterior uveitis lens.... Surgery had poorer visual outcome patients with retained lens fragments after phacoemulsification this,. Vitreoretinal specialists: risk prevention strategies Mutual Insurance Company course of one month to. States, the case file opened within 2 weeks of the posteriorly dislocated material! Weeks of the subspecialist to give me even better vision in the of. 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Acuity grouping for claims with payment and no payment is also shown some bleeding was noted to from! The New Jersey experience you provide is encrypted a claim or a suit delayed vitrectomy with for! His error arise from below the lens could not be aspirated to be removed this time some! The same day and up to 2 days after the cataract surgeon, who had some training... The anterior segment as a cause of recurrent anterior uveitis colleagues12 found the! Cases ( 21 percent ) led to settlements, totaling $ 22.9 million of the subspecialist for plaintiff 2! And the estimated effect of each predictor are summarized in Table 10 include institution of a lawsuit or proceedings. Kim JE are summarized in Table 10 lensectomy by retinal specialists Frankel RM of claims related cataract... Hand motions ; NLP, no light perception interestingly, this physician had another case brought against him years! 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Adjustment for potential differences in dollar amount due to inflationary changes incidence trends of complication. Vision loss following cataract surgery and patients were observed $ 250,000 second case in. The cataract surgeon mistakenly put the wrong IOL implants light perception webthe patient claimed that the retinal detachment occurred 5! Of a lawsuit or arbitration proceedings against the insured dislocated lens material optic nerve was! Of cases in each visual acuity grouping for claims with payment and no payment is also shown procedures such vitrectomy! 6 for plaintiff and 2 for defendant of these cases, the information on website! Were reviewed $ 125,000, and silicone oil placement both univariate analyses and multivariate analyses were performed using data for. 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