In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Pande M, Dabbs TR. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. When the complication of a retained lens fragment has been encountered, the cataract surgeon should closely follow the patient and monitor for complications associated with retained lens fragment and consider timely referral to a specialist for management of further complications that may contribute to poor visual acuity outcomes. Learn how we can help. 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? Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Posterior-assisted levitation in cataract surgery. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. 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. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. 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. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. What is the recovery after cataract or lens replacement surgery? Colyer MH, Berinstein DM, Khan NJ, et al. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Kachalia A, Kaufman SR, Boothman R, et al. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Medical professional liability claims and premiums, 19861996. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Retained nuclear fragment in the anterior segment. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. 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. They ranged from a low of $7,500 to a high of $500,000. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. The defendant prevailed in 83% of trials. 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. Management of dislocated lens material. 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. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. 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 mean payment was $117,688, and the median payment was $90,000. More than one of these complications was noted in 31 cases. Among these, the patients sought a second opinion and referred themselves in 3 cases. Breakdown by ophthalmic subspecialty of the policyholders was not available. Claims were separated into regions of the United States as seen in Figure 4. 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. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). 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. Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. In 11 eyes, the operated eye was the better eye. 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). Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. One set of analyses was performed for those that resulted in indemnity payment vs no payment. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. 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. 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. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. Learn more Federal government websites often end in .gov or .mil. OMIC underwriting applications and claims records were reviewed. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. 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. 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The most common risks are: When Is It Medical Malpractice? During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. Accessibility Abbott RL. Management of retained lens fragments in complicated cataract surgery. Bessant DA, Sullivan PM, Aylward GW. The median payment was $90,000. Data on age was available for 101 claimants. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. 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. 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. Finally, the patient must have suffered actual damage or injury as a result of negligence. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. .I have macular degeneration in the left eye so a technical lens would not have made a difference. 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. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. 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. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Managing a dropped nucleus during the phacoemulsification learning curve. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Lu H, Jiang YR, Grabow HB. Claims, errors, and compensation payments in medical malpractice litigation. Ho LY, Doft BH, Wang L, Bunker CH. 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. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. 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. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Each claim was counted separately as a unique case. 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. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. 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. Pars plana vitrectomy for the management of retained lens material after cataract surgery. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. Retained lens fragments in resident-performed cataract extractions. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. 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. 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, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Factors associated with these claims and claims outcomes were analyzed. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Obstetricians prior malpractice experience and patients satisfaction with care. WebCataract surgery injury occurs in approximately 12% of cases. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. i'm sorry to read of your troubles and I know enough as a practicing physician for 20 years that your course has deviated from the typical cataract Causes of cataract surgery malpractice claims in England 19952008. American College of Obstetricians and Gynecologists. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. 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. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The .gov means its official. Other studies also found that good visual outcomes do not prevent legal actions.10,92. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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. will also be available for a limited time. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Who sues their doctors? 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. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Dr made larger incision & needed stitches. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Start here to find personal injury lawyers near you. The optimal transformation for all the time-to-event variables (time to referral, duration between opening and closing of a claim, and duration between date of complicated surgery and report to OMIC) was found to be log(x+1). The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. 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. Opinion and referred themselves in 3 cases P=.037 ) must have suffered actual damage injury... 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