The management of dislocated lens material after phacoemulsification. 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. Available at: Slora EJ, Gonzales ML. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. An example of one unit change in visual acuity would be going from 20/20 to 20/200. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. .I have macular degeneration in the left eye so a technical lens would not have made a difference. The attorney listings on this site are paid attorney advertising. Kraushar MF, Robb JH. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Moore JK, Scott IU, Flynn HW, Jr, et al. This is without adjustment for potential differences in dollar amount due to inflationary changes. The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL 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. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. 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 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. and transmitted securely. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. 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. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. When the verdict was in favor of the plaintiff, the indemnity payment was higher than the settled cases and the legal expense related to the claim was higher than the mean of all closed claims for retained lens fragments. Since corneal edema is a common finding in eyes with retained lens fragments, close postoperative monitoring and appropriate treatment are advised.2022,27 Furthermore, the cataract surgeon should minimize significant trauma to the cornea intraoperatively during an effort to handle posterior dislocation of the lens material. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. 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. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. 5.3k views Reviewed >2 years ago. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. 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. Ross WH. Mello MM, Chandra A, Gawande AA, Studdert DM. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). 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. 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. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. Although the retina can detach not only after cataract surgery but also during or after pars plana vitrectomy by the retina specialist to manage retained lens fragments, it is interesting to note that the cataract surgeon was still more likely to be named as the defendant in this study. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. 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). After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Hickson GB, Clayton EW, Githens PB, Sloan FA. It appeared that the nucleus was resting on the optic nerve. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. 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. Teo L, Chee SP. Accessibility The average insurance company payment - mostly settlements -- in these cases were $112,000. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Can I sue a doctor for a botched cataract surgery? However, the patient did not show up for appointments, despite being sent no show letters. Retained lens fragments in resident-performed cataract extractions. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Ho LY, Doft BH, Wang L, Bunker CH. Causes of cataract surgery malpractice claims in England 19952008. Of the 66 claims that were dismissed, Texas had the most claims with 14, followed by Louisiana with 9, California with 8, Illinois with 7, Virginia and Florida each with 4, Kentucky and Colorado each with 3, Arizona, Michigan, and Missouri each with 2, and Alabama, Massachusetts, Nevada, North Carolina, Ohio, Pennsylvania, West Virginia, and Washington, DC, each with one claim. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. 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. Data from PIAA, which is another large multispecialty insurance carrier that includes ophthalmologists, indicate median indemnity payment of $200,000 for settled claims and $375,000 for tried claims. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Benson JS, Coogan CL. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. In 11 eyes, the operated eye was the better eye. 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. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. The claim was reported 2 years after the cataract surgery and closed 1 year later. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Who sues their doctors? This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Retrospective, noncomparative, consecutive case series. 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 The new PMC design is here! The median time to referral was 1 week in this study. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. The https:// ensures that you are connecting to the Ophthalmic malpractice lawsuits with large monetary awards. 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. 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. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. 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. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. 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. 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 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. 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. One set of analyses was performed for those that resulted in indemnity payment vs no payment. Distribution of closed claims related to retained lens fragments by region in the United States. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. 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. Vitrectomy for removal of retained lens material. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). The trial was in favor of the plaintiff with a payment of $231,754. 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. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. 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. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. He was referred to a retina specialist, who saw him the next day. Among these, the patients sought a second opinion and referred themselves in 3 cases. Scott IU, Flynn HW, Jr, Smiddy WE, et al. 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. Vanner EA, Stewart MW. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Attempts for post-trial settlement were rejected by the plaintiff. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Outcome of vitrectomy for retained lens fragments after phacoemulsification. Intermittent corneal edema due to anterior segment retained lens fragments. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. 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. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. HHS Vulnerability Disclosure, Help Holak sued Tyson and Eye Associates. The mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. Wilkinson CP, Green WR. CF, counting fingers; HM, hand motions; NLP, no light perception. In these early referral cases, the claim was more likely to be dismissed. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. In the table, the estimates give the odds ratio of an indemnity payment when the predictor is changed by one unit for continuous variable (eg, visual acuity change), whereas for categorical variable (eg, corneal edema or decompensation), it means a change from the unlisted group to the listed one. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Incidence of lens matter dislocation during phacoemulsification. In 94 cases, a referral was made to a subspecialist. 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? This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. 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. 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. 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. 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. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. Dr made larger incision & needed stitches. Risk factors for and management of dropped nucleus during phacoemulsification. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. 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. 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 Learn how we can help. My vision actually was worse after the lens placement. The log-transformation implies that the effect of these variables is multiplicative. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. A steroid drop prescribed by your ophthalmologist can help. 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. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Bessant DA, Sullivan PM, Aylward GW. Studdert DM, Mello MM, Gawande AA, et al. Follow Posted 4 years ago, 24 users are following. Cheney FW, Posner K, Caplan RA, Ward RJ. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Jena AB, Seabury S, Lakdawalla D, Chandra A. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Management of dislocated lens fragments following phacoemulsification surgery. 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.
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