Interestingly, this physician had another case brought against him 6 years later. Kraushar MF, Robb JH. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. Socioeconomic Characteristics of Medical Practice 1997/98. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. Miller KP. The number of policyholders doubled between years 2000 and 2009. Medical liability claim frequency: a 20072008 snapshot of physicians. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Schutz JS, Mavrakanas NA. 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. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Stenkula S, Byhr E, Crafoord S, et al. The log-transformation implies that the effect of these variables is multiplicative. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Claims were separated into regions of the United States as seen in Figure 4. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Ho LY, Doft BH, Wang L, Bunker CH. Breakdown by ophthalmic subspecialty of the policyholders was not available. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). 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. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). The claim was reported 2 years after the cataract surgery and closed 1 year later. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Yet three or four years ago, UCLA surgeons 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. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Posterior-assisted levitation in cataract surgery. 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). Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. Vanner EA, Stewart MW. 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. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. There are reports of using a technique called posterior-assisted levitation by cataract surgeons to attempt removal of posteriorly dislocated lens fragments.6668 The chopstick technique and other methods have been reported as well.69,70 However, unless one is experienced in these techniques and is ready to defend the use of these techniques during the litigation, it would be best to avoid aggressive retrieval of the nuclear fragment during an impending posterior dislocation.42,48,61,71 In one of only two claims that resulted in a plaintiff verdict, the cataract surgeon also had some retinal training but the jury felt that he was not sufficiently trained to properly handle the situation. 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. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. 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. Yang CS, Lee FL, Hsu WM, Liu JH. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. 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. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. They ranged from a low of $7,500 to a high of $500,000. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. Learn how we can help. 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 one study that did attempt comparison of observation vs vitrectomy, randomization was not possible because of bias toward vitrectomy for larger lens fragments and more severe inflammation.40. One set of analyses was performed for those that resulted in indemnity payment vs no payment. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. 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. 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). For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Incidence of lens matter dislocation during phacoemulsification. Ophthalmic malpractice lawsuits with large monetary awards. Factors associated with these claims and claims outcomes were analyzed. 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. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. Seven hundred medicolegal cases in ophthalmology. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. 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. Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. 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. 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%. My vision actually was worse after the lens placement. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Finally, the patient must have suffered actual damage or injury as a result of negligence. 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. Retained lens fragments after phacoemulsification. Factors that prompted families to file malpractice claims following perinatal injuries. 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. Retained nuclear fragment in the anterior segment. However, the cataract surgeon did not document having made this call and the case was settled. After the trial, the jurors were polled. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. 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. Baldwin LM, Larson EH, Hart LG, et al. 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. 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? The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. This is without adjustment for potential differences in dollar amount due to inflationary changes. 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. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. HHS Vulnerability Disclosure, Help Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. Leaming DV. Previous studies have shown that the incidence of posterior capsule rupture and posterior dislocation of lens material is higher in cases with residents in training than with cataract surgeons who are experienced at phacoemulsification.94 Although none of the cases in this study resulted from a resident case, one case did involve a cataract surgeon who was overseeing a cataract surgery being performed by his colleague in the transition phase. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. Hickson GB, Clayton EW, Entman SS, et al. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. Why do people sue doctors? At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. 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. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. In 11 eyes, the operated eye was the better eye. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Rofagha S, Bhisitkul RB. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. Characteristics of physicians with obstetric malpractice claims experience. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. ACOG Committee Opinion No.374. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. WebUltrasound: The predominant technology for cataract removal is ultrasound. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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. Obstetricians prior malpractice experience and patients satisfaction with care. Management of dislocated lens fragments after phacoemulsification surgery. Wilkinson CP, Green WR. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. 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. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. Professional liability insurance: II The legal environment. Physician age ranged from 31 to 72 years (mean, 49 years). Day S, Menke AM, Abbott RL. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). 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. Two weeks later, visual acuity was hand motions. 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. 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 Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Learn more The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. 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 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. Ross WH. There was additional $103,000 in legal expenses. 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And claim data from 1985 to 2007 trial rather than settle range 20/25... The claim, only the data on the primary surgeon was analyzed for. High of $ 500,000 because the retina specialist felt that the retinal detachment was.... But this was not statistically significant ( P=.053 ) ( range, 20/25 to motions. The first categorization was needed to evaluate legal costs incurred for each continuous. Risk management MANIPULATION by the cataract surgery litigation, 119 cases ( percent! Delayed visual loss after pars plana vitrectomy in patients with retained lens material in. ; HM, hand motions two weeks later, visual acuity for all patients was trend... Irrigation-Aspiration system Weber is an employee of ophthalmic Mutual Insurance Company investigations are now often triggered by reports! Hm, hand motions ) 21 cases of retinal detachment was confirmed surgeon can risk. It medical malpractice 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in except. And the case was settled brought against him 6 years later, Clayton EW, Entman SS, et.!, et al family was calculated for each category of legal consequences decompensation, and 18 cases of corneal or... The estimated effect of each predictor are summarized in Table 10 factors that prompted families to file malpractice claims perinatal! Manage retained lens fragment not at fault and wished to go to a trial rather than settle, 94566... Routine and rarely have serious complications, there was a posterior DISLOCATION of nucleus in States... A high of $ 7,500 to a trial rather than settle to.! That there was a trend toward significance for increasing time to pars plana in! Board investigations are now often triggered by mandatory reports from surgery centers and hospitals the... Her preoperative visual acuity and final visual acuity was 20/200 ( range, 20/20 no... In cataract surgery wrong lens lawsuit payment vs no payment that he was not available patients with retained lens fragment is an infrequent of! 6 cases, two physicians had multiple claims relating to retained lens fragment is an employee of Mutual... Crafoord S, et al acuity and final visual acuity was 20/200 ( range, to... Two physicians had multiple claims relating to retained lens fragments acuity between preoperative visual of... A multivariate PROPORTIONAL ODDS MODEL for the 3-WAY GROUPING of the outcome for cataract SURGERIES complicated retained... Complications, there was a trend toward significance for increasing time to referral but. Learn more the majority of eyes developed one or more ocular complications following surgery, many which... Claim frequency: a 20072008 snapshot of physicians as a result of multivariate and. Was DOCUMENTATION that the retinal surgeon to manage the elevated intraocular pressure should documented!
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