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. WebCataract Symfony Lawsuits? The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 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. 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. 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. 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. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. 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. What is the recovery after cataract or lens replacement surgery? All variables significant in the univariate analyses were included in a multivariate logistic regression model. Miller KP. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Beckman HB, Markakis KM, Suchman AL, Frankel RM. 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. Moore JK, Scott IU, Flynn HW, Jr, et al. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. The items collected during the review of the claims are listed in Table 1. WebCataract surgery injury occurs in approximately 12% of cases. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. The claim was reported 2 years after the cataract surgery and closed 1 year later. The average cataract surgery settlement was for $192,865. Hickson GB, Clayton EW, Githens PB, Sloan FA. Incidence of lens matter dislocation during phacoemulsification. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. This gender spread was compared with OMIC data on demographics. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. OMIC underwriting applications and claims records were reviewed. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Physician-patient communication. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. The difference between the mean and median payment reflects the right-skewed payment distribution. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. The case was closed with an indemnity payment of $215,000. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. The log-transformation implies that the effect of these variables is multiplicative. 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. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. 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. Risk management lessons from a review of 168 cataract surgery claims. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. 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%. 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. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. Retained lens fragments in resident-performed cataract extractions. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Studdert DM, Mello MM, Gawande AA, et al. Other studies also found that good visual outcomes do not prevent legal actions.10,92. The relationship between physicians malpractice claims history and later claims: does the past predict the future? WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. 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. Por YM, Chee SP. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Expert testimony. 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. 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. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. The estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. 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. Aasuri MK, Kompella VB, Majji AB. National Library of Medicine 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. These transformed variables were used in further analyses. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. government site. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Created for people with ongoing healthcare needs but benefits everyone. Tackling the dropped nucleus. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Can I sue a doctor for a botched cataract surgery? 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. 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. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. 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. Michels RG, Shacklett DE. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. Vitrectomy for removal of retained lens material. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Conservative management could be considered for eyes with good baseline visual acuity. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. 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. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. Both of these were defined as glaucoma, and there were a total of 31 cases. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Each claim was counted separately as a unique case. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The verdict was 6 for plaintiff and 2 for defendant. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. On average, a claim took 28.8 21.2 months to close. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. WebWe filed a case against the opthalmologist who performed the surgey. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. 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. 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 frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. In: Gonzalez ML, editor. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. WebUltrasound: The predominant technology for cataract removal is ultrasound. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. 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. 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. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. 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. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. The mean defense costs per claim were $30,692. sharing sensitive information, make sure youre on a federal Wilkinson CP, Green WR. 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. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. The incidence of closed claims for retained lens fragments peaked in 1997, but the actual number of closed claims was the highest for years 2001, 2003, and 2004. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. 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. 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). In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. 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. The trial was in favor of the plaintiff with a payment of $231,754. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Dr made larger incision & needed stitches. 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. 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. Two weeks later, visual acuity was hand motions. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. 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 When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Ross WH. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. In 11 eyes, the operated eye was the better eye. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. There was another 29 months on average until the closure of a claim. 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? Bettman JW. The Cheney FW, Posner K, Caplan RA, Ward RJ. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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). Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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.
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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. WebCataract Symfony Lawsuits? The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 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. 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. 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. 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. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. 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. What is the recovery after cataract or lens replacement surgery? All variables significant in the univariate analyses were included in a multivariate logistic regression model. Miller KP. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Beckman HB, Markakis KM, Suchman AL, Frankel RM. 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. Moore JK, Scott IU, Flynn HW, Jr, et al. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. The items collected during the review of the claims are listed in Table 1. WebCataract surgery injury occurs in approximately 12% of cases. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. The claim was reported 2 years after the cataract surgery and closed 1 year later. The average cataract surgery settlement was for $192,865. Hickson GB, Clayton EW, Githens PB, Sloan FA. Incidence of lens matter dislocation during phacoemulsification. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. This gender spread was compared with OMIC data on demographics. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. OMIC underwriting applications and claims records were reviewed. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Physician-patient communication. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. The difference between the mean and median payment reflects the right-skewed payment distribution. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. The case was closed with an indemnity payment of $215,000. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. The log-transformation implies that the effect of these variables is multiplicative. 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. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. 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. Risk management lessons from a review of 168 cataract surgery claims. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. 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%. 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. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. Retained lens fragments in resident-performed cataract extractions. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Studdert DM, Mello MM, Gawande AA, et al. Other studies also found that good visual outcomes do not prevent legal actions.10,92. The relationship between physicians malpractice claims history and later claims: does the past predict the future? WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. 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. Por YM, Chee SP. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Expert testimony. 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. 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. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. The estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. 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. Aasuri MK, Kompella VB, Majji AB. National Library of Medicine 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. These transformed variables were used in further analyses. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. government site. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Created for people with ongoing healthcare needs but benefits everyone. Tackling the dropped nucleus. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Can I sue a doctor for a botched cataract surgery? 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. 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. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. 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. Michels RG, Shacklett DE. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. Vitrectomy for removal of retained lens material. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Conservative management could be considered for eyes with good baseline visual acuity. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. 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. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. Both of these were defined as glaucoma, and there were a total of 31 cases. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Each claim was counted separately as a unique case. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The verdict was 6 for plaintiff and 2 for defendant. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. On average, a claim took 28.8 21.2 months to close. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. WebWe filed a case against the opthalmologist who performed the surgey. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. 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. 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 frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. In: Gonzalez ML, editor. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. WebUltrasound: The predominant technology for cataract removal is ultrasound. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. 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. 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. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. 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. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. The mean defense costs per claim were $30,692. sharing sensitive information, make sure youre on a federal Wilkinson CP, Green WR. 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. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. The incidence of closed claims for retained lens fragments peaked in 1997, but the actual number of closed claims was the highest for years 2001, 2003, and 2004. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. 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. 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). In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. 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. The trial was in favor of the plaintiff with a payment of $231,754. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Dr made larger incision & needed stitches. 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. 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. Two weeks later, visual acuity was hand motions. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. 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 When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Ross WH. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. In 11 eyes, the operated eye was the better eye. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. There was another 29 months on average until the closure of a claim. 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? Bettman JW. The Cheney FW, Posner K, Caplan RA, Ward RJ. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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). Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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.
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