Because the surgeon ultimately becomes responsible for the outcome of the surgery, it is important to communicate with the anesthesiologist as well as to oversee and proactively troubleshoot any preventable disasters in the operating room.93. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Standard of care and anesthesia liability. In 94 cases, a referral was made to a subspecialist. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. The remaining 76 claims (70%) closed without any payments. There 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 be written on this topic.1978 The incidence of retained or dropped lens fragments during cataract surgery is estimated to be between 0.1% and 1.6% of cataract surgeries.18,19,23,29,45,54,64 There are numerous articles to indicate that a capsular tear with retained lens fragment is a well-known complication of cataract surgery.2049 Studies show that reasonably favorable visual outcome can be obtained with intervention usually in the form of pars plana vitrectomy.2049,7477 Therefore, encountering this complication in itself would not be a malpractice. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Therefore, claims related to cataract surgery accounted for 33% of all closed claims during this period, and cataract surgeries complicated by retained lens fragments accounted for 4% of all closed claims and 12.5% of cataract-related claims. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. 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. Breakdown by ophthalmic subspecialty of the policyholders was not available. Intermittent corneal edema due to anterior segment retained lens fragments. Data from the PIAA show that for all medical claims in 2008, average defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and time associated with a lawsuit to the plaintiff or to the defendant. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. What is the recovery after cataract or lens replacement surgery? Distribution of closed claims related to retained lens fragments by region in the United States. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Managing a dropped nucleus during the phacoemulsification learning curve. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. The issue of malpractice has wide-ranging stakeholders, including our society. 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. Kane CK. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Male physicians may have a higher likelihood of being sued because male physicians are historically concentrated in the specialties with the highest levels of claim incidence, such as surgery, and female physicians in those with the lowest incidences, such as pediatrics. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. The doctor used a technical lens for my right eye and a standard lens for the left one. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. In: Gonzalez ML, editor. The technical lens was suppose to give me even better vision in the right eye. Yang CS, Lee FL, Hsu WM, Liu JH. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. 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. Brick DC. Gonzalez ML. An example of one unit change in visual acuity would be going from 20/20 to 20/200. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. 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 ". Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. 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. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. 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. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. The case was closed with an indemnity payment of $215,000. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians and gynecologists than it was for pediatricians and psychiatrists. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. 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). government site. Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. 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. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. 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. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. 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. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. Retained lens fragments in resident-performed cataract extractions. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Vitrectomy for removal of retained lens material. In the multivariate analysis, two factors were found to be associated with indemnity payment: (1) the difference between preoperative visual acuity and final visual acuity and (2) the development of corneal edema or corneal decompensation. This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. 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. On average, a claim took 28.8 21.2 months to close. 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. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. During the surgery, the new lens was too small due to a WebWe filed a case against the opthalmologist who performed the surgey. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. 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 Only the claims that closed by December 2009 were included. 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. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. A steroid drop prescribed by your ophthalmologist can help. Medical liability claim frequency: a 20072008 snapshot of physicians. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. The mean age was 69 years (range, 4090 years). 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. Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. 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 addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. Risk factors for and management of dropped nucleus during phacoemulsification. Pars plana vitrectomy for the management of retained lens material after cataract surgery. Day S, Menke AM, Abbott RL. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. What helps? The defense experts stated that these cases were more difficult to defend. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. 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 third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Management of retained intravitreal lens fragments after phacoemulsification surgery. 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. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. The mean payment was $117,688, and the median payment was $90,000. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. 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. 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. The possible outcomes are assumed to be ordered: Trial with a verdict > Settled > Dismissed and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Medical professional liability claims and premiums. Start here to find personal injury lawyers near you. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Colyer MH, Berinstein DM, Khan NJ, et al. If you have experienced complications after cataract surgery because of surgical error, consult with the St. Louis surgical error attorneys at Zevan and Davidson Law Firm, LLC at (314) 588-7200. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). 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.). Medical professional liability claims and premiums, 19861996. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Physician age ranged from 31 to 72 years (mean, 49 years). Characteristics of physicians with obstetric malpractice claims experience. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. 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. Gilliland GD, Hutton WL, Fuller DG. Schaal S, Barr CC. 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. In the first case, the cataract surgery was performed in 1989. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Smiddy WE, Flynn HW, Jr, Kim JE. about navigating our updated article layout. 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. If a physician had multiple claims from separate cataract surgeries, each was counted separately. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. 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. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Factors associated with these claims and claims outcomes were analyzed. CF, counting fingers; HM, hand motions; NLP, no light perception. The patient claimed that the physician should have Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. Liability claims and costs before and after implementation of a medical error disclosure program. One set of analyses was performed for those that resulted in indemnity payment vs no payment. Furthermore, they estimated that an additional $45.59 billion was spent on defensive medicine, most of which went to pay for tests, procedures, and treatments associated with defensive medicine. 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<.001). WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Management of nucleus loss into the vitreous: long term follow up in 63 patients. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. 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. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. Careers. My father had cataract surgery two years ago. This is without adjustment for potential differences in dollar amount due to inflationary changes. Factors that prompted families to file malpractice claims following perinatal injuries. 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%. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Management of retained lens fragments in complicated cataract surgery. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. 19851989. Follow Posted 4 years ago, 24 users are following. The Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. 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 CF, counting fingers; HM, hand motion; NLP, no light perception. official website and that any information you provide is encrypted 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. Retrospective, noncomparative, consecutive case series. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. The hypothesis of the analysis VARIABLES by CLAIMSOUTCOME associated with cataract surgery COMPLICATED by retained fragments... A, Nohutcu AF, Keskinbora KH, there was documentation that the physician fails to follow the of. 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