Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Bethesda, MD 20894, Web Policies Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. All variables significant in the univariate analyses were included in a multivariate logistic regression model. The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). Four patients declined any further surgery. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Kane CK. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. May M, Stengel B. ACOG Committee Opinion No.374. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. Kwok AK, Li KK, Lai TY, Lam DS. 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. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Ross WH. He was referred to a retina specialist, who saw him the next day. In: Gonzalez ML, Zhang P, editors. Kachalia A, Kaufman SR, Boothman R, et al. Continuous irrigation was performed, but the nuclear fragment could not be elevated. 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. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. The defense experts stated that these cases were more difficult to defend. Socioeconomic Characteristics of Medical Practice 1997/98. The patient was informed of the complication. The issue of malpractice has wide-ranging stakeholders, including our society. The Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. In 91 eyes, preoperative visual acuity was recorded for both eyes. 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. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. WebCataract surgery injury occurs in approximately 12% of cases. Accessibility The model was simplified using backward selection keeping all predictors with a P value of .25 or less. An example of one unit change in visual acuity would be going from 20/20 to 20/200. Managing a dropped nucleus during the phacoemulsification learning curve. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. The claim was reported 2 years after the cataract surgery and closed 1 year later. 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 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%. In some states, the information on this website may be considered a lawyer referral service. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Who sues their doctors? Occurrence of retained lens fragments after phacoemulsification in The Netherlands. 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. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. 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? 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. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. It involved a 70-year-old female patient who went from preoperative visual acuity of 20/60 to final visual acuity of no light perception. Schutz JS, Mavrakanas NA. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). 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. 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. 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. 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. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). Other potential associated factors that were identified in univariate analysis but fell out in multivariate analysis for a trial or resulting in an indemnity payment included the duration between complicated cataract surgery and referral to a specialist, and development of elevated intraocular pressure. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Available at: Slora EJ, Gonzales ML. Causes of cataract surgery malpractice claims in England 19952008. about navigating our updated article layout. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. Vincent C, Young M, Phillips A. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. During the surgery, the new lens was too small due to a CI, confidence interval; OR, odds ratio; SE, standard error. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. More than one of these complications was noted in 31 cases. 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. Day S, Menke AM, Abbott RL. 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. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. The number of policyholders doubled between years 2000 and 2009. 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. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). For this study, a P value <.05 was considered significant. Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. Management of retained lens fragments in complicated cataract surgery. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. Scott IU, Flynn HW, Jr, Smiddy WE, et al. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. Miller KP. 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. 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. During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. 5.3k views Reviewed >2 years ago. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. Baldwin LM, Larson EH, Hart LG, et al. Hickson GB, Clayton EW, Githens PB, Sloan FA. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. The management of dislocated lens material after phacoemulsification. Smiddy WE, Flynn HW, Jr, Kim JE. Regan JJ, Regan WM. Kraushar MF, Robb JH. 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