Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Oruc S, Kaplan HJ. This grouping was done to compare the findings of this study to other published data. In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. PMC legacy view The average cataract surgery settlement was for $192,865. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Total cost of defense for all 108 claims was $3,312,688. 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. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. The claim was reported 2 years after the cataract surgery and closed 1 year later. Conservative management could be considered for eyes with good baseline visual acuity. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Bettman JW. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. Learn how we can help. In the first case, the cataract surgery was performed in 1989. 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. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. In 3 cases, malfunctioning or unavailability of necessary equipment resulting in prolonged cataract surgery time was thought to have contributed to the patient movement and complication of capsular tear. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Physician-patient communication. Management of dislocated lens fragments following phacoemulsification surgery. It also does not answer whether true negligence and damage were present in these malpractice claims. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. However, the patient did not show up for appointments, despite being sent no show letters. Pande M, Dabbs TR. Retained lens fragments in resident-performed cataract extractions. National Library of Medicine 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. 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. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Malpractice risk according to physician specialty. Data on age was available for 101 claimants. 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. Hickson GB, Clayton EW, Entman SS, et al. Benson JS, Coogan CL. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. 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. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. Characteristics of physicians with obstetric malpractice claims experience. Can I sue a doctor for a botched cataract surgery? Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Retained intravitreal lens fragments after cataract 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. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. The mean defense costs per claim were $30,692. Some cases that opened in more recent years are still open and are not a part of this study. The attorney listings on this site are paid attorney advertising. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Management of dislocated lens material. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. 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. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Therefore, 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. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. 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. 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 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. 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. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. 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. Seven hundred medicolegal cases in ophthalmology. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the 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. The trial was in favor of the plaintiff with a payment of $231,754. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Malpractice, in contrast, requires demonstration of negligence, defined as substandard care that resulted in harm.1 Malpractice suits are usually based on the legal theory of negligence, requiring the presence of the following four elements: (1) duty to treat, (2) breach of duty, (3) cause, and (4) damages. 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. 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. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Kim JE, Flynn HW, Jr, Smiddy WE, et al. 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. 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. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. 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. Two cases went on to trial and ended with a verdict in favor of the plaintiff. 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. 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. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. The relationship between physicians malpractice claims history and later claims: does the past predict the future? What helps? Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. 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. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. 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. 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. Two weeks later, visual acuity was hand motions. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. A claim may include institution of a lawsuit or arbitration proceedings against the insured. The .gov means its official. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. 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