Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. Before The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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). In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. 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. Ho LY, Doft BH, Wang L, Bunker CH. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Distribution of closed claims related to retained lens fragments by region in the United States. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. 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. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. 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. What helps? Por YM, Chee SP. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. The issue of malpractice has wide-ranging stakeholders, including our society. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. The site is secure. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. 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. [tdc_zone type=tdc_content][vc_row][vc_column][td_block_trending_now limit=3][/vc_column][/vc_row][vc_row tdc_css=eyJhbGwiOnsiYm9yZGVyLXRvcC13aWR0aCI6IjEiLCJib3JkZXItY29sb3IiOiIjZTZlNmU2In19][vc_column width=2/3][td_block_slide sort=featured limit=3][td_block_2 border_top=no_border_top category_id= limit=6 td_ajax_filter_type=td_category_ids_filter ajax_pagination=next_prev sort=random_posts custom_title=SEA MOSS RECIPES][td_block_1 border_top=no_border_top category_id= sort=random_posts custom_title=SEA MOSS BEAUTY][td_block_ad_box spot_id=custom_ad_1][td_block_15 category_id= limit=8 sort=random_posts custom_title=SEA MOSS HEALTH BENEFITS][/vc_column][vc_column width=1/3][td_block_social_counter custom_title=STAY CONNECTED facebook=tagDiv twitter=tagdivofficial youtube=tagdiv border_top=no_border_top][td_block_9 custom_title=LIFESTYLE border_top=no_border_top category_id= ajax_pagination=next_prev sort=random_posts][td_block_ad_box spot_id=sidebar][td_block_2 sort=random_posts limit=3 category_id= custom_title=SEA MOSS BUSINESS][td_block_title][td_block_10 limit=3 custom_title= border_top=no_border_top tdc_css=eyJhbGwiOnsibWFyZ2luLXRvcCI6Ii0yMCJ9fQ==][/vc_column][/vc_row][/tdc_zone], Designed by Elegant Themes | Powered by WordPress. 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. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. These transformed variables were used in further analyses. 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. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Dr. did correction surgery (for free) after finding and admitting his error. Tackling the dropped nucleus. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Management of dislocated nuclear fragments after phacoemulsification. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Attempts for post-trial settlement were rejected by the plaintiff. The patient was released to a general ophthalmologist. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Management of retained intravitreal lens fragments after phacoemulsification surgery. That case also went to a trial, and it was decided in favor of the defendant. HHS Vulnerability Disclosure, Help Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. Ross WH. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Conservative management could be considered for eyes with good baseline visual acuity. 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. Miller KP. 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. There were differences between claims associated with retained lens fragments that went on to a trial vs settled vs dismissed and whether indemnity payment occurred or not. 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. 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. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. 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. Postoperative complications with significant inflammation causing corneal edema or corneal decompensation were found to be a potential risk factor for increasing the odds of an indemnity payment by more than threefold (P=.037). The remaining 9 cases (10%) were left aphakic by the cataract surgeon. 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 retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Ophthalmic malpractice lawsuits with large monetary awards. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. 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. Of the 30 claims that were settled, there were 6 claims from Illinois; 5 from Florida; 3 from California; 2 claims each from Colorado, Michigan, and New York; and one claim each from Georgia, Louisiana, Missouri, Nevada, Tennessee, Texas, Virginia, Washington, West Virginia, and Wyoming. Ho SF, Zaman A. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. 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. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. The patient was informed of the complication. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. 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. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. 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. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. 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. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. 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. 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). Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. 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. Available at: Slora EJ, Gonzales ML. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). This grouping was done to compare the findings of this study to other published data. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. It also does not answer whether true negligence and damage were present in these malpractice claims. Final visual acuity was the last recorded visual acuity. There are reports of using a technique called posterior-assisted levitation by cataract surgeons to attempt removal of posteriorly dislocated lens fragments.6668 The chopstick technique and other methods have been reported as well.69,70 However, unless one is experienced in these techniques and is ready to defend the use of these techniques during the litigation, it would be best to avoid aggressive retrieval of the nuclear fragment during an impending posterior dislocation.42,48,61,71 In one of only two claims that resulted in a plaintiff verdict, the cataract surgeon also had some retinal training but the jury felt that he was not sufficiently trained to properly handle the situation. 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. 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? Interestingly, this physician had another case brought against him 6 years later. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. Retained intravitreal lens fragments 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. Start here to find personal injury lawyers near you. WebCataract Symfony Lawsuits? 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. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. The case was closed with an indemnity payment of $215,000. The mean payment was $117,688, and the median payment was $90,000. What is the recovery after cataract or lens replacement surgery? Standard of care and anesthesia liability. 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). 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. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Ross WH. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. Factors associated with these claims and claims outcomes were analyzed. 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. 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. 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. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for OMIC underwriting applications and claims records were reviewed. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. Expert testimony. 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. 3,312,688 was spent on legal expenses for each group each group, Popli J. Chopstick technique nucleus. But referrals also included cornea and glaucoma specialists Davis a, Bageja S, Strogatz D. surgical in! 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