Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. 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. 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. Data on age was available for 101 claimants. Bethesda, MD 20894, Web Policies There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). 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. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. 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. 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. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. The issue of malpractice has wide-ranging stakeholders, including our society. Baker PS, Spirn MJ, Chiang A, et al. 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. The patient claimed that the physician should have The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. 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. Most people may get benefited from an IOL transplant during surgery. Management of retained intravitreal lens fragments after phacoemulsification surgery. The Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. The estimated effects of each predictor are shown in Table 8. 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. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Obstetricians prior malpractice experience and patients satisfaction with care. Vitrectomy for retained lens fragments after phacoemulsification. 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. 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. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Learn how we can help. 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). Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. 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. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Outcome of vitrectomy for retained lens fragments after phacoemulsification. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Kwok AK, Li KK, Lai TY, Lam DS. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. 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. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Leaming DV. 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 median time to referral was 1 week in this study. In 91 eyes, preoperative visual acuity was recorded for both eyes. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Retained intravitreal lens fragments after cataract surgery. The site is secure. will also be available for a limited time. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. 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. 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. 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. 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). 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. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Day S, Menke AM, Abbott RL. The median payment was $90,000. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. In: Gonzalez ML, Zhang P, editors. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Smiddy WE, Flynn HW, Jr, Kim JE. Risk factors for and management of dropped nucleus during phacoemulsification. Ho SF, Zaman A. Why do people sue doctors? 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. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract The case was closed with an indemnity payment of $215,000. 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. Among 108 patient claimants, 54 were men and 54 were women. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. Physician age ranged from 31 to 72 years (mean, 49 years). Claims that were dismissed, dropped, or closed without compensation were combined as dismissed, and the term dismissed was used interchangeably with closed without compensation, dropped, and withdrawn, unless specified. Stenkula S, Byhr E, Crafoord S, et al. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. Yet three or four years ago, UCLA surgeons The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. For statistical purposes, only the data from the primary surgeon was analyzed in the study. Finally, the patient must have suffered actual damage or injury as a result of negligence. 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. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Retained nuclear fragment in the anterior segment. 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. Causes of cataract surgery malpractice claims in England 19952008. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. 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. Florida and Louisiana each had 10 claims. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. However, the majority of the claims were dismissed and did not result in an indemnity payment. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Half of all claims in this study were referred within 1 week of cataract surgery or the same day as detection of the retinal detachment. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. 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. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. National costs of the medical liability system. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. 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. 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. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Pande M, Dabbs TR. The term claim was used in this study to include suits, unless specified. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Teo L, Chee SP. He also damaged the film over the 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. 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. 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.). With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. Vanner EA, Stewart MW. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. 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. 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. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Risk management lessons from a review of 168 cataract surgery claims. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. My father had cataract surgery two years ago. The difference between the mean and median payment reflects the right-skewed payment distribution. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. WebThere 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 Physician-patient communication. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for 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. 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. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. 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. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. WebCataract Symfony Lawsuits? National Library of Medicine Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. Only the claims that closed by December 2009 were included. The patient refused laser treatment for vitreolysis. 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. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. Retained lens fragments after phacoemulsification. 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. Federal government websites often end in .gov or .mil. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. 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