This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. In addition to alleged negligent cataract surgery with retained lens fragments, placement of the wrong IOL was cited as a contributing negligence in 3 cases: (1) placement of wrong-powered IOL handed to the surgeon by a nurse; (2) not having the correct type of IOL to insert in the setting of capsular rupture, resulting in increased likelihood of subsequent dislocation of IOL; and (3) placement of wrong-powered IOL due to incorrect transfer of A-scan data by a technician. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Yang CS, Lee FL, Hsu WM, Liu JH. 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. 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). Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. 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. Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. 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. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Medical professional liability claims and premiums. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. 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). Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. 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. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as 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. Retained lens fragments can be successfully managed by the retina specialists in most cases. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Regan JJ, Regan WM. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Vincent C, Young M, Phillips A. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. Characteristics of physicians with obstetric malpractice claims experience. Scott IU, Flynn HW, Jr, Smiddy WE, et al. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to 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. The difference between the mean and median payment reflects the right-skewed payment distribution. 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. For this study, a P value <.05 was considered significant. Who sues their doctors? 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. Claims were separated into regions of the United States as seen in Figure 4. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. An anterior vitrectomy was performed. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Conservative management could be considered for eyes with good baseline visual acuity. 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. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. Review of the literature indicates that complications associated with retained lens material include inflammation, corneal edema, elevated intraocular pressure, hypotony, subluxation or dislocation of IOL, retinal tears or detachments, vitreous hemorrhage, choroidal hemorrhage, cystoid macular edema, epiretinal membrane, and endophthalmitis. Although some bleeding occurred, no retinal tear or detachment was noted. The patient was informed of the complication. 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. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. Miller KP. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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. Kim IK, Miller JW. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. The doctor used a technical lens for my right eye and a standard lens for the left one. 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? National costs of the medical liability system. 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. Vitrectomy for retained lens fragments after phacoemulsification. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). 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. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. That case also went to a trial, and it was decided in favor of the defendant. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. Causes of cataract surgery malpractice claims in England 19952008. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Among these, the patients sought a second opinion and referred themselves in 3 cases. Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. Can I sue a doctor for a botched cataract surgery? On average, a claim took 28.8 21.2 months to close. HHS Vulnerability Disclosure, Help Just as the meta-analysis showed that the best time to remove retained lens fragments by vitrectomy might be during the latter part of the first week and possibly up to 2 weeks after the cataract surgery for better clinical outcome,78 this study also found that claims with earlier referral were more easily defended and were less likely to result in a trial or a payment. 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. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Margherio RR, Margherio AR, Pendergast SD, et al. Physician age ranged from 31 to 72 years (mean, 49 years). The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Among the 3 claims involving retina surgeons, one claim alleged negligent surgery to remove the dropped nucleus and dislocated IOL, which allegedly led to a subsequent retinal detachment. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. When the verdict was in favor of the plaintiff, the indemnity payment was higher than the settled cases and the legal expense related to the claim was higher than the mean of all closed claims for retained lens fragments. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. Ho SF, Zaman A. This gender spread was compared with OMIC data on demographics. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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 overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. 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. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Teo L, Chee SP. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. 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. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Start here to find personal injury lawyers near you. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Retained nuclear fragment in the anterior segment. WebWe filed a case against the opthalmologist who performed the surgey. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. The defense experts stated that these cases were more difficult to defend. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Baldwin LM, Larson EH, Hart LG, et al. 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). Those with valid cataract surgery malpractice In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. 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. WebCataract surgery injury occurs in approximately 12% of cases. 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). Gilliland GD, Hutton WL, Fuller DG. 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 final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. and transmitted securely. 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 retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. WebCataract Symfony Lawsuits? CI, confidence interval; OR, odds ratio; SE, standard error. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Brick DC. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. 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 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. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. 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. government site. The remaining 76 claims (70%) closed without any payments. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. The patient refused laser treatment for vitreolysis. When the complication of a retained lens fragment has been encountered, the cataract surgeon should closely follow the patient and monitor for complications associated with retained lens fragment and consider timely referral to a specialist for management of further complications that may contribute to poor visual acuity outcomes. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Beckman HB, Markakis KM, Suchman AL, Frankel RM. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. Malpractice risk according to physician specialty. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Por YM, Chee SP. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. 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. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Merani R, Hunyor AP, Playfair TJ, et al. Careers. The Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. 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 The number of policyholders doubled between years 2000 and 2009. 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. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Schaal S, Barr CC. Yet three or four years ago, UCLA surgeons The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. The trial was in favor of the plaintiff with a payment of $231,754. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. 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. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Bettman JW. In the table, the estimates give the odds ratio of an indemnity payment when the predictor is changed by one unit for continuous variable (eg, visual acuity change), whereas for categorical variable (eg, corneal edema or decompensation), it means a change from the unlisted group to the listed one. 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. 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. 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. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. WebUltrasound: The predominant technology for cataract removal is ultrasound. The case was closed with an indemnity payment of $215,000. 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 median payment was $90,000. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. Vitrectomy for removal of retained lens material. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Dr. did correction surgery (for free) after finding and admitting his error. Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. 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. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. Versus delayed vitrectomy with endoscopy for management of retained lens fragments compared to the number of closed claims for is... 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