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defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and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. A claim may include institution of a lawsuit or arbitration proceedings against the insured. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. He also damaged the film over the During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. 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. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 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. 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. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. Why do people sue doctors? Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The most common risks are: When Is It Medical Malpractice? Postoperatively, the patient developed hypotony and fibrin reaction. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. The management of dislocated lens material after phacoemulsification. 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). The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. 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. 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. 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. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Managing a dropped nucleus during the phacoemulsification learning curve. The verdict was 6 for plaintiff and 2 for defendant. von Lany H, Mahmood S, James CR, et al. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. 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. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. 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. Baker PS, Spirn MJ, Chiang A, et al. 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. Aasuri MK, Kompella VB, Majji AB. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. 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. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. The trial was in favor of the plaintiff with a payment of $231,754. Yet three or four years ago, UCLA surgeons In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. The average insurance company payment - mostly settlements -- in these cases were $112,000. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. 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). 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. Gedde SJ, Karp CL, Budenz DL. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. ACOG Committee Opinion No.374. Each claim was counted separately as a unique case. Obstetricians prior malpractice experience and patients satisfaction with care. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. Retained lens fragments in resident-performed cataract extractions. The .gov means its official. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. In 11 eyes, the operated eye was the better eye. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. 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. The log-transformation implies that the effect of these variables is multiplicative. Incidence of lens matter dislocation during phacoemulsification. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. The https:// ensures that you are connecting to the The defense experts stated that these cases were more difficult to defend. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. The mean age was 69 years (range, 4090 years). 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.). She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. On average, a claim took 28.8 21.2 months to close. 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. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. Practice styles and preferences of ASCRS members1994 survey. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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. Interestingly, this physician had another case brought against him 6 years later. The Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. 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. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Vanner EA, Stewart MW. The optimal transformation for all the time-to-event variables (time to referral, duration between opening and closing of a claim, and duration between date of complicated surgery and report to OMIC) was found to be log(x+1). Risk factors for and management of dropped nucleus during phacoemulsification. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. Malpractice risk according to physician specialty. Outcome of vitrectomy for retained lens fragments after phacoemulsification. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. 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. Posterior-assisted levitation in cataract surgery. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. The average cataract surgery settlement was for $192,865. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. 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. Management of dislocated lens fragments after phacoemulsification surgery. Management of nucleus loss into the vitreous: long term follow up in 63 patients. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. Merani R, Hunyor AP, Playfair TJ, et al. 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. 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. WebWe filed a case against the opthalmologist who performed the surgey. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. The patient claimed that the physician should have 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. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. 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. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. The number of policyholders doubled between years 2000 and 2009. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. There was additional $103,000 in legal expenses. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. Closed claims data from OMIC were chosen to be the basis of this study because OMIC provides coverage to a large number of ophthalmologists and can provide data specific to an ophthalmic procedure. 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 5.3k views Reviewed >2 years ago. 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