Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. The remaining 76 claims (70%) closed without any payments. 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. 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. 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. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. 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. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. 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. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. 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. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. Most people may get benefited from an IOL transplant during surgery. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. 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. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. More than one of these complications was noted in 31 cases. Kachalia A, Kaufman SR, Boothman R, et al. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. 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. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. 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. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). 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. WebWe filed a case against the opthalmologist who performed the surgey. Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. Seven hundred medicolegal cases in ophthalmology. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. 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. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. The issue of malpractice has wide-ranging stakeholders, including our society. 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. WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Although these findings may cause fear and increased practice of defensive medicine by physicians, better understanding of the incidence, associated factors, and outcomes of medical malpractice claims may result in increased knowledge to the physicians and more effective and improved care to the patients. 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). Other potential associated factors that were identified in univariate analysis but fell out in multivariate analysis for a trial or resulting in an indemnity payment included the duration between complicated cataract surgery and referral to a specialist, and development of elevated intraocular pressure. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Postoperatively, the patient developed hypotony and fibrin reaction. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The term claim was used in this study to include suits, unless specified. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. 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. Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. However, the cataract surgeon did not document having made this call and the case was settled. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. The median payment was $90,000. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. ACOG Committee Opinion No.374. Rofagha S, Bhisitkul RB. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. National costs of the medical liability system. Bohigian GM, Wexler SA. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Physician-patient communication. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. 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). In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. However, the patient did not show up for appointments, despite being sent no show letters. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. Ho LY, Doft BH, Wang L, Bunker CH. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. 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. 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. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. Among 108 patient claimants, 54 were men and 54 were women. 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. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. 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. Professional liability insurance: II The legal environment. 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. 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). Factors that prompted families to file malpractice claims following perinatal injuries. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Colyer MH, Berinstein DM, Khan NJ, et al. 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. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Retained nuclei after cataract surgery. The mean payment was $117,688, and the median payment was $90,000. 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. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. 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. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. After the trial, the jurors were polled. Kraushar MF, Robb JH. 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