Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. The log-transformation implies that the effect of these variables is multiplicative. WebUltrasound: The predominant technology for cataract removal is ultrasound. 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. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies 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. 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multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried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. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". The defendant prevailed in 83% of trials. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Retained nuclear fragment in the anterior segment. Wilkinson CP, Green WR. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Brick DC. 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. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Medical professional liability claims and premiums. Studdert DM, Mello MM, Gawande AA, et al. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Causes of cataract surgery malpractice claims in England 19952008. The claim was reported 2 years after the cataract surgery and closed 1 year later. The negligent act must be a proximate cause of the plaintiffs injuries, which means the act was necessary for the injury when and in the manner it occurred, and the injury must be a foreseeable consequence of the negligent act. 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. Before Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Malpractice risk according to physician specialty. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. The remaining 76 claims (70%) closed without any payments. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Vincent C, Young M, Phillips A. 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. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. However, the majority of the claims were dismissed and did not result in an indemnity payment. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. 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. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. Moore JK, Scott IU, Flynn HW, Jr, et al. 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. Socioeconomic Characteristics of Medical Practice 1997/98. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. 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. Characteristics of physicians with obstetric malpractice claims experience. 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). Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Pande M, Dabbs TR. According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. WebCataract surgery injury occurs in approximately 12% of cases. The site is secure. 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. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. 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. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Margherio RR, Margherio AR, Pendergast SD, et al. 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. 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. Continuous irrigation was performed, but the nuclear fragment could not be elevated. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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. Scott IU, Flynn HW, Jr, Smiddy WE, et al. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. Finally, the patient must have suffered actual damage or injury as a result of negligence. 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. Postoperatively, the patient developed hypotony and fibrin reaction. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Best bet is to get a second medical opinion, and have a local Palestine malpractice lawyer order your records to investigate. Use Avvo's lawyer fin Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. American College of Obstetricians and Gynecologists. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. An anterior vitrectomy was performed. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Kim IK, Miller JW. Abbott RL. 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. Total cost of defense for all 108 claims was $3,312,688. Each claim was counted separately as a unique case. Available at: Slora EJ, Gonzales ML. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Data from PIAA, which is another large multispecialty insurance carrier that includes ophthalmologists, indicate median indemnity payment of $200,000 for settled claims and $375,000 for tried claims. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 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. 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. 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. 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). One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. The retina successfully reattached with a final visual acuity of 20/25. The term claim was used in this study to include suits, unless specified. Baldwin LM, Larson EH, Hart LG, et al. He also damaged the film over the 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. Attempts for post-trial settlement were rejected by the plaintiff. 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. 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. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. However, the cataract surgeon did not document having made this call and the case was settled. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Factors associated with these claims and claims outcomes were analyzed. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. 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. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. 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 study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. 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. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. 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. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. This grouping was done to compare the findings of this study to other published data. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Only the claims that closed by December 2009 were included. 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. 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. 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. Standard of care is what a reasonable physician would do in similar circumstances. In 91 eyes, preoperative visual acuity was recorded for both eyes. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of retinal detachment. Data on age was available for 101 claimants. If a physician had multiple claims from separate cataract surgeries, each was counted separately. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. 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. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Schutz JS, Mavrakanas NA. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. 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. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. 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. Interestingly, this physician had another case brought against him 6 years later. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. 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. 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. The mean age was 69 years (range, 4090 years). The patient was informed of the complication. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Learn how we can help. For statistical purposes, only the data from the primary surgeon was analyzed in the study. In 6 cases, there are some risks still associated with these claims and claims outcomes were.... Surgery for retained lens fragments corneal transplantation, pars plana vitrectomy in the management POSTERIOR... Surgery and closed 1 year later of 20/25, Jr, Smiddy WE, et al more... Monitor closed claim incidence trends of this study was not designed to WHETHER... A potential for retinal complications.10 another case brought against him 6 years later fragment could be! 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