Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Bessant DA, Sullivan PM, Aylward GW. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). Bethesda, MD 20894, Web Policies Among these, the patients sought a second opinion and referred themselves in 3 cases. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. and transmitted securely. Careers. Liability claims and costs before and after implementation of a medical error disclosure program. 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. Two cases went on to trial and ended with a verdict in favor of the plaintiff. 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. A claim may include institution of a lawsuit or arbitration proceedings against the insured. In 11 eyes, the operated eye was the better eye. Hickson GB, Clayton EW, Githens PB, Sloan FA. Ho SF, Zaman A. Accessibility 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 ". On average, a claim took 28.8 21.2 months to close. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. 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. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. PMC legacy view For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. 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). Florida and Louisiana each had 10 claims. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. 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. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Therefore, claims related to cataract surgery accounted for 33% of all closed claims during this period, and cataract surgeries complicated by retained lens fragments accounted for 4% of all closed claims and 12.5% of cataract-related claims. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. 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. Aasuri MK, Kompella VB, Majji AB. Managing a dropped nucleus during the phacoemulsification learning curve. Each claim was counted separately as a unique case. The median time to referral was 1 week in this study. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. 5.3k views Reviewed >2 years ago. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. 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. Available at: Slora EJ, Gonzales ML. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Both of these were defined as glaucoma, and there were a total of 31 cases. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. 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. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. Learn how we can help. 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. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. The trial was in favor of the plaintiff with a payment of $231,754. 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. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The new PMC design is here! A steroid drop prescribed by your ophthalmologist can help. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. about navigating our updated article layout. Malpractice risk according to physician specialty. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. Although some bleeding occurred, no retinal tear or detachment was noted. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. Only the claims that closed by December 2009 were included. 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 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. The doctor used a technical lens for my right eye and a standard lens for the left one. Pars plana vitrectomy for the management of retained lens material after cataract surgery. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. 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. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. Intermittent corneal edema due to anterior segment retained lens fragments. 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. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. 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. 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. 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. 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. Retained lens fragments after phacoemulsification. 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. 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. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. Who sues their doctors? In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. 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. Wilkinson CP, Green WR. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Whether the findings of this study are representative depends on whether physicians who were covered by the insurance carrier of this study were more or less likely to be sued than physicians who were insured elsewhere. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. 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