Attempts for post-trial settlement were rejected by the plaintiff. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. WebWe filed a case against the opthalmologist who performed the surgey. 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. 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. 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. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto Ho LY, Doft BH, Wang L, Bunker CH. Michels RG, Shacklett DE. It appeared that the nucleus was resting on the optic nerve. will also be available for a limited time. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. 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 ". Posterior-assisted levitation in cataract surgery. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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 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). 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 addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Available at: Slora EJ, Gonzales ML. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. 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. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. 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. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. 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. A claim may include institution of a lawsuit or arbitration proceedings against the insured. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The .gov means its official. 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. The site is secure. 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. Retained lens fragments in resident-performed cataract extractions. Outcome of vitrectomy for retained lens fragments after phacoemulsification. Wilkinson CP, Green WR. 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. However, these numbers may reflect the states in which OMIC has a major presence, since these are also states in which OMIC has the highest number of insured ophthalmologists. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Stenkula S, Byhr E, Crafoord S, et al. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. FOIA Schutz JS, Mavrakanas NA. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). The trial was in favor of the plaintiff with a payment of $231,754. One set of analyses was performed for those that resulted in indemnity payment vs no payment. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. There was another 29 months on average until the closure of a claim. Follow Posted 4 years ago, 24 users are following. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. The items collected during the review of the claims are listed in Table 1. 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. 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. Kim IK, Miller JW. OMIC underwriting applications and claims records were reviewed. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. PMC legacy view 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. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. He was referred to a retina specialist, who saw him the next day. This study is limited to those claims from a single insurer, which may not be nationally representative, although it is one of the largest insurers of ophthalmologists in the United States. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. 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. 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. 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. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. 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? In some cases, the cause of capsular tear and resulting complication of retained lens fragment was due to circumstances other than the surgeons surgical technique. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The doctor used a technical lens for my right eye and a standard lens for the left one. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Kane CK. 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. The needle impaled the lens and tore the lens capsule. Conservative management could be considered for eyes with good baseline visual acuity. 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. Can I sue a doctor for a botched cataract surgery? 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. Levinson W, Roter DL, Mullooly JP, et al. The defendant prevailed in 83% of trials. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. government site. The mean defense costs per claim were $30,692. about navigating our updated article layout. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. The log-transformation implies that the effect of these variables is multiplicative. The patient was informed of the complication. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. Socioeconomic Characteristics of Medical Practice 1990/1991. 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 were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Ross WH. Bohigian GM, Wexler SA. Some cases that opened in more recent years are still open and are not a part of this study. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. 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. Socioeconomic Characteristics of Medical Practice 1997/98. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. 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. The distribution of the number of closed claims related to the complication of retained lens fragments per year from 1989 through December 2009 is shown in Figure 2. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. 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. D. Surgical confusions in ophthalmology 20/40 and the posterior chamber IOL was documented to in! 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