Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. 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. The attorney listings on this site are paid attorney advertising. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). National Library of Medicine In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. 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. The number of policyholders doubled between years 2000 and 2009. 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 new PMC design is here! The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. The According to the 2010 report to the OMIC members, approximately 17% of practicing ophthalmologists in the United States are female and 18% of OMIC-insured ophthalmologists are female.17. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Most people may get benefited from an IOL transplant during surgery. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. von Lany H, Mahmood S, James CR, et al. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 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. 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. For statistical purposes, only the data from the primary surgeon was analyzed in the study. It appeared that the nucleus was resting on the optic nerve. What is the recovery after cataract or lens replacement surgery? Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Physician-patient communication. Dr made larger incision & needed stitches. 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. However, the majority of the claims were dismissed and did not result in an indemnity payment. Given the differences in the frequency of claims for various medical specialties and the limited number of studies in the literature related to malpractice claims in ophthalmology, this current study used the available data from a large ophthalmology-specific insurance company in an effort to gather specialty-specific data. 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. Interestingly, this physician had another case brought against him 6 years later. Retained nuclei after cataract surgery. 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. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Kim JE, Flynn HW, Jr, Smiddy WE, et al. OMIC underwriting applications and claims records were reviewed. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). The verdict was 6 for plaintiff and 2 for defendant. 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. Created for people with ongoing healthcare needs but benefits everyone. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. Gedde SJ, Karp CL, Budenz DL. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. 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. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. 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. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. 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. sharing sensitive information, make sure youre on a federal Kwok AK, Li KK, Lai TY, Lam DS. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. 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. i'm sorry to read of your troubles and I know enough as a practicing physician for 20 years that your course has deviated from the typical cataract There was another 29 months on average until the closure of a claim. Schutz JS, Mavrakanas NA. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. During the surgery, the new lens was too small due to a In 94 cases, a referral was made to a subspecialist. 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. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. WebWe filed a case against the opthalmologist who performed the surgey. 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 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. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Four patients declined any further surgery. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. Merani R, Hunyor AP, Playfair TJ, et al. 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. The patient was released to a general ophthalmologist. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. 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%. Ross WH. Kim IK, Miller JW. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. Smiddy WE, Flynn HW, Jr, Kim JE. There was additional $103,000 in legal expenses. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. In: Gonzalez ML, editor. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the Standard of care and anesthesia liability. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. A study based on a survey of retina specialists recommended that vitreoretinal surgeons should place an increased importance on the informed consent process and the patient/doctor relationship in order to improve risk management.16 Informed consent is a process rather than a form. 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 ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. The issue of malpractice has wide-ranging stakeholders, including our society. 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. The relationship between physicians malpractice claims history and later claims: does the past predict the future? WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Hickson GB, Clayton EW, Entman SS, et al. My father had cataract surgery two years ago. Beckman HB, Markakis KM, Suchman AL, Frankel RM. Only the claims that closed by December 2009 were included. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. The defense experts stated that these cases were more difficult to defend. Kraushar MF, Robb JH. Socioeconomic Characteristics of Medical Practice 1990/1991. 19851989. Management of dislocated lens fragments following phacoemulsification surgery. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. Management of retained lens fragments in complicated cataract surgery. WebThere has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to Retained lens fragments in resident-performed cataract extractions. Studdert DM, Mello MM, Gawande AA, et al. Final visual acuity was the last recorded visual acuity. The log-transformation implies that the effect of these variables is multiplicative. Causes of cataract surgery malpractice claims in England 19952008. Leaming DV. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. The case was closed with an indemnity payment of $215,000. 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. Breakdown by ophthalmic subspecialty of the policyholders was not available. The mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. Medical professional liability claims and premiums, 19861996. 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. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. 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 first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. The retina successfully reattached with a final visual acuity of 20/25. If these cases are excluded, there was a mean of 1.5 return visits to the operating room among 94 patients who had additional surgical procedures. 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. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). The needle impaled the lens and tore the lens capsule. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. 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. 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. 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). Learn how we can help. Florida and Louisiana each had 10 claims. Kraushar MF. 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. 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. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. 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. Causes of cataract surgery malpractice claims in England 19952008 this site are paid attorney.. 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