Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. Smiddy WE, Flynn HW, Jr, Kim JE. Bohigian GM, Wexler SA. 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. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. 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. This grouping was done to compare the findings of this study to other published data. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. Retained lens fragments can be successfully managed by the retina specialists in most cases. 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. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. 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. 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. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. will also be available for a limited time. 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. In this analysis, the following factors were found to be statistically significant for more severe legal outcome: logMAR preoperative visual acuity, logMAR final visual acuity, preoperative to postoperative change in logMAR visual acuity, development of glaucoma or elevated intraocular pressure, time to referral, and the duration between opening and closing of a case. 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 number of policyholders doubled between years 2000 and 2009. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. The .gov means its official. 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. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. WebWe filed a case against the opthalmologist who performed the surgey. 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. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Finally, the patient must have suffered actual damage or injury as a result of negligence. Leaming DV. Kachalia A, Kaufman SR, Boothman R, et al. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Ali N, Little BC. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. 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. 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. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. In addition to alleged negligent cataract surgery with retained lens fragments, placement of the wrong IOL was cited as a contributing negligence in 3 cases: (1) placement of wrong-powered IOL handed to the surgeon by a nurse; (2) not having the correct type of IOL to insert in the setting of capsular rupture, resulting in increased likelihood of subsequent dislocation of IOL; and (3) placement of wrong-powered IOL due to incorrect transfer of A-scan data by a technician. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. Can I sue a doctor for a botched cataract surgery? The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. 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. Follow Posted 4 years ago, 24 users are following. This gender spread was compared with OMIC data on demographics. WebUltrasound: The predominant technology for cataract removal is ultrasound. Kraushar MF. For this study, a P value <.05 was considered significant. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. 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). Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. 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. In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. 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. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Four patients declined any further surgery. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. and transmitted securely. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. 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. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. 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. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Tackling the dropped nucleus. 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Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. 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. 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. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. Management of dislocated lens fragments following phacoemulsification surgery. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. What is the recovery after cataract or lens replacement surgery? An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. A claim may include institution of a lawsuit or arbitration proceedings against the insured. Obstetricians prior malpractice experience and patients satisfaction with care. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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. The mean defense costs per claim were $30,692. Scott IU, Flynn HW, Jr, Smiddy WE, et al. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Vitrectomy for retained lens fragments after phacoemulsification. The average insurance company payment - mostly settlements -- in these cases were $112,000. Bovbjerg RR, Petronis KR. Management of dislocated lens fragments after phacoemulsification surgery. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Management of dislocated nuclear fragments after phacoemulsification. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. Standard of care and anesthesia liability. However, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. 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. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. 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. 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. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. Postoperatively, the patient developed hypotony and fibrin reaction. The primary surgeon was analyzed the inferior portion of the posterior capsule seen... The use in multivariate modeling, an optimal transformation from the multivariate LOGISTIC REGRESSION MODEL for payment. Hypotony and fibrin reaction fragments are listed in Table 4 OMIC data on demographics prior. 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