Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). 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. Retained nuclear fragment in the anterior segment. Claims, errors, and compensation payments in medical malpractice litigation. OMIC underwriting applications and claims records were reviewed. WebCataract Symfony Lawsuits? In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. Postoperative complications with significant inflammation causing corneal edema or corneal decompensation were found to be a potential risk factor for increasing the odds of an indemnity payment by more than threefold (P=.037). WebCataract surgery injury occurs in approximately 12% of cases. 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. Studdert DM, Mello MM, Gawande AA, et al. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. In some states, the information on this website may be considered a lawyer referral service. Finally, the patient must have suffered actual damage or injury as a result of negligence. 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. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). 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. Federal government websites often end in .gov or .mil. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. 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. The verdict was 6 for plaintiff and 2 for defendant. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Management of retained lens fragments in complicated cataract surgery. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. 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. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Vanner EA, Stewart MW. In the table, the estimates give the odds ratio of an indemnity payment when the predictor is changed by one unit for continuous variable (eg, visual acuity change), whereas for categorical variable (eg, corneal edema or decompensation), it means a change from the unlisted group to the listed one. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. PMC legacy view Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). CI, confidence interval; OR, odds ratio; SE, standard error. Spicer J. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. All variables significant in the univariate analyses were included in a multivariate logistic regression model. Pars plana vitrectomy for the management of retained lens material after cataract surgery. 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. 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. 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. Conservative management could be considered for eyes with good baseline visual acuity. If you have experienced complications after cataract surgery because of surgical error, consult with the St. Louis surgical error attorneys at Zevan and Davidson Law Firm, LLC at (314) 588-7200. 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. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. In these early referral cases, the claim was more likely to be dismissed. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. Bessant DA, Sullivan PM, Aylward GW. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. 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. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. The mean age was 69 years (range, 4090 years). 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 Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. ACOG Committee Opinion No.374. 5.3k views Reviewed >2 years ago. 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. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. The median time to referral was 1 week in this study. The remaining 76 claims (70%) closed without any payments. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. 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. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. Obstetricians prior malpractice experience and patients satisfaction with care. WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. 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. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. The needle impaled the lens and tore the lens capsule. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. The items collected during the review of the claims are listed in Table 1. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. 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. In 94 cases, a referral was made to a subspecialist. 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. Medical liability claim frequency: a 20072008 snapshot of physicians. 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. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. If a physician had multiple claims from separate cataract surgeries, each was counted separately. 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. 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. The term claim was used in this study to include suits, unless specified. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. 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. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. 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. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. Malpractice risk according to physician specialty. 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. 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. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. 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 Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. These manipulations included use of a lens loop, an attempt at impaling the lens with a microvitreoretinal blade, irrigation to float the lens, and pars plana vitrectomy by the cataract surgeon. Medical professional liability claims and premiums, 19861996. 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. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. 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. Vincent C, Young M, Phillips A. Dr. did correction surgery (for free) after finding and admitting his error. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Tackling the dropped nucleus. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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. During the surgery, the new lens was too small due to a After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. 8600 Rockville Pike 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. Management of dislocated lens fragments following phacoemulsification surgery. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. These transformed variables were used in further analyses. The https:// ensures that you are connecting to the Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Start here to find personal injury lawyers near you. The The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. 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.

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