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<.001). von Lany H, Mahmood S, James CR, et al. 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. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. Data on age was available for 101 claimants. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Moore JK, Scott IU, Flynn HW, Jr, et al. Why do people sue doctors? 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. Final visual acuity was the last recorded visual acuity. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. This is without adjustment for potential differences in dollar amount due to inflationary changes. On average, a claim took 28.8 21.2 months to close. For this study, a P value <.05 was considered significant. Yang CS, Lee FL, Hsu WM, Liu JH. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Physicians Insurers Association of America . Schaal S, Barr CC. 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. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Medical liability claim frequency: a 20072008 snapshot of physicians. Day S, Menke AM, Abbott RL. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. 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. Abbott RL. 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. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. The defense experts stated that these cases were more difficult to defend. 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. In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. The patient claimed that the physician should have Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. 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. 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). Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Factors that prompted families to file malpractice claims following perinatal injuries. Lu H, Jiang YR, Grabow HB. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. Physician-patient communication. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Kraushar MF, Robb JH. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. Careers. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. The median payment was $90,000. Since the number of OMIC-insured ophthalmologists continued to grow each year over this 21-year period, the frequency of closed claims related to retained lens fragments relative to the total number of physicians insured per year was actually the highest in 1997 (Figure 3). The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. The median time to referral was 1 week in this study. FOIA CF, counting fingers; HM, hand motion; NLP, no light perception. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. The possible outcomes are assumed to be ordered: 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. 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. The average cataract surgery settlement was for $192,865. 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 Management of retained intravitreal lens fragments after phacoemulsification surgery. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. 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. 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. 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. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Beckman HB, Markakis KM, Suchman AL, Frankel RM. The mean and median indemnity payments for this group of claims were similar to mean and median of all ophthalmology-related claims combined for this single specialty insurance company. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). Bohigian GM, Wexler SA. 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. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. Kachalia A, Kaufman SR, Boothman R, et al. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Malpractice, in contrast, requires demonstration of negligence, defined as substandard care that resulted in harm.1 Malpractice suits are usually based on the legal theory of negligence, requiring the presence of the following four elements: (1) duty to treat, (2) breach of duty, (3) cause, and (4) damages. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. In: Gonzalez ML, Zhang P, editors. will also be available for a limited time. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to Only the claims that closed by December 2009 were included. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. 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. After the trial, the jurors were polled. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Among these, the patients sought a second opinion and referred themselves in 3 cases. The average insurance company payment - mostly settlements -- in these cases were $112,000. In: Gonzalez ML, editor. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. 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. Bessant DA, Sullivan PM, Aylward GW. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Causes of cataract surgery malpractice claims in England 19952008. Smiddy WE, Flynn HW, Jr, Kim JE. 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However, the patient did not show up for appointments, despite being sent no show letters. It appeared that the nucleus was resting on the optic nerve. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. 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. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. 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. 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? If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. 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. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. 8600 Rockville Pike In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. 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 Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Stenkula S, Byhr E, Crafoord S, et al. Baldwin LM, Larson EH, Hart LG, et al. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract 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. 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. Created for people with ongoing healthcare needs but benefits everyone. Two cases went on to trial and ended with a verdict in favor of the plaintiff. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Although some bleeding occurred, no retinal tear or detachment was noted. The Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. 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.
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