He also damaged the film over the Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Smiddy WE, Flynn HW, Jr, Kim JE. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). Abbott RL. sharing sensitive information, make sure youre on a federal 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. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. Ophthalmic malpractice lawsuits with large monetary awards. 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. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Bovbjerg RR, Petronis KR. This is without adjustment for potential differences in dollar amount due to inflationary changes. 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. 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. The mean age was 69 years (range, 4090 years). Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. An official website of the United States government. Outcome of vitrectomy for retained lens fragments after phacoemulsification. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. 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. 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. 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. The median payment was $90,000. The mean defense costs per claim were $30,692. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. The attorney listings on this site are paid attorney advertising. The items collected during the review of the claims are listed in Table 1. Bethesda, MD 20894, Web Policies All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. 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. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. PMC legacy view Por YM, Chee SP. Beckman HB, Markakis KM, Suchman AL, Frankel RM. 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. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. 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. Conservative management could be considered for eyes with good baseline visual acuity. 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. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. 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. 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). In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. Federal government websites often end in .gov or .mil. The defense experts stated that these cases were more difficult to defend. 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. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. Most people may get benefited from an IOL transplant during surgery. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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. After the trial, the jurors were polled. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. In the multivariate analysis, two factors were found to be associated with indemnity payment: (1) the difference between preoperative visual acuity and final visual acuity and (2) the development of corneal edema or corneal decompensation. Careers. In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Can I sue a doctor for a botched cataract surgery? The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. 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 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. The technical lens was suppose to give me even better vision in the right eye. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. It involved a 70-year-old female patient who went from preoperative visual acuity of 20/60 to final visual acuity of no light perception. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. 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. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. The management of dislocated lens material after phacoemulsification. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. Brick DC. My vision actually was worse after the lens placement. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Why do people sue doctors? There was additional $103,000 in legal expenses. Lu H, Jiang YR, Grabow HB. 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 lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Follow Posted 4 years ago, 24 users are following. The .gov means its official. 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). 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