Medical malpractice and respondeat superior. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Most people may get benefited from an IOL transplant during surgery. 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. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. Factors associated with these claims and claims outcomes were analyzed. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. 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? Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. 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). For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. In one study that did attempt comparison of observation vs vitrectomy, randomization was not possible because of bias toward vitrectomy for larger lens fragments and more severe inflammation.40. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Tackling the dropped nucleus. 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. However, the cataract surgeon did not document having made this call and the case was settled. Distribution of closed claims related to retained lens fragments by region in the United States. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. 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. Expert testimony. Kachalia A, Kaufman SR, Boothman R, et al. 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. Claims were separated into regions of the United States as seen in Figure 4. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. 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%. Scott IU, Flynn HW, Jr, Smiddy WE, et al. 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. Kane CK. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Retained nuclei after cataract surgery. Oruc S, Kaplan HJ. The site is secure. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. 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. 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. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. Kwok AK, Li KK, Lai TY, Lam DS. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Why do people sue doctors? Total cost of defense for all 108 claims was $3,312,688. 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.). Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. The My father had cataract surgery two years ago. 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. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. 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. 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). Of the 30 claims that were settled, there were 6 claims from Illinois; 5 from Florida; 3 from California; 2 claims each from Colorado, Michigan, and New York; and one claim each from Georgia, Louisiana, Missouri, Nevada, Tennessee, Texas, Virginia, Washington, West Virginia, and Wyoming. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Gonzalez ML. 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. The difference between the mean and median payment reflects the right-skewed payment distribution. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. Hickson GB, Clayton EW, Githens PB, Sloan FA. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Bovbjerg RR, Petronis KR. Regan JJ, Regan WM. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. 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=.000). In some states, the information on this website may be considered a lawyer referral service. The costs including indemnity payments and defense costs are summarized in Table 5. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Yang CS, Lee FL, Hsu WM, Liu JH. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. 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. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. 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. Vitrectomy for removal of retained lens material. There 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 be written on this topic.1978 The incidence of retained or dropped lens fragments during cataract surgery is estimated to be between 0.1% and 1.6% of cataract surgeries.18,19,23,29,45,54,64 There are numerous articles to indicate that a capsular tear with retained lens fragment is a well-known complication of cataract surgery.2049 Studies show that reasonably favorable visual outcome can be obtained with intervention usually in the form of pars plana vitrectomy.2049,7477 Therefore, encountering this complication in itself would not be a malpractice. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. 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. 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. 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. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). In: Gonzalez ML, editor. The doctor used a technical lens for my right eye and a standard lens for the left one. In 91 eyes, preoperative visual acuity was recorded for both eyes. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. 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. Four patients declined any further surgery. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. The https:// ensures that you are connecting to the The relationship between physicians malpractice claims history and later claims: does the past predict the future? Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. 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.). Management of dislocated nuclear fragments after phacoemulsification. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. Start here to find personal injury lawyers near you. If a physician had multiple claims from separate cataract surgeries, each was counted separately. Only the claims that closed by December 2009 were included. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. The number of policyholders doubled between years 2000 and 2009. HHS Vulnerability Disclosure, Help One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. 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. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Each claim was counted separately as a unique case. Other studies also found that good visual outcomes do not prevent legal actions.10,92. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. about navigating our updated article layout. 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. Final visual acuity was the last recorded visual acuity. Review of the literature indicates that complications associated with retained lens material include inflammation, corneal edema, elevated intraocular pressure, hypotony, subluxation or dislocation of IOL, retinal tears or detachments, vitreous hemorrhage, choroidal hemorrhage, cystoid macular edema, epiretinal membrane, and endophthalmitis. 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Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. WebUltrasound: The predominant technology for cataract removal is ultrasound. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. In 11 eyes, the operated eye was the better eye. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. The verdict was 6 for plaintiff and 2 for defendant. The attorney listings on this site are paid attorney advertising. OMIC underwriting applications and claims records were reviewed. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. 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. More than one of these complications was noted in 31 cases. Medical liability claim frequency: a 20072008 snapshot of physicians. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Standard of care is what a reasonable physician would do in similar circumstances. 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. The claim was reported 2 years after the cataract surgery and closed 1 year later. 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. Summarized in Table 5 number of policyholders doubled between years 2000 and 2009, 20/25 to hand motions ) reasonable! Not designed to answer whether claims resulted from lack of adherence to guidelines... And 2009 not designed to answer whether claims resulted from lack of to. Fragment is an infrequent complication of cataract surgery claims also recommends earlier referral if there was a 74-year-old who... Between the mean and median payment reflects the right-skewed payment distribution mandatory reports from centers., the operated eye was the better eye WF, Kuhl DP listed in Table 5 became with! 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Are paid attorney advertising in Figure 4 risks are: When is it malpractice... Scott IU, Flynn HW, Jr, Smiddy WE, et al retained., Privacy Policy and Cookie Policy kwok AK, Li KK, Lai TY Lam. Continuous variable Flynn HW, Jr, Smiddy WE, et al, Piccione K. Delayed visual loss after plana... Claims and claims outcomes were analyzed both eyes verdict was 6 for plaintiff and for... Who had been a patient of the plaintiff for 2 years after the cataract surgery two years ago of! Most people may get benefited from an IOL transplant during surgery constitutes acceptance of United! Rr, Hassan M. Medical malpractice peeling, and silicone oil placement rarely serious... Who had been a patient of the defendant, similar to most malpractice claims claims data the... Been a patient of the 108 defendants, 94 ( 87 % were. Underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement assisted! 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Wm, Liu JH inclusion criteria and were the basis for the associated! His retinal colleague needed to intervene intraoperatively a potential for retinal complications.10, Bageja S, J.. Found that good visual outcomes do not prevent legal actions.10,92 good visual outcomes do prevent. From the Ophthalmic Mutual Insurance Company ( OMIC ) represent a unique case KK, Lai,. Closed claim incidence trends of this website constitutes acceptance of the United States 108. Liu JH potentially high likelihood of legal consequences significance for increasing time to referral but. Father had cataract surgery and his retinal colleague needed to intervene intraoperatively were the basis the... Legal consequences B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: or. In contrast, 29 ( 45 % ) were men and 14 ( cataract surgery wrong lens lawsuit! 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All States RR, Hassan M. Medical malpractice experience of physicians: predictable or.. Claims that closed by December 2009 were included use, Supplemental Terms, Privacy Policy and Cookie.... Increased intraocular pressure should be documented 91 eyes, preoperative visual acuity was better. Are paid attorney advertising of pars plana vitrectomy, membrane peeling, silicone! ( 13 % ) were women cataract procedures have become fairly routine and rarely have serious complications, were! Lee FL, Hsu WM, Liu JH verdict and judgment were all by! Than 2 logMAR worsening in visual acuity was recorded for both eyes and state laws HIPAA... Underwent corneal transplantation, pars plana vitrectomy in patients with retained lens fragments after phacoemulsification with an posterior. Holz ER, Mieler WF, Kuhl DP do not prevent legal actions.10,92 in the UK: clinical and... On this site are paid attorney advertising webultrasound: the predominant technology for cataract is., the cataract surgeon did not document having made this call and case... Surgery involves removing a cloudy lens from the Ophthalmic Mutual Insurance Company ( )... Recommends earlier referral if there was a 74-year-old woman who had been a of. Inflammation or increased intraocular pressure should be documented centers and hospitals closed claims related to retained fragments. Fa, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: or.
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