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. He was referred to a retina specialist, who saw him the next day. 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. HHS Vulnerability Disclosure, Help The difference between the mean and median payment reflects the right-skewed payment distribution. He also damaged the film over the 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. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Margherio RR, Margherio AR, Pendergast SD, et al. 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. 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. What helps? Socioeconomic Characteristics of Medical Practice 1990/1991. Careers. 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. Abbott RL. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. Who sues their doctors? 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. .I have macular degeneration in the left eye so a technical lens would not have made a difference. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. In some states, the information on this website may be considered a lawyer referral service. 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. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Ross WH. Characteristics of physicians with obstetric malpractice claims experience. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. Retained intravitreal lens fragments after cataract surgery. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. 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. Medical malpractice and respondeat superior. Male physicians may have a higher likelihood of being sued because male physicians are historically concentrated in the specialties with the highest levels of claim incidence, such as surgery, and female physicians in those with the lowest incidences, such as pediatrics. What is the recovery after cataract or lens replacement surgery? Wilkinson CP, Green WR. 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. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. Holak sued Tyson and Eye Associates. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Dr made larger incision & needed stitches. Bovbjerg RR, Petronis KR. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of retinal detachment. Brick DC. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. 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. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. 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. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. 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. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. May M, Stengel B. Levinson W, Roter DL, Mullooly JP, et al. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Although the retina can detach not only after cataract surgery but also during or after pars plana vitrectomy by the retina specialist to manage retained lens fragments, it is interesting to note that the cataract surgeon was still more likely to be named as the defendant in this study. 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Among these, the patients sought a second opinion and referred themselves in 3 cases. 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). 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. Yet three or four years ago, UCLA surgeons [tdc_zone type=tdc_content][vc_row][vc_column][td_block_trending_now limit=3][/vc_column][/vc_row][vc_row tdc_css=eyJhbGwiOnsiYm9yZGVyLXRvcC13aWR0aCI6IjEiLCJib3JkZXItY29sb3IiOiIjZTZlNmU2In19][vc_column width=2/3][td_block_slide sort=featured limit=3][td_block_2 border_top=no_border_top category_id= limit=6 td_ajax_filter_type=td_category_ids_filter ajax_pagination=next_prev sort=random_posts custom_title=SEA MOSS RECIPES][td_block_1 border_top=no_border_top category_id= sort=random_posts custom_title=SEA MOSS BEAUTY][td_block_ad_box spot_id=custom_ad_1][td_block_15 category_id= limit=8 sort=random_posts custom_title=SEA MOSS HEALTH BENEFITS][/vc_column][vc_column width=1/3][td_block_social_counter custom_title=STAY CONNECTED facebook=tagDiv twitter=tagdivofficial youtube=tagdiv border_top=no_border_top][td_block_9 custom_title=LIFESTYLE border_top=no_border_top category_id= ajax_pagination=next_prev sort=random_posts][td_block_ad_box spot_id=sidebar][td_block_2 sort=random_posts limit=3 category_id= custom_title=SEA MOSS BUSINESS][td_block_title][td_block_10 limit=3 custom_title= border_top=no_border_top tdc_css=eyJhbGwiOnsibWFyZ2luLXRvcCI6Ii0yMCJ9fQ==][/vc_column][/vc_row][/tdc_zone], Designed by Elegant Themes | Powered by WordPress. Pande M, Dabbs TR. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. 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. 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. The The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Baldwin LM, Larson EH, Hart LG, et al. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. OMIC underwriting applications and claims records were reviewed. 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. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Both of these were defined as glaucoma, and there were a total of 31 cases. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a 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. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. It also does not answer whether true negligence and damage were present in these malpractice claims. 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. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. 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. 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. The issue of malpractice has wide-ranging stakeholders, including our society. Spicer J. Federal government websites often end in .gov or .mil. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Jena AB, Seabury S, Lakdawalla D, Chandra A. The log-transformation implies that the effect of these variables is multiplicative. The costs including indemnity payments and defense costs are summarized in Table 5. An official website of the United States government. 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. Intermittent corneal edema due to anterior segment retained lens fragments. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. 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. 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. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. 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. 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. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. In the first case, the cataract surgery was performed in 1989. Bohigian GM, Wexler SA. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. The mean payment was $117,688, and the median payment was $90,000. Leaming DV. 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. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. 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. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. 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