Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. The needle impaled the lens and tore the lens capsule. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. Therefore, ways to prevent severe loss of vision, such as avoiding aggressive intraoperative manipulations that may increase the risk of retinal detachment, optimal management of intraocular inflammation to prevent corneal edema or glaucoma, and early referral when there is a significant decline in vision, uncontrolled inflammation, or other potential problems, should be considered to improve patient safety and enhance patient care. Liability claims and costs before and after implementation of a medical error disclosure program. The .gov means its official. Postoperatively, the patient developed hypotony and fibrin reaction. 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. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. 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. Scott IU, Flynn HW, Jr, Smiddy WE, et al. 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. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Management of dislocated lens fragments after phacoemulsification surgery. Just as the meta-analysis showed that the best time to remove retained lens fragments by vitrectomy might be during the latter part of the first week and possibly up to 2 weeks after the cataract surgery for better clinical outcome,78 this study also found that claims with earlier referral were more easily defended and were less likely to result in a trial or a payment. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). 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. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). 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 evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. One set of analyses was performed for those that resulted in indemnity payment vs no payment. 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. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. .I have macular degeneration in the left eye so a technical lens would not have made a difference. Bohigian GM, Wexler SA. Benson JS, Coogan CL. 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. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. Why do people sue doctors? The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Among 108 patient claimants, 54 were men and 54 were women. and transmitted securely. Schutz JS, Mavrakanas NA. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. 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. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. 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. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. 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 Retained nuclear fragment in the anterior segment. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). The new PMC design is here! Yang CS, Lee FL, Hsu WM, Liu JH. The estimated effects of each predictor are shown in Table 8. 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. official website and that any information you provide is encrypted 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. Wilkinson CP, Green WR. 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. This study is limited to those claims from a single insurer, which may not be nationally representative, although it is one of the largest insurers of ophthalmologists in the United States. The The median payment was $90,000. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. 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. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. Management of retained lens fragments in complicated cataract surgery. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. In these early referral cases, the claim was more likely to be dismissed. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). May M, Stengel B. Two weeks later, visual acuity was hand motions. Available at: Slora EJ, Gonzales ML. During the surgery, the new lens was too small due to a Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Four patients declined any further surgery. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. National costs of the medical liability system. Baker PS, Spirn MJ, Chiang A, et al. Retrospective, noncomparative, consecutive case series. Because the surgeon ultimately becomes responsible for the outcome of the surgery, it is important to communicate with the anesthesiologist as well as to oversee and proactively troubleshoot any preventable disasters in the operating room.93. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. Colyer MH, Berinstein DM, Khan NJ, et al. government site. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. 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The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. 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. Malpractice trends: viewing the data and avoiding the hot seat of litigation. A steroid drop prescribed by your ophthalmologist can help. 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. These transformed variables were used in further analyses. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. As noted already, the majority of claims are dropped, dismissed, or closed without payment. 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. Physician age ranged from 31 to 72 years (mean, 49 years). 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. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. In some cases, the cause of capsular tear and resulting complication of retained lens fragment was due to circumstances other than the surgeons surgical technique. 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. All variables significant in the univariate analyses were included in a multivariate logistic regression model. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Management of dislocated lens material. Gilliland GD, Hutton WL, Fuller DG. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. 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. 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. In 11 eyes, the operated eye was the better eye. A claim may include institution of a lawsuit or arbitration proceedings against the insured. CF, counting fingers; HM, hand motion; NLP, no light perception. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. WebCataract Symfony Lawsuits? Conservative management could be considered for eyes with good baseline visual acuity. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. Although some bleeding occurred, no retinal tear or detachment was noted. 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. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. 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