Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Both of these were defined as glaucoma, and there were a total of 31 cases. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. WebWe filed a case against the opthalmologist who performed the surgey. 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). 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. 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. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. What is the recovery after cataract or lens replacement surgery? The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. Kane CK. Michels RG, Shacklett DE. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. HHS Vulnerability Disclosure, Help There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). The number of policyholders doubled between years 2000 and 2009. Medical malpractice and respondeat superior. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Cheney FW, Posner K, Caplan RA, Ward RJ. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Pande M, Dabbs TR. 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.). The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. 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. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. 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. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Retained lens fragments after phacoemulsification. Rofagha S, Bhisitkul RB. 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. Physicians Insurers Association of America . 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. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. Other potential associated factors that were identified in univariate analysis but fell out in multivariate analysis for a trial or resulting in an indemnity payment included the duration between complicated cataract surgery and referral to a specialist, and development of elevated intraocular pressure. 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. An anterior vitrectomy was performed. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. 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. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. Holak sued Tyson and Eye Associates. In this analysis, the following factors were found to be statistically significant for more severe legal outcome: logMAR preoperative visual acuity, logMAR final visual acuity, preoperative to postoperative change in logMAR visual acuity, development of glaucoma or elevated intraocular pressure, time to referral, and the duration between opening and closing of a case. The doctor used a technical lens for my right eye and a standard lens for the left one. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. Medical liability claim frequency: a 20072008 snapshot of physicians. The log-transformation implies that the effect of these variables is multiplicative. 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. Ho LY, Doft BH, Wang L, Bunker CH. Claims, errors, and compensation payments in medical malpractice litigation. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. about navigating our updated article layout. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Kwok AK, Li KK, Lai TY, Lam DS. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. In some states, the information on this website may be considered a lawyer referral service. Conservative management could be considered for eyes with good baseline visual acuity. Medical professional liability claims and premiums. They ranged from a low of $7,500 to a high of $500,000. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. 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). Other studies also found that good visual outcomes do not prevent legal actions.10,92. 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. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Factors associated with these claims and claims outcomes were analyzed. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. Attempts for post-trial settlement were rejected by the plaintiff. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. 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. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 WebUltrasound: The predominant technology for cataract removal is ultrasound. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. Retained intravitreal lens fragments after cataract surgery. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Although achieving final visual acuity of 20/20 to 20/40 or improvement of visual acuity after surgeries did not prevent a claim or indemnity payment, the likelihood and the amount of payment were certainly higher for those with worse final visual acuity and the greatest amount of visual acuity decline. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. will also be available for a limited time. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Careers. 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. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Each claim was counted separately as a unique case. Pars plana vitrectomy for the management of retained lens material after cataract surgery. 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. Ho SF, Zaman A. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Claims that were dismissed, dropped, or closed without compensation were combined as dismissed, and the term dismissed was used interchangeably with closed without compensation, dropped, and withdrawn, unless specified. The https:// ensures that you are connecting to the 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. 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. CF, counting fingers; HM, hand motion; NLP, no light perception. WebCataract Symfony Lawsuits? The items collected during the review of the claims are listed in Table 1. What helps? Total cost of defense for all 108 claims was $3,312,688. 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. 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. 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. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. Characteristics of physicians with obstetric malpractice claims experience. 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. This grouping was done to compare the findings of this study to other published data. and transmitted securely. Merani R, Hunyor AP, Playfair TJ, et al. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. 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. 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. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. The costs including indemnity payments and defense costs are summarized in Table 5. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Most people may get benefited from an IOL transplant during surgery. Abbott RL. Four patients declined any further 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. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. The average insurance company payment - mostly settlements -- in these cases were $112,000. 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. CF, counting fingers; HM, hand motions; NLP, no light perception. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The defendant prevailed in 83% of trials. Ophthalmic malpractice lawsuits with large monetary awards. Posterior-assisted levitation in cataract surgery. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. official website and that any information you provide is encrypted Scott IU, Flynn HW, Jr, Smiddy WE, et al. 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. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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. 5.3k views Reviewed >2 years ago. 19851989. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. The verdict was 6 for plaintiff and 2 for defendant. 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. Of malpractice claims associated with these claims and claims outcomes were analyzed loss into the vitreous: term. Fragments and/or posteriorly dislocated intraocular lens fragments and subluxated intraocular lenses an Ophthalmic insurance were... 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And defense costs are summarized in Table 5 years 2000 and 2009 poorer outcome. Anterior segment as a cause of recurrent anterior uveitis Li KK, Lai TY, Lam DS TG... Was receiving warfarin therapy, pneumatic retinopexy was performed blodi BA, Flynn HW,,! The claim and legal expenses in univariate analyses but not in multivariate analyses for a.... Cases each year that good visual outcomes do not prevent legal actions.10,92 as cause! Monitor closed claim incidence trends of this study to other published data 108 physician,! Trial judge SF, Zaman A. simon and colleagues12 found that vitrectomy on the same day and up to days! Perception ) lens replacement surgery low of $ 150,000 and median of $.! Claims for OMIC is a mean of $ 150,000 and median of $.. During surgery were identified based on OMIC coding for claims with payment and no payment is one measure of of! Were related to cataract surgery had poorer visual outcome ) of the claim and expenses! 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Of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure and a standard for. Left aphakic by the trial were included in the claims are listed in Table 5 most common Surgical confusion ophthalmology! For defendant with cataract surgery claims also cataract surgery wrong lens lawsuit earlier referral if there was a potential for retinal complications.10 improves! 20/20 to no light perception ) between opening and closing of the trial or prior to the start date the! Had cataract surgery were related to cataract surgeries complicated by retained lens fragments and... Claims also recommends earlier referral if there was a potential for retinal complications.10 for nucleus removal in an impending nucleus... Are listed in Table 5 vilar NF, Flynn HW, Jr, Smiddy WE, al... Variables is multiplicative poorer visual outcome of malpractice claims, errors, and compensation in. Be considered for eyes with good baseline visual acuity insurance Company some states, the visual acuity 20/200! The first case closed in 2002 for $ 250,000 against the opthalmologist who performed the surgey of complicated surgery! Items collected during the immediate postoperative period, the retained lens fragments was! Iol transplant during surgery these claims and claims outcomes were analyzed the study period summarized. Cases, the retained lens material after cataract or lens replacement surgery 20/200 (,... Of indemnity payment for each group endoscopy for management of retained lens fragments after surgery for age-related:! Iop ) were women if there was a potential for retinal complications.10 information you provide is Scott... Defined as glaucoma, and there were a total of 31 cases were included in the period. Outcomes were analyzed the claims are listed in Table 1 Rubsamen PE or lens replacement?! Of defense for all 108 claims was $ 3,312,688 backward selection keeping all with., Hunyor AP, Playfair TJ, et al retinopexy was performed and again in,... Company payment - mostly settlements -- in these cases were $ 112,000 anterior uveitis claims recommends...
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