cataract surgery wrong lens lawsuit

Teo L, Chee SP. 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%. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Some cases that opened in more recent years are still open and are not a part of this study. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. Tackling the dropped nucleus. Medical professional liability claims and premiums. Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. The trial was in favor of the plaintiff with a payment of $231,754. Retained lens fragments after phacoemulsification. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. Margherio RR, Margherio AR, Pendergast SD, et al. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. The issue of malpractice has wide-ranging stakeholders, including our society. Retained intravitreal lens fragments after cataract surgery. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies The Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. These transformed variables were used in further analyses. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. government site. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. 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. Regan JJ, Regan WM. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. Michels RG, Shacklett DE. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). 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. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. The mean and median indemnity payments for this group of claims were similar to mean and median of all ophthalmology-related claims combined for this single specialty insurance company. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). In 94 cases, a referral was made to a subspecialist. 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. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Baldwin LM, Larson EH, Hart LG, et al. Abbott RL. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. 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. The number of policyholders doubled between years 2000 and 2009. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians and gynecologists than it was for pediatricians and psychiatrists. Management of dislocated lens fragments after phacoemulsification surgery. The log-transformation implies that the effect of these variables is multiplicative. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. 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). 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. 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. Best bet is to get a second medical opinion, and have a local Palestine malpractice lawyer order your records to investigate. Use Avvo's lawyer fin He was referred to a retina specialist, who saw him the next day. Ross WH. However, these numbers may reflect the states in which OMIC has a major presence, since these are also states in which OMIC has the highest number of insured ophthalmologists. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. Gonzalez ML. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. 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. There are reports of using a technique called posterior-assisted levitation by cataract surgeons to attempt removal of posteriorly dislocated lens fragments.6668 The chopstick technique and other methods have been reported as well.69,70 However, unless one is experienced in these techniques and is ready to defend the use of these techniques during the litigation, it would be best to avoid aggressive retrieval of the nuclear fragment during an impending posterior dislocation.42,48,61,71 In one of only two claims that resulted in a plaintiff verdict, the cataract surgeon also had some retinal training but the jury felt that he was not sufficiently trained to properly handle the situation. 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. Kane CK. The verdict was 6 for plaintiff and 2 for defendant. 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. 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. Factors associated with these claims and claims outcomes were analyzed. 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. Medical professional liability claims and premiums, 19861996. 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. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. 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. 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). The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Finally, the patient must have suffered actual damage or injury as a result of negligence. Therefore, claims related to cataract surgery accounted for 33% of all closed claims during this period, and cataract surgeries complicated by retained lens fragments accounted for 4% of all closed claims and 12.5% of cataract-related claims. 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. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Interestingly, this physician had another case brought against him 6 years later. 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. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. 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. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. In the first case, the cataract surgery was performed in 1989. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. The https:// ensures that you are connecting to the Half of all claims in this study were referred within 1 week of cataract surgery or the same day as detection of the retinal detachment. Kraushar MF, Robb JH. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. This gender spread was compared with OMIC data on demographics. WebCataract Symfony Lawsuits? FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. 19851989. 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. While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. The costs including indemnity payments and defense costs are summarized in Table 5. 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. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. Bettman JW. 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. 8600 Rockville Pike 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. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. Kim IK, Miller JW. All 3 claims were dismissed due to lack of prosecution and closed without payment. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. 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. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. 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. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 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. The patient was released to a general ophthalmologist. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as 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. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. A study based on a survey of retina specialists recommended that vitreoretinal surgeons should place an increased importance on the informed consent process and the patient/doctor relationship in order to improve risk management.16 Informed consent is a process rather than a form. Medical liability claim frequency: a 20072008 snapshot of physicians. 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. 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. Before DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. In: Gonzalez ML, Zhang P, editors. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Two weeks later, visual acuity was hand motions. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Stenkula S, Byhr E, Crafoord S, et al. Why do people sue doctors? Ophthalmic malpractice lawsuits with large monetary awards. 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. It appeared that the nucleus was resting on the optic nerve. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. The 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. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Risk management lessons from a review of 168 cataract surgery claims. Bessant DA, Sullivan PM, Aylward GW. von Lany H, Mahmood S, James CR, et al. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. 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. The doctor used a technical lens for my right eye and a standard lens for the left one. 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. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. 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. 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. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. Among 108 patient claimants, 54 were men and 54 were women. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). Pande M, Dabbs TR. The attorney listings on this site are paid attorney advertising. In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. The defendant prevailed in 83% of trials. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Postoperatively, the patient developed hypotony and fibrin reaction. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. Characteristics of physicians with obstetric malpractice claims experience. 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. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Accessibility The median payment was $90,000. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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. Were $ 30,692 and ranged from a review of 168 cataract surgery claims confidence interval ; IOP, pressure! 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