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cataract surgery wrong lens lawsuit

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). A steroid drop prescribed by your ophthalmologist can help. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. Spicer J. Miller KP. 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. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. Why do people sue doctors? 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. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Kachalia A, Kaufman SR, Boothman R, et al. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). 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 difference between the mean and median payment reflects the right-skewed payment distribution. Even when an IOL has been inserted by the cataract surgeon, the retinal surgeon should be prepared to manage subsequent complications of dislocated or malpositioned IOL, as was the case in some of the claims in this study. Baker PS, Spirn MJ, Chiang A, et al. 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. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. Hickson GB, Clayton EW, Githens PB, Sloan FA. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. Schaal S, Barr CC. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. This gender spread was compared with OMIC data on demographics. 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. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Socioeconomic Characteristics of Medical Practice 1997/98. WebThere 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 Merani R, Hunyor AP, Playfair TJ, et al. 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. Retained lens fragments can be successfully managed by the retina specialists in most cases. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Regan JJ, Regan WM. 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. Studdert DM, Mello MM, Gawande AA, et al. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. 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.). In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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 complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. The term claim was used in this study to include suits, unless specified. 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. 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. 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. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. 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. Only the claims that closed by December 2009 were included. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Malpractice risk according to physician specialty. PMC legacy view Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. This grouping was done to compare the findings of this study to other published data. Retained nuclear fragment in the anterior segment. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. In: Gonzalez ML, editor. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. 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. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. Postoperatively, the patient developed hypotony and fibrin reaction. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Risk factors for and management of dropped nucleus during phacoemulsification. 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. Beckman HB, Markakis KM, Suchman AL, Frankel RM. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. 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. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. 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. However, the cataract surgeon did not document having made this call and the case was settled. Ho SF, Zaman A. Available at: Slora EJ, Gonzales ML. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. Ho LY, Doft BH, Wang L, Bunker CH. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. 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. These transformed variables were used in further analyses. Kim IK, Miller JW. Vincent C, Young M, Phillips A. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. 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. 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. 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. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. 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. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. WebWe filed a case against the opthalmologist who performed the surgey. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. Managing a dropped nucleus during the phacoemulsification learning curve. 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. Bohigian GM, Wexler SA. 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. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. 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. Socioeconomic Characteristics of Medical Practice 1990/1991. Preoperative visual acuity was the visual acuity shortly prior to cataract surgery. 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. Can I sue a doctor for a botched cataract surgery? 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. 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. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. The patient was informed of the complication. 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. Created for people with ongoing healthcare needs but benefits everyone. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. about navigating our updated article layout. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. 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. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant.

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