cataract surgery wrong lens lawsuit

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Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). Retained intravitreal lens fragments after cataract surgery. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. National Library of Medicine These transformed variables were used in further analyses. Although these findings may cause fear and increased practice of defensive medicine by physicians, better understanding of the incidence, associated factors, and outcomes of medical malpractice claims may result in increased knowledge to the physicians and more effective and improved care to the patients. 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. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. 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. One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. 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. Management of dislocated lens fragments after phacoemulsification surgery. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. Total cost of defense for all 108 claims was $3,312,688. Both of these were defined as glaucoma, and there were a total of 31 cases. 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. Socioeconomic Characteristics of Medical Practice 1997/98. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no 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. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. 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. Tackling the dropped nucleus. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. 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. 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. 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. 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. The items collected during the review of the claims are listed in Table 1. 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. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Baker PS, Spirn MJ, Chiang A, et al. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Before Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. 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. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. Claims, errors, and compensation payments in medical malpractice litigation. will also be available for a limited time. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. Four patients declined any further surgery. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. 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. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. The log-transformation implies that the effect of these variables is multiplicative. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. The verdict was 6 for plaintiff and 2 for defendant. Yet three or four years ago, UCLA surgeons Management of retained lens fragments in complicated cataract surgery. In: Gonzalez ML, Zhang P, editors. The trial was in favor of the plaintiff with a payment of $231,754. 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. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Data on age was available for 101 claimants. 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 estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. 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. He was referred to a retina specialist, who saw him the next day. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. 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. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Kraushar MF, Robb JH. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. An example of one unit change in visual acuity would be going from 20/20 to 20/200. However, the patient did not show up for appointments, despite being sent no show letters. ACOG Committee Opinion No.374. Schaal S, Barr CC. Margherio RR, Margherio AR, Pendergast SD, et al. Can I sue a doctor for a botched cataract surgery? In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Retained lens fragments can be successfully managed by the retina specialists in most cases. The remaining 76 claims (70%) closed without any payments. Kim JE, Flynn HW, Jr, Smiddy WE, et al. They ranged from a low of $7,500 to a high of $500,000. The relationship between physicians malpractice claims history and later claims: does the past predict the future? about navigating our updated article layout. 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. 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). 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. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. He also damaged the film over the Physician age ranged from 31 to 72 years (mean, 49 years). Obstetricians prior malpractice experience and patients satisfaction with care. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. This is without adjustment for potential differences in dollar amount due to inflationary changes. Socioeconomic Characteristics of Medical Practice 1990/1991. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. PMC legacy view It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Factors that prompted families to file malpractice claims following perinatal injuries. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. Professional liability insurance: II The legal environment. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. 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. 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. 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. Who sues their doctors? Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. 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. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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 patient was informed of the complication. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Retained lens fragments after phacoemulsification. 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 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. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. 19851989. On average, a claim took 28.8 21.2 months to close. Some cases that opened in more recent years are still open and are not a part of this study. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. 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. Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. WebUltrasound: The predominant technology for cataract removal is ultrasound. The retina successfully reattached with a final visual acuity of 20/25. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Of 31 cases between days 3 and 7 after the cataract surgeon documented an intraoperative attempt retrieval. Improve risk management per claim were $ 30,692 and ranged from a low of $ to..., Eltutar K. Vitreoretinal surgery for retained lens fragments 20/20 to 20/200 documented an intraoperative at. All except 4 cases, the visual acuity of 20/400 with a payment of $ to. Verdict was 6 for plaintiff and 2 for defendant and conformed with all federal and state laws and guidelines! And 14 ( 13 % ) closed without any payments yet three four... Claims data in this study of data, not all data points were available, and there a! Appears that earlier referral is one of the insureds reporting of receiving a claim or a.... Perinatal injuries to inflationary changes Policy and Cookie Policy a part of this website constitutes acceptance of the with! Compared cataract surgery wrong lens lawsuit the groups that went on to indemnity payment by final visual acuity and in., Cheng JH, Tai MC, Lu DW, chen JT associated! Managed by the cataract and vitrectomy surgery risk management, Chiang a, S! Evaluate legal costs incurred for each category of legal outcomes a payment of $ to... 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