Bohigian GM, Wexler SA. 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. All 3 claims were dismissed due to lack of prosecution and closed without payment. However, the cataract surgeon did not document having made this call and the case was settled. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Management of dislocated lens fragments following phacoemulsification surgery. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. CF, counting fingers; HM, hand motions; NLP, no light perception. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. 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. 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. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. 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. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Retained lens fragments in resident-performed cataract extractions. 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. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. The number of policyholders doubled between years 2000 and 2009. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. In 11 eyes, the operated eye was the better eye. Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. WebCataract surgery injury occurs in approximately 12% of cases. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. Management of dislocated lens material. It appeared that the nucleus was resting on the optic nerve. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. 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. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. 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. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. The issue of malpractice has wide-ranging stakeholders, including our society. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. Vanner EA, Stewart MW. Start here to find personal injury lawyers near you. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Yet three or four years ago, UCLA surgeons In this study, 23 (72%) of 32 cases with indemnity payments had final visual acuity of 20/200 or worse. 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. 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. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. An anterior vitrectomy was performed. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". Continuous irrigation was performed, but the nuclear fragment could not be elevated. 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. 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. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Causes of cataract surgery malpractice claims in England 19952008. 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. Studdert DM, Mello MM, Gawande AA, et al. 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. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. The log-transformation implies that the effect of these variables is multiplicative. Factors associated with these claims and claims outcomes were analyzed. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. However, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. 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. Breakdown by ophthalmic subspecialty of the policyholders was not available. Kim IK, Miller JW. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. 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. The technical lens was suppose to give me even better vision in the right eye. 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. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. 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. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. The median payment was $90,000. 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). Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. CF, counting fingers; HM, hand motions; NLP, no light perception. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. 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