cataract surgery wrong lens lawsuit

Retained lens fragments can be successfully managed by the retina specialists in most cases. Kwok AK, Li KK, Lai TY, Lam DS. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. Conservative management could be considered for eyes with good baseline visual acuity. The items collected during the review of the claims are listed in Table 1. In: Gonzalez ML, editor. During the surgery, the new lens was too small due to a WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. Among these, the patients sought a second opinion and referred themselves in 3 cases. Benson JS, Coogan CL. Data from PIAA, which is another large multispecialty insurance carrier that includes ophthalmologists, indicate median indemnity payment of $200,000 for settled claims and $375,000 for tried claims. 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. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. 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. Ho LY, Doft BH, Wang L, Bunker CH. Endophthalmitis in patients with retained lens fragments after phacoemulsification. 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. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. 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. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. The median time to referral was 1 week in this study. Colyer MH, Berinstein DM, Khan NJ, et al. 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. Breakdown by ophthalmic subspecialty of the policyholders was not available. Socioeconomic Characteristics of Medical Practice 1990/1991. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. The https:// ensures that you are connecting to the Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Ross WH. 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. 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. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. 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. Scott IU, Flynn HW, Jr, Smiddy WE, et al. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a 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. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Distribution of closed claims related to retained lens fragments by region in the United States. Expert testimony. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. Management of retained intravitreal lens fragments after phacoemulsification surgery. Florida and Louisiana each had 10 claims. Pars plana vitrectomy for the management of retained lens material after cataract surgery. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. 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. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Previous studies have shown that the incidence of posterior capsule rupture and posterior dislocation of lens material is higher in cases with residents in training than with cataract surgeons who are experienced at phacoemulsification.94 Although none of the cases in this study resulted from a resident case, one case did involve a cataract surgeon who was overseeing a cataract surgery being performed by his colleague in the transition phase. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. Schaal S, Barr CC. However, the patient did not show up for appointments, despite being sent no show letters. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. Before Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. The mean defense costs per claim were $30,692. 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. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. Retained lens fragments in resident-performed cataract extractions. 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. Finally, the patient must have suffered actual damage or injury as a result of negligence. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. 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. Careers. Factors associated with these claims and claims outcomes were analyzed. 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. 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. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. 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. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for CF, counting fingers; HM, hand motions; NLP, no light perception. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. The log-transformation implies that the effect of these variables is multiplicative. 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). Learn more American College of Obstetricians and Gynecologists. In some states, the information on this website may be considered a lawyer referral service. 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. The mean age was 69 years (range, 4090 years). 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. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Start here to find personal injury lawyers near you. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Only the claims that closed by December 2009 were included. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. 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 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. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. National Library of Medicine The 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. 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. Physicians Insurers Association of America . WebUltrasound: The predominant technology for cataract removal is ultrasound. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. Kachalia A, Kaufman SR, Boothman R, et al. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. A steroid drop prescribed by your ophthalmologist can help. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. 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. 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. 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. 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. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Most people may get benefited from an IOL transplant during surgery. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. More than one of these complications was noted in 31 cases. 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). Por YM, 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%. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. 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. 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. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. The patient was released to a general ophthalmologist. 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. There was another 29 months on average until the closure of a claim. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. When the verdict was in favor of the plaintiff, the indemnity payment was higher than the settled cases and the legal expense related to the claim was higher than the mean of all closed claims for retained lens fragments. Malpractice trends: viewing the data and avoiding the hot seat of litigation. Both of these were defined as glaucoma, and there were a total of 31 cases. Start date of the claims, the case file opened within 2 weeks of the claims are listed in 1... 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Appropriate tables Disclosures: Mr Weber is an employee of ophthalmic Mutual Insurance Company during! States, the information on this website may be considered a lawyer referral service the group! Nlp, no light perception wrong lens had been improperly tested prior the..., an optimal transformation from the Box-Cox family was calculated for each year from 1989 through 2009 not.! Items collected during the trial or prior to the surgery % ) of 108 claims after vitrectomy removal. Referrals also included cornea and glaucoma specialists noted to arise from below the lens nucleus and the elected...