The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). 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. WebCataract surgery injury occurs in approximately 12% of cases. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Kraushar MF, Robb JH. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. 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. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. 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. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. 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%. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. 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. Start here to find personal injury lawyers near you. 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the 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. 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. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. 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. Rofagha S, Bhisitkul RB. The doctor used a technical lens for my right eye and a standard lens for the left one. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. All variables significant in the univariate analyses were included in a multivariate logistic regression model. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. The site is secure. 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. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Risk management lessons from a review of 168 cataract surgery claims. This is without adjustment for potential differences in dollar amount due to inflationary changes. 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. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. 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 ". During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Characteristics of physicians with obstetric malpractice claims experience. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. Physician-patient communication. Medical liability claim frequency: a 20072008 snapshot of physicians. CF, counting fingers; HM, hand motions; NLP, no light perception. 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. Factors that prompted families to file malpractice claims following perinatal injuries. Data on age was available for 101 claimants. Whether the findings of this study are representative depends on whether physicians who were covered by the insurance carrier of this study were more or less likely to be sued than physicians who were insured elsewhere. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. The issue of malpractice has wide-ranging stakeholders, including our society. The case was closed with an indemnity payment of $215,000. official website and that any information you provide is encrypted Claims were separated into regions of the United States as seen in Figure 4. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. Kraushar MF. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. 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. Therefore, ways to improve risk management and enhance patient outcome would include optimal management of intraocular pressure and inflammation, avoidance of aggressive maneuvers intraoperatively that may result in retinal detachment, close follow-up and sufficient documentation, and timely referral to a subspecialist when necessary. 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. Aasuri MK, Kompella VB, Majji AB. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. Postoperatively, the patient developed hypotony and fibrin reaction. However, the patient did not show up for appointments, despite being sent no show letters. However, the cataract surgeon did not document having made this call and the case was settled. Since corneal edema is a common finding in eyes with retained lens fragments, close postoperative monitoring and appropriate treatment are advised.2022,27 Furthermore, the cataract surgeon should minimize significant trauma to the cornea intraoperatively during an effort to handle posterior dislocation of the lens material. Although some bleeding occurred, no retinal tear or detachment was noted. Tackling the dropped nucleus. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. Physicians Insurers Association of America . 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. The needle impaled the lens and tore the lens capsule. 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. OMIC underwriting applications and claims records were reviewed. 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. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Continuous irrigation was performed, but the nuclear fragment could not be elevated. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. 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. Causes of cataract surgery malpractice claims in England 19952008. 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. During the surgery, the new lens was too small due to a She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. The median time to referral was 1 week in this study. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. My vision actually was worse after the lens placement. 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 .gov means its official. Factors associated with these claims and claims outcomes were analyzed. Teo L, Chee SP. 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. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Given the differences in the frequency of claims for various medical specialties and the limited number of studies in the literature related to malpractice claims in ophthalmology, this current study used the available data from a large ophthalmology-specific insurance company in an effort to gather specialty-specific data. 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. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Risk factors for and management of dropped nucleus during phacoemulsification. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. Michels RG, Shacklett DE. 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. Retained lens fragments after phacoemulsification. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. 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. An example of one unit change in visual acuity would be going from 20/20 to 20/200. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. This grouping was done to compare the findings of this study to other published data. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. Holak sued Tyson and Eye Associates. Professional liability insurance: II The legal environment. Gonzalez ML. For statistical purposes, only the data from the primary surgeon was analyzed in the study. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies In the first case, the cataract surgery was performed in 1989. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. 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