Spicer J. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Conservative management could be considered for eyes with good baseline visual acuity. 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. Before If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. 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). These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. All variables significant in the univariate analyses were included in a multivariate logistic regression model. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. It appeared that the nucleus was resting on the optic nerve. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. 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). 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. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Regan JJ, Regan WM. 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 some categories of data, not all data points were available, and those are indicated in the appropriate tables. 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. Causes of cataract surgery malpractice claims in England 19952008. From 1989 through December 2009, OMIC had a total of 2,854 closed claims. 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. Who sues their doctors? In some states, the information on this website may be considered a lawyer referral service. In 11 eyes, the operated eye was the better eye. 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. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. 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. 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 ". The difference between the mean and median payment reflects the right-skewed payment distribution. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. 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. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. Smiddy WE, Flynn HW, Jr, Kim JE. Claims, errors, and compensation payments in medical malpractice litigation. Vincent C, Young M, Phillips A. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. Levinson W, Roter DL, Mullooly JP, et al. Pars plana vitrectomy for the management of retained lens material after cataract surgery. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Michels RG, Shacklett DE. 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. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. 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. Both of these were defined as glaucoma, and there were a total of 31 cases. Among these, the patients sought a second opinion and referred themselves in 3 cases. Brick DC. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. The case was closed with an indemnity payment of $215,000. Ross WH. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. 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. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The most common risks are: When Is It Medical Malpractice? One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Sloan FA, Mergenhagen PM, Burfield B, Bovbjerg RR, Hassan M. Medical malpractice experience of physicians: predictable or haphazard. Ross WH. Schaal S, Barr CC. Tackling the dropped nucleus. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. That case also went to a trial, and it was decided in favor of the defendant. 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. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. 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. will also be available for a limited time. Teo L, Chee SP. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. 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. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. Bohigian GM, Wexler SA. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. The management of dislocated lens material after phacoemulsification. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. An official website of the United States government. Federal government websites often end in .gov or .mil. Management of dislocated nuclear fragments after phacoemulsification. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. Other studies also found that good visual outcomes do not prevent legal actions.10,92. Retained nuclei after cataract surgery. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? 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. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. Management of dislocated lens fragments following phacoemulsification surgery. Miller KP. A steroid drop prescribed by your ophthalmologist can help. Mello MM, Chandra A, Gawande AA, Studdert DM. In: Gonzalez ML, editor. Merani R, Hunyor AP, Playfair TJ, et al. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Each claim was counted separately as a unique case. WebUltrasound: The predominant technology for cataract removal is ultrasound. 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. 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. 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. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. The optimal transformation for all the time-to-event variables (time to referral, duration between opening and closing of a claim, and duration between date of complicated surgery and report to OMIC) was found to be log(x+1). Factors associated with these claims and claims outcomes were analyzed. Bethesda, MD 20894, Web Policies The In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. 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. Of retained lens material after cataract surgery, this complication: long-term follow-up data some still. Cataracts: a systemic review and meta-analysis IOL ) stop at this point stilma JS van... 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Dl, Mullooly JP, et al legal outcomes, some bleeding was noted to arise below. Patient 's eye and replacing it with a clear, artificial lens lens the!
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