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. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. 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. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Retained intravitreal lens fragments after cataract surgery. In the table, the estimates give the odds ratio of an indemnity payment when the predictor is changed by one unit for continuous variable (eg, visual acuity change), whereas for categorical variable (eg, corneal edema or decompensation), it means a change from the unlisted group to the listed one. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. The patient was released to a general ophthalmologist. In the first case, the cataract surgery was performed in 1989. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. 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. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. The https:// ensures that you are connecting to the If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for That case also went to a trial, and it was decided in favor of the defendant. Retained lens fragments can be successfully managed by the retina specialists in most cases. The remaining 76 claims (70%) closed without any payments. Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. In 91 eyes, preoperative visual acuity was recorded for both eyes. WebUltrasound: The predominant technology for cataract removal is ultrasound. The management of dislocated lens material after phacoemulsification. In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. The defendant prevailed in 83% of trials. Follow Posted 4 years ago, 24 users are following. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. Abbott RL. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. 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). This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. 5.3k views Reviewed >2 years ago. 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. Miller KP. sharing sensitive information, make sure youre on a federal There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Two weeks later, visual acuity was hand motions. Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. This is without adjustment for potential differences in dollar amount due to inflationary changes. Baker PS, Spirn MJ, Chiang A, et al. An official website of the United States government. 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. Data from the PIAA show that for all medical claims in 2008, average defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and time associated with a lawsuit to the plaintiff or to the defendant. 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. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the 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). Physicians Insurers Association of America . Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. 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. Management of dislocated nuclear fragments after phacoemulsification. Postoperatively, the patient developed hypotony and fibrin reaction. Accessibility One set of analyses was performed for those that resulted in indemnity payment vs no payment. 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. 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. The difference between the mean and median payment reflects the right-skewed payment distribution. Federal government websites often end in .gov or .mil. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. Risk factors for and management of dropped nucleus during phacoemulsification. Ho SF, Zaman A. Management of dislocated lens fragments following phacoemulsification surgery. Among 117 closed claims that were related to cataract surgery complicated by retained lens fragments, 9 cases had multiple claims, including 8 cases where both the physician and the OMIC-insured entity were named in the suit and one case where two OMIC-insured physicians were named. 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. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. This grouping was done to compare the findings of this study to other published data. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. 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. My father had cataract surgery two years ago. 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. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. HHS Vulnerability Disclosure, Help After the trial, the jurors were polled. 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. Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. Management of retained intravitreal lens fragments after phacoemulsification surgery. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Closed claims data from OMIC were chosen to be the basis of this study because OMIC provides coverage to a large number of ophthalmologists and can provide data specific to an ophthalmic procedure. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. The attorney listings on this site are paid attorney advertising. Gedde SJ, Karp CL, Budenz DL. Bettman JW. 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. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. Characteristics of physicians with obstetric malpractice claims experience. 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. On average, a claim took 28.8 21.2 months to close. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. 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. Schaal S, Barr CC. Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. American College of Obstetricians and Gynecologists. The 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.). Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. 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