cataract surgery wrong lens lawsuitwhy was caulerpa selectively bred in germany
Updated January, 2023
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. 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. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. 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=.000). Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. Pande M, Dabbs TR. 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. There was another 29 months on average until the closure of a claim. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. The defendant prevailed in 83% of trials. Baldwin LM, Larson EH, Hart LG, et al. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. Por YM, Chee SP. Oruc S, Kaplan HJ. Total cost of defense for all 108 claims was $3,312,688. If these cases are excluded, there was a mean of 1.5 return visits to the operating room among 94 patients who had additional surgical procedures. Bohigian GM, Wexler SA. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Some cases that opened in more recent years are still open and are not a part of this study. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. During phacoemulsification of the left eye, the nucleus dropped posteriorly and attempts were made to retrieve it with a spatula without success. 8600 Rockville Pike 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. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. 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. They ranged from a low of $7,500 to a high of $500,000. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. 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. If a physician had multiple claims from separate cataract surgeries, each was counted separately. Ho LY, Doft BH, Wang L, Bunker CH. Among 108 patient claimants, 54 were men and 54 were women. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. Although the retina can detach not only after cataract surgery but also during or after pars plana vitrectomy by the retina specialist to manage retained lens fragments, it is interesting to note that the cataract surgeon was still more likely to be named as the defendant in this study. In: Gonzalez ML, editor. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. 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. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. Ophthalmic malpractice lawsuits with large monetary awards. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. The median time to referral was 1 week in this study. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Management of dislocated lens fragments following phacoemulsification surgery. Aasuri MK, Kompella VB, Majji AB. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. The https:// ensures that you are connecting to the Incidence of lens matter dislocation during phacoemulsification. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. Claims were separated into regions of the United States as seen in Figure 4. The patients visual acuity prior to cataract surgery was 20/200 and at the last follow-up, 5 months following vitrectomy, was 20/80. The estimated effects of each predictor are shown in Table 8. Professional liability insurance: II The legal environment. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. The doctor used a technical lens for my right eye and a standard lens for the left one. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. The median payment was $90,000. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. 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. Dr. did correction surgery (for free) after finding and admitting his error. Of the 66 claims that were dismissed, Texas had the most claims with 14, followed by Louisiana with 9, California with 8, Illinois with 7, Virginia and Florida each with 4, Kentucky and Colorado each with 3, Arizona, Michigan, and Missouri each with 2, and Alabama, Massachusetts, Nevada, North Carolina, Ohio, Pennsylvania, West Virginia, and Washington, DC, each with one claim. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. During the surgery, the new lens was too small due to a 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. Abbott RL. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. The mean defense costs per claim were $30,692. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. von Lany H, Mahmood S, James CR, et al. It also does not answer whether true negligence and damage were present in these malpractice claims. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Expert testimony. There were differences between claims associated with retained lens fragments that went on to a trial vs settled vs dismissed and whether indemnity payment occurred or not. Most people may get benefited from an IOL transplant during surgery. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Rofagha S, Bhisitkul RB. Claims, errors, and compensation payments in medical malpractice litigation. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Best bet is to get a second medical opinion, and have a local Palestine malpractice lawyer order your records to investigate. Use Avvo's lawyer fin Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. An example of one unit change in visual acuity would be going from 20/20 to 20/200. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. The attorney listings on this site are paid attorney advertising. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). WebThe patient claimed that the ophthalmologist was negligent in placing the incorrect lens during his right eye surgery. In 94 cases, a referral was made to a subspecialist. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. 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. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. 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. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. 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%. 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. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. Retained nuclear fragment in the anterior segment. 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 Posterior-assisted levitation in cataract surgery. Final visual acuity was the last recorded visual acuity. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. 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 mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. Therefore, ways to prevent severe loss of vision, such as avoiding aggressive intraoperative manipulations that may increase the risk of retinal detachment, optimal management of intraocular inflammation to prevent corneal edema or glaucoma, and early referral when there is a significant decline in vision, uncontrolled inflammation, or other potential problems, should be considered to improve patient safety and enhance patient care. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Before Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. 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. Regan JJ, Regan WM. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. An official website of the United States government. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. The technical lens was suppose to give me even better vision in the right eye. 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. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. WebCataract surgery injury occurs in approximately 12% of cases. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Medical liability claim frequency: a 20072008 snapshot of physicians. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the Postoperatively, the patient developed hypotony and fibrin reaction. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Vitrectomy for retained lens fragments after phacoemulsification. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. 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. 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. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. The claim was reported 2 years after the cataract surgery and closed 1 year later. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. 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). The average insurance company payment - mostly settlements -- in these cases were $112,000. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Ho SF, Zaman A. 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. There was additional $103,000 in legal expenses. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. 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. 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.). The case was closed with an indemnity payment of $215,000. 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. However, the cataract surgeon did not document having made this call and the case was settled. Margherio RR, Margherio AR, Pendergast SD, et al. 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. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. Pars plana vitrectomy for the management of retained lens material after cataract surgery. After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. 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. A steroid drop prescribed by your ophthalmologist can help. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. CF, counting fingers; HM, hand motions; NLP, no light perception. There has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to be written on this topic.1978 The incidence of retained or dropped lens fragments during cataract surgery is estimated to be between 0.1% and 1.6% of cataract surgeries.18,19,23,29,45,54,64 There are numerous articles to indicate that a capsular tear with retained lens fragment is a well-known complication of cataract surgery.2049 Studies show that reasonably favorable visual outcome can be obtained with intervention usually in the form of pars plana vitrectomy.2049,7477 Therefore, encountering this complication in itself would not be a malpractice. Socioeconomic Characteristics of Medical Practice 1997/98. 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. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema.