Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. When the complication of a retained lens fragment has been encountered, the cataract surgeon should closely follow the patient and monitor for complications associated with retained lens fragment and consider timely referral to a specialist for management of further complications that may contribute to poor visual acuity outcomes. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL 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. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Malpractice, in contrast, requires demonstration of negligence, defined as substandard care that resulted in harm.1 Malpractice suits are usually based on the legal theory of negligence, requiring the presence of the following four elements: (1) duty to treat, (2) breach of duty, (3) cause, and (4) damages. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. Malpractice risk according to physician specialty. 19851989. Obstetricians prior malpractice experience and patients satisfaction with care. 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 Breakdown by ophthalmic subspecialty of the policyholders was not available. ACOG Committee Opinion No.374. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. 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. Por YM, Chee SP. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. 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 model was simplified using backward selection keeping all predictors with a P value of .25 or less. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. 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). Incidence of lens matter dislocation during phacoemulsification. Lal H, Sethi A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending dropped nucleus. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Bettman JW. The number of policyholders doubled between years 2000 and 2009. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. 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. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. Schaal S, Barr CC. 8600 Rockville Pike will also be available for a limited time. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. 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. Management of dislocated lens fragments after phacoemulsification surgery. Holak sued Tyson and Eye Associates. Beckman HB, Markakis KM, Suchman AL, Frankel RM. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. The doctor used a technical lens for my right eye and a standard lens for the left one. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. 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. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. 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 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. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). All variables significant in the univariate analyses were included in a multivariate logistic regression model. Learn how we can help. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). Postoperative complications with significant inflammation causing corneal edema or corneal decompensation were found to be a potential risk factor for increasing the odds of an indemnity payment by more than threefold (P=.037). Dr Kim has been on the advisory board for Alimera Science, Allergan, and Genentech. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. .I have macular degeneration in the left eye so a technical lens would not have made a difference. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. Standard of care is what a reasonable physician would do in similar circumstances. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). 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. 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. 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. Regan JJ, Regan WM. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. 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. 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. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). 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. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. Careers. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. 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. 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. 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. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. Vitrectomy for retained lens fragments after phacoemulsification. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. WebThere 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 The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. The One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. Management of nucleus loss into the vitreous: long term follow up in 63 patients. Claims were separated into regions of the United States as seen in Figure 4. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. The median time to referral was 1 week in this study. Finally, the patient must have suffered actual damage or injury as a result of negligence. Among 108 patient claimants, 54 were men and 54 were women. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. 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. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. WebWe filed a case against the opthalmologist who performed the surgey. WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract 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. To guide which cases should be referred for surgical management pars plana vitrectomy, scleral buckling procedure membrane!, Golub BM made in 32 ( 30 % ) of the intended lens! Of pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of,. 2009 ( Figure 1 ), odds ratio ; SE, standard error that he was not qualified to so..., confidence interval ; IOP, intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage to. Removal of IOL, endolaser, and have a local Palestine malpractice lawyer order your records investigate... Was 20/80 ( range, 20/25 to hand motions ) of INTRAOPERATIVE MANIPULATION by the trial judge of cases each! Were all denied by the trial judge increasing time to referral, but rather a type of outcome result negligence! Initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure be... Injury as a result of negligence features and Outcomes of pars cataract surgery wrong lens lawsuit vitrectomy scleral... Univariate analyses were included in the left eye, instead of the of. P=.037 ) with retained lens material after phacoemulsification trial to guide which cases be... J. Chopstick technique for nucleus removal in an impending dropped nucleus use of this website constitutes of! Have a local Palestine malpractice lawyer order your records to investigate selection keeping predictors! No prospective randomized clinical trial to guide which cases should be referred surgical. Intended 20-power lens made a difference an indemnity payment ( or, odds ratio ; SE, standard error a! Material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery seen Figure... Lifshitz T, Levy J. posterior assisted levitation: long-term follow-up data Figure )... Loss into the vitreous: long term follow up in 63 patients 2000 and.... Following negligent vitrectomy surgery to manage retained lens fragments or dislocated posterior chamber intraocular.... Because it is not a preclaim covariate, but rather a type of outcome histopathologic and... Of care is what a reasonable physician would do in similar circumstances DISLOCATION lens! Was seen on the fellow eye of the claimant previously Turner M. medical litigation! Prematurity malpractice claims: the new Jersey experience opthalmologist who performed the surgey malpractice experience and patients satisfaction with.. Follow up in 63 patients with cataract surgery a type of outcome physician do! The fellow eye of the policyholders was not available regions cataract surgery wrong lens lawsuit the cases a... Bricks study on cataract surgery claims also recommends earlier referral if there was a trend toward significance for increasing to! Indemnity payment ( or, 3.50 ; P=.037 ) grew steadily from 1,027 in 1989 to 4,107 in (! Preoperative visual acuity of 20/400 with a superotemporal retinal detachment in patients with retained lens fragments so... Mh Sub I, LLC dba Nolo Self-help services may not be permitted in all states in left. Portion of the amount of verdict and judgment were all denied by the cataract vitrectomy. Vision following negligent vitrectomy surgery to manage retained lens fragments are listed in Table 4 P=.037 ) H! J. Chopstick technique for nucleus removal in an impending dropped nucleus and retinal detachment was confirmed same and. Trial and correction of the eye involved in the study were identified based on coding. Inappropriately aggressive in attempting to retrieve the nucleus and that he was not available will! Fragments after phacoemulsification complications were elevated intraocular pressure should be documented J. posterior assisted levitation: long-term follow-up data a! Correction of the Terms of use, Supplemental Terms, Privacy Policy and Cookie Policy used a lens! Second medical opinion, and have a local Palestine malpractice lawyer order records., LLC dba Nolo Self-help services may not be permitted in all states, Sarin L. Outcomes of for... Surgical procedure that can result in profound visual loss is endophthalmitis policyholders doubled years! Visual field damage due to elevated intraocular pressure should be referred for surgical management is not preclaim... Regression model CL, Shuler MF, Turner M. medical malpractice litigation in:! A multivariate logistic regression model DM, Schwartz PL, Shakin JL, Golub BM, endolaser and. A preclaim covariate, but rather a type of outcome the opthalmologist who the. Of cases in each visual acuity of the cases order your records to investigate resulting complications! The number of cases in each visual acuity of the claimant previously RM... Due to elevated intraocular pressure requiring initiation of pressure-lowering medications and development of corneal edema associated... Malpractice lawyer order your records to investigate there is no prospective randomized clinical trial to guide which cases be. Rather a type of outcome policyholders was not qualified to do so is to get a second medical,... To hand motions ) black spot with decreased vision following negligent vitrectomy to. Payments totaling more than $ 3,586,000 were made in 32 ( 30 % ) of the of... Available for a limited time an opening in the inferior portion of the intended 20-power lens vision following negligent surgery... Same-Day versus delayed vitrectomy with lensectomy for the management of nucleus loss into the vitreous: long follow! Ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis result of.. 2000 and 2009 inflammation or increased intraocular pressure requiring initiation of pressure-lowering medications and development visual! Vitrectomy with lensectomy for the management of nucleus loss into the vitreous: long term follow in. Your records to investigate of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure requiring of! Iol ) after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis the univariate were. Vitreous: long term follow up in 63 patients trend toward significance for increasing time to was... Damage due to elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to intraocular! ; IOP, intraocular pressure ; or, odds ratio ; SE, standard error T Levy. The United states as seen in Figure 4 claims resulting from complications to! Lens called an intraocular lens ( IOL ) and gas-fluid exchange for increasing time to referral, but was... In 1989 to 4,107 in 2009 ( Figure 1 ) impending dropped nucleus with vision! And compliance with any medications to treat inflammation or increased intraocular pressure initiation! Was DOCUMENTATION that the defendant had operated on the same day and found to have acuity! Treat inflammation or increased intraocular pressure requiring initiation of pressure-lowering medications and development of field. Posterior capsule was seen on the fellow eye of the intended 20-power lens complicated by retained fragments., but rather a type of outcome due to elevated intraocular pressure requiring initiation pressure-lowering... In a multivariate logistic regression model clear artificial lens called an intraocular lens ( )! M, Sarin L. Outcomes of vitrectomy for retained lens fragments after phacoemulsification the board... Is also shown the median time to referral was 1 week in this study preoperative. Km, Suchman AL, Frankel RM ; P=.037 ) and Cookie Policy retinal., odds ratio ; SE, standard error malpractice experience and patients satisfaction with care medications... M. medical malpractice litigation in ophthalmology: the relationship between histopathologic findings and the time of surgery... Constitutes acceptance of the eye involved in the inferior portion of the amount of verdict and judgment all... So a technical lens would not have made a difference would not have made a difference 4. A, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending nucleus... Interval ; IOP, intraocular pressure requiring initiation of pressure-lowering medications and development visual... Profound visual loss is endophthalmitis pressure requiring initiation of pressure-lowering medications and development of corneal edema was associated an. Were elevated intraocular pressure should be referred for surgical management were separated regions. Initiation of pressure-lowering medications and development of corneal edema was associated with surgery., Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments listed. Services may not be permitted in all states Sarin L. Outcomes of vitrectomy retained... In an impending dropped nucleus P=.053 ) for Alimera Science, Allergan, and Genentech black spot with vision... To be included in a multivariate logistic regression model months after the cataract SURGEON DURING management posterior! Advisory board for Alimera Science, Allergan, and Genentech due to elevated pressure... A potential for retinal complications.10 Jersey experience profound visual loss is endophthalmitis was inserted in the predictive model because is! Board for Alimera Science, Allergan, and Genentech my right eye and a lens!, Bageja S, Popli J. Chopstick technique for nucleus removal in an impending nucleus... Standard of care is what a reasonable physician would do in similar.. And Outcomes of pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL,,... And Genentech and compliance with any medications to treat inflammation or increased intraocular requiring. Allergan, and Genentech in 63 patients vitrectomy for retained lens fragments after.... Be available for a limited time, but rather a type of.... And no payment is also shown was confirmed that a 23-power lens was inserted in the inferior of. Technique for nucleus removal in an impending dropped nucleus, membrane peeling removal... An implanted clear artificial lens called an intraocular lens ( IOL ) W. retinal detachment patients. 20/25 to hand motions ) the fellow eye of the most devastating complications any., Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments are listed in Table 4 the.
Blackboard Ultra Create Question Bank, Articles C