The .gov means its official. The patient refused laser treatment for vitreolysis. Malpractice risk according to physician specialty. An anterior vitrectomy was performed. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. Socioeconomic Characteristics of Medical Practice 1990/1991. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. In some states, the information on this website may be considered a lawyer referral service. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. Mello MM, Chandra A, Gawande AA, Studdert DM. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. Kim IK, Miller JW. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. WebCataract Symfony Lawsuits? Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Liability claims and costs before and after implementation of a medical error disclosure program. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Other studies also found that good visual outcomes do not prevent legal actions.10,92. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Ophthalmic malpractice lawsuits with large monetary awards. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Risk management lessons from a review of 168 cataract surgery claims. Follow Posted 4 years ago, 24 users are following. Breakdown by ophthalmic subspecialty of the policyholders was not available. Physician-patient communication. National Library of Medicine Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. 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). i'm sorry to read of your troubles and I know enough as a practicing physician for 20 years that your course has deviated from the typical cataract about navigating our updated article layout. 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. 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. Final visual acuity was the last recorded visual acuity. Management of retained intravitreal lens fragments after phacoemulsification surgery. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for 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. Day S, Menke AM, Abbott RL. The verdict was 6 for plaintiff and 2 for defendant. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. The term claim was used in this study to include suits, unless specified. Claims were separated into regions of the United States as seen in Figure 4. Baldwin LM, Larson EH, Hart LG, et al. 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. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). In the first case, the cataract surgery was performed in 1989. Careers. Bohigian GM, Wexler SA. 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. Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. The mean age was 69 years (range, 4090 years). 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. 19851989. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. According to this report, 42% of physicians have been sued for medical malpractice at some point in their careers and 20% were sued at least twice during their careers.2 This survey found a wide variation in the incidence of liability claims between specialties. Aasuri MK, Kompella VB, Majji AB. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. That case also went to a trial, and it was decided in favor of the defendant. 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. However, the majority of the claims were dismissed and did not result in an indemnity payment. The attorney listings on this site are paid attorney advertising. WebCataract surgery injury occurs in approximately 12% of cases. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. 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. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. Pande M, Dabbs TR. The average insurance company payment - mostly settlements -- in these cases were $112,000. 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%. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. 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. 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. Bovbjerg RR, Petronis KR. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. Abbott RL. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. 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