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. 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. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. 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 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. and transmitted securely. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. 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. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Merani R, Hunyor AP, Playfair TJ, et al. Given the differences in the frequency of claims for various medical specialties and the limited number of studies in the literature related to malpractice claims in ophthalmology, this current study used the available data from a large ophthalmology-specific insurance company in an effort to gather specialty-specific data. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. 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. The https:// ensures that you are connecting to the The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. 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. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. 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. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. 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. 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. Physicians Insurers Association of America . Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. 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. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. It also does not answer whether true negligence and damage were present in these malpractice claims. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. 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. 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. Abbott RL. My father had cataract surgery two years ago. 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). Learn how we can help. 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. 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? Posterior-assisted levitation in cataract surgery. 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. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. 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. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). There was additional $103,000 in legal expenses. 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). Teo L, Chee SP. Stenkula S, Byhr E, Crafoord S, et al. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. 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. 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. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. It appeared that the nucleus was resting on the optic nerve. A claim may include institution of a lawsuit or arbitration proceedings against the insured. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. The term claim was used in this study to include suits, unless specified. 8600 Rockville Pike The Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. Ho SF, Zaman A. 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.