cataract surgery wrong lens lawsuitcataract surgery wrong lens lawsuit
Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. 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. In 91 eyes, preoperative visual acuity was recorded for both eyes. The costs including indemnity payments and defense costs are summarized in Table 5. 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. 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. 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. For statistical purposes, only the data from the primary surgeon was analyzed in the study. Medical malpractice and respondeat superior. 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 retina successfully reattached with a final visual acuity of 20/25. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. They ranged from a low of $7,500 to a high of $500,000. The mean age was 69 years (range, 4090 years). Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Gonzalez ML. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. The technical lens was suppose to give me even better vision in the right eye. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. Physician-patient communication. My father had cataract surgery two years ago. 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). Follow Posted 4 years ago, 24 users are following. 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. 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. Distribution of closed claims related to retained lens fragments by region in the United States. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. 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. 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. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Among these, the patients sought a second opinion and referred themselves in 3 cases. Mello MM, Chandra A, Gawande AA, Studdert DM. CI, confidence interval; OR, odds ratio; SE, standard error. 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. What is the recovery after cataract or lens replacement surgery? The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. 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. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. 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. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. 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. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. In some states, the information on this website may be considered a lawyer referral service. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. 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). The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. In: Gonzalez ML, Zhang P, editors. According to the 2010 report to the OMIC members, approximately 17% of practicing ophthalmologists in the United States are female and 18% of OMIC-insured ophthalmologists are female.17. Kraushar MF. 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National costs of the medical liability system. .I have macular degeneration in the left eye so a technical lens would not have made a difference. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. In: Gonzalez ML, editor. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. 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. 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. In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. 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. Standard of care and anesthesia liability. Careers. Scott IU, Flynn HW, Jr, Smiddy WE, et al. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. Socioeconomic Characteristics of Medical Practice 1990/1991. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. He was referred to a retina specialist, who saw him the next day. 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. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. The difference between the mean and median payment reflects the right-skewed payment distribution. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. 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. The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. The log-transformation implies that the effect of these variables is multiplicative. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. The The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. Moore JK, Scott IU, Flynn HW, Jr, et al. The top 5 states in terms of overall frequency of claims in rank order were Illinois (18 cases), Texas (16 cases), California (11 cases), Florida (10 cases), and Louisiana (10 cases). Holak sued Tyson and Eye Associates. PMC legacy view 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. May M, Stengel B. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. The defendant prevailed in 83% of trials. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Wilkinson CP, Green WR. Dr made larger incision & needed stitches. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. Outcome of vitrectomy for retained lens fragments after phacoemulsification. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Bohigian GM, Wexler SA. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. Bessant DA, Sullivan PM, Aylward GW. She was referred to a glaucoma specialist, oral and topical corticosteroid therapy was begun, and a posterior subtenons corticosteroid injection was given. 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. 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. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Studdert DM, Mello MM, Gawande AA, et al. how badly you were actually hurt and how much that injury actually cost you in medical expenses, lost wages, diminished quality of life, etc. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. Ali N, Little BC. The estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. Pande M, Dabbs TR. 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. Clinical predictors and outcomes of pars plana vitrectomy for retained lens material after cataract extraction. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. 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. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. Professional liability insurance: II The legal environment. 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. Retained intravitreal lens fragments after cataract surgery. Practice styles and preferences of ASCRS members1994 survey. 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