The relationship between physicians malpractice claims history and later claims: does the past predict the future? 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. There was additional $103,000 in legal expenses. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. Rosenbaum JT, Samples JR, Seymour B, Langlois L, David L. Chemotactic activity of lens proteins and the pathogenesis of phacolytic glaucoma. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Studdert DM, Mello MM, Gawande AA, et al. 8600 Rockville Pike 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. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. I am currently evaluating a similar case in involving a surgeon placing a wrong lens into a patient, however the error was recognized during the su 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. 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. 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 ". Accessibility 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. Two weeks later, visual acuity was hand motions. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. Kraushar MF. The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Gender of the physician was not found to be a significant predictor of indemnity payment of the claims outcomes (Tables 6 and and77). 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. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. 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. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. Factors that prompted families to file malpractice claims following perinatal injuries. During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. 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. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. 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. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. An example of one unit change in visual acuity would be going from 20/20 to 20/200. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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). Kwok AK, Li KK, Lai TY, Lam DS. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL Retained intravitreal lens fragments after cataract surgery. Careers. Start here to find personal injury lawyers near you. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Endophthalmitis in patients with retained lens fragments after phacoemulsification. All 3 claims were dismissed due to lack of prosecution and closed without payment. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Monshizadeh R, Samiy N, Haimovici R. Management of retained intravitreal lens fragments after cataract surgery. ACOG Committee Opinion No.374. 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. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. CF, counting fingers; HM, hand motion; NLP, no light perception. Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. The term claim was used in this study to include suits, unless specified. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). The WebCataract surgery injury occurs in approximately 12% of cases. 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). According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. 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). 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. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. Mello MM, Gawande AA, et al 7 months after the cataract and vitrectomy.. 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