The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Socioeconomic Characteristics of Medical Practice 1990/1991. ITEMS REVIEWED FOR POTENTIAL ASSOCIATED FACTORS FOR LITIGATION OUTCOMES FROM CLOSED CLAIMS RELATED TO CATARACT SURGERY COMPLICATE BY RETAINED LENS FRAGMENTS. 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. 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. In these early referral cases, the claim was more likely to be dismissed. about navigating our updated article layout. Aasuri MK, Kompella VB, Majji AB. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. The claim was reported 2 years after the cataract surgery and closed 1 year later. In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. 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. In the multivariate analysis, two factors were found to be associated with indemnity payment: (1) the difference between preoperative visual acuity and final visual acuity and (2) the development of corneal edema or corneal decompensation. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Other potential associated factors that were identified in univariate analysis but fell out in multivariate analysis for a trial or resulting in an indemnity payment included the duration between complicated cataract surgery and referral to a specialist, and development of elevated intraocular pressure. It involved a 70-year-old female patient who went from preoperative visual acuity of 20/60 to final visual acuity of no light perception. HHS Vulnerability Disclosure, Help A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). Final visual acuity was the last recorded visual acuity. American College of Obstetricians and Gynecologists. For this study, a P value <.05 was considered significant. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as trial with a verdict > settled > dismissed, and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. CI, confidence interval; OR, odds ratio; SE, standard error. The case was closed with an indemnity payment of $215,000. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. 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. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Data on age was available for 101 claimants. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Kraushar MF. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Management of dislocated lens material. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Ho SF, Zaman A. May M, Stengel B. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. 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. 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. A steroid drop prescribed by your ophthalmologist can help. The management of dislocated lens material after phacoemulsification. Two cases went on to trial and ended with a verdict in favor of the plaintiff. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Por YM, Chee SP. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. The mean age was 69 years (range, 4090 years). Bethesda, MD 20894, Web Policies Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Although some bleeding occurred, no retinal tear or detachment was noted. There was another 29 months on average until the closure of a claim. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. The needle impaled the lens and tore the lens capsule. Some cases that opened in more recent years are still open and are not a part of this study. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. Management of nucleus loss into the vitreous: long term follow up in 63 patients. What helps? The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. 8600 Rockville Pike 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. 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. 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. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. The costs including indemnity payments and defense costs are summarized in Table 5. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. Why do people sue doctors? The term claim was used in this study to include suits, unless specified. Among the 3 claims involving retina surgeons, one claim alleged negligent surgery to remove the dropped nucleus and dislocated IOL, which allegedly led to a subsequent retinal detachment. National Library of Medicine Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. CF, counting fingers; HM, hand motion; NLP, no light perception. This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. Bovbjerg RR, Petronis KR. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. The attorney listings on this site are paid attorney advertising. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. Considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema or. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology of..., when refractive surprises occur with no warning after routine cataract surgery it. 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