will also be available for a limited time. Data from the PIAA show that for all medical claims in 2008, average defense costs per claim were $40,649, ranging from a low of $22,163 among claims that were dropped, dismissed, or withdrawn, to a high of over $100,000 for tried cases.79 However, none of the studies, including this study, have addressed additional costs that result from stress and time associated with a lawsuit to the plaintiff or to the defendant. Beckman HB, Markakis KM, Suchman AL, Frankel RM. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. 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. 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. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. After the trial, the jurors were polled. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. 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. In: Gonzalez ML, editor. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Male physicians may have a higher likelihood of being sued because male physicians are historically concentrated in the specialties with the highest levels of claim incidence, such as surgery, and female physicians in those with the lowest incidences, such as pediatrics. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. Characteristics of physicians with obstetric malpractice claims experience. Jena AB, Seabury S, Lakdawalla D, Chandra A. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Lu H, Jiang YR, Grabow HB. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Management of dislocated lens fragments following phacoemulsification surgery. Her preoperative visual acuity was 20/25 in the right eye and 20/60 in the left eye, which fell to 20/400 with glare testing. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. In addition, there are potential complications associated with any surgical procedure due to unavoidable risks despite appropriate care, complications that are unexpected or unpredictable, or decisions that were made carefully by the patient and physician with informed consent but, in retrospect, were less than optimal owing to the uncertainties inherent to the practice of medicine. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. Management of nucleus loss into the vitreous: long term follow up in 63 patients. The number of policyholders doubled between years 2000 and 2009. Ho LY, Doft BH, Wang L, Bunker CH. If a physician had multiple claims from separate cataract surgeries, each was counted separately. 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. In the first case, the cataract surgery was performed in 1989. This gender spread was compared with OMIC data on demographics. Finally, the patient must have suffered actual damage or injury as a result of negligence. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Why do people sue doctors? Wilkinson CP, Green WR. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. The mean payment was $117,688, and the median payment was $90,000. 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. Missouri Medical Malpractice Lawyer If you have suffered as a result of medical malpractice, contact our legal team right away. Risk factors for and management of dropped nucleus during phacoemulsification. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. 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. Interestingly, this physician had another case brought against him 6 years later. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Seven hundred medicolegal cases in ophthalmology. 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. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. My vision actually was worse after the lens placement. 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). Kim IK, Miller JW. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. However, the patient did not show up for appointments, despite being sent no show letters. 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). 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. 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. Accessibility Total cost of defense for all 108 claims was $3,312,688. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. Who sues their doctors? Risk management lessons from a review of 168 cataract surgery claims. The Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Abbott RL. Dr. did correction surgery (for free) after finding and admitting his error. Claims were separated into regions of the United States as seen in Figure 4. Development of corneal edema was statistically significantly associated with an indemnity payment but not for a trial. Schaal S, Barr CC. 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. Duty to treat means that a doctor-patient relationship must be established prior to the alleged negligent act. Laser has been developed to assist in cataract surg Read more pressure, cystoid macular,! 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