The OMIC Professional Liability Policy defines a claim as a written notice or demand for money or services by the patient (plaintiff) to the insured (physician or entity) for compensation from a medical incident. Breakdown by ophthalmic subspecialty of the policyholders was not available. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. 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. Tackling the dropped nucleus. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). The patient refused laser treatment for vitreolysis. Risk management lessons from a review of 168 cataract surgery claims. Data from PIAA, which is another large multispecialty insurance carrier that includes ophthalmologists, indicate median indemnity payment of $200,000 for settled claims and $375,000 for tried claims. For this study, a P value <.05 was considered significant. This gender spread was compared with OMIC data on demographics. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. WebThere 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 Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. The patient was released to a general ophthalmologist. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. National costs of the medical liability system. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. The new PMC design is here! Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. The case was closed with an indemnity payment of $215,000. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies The median payment was $90,000. In some states, the information on this website may be considered a lawyer referral service. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. 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. The needle impaled the lens and tore the lens capsule. 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. Management of retained intravitreal lens fragments after phacoemulsification surgery. For instance, indemnity payment by OMIC is 21% less than ophthalmic claims payment by the next largest insurer of ophthalmologists when settlement was required.97 Therefore, payment amount in this study using OMIC data would be on the lower side compared to the combined indemnity payment from all insured ophthalmologists. 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. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. Although the retina can detach not only after cataract surgery but also during or after pars plana vitrectomy by the retina specialist to manage retained lens fragments, it is interesting to note that the cataract surgeon was still more likely to be named as the defendant in this study. The average insurance company payment - mostly settlements -- in these cases were $112,000. A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. Professional liability insurance: II The legal environment. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. 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. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. Who sues their doctors? The largest indemnity payment case, with a payment of $500,000, closed in 2005 with a settlement. 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. An anterior vitrectomy was performed. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience. ACOG Committee Opinion No.374. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. 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. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. Retained lens fragments in resident-performed cataract extractions. OMIC underwriting applications and claims records were reviewed. 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). Why do people sue doctors? 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). Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. 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. The number of ophthalmologists being insured by OMIC grew steadily from 1,027 in 1989 to 4,107 in 2009 (Figure 1). The remaining 9 cases (10%) were left aphakic by the cataract surgeon. National Library of Medicine Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. Kraushar MF. In 11 eyes, the operated eye was the better eye. will also be available for a limited time. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. What is the recovery after cataract or lens replacement surgery? Ho SF, Zaman A. Kim JE, Flynn HW, Jr, Smiddy WE, et al. Retained lens fragments can be successfully managed by the retina specialists in most cases. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. One of the ways to reduce the complication of retained lens fragments could be monitoring and reducing the possibility of a sudden patient movement during surgery. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. Seven hundred medicolegal cases in ophthalmology. Hickson GB, Clayton EW, Githens PB, Sloan FA. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). 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