Causes of cataract surgery malpractice claims in England 1995-2008

Abstract

Aims:To analyse the causes of malpractice claims related specifically to cataract surgery in the National Health Service in England from 1995-2008.Methods: All the malpractice claims related to cataract surgery from 1995-2008 from the National Health Service Litigation Authority were analysed. Claims were classified according to causative problem. Total numbers of claims, total value of damages, mean level damages and paid:closed ratio (a measure of the likelihood of a claim resulting in payment of damages) were determined for each cause. Results:Over the 14 year period there were 324 cataract surgery claims with total damages of £1.97 million and mean damages for a paid claim of £19,900. Negligent surgery (including posterior capsule tear and dropped nucleus) was the most frequent cause for claims, while reduced vision accounted for the highest total and mean damages. Claims relating to biometry errors/ wrong intra-ocular lens power were the second most frequent cause of claims and result in payment of damages in 62% of closed cases. The claims with the highest paid:closed ratio were inadequate anaesthetic (75%) and complications of anaesthetic injections including globe perforation (67%). Conclusions:Claims from cataract surgery in the NHS are extremely infrequent. Consent, though essential, may not prevent a claim arising or resulting in damages. Refractive accuracy has significant medicolegal impact. Endophthalmitis can lead to successful claims if there is delay in diagnosis. Claims relating to inadequate anaesthesia or anaesthetic injection complications are particularly hard to defend.

Wrong intraocular lens implant; learning from reported patient safety incidents

“…Surgical confusions (ie wrong patient, wrong site or side surgery, wrong procedure or implant) are an infrequent, but important and preventable cause of patient morbidity in general and relevant to ophthalmic surgeons. [2][3][4][5]8,9 The Department of Health in England consultation exercise on 'never events' states that insertion of an incorrect implant is an event that should never happen. 10 Ophthalmologists and orthopaedic surgeons at the Veterans' Health Administration experienced the highest rate of preventable adverse events resulting not only from wrong site procedures, but seemingly high rates of incorrect medical device implantation.…”

“…3 Claims relating to biometry errors/ wrong IOL power were frequent in the NHSLA review. 4 The litigation claims in cataract care in the United States are for similar reasons. 5 Following several influential reports on patient safety, learning from clinical failure or incident is now widely regarded as a core principle underpinning improvement in patient safety.…”

Role of the treating surgeon in the consent process for elective refractive surgery

“…Inadequate consenting process (combined with poor outcomes) is one of the most common reasons for malpractice litigation in ophthalmology 4–8. This problem is particularly hard to overcome, as many publications have shown that very little information presented during informed consent is actually retained by the patient 9–13.…”

A oftalmologia no tribunal: avaliação das sentenças judiciais no âmbito do Tribunal de Justiça do Estado de São Paulo

“…Paralelamente, quando observamos as alegações dos autores, somando os que afirmaram perda total e perda parcial da visão, chegamos a um total de 83,5% de descontentamento com a acuidade visual final após intervenção médica. Estes dados parecem indicar que, assim como já observado por outros autores 12,13 , os casos em sua maioria resultam de insatisfação com resultados e não por erro médico.…”