Risk management strategies following analysis of cataract negligence claims

Bhan, A; Dave, Deepak; Vernon, S A; Bhan, Kanchan; Bhargava, J S; Goodwin, Halle

doi:10.1038/sj.eye.6701493

Cited by 27 publications

(22 citation statements)

References 6 publications

(1 reference statement)

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“…The first examined 168 claims from 1987 to 1997 in the USA 3. The second study analysed 96 claims from 1990 to 1999 arising from private practice in the UK 9. However, the independent sector differs in many regards from the context of cataract surgery in the NHS: the number of operations is far fewer; surgery is performed only by consultants; and patient demographics and expectations are different.…”

Section: Introductionmentioning

confidence: 99%

Causes of cataract surgery malpractice claims in England 1995-2008

Ali

Little

2010

British Journal of Ophthalmology

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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.

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Section: Introductionmentioning

confidence: 99%

Causes of cataract surgery malpractice claims in England 1995-2008

Ali

Little

2010

British Journal of Ophthalmology

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“…As for the reasons for medical disputes, several studies have revealed an association with the relationship between the doctor and the patient, not the outcome of the management [ 21 ]. In the process of medical treatment, the doctor's ability to communicate is considered the fourth skill in the field of medicine, after the abilities to prescribe drugs, treat patients, and perform operations.…”

Section: Discussionmentioning

confidence: 99%

Physicians' communication skills with patients and legal liability in decided medical malpractice litigation cases in Japan

2008

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Background: In medical malpractice litigations in recent years in Japan, it is notable that the growing number of medical litigation cases includes the issue of a doctor's explanation to the patient as a pivotal point. The objective of this study was to identify factors of physicians' communication skills with patients, as related to their legal liability, and differences in doctors' communication skills with patients by the type of medical facility.

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“…In a 10-year analysis of cataract surgery-related claims for negligence in the NHS, more than 50% involved known complications of cataract surgery and should have been defensible if the risks were adequately explained to the patient before surgery (Bhan et al 2005). This underscores the importance of good doctor-patient communication in the consent process.…”

Section: Introductionmentioning

confidence: 99%

Should patients set the agenda for informed, consent? A prospective survey of desire for information and discussion prior to routine cataract surgery

Tan

Jenkins²,

Roberts-Harry³

et al. 2008

TCRM

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Purpose:To ascertain the level of information relating to specifi c risks desired by patients prior to cataract surgery. Setting: Dedicated cataract surgery pre-assessment clinics of 2 hospitals in South West Wales, UK. Methods: Consecutive patients (106) were recruited prospectively. Of these, 6 were formally excluded due to deafness or disorientation. Eligible patients (100) were asked a set of preliminary questions to determine their understanding of the nature of cataract, risk perception, and level of information felt necessary prior to giving consent. Those who desired further information were guided through a standardized questionnaire, which included an audio-visual presentation giving information relating to each potential surgical complication, allowing patients to rate them for relevance to their giving of informed consent. Results: Of the entire group of 100, 32 did not wish to know "anything at all" about risks and would prefer to leave decision making to their ophthalmologist; 22 were interested only in knowing their overall chance of visual improvement; and 46 welcomed a general discussion of possible complications, of whom 25 went on to enquire about specifi c complications. Of these 25, 18 wished to be informed of posterior capsular (PC) tearing, 17 of endophthalmitis, 16 each of dropped lens, retinal detachment and corneal clouding, and 15 of bleeding, sympathetic ophthalmia, and PC opacifi cation. Conclusion: Patients differ in their desire for information prior to cataract surgery, with one signifi cant minority favoring little or no discussion of risk and another wishing detailed consideration of specifi c risks. A system of consent where patients have a choice as to the level of discussion undertaken may better suit patients' wishes than a doctor-specifi ed agenda.

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Risk management strategies following analysis of cataract negligence claims

Cited by 27 publications

References 6 publications

Causes of cataract surgery malpractice claims in England 1995-2008

Causes of cataract surgery malpractice claims in England 1995-2008

Physicians' communication skills with patients and legal liability in decided medical malpractice litigation cases in Japan

Should patients set the agenda for informed, consent? A prospective survey of desire for information and discussion prior to routine cataract surgery

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