Presenting a live 90‐minute webinar with interactive Q&A Ohhl l Ml i Si Ophthalmology Malpractice Suits Navigating Eye Injury Proof Issues and Claims Involving LASIK, Cataracts, ROP, and Other Procedures T d ’ f l f 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific TUESDAY, APRIL 23, 2013 T oday’ s faculty features: Todd J. Krouner, Law Office of Todd J. Krouner, Chappaqua, N.Y. C. Gregory Tiemeier, Partner, Tiemeier & Stich, Denver The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10.
Transcript
Presenting a live 90‐minute webinar with interactive Q&A
O h h l l M l i S iOphthalmology Malpractice SuitsNavigating Eye Injury Proof Issues and Claims Involving LASIK, Cataracts, ROP, and Other Procedures
Todd J. Krouner, Law Office of Todd J. Krouner, Chappaqua, N.Y.
C. Gregory Tiemeier, Partner, Tiemeier & Stich, Denver
The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10.
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3. SURGEONS TURN CORNEAS INTO COMMODITIES, INVITING CONVEYOR BELT ANALOGIES THAT DESTROY BELT ANALOGIES THAT DESTROY JURIES’ PREDISPOSITION IN FAVOR OF DOCTORSOF DOCTORS.$250/EYE!
Cataract Surgery 201 $22 0 $60 000Cataract Surgery 201 $22.0 $60,000
Medical Evaluation 80 $17.8 $100,000
Oculoplastics 79 $12.4 $75,000
Refractive Surgery 86 $11.4 $55,000
Retina 63 $10.0 $100,000
$ $ROP 9 $8.3 $575,000
Glaucoma 39 $7.3 $135,000
Miscellaneous Other 79 $7.1 $30,000 $ $ ,
Corneal 19 $4.1 $75,000
Trauma related 24 $3.6 $110,000
Local Anesthesia 11 $2.6 $85,000
Strabismus 11 $1.4 $100,000 13
II. LASIK SURGERY NEGLIGENCE
A. TYPES OF CASES
CONTRAINDICATIONS - -
ECTASIA
Corneal ectasia is one of the most devastating complications ft LASIK P t LASIK t i i id d i after LASIK. Post-LASIK ectasia is considered in
patients who developed increasing myopia, with or without increasing astigmatism, loss of uncorrected visual acuity, often loss of best-corrected visual acuity, with keratometric steepening, with or without central with keratometric steepening, with or without central and paracentral corneal thinning, and topographic evidence of asymmetric inferior corneal steepening after LASIK procedure. Ectatic changes can occur as early as 1 week or can be delayed up to several years after LASIKLASIK.
ECTASIA IS PRESUMPTIVE EVIDENCE OF MEDICAL MALPRACTICE95% OF THE TIME POST-LASIK ECTASIA IS
CAUSED BY A SURGEON MISSING
WARNING SIGNS IN PRE-OPERATIVE
TOPOGRAPHIESTOPOGRAPHIES.See J. Bradley Randleman, MD, Buddy Russell, FCLSA,
Michael A. Ward, MMSc, FAAO, Keith P. Thompson, MD, R D l St lti MD PhD Ri k F t d P i f R. Doyle Stulting, MD, PhD, Risk Factors and Prognosis for Corneal Ectasia After LASIK, Ophthalmology, 2003; 110:267-275; Randleman JB, Woodward M, Lynn MJ, Stulting RD, Risk Assessment for Ectasia after Corneal g , f fRefractive Surgery, Ophthalmology 2008; 115: 37-50.
REFRACTIVE SURGERY MALPRACTICEREFRACTIVE SURGERY MALPRACTICE 1. Schiffer v. Speaker – Ectasia - $7.25 M Verdict 2. J.C. - Ectasia where prior doctor said patient was not a good candidate 3. R.P. - Failure to calibrate laser resulting in severe central islands 4. R.G. - PRK on central frank keratoconus (see case study by Dr. Randleman) 5. Martinez v. Neatrour - Ectasia 6. S.D. - DEA cocaine use (ectasia) 7. A. P. - Ectasia/alteration of records/loss of insurance coverage 8. Devadas v. Niksarli - Ectasia/alteration of records/$5.6 M verdict 9. R.D. - Ectasia 10. J.R. - Defective medical device recall of Alcon Ladar vision 6000 central
islands11 D K D f ti di l d i ll f Al L d i i 6000 t l 11. D.K. - Defective medical device recall of Alcon Ladar vision 6000 central islands
12. S.P. - Defective medical device recall of Alcon Ladar vision 6000 central islands
13. M.S. -Hyperopic ectasia after 11 refractive proceduresyp p p 14. L.S. - Hyperopic ectasia following four surgeries 15. J.D. - Steroid induced glaucoma following LASIK 16. E.K. - Ectasia - $950,000 for housewife with no loss of earned income 17. D.D. – Ectasia - $1M$
C STANDARD OF CAREC. STANDARD OF CARE WHITE PAPER WHITE PAPER
See Perry S Binder MS MD; Richard L Lindstrom MD; R Doyle Stulting See Perry S. Binder, MS, MD; Richard L. Lindstrom, MD; R. Doyle Stulting, MD, PhD; Eric Donnenfeld, MD; Helen Wu, MD; Peter McDonnell, MD; Yaron Rabinowitz, MD; Keratoconus and Corneal Ectasia After LASIK, Journal of Refractive Surgery, 2005, 21:749-752.
LIGHT SENSITIVITYDIFFICULTY NIGHT DRIVINGDOUBLE VISIONFLUCTUATION IN VISIONGLAREHALOSSTARBURSTSTARBURSTDRYNESSPAINFOREIGN BODYFOREIGN BODYSEE GEORGE WARING, M.D., et al., “Laser in situ Keratomileusis for Spherical Hyperopia and Hyperopic Astigmatism Using the NIDEK EC-5000 Excimer Laser,” JOURNAL OF REFRACTIVE SURGERY, 2008; 24 123 136
Wrong IOL Powerg Possible Problems:◦ Contact vs. Immersion A-scanContact vs. Immersion A scan◦ IOL Master ◦ Correct calculation mistake in picking lensCorrect calculation, mistake in picking lens◦ Capsule shrinkage – change in location◦ Improper calculation◦ Improper calculation◦ Using a Posterior lens for Anterior (or Sulcus)
Wrong IOL/Wrong Patientg g Possible Problems◦ Surgery Center staff mis-orders patient, or Surgery Center staff mis orders patient, or
lens stock◦ Patient ID mixupp◦ Pick the wrong IOL power◦ Bringing in the Surgery Center staff?Bringing in the Surgery Center staff? Captain of Ship Supervision and Control?
Ruptured Capsule –Vitrectomyp p y Possible Problems:◦ High rate of capsular ruptureHigh rate of capsular rupture◦ Poor Capsulorhexis ◦ Excessive Emulsification powerExcessive Emulsification power◦ Failure to recognize – strand displaces IOL◦ Vitreous strand to the wound (infection)◦ Vitreous strand to the wound (infection)
Ectasia Possible Problems:◦ Misinterpretation of corneal topography, Misinterpretation of corneal topography,
Orbscan◦ Did not review topography, Orbscanp g p y,◦ Did not verify corneal stability pre-op◦ Predisposition to Ectasia/KeratoconusPredisposition to Ectasia/Keratoconus Keratoconus in contralateral eye
Under/Overcorrection Possible Problems:◦ No determination of corneal stability pre-opNo determination of corneal stability pre op◦ Laser calibration◦ Incorrect data entryIncorrect data entry◦ Laser malfunction (3rd party practice)◦ Human variability (e g my result)◦ Human variability (e.g. my result)
1 PHYSICAL1. PHYSICAL2. EMOTIONAL – DEPRESSION3 LOSS OF LIFE’S ENJOYMENT3. LOSS OF LIFE S ENJOYMENT4. PERSONALITY AFFECT5 AESTHETIC LOSS5. AESTHETIC LOSS6. HAZARDS
(a) MEDICAL CORNEAL (a) MEDICAL – CORNEAL TRANSPLANT(b) ENVIRONMENTAL(b) ENVIRONMENTAL
Goals of Discovery, based on what can or ycannot be done to rehabilitate eye after injury.j y
Keep in mind that injury is completely Keep in mind that injury is completely subjective, like a headache or pain.◦ So need to look for consequential behavior or ◦ So need to look for consequential behavior or
actions
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Cataract Discovery Goals Cataract Discovery Goals --DamagesDamages Wrong IOL Powerg Treatment Options:◦ Remove, replace IOLRemove, replace IOL◦ “Piggyback” IOL◦ LASIK or PRK LASIK or PRK ◦ Contact Lens or Glasses
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Cataract Discovery Goals Cataract Discovery Goals --DamagesDamages Wrong IOL/Wrong Patientg g Treatment options:◦ Remove, replace IOLRemove, replace IOL◦ “Piggyback” IOL◦ LASIK or PRK LASIK or PRK ◦ Contact Lens or Glasses ◦ DON’T SEND TO COLLECTIONS◦ DON T SEND TO COLLECTIONS
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Cataract Discovery Goals Cataract Discovery Goals --DamagesDamages Ruptured Capsule –Vitrectomyp p y Treatment Options:◦ Refer to a Retinal Specialist Refer to a Retinal Specialist ◦ Antibiotic coverage◦ IOL re-positioningIOL re positioning
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Cataract Discovery Goals Cataract Discovery Goals --DamagesDamages Lens Displacement –Rotationp Treatment Options:◦ Remove/replace IOL with different type of Remove/replace IOL with different type of
IOL◦ Rotate lens with hook◦ Move lens fixation to sulcus, anterior chamber
Under/Overcorrection Treatment Options◦ Re-operation (“enhancement”)Re operation ( enhancement )◦ Mitigation of damages? Consent form discuss need for re-operationConsent form discuss need for re operation
