Risk Management

State Medical Board Equates Wrong Powered IOL implant with Wrong Site Surgery

By Ryan Bucsi, OMIC Senior Litigation Analyst

ALLEGATION

Misreading of intraocular lens power calculation, resulting in incorrect lens implantation andaneedfora second surgery.

DISPOSITION

Case was settled between the insured and the state board of medicine. The patient did not pursue a claim.

Case Summary

An OMIC insured performed an uncomplicated cataract surgery however on postoperative day one, the patient’s vision was 20/200 OD with a significant hyperopic refractive error that corrected to 20/20. the insured realized that the power of the posterior chamber lens implant had been inadvertently switched with the corresponding power for an anterior chamber lens, resulting in an implant difference of 3.5 diopters. he informed the patient of the error and presented options for treatment, such as wearing glasses, a contact lens, or undergoing an iOL exchange. the patient chose the iOL exchange procedure, which was uncomplicated, and eventually the patient’s uncorrected vision was 20/25 OD.

Analysis

Soon after, the insured received and responded to a letter of investigation from the state medical board. Without contacting OMIC, the insured acknowledged the error that led to the implantation of the wrong iOL. the medical board examiner retained an ophthalmology expert, who opined that the implantation of the incorrect powered iOL was beneath the standard of care. Following this expert’s review, the examiner presented the insured with a settlement proposal, which included a fine, reimbursement of costs of the investigation, a letter of concern from the board, continuing education units, and community service. upon receiving this proposal, the insured reported the matter to OMIC. the case was referred to an attorney, who advised that the insured had put himself at a disadvantage by directly responding to the medical board and not making his response through an attorney. since the board had already conducted an investigation and proposed sanctions, it was significantly more difficult to handle the matter.

OMIC counsel retained two experts who disagreed with the original opinion that the implantation of a wrong powered iOL was beneath the standard of care. While the medical board’s expert did not change his opinion that the insured had violated the standard of care, he disagreed with the board’s finding that wrong powered intraocular lens insertion was tantamount to wrong site surgery and warranted the same fines and penalties. this expert believed that a letter of concern would be sufficient in this case, especially since the insured had taken steps in his practice to ensure that such an error would not recur. the medical board disagreed with its own retained expert and continued to view wrong powered iOL insertion as the equivalent of wrong site surgery.

Risk Management Principles

The insured ophthalmologist should be commended for working with the patient to avoid a claim. Once the error was recognized on postoperative day one, he candidly discussed the error with the patient and the treatment options to address the error. With the insured’s assistance, the patient was able to make a well educated decision on how to proceed. in the event of a medical error, it is wise to withhold billing for the errant surgery and to perform any follow-up procedures at no out-of-pocket cost to the patient. these steps may decrease the likelihood of a patient pursuing a claim or litigation.

As this case illustrates, however, state medical boards have become proactive in response to concerns of patient safety and may take action even if the patient involved is satisfied with the care. Medical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMIC’s Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 for Claims or option 4 for Risk Management.

OMIC is collaborating with the American Academy of Ophthalmology and other ophthalmic organizations on a campaign to prevent wrong patient, wrong surgery, and wrong iOL insertion. the Lead and Hotline articles in this Digest provide further insight in to this area of concern.