Purpose
To evaluate the types of anesthesia-related closed claims and their contributing factors,
using data from the Ophthalmic Mutual Insurance Company (OMIC).
Design
Retrospective analysis of preexisting data.
Participants
Plaintiffs who filed a professional liability claim or suit (written demand for money)
against OMIC-insured ophthalmologists, ophthalmic practices, or surgicenters in which
the surgical case occurred.
Methods
Plaintiff claims were collected from the OMIC database from 2008 to 2018 using search
queries for terms associated with known complications of ophthalmic anesthesia.
Main Outcome Measures
Number and types of anesthesia-related injuries and claims, who administered the anesthesia,
the outcomes of the claim or suit, cost to defend, and payments made to plaintiffs.
Results
Sixty-three anesthesia-related claims or suits were filed by 50 plaintiffs. Anesthesia-related
injuries included globe perforation (n = 17), death (n = 13), retrobulbar hemorrhage
(n = 7), optic nerve damage (n = 4), vascular occlusions (n = 2), pain (n = 2), eye
or head movement resulting in injury (n = 2), and 1 case each for numbness, diplopia,
and tooth loss during intubation. All but 1 patient who died had preexisting, significant
comorbidities. Two deaths were related to brainstem anesthesia. Regarding the type
of anesthesia in the closed claims, retrobulbar and peribulbar anesthesia were the
most common types (n = 16 each), followed by local infiltration around the lids and
facial nerve (n = 6), topical anesthesia (n = 5), and general anesthesia (n = 5).
In 2 cases, the exact type of anesthesia was unknown but not general. The 5 topical
with sedation anesthesia-related claims were due to inadequate pain control (n = 2),
ocular movement resulting in capsular rupture (n = 2), or death (n = 1) allegedly
related to excessive or inadequate monitoring of sedation. There were 5 claims related
to general anesthesia including 4 deaths and 1 tooth loss during intubation. Sedation
was alleged to be a factor in 5 cases resulting in death. Anticoagulants were a factor
in 3 retrobulbar hemorrhage cases.
Conclusions
Although claims and suits were infrequent given the large number of insured ophthalmologists
and the large number of surgical cases requiring various types of anesthesia performed
over the 10.5-year study period, severe injuries can occur.
Abbreviations and Acronyms:
ASCVD ( atherosclerotic cardiovascular disease), CPR ( cardiopulmonary resuscitation), DM ( diabetes mellitus), OMIC ( Ophthalmic Mutual Insurance Company)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 25, 2019
Accepted:
December 18,
2019
Received in revised form:
December 13,
2019
Received:
November 12,
2019
Footnotes
Financial Disclosure(s): The author(s) have made the following disclosure(s): K.C.N.: Royalties – UpToDate.
HUMAN SUBJECTS: Our study is considered exempt from human subject's regulations, category 4 under exemption 4. This is a retrospective study of existing malpractice claims data for quality improvement purposes. Informed consent was not obtained. All research adhered to the tenets of the Declaration of Helsinki.
No animal subjects were used in this study.
Author Contributions:
Conception and design: Morley, Menke
Data collection: Morley, Menke
Analysis and interpretation: Morley, Menke, Nanji
Obtained funding: N/A
Overall responsibility: Morley, Menke, Nanji
Identification
Copyright
© 2020 by the American Academy of Ophthalmology
