Breast cancer medical malpractice litigation in New York: The past 10 years.

Medical error is a leading cause of preventable death in the U.S., with diagnostic errors comprising the majority of errors. Delay in diagnosing breast cancer is a unique multidisciplinary phenomenon involving primary care physicians, gynecologists, radiologists, pathologists, and general surgeons. The New York medical malpractice court system remains among the most active court systems in the country. The purpose of this study is to analyze the characteristics of medical malpractice litigation involving breast cancer in New York for the past 10 years. Jury verdicts and settlements from 2007 to 2017 were obtained from a computerized legal database and were analyzed. Data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were collected. The study identified 48 cases of litigation pertaining to breast cancer. Overall, 14 of the verdicts were won by defendants (46.7%). Among the plaintiffs' verdicts and settlements, the median payout was $1.8 million (mean $2.9) overall, $2.6 million (mean $4.3) for verdicts alone, and $1.68 million (mean $1.9) for settlements. The most commonly named specialty among the defendants was radiology (32) and the second was surgery (15). Inappropriate workup of mammography findings was alleged in 18 cases. The average delay to diagnosis was 13.4 months (sd 7.1). Fourteen cases involved diagnosis at stage 4, nine cases at stage 3, and fifteen at stage 2. The average verdict payout was more than two times higher than the average settlement payout. Errors leading to malpractice claims may be attributable in part to lapses in communication among medical providers involved in the workup of suspicious breast lesions.

Goldmann applanation tonometry and dynamic contour tonometry are not correlated with central corneal thickness in primary open angle glaucoma.

PURPOSE: To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) and assess their relationship to central corneal thickness (CCT) in patients with primary open angle glaucoma (OAG). PATIENTS AND METHODS: GAT, DCT, and CCT were assessed in 116 patients with OAG [mean age 65.9 (10.5); 59% female] participating in the Indianapolis Glaucoma Progression Study. GAT and DCT were measured in a randomized order followed by CCT (ultrasonic corneal pachymetry) during a single study visit. Bland-Altman plots were used to evaluate the limits of agreement between tonometery methodologies whereas multivariate regression analysis was used to evaluate the influence of CCT on GAT and DCT IOP measurements. RESULTS: IOP values obtained by DCT and GAT showed a strong positive correlation in patients with OAG (r=0.93; P<0.001). Mean IOP measured with DCT [18.4 (5.1) mm Hg] was significantly higher (P<0.001) than GAT IOP measurements [16.5 (4.5) mmHg]. CCT did not seem to influence either GAT or DCT measurements (r=0.1025, P=0.16; r=0.05, P=0.46), respectively. The Bland-Altman data showed that the amount of disagreement between IOP assessment techniques varied, suggesting a proportional bias. CONCLUSIONS: In this group of patients with OAG, there was a strong correlation between GAT and DCT measurements of IOP. IOP measured with DCT was consistently higher than IOP measured with GAT. Neither GAT nor DCT measurements were correlated with CCT. This data suggests that factors other than CCT may be involved in the tendency of DCT to produce higher measures of IOP than GAT.

Ocular blood flow and oxygen delivery to the retina in primary open-angle glaucoma patients: the addition of dorzolamide to timolol monotherapy.

PURPOSE: To assess the effects of adding dorzolamide to timolol monotherapy on ocular haemodynamics and retinal oxygen saturation in patients with primary open-angle glaucoma (POAG). METHODS: Twenty-four patients (12 healthy, 12 with POAG) were treated with dorzolamide/timolol combination (DT) versus timolol maleate 0.5% twice daily in a randomized, crossover, double-blind study conducted over a period of 18 months. Patients received each treatment for 8 months then crossed over to the other treatment after a 1-month washout and second baseline. Goldmann applanation tonometry, Heidelberg retinal flowmetry (HRF), colour Doppler imaging (CDI) and retinal photographic oximetry were performed at each visit. RESULTS: DT significantly reduced intraocular pressure (IOP) in both glaucomatous [right eye (OD) -13.15%, left eye (OS) -14.43%; p < 0.036] and non-glaucomatous (OD -12.4%, OS -13.88%; p < 0.039) patients compared to timolol after 8 months of treatment. DT significantly reduced the number of zero blood flow pixels in the superior (-39.72%; p < 0.014) and inferior (-51.44%; p < 0.008) retina in the non-glaucomatous group and inferior retina in the glaucomatous group (-55.38%, p < 0.006). The continuation of timolol monotherapy from baseline did not change (p < 0.05) any measured parameter and neither treatment had a significant effect (p < 0.05) on retinal oximetry or CDI parameters. CONCLUSION: The addition of dorzolamide to timolol monotherapy decreases IOP and increases retinal blood flow in the superficial retinal vasculature in both glaucomatous and healthy patients following 8 months of treatment. The combination of increased retinal blood flow with consistent oxygen saturation may potentially increase oxygen delivery to the retina.