Bad Surgery Outcome, What Should I Do About The Fee?

Hi all,

I had a cataract surgery performed by a surgeon about 2 months ago.

The Doctor had promised me a significant improvement in vision after surgery but I am no better than before the surgery in fact there are side effects like seeing a halo in the night or in artificial lights and seeing a constant shadow in the corner of the eye. Plus I have recently developed inflammation in the eye. The Doctor just keeps giving me new medications and asks me to come back in a few weeks with no convincing answers.

The receptionist keeps asking for the Doctor's surgery fee, and I did mention to her that my treatment is still in progress. I have low confidence that my vision will see any improvement and probably will have to live with side effects with the rest of my life ..as the Doctor says it takes a few months in "some" cases to go away..clearly he just is setting a time frame so I can pay him and then I just live with it. I know eye is more important and I am planning to see another Doctor which may mean another surgery….that would be a double whammy.

PS: My insurance doesn't cover cataracts.

Comments

  • +4

    Did you get the doctor's promise in writing? Or did you just sign a thing saying that you want him to perform the surgery.

    • -4

      see a lawyer OP :)

    • +2

      Speaking as a surgeon its bad form to charge someone for failed surgery - basically to prevent a complaint or bad feeling.

      Having said that I'm old school and this dogma is disappearing with the younger generation of docs with debts to pay.

  • do they have satisfaction guarantee clause?

    • Nothing explicit

      • +15

        You have your answer.
        Pay the fee

  • +1

    Sorry to head about this. I can feel for you as one of my relative went through a similar process and having multiple operation did not fix this and it turned into glaucoma. Hope your situation is different. Do keep an eye (no pun) on it.

    Sometimes they have plans available to pay off large bills in instalments. If paying lumpsum is not an option for you. Ultimately you have to pay the fees for this operation but you can always claim/sue for negligence. Keep a diary of all meetings with the doctors and what they say etc. Could be important later down the track. I guess it will not hurt to get another opinion.

    • Thanks. This scares me as I have a family history of glaucoma

      • Try not to focus or worry about that right now. Lots of people have family history of certain illness/disease, it’s just important to ensure that you keep monitoring and checking regularly. I’ve got a family history of diabetes, heart condition, and bowel cancer :/ So, I need to keep monitoring.

  • +9

    It's a relatively common complication of cataract surgery.

    You do not have much legal recourse in terms of treatment "expectations".

    If the complications and/or limited success wasn't clearly conveyed to you, you may want to look into informed consent laws.

  • +1

    Sorry to hear about that, that sounds bad. At least 3-4 members in my extended family (all over 60 years) have got the cataract surgery done and recovery did not take months from what I can remember. Maybe consider seeing another specialist and see if he can find out anything that seems out of place. Looks like this doctor might not want to admit that the surgery didn't have the promised effect, so he's trying to tire you out and get his fees paid. Next time make it clear that you don't intend to pay until this is resolved to your satisfaction.

    Just sharing my experience, the assistant surgeon did a bad stitching job during my laparoscopic cholecystectomy. I had strings sticking out in at least three places and it pricked like a thorn on contact. The lead surgeon was pretty pissed off when he saw that during my review and I assume the assistant surgeon got a good earful from this guy. As a result, I never received a bill for the assistant surgeons's excess fee.

    • Thanks for your advice and taking the time.

    • +16

      Great username. Unfortunately:

      Looks like this doctor might not want to admit that the surgery didn't have the promised effect, so he's trying to tire you out and get his fees paid. Next time make it clear that you don't intend to pay until this is resolved to your satisfaction.

      This isn't a thing. Doctors never promise an outcome. They tell you the desired outcome, probability of success, and charge for what they actually do. Individual outcomes depend very much on the individual. OP has no latitude to actually not pay - they can ask, for installments, for a discount, for a discount on future remedial surgery, but not to outright not pay.

      • +4

        Whenever I see "doctors said I'd never <x> again" I always cringe. Doctors didn't say that. You might have heard that but the doctor didn't say that.

        I've seen it happen first hand when with family. Doctor comes in and says there's a reasonable chance of <x>, she leaves and five minutes later a family member is talking about how the doctor guaranteed <x>.

        Doctors don't do this. They are trained extensively not to do this. Their experience reinforces that you cannot do this.

        But people don't like ambiguity or chance so they just filter it into what they want it to be.

      • +1

        Well, they could certainly ask, but I agree in the sense of what entitlements they have.

        Edit; ask not to pay.

  • +5

    "I did mention to her that my treatment is still in progress"

    Stick with that line.

    I like it and it makes sense.

    • +17

      It only makes sense if you have no idea how these things work. OP is being charged for surgery that they received - medical procedures are never 100%, and you are never paying for 'outcomes'.

      • Sounds like you want to leave them high and dry ;P

        • +6

          Sigh. I hate that I give the impression that I'm just callous and want for people to suffer. Well, I don't really hate it as much as I'd just prefer it not be the case.

          But I've had a few surgeries myself - very routine and standard surgeries - and even then the doctors still went through all the risks of surgery. For something like this? There's no chance the doctor promised a 100% chance of anything. OP is blaming the Dr for not listening to that Dr properly and hearing only what they want to hear.

          • +2

            @HighAndDry: Agreed, shoulder recon and wrist surgery. Risks and side effects all explained, waivers signed. While my shoulder feels tighter and more secure now, I haven't regained some of the pre-op or pre injury movement which is disappointing, but that's the way it goes sometimes. Having said that, majority of my expenses were covered by private health insurance, I'd feel a lot more hard done by if I paid $5k+ for the same result.

            I can't recall exact conversations pre-op, but I'm certain that there were no "guarantees" that it would be better than before. Definitely agree that this is a case of someone reading in to it, or hearing what they wanted to hear during the conversation.

            It's a difficult situation to be in, desperately wanting to improve your quality of life and having to pay for that, then coming out the other side no better off than before, if not worse. But that's the risks with surgeries unfortunately.

  • +4

    Get a second opinion from another Doctor if you aren't happy with the result from the one that did the surgery.
    The second Doctor may give a more objective opinion.

  • +9

    To be fair, you're paying after the fact, no? Surgery has been done, people have spent the time to do it, now you pay for their time. If you believe they did a bad job then you need to go through the relevant legal channels.

    Don't pay and they'll just stop letting you have appointments, or send the bill to a debt collector.

    • +8

      So if you took the car for repairs…and after the mechanic spends a day when you test drive the car you find not only the issue is not fixed but the car has been damaged and in worse condition…so going by your logic…you would pay him because time has been spent on the car…

      • +7

        That's about it.

        • +1

          I mean is he saying ..people should be paid for the effort and outcome is irrelevant…hope I get paid for just showing up to work as opposed to delivering an outcome…that would be nice

          • +6

            @NoBucks: Well actually contractually you usually be paid either for every hour or for 160 hours a month. What you deliver won't make a difference to this amount, unless you get a bonus for exceptional delivery or don't deliver at all and you get fired for non delivery. Best you pay the doctor and fire him for non delivery then, going on your analogy.

      • -1

        you would pay him because time has been spent on the car

        The patient should pay because they've a contract.

      • +16

        This is an utterly ridiculous comparison. Medical procedures are never 100% guaranteed of anything. You would still pay the mechanic if you agreed beforehand - as you did - to pay for his time to try and diagnose an issue that he's not sure about. There is zero chance you went into surgery without that kind of agreement signed on the dotted line, likely in multiple places.

        • +3

          Thanks for this common sense response. It appears common sense isn't too common on these forums.

        • +1

          Its not such a ridiculous comparision (because I agree with you). You would still pay for the diagnosis in humans and cars. You can sue for a misdiagnosis if you can prove it (you get a larger payout for humans thus the cases are more common) but you still pay for the diagnosis work whether they discover anything or not.

          You have a backache, you go do a CT, they say they can't find anything, your backache is still there, but you still have to pay for the CT. Maybe you need an MRI.

          You pay for a test drive, pressure testing and underbody inspection. Mechanic can't find anything beyond specs but the rattle is still there. You still pay for the job. Maybe you need a cylinder/head inspection.

          Repairs on cars aren't guaranteed also. The mechanic (or at least a decent one), "based on my professional opinion, yadah yadah, if you want a stronger confirmation, this diagnosis procedure will need to be done, but it cost more than the actual replacement, so lets try it yadah yadah". Then you make your decision on what you'd like to do.

          The mechanic would charge based on the consumables, parts and time. If they did what they were supposed to do on the invoice to the appropriate standard AND they explained everything correctly, they should still get paid.

          The difference here is likely the explanation and as you mentioned "Informed consent". Mechanics may be more likely to misrepresent things than doctors. Patients are also more likely to misinterpret things because they are more emotionally involved and believe that medical procedures are like putting some lego bricks together. Probably because doctors are put on the pedestal (they do this to themselves though sometimes)and that someone in a white coat being well paid = outcome assured.

      • +2

        They didn't just test drive the car.

        Your surgeon didn't just examine you, a procedure was completed. Cars and people are also of significantly different complexity. The car doesn't have a recovery period, people do and post-op instructions are often ignored.

      • Humans are not cars.

        You have to pay the bill no matter what. If you were misled and not told about possible risks and negative outcomes you'll need to speak with a lawyer.

        Unfortunately a mechanic can rectify the situation and make it right while a doctor usually can't. Your body doesn't often agree with any sort of outcome no matter how much the doctor wants to give it to you, or how much they work.

        • +1

          I identify as a car and find this offensive

      • If the mechanic explained the risks to you and the risks were in line with the damage and condition.

        Which is unlikely as cars are assembled from separate parts by humans and are designed to be inspected by other humans in most situations. Humans aren't assembled from separate parts by humans so you can't reverse the process without any risks (I.e opening it up).

        But if the mechanical procedure does have risks that you knowingly agreed to (if the mechanic replaces this part and recommends replacing another part because of the risk of something going bad but you agree to take the risk instead of replacing the part. Yes you still pay for the time work done on the car.

      • +1

        Terrible analogy. The human body is not a car.

    • +6

      Right or wrong, this response is correct.

      I had carpal tunnel surgery done last year. The surgeon was very explicit in his wording, "we performed the surgery as planned". I questioned whether he found what he expected, and whether he fixed it, to which he responded "we performed the surgery as planned and will monitor the recovery". Note he did not say it was successful. This way of phrasing is drilled into medical professionals. My surgeon did say during the consultations that he does this all the time and it has a very high chance of success, but at no point did he explicitly say that my surgery would be successful.

      Without being in your consulting room I would never be able to say, but I would suggest your medical professional would have phrased things in a similar manor. Unfortunately when we are suffering we might bias what we hear and remember only our interpretation of the intent, not the specific wording.

      • Out of curiosity, did the surgery improve your carpal tunnel? I was referred to a specialist to get surgery too, but a cortisone injection did nothing so am afraid of going through surgery and it getting worse.

        • +1

          Yes.

          I had it done when I was 34. My fingers were going so numb while I was sleeping that it was waking me up, then once up it would take 3-4 hours to come right. I was also losing muscle tone for my thumb and was advised that if I didn't have it done I would eventually lose the use of my thumb. It's 18-months later and the muscle still hasn't recovered (dominant hand), but then it is no worse either.

          I was advised that I'll probably need it done again in 20 years or so as the tunnel may close up again.

          Cortisone didn't even come up in conversation for my condition, must have been written off immediately by the health professionals.

  • -6

    Thanks everyone just thinking if I can ask him to meet in the middle so it offsets my costs for now going to another Doctorabd a possible surger

    • +9

      No. You can ask to pay in installments if you don't have the money. Medical procedures never come with a guarantee - and you go into surgery definitely knowing that.

    • +2

      Nope, you're paying for what you received whether you like it or not

  • If you have doubts about the current treatment, you can ask your GP for a referral to another eye specialist for a second opinion

  • -6

    A service was promised but not provided, get a second opinion, and ask the fee be waived as there was 0 improvement, if they refuse pay the fee, then sue them, is pretty much your only recourse.

    • +2

      I have just paid the hospital fee and haven't paid the Doctor his fee

    • +12

      A service was promised but not provided

      You mean an outcome was expected but not achieved?

    • +2

      Wrong. The service was provided but the outcome wasn't what the patient expected. I'm 99.99% sure that the surgeon wouldn't have promised an outcome and as with all surgeries, some provide a 'successful' outcome and some don't.

  • -6

    Lawyer up and claim against his insurance.

    • +1

      What negligence is there that has occurred?
      How are the lawyers going to overturn a document that explains risks and outcomes that has OPs signature on it?

      • Often wondered if you sign it with a diff signiture then your like thats not my signiture what happens lol

        • +1

          You'll need to sign a Statutory Declaration form stating that you didn't sign it.

          If you intentionally make a false statement in a statutory declaration you can be charged with a criminal offence which carries the possibility of up to four years imprisonment. - Source

          • @rompastompa: Actually, likely an affidavit rather than a stat dec. Penalties are even more severe.

      • What negligence is there that has occurred?

        I'm not sure but it sounds like there might be a possibility of negligence given the poor outcome. It is certainly the only realistic way of not paying the bill or having further surgery done for free. A lawyer who deals with medical cases will be able to let you know pretty quickly (and probably for free) whether your case stands any chance of being successful.

        • +2

          But outcomes are not guaranteed. He would have to have evidence that the surgeon intentionally diverted from protocol in a way that would cause harm and that would simply not happen.

          This surgery is as routine as it gets

  • -7

    Unfortunately doctors aren’t very accountable for their actions. Many think nothing of charging extortionate fees for the most minimal service and then take no responsibility for the outcome. Not saying that’s happened in your case necessarily but I’m amazed how doctors as a profession enjoy such a good reputation despite so many ripping off their patients and taxpayers.

    • +6

      I'd like to think all complications of surgeries only happen to people like you.

      • +1

        If only the world was this just….

    • -2

      I agree 100%. They are untouchable and unaccountable. It's abhorrent.

      • You should never see a doctor. They're all out to steal your wallet and leave you for dead.

      • +3

        They are very accountable - hence their extensive and expensive personal liability insurance.

    • +3

      Leaving aside the bit about ripping off their patients (I don't accept that but can see why someone may think it), perhaps they're held in such a good reputation because they save and improve the lives of millions upon millions of people every year?

      Maybe not for you, but most of us greatly enjoy staying alive.

  • +1

    Speak to the Health Complaints Commission in your state

    • Thanks didn't that exsisted

  • +4

    Sorry to hear that. The halo you are perceiving may be from vitreous floaters which you may have not noticed previously because the cataract (which is now removed) was reducing the amount of light entering through to your eye.

    I have doubts you will have great vision if you experiencing some sort of post-op inflammation, and as you said you are currently still undergoing treatment. Like any surgery, there will be risk involved. One would assume that the ophthalmologist would have discussed such with you prior to surgery. If you are uncomfortable with your current ophthalmologist, as your optometrist/GP for another referral regarding a second opinion.

    • -1

      The halo is actually the lens that has bee6 placed in the eye …so I see the circumference of the lens in artificial light..its particularly bad while driving at night

  • +1

    Hey Mate, im an optometrist- quick question- did the ophthal talk you in to getting a multifocal implant lens in your eye with the promise that you would be "glasses free"?

    • Luckily I was pre warned about those …so when asked what I wanted I opted for distance correction so I don't need glasses when I am not reading ….i have astgamistism too…and he said the angle had changed after surgery which is not common…

      • +2

        Its now common than you think. I would recommend you see an optometrist to ascertain your residual prescription- it will give you more negotiating power when you take to the ophthalmologist about a resolution.

        Not to burst your bubble but ophthals promising more than they deliver is quite common and so you will have to be firm if you want anything changed.

  • I had cataract surgery a few years ago. I had complications e.g. halos, poor vision and the opthal said the lens moved. He then operated a second time within the week.

    I was on anti inflammatory andbother drops drops for months after that.

    • Can I ask what was the intention of the 2nd surgery basically what needed to be corrected and what was the outcome.
      Thanks

      • I believe he removed the first one and put a new one in, or he just repositioned the first one.

        The improvement was huge. Hardly any halos etc. It did take many months to settle down but finally got it sorted with various drops

  • +6

    The Doctor had promised me a significant improvement in vision after surgery

    I very much doubt this. I suspect the wording used included phrases like "High likelihood of…" or "most patients see…." or things of that nature. Doctors almost never give concrete promises because in medicine there's basically never 100% certainty.

    • +7

      Classic case of the patient shifting the goalposts after the fact.

    • +1

      You would be amazed at how much marketing skills some eye surgeons use in the initial consultations. Promise is not the word he would have used, but thats extactly the impression he would try and create by exploting the patients emotional state.

      • -2

        but thats extactly the impression he would try and create by exploting the patients emotional state.

        Oh com'on. If the doctor doesn't actually promise anything - how is that on anyone but the patient for either misunderstanding, or hearing what they want to hear? And "exploiting"? Please. OP is an adult with adult mental faculties, he's not a child.

        • Are you actually being serious, or just trolling for attention?

          • +3

            @ensanguined: I've had surgeries before, the process is very standard. There is no chance the doctor promised anything, and it's far more likely (and common) that OP and patients just choose to hear only what they want to hear. I'm a little surprised this is even an issue being debated - there's literally no argument here, unless OP is alleging malpractice. That isn't the case here.

        • Just as an example in WRITING: http://www.newvisionclinics.com.au/patient-information/side-…

          "As with any surgery, complications are possible. Laser eye surgery has been shown to be proven and effective and no continuing adverse long-term effects have been identified."

          Halos and poor quality night vision will be considered adverse by most patients but the surgeon will just redefinite it to suit their criteria.

          This is actually a special example because it is rare to even see this in writing from any other eye clinics. Most of them have pages detailing a LOT of adverse effects and informing the patient accurately.

          • @wyrmy: That's a website. I doubt anyone is walking into an operating theatre after reading only the website. Also the page is about laser eye surgery. OP didn't get laser eye surgery.

            Could your comment be any less relevant? (No, in case you're wondering, that's not a challenge.)

            • +1

              @HighAndDry: Aw come on.. so laser eye surgery is not a surgery and not performed by doctors? I didnt realise the conversation suddenly got reframed to only include non elective or cataract surgery.

              What happened to doctors not making definitive statements about adverse effects despite opposing evidence?

              And no, people dont walk into a theatre after just reading websites. They have a consultation where some clinicans do exploit word play.

              • -1

                @wyrmy:

                I didnt realise the conversation suddenly got reframed to only include non elective or cataract surgery.

                Laser surgery isn't really surgery in any normal definition of the word - if it's counted, it's certainly among the most minimally invasive surgeries that exist, closer to something like pulling a bad tooth.

                Plus again, it's a website. Believe me, you'll sign a whole ream of waivers and disclaimers before they actually get you into the chair for it.

                They have a consultation where some clinicans do exploit word play.

                Oh please. I'm not saying doctors are truthful because they're nice, they're truthful because I haven't met a doctor who isn't about a malpractice suit - even frivolous and baseless ones - from an unreasonable patient like OP.

                • +1

                  @HighAndDry: It is surgery - the clue is in the title, laser eye SURGERY…

                  While I've only been briefly involved in the medical industry, I've also heard many rumours about Ophthalmologists exaggerating benefits and over promising things. I don't know why you think a possibly malpractice suit changes anything - the consultation isn't recorded so it's he said/she said. I don't think a doctor happy to mislead a patient is going to suddenly be too honest to lie about it.

                  On balance, I do actually agree with you more, but your outright dismissal is arrogant and not necessarily correct.

  • +1

    my mum had cataract surgery a few years back, doctor said she wouldn't need glasses anymore, she still does

    • +1

      I was told the same…

  • Advice for next time, and others reading, when the fee is mentioned prior to the procedure, negotiate.

    Don't accept the practitioner's fee as set in concrete, negotiate.

    Want a free eye exam? Go to an optometrist. Get a glaucoma pressure test as well. Medicare will be your friend.

    • Thanks mate but I didn't know we could do that…have you ever or know anyone who may have and do they because I thought they have more than enough patient

      • I have negotiated recently with an ophthalmologist when I had cataract removal. I felt that his fee was exorbitant and requested a reduction. After a brief discussion with the practice manager it was nearly halved.

    • +2

      Eye examinations are not free…they are bulk-billed. Learn the difference

      • Tsk [yawns]…

        Do you want a free, err.. sorry, maybe at no cost to you, bulk billed* eye exam, which btw ends up with no direct fee payable by you other than the medicare levy, which I believe varies with your level of income**? Go to an optometrist. Get a glaucoma pressure test as well. Medicare will be your friend.

        I apologise for my brevity in the previous post which may have been confusing with regards to your costs.

        **In some cases, you may not have to pay this levy at all. https://www.ato.gov.au/Individuals/Medicare-levy/

    • +3

      You want to negotiate with someone operating on your eyes? I really don't understand about people negotiating with their health management. Pay peanuts, get monkeys

      • Huh? You're negotiating with the same doctor - are you saying he'll just not bother to do it properly if he doesn't think you're paying enough?

        • No, but most doctors won't negotiate on their fees (waste of time, patient complaining if they find out the next person paid less etc, not worth the hassle) but the patient has the choice to choose a different doctor.

        • To a degree, and most likely subconciously, yes. There are many ways to perform the same procedure successfuly. It is human to do a better job when happy doing it

  • +2

    An Ophthalmologist said to me when grand-mum was considering it "You can replace a lens on the camera but it's still an old camera"

    • That's a great way of putting it .. I hope they wrote that sentiment into the waver forms or whatever that she had to sign :)

  • +2

    No surgery is guaranteed… people die on the operating table (obviously not for eyes). Your rolling the dice for the chance of a better quality of life.

    • Agreed but we are talking 0 improvement…and I am not very old I am just unlucky to have got it early in life ..the last time the doc said the angle of the lens is not where it should be …I am guessing that's the core of the issue

  • If your eye is still inflamed then your vision will not be 100%, the halo you describe could be part of that.

    I'm not a doctor, but you have every right to discuss your concerns with an optom.

  • Surgery has side effects. I am sure the surgeon went through it with you and made you sign something before hand.

  • I'm not a doctor but am a health professional. I always make sure to ask lots of questions when other health professionals start using absolute terms about treatments such as: promise, guaranteed, definite, certain, etc.

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