IV Case in Point
Illustrated Verdict shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of health care providers. Please feel free to forward it to colleagues or clients.

About Us
IV is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. IV receives judgment for the defense in over 94% of the cases we participate in, as compared to the national average of 73%. Additionally, insurers who supply us with their trial list enjoy a win rate of up to 97%.
To learn more, e-mail us or call 617-530-1001.
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Case In Point Library
Click to view other editions:

Case In Point Library Page

Pregnancy and Delivery:
Fetal Assessment 2009v1
Shoulder Dystocia 2009v3
MVA Leads to Fetal Demise 2010v4
Fetal Descent Stalled 2010v5
Shoulder Dystocia / Erb's 2011v4
Fetal Tracings / Hypoxic Injury? 2013v1

Heart:
Coronary Artery Disease 2009v5
CAD / Recurrent MI 2010v1
Aortic Valve Replacement 2011v1

Lungs:
Stroke After Lung Surgery 2009v2
PE / Infection 2010v3
PE Following Roux En Y 2012v1
Intubation / Macklin Effect 2012v4
Lung Cancer vs. Infection 2015v3

Female Pelvis:
Hysterectomy / Fistula 2011v9
Hysterectomy / Ureter Injury 2010v2
Hysterectomy / Kinked Ureter 2010v8
Diag Lap / Bowel Injury 2012v3
Cervical Cancer 2013v3
Endometrial Cancer 2014v1

Male Pelvis:
Bladder Cancer 2013v2

Digestive System:
Gastric Bypass 2009v6
Recurrent Hiatal Hernia 2009v8
Right Colectomy / Leak 2010v7
Gastric Bypass / Volvulus 2011v2
Nissen Fundoplication 2011v3
Large Hiatal Hernia 2013v5
Necrotizing Enterocolitis 2013v7
Arrest during ERCP 2015v4
Diverticulitis Complications 2015v5

Abdomen:
Spleen Injury and Bleed 2009v4
Bleed Following Lithotripsy 2012v2
Lap Cholecystectomy 2012v5
Bowel Injury Lap Ovarian Cyst Removal 2013v6
LapChole - Hepatic Duct Injury2015v1

Orthopedic:
Partial Hip Replacement 2010v6

Vasculature:
tPA Infusion 2009v7
Vertebral A. Coil Embolization 2015v7

Head and Neck:
Bell's Palsy 2013v4
Tongue Cancer 2014v2
Chiari I - Vision Loss 2015v2

Judgment for the Defense
Fetal Assessment and Response

PLAINTIFF'S CLAIM:
Delay in performing a Caesarean delivery, caused low APGAR scores and cerebral palsy.

DEFENSE'S ARGUMENT:
The clinical management of labor was reasonable. While decelerations were noted, they recovered with positioning of the mother and the strips returned to baseline with good variability -- a sign of no ischemic event. At Phase 3 of labor the labor and delivery team encountered limited progress and prepped the mother for vacuum extraction. But, vacuum also resulted in limited progress. The team realized that the mother's pelvic disproportion made vaginal delivery impossible. As soon as they realized this, a Caesarean was performed.

VISUAL STRATEGY:
Like many cases, the challenge here was to back the jury up to the beginning of the delivery and help them understand how temporal labor is. Despite the bad outcome, the healthcare provided along the way was appropriate, given the information the team had.

A major portion of our visual strategy was to rely on the Fetal Monitoring Strips:

  • Using the Plaintiff's Fetal Monitoring Strips in an HTML-based template, with recognized textbook examples, the jury was walked through the labor.
  • Testifying experts explained visually where decelerations took place, where the recovery and return to baseline occurred, and what steps were performed to correct the problem.
  • Experts were able to explain terms such as baseline, variability, late deceleration, variable deceleration in a way that the jury could understand.
  • Decelerations are worrisome if they are consistently repetitive, and do not recover using the accepted maneuvers such as turning the mother and administering O2 and Fluid.
  • The nurses documented on the strip when the vacuum was applied, for how long and when they decided to go to Caesarean delivery. Documentation directly on the fetal strips by the nurses, in real-time, demonstrated that the team responded promptly and appropriately to each situation.
  • The jury was very responsive to the demonstrative evidence and with a defense verdict in less than 2.5hrs.
RESULT:
Judgment for the defense.