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.
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%.
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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
Coronary Artery Disease 2009v5
CAD / Recurrent MI 2010v1
Aortic Valve Replacement 2011v1
Stroke After Lung Surgery 2009v2
PE / Infection 2010v3
PE Following Roux En Y 2012v1
Intubation / Macklin Effect 2012v4
Lung Cancer vs. Infection 2015v3
Hysterectomy / Fistula 2011v9
Hysterectomy / Ureter Injury 2010v2
Hysterectomy / Kinked Ureter 2010v8
Diag Lap / Bowel Injury 2012v3
Cervical Cancer 2013v3
Endometrial Cancer 2014v1
Bladder Cancer 2013v2
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
Spleen Injury and Bleed 2009v4
Bleed Following Lithotripsy 2012v2
Lap Cholecystectomy 2012v5
Bowel Injury Lap Ovarian Cyst Removal 2013v6
LapChole - Hepatic Duct Injury2015v1
Partial Hip Replacement 2010v6
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
Stroke After Lung Surgery
After surgery to remove a pulmonary sequestration (a cystic piece of abnormal lung tissue), post-operative bleeding occurred in a patient. The plaintiff alleged that the surgeons should have responded more aggressively by removing additional lung tissue. They further alleged that the post-operative care and drug administration caused the patient's stroke and subsequent death.
Post-operative bleeding is a well-known complication of Video Assisted Thoracic Surgery (VATS). Every attempt was made to stabilize the patient post-operatively and, while there was an adverse outcome, it was not the result of negligence.
This was a complicated surgery with complex post-operative issues including atelectasis (the collapse or incomplete expansion of part of a lung) and fibrinolysis (the breakdown of blood clots), that had to be explained to the jury.
Prior to trial, IV assisted in the preparation of visuals for a Focus Group and worked in direct consultation with the defendant to create all of the medical Illustrations for trial.
Our involvement throughout the defense effort enabled us to help the defendant tell his story-first, locating the sequestration in the lung tissue; then performing surgery to remove it; identifying the post-operative complications; and finally, undertaking appropriate treatments to correct them. The visuals pulled together the complicated nature of the case and allowed the defendant to explain to a lay audience the medicine and care involved. This included:
- Normal anatomy of the lungs and the surrounding structures.
- Location of sequestration growth in the lung and surrounding structures, with dense adhesions.
- The steps taken during the VATS:
- Post-operative care and complications:
- Immediately post-op, PEEP (Positive End-Expiratory Pressure) was applied to reinflate the lungs.
- Two to three hours later, under normal respiration, a clot began to form in the area of atelectasis. At the same time, regional fibrinolysis began breaking down the clot and caused bleeding out of the chest tube.
- Treatments were applied to stop excessive bleeding from the chest tube. PEEP was utilized to fully inflate the lung and to tamponade bleeding with pressure. The drug, Amicar, was administered to neutralize fibrinolysis and stop further break down of the clot.
The treatments were successful in stopping any further post-op bleeding. Despite the unfortunate outcome of stroke, the health care provided both during the surgery and also post-operatively was appropriate and within the standard of care.
Judgment for the defense.