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.

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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
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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
Shoulder Dystocia

http://www.illustratedverdict.com/projectreview/IV/IV_0309web/2093mainimage.jpg

The plaintiff was a 30 year old gravida 2 para 1 who presented to her physician for evaluation at 40+ weeks’ gestation.  She had previously delivered an 8 lb 7 oz child, and this baby’s weight this time was estimated to be at least 9 lbs. The care team decided, with the patient’s input, to induce labor. The labor went smoothly until the time of delivery.  When the head was delivered, a shoulder dystocia was encountered.  The result in this case was a successful vaginal delivery, but with an injury to the brachial plexus resulting in an Erb’s palsy.

PLAINTIFF'S CLAIM:
The plaintiff argued that a shoulder dystocia could have been avoided in this situation.  Given the high estimated fetal weight and her delivery history, preventive steps, such as a planned cesarean delivery, should have been taken. 

DEFENSE'S ARGUMENT:
The plaintiff had a history of a successful full-term vaginal birth for a child weighing just slightly less than the estimated fetal weight for this pregnancy.  This history lessened the risk of encountering a shoulder dystocia with this delivery.  The course of the labor moved along at a steady rate, giving no indication of a problem with the baby's descent and appropriate steps were taken to relieve the shoulder dystocia once encountered. . 

VISUAL STRATEGY:
In this case, as with the majority of our shoulder dystocia cases, we wanted to visually walk the jury step through what a shoulder dystocia is and the maneuvers used to relieve it.  This included the following:

Once the baby’s head was delivered and the defendant recognized a shoulder dystocia, all appropriate measures were taken.  The defendant followed the standard of care in applying specific maneuvers to help free the baby’s anterior shoulder.  Despite the Erb's palsy, the health care provided during the labor was appropriate and within the standard of care.

RESULT:
Judgment for the defense.

   



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