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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
Spleen Injury and Bleed

http://www.illustratedverdict.com/projectreview/IV/IV_0409web/2062_998w2alg.jpg

A 60+ year-old woman was injured in a car accident, fracturing her spine, leg, and foot, as well as lacerating her spleen. She was treated at the hospital and sent to a rehab facility. Because of the injury to her spleen and an overriding concern about bleeding, her treating physicians decided not to give heparin for deep vein thrombosis (DVT) prophylaxis. She ultimately developed a DVT, which led to a fatal pulmonary embolism (PE).

PLAINTIFF'S CLAIM:
The plaintiff lawyer argued the physicians did not follow the standard of care because they failed to provide DVT prophylaxis with heparin. They contended the DVT would have not have formed if she had been treated, and she would still be alive.

DEFENSE'S ARGUMENT:
The defense lawyer contended the physicians were well within the standard of care. The defense argument was based on the patient’s large spleen laceration, which had significant risk for rebleeding. The CT scans showed in the week following the accident, the blood seen near the spleen remained the same and even enlarged slightly. The physicians monitored the patient’s injury closely to make sure that further bleeding did not occur, knowing she could die as a result. Because of their concern of hemorrhage, the doctors weighed the risks of DVT vs. bleeding heavily from the spleen laceration. They decided that her risk of bleeding if she received heparin far exceeded the risk of developing a DVT at that time.

VISUAL STRATEGY:
We worked with the attorneys and experts to develop a visual strategy that would help explain to the jury the nature of the spleen laceration and the bleed.

The CT scans were helpful in showing the location of the bleed and the severity of the laceration. They also showed that over time the blood seen around the spleen remained the same size and even enlarged slightly, indicating a greater risk for further hemorrhage if heparin was introduced at that time. Medical illustrations of the anatomy were also very important in showing the marked vascularity of the spleen and the large amount of blood that flows through it. We also had a specific request from the attorney to help alleviate some confusion on the plaintiff’s end about the difference between atrial fibrillation leading to stroke from blood clot and deep vein thrombosis leading to pulmonary embolism.

RESULT:
Judgment for the defense.